Chlorhexidine does not increase immediate bond strength of etch-and-rinse adhesive to caries-affected dentin of primary and permanent teeth

The aim of this study was to evaluate the effect of 2% chlorhexidine digluconate (CHX) on immediate bond strength of etch-and-rinse adhesive to sound (SD) and caries-affected (CAD) primary dentin compared with permanent dentin. Flat dentin surfaces from 20 primary molars (Pri) and 20 permanent molars (Perm) were assigned to 8 experimental groups (n=5) according to tooth type (Pri or Perm), dentin condition (SD or CAD - pH-cycling for 14 days) and treatment (control - C or 60 s application of 2% CHX solution after acid etching - CHX). The bonding system (Adper Single Bond 2) was applied according to manufacturer's instructions followed by resin composite application (Filtek Z250). After 24 h water storage, specimens with cross-section area of 0.8 mm² were prepared for being tested under microtensile test (1 mm/min). Data were submitted to ANOVA and Tukey's post hoc test (α=0.05). Failure mode was evaluated using a stereomicroscope at ×400. Treatment with CHX did not result in higher bond strength values than no pre-treatment (C groups), independently of tooth type. Primary teeth and caries-affected dentin showed significantly lower (p<0.05) bond strength means compared with permanent teeth and sound dentin, respectively. Predominance of adhesive/mixed failure was observed for all groups. CHX did not influence the immediate bond strength to sound or caries-affected dentin of primary and permanent teeth.

Dental caries-related quality of life and socioeconomic status of preschool children, Bauru, SP

AIM: To evaluate oral health-related quality of life of preschool children of Bauru, State of São Paulo, Brazil, and associate it with socioeconomic profile of households. METHODS: The sample consisted of 229 preschool children between 3 and 5 years and the dmft (decayed, missing due to caries, filled teeth) index was adopted for assessment children's dental caries in accordance with the standards recommended by the World Health Organization. Questionnaires were used for evaluation oral health-related quality of life (Early Childhood Oral Health Impact Scale) and socioeconomic profile of parents or guardians of the preschool children. Statistical analysis was performed descriptively by relative and absolute frequencies and by Spearman's correlation and Kruskal-Wallis test (p <0.05). RESULTS: A dmft of 1.65 (± 2.87) and a Sic Index 4.88 (± 3.20) were found, indicating the polarization of dental caries in the studied group. It was verified low influence of oral health on quality of life of the children examined. With respect to socioeconomic classification, 66.38% of families were in the lower middle class. Linear and statistically significant correlation was found between dmft and oral health-related quality of life for the overall score and domains of the questionnaire (p<0.001). CONCLUSIONS: It was found low influence of oral health on quality of life of the preschool children and the assessment of socioeconomic conditions of the children's families may guide practices aiming to reducing inequalities in the distribution of dental caries in the population.

Children's discomfort in assessments using different methods for approximal caries detection

Because discomfort caused by different approximal caries detection methods can influence their performance, the assessment of this discomfort is important. Thus, this study aimed to evaluate the discomfort reported by children after the use of different diagnostic methods to detect approximal caries lesions in primary teeth: visual inspection, bitewing radiography, laser fluorescence (DIAGNOdent pen - LFpen) and temporary separation with orthodontic rubbers. Seventy-six children aged 4 to 12 years were examined using these methods. Their discomfort was assessed using the Wong-Baker scale and compared among the methods. Visual inspection caused less discomfort than did other methods. Radiography and the LFpen presented similar levels of discomfort. Older children reported higher discomfort using temporary separation, whereas younger children reported less discomfort with the LFpen. In conclusion, radiographic, temporary separation and LFpen methods provoke higher discomfort than visual inspection.

Dental caries associated factors in 12 year-old schoolchildren from a municipality in the state of São Paulo, Brazil

Objective To analyze the possible association between dental caries, fluorosis and the need for treatment in 12 year-old schoolchildren and the socioeconomic conditions of parents/guardians in the city of Franca, in the state of São Paulo. Methods A random sample of schoolchildren aged 12 was obtained from the school records in Franca, using a systematic random technique. The epidemiological survey was carried out by a single calibrated examiner, on 258 public and private schoolchildren in order to obtain the prevalence of dental caries, the need for treatment and the severity of dental fluorosis. Parents/guardians were also interviewed to assess their socioeconomic conditions (education and per capita income). We used multiple correlation analysis to investigate associations between category variables. Results It was possible to identify two distinct groups, with associations between the variables: the first group, represented by schoolchildren with average prevalence of caries, need for treatment, low level of parental education and income; and a second group represented by schoolchildren with low prevalence of caries, no need for treatment, high parental education and income. The two dimensions explained approximately 35% of total inertia. The factors within each group are related. Conclusion High income and parental education are associated with the low prevalence of dental caries but there is no association with dental fluorosis.

Parental reports of the oral health-related quality of life of children with cerebral palsy

Background: The severity of physical and mental impairments and oral problems, as well as socioeconomic factors, may have an impact on quality of life of children with cerebral palsy (CP). The aim of this research was to assess the impact of impairments and oral health conditions, adjusted by socioeconomic factors, on the Oral Health-Related Quality of Life (OHRQoL) of children with CP using their parents as proxies. Methods: Sixty children, between 6-14 years of age were selected. Their parents answered a children's OHRQoL instrument (5 domains) which combines the Parental-Caregivers Perception Questionnaire (P-CPQ) and Family Impact Scale (FIS). The severity of dental caries, type of CP, communication ability, gross motor function, seizures and socioeconomic conditions were assessed. Results: Considering the total score of the OHRQoL instrument, only the reduction of communication ability and dental caries severity had a negative impact on the OHRQoL (p < 0.05). Considering each domain of the instrument, the severity of the type of CP and its reduction of communication ability showed a negative impact on oral symptoms and functional limitations domains (p < 0.05). Seizures have a negative impact on oral symptoms domain (p = 0.006). The multivariate fitted model showed that the severity of dental caries, communication ability and low family income were negatively associated with the impact on OHRQoL (p = 0.001). Conclusions: The severity of dental caries, communication ability, and family income are conditions strongly associated with a negative impact on OHRQoL of children with CP.

Application of an active attachment model as a high-throughput demineralization biofilm model

Objectives: To investigate the potential of an active attachment biofilm model as a highthroughput demineralization biofilm model for the evaluation of caries-preventive agents. Methods: Streptococcus mutans UA159 biofilms were grown on bovine dentine discs in a highthroughput active attachment model. Biofilms were first formed in a medium with high buffer capacity for 24 h and then subjected to various photodynamic therapies (PACT) using the combination of Light Emitting Diodes (LEDs, Biotable (R)) and Photogem (R). Viability of the biofilms was evaluated by plate counts. To investigate treatment effects on dentine lesion formation, the treated biofilms were grown in a medium with low buffer capacity for an additional 24 h. Integrated mineral loss (IML) and lesion depth (LD) were assessed by transversal microradiography. Calcium release in the biofilm medium was measured by atomic absorption spectroscopy. Results: Compared to the water treated control group, significant reduction in viability of S. mutans biofilms was observed when the combination of LEDs and Photogem (R) was applied. LEDs or Photogem (R) only did not result in biofilm viability changes. Similar outcomes were also found for dentine lesion formation. Significant lower IML and LD values were only found in the group subjected to the combined treatment of LEDs and Photogem (R). There was a good correlation between the calcium release data and the IML or LD values. Conclusions: The high-throughput active attachment biofilm model is applicable for evaluating novel caries-preventive agents on both biofilm and demineralization inhibition. PACT had a killing effect on 24 h S. mutans biofilms and could inhibit the demineralization process. (C) 2011 Elsevier Ltd. All rights reserved.

Salivary Cortisol, Alpha-Amylase and Heart Rate Variation in Response to Dental Treatment in Children

Objective. Anxiety and stress are usually related to the dental treatment situation. The objective was to investigate salivary cortisol and alpha-amylase levels (salivary biomarkers) and heart rate in children undergoing a minor dental procedure (dental prophylaxis). Study design. In total, 31 children (range 84-95 months) of both genders without caries or history of dental treatment/pain/trauma were selected. Three saliva samples were gathered: one prior to dental prophylaxis, one immediately after, and one ten minutes later Weight and height were assessed, and heart rate was evaluated prior to and during the procedure. Data were analyzed by correlation tests and t-test/Wikoxon (alpha=0.05). Results. Higher cortisol and amylase levels were observed before prophylaxis compared to afterward. Cortisol and amylase levels did not show a significant correlation, nor did salivary biomarkers and body mass index. However, heart rate and amylase levels showed a significant positive correlation. Conclusions. In the studied sample, certain anticipation of the dental treatment was observed because higher cortisol and amylase levels were observed before, rather than after, the event; moreover, a significant correlation between amylase levels and heart rate was observed. Thus, salivary biomarkers may be a valuable tool for evaluating anxiety-producing events, such as dental treatment, in children.

In situ Evaluation of the Erosive Potential of Orange Juice Modified by Food Additives

The aim of this study was to evaluate the erosive potential of orange juice modified with food-approved additives: 0.4 g/l of calcium (Ca) from calcium lactate pentahydrate, 0.2 g/l of linear sodium polyphosphate (LPP) or their combination (Ca+LPP) were added to a commercially available orange juice (negative control, C-). A commercially available calcium-modified orange juice (1.6 g/l of calcium) was the positive control (C+). These juices were tested using a short-term erosion in situ model, consisting of a five-phase, single-blind crossover clinical trial involving 10 subjects. In each phase, subjects inserted custom-made palatal appliances containing 8 bovine enamel specimens in the mouth and performed erosive challenges for a total of 0 (control), 10, 20, and 30 min. Two specimens were randomly removed from the appliances after each challenge period. Enamel surface microhardness was measured before and after the clinical phase and the percentage of surface microhardness change (%SMC) was determined. Before the procedures, in each phase, the subjects performed a taste test, where the juice assigned to that phase was blindly compared to C-. Overall, C+ showed the lowest %SMC, being the least erosive solution (p < 0.05), followed by Ca+LPP and Ca, which did not differ from each other (p > 0.05). LPP and C- were the most erosive solutions (p <0.05). Taste differences were higher for C+ (5/10 subjects) and Ca (4/10 subjects), but detectable in all groups, including C- (2/10 subjects). Calcium reduced the erosive potential of the orange juice, while no protection was observed for LPP. Copyright (C) 2012 S. Karger AG, Basel

56-month clinical performance of Class I and II resin composite restorations

Objective: This study evaluated the 56-month clinical performance of Class I and II resin composite restorations. Filtek P60 was compared with Filtek Z250, which are both indicated for posterior restorations but differ in terms of handling characteristics. The null hypothesis tested was that there is no difference in the clinical performance of the two resin composites in posterior teeth. Material and Methods: Thirty-three patients were treated by the same operator, who prepared 48 Class I and 42 Class II cavities, which were restored with Single Bond/Filtek Z250 or Single Bond/Filtek P60 restorative systems. Restorations were evaluated by two independent examiners at baseline and after 56 months, using the modified USPHS criteria. Data were analyzed statistically using Chi-square and Fisher's Exact tests (alpha=0.05). Results: After 56 months, 25 patients (31 Class I and 36 Class II) were analyzed. A 3% failure rate occurred due to secondary caries and excessive loss of anatomic form for P60. For both restorative systems, there were no significant differences in secondary caries and postoperative sensitivity. However, significant changes were observed with respect to anatomic form, marginal discoloration, and marginal adaptation. Significant decreases in surface texture were observed exclusively for the Z250 restorations. Conclusions: Both restorative systems can be used for posterior restorations and can be expected to perform well in the oral environment.

Effectiveness of Tooth Wipes in Removing Babies' Dental Biofilm

Purpose: To assess the effectiveness of tooth wipes in removing dental biofilm from babies' anterior teeth, as well as to evaluate the babies' behaviour and the guardians' preference concerning hygiene methods. Materials and Methods: In this random blind cross-over study, 50 high caries risk babies, from 8 to 15 months old, were divided into two groups: babies with oral hygiene performed by caregivers (n = 25) or by their mothers (n = 25). The caregivers and mothers removed biofilm using three methods of oral hygiene (tooth wipes, toothbrushes and gauze), one in each experimental phase. Professional cleaning was done before each phase, which had 2 days of biofilm accumulation and 1 experimental day, when caregivers and mothers used one method to remove biofilnn. Examiners blinded to the study design assessed the biofilm index at baseline, prior to and following biofilm removal using each method. The babies' behaviour and the mothers'/caregivers' preference were assessed. Results: The tooth wipes, toothbrushes and gauze significantly reduced the amount of biofilm (P < 0.001). The mothers' group removed more biofilm than the caregivers' group, using toothbrushes or tooth wipes (P < 0.05). Babies in the mothers' group had better behaviour using tooth wipes than toothbrushes (P < 0.05). Mothers and caregivers preferred to use tooth wipes. Conclusions: Tooth wipes are effective in removing biofilrn from babies' anterior teeth and are the method best accepted by mothers, caregivers and babies.

Quantitative Proteomic Analysis of the Effect of Fluoride on the Acquired Enamel Pellicle

The acquired enamel pellicle (AEP) is a thin film formed by the selective adsorption of salivary proteins onto the enamel surface of teeth. The AEP forms a critical interface between the mineral phase of teeth (hydroxyapatite) and the oral microbial biofilm. This biofilm is the key feature responsible for the development of dental caries. Fluoride on enamel surface is well known to reduce caries by reducing the solubility of enamel to acid. Information on the effects of fluoride on AEP formation is limited. This study aimed to investigate the effects of fluoride treatment on hydroxyapatite on the subsequent formation of AEP. In addition, this study pioneered the use of label-free quantitative proteomics to better understand the composition of AEP proteins. Hydroxyapatite discs were randomly divided in 4 groups (n = 10 per group). Each disc was exposed to distilled water (control) or sodium fluoride solution (1, 2 or 5%) for 2 hours. Discs were then washed and immersed in human saliva for an additional 2 hours. AEP from each disc was collected and subjected to liquid chromatography electrospray ionization mass spectrometry for protein identification, characterization and quantification. A total of 45 proteins were present in all four groups, 12 proteins were exclusively present in the control group and another 19 proteins were only present in the discs treated with 5% sodium fluoride. Relative proteomic quantification was carried out for the 45 proteins observed in all four groups. Notably, the concentration of important salivary proteins, such as statherin and histatin 1, decrease with increasing levels of fluoride. It suggests that these proteins are repulsed when hydroxyapatite surface is coated with fluoride. Our data demonstrated that treatment of hydroxyapatite with fluoride (at high concentration) qualitatively and quantitatively modulates AEP formation, effects which in turn will likely impact the formation of oral biofilms.

Dental health in Northern Chile's Atacama oases: Evaluating the Middle Horizon (AD 500-1000) impact on local diet

As one of the few areas apt for horticulture in Northern Chile's arid landscape, the prehistory of the Atacama oases is deeply enmeshed with that of the inter-regional networks that promoted societal development in the south central Andes. During the Middle Horizon (AD 5001000), local populations experienced a cultural apex associated with a substantial increase in inter-regional interaction, population density, and quantity and quality of mortuary assemblages. Here, we test if this cultural peak affected dietary practices equally among the distinct local groups of this period. We examine caries prevalence and the degree of occlusal wear in four series recovered from three cemeteries. Our results show a reduction in the prevalence of caries for males among an elite subsample from Solcor 3 and the later Coyo 3 cemeteries. Dental wear tends to increase over time with the Late Middle Horizon/Late Intermediate Period cemetery of Quitor 6 showing a higher average degree of wear. When considered in concert with archaeological information, we concluded that the Middle Horizon was marked by dietary variability wherein some populations were able to obtain better access to protein sources (e.g., camelid meat). Not all members of Atacameno society benefited from this, as we note that this dietary change only affected men. Our results suggest that the benefits brought to the San Pedro oases during the Middle Horizon were not equally distributed among local groups and that social status, relationship to the Tiwanaku polity, and interment in particular cemeteries affected dietary composition. Am J Phys Anthropol, 2012. (C) 2012 Wiley Periodicals, Inc.

Relevant methodological issues from the SBBrasil 2010 Project for national health surveys

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the country's five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

Xylitol concentrations in artificial saliva after application of different xylitol dental varnishes

Objective: The present study analyzed xylitol concentrations in artificial saliva over time after application of varnishes containing 10% and 20% xylitol. Material and Methods: Fifteen bovine enamel specimens (8x4 mm) were randomly allocated to 3 groups (n=5/group), according to the type of varnish used: 10% xylitol, 20% xylitol and no xylitol (control). After varnish application (4 mg), specimens were immersed in vials containing 500 mu L of artificial saliva. Saliva samples were collected in different times (1, 8, 12, 16, 24, 48 and 72 h) and xylitol concentrations were analyzed. Data were assessed by two-way repeated-measures ANOVA (p<0.05). Results: Colorimetric analysis was not able to detect xylitol in saliva samples of the control group. Salivary xylitol concentrations were significantly higher up to 8 h after application of the 20% xylitol varnish. Thereafter, the 10% xylitol varnish released larger amounts of that polyol in artificial saliva. Conclusions: Despite the results in short-term, sustained xylitol releases could be obtained when the 10% xylitol varnish was used. These varnishes seem to be viable alternatives to increase salivary xylitol levels, and therefore, should be clinically tested to confirm their effectiveness.

Evolution in access to fluoridated water in Sao Paulo State, Brazil, from the 1950s to the early 21st century

Access to fluoridated water is a known protective factor against dental caries. In 1974, fluoridation of the public water supply became mandatory by law in Brazil, resulting in improved coverage, especially in more developed regions of the country. Coverage increased across the country as a priority under the national oral health policy. This article systematizes information on the implementation and expansion of fluoridation in Sao Paulo State from 1956 to 2009, using secondary data from technical reports, official documents, and the Information System for Surveillance of Water Quality for Human Consumption (SISAGUA). In 2009, fluoridation covered 546 of 645 counties in Sao Paulo State (84.7%), reaching 85.1% of the total population and 93.5% of the population with access to the public water supply. The results indicate that fluoridation has been consolidated as part of State health policy. However, the challenge remains to implement and maintain fluoridation in 99 counties, benefiting 6.2 million inhabitants that are still excluded from this service.