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Objective. To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents. Study design. A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria. Abstracts and full-text articles were assessed independently by two reviewers. The quality of studies was graded according to the QUADAS tool. The quality of evidence of models and single predictors was assessed using the GRADE approach. Results. Ninety original articles fulfilled the inclusion criteria. Seven studies had high quality, 35 moderate and the rest poor quality. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. However, the models had seldom been validated in independent populations, making their accuracy uncertain. Of the single predictors, baseline caries experience had moderate/good accuracy in pre-school children and limited accuracy in schoolchildren/adolescents. The period of highest risk for caries incidence in permanent teeth was the first few years after tooth eruption. In general, the quality of evidence was limited. Conclusions. Multivariate models and baseline caries prevalence performed better in pre-school children than in schoolchildren/adolescents. Baseline caries prevalence was the most accurate single predictor in all age groups. The heterogeneity of populations, models, outcome criteria, measures and reporting hampered the synthesis of results. There is a great need to standardize study design, outcome measures and reporting of data in studies on caries risk assessment. The accuracy of prediction models should be validated in at least one independent population. [ABSTRACT FROM AUTHOR]

The caries preventive outcome of a school-based program with salivary; lactobacillus counts as sugar-motivating tool was evaluated in six cohorts of totally 936 adolescents in a comprehensive school in Sweden. Students from a neighboring district with similar socioeconomic structure but with no corresponding dental health-promoting activities were selected as reference. The program started in the beginning of the 7th grade (13 years) and was terminated at the end of the 9th grade (16 years). Salivary lactobacilli were evaluated semi-annually with a dip-slide method and used for individual counseling. Dental caries was scored from the dental records and bitewing radiographs of each 4th participant at baseline and at 16 and 19 years of age. The number of salivary lactobacilli decreased significantly (P< 0.05) in all cohorts but one during the program. There was no significant difference in the increment of caries (DFS) between the participants from the study and reference schools, either at the end of the program or at 19 years of age. The increment of proximal enamel caries was slightly lower in the study group compared with the reference group (P< 0.05) at the final registration. Considering the time and efforts spent, the results did not seem to justify a school-based intervention with lactobacillus counts as a sugar-motivating tool in an adolescent low-caries population. [ABSTRACT FROM AUTHOR]

Introduction: Conflicting results exist regarding mode of delivery and caries. We investigated the influence of the mode of delivery and selected family- and nursing factors during the first 2 years of life on the prevalence of dental caries at 5 years., Materials and Methods: 551 infants were invited to a prospective medical study with focus on growth and overweight prevention. The parents of 346 infants (179 boys and 167 girls) accepted this invitation and at the age of 2-years, 336 of them agreed to dental check-ups and salivary samplings. At the ages of three and five years, 302 (90%) and 292 children (87%) could be re-examined with respect to caries by one of two calibrated examiners. All stages of caries lesions were scored on tooth and surface level. Background maternal and nursing data were collected semiannually through validated questionnaires and interviews., Results: The caries prevalence (initial + cavitated lesions) was 5.6% at 3 years of age and 18.9% at 5 years. The 5-year-olds delivered with caesarian section displayed a significantly elevated risk of having caries (relative risk [RR] 2.2; 95% confidence interval (CI) 1.4-3.6; p < .05). Parental smoking and siblings with caries were the most influential family determinants (p < .05) while drinking juice to meals at 2 years of age (p < .05) was most outstanding among the nursing factors (p < .05)., Conclusions: In this cohort, the mode of delivery (caesarian section) had a significant impact on the risk of early childhood caries (ECC) but also other family and infant nursing determinants were related to the development of the disease.

Objectives: To evaluate the effect of daily ingestion of probiotic lactobacilli on the levels of secretory IgA (sIgA) and selected cytokines in whole saliva of healthy young adults., Materials and Methods: The study group consisted of 47 healthy adults (18-32 years) who volunteered for a randomized, double-blind, placebo-controlled, cross-over trial after informed consent. During intervention, the subjects ingested two lozenges per day containing two strains of the probiotic bacterium Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) or placebo lozenges. The intervention and wash-out periods were 3 weeks. Saliva samples were collected at baseline, immediately after each intervention period and 3 weeks post-intervention. ELISA was used to measure sIgA and luminex technology was used to measure the interleukins (IL)-1β, IL-6, IL-8 and IL-10. For statistical analyses a mixed ANOVA model was employed to calculate changes in the salivary outcome variables., Results: Forty-one subjects completed the study and reported a good compliance. No significant differences in the concentrations of salivary sIgA or cytokines were recorded between the L. reuteri and placebo interventions or between baseline and 3 weeks post-intervention levels. No side- or adverse effects were reported., Conclusions: Supplementation with two strains of the probiotic L. reuteri did not affect sIgA or cytokine levels in whole saliva in healthy young adults. The results thereby indicate that daily oral supplementation with L. reuteri do not seem to modulate the salivary oral immune response in healthy young subjects (ClinicalTrials.gov NCT02017886).

Objective: The aim of this double-blind randomized placebo-controlled trial was to evaluate the effects of probiotic supplements in adjunct to conventional management of peri-implant mucositis., Materials and Methods: Forty-nine adult patients with peri-implant mucositis were consecutively recruited after informed consent. After initial mechanical debridement and oral hygiene instructions, the patients received a topical oil application (active or placebo) followed by twice-daily intake of lozenges (active or placebo) for 3 months. The active products contained a mix of two strains of Lactobacillus reuteri. Patients were clinically monitored and sampled at baseline and after 1, 2, 4, 12 and 26 weeks. The clinical end-points were pocket-probing depth (PPD), plaque index (PI) and bleeding on probing (BOP). In addition, the subgingival microbiota was processed with checkerboard DNA-DNA hybridization and samples of gingival crevicular fluid (GCF) were analyzed for selected cytokines with the aid of multiplex immunoassays., Results: After 4 and 12 weeks, all clinical parameters were improved in both the test and the placebo group. PPD and BOP were significantly reduced compared with baseline (p < 0.05), but no significant differences were displayed between the groups. The clinical improvements persisted 3 months after the intervention. No major alterations of the subgingival microflora were disclosed and the levels of inflammatory mediators in GCF did not differ between the groups., Conclusions: Mechanical debridement and oral hygiene reinforcement resulted in clinical improvement of peri-implant mucositis and a reduction in cytokine levels. Probiotic supplements did not provide added benefit to placebo.

Objective: To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls., Materials and Methods: The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization., Results: The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected., Conclusions: Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.

Aim: To investigate selected lifestyle factors in relation to active caries and restored root surface lesions in adults., Materials and Methods: Based on clinical examinations and questionnaires, data on root caries, socioeconomic status, body mass index, dietary habits, alcohol consumption, tobacco use and oral hygiene routines were collected from 4369 adults aged 21-89 who took part in a survey covering 13 municipalities across Denmark. Uni- and multivariate logistic regression analyses were applied to analyse the relationship between the independent lifestyle variables and active caries and restored root surface lesions, respectively., Results: The prevalence of active root caries was 4%, while 26% displayed restored root surfaces. The sugar intake was not related to root caries. A multivariate logistic regression analysis revealed that, in subjects aged 45 or over, smoking and wearing dentures were significantly associated with presence of active root caries (p<0.01). The intake of 15 drinks or more per week was associated with higher odds of root surface restorations compared with no alcohol intake (OR=1.7; p<0.001)., Conclusions: Lifestyle factors such as tobacco use and alcohol consumption, as well as wearing dentures, were significantly associated with the occurrence of untreated caries and restored root surface lesions, especially in persons over 45. Thus, such lifestyle factors should be taken into consideration, identifying persons with a need of preventive dental services. In addition, oral health education should focus on the possible risks of smoking and a high alcohol intake.

Objective: It was hypothesized that, by comparing matched subjects with major differences in these dental diseases, but yet normal saliva flow rates, it would be possible to obtain data on the effect of saliva composition on dental disease isolated from the effect of the flow rate. Thus, the aim of the study was to compare the major physicochemical characteristics of stimulated whole saliva in three groups of 85 subjects, each with normal saliva flow rates and at least 24 remaining teeth., Materials and Methods: A group with very little dental disease (healthy), a group with dental erosion (erosion) and a group with very high caries experience (caries) were chosen. Furthermore, the aim was to determine whether differences among groups could also be found on an individual level., Results: Although it was not possible to retrieve three groups whose members were completely identical, the present study points in the direction that, on a group level, subjects with very little dental disease seemed to have a more favorable physicochemical saliva composition with respect to higher calcium, phosphate, bicarbonate, pH, degree of saturation with respect to hydroxyapatite and a lower critical pH (p < 0.05 or less). However, on an individual level the explanatory power for the saliva composition was only 10% for caries experience and only 11% for dental erosion (p < 0.001)., Conclusion: The compositional analyses performed in this study on stimulated whole saliva, including major physicochemical characteristics of saliva, will most likely have little predictive value for future dental caries and erosion in single individuals.

Objectives: To validate a risk classification model according to the Public Dental Service (PDS) guidelines with the actual 3-year caries outcome in terms of predictive values., Materials and Methods: All 19-year-old patients registered at eight public dental clinics in Skåne, Sweden were invited to participate (n = 1699). The study group who completed the baseline examination consisted of 1295 subjects, representing 10% of the age group attending the public dental care in the region. A risk classification of each patient in four categories was made by the patient's regular team according to the guidelines. At the follow-up 3 years later, 75.8% were accessible. The final examinations included bitewing radiographs and the actual caries increment for 982 patients was calculated., Results: At baseline, 11.9% were assessed as being at 'high' or 'very high' risk. The dropouts had significantly more caries than the remaining patients (p < 0.05). The general disease activity was low, but those grouped into the two highest risk groups displayed significantly more new caries than those at lower risk (p < 0.05). With a cut-off value ΔDFS > 0 vs DFS = 0, the sensitivity was 81% and the specificity 56% for 'low' risk vs any risk. By combining the 'low' and 'some' risk categories, the PDS model generated an improved specificity (94%)., Conclusions: The risk assessment scheme used by the Public Dental Service for young adults relied basically on past and current caries activity and 65-70% of the patients were correctly classified. The model was most effective to screen out patients with low caries risk.

Objective: The aims of the oral part of the Danish Health Examination Survey (DANHES 2007-2008) were (1) to establish an oral health database for adult Danes and (2) to explore the influence of general diseases and lifestyle on oral health. This paper presents the study population, examination methods, questionnaire and baseline results., Materials and Methods: The study population comprised 4402 subjects, aged 18-96, consecutively enrolled from 18 065 DANHES participants from 13 municipalities in Denmark. The oral part consisted of a validated questionnaire and a clinical examination, carried out in mobile units by three trained and calibrated dental hygienists. The data were processed with descriptive statistics and mono- and bivariate analyses., Results: The mean age was 54.1 years and 60% were women. The mean number of natural teeth was 26.6; the mean DMFT/DMFS values were 18.9 and 61.0, and varied with age (DMFT 8.7-24.3). A higher proportion of females suffered from dental erosion in the younger age groups. Forty per cent of all subjects had a mean clinical attachment loss ≥ 3 mm, varying from 4% among those aged 18-34 to 80% in those over 75. A sub-optimal saliva secretion rate was more common among females than males (17.7% vs 10.4%) and this was reflected by the reported frequency of dry mouth., Conclusion: This extensive cross-sectional study provides a platform for obtaining future knowledge of the impact of health- and lifestyle-related factors on oral diseases. The validated questionnaire and the clinical characteristics enable robust analyses, although the conclusions may be hampered by limited external validity.

Aim: Probiotic bacteria have been introduced for prevention and treatment of periodontal diseases. The aim was to assess if daily oral administration of probiotic bacteria could influence the inflammatory response and the composition of supragingival plaque in an experimental gingivitis model., Materials and Methods: Eighteen healthy female adults volunteered after informed consent. A double-blind randomized placebo-controlled cross-over design was used. The buccal surface of first molars was used as experimental sites. A mouth-guard covering the first premolar to second molar was used when brushing, preventing accidental cleaning during 3 weeks of plaque accumulation. Lozenges containing L. reuteri (ATCC55730 and ATCC PTA5289) or placebo were taken twice a day. During the run-in and washout periods, professional tooth cleaning was performed 5 days/week. At baseline and follow-up, plaque index, gingival index and bleeding on probing were recorded. Samples of gingival crevicular fluid (GCF) were analysed for concentration of seven inflammatory mediators. Bacterial samples were processed with checkerboard DNA/DNA-hybridization., Results: All subjects presented a local plaque accumulation and developed manifest gingivitis at the test sites during the intervention periods. The volume of GCF increased in both groups but was statistically significant only in the placebo group (p < 0.05). The concentrations of IL1-β and IL-18 increased significantly (p < 0.05), while IL-8 and MIP1-β decreased (p < 0.05). No differences were displayed between test and placebo. Likewise, the microbial composition did not differ between the groups., Conclusion: Daily intake of probiotic lozenges did not seem to significantly affect the plaque accumulation, inflammatory reaction or the composition of the biofilm during experimental gingivitis.

Objective: To assess the diagnostic accuracy of adjunct methods used to detect and quantify dental caries., Study Design: A systematic literature search for relevant papers was conducted with pre-determined inclusion and exclusion criteria. Abstracts and full text articles were assessed independently by two reviewers. The study characteristics were compiled in tables and quality graded according to the QUADAS tool. The level of evidence for each diagnostic technology (fiber-optic methods, fluorescence methods, electrical methods) was based on studies of high or moderate quality according to the GRADE approach., Results: Twenty-five reports fulfilled the inclusion criteria. One study was of high quality, 10 were graded as moderate, while the remaining 14 reports were of low quality. Electrical methods (ECM) and laser fluorescence (DIAGNOdent) displayed sensitivities and specificities around 70-80% regarding occlusal dentin lesions with a mean Youden's index of 0.52-0.54. The mean accuracy of laser fluorescence for detecting enamel and dentin lesions was 0.68 and 0.91, respectively. The heterogeneity of the published reports hampered the analysis., Conclusions: There was insufficient scientific evidence for diagnostic accuracy regarding fiber-optic methods and quantitative light-induced fluorescence (+OOO). The electrical methods and laser fluorescence could be useful adjuncts to visual-tactile and radiographic examinations, especially on occlusal surfaces in permanent and primary molars, but evidence was graded as limited (++OO). No conclusions could be drawn regarding the cost-effectiveness of the methods. There is an obvious need to standardize study designs for in vitro and in vivo validation of the different methods.

Objective: To investigate the effect of daily intake of fluoridated milk on enamel demineralization adjacent to fixed orthodontic brackets assessed with quantitative light-induced fluorescence (QLF)., Materials and Methods: Sixty-four healthy adolescents (13-18 years) undergoing orthodontic treatment with fixed appliances were enrolled and randomly allocated to a randomized controlled trial with two parallel groups. The intervention group was instructed to drink one glass of milk (≈ 200 ml) supplemented with fluoride (5 ppm) once daily and the subjects of the control group to drink the same amount of milk without fluoride. The intervention period was 12 weeks and the end-point was mineral gain or loss in enamel, assessed by QLF on two selected sites from each individual. The attrition rate was 12.5% and 112 sites were included in the final evaluation., Results: There was no statistically significant difference between the groups concerning fluorescence (ΔF) values and lesion area (A mm(2)) at baseline. After 12 weeks, a significant decrease (p < 0.05) in ΔF was registered in the fluoridated milk group and a significant increase in the non-fluoride control group (p < 0.05). The mean reduction in the test group was somewhat lower (14%) than the increase in the control group (18%), but individual variations were evident. Only minor alterations of lesion area were recorded over the 12-week period and no statistically significant differences compared with baseline were found in any of the groups., Conclusion: Daily intake of fluoridated milk may aid remineralization of white spot lesions adjacent to fixed orthodontic appliances.

Objectives: To investigate the caries risk profiles in young adults and to compare the risk classification using the Public Dental Service (PDS) guidelines with a risk assessment program, the Cariogram., Materials and Methods: All 19-year-old patients registered at eight public dental clinics were invited to participate (n = 1699). The study group who completed the baseline examination consisted of 1295 subjects representing 10% of all 19 year-olds attending dental care at the PDS in Skåne, Sweden. A risk classification of each patient was made by the patient's regular team according to the PDS guidelines. A research team collected whole saliva samples and information from a questionnaire and a structured interview in order to calculate risk according to the Cariogram model., Results: The mean DFS value was 4.9 and 23% of the patients were registered as caries-free (DFS = 0). The PDS risk classification was predominantly based on past caries and/or present caries activity. The majority was classified as 'some risk', while 16.7% were assessed as being of 'high' or 'very high risk'. The corresponding value for the two highest risk groups in the Cariogram model was 17.4%. The agreement between the two models was found acceptable (77.5%) for those assessed as low risk, while discrepancies were disclosed among those classified with higher risks., Conclusions: Although the proportion of subjects assessed with high or very high risk was similar using the PDS guidelines and the Cariogram model, the agreement between the models was fair. An acceptable agreement was only disclosed for the low risk category.

Objective: The mode of delivery may significantly influence the diversity and composition of the oral microflora and facilitate early acquisition of mutans streptococci. The aim was to compare caries prevalence and experience in 3-year-old children delivered vaginally and by caesarean section (C-section)., Materials and Methods: The study had an observational cohort protocol based on extracted information from governmental databases and nationwide registers concerning birth, social and educational levels and dental status. Children born at the Copenhagen University Hospital in 2005 were eligible and the final study group with complete information consisted of 594 children, 443 delivered vaginally and 151 by C-section., Results: The total caries prevalence was 8% and no significant difference was displayed between the groups. When only the children with caries (dmfs > 0) were compared, those delivered by C-section had a higher mean value in comparison with those delivered vaginally (dmfs 6.8 vs 3.2), but the difference was not statistically significant. There was a significant relationship between caries prevalence and low family income in the total study group (OR = 5.8, p < 0.05)., Conclusions: Within the limitations of this observational cohort study, caries prevalence in 3-year-old children was not related to the mode of delivery. However, the tendency of more severe caries in the C-section group justifies further studies, preferably with a prospective design.

Objective: To evaluate the effect of chewing gums containing probiotic bacteria on oral malodour. The null hypothesis was that no difference would be displayed compared with placebo gums., Materials and Methods: Twenty-five healthy young adults with self-reported malodorous morning breath completed this randomized double-blind placebo-controlled cross-over trial. The design included run-in and wash-out periods interspersed by two intervention periods of 14 days each. The subjects were instructed to chew one gum in the morning and one in the evening containing either two strains of probiotic lactobacilli (L. reuteri DSM 17938 and L. reuteri ATCC PTA 5289) or placebo. The outcome measures were (i) organoleptic scores (0-5) by a certified test panel, (ii) concentration of volatile sulphur compounds (VSC) measured with a Halimeter and (iii) concentration of VSC after a cysteine rinse. Registrations were made at baseline and after each intervention period. Differences between the groups were assessed by non-parametric paired statistics and chi-square test., Results: The median organoleptic score was similar (score 2) in both groups at baseline. After 14 days of treatment, the organoleptic scores were significantly lower in the probiotic group compared with the placebo group (p < 0.05). Assessments of the VSC levels displayed no significant differences between the groups, either before or after rinsing with L-cysteine. No adverse effects were registered., Conclusion: The results demonstrated that probiotic chewing gums may have some beneficial effect on oral malodour assessed by organoleptic scores. The results indicate that the probiotic gum may affect bacteria that produce malodourous compounds other than VSCs.

Objectives: To describe the occurrence and severity of dental caries in children and adolescents and to relate these findings to the subject's socio-cultural and socio-economic backgrounds., Material and Methods: A cross-sectional study in 12 706 children aged 5, 7, 12 and 15 years was conducted in 2006. Data on children's caries experience were collected from public oral health registers and pooled with socio-cultural and socio-economic data obtained from official statistics. The study population represented 76% of all registered inhabitants., Results: Among 5- and 7-year-old children with non-Danish mothers, the mean caries experience was three to four times higher than among children of Danish mothers, and a doubled rate was seen among the adolescents (p < 0.001). Significant differences in caries experience were found in various ethnic minorities. Multiple regression analysis showed that the level of caries was highest among children in families where mothers were not Danish, with low income, where mothers' educational levels were low, and in with a high number of children (p < 0.001)., Conclusions: Although almost all children and adolescents attend the prevention-oriented, free public dental service, a social gradient still exists for dental health. In addition, in all age groups, major inequalities in dental health were found when families with Danish and non-Danish backgrounds were compared. The findings indicate a need for social action by policymakers. Furthermore, a change in the oral health preventive strategy is proposed to meet the needs of children in risk of caries, and appropriate oral health-promotion programmes should be organized in collaboration with leaders from different ethnic minorities.

Objective: To evaluate the in vitro abilities of probiotic bacteria derived from consumer products to coaggregate with caries-associated mutans streptococci., Material and Methods: Six lactobacillus strains (L. acidophilus (CCUG 5917), L. plantarum 299v, L. rhamnosus GG and LB21, L. paracasei F19, L. reuteri PTA5289) were cultivated under anaerobic conditions at 37°C in Man Rogosa Sharpe (MSB) broth for 24 h. Four strains of human streptococci (S. mutans Ingbritt, S. mutans (ATCC 25175), S. mutans GS-5, S. sobrinus (ATCC 33478) were similarly grown in Brain Heart Infusion (BHI) broth. A gastrointestinal pathogen (Escherichia coli) was aerobically cultivated on BHI broth as a positive control. After incubation, the bacteria were aerobically harvested, washed, and suspended in 10 mmol/l phosphate-buffered saline (pH 7.2). The probiotic strains were characterized with the API 50 CH system to confirm their identity. Coaggregation was determined by spectrophotometry in mixtures and bacterial suspensions alone after 1, 2, 4, and 24 h and expressed as the aggregation ratio (%)., Results: All probiotic strains showed coaggregation abilities with the oral pathogens and the results were strain specific and dependent on time. S. mutans GS-5 exhibited a significantly higher ability to coaggregate with all the probiotic strains than the other mutans streptococci and E. coli. The differences among the probiotic strains were modest with L. acidophilus being the most prone and L. rhamnosus LB21 the least prone to coaggregate with the oral streptococci., Conclusions: The results demonstrated different abilities of lactobacilli-derived probiotic bacteria to coaggregate with selected oral streptococci. Aggregation assays may be a useful complement for screening of probiotic candidates with possible anti-caries properties.

Objectives: (i) To validate caries risk profiles assessed with a computer program against actual caries development in preschool children, (ii) to study the possible impact of a preventive program on the risk profiles, and (iii) to compare the individual risk profiles longitudinally., Material and Methods: Caries risk was assessed in 125 two-year-old children invited to participate in a 2-year caries-preventive trial with xylitol tablets. At 7 years of age, 103 were available for follow-up, 48 from the former intervention group and 55 from the control group. At baseline and after 5 years, 7 variables associated with caries were collected through clinical examinations and questionnaires, and scored and computed with a risk assessment program (Cariogram)., Results: Children assessed as having a "low chance (0-20%) of avoiding caries" had significantly higher caries at 7 years of age compared to children with a lower risk in the control group (p<0.05) but not in the intervention group. Overall predictive accuracy and precision, however, were moderate in both groups. Less than half of the children remained in the same risk category at both ages, despite a largely unchanged consumption pattern of sugar. The majority of the children who changed category displayed a lowered risk at 7 years. The intervention program seemed to impair the predictive abilities of Cariogram., Conclusion: A modified Cariogram applied on preschool children was not particularly useful in identifying high caries risk patients in a low-caries community.

Objective: To investigate the effect of a chewing gum containing probiotic bacteria on gingival inflammation and the levels of selected inflammatory mediators in gingival crevicular fluid (GCF)., Material and Methods: Forty-two healthy adults with moderate levels of gingival inflammation entered a double-blind placebo-controlled study design. The subjects were randomly assigned to one of three parallel arms: Group A/P was given one active and one placebo gum daily, Group A/A received two active chewing gums, and Group P/P two placebo gums. The chewing gums contained two strains of Lactobacillus reuteri: ATCC 55730 and ATCC PTA 5289 (1 x 10(8) CFU/gum, respectively). The subjects were instructed to chew the gums for 10 min over the course of 2 weeks. Bleeding on probing (BOP) and GCF sampling were conducted at baseline and after 1, 2 and 4 weeks. The levels of IL-1beta, TNF-alpha, IL-6, IL-8 and IL-10 were determined using luminex technology and multiplex immunoassay kits., Results: BOP improved and GCF volume decreased in all groups during the chewing period, but the results were statistically significant (p<0.05) only in Groups A/P and A/A. The levels of TNF-alpha and IL-8 decreased significantly (p<0.05) in Group A/A compared with baseline after 1 and 2 weeks, respectively. A non-significant decreasing tendency was also observed concerning IL-1beta during the chewing period. The levels of IL-6 and IL-10 were unaffected in all groups after 1 and 2 weeks., Conclusions: The reduction of pro-inflammatory cytokines in GCF may be proof of principle for the probiotic approach combating inflammation in the oral cavity.

Objective: To evaluate the cost of true-positive occlusal dentine caries detection in permanent molars assessed by: (I) visual-tactile examination, (II) visual-tactile examination combined with bitewing radiographs, and (III) selective radiographic examination of patients with lesions detected clinically. A second aim was to analyse the different strategies when the costs of the subsequent restorative care are considered., Methods: A model analysis was applied owing to the lack of original articles. Sensitivity and specificity were calculated from a systematic review and included in vitro and in vivo studies of medium and high quality. The direct costs for examinations and restorative care were extracted from the costs of the Public Dental Service in Sweden (2006)., Results: The diagnostic costs per true-positive finding were dependent on the occurrence of occlusal caries and increased with decreasing prevalence. The strategy by which radiographs were exposed selectively on the basis of findings from visual-tactile examination resulted in higher initial costs compared with the first and second strategies. When the costs of the subsequent restorative care were added, the selective strategy was most beneficial by up to 26% savings per true-positive diagnosis. However, with this selective strategy, more cases of true-positive dentine caries were assumed would remain undetected as compared with the combined strategy with visual-tactile examination and radiographs for all., Conclusions: The cost for a true-positive caries diagnosis was inversely related to caries occurrence, and different diagnostic strategies may display contrasting outcomes when subsequent restorative care is taken into account.

Objective: Probiotic bacteria are thought to reduce the risk of some infectious diseases. The aim of the present study was to examine whether or not short-term consumption of ice-cream containing bifidobacteria can affect the salivary levels of mutans streptococci and lactobacilli in young adults., Material and Methods: A double-blind, randomized crossover study was performed and 24 healthy subjects (mean age 20 years) were followed over 4 periods. During periods 2 and 4 (10 days each), they ingested 100 ml (53 g) ice-cream containing Bifidobacterium lactis Bb-12 once daily or a control ice-cream without viable bacteria. Periods 1 and 3 were run-in and washout periods, respectively. Salivary mutans streptococci and lactobacilli were enumerated with chair-side kits at baseline and immediately after the intervention period., Results: A statistically significant reduction (p<0.05) of salivary mutans streptococci was recorded after consumption of the probiotic ice-cream. A decline of high mutans streptococci counts was also seen after intake of the control ice-cream, but the difference compared to baseline was not statistically significant. The salivary lactobacilli levels were unaltered after both regimes., Conclusions: Daily consumtion of ice-cream containing probiotic bifidobacteria may reduce the salivary levels of mutans streptococci in young adults.

Objective: To explore and describe attitudes to oral health among adolescents with high caries risk., Material and Methods: A strategic selection of 45 subjects (15 to 19 years of age) assessed with high caries risk were invited to participate in the study, and 7 girls and 10 boys gave their informed consent. Semi-structured interviews performed, recorded, and transcribed verbatim were evaluated using qualitative content analysis., Results: Three categories and seven associated subcategories could be determined, and cognitive consistency in parallel with emotional inconsistency in relation to oral health was disclosed. On a cognitive level, attitudes to oral health were characterized by an awareness of the determinants (diet, plaque, fluoride) for caries. Fresh breath and even, white, teeth were considered signs of good oral health. Breath and esthetic appearance were important inducements for home care. Although toothbrushing was considered the most important activity for maintaining good oral health, forgetfulness and lack of time were the main reasons for not brushing. The provision of adequate information on caries risk was perceived as important. On the emotional level, the three subcategories were: (i) a positive attitude to oral health and clear self-confidence that improved health would be achieved, (ii) an impassive attitude that everything would be all right and fixed by the dentist, and (iii) a negative attitude characterized by frustration and a tendency to give up., Conclusions: Allowing adolescents with high caries risk to relate their views on oral health is important for dental professionals when encouraging patients at caries risk towards healthy behavior.

Objective: To longitudinally apply a laser fluorescence (LF) device (DIAGNOdent) in newly erupted 1st permanent molars over a 3-year period and to relate the findings to mutans streptococci (MS) colonization, fissure morphology, and caries development., Material and Methods: The material consisted of 101 consecutive 5 to 6-year-old children attending a Public Dental Clinic and who volunteered after ethical approval and informed consent had been given. Only fully erupted molars with clinically sound fissures were included. At baseline, the fissures were subjectively categorized as "shallow" or "deep", and, prior to the LF readings, a plaque sample was collected and cultivated for MS using a chair-side kit. The registrations were repeated annually and the microbial samplings after 2 years. The total drop-out rate was 12%., Results: The mean LF values increased significantly (p<0.05) with increasing age from 8.2 to 12.4 in the teeth that remained sound. Thirty-five teeth were decayed or filled during the follow-up and their mean LF values increased from 13.4 to 40.7. The LF readings were significantly higher in molars with "deep" fissures (p<0.05) at all visits. MS colonization at baseline was associated with an increased risk for caries (OR = 11.6, p<0.05) and significantly elevated LF readings. Baseline LF readings > or =12 were not diagnostic for dentin caries or fillings over the study period (sensitivity 0.57; specificity 0.86)., Conclusion: LF readings could be used to some extent to monitor fissure morphology and caries development in fissures of newly permanent molars over time, but elevated initial values were not predictive for caries development.

Objective: Previous studies have suggested that lactobacilli-derived probiotics in dairy products may affect oral ecology, but the impact of different vehicles of ingestion has received little attention. The aim of the present study was to investigate the effect of the probiotic bacterium Lactobacillus reuteri ATCC 55730 on the levels of salivary mutans streptococci and lactobacilli in young adults when ingested by two different delivery systems., Material and Methods: The material comprised 120 healthy young adults (21-24 years) and a placebo-controlled study design with parallel arms was utilized. The subjects were randomly assigned to four equally sized groups: group A drank 200 ml of water through a prepared straw containing L. reuteri ATCC 55730 once daily for 3 weeks, while group B took 200 ml water through a placebo straw during the same period. Group C was given one tablet containing L. reuteri ATCC 55730 once daily for 3 weeks, while group D received placebo tablets without bacteria. Salivary mutans streptococci and lactobacilli were enumerated with chair-side kits at baseline and 1 day after the final ingestion., Results: A statistically significant reduction of the mutans streptococci levels was recorded after ingestion of the probiotic bacteria via the straw (p<0.05) and the tablets (p<0.01), which was in contrast to the placebo controls. A similar but non-significant trend was seen for lactobacilli., Conclusions: A short-term daily ingestion of lactobacilli-derived probiotics delivered by prepared straws or lozenges reduced the levels of salivary mutans streptococci in young adults.

Probiotic bacteria are thought to reduce the risk of disease. Previous studies have suggested that lactobacilli-derived probiotics in dairy products may affect the oral ecology, but the effect of bifidobacteria has not previously been reported. The aim of the present study was to examine whether or not short-term consumption of yogurt containing bifidobacteria would affect the salivary levels of mutans streptococci and lactobacilli in young adults. A double-blind, randomized crossover study was performed and 21 healthy subjects were followed over four periods. During periods 2 and 4 (2 weeks each), they ingested 200 g yogurt containing Bifidobacterium DN-173 010 once daily or a control yogurt without viable bacteria. Periods 1 and 3 were run-in and washout periods, respectively. Salivary mutans streptococci and lactobacilli were enumerated with chair-side kits. A statistically significant reduction (p <0.05) of salivary mutans streptococci was recorded after the probiotic yogurt consumption, which was in contrast to the controls. A similar trend was seen for lactobacilli, but this decrease failed to reach statistical significance. In conclusion, probiotic bifidobacteria in yogurt may reduce the levels of selected caries-associated microorganisms in saliva.

Objective: The aim was to investigate the effect of high and low amounts of xylitol on the interdental plaque-pH, directly and after sucrose challenge, in schoolchildren with habitual consumption., Material and Methods: The study group consisted of 11 healthy children (10-15 years) with low caries risk and the experiment had a single-blind crossover (Latin square) design. After a 2-week run-in period with a daily 4.0 g xylitol intake, the children were subjected to single-dose exposures of chewing gums with (i) paraffin (CTR; no xylitol), (ii) low-dose xylitol (LX; 2.0 g xylitol), and (iii) high-dose xylitol (HX; 6.0 g xylitol) in a randomized order separated by a washout period of 1 week. Samples of chewing-stimulated whole saliva were collected prior to and after the experimental period for determination of bacterial counts. The outcome measures were in situ plaque-pH (micro-touch method) and area under the pH curve (AUC)., Results: The AUC was significantly greater (p < 0.05) in the HX group compared to the LX and control groups during the first 5 min after chewing. After a 10% sucrose rinse, the interdental plaque-pH dropped in all groups but the HX regimen displayed significantly less reduction 0-5 min after chewing (p < 0.05). No significant alterations of the total viable counts or mutans streptococci levels in saliva were disclosed during the 4-week experimental period., Conclusions: The present results suggested that a high single dose of xylitol had a short and limited beneficial effect on interdental plaque-pH in habitual xylitol consumers, while a low single dose, resembling normal chewing gum use, did not differ from the control.

The aim of this study was to evaluate the caries-preventive effect of an oral health program for preschool children living in a multicultural, low socio-economic area. In total, 804 2-year-old children were invited and recalled every 3rd month to an outreach facility for parent education and toothbrushing instruction. In addition, fluoride tablets (0.25 mg/day) were provided free of charge. A clinical examination and questionnaire were completed at baseline and at age 3 years. The results of the intervention were compared with a non-intervention Reference group of 3-year-old children (n=217) from the same area. In the Intervention group, the 1-year attrition rate was 8.2%, and more than 90% of the children attended at least 4 of their scheduled appointments. The parents' daily assistance with toothbrushing and the use of fluoride toothpaste and tablets improved significantly during the intervention. Compared with the Reference group when the children were 3 years old, the number of children in the Intervention group who consumed frequent in-between meals and sweet drinks at night was significantly lower. Caries prevalence at age 3 was significantly lower in the Intervention group than in the Reference group (3.0 deft versus 4.4 deft; p<0.01). The number of caries-free children after the 1-year intervention was 37% in the Intervention group compared with 15% in the Reference group. The relative risk (RR) was calculated to be 2.5 (95% CI 1.8-3.4) and the number needed to treat (NNT) 4.6. In conclusion, this study demonstrated that the oral health program significantly affected the prevalence of caries and various risk factors for caries development.

The aim of this study was to monitor the effect of an antibacterial varnish using the readings of a caries-detecting device (DIAGNOdent) in fissures of young permanent molars. The material consisted of 32 healthy patients with a mean age of 14.1 years undergoing orthodontic treatment with fixed appliances. The inclusion criteria were presence of one homologous pair of 2nd upper or lower molars with clinically intact occlusal surfaces. A split-mouth study design was used in which the fissures were treated with either an antibacterial chlorhexidine/thymol-containing varnish or a placebo varnish every 6th week. The follow-up period was 42 weeks and laser fluorescence (LF) readings were carried out every 12th week. The mean LF values increased significantly (P < 0.05) after 24, 36, and 48 weeks compared to baseline following the placebo treatments but not after treatment with the active antibacterial varnish. During the study period, micro-cavities were diagnosed in two test-treated and five placebo-treated teeth. In conclusion, the results reinforce previous findings that frequent applications of a chlorhexidine/thymol-containing dental varnish might have a protective role in fissures of young permanent molars and that this could be monitored with a chair-side caries detecting LF device.

The aim of this study was to evaluate the effect of maternal use of chewing gums containing combinations of xylitol, sorbitol, chlorhexidine, and fluoride on salivary mutans streptococci (MS) counts and caries prevalence in the mothers' 3-year-old children. After screening 416 women with newborn babies, 173 mothers with high counts of salivary MS were randomly assigned into 3 experimental chewing gum groups containing (A) xylitol (n = 61), (B) chlorhexidine/xylitol/sorbitol (n = 55), and (C) sodium fluoride/xylitol/ sorbitol (n = 57). Mothers with low or medium MS counts formed a reference group (D) without any intervention (n = 232). The participants in the experimental groups were instructed to chew one piece of the gum for 5 min 3 times a day. The chewing regimen started when the child was 6 months old and was terminated 1 year later. The outcome measures were salivary MS counts and caries prevalence at the age of 3 years. Bacterial enumeration was carried out with a chair-side technique and caries (defs) was scored by clinical examination. Medium and high counts of salivary MS were found in 13%, 16%, and 22% in groups A, B, and C, respectively. The mean defs was 0.1 in group A, 0.2 in group B, and 0.4 in group C. The differences concerning salivary MS and caries were not statistically significant. The MS counts and caries prevalence in children of mothers with low MS counts (group D) were similar to those found in groups A and B. In conclusion, lower but non-significant levels of salivary MS and dental decay were observed in 3-year-old children to mothers who used high-content xylitol gums compared with those who used lower amounts of xylitol. The efficiency of this type of targeted intervention in a low-caries community may be questioned.

The aim of this study was to investigate the relationship between salivary buffer capacity and menarche, and to explore any association with levels of the sex hormone progesterone in stimulated whole saliva in adolescent girls. The material comprised 162 girls, 12 years of age at baseline in the 6th grade, who were followed for 3 years. Every 4th month, a stimulated whole saliva sample was collected, secretion rate and buffer capacity were determined, and information was gathered on menarche, ongoing menses, and caries increment. Once yearly, the salivary concentration of progesterone was determined with an enzyme immunoassay kit. The results showed a significantly impaired salivary buffer capacity over the years (P < 0.05). Low buffer capacity was significantly correlated with low secretion rate (r = 0.42; P< 0.001) and DMFT increment (r=0.20; P<0.05). Pre-menarche buffer capacity did not differ from the postmenarche scores. The concentration of progesterone in saliva increased with age but displayed no significant relationship to buffer capacity, flow rate, or caries increment. In conclusion, the findings of this study suggest that the salivary buffer capacity may be impaired over the adolescent years in females, but the reason remains unclear.

The Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on different caries-preventive methods. The aim of this article was to report the findings concerning the caries-preventive effect of fluoride mouthrinses (FMRs) in various age groups, with special reference to background fluorides. A systematic search in electronic databases for literature published between 1966 and August 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years' follow-up, and caries increment in the permanent dentition (DeltaDMFS/T) as endpoint. Out of 174 articles originally identified, 62 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A-C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF) expressed as percent. The level of evidence was based on 25 articles. The results revealed limited evidence (evidence level 3) for the caries-preventive effect (PF 29%) of daily or weekly sodium fluoride rinses compared with placebo in permanent teeth of schoolchildren and adolescents with no additional fluoride exposure and for a caries-preventive effect on root caries in older adults. Inconclusive evidence (evidence level 4) was found regarding the effect of FMRs in schoolchildren and adolescents exposed to additional fluoride sources such as daily use of fluoride toothpaste. No firm support for the use of FMRs was disclosed in a small number of studies designed for patients at caries risk. Furthermore, no association between the frequency of the rinses and prevented fraction or saved surfaces per year was found. In conclusion, this systematic review suggests that sodium fluoride mouthrinses may have an anti-caries effect in children with limited background of fluoride exposure, while its additional effect in children with daily use of fluoride toothpaste could be questioned. The need for further clinical trials to elucidate the effect of FMRs in risk patients and older adults is emphasized.

The aim of this systematic review was to evaluate the caries-preventive effect of combined caries-preventive methods, defined as two or more different interventions in combination, each expected to prevent dental caries. The Medline database was searched for articles published in the period January 1966 to June 2003. Twenty-four controlled studies met the inclusion criteria, and their value as evidence was assessed according to predetermined criteria. The level of evidence for the overall conclusion regarding each method was graded according to the protocol of the Swedish Council on Technology Assessment in Health Care. The scientific evidence for the combination of treatments involving fluoride that had a preventive effect on caries in children and adolescents was graded as moderate. However, for elderly patients the scientific evidence for the caries-preventive effect of different combinations of treatments was found to be incomplete. No conclusion could be drawn regarding the evidence for combinations of treatments being effective for groups at high caries risk, as the results from the identified clinical studies were conflicting.

The aim of this paper was systematically to evaluate the caries-preventive effect of professional fluoride varnish treatments. A search of the literature for articles published between 1966 and August 2003 was carried out in electronic databases, reference lists of articles, and selected textbooks in accordance with the strategy of the Swedish Council on Technology Assessment in Health Care. Out of 302 identified papers, 24 randomized and controlled clinical trials comparing fluoride varnish with placebo, no active treatment or other fluoride preventive regimens of at least 2 years' study duration were included. The trials that met the inclusion criteria were assessed independently and systematically by at least two reviewers and scored from A to C according to predetermined criteria for methodology and performance. The main outcome measure was the preventive fraction expressed as a percentage. The results displayed limited evidence (evidence level 3) for the caries preventive effect of topical applications of fluoride varnishes in permanent teeth. The average prevented fraction was 30% (0-69%) when compared with untreated controls. Inconclusive evidence (evidence level 4) was found for fluoride varnish treatment in the primary dentition and in adults. This systematic review reinforces the need for future dinical research of high quality, incorporating modern concepts of dinical performance and evaluation to assess dental caries control using professional fluoride varnish.

The aim was to evaluate the effect of habitual consumption of fluoridated milk on the composition of the salivary microflora. The study group comprised 20 healthy schoolchildren and young adults with a mean age of 13.6 years and the investigation had a randomized double-blind crossover design with a washout period of 1 month. After professional tooth-cleaning at baseline, the subjects were supplied with either fluoridated (250 mL, 5 ppm F) or non-fluoridated milk for one daily intake during a period of 4 weeks. Salivary samples were collected immediately before tooth-cleaning and after 1, 2, and 4 weeks, respectively. The samples were immediately cultivated for total viable counts, oral streptococci, mutans streptococci, lactobacilli, and actinomyces spp. Bacterial counts were logarithmically transformed before statistical evaluation using ANOVA. No significant alterations of the salivary microflora were found during any of the milk regimens compared with baseline. There was a slight reduction in the proportion of mutans streptococci after 2 and 4 weeks during consumption with fluoridated milk but the difference failed to reach statistical significance. In conclusion, this study was unable to disclose any significant alteration of the composition of the salivary microflora following daily intake of fluoridated milk.

The aim of the present study was to compare concentrations of cytokines, matrix metalloproteinases (MMPs) and a metalloproteinase inhibitor (TIMP-1) in gingival crevicular fluids (GCF) from sites with gingival inflammation in 28 young patients with Papillon-Lefèvre syndrome (PLS), and in age- and gender-matched controls. Each group consisted of 17 females and 11 males with a mean age of 11.0 years (range 4-22 years). In both groups, anterior upper sites with a clinical diagnosis of gingival inflammation and with pockets < or = 3 mm were selected for sampling of GCF, which was carried out with filter disks inserted into the gingival crevice until saturated. The concentrations of cytokines (IL-1alpha, IL-1beta, TNF-alpha, and IL-8), matrix metalloproteinases (MMP-1, MMP-3, MMP-8, and MMP-9), and their tissue inhibitor (TIMP-1) were analysed using commercial ELISA kits. Significantly higher levels of IL-1beta (P < 0.001) and MMP-8 (P < 0.05) were disclosed among the PLS patients compared with their controls, while the opposite was found for IL-8 (P < 0.05) and MMP-1 (P < 0.001). The individual variations were considerable in both groups. When comparing the expression of cytokines, MMPs, and TIMP-1 in PLS patients with clinically active and non-active periodontitis, the non-active PLS patients showed significantly higher values of IL-1beta than the patients with active periodontal disease (ANOVA, P < 0.01). In conclusion, this study was unable to demonstrate a clear-cut pathognomonic expression of cytokines or MMPs in patients with PLS, but further studies on cytokine and MMP output are warranted.

The objectives of this study were to evaluate systematically the evidence of the caries-preventive effect of fissure sealing of occlusal tooth surfaces and to examine factors potentially modifying the effect. The search strategies included electronic databases, reference lists of articles, and selected textbooks. Inclusion criteria were randomized or quasi-randomized clinical trials or controlled clinical trials comparing fissure sealing with no treatment or another preventive treatment in children up to 14 years of age at the start; the outcome measure was caries increment; the diagnostic criteria had been described; and the follow-up time was at least 2 years. Inclusion decisions were taken and grading of the studies was done independently by two of the authors. The main measure of effect was relative risk reduction. Thirteen studies using resin-based or glass ionomer sealant materials were included in the final analysis. The results showed that most studies were performed during the 1970s and a single application had been utilized. The relative caries risk reduction pooled estimate of resin-based sealants on permanent 1st molars was 33% (relative risk = 0.67; CI = 0.55-0.83). The effect depended on retention of the sealant. In conclusion, the review suggests limited evidence that fissure sealing of 1st permanent molars with resin-based materials has a caries-preventive effect. The evidence is incomplete for permanent 2nd molars, premolars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations with a low and a high caries risk, respectively.

The aim of this study was, systematically, to evaluate the effect of dietary changes in the prevention of dental caries. A search and analysis strategy was followed, as suggested by the Swedish Council on Technology Assessment in Health Care (SBU). The search strategy for articles published in 1966-2003 was performed using electronic databases and reference lists of articles and selected textbooks. Out of 714 articles originally identified, 18 met the inclusion criteria for a randomized or controlled clinical trial--at least 2 years' follow-up and caries increment as a primary endpoint. This included the total or partial substitution of sucrose with sugar substitutes or the addition of protective foods to chewing gum. No study was found evaluating the effect of information designed to reduce sugar intake/frequency as a single preventive measure. It is suggested that the evidence for the use of sorbitol or xylitol in chewing gum, or for the use of invert sugar, is inconclusive. No caries-preventive effect was found from adding calcium phosphate or dicalcium phosphate dihydrate to chewing gums. The review dearly demonstrates the need for well-designed randomized clinical studies with adequate control groups and high compliance.

The aim of the present study was to perform a systematic review of economic evaluations of caries prevention. A search in Medline from 1966 until May 2003 and a manual search in a number of journals identified 154 references, 74 of which were included. There were 17 original studies including an economic evaluation, and these form the basis of the present article. The rest were reviews, model studies and reports concerning economic practice in dentistry. The results show that the reviewed original studies on economic evaluation of caries prevention do not provide support for the economic value of caries prevention. The scarcity of well-conducted studies, as well as contradictory evidence in the reviewed articles, makes it difficult to judge the health-economic effect of the studied caries-prevention methods.

With a questionnaire addressed to general dental practitioners in Sweden, the Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on various caries preventive methods. The aim of this article was to report findings concerning the caries preventive effect of fluoride toothpastes in various age groups, with special emphasis on fluoride concentration and supervised versus non-supervised brushing. A systematic search in electronic databases for articles published between 1966 and April 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years follow-up and caries increment in the permanent (deltaDMFS/T) or primary (deltadmfs/t) dentition as endpoint. Out of 905 articles originally identified, 54 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A-C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF), expressed as percent. The results revealed strong evidence (level 1) (i) for the caries preventive effect of daily use of fluoride toothpaste compared to placebo in the young permanent dentition (PF 24.9%), (ii) that toothpastes with 1,500 ppm of fluoride had a superior preventive effect compared with standard dentifrices with 1,000 ppm F in the young permanent dentition (PF 9.7%), and (iii) that higher caries reductions were recorded in studies with supervised toothbrushing compared with non-supervised (PF 23.3%). However, incomplete evidence (level 4) was found regarding the effect of fluoride toothpaste in the primary dentition. In conclusion, this review reinforced the importance of daily toothbrushing with fluoridated toothpastes for preventing dental caries, although long-term studies in age groups other than children and adolescents are still lacking.

The effect of a triclosan-containing (0.3%) dental gel on inflammatory mediators in gingival crevicular fluid (GCF) was evaluated in 14 healthy adolescents undergoing orthodontic treatment with fixed appliances. A double-blind randomized split-mouth study design was used with color-coded experimental and placebo gels. The gel was self-applied for 5 min twice daily for 14 days in custom-made soft plastic trays. Clinic al data (visible plaque index (VPI) and gingival bleeding index (GBI) and samples of GCF were collected at baseline and after 1, 2, 4, and 6 weeks. The concentrations of prostaglandin I2 (PGI2) and interleukin-1beta (IL-1beta were determined by radioimmuno- and enzyme-linked immunosorbent assays, respectively. No clinical effects of the gel applications regarding amount of plaque or gingival bleeding were unveiled. Neither the experimental nor the placebo gel applications caused any statistically significant alterations in the inflammatory mediators, PGI2 and IL-1beta, compared to baseline. In conclusion, the present study did not reveal any beneficial cffects of the triclosan-containing gel regimen on mild gingivitis in adolescents with fixed orthodontic appliances.

The aim of this study was to evaluate the fluoride concentration in supragingival dental plaque after single and repeated intakes of fluoridated milk. The study group consisted of 22 schoolchildren, young adults and adults of both sexes, 8-41 years of age. After a 2-week fluoride depletion period and 3 days of plaque accumulation, 200 ml of fluoridated milk (1g F) was ingested along with a standardized lunch meal. Plaque samples were collected immediately before the intake and after 30, 120 and 240 min. From the adult participants (n = 9) additional samples were collected after 12 and 18 h. After a fluoride-free washout period of at least 2 weeks, the whole experimental procedure was repeated after 4 consecutive daily intakes of fluoridated milk. The fluoride concentration was determined after micro-diffusion with a fluoride selective electrode. The results showed a statistically significant 3-fold increase of the plaque fluoride levels up to 4 h after the intake. At 12 and 18 h after the intake, the recorded levels went gradually back to baseline. There was no significant difference between the fluoride concentrations in the supragingival plaque after the single intake compared with the repeated intakes. In conclusion, the findings support the suggestion that milk is a suitable vehicle for local fluoride administration into the oral cavity, also when consumed together with a meal.

The effect of an anti-adhesive enamel coating on plaque accumulation, gingival health, and enamel demineralization was evaluated in 39 adolescents undergoing treatment with fixed orthodontic appliances using a prospective split-mouth design. Immediately after bracket insertion, the polymer was randomly applied after enamel etching to the buccal surfaces of the teeth in the left or right upper quadrant, leaving the opposite quadrant as an untreated control (218 test and 216 control teeth). Reapplications were carried out every 3rd month during the course or the study. The following data were collected at baseline and at designated follow-ups: visible plaque index, total viable counts and proportion of mutans streptococci in plaque samples, gingival bleeding index, and amount of gingival crevicular fluid. The incidence of enamel demineralization adjacent to the appliances was scored clinically at the termination of the orthodontic treatment. The observation time ranged from 6-24 months, during which the participants used fluoride rinses and toothpaste daily. A slightly impaired gingival health and increased levels or mutans streptococci compared with baseline was disclosed during the treatment. Five subjects showed enamel demineralization on a total of 30 teeth at the time of de-bonding. The results indicated no statistically significant differences between the enamel-coated and untreated teeth with regard to the studied variables at any follow-up. In conclusion, the present findings did not support a clinically beneficial effect of the polymeric tooth coating in a low-caries group of adolescents treated with fixed orthodontic appliances.

Fluoride concentration in whole saliva and in separate gland secretions was determined after a single application of each of 3 different fluoride varnishes with contrasting levels of fluoride in a randomized crossover design. The study group comprised 8 healthy schoolchildren aged 10-12 years treated with A: Bifluorid 12 (6% F); B: Duraphat (2.26% F); and C: Fluor Protector (0.1% F). Unstimulated and stimulated whole saliva, as well as stimulated parotid and submandibular-sublingual saliva, were collected at baseline and 1, 6, 12, and 24h after the varnish treatments. The fluoride concentrations were determined with an ion-selective electrode. Time- and dose-dependent concentration curves were obtained in all the collected secretions, A > B > C. In whole saliva, the fluoride levels were significantly elevated (P<0.01) 1 h after the A and B varnish applications compared with baseline, while the increase was insignificant for varnish C. Similar patterns were unveiled in the parotid and submandibular-sublingual secretions, although the increase in fluoride concentration was modest. The elevated levels did not exceed 6 h for any of the varnish tested. The results of this study suggest a correlation between the concentration of fluoride of the varnish and fluoride levels obtained in saliva after application.

The aim of this study was to evaluate interdental caries incidence and progression in relation to the effect of antibacterial varnish treatments in schoolchildren anticipated at caries risk. After a screening procedure, 110 healthy children (8-10 years) with moderate and high counts of salivary mutans streptococci (MS) were invited to join a 2-year longitudinal study. At baseline, MS were enumerated at all mesial interdental sites of the first permanent molars with a chair-side technique. The children were then treated 3 times within 2 weeks by interdental spot applications with a 1% chlorhexidine/thymol-containing varnish (Cervitec). Follow-up samples of saliva and plaque were collected 1, 3, 6, and 12 months after onset of treat. Caries prevalence, incidence and progression of the selected approximal surfaces were scored from bitewing radiographs exposed at baseline and after 2 years. Sixty-three children of the same age formed a non-varnish-treated reference group. Reduction of caries incidence and progression was dearly dependent on the outcome of the antibacterial treatment. A significantly (P< 0.01) higher progression score was found among children who exhibited a less marked suppression of interdental MS levels compared with those with high suppression and the children of the reference group. The results suggest that a suppression of MS in interdental plaque may be an important event to prevent and arrest approximal caries development in schoolchildren at risk. Monitoring the effect of antibacterial agents in a site-specific way could therefore be advocated.

The aim of this study was to investigate the effects of a chlorhexidine/thymol-containing dental varnish on the levels of prostaglandin E2 (PGE2), prostaglandin I2 (PGI2), leukotriene B4 (LTB4), and interleukin-1 beta (IL-1 beta) in gingival crevicular fluid (GCF). The material consisted of 15 adolescents undergoing treatment with fixed orthodontic appliances. Four buccal sites adjacent to bands or brackets and exhibiting a mild chronic gingival inflammation were selected in the upper quadrants of each patient. According to a split-mouth technique, the first and second quadrants were randomly treated with either a varnish (Cervitec) containing 1% chlorhexidine diacetate and thymol (CHX/thymol) or a placebo varnish without active ingredients. The varnishes were applied immediately after the baseline registration, and follow-up examinations were carried out after 3, 8, and 30 days. GCF was sampled with the aid of a paper strip and the volume was determined using a Periotron 8000. The concentrations of PGE2, PGI2, LTB4, and IL-1 beta in GCF were assessed using radioimmunoassay and ELISA techniques. The results unveiled statistically significant reductions of PGE2, PGI2, and LTB4 levels in GCF following the active varnish treatment when compared to baseline values. A slight drop in IL-1 beta levels was registered after both active and placebo varnish applications, but the differences were not significant. The results suggest that treatment with an antibacterial varnish decreases the levels of inflammatory mediators PGE2, PGI2, and LTB4 in gingival crevicular fluid and further support the concept that topical application of a CHX/thymol-containing varnish is beneficial in patients with chronic gingival inflammation.