Andrew Rugg-Gunn

Relationship between dietary habits and caries increment assessed over two years in 405 English adolescent school children

The study was conducted in seven schools on children initially aged 11.5 years. They recorded their diet on five occasions, each of three days, and received an annual dental examination, including radiography. Caries increments were low, mostly (58 per cent) in fissure surfaces. Correlations between caries increment and dietary factors were low due to the low caries increments observed and the large error associated with dietary data where analyses attempt to discriminate between individuals. The highest correlation was between caries increment and weight of daily intake of sugars (+0.143, p less than 0.01). Multivariate analyses revealed that this relationship could not be explained by differences in sex, social class, tooth-brushing habits or level of plaque as measured by gingival inflammation. Weight of sugar intake appeared to be more strongly correlated to caries than frequency of intake; concentration of sugars in foods was positively related, and sugars in snacks were more strongly related to caries than total dietary sugars. The 31 children who consumed most sugar (greater than 163 g/day) developed 5.0 DMFS during the 2 years, 0.9 DMFS per year more than the 31 children (3.2 DMFS during 2 years) who had the lowest sugar intake (less than 78 g/day).

Associations between dietary intake, dental caries experience and salivary bacterial levels in 12-year-old English schoolchildren

A population of 328 12-yr-old English schoolchildren, consuming their normal diets, was investigated in a cross-sectional study to determine the interactions between caries experience, oral hygiene status as gingival index (GI), dietary intake (as number of eating events per day and the number of eating events per day at which sugar-containing foodstuffs, confectionery or starch-containing foods were consumed) and salivary levels of caries-associated micro-organisms (mutants streptococci, lactobacilli and yeasts). The mean (+/- SD) decayed, missing and filled surfaces (DMFS) (excluding precavitation lesions) score was 3.05 +/- 3.85 and 5.72 +/- 5.00 (including precavitation lesions). The DMFS scores were significantly related to the salivary levels of caries-associated micro-organisms and to the number of eating events per day for total number of eating events and the number of eating events at which sugar-containing foods or confectionery were consumed. These associations were apparent in both bivariate and partial correlation coefficients with the caries-associated micro-organisms and GI controlled. The total daily intakes of food types, except for starch, were not associated with caries experience. No significant correlations were found between intake of food types and salivary levels of caries-associated micro-organisms except that the mean number of confectionery-eating events was correlated with lactobacillus levels (r = 0.136, p < 0.01). The salivary levels of mutans streptococci, lactobacilli and yeasts were significantly correlated with GI scores. These data do not indicate simple associations between dietary intake, caries and levels of caries-associated micro-organisms. Poor oral hygiene, in children consuming unrestricted diets, may influence the salivary levels of mutans streptococci, lactobacilli and yeasts irrespective of the frequency or amount of sugar consumed. Multiple regression analyses revealed that three variables--GI (probably an indicator of toothbrushing behaviour with a fluoride-containing toothpaste), salivary concentration of lactobacilli and frequency of ingestion of confectionery/sugary foods--were independently and positively related to caries experience.

Xylitol and caries prevention--is it a magic bullet?

Several recent publications have focused discussion on the value of xylitol in caries prevention. Some reviewers have concluded that xylitol has a unique active role in caries prevention, while other reviewers have been more cautious saying that the case is not yet proven. Chewing xylitol gum is certainly effective at preventing caries development compared with chewing sugared gum or not chewing any gum. Xylitol gum appears to be more effective than sorbitol gum or combinations of xylitol and sorbitol. One recent trial suggested that the effectiveness of eating a xylitol candy could be similar to that of chewing xylitol gum: this is valuable as it would remove the necessity of disposing of spent gum; it has also been suggested that xylitol has a positive action in addition to the favourable effect of chewing. A further recent publication reported substantial reductions in caries development in children whose mothers had chewed xylitol gum. The main explanation appears to be that xylitol changed the plaque flora of the mothers so that transmission of cariogenic oral micro-organisms from mother to child was reduced. Further developments in this field are awaited, but at present we may conclude that xylitol exhibits dental health benefits which are superior to other polyols in all areas where polyols have been shown to have an effect. In addition, xylitols specific effects on oral flora and especially on certain strains of mutans streptococci add to its caries-preventive profile and give it a unique role in preventive strategies for dental health.

Nutritional intake, height and weight of 11-12-year-old northumbrian children in 1990 compared with information obtained in 1980

There is little age-specific information on changes in dietary intake over time in this country, yet this is valuable in assessing the effectiveness of health education programmes particularly in vulnerable groups such as adolescents. In 1990, 379 children aged 12 years completed two 3 d dietary records. They were interviewed by one dietitian on the day after completion of each diary to verify and enlarge on the information provided and, with the aid of food models, obtain a quantitative record of food intake. Nutrient intake was calculated using computerized food tables. These children attended the same seven Middle schools in Northumberland as 405 children of the same age who recorded their diet using the same method, 10 years previously. Heights and weights were also recorded in both studies in the same manner. Comparing the nutrient intakes in 1990 with 1980, energy intake fell in the boys (to 8.6 MJ) but not in the girls (8.3 MJ). The contribution of fat to energy intake was unchanged at about 40% (about 90 g/d). Likewise, intake of sugars was unchanged at about 22% of energy (about 118 g/d). Calcium intake remained the same in the girls (763 mg/d in 1990) but fell in the boys (786 mg/d in 1990). Iron, vitamin C and unavailable carbohydrate intakes increased in both sexes, and the nutrient density of the diet improved in all sex and social-class groups. However, a social trend evident in 1980 still existed in 1990 with low social groups having the poorest-quality diet. It is concluded that there is little evidence of substantial progress towards improving the diet of adolescents in this country.

Effect of Human Milk on Plaque pH in situ and Enamel Dissolution in vitro Compared with Bovine Milk, Lactose, and Sucrose

The acidogenic and enamel dissolution potential of human milk was compared with bovine milk and solutions of lactose and sucrose. It was found that human milk caused a greater fall in plaque pH than b

Dental health of children taking antimicrobial and non-antimicrobial liquid oral medication long-term.

A large number of liquid oral medicines contain sugars and there is concern for the dental health of children requiring this medication long-term for chronic medical problems. Ninety-four chronically sick children aged 2-17 years taking sugar-based or sugar-free liquid oral medication for 1 year or more, and their 92 siblings were dentally examined. The medical problems of the sick children included epilepsy, cystic fibrosis, chronic renal failure, asthma, recurrent urinary tract infections, cardiac disease and chronic constipation. Ordinal logistic regression analysis compared differences between sick children and their healthy siblings and showed the only significant confounding factors related to dental health to be age (for dmfs p = 0.013, DMFS p < 0.001) and exposure to fluoridation (for DMFS p = 0.0097, DFS (approximal) p = 0.013). Children taking long-term liquid oral medicines had significantly more caries of deciduous anterior teeth than their siblings (p = 0.046).

Malnutrition and Developmental Defects of Enamel in 2- to 6 -Year-Old Saudi Boys

Three hundred and ninety boys aged 2, 4 or 6 years from Riyadh, Saudi Arabia, took part in a survey in 1993/94. The main aims of the study were first, to identify factors related to malnutrition in young children since a study of older children from the same area 1 year before had shown malnutrition to be strongly related to prevalence of developmental defects of enamel (DDE) of permanent teeth and, second, to identify factors related to the prevalence of developmental defects of primary teeth. Enamel defects were recorded by clinical examination of the buccal surfaces of all primary teeth by 1 examiner using the DDE index. A questionnaire to parents provided information on socio-economic status, illness in the mother and child, infant feeding, trauma to teeth and toothbrushing. A 24-hour dietary record, to estimate water and milk intake, and a 24-hour urine collection were obtained for each child twice. Nutritional status was calculated from height for age using WHO methods. Multiple regression analyses revealed four variables related (p < 0.05) to malnourished status: low birth-weight, low volume of water drunk, child stopped breast- and bottle-feeding before 1 year of age, and low class urban or rural area of residence. Birth-weight was itself related to area of residence (p = 0.02), parental education (p = 0.02) and maternal illness during pregnancy (p = 0.06). Malnutrition (p < 0.001), low birth-weight (p < 0.001), childhood illness (p < 0.001), brushing of child’s teeth (p = 0.003) and swallowing toothpaste (p < 0.001) were related to the prevalence of developmental defects of primary teeth. This study indicated several independent variables which may be related to the prevalence of enamel defects in primary and permanent teeth, but longitudinal studies are required to determine which are causes and which are markers of these developmental defects.

Dental fluorosis in permanent incisor teeth in relation to water fluoridation, social deprivation and toothpaste use in infancy

Objectives To determine the prevalence and severity of fluorosis in permanent incisor teeth in young children in a fluoridated and a fluoride-deficient community and to establish what relationship, if any, there was between the occurrence of dental fluorosis and the reported use of fluoride toothpaste in childhood. Design A prevalence study of children aged 8‐9 years who had been continuous residents in fluoridated Newcastle or fluoridedeficient Northumberland. Method The permanent maxillary central incisor teeth were examined clinically and photographically by one examiner using the Thylstrup-Fejerskov index; the photographs were read blind to child identity and clinical score. A closed-response questionnaire enquired into the child’s early experiences of toothbrushing and use of fluoride toothpastes. Social deprivation was measured by a Jarman score. The study took place in 1998. Outcome measure Prevalence of dental fluorosis measured by the Thylstrup‐Fejerskov index. Results Complete data were available for 78% (n = 409) and 79% (n = 403) of eligible sampled children in the two areas, respectively. Clinical and photographic results agreed closely and had high reproducibility. The prevalence of fluorosis was 54% in the fluoridated area and 23% in the fluoride-deficient area when all grades (> 0) of fluorosis were included; percentage prevalence of mild to moderate fluorosis (≥ 3) was 3% and 0.5% in the two areas, respectively. Multivariate analysis indicated that area of residence (odds ratio = 4.5), Jarman score (odds ratio = 0.99 per Jarman unit) and type of toothpaste (odds ratio = 1.6) were statistically significantly related to presence or absence of fluorosis: the risk factors were — fluoridated area, affluence, and use of adult toothpaste. Conclusions and recommendations The prevalence of aesthetically important dental fluorosis was low, although higher

A 2-year longitudinal nutritional survey of 405 Northumberland children initially aged 11.5 years.

Children (405), initially of average age 11.5 years, recorded all food and drinks consumed for three consecutive days (with an interview on the fourth day) on five separate occasions over a 2-year period. Food tables (Paul & Southgate, 1978) enabled nutrient intakes to be calculated. The data collected were found to be of high reliability (Hackett et al. 1983). The mean energy intakes showed broad agreement with other recent British dietary surveys but were well below those recorded in the prewar study by Widdowson (1947) and the FAO/WHO (1973) recommended levels. They were slightly below the current Department of Health and Social Security (DHSS; 1979) recommended intakes. Over the 2-year period, the energy intake of the boys increased by 13% compared with an increase of only 7% in the girls. The iron and vitamin A intakes of all groups of children were low compared with current recommendations (DHSS, 1979). This seems to be a result of falling energy intake. Mean calcium intakes were also only marginally in excess of the recommended intake, and those of most of the girls would fall below the recommendation if the proposal to end the fortification of flour (DHSS, 1981) is implemented.

COMPARISON OF EROSION OF DENTAL ENAMEL BY FOUR DRINKS USING AN INTRA-ORAL APPLICANCE

There are several causes of erosion – acidic foods and drinks have been implicated and reducing their erosive potential would seem an important area of research. Calcium-citrate-malate (CCM) appeared to have potentially useful properties as an anti-erosion additive. The study aims were to test the ability of an intra-oral enamel slab system to measure erosion and to compare the erosive potential of a citric acid-based orange juice drink either with or without added CCM and a positive and negative control. Eleven adults wore an upper removable appliance for four periods each of 6 days. Each appliance held two enamel slabs which were inserted into the test drinks for 15 min 4 times a day for 6 days. Loss of enamel was quantified by profiling casts of the enamel slabs taken before and after the test period. Loss of enamal was greatest during exposure to a diet phosphoric acid-based cola drink (p < 0.001) but was similar during exposure to the two citric acid-based orange drinks, with or without CCM, and distilled water. The loss of surface enamel measured from a scanning electron micrograph agreed well with the measurement obtained by profilometry. It can be concluded that (a) the intra-oral enamel slab system was able to discriminate between drinks in their erosive potential, and (b) it was not possible to determine if CCM had any potential for reduction in erosion in an acid beverage as the level of erosion observed for both the critic acid-based orange drinks was not statistically significantly different from that observed with distilled water.