Eleni Mamai-Homata

Effect of fluoride and of calcium sodium phosphosilicate toothpastes on pre-softened dentin demineralization and remineralization in vitro.

OBJECTIVES The purpose of this in vitro study was to evaluate the effect of toothpastes containing sodium fluoride in different concentrations or a calcium sodium phosphosilicate system on pre-softened dentin demineralization and remineralization. METHODS During a ten day pH-cycling protocol, pre-softened bovine root dentin slabs were immersed twice daily, after the demineralization periods, for 2min, in the following toothpaste slurries: (a) non-fluoridated (control), (b) 7.5% calcium sodium phosphosilicate, (c) 1450 ppm F, (d) 2800 ppm F and (e) 5000 ppm F. Subsequently, the specimens were subjected to a 15-h acid resistance test. Surface microhardness was assessed initially and during the pH-cycling and the acid resistance test period. Repeated measurements in each group were analyzed through appropriate regression models for longitudinal data. RESULTS All fluoride groups, during pH cycling, showed significantly less microhardness loss (p < or = 0.010, p < or = 0.002, p < or = 0.002) and subsequently exhibited increased acid resistance (p < or = 0.010, p < or = 0.001, p < or = 0.001) compared to the control. The 5000 ppm and 2800 ppm F toothpastes, inhibited demineralization significantly more effectively than the 1450 ppm F (p < or = 0.001, p < or = 0.030) and the calcium sodium phosphosilicate toothpaste (p < or = 0.001), while no significant differences were found between the two high fluoride groups (p=0.130). The calcium sodium phosphosilicate toothpaste, during pH cycling showed a difference that approached statistical significance compared to control (p=0.079), but its acid resistance behavior was similar to control (p=0.610). CONCLUSIONS Under these experimental conditions, the high fluoride toothpastes promoted remineralization and inhibited demineralization more effectively, than the 1450 ppm F, the non-fluoridated (control) and the calcium sodium phosphosilicate toothpastes.

Socio-behavioural factors influencing oral health of 12 and 15 year old Greek adolescents. A national pathfinder survey

AIM: To estimate the frequency in use of oral health services, oral health self-assessment, oral hygiene practices of 12- and 15-year-old Greek children and adolescents, to investigate possible influences of these factors and other socio-demographic parameters on oral health. METHODS: A stratified cluster sample of 1,224 12-year-old and 1,257 15-year-old children and adolescents of Greek nationality were selected and examined by calibrated examiners. Clinical examination included recording of caries according to the BASCD diagnostic criteria, while oral hygiene and periodontal status were assessed by means of the simplified debris and the community periodontal index. Subjects were interviewed to answer questions on socio-behavioural risk factors through a structured questionnaire. The student’s t-test and ANOVA were used for statistical evaluation of the means and the chi-square test was applied for statistical comparison of the proportions. Multiple linear regression analysis was performed to assess the statistical association between variables. RESULTS: Caries experience and untreated caries were significantly higher among children and adolescents who visited the dentist only when in pain or for restoring a tooth, compared with those visiting for check-ups or prevention and having more frequent application of topical fluorides. Tooth brushing, at least twice a day, and flossing were significantly associated with periodontal and oral hygiene status, but not with caries presence. Multivariate analysis revealed that parental educational status and reason for visiting a dentist were strong determinants for caries experience and oral hygiene status but not for periodontal health of children and adolescents. CONCLUSIONS: This study has identified several socio-demographic and behavioural determinants for dental caries, oral hygiene and periodontal health of Greek children and adolescents.

Risk indicators of coronal and root caries in Greek middle aged adults and senior citizens

BackgroundDental caries is the result of a complex interplay of multiple determinants which may change overtime. Therefore, periodic surveys of caries experience and redetermination of the risk indicators of the disease are needed. The aim of this study was to assess the prevalence and severity of coronal and root caries in Greeks aged 35-44 and 65-74-year-old in relation to socio-demographic parameters. Furthermore, trends in coronal caries experience of the 35-44-year-olds were investigated.MethodsA sample of 1188 35-44-year-old and 1093 65-74-year-old individuals was selected in 2005 according to WHO guidelines for national pathfinder surveys. Caries was assessed in dentate subjects using the DMFT, DMFS, RDFS and RCI indices. Socio-demographic data were also collected. Univariate and multivariate regression analyses were performed to identify the effect of socio-demographic parameters.ResultsThe mean DMFT and DMFS scores of the adults were 14.06 and 45.78 respectively, while those of the senior citizens were 20.63 and 89.82. Among the 35-44-year-ods, men and those having a higher educational attainment had significantly lower DMFS values (women OR = 1.679, CI: 1.243-2.267 and >12 years of education OR = 0.321, CI: 0.193-0.535 respectively), while educational level was the only predictor of DMFS in senior citizens (OR = 0.279, CI: 0.079-0.992). The mean DMFT score of the 35-44-year-olds has not improved since 1985, but there was a remarkable reduction in the number of DT related to a simultaneous increase in the number of FT. The mean RDFS rose from 0.39 in adults to 2.66 in senior citizens. The mean RDFS score of the middle aged adults was significantly correlated with education (OR = 0.346, CI: 0.180-0.664). The RCI was almost four times greater in seniors (9.73) than in adults (2.53). There were significant differences in caries experience between the surveyed regions. MS and RDS were the major components of the DMFS and RDFS indices respectively, in both age groups.ConclusionsCaries experience in Greek adults is similar to what is observed in most industrialized countries. The mean DMFT score of the 35-44-year-olds has not improved since 1985, but a great improvement in restorative care has been observed. Senior citizens had a high percentage of untreated coronal and root surfaces. Region and education were the strongest predictors of caries experience. An increase in oral care utilization and effective prevention over the whole lifespan are needed to improve the dental health of the Greek adult population.

Oral hygiene and periodontal status of 12 and 15-year-old Greek adolescents. a national pathfinder survey

AIM: To investigate oral hygiene and periodontal status of 12- and 15-year old Greek adolescents, in relation to sociodemographic and behavioural parameters. METHODS: A stratified cluster sample of 1,224 12-year old and 1,257 15-year old adolescents of Greek nationality were selected and examined by calibrated examiners. Periodontal and oral hygiene status were assessed using the Community Periodontal Index (CPI) and the simplified Debris Index (DI-s) respectively. The socio-demographic and behavioural data collected included region, location, gender, parental educational level, tooth brushing frequency and reason for dental attendance. RESULTS: The majority of adolescents aged 12 (75.0%) and 15-years (61.4%) had fair oral hygiene levels. The most frequently observed condition in both ages was calculus with or without bleeding (42.8% in the younger and 53.3% in the older age group). Bleeding on probing was found in 41.5% of the 12-year-olds and in 30.0% of the 15-year-olds. The occurrence of shallow and/ or deep periodontal pockets was very low (0.2%). Multivariable modelling revealed that gender, location and tooth brushing frequency were strongly associated with oral hygiene status in both ages; girls, those living in urban areas and brushing teeth more frequently had significantly lower DI-s. Tooth brushing frequency was also associated with periodontal status in both ages, while living in urban areas was associated with better periodontal health only in the 15-year-olds. CONCLUSIONS: The study demonstrated that oral hygiene conditions among Greek children and adolescents are not satisfactory and that the occurrence of gingivitis is high. More efforts on oral health education and oral hygiene instruction are needed to improve their periodontal and oral hygiene status.

Prevalence of sealants in relation to dental caries on the permanent molars of 12 and 15-year-old Greek adolescents. A national pathfinder survey

BackgroundThe use of sealants as an effective measure for the prevention of pit and fissure caries in children has been well documented by several studies; either they are used on an individual or on a public health basis. In order to plan and establish a national preventive program with sealants in a community, it is mandatory to know the epidemiological pattern of caries along with other variables influencing their use and effectiveness. Aims: To assess the utilization and distribution pattern of pit and fissure sealants on the first and second permanent molars of Greek adolescents and to evaluate whether the existing usage of sealants and some socio-demographic factors are correlated to caries prevalence on the population examinedMethodsA stratified cluster sample of 2481 Greek adolescents was selected according to WHO guidelines (1224 twelve and 1,257 fifteen-year-old), living in urban and rural areas in 11 districts within the country. Five calibrated examiners carried out clinical examinations, recording caries experience at the dentine threshold (BASCD criteria) and presence or absence of sealants along with Socio-demographic indicators associated with oral health. Mann Whitney and Pearsons chi-square non parametric tests were utilized for assessing the data. The level of significance was p < 0.05.ResultsSealants utilization varied considerably within the different districts, with 8,3% of the 12 and 8,0% of the 15-year-old adolescents having at least one sealed molar. Sealants reduced DMFS scores by 11% in the 12-year-olds and by 24% in the 15-year-olds, while 15-year-old adolescents from rural areas had a statistically significant (p = 0.002) less chance of having sealants (71%) compared to children from urban areas. Girls had higher chance to receive sealants in both age groups (26% for the 12 and 19% for the 15-year-old) as well as patients that visited the dentist for prevention compared to those visiting the dentist because they thought they needed a restoration or because they were in pain.ConclusionsThe finding that sealants reduced DMFS scores despite their very low utilization, along with the high prevalence of dental caries found on the occlusal surfaces of the posterior teeth of Greek adolescents, is calling for a national preventive program with sealants which could eliminate caries to a larger extent.

Prevalence of dental caries in 5‐year‐old Greek children and the use of dental services: evaluation of socioeconomic, behavioural factors and living conditions

OBJECTIVES To assess dental caries and use of dental services experience in 5-year-old children attending public kindergartens in Attica, Greece and to examine the influence of certain socioeconomic factors and living conditions as well as dental behaviours and attitudes. METHODS In this cross-sectional study, a random and stratified sample of 605 Greek children was examined using decayed, missing, filled tooth surfaces and simplified debris indices. The use of dental services was measured by childrens dental visits (any dental visit up to the age of 5 years). Care Index was also calculated. Risk indicators were assessed by a questionnaire. Zero-inflated Poisson and Logistic Regression Analysis were generated to test statistical significant associations. RESULTS The prevalence of dental caries was 16.5%. Care Index was 32% and dental visits were reported for the 84% of the children. Medium Socio-Economic Level (SEL) was associated with no detectable caries. High SEL was related to decreased decayed, missing, filled teeth values, while female gender and rented houses had the opposite effect. The age of the mother (35-39 years) and the higher SEL were related to higher levels of dental services use. CONCLUSIONS It is suggested that there are differences in the experience of dental caries and use of dental services among preschool children in Attica, which are related to demographic, socioeconomic factors and living conditions. Dental public polices should focus on groups with specific characteristics in order to improve oral health levels of disease-susceptible populations.

Dental caries prevalence and treatment needs of 5- to 12-year-old children in relation to area-based income and immigrant background in Greece.

OBJECTIVES   To investigate the association between certain socio-demographic characteristics and dental health status of 5- to 12-year-old children attending public kindergarten and primary schools in Piraeus, Greece. METHODS   Gender, age, place of residence, immigrant background and area-based income were associated with dental caries prevalence, treatment needs and oral hygiene level in 5,116 children. RESULTS   The mean number of decayed, missing and filled deciduous teeth (dmft) and Unmet Restorative Treatment Needs Index (UTN) at 6-year-olds were 1.54 and 84.6% respectively, and the DMFT and UTN at 12-year-olds were 1.35 and 71.8%. Caries experience/severity significantly increased with age, whereas treatment needs and oral hygiene level decreased (P<0.001). Immigrant background and low area-based income was associated with poorer oral health outcomes. The above associations retained statistical significance after multivariate analysis. Children who live in areas with lower average income present 1.20 to 2.14 greater risk of having higher caries severity and poorer oral hygiene in comparison to those living in more affluent areas, and children with an immigrant background have 1.68 to 4.34 higher likelihood to present higher dmft and DMFT values, higher unmet treatment needs, and poorer oral hygiene levels compared to their Greek counterparts above and beyond the effect of the other risk factors assessed. CONCLUSIONS   The present study revealed a socio-demographic gradient in oral health status and treatment needs of children in Piraeus, Greece.

Novel methods of balancing covariates for the assessment of dental erosion: A contribution to validation of a synthetic scoring system for erosive wear

OBJECTIVES The purpose of the study was to balance several potential erosive covariates, using traditional and novel epidemiological approaches, in order to assess the relative risks of dental erosion more precisely. METHODS Traditional (univariate and logistic regression analysis) and novel techniques (propensity scores and Inverse Probability Weighting-IPW) were applied for evaluating the effect of twenty covariates on dental erosion among 502 adolescents. RESULTS Different approaches gave different estimates of the relative risks of dental erosion. The increased consumption of carbonated soft drinks had the major erosive effect, when traditional analyses were used (unadjusted: OR=3.475 and CI: 1.499-8.052, logistic regression: OR=3.219 and CI: 1.373-7.547). On the other hand, IPW method indicated that the consumption of erosion drinks immediately after intense physical exercise had the highest odds ratio (OR=1.363 and CI: 0.963-1.929), followed by the increased consumption of citrus fruit juice (OR=1.326 and CI: 1.004-1.752). This method also demonstrated a marked improvement in balance, with the 95% CIs for each OR being considerably narrower than those reported in the initial analysis. CONCLUSIONS Standardization of the potential aetiological criteria of erosive wear is a considerably difficult process. Nevertheless, novel methods revealed that the increased consumption of carbonated soft drinks and citrus fruit juices could be included as aetiologic factors in a synthetic scoring system for erosion. Parameters which are related to salivary protective mechanisms (e.g. consumption of erosion drinks immediately after intense physical exercise) could also be a part of such an index. Further research is required in order to achieve the maximum validation of the potential erosive risk factors.

Gender differences in oral health status and behavior of Greek dental students: A meta-analysis of 1981, 2000, and 2010 data

Background: The aim of this study was to investigate the oral health status and behavior of Greek dental students over time, and to meta-analyze these findings to test the widely documented hypothesis that women have better oral health behavior, oral hygiene, and periodontal status but higher dental caries rates than men. Materials and Methods: A total sample of 385 students was examined using identical indices to assess oral health and behavioral data initially in 1981 while the years 2000 and 2010 were selected due to significant changes that took place in the dental curriculum in the 1990s and 2000s. Data by gender concerning the outcome variables recorded in every one of the three surveys were analyzed using Mantel—Haenszel and continuous outcomes methods. Results: A significant improvement in the oral health status and behavior of students was observed over time. The meta-analysis of data by gender showed that females brushed their teeth significantly more often than males [summary odds ratio (OR): 1.95 and 95% confidence interval (CI): 1.08—3.54]. Males and females were found to have a similar risk of developing dental caries. Conclusion: The hypothesis that young women have better oral hygiene habits compared to men was confirmed. However, the hypothesis that women have better oral hygiene and periodontal status but exhibit higher dental caries experience than men was not supported by the findings of the study.

Periodontal Diseases in Greek Senior Citizens-Risk Indicators

Periodontal diseases are among the most common chronic diseases affecting people of all ages worldwide. However, their severe forms are more pronounced in older individuals primarily due to prolonged exposure to risk factors. One of the major risk factors of periodontal diseases is considered to be poor oral hygiene since the accumulation of dental plaque biofilms on clean tooth surfaces results in the development of an inflammatory process encompassing local gingival and periodontal tissues around teeth (Albandar, 2002). If the microbial film is not removed the local inflammation will persist and chronic gingivitis will be developed. Hence, dental plaque is considered today the primary etiologic factor of chronic gingivitis, while chronic periodontitis is now seen as resulting from a complex interplay of bacterial infection and host response, often modified by local factors within the mouth, systemic factors related to the host, and external (environmental) factors (Albandar, 2002). For example, current preventive oral health practices, such as frequent tooth brushing and flossing as well as regular dental attendance, were found to be significantly associated with lower plaque, gingivitis and calculus scores (Lang et al., 1995). In addition, through these associations, the aforementioned preventive behaviors appeared to be indirectly related to shallower pocket depths and less attachment loss (Lang et al., 1995). Furthermore, sociodemographic variables like area of residence, gender, education and income are considered as risk indicators for periodontal diseases (Albandar, 2002; Locker & Leake 1992; MamaiHomata et al., 2010) Some of these, as well as other variables that have been associated with periodontal status may change overtime and therefore the prevalence and severity of periodontal diseases in a population may also change. Therefore, periodic surveys of the periodontal health status of the population and redetermination of the variables that may affect the initiation and/or progression of periodontal diseases are needed. In Greece, a national oral health pathfinder survey was organized in 1985 by the dental department of the Ministry of Health, Welfare and Social Security in cooperation with the Regional Office for Europe of the World Health Organization. The purpose of that survey was to evaluate the oral health status and treatment needs of the population aged 7, 12 and 35-44 years-old and formulate measures for the prevention of dental caries and the elimination of periodontal diseases.