Göran Dahllöf

Stepwise Prediction of Dental Caries in Children up to 3.5 Years of Age

The present study is a part of a prospective, longitudinal investigation of caries development in children (n = 692) living in the southern suburbs of Stockholm. The aim was to evaluate, longitudinally, the caries-predictive ability of variables describing social and immigrant background, dietary habits, microbial and oral hygiene factors, and fluoride exposure in children at 1 and 2.5 years of age with respect to caries development before the age of 3.5. The predictors for caries development in children before 2.5 years of age were mutans streptococci (p < 0.01), immigrant background (p < 0.01), and consumption of candy (p < 0.01). The predictors for developing manifest caries between 2.5 and 3.5 years of age were mutans streptococci (p < 0.001), mothers education (p < 0.001), immigrant background (p < 0.01), and consumption of candy (p < 0.05) and sugar-containing beverages (p < 0.05). The caries incidence at 2.5 years of age as well as the caries increment between 2.5 and 3.5 years of age were significantly higher in children with immigrant background compared to non-immigrants. This study indicates that the possibility of identifying children at risk for caries development increases longitudinally from 1 to 3.5 years of age and there was a synergistic effect between age and each predictor.

Caries Development in Children from 2.5 to 3.5 Years of Age: A Longitudinal Study

The development of dental caries from the age of 2.5 to 3.5 years was studied longitudinally in 692 children living in the southern suburbs of Stockholm. The parents answered a structured questionnaire concerning the familys social and immigrant background as well as the dietary habits, oral hygiene and fluoride exposure of their children. Furthermore, the occurrence of mutans streptococci and lactobacilli was determined in samples taken from the tongue of the children, and the buffer capacity of the saliva was measured. At baseline examination, 11.3% of the children exhibited dental caries. At follow-up, 1 year later, decayed and/or filled surfaces were registered in 36.7% of the subjects. The majority of the new lesions were located on the occlusal surfaces of the second molar. Ninety-two percent of the children with caries at baseline developed new carious lesions during the 1-year period, compared to 29% of the children who were caries-free at baseline (p < 0.001). Of the lesions diagnosed at baseline as initial caries, 64% progressed to manifest lesions during the 1-year period. The study indicates that children with early caries development exhibit high caries progression as well as a high risk for further development of an extensive number of new carious lesions.

Prediction of Dental Caries Development in 1-Year-Old Children

Dietary habits, oral hygiene, fluoride exposure and occurrence of mutans streptococci were studied in 1-year-old children (n = 786) as well as the socio-economic and immigrant background of their parents. The purpose was to evaluate the predictive ability of variables studied in 1-year-old children that could be used to identify children at risk for early caries development. In a multivariate logistic regression analysis, the variables significantly associated with caries at 3.5 years of age were immigrant background (p < 0.001), mothers education (p < 0.001), consumption of sugar-containing beverages (p < 0.001), mutans streptococci (p < 0.05) and candy (p < 0.05). The probability of caries development was 87% when all the variables associated with caries were present at 1 year of age. The relative risk (odds ratio) of those children to develop manifest caries at 3.5 years of age was estimated to be 32 times higher than in the children where corresponding risk factors were not present. The results indicate that prediction at 1 year of age, built on risk factors associated with dental caries, can provide an indication of possible preventive interventions.

The oral cavity as a port of entry for early infections in patients treated with bone marrow transplantation

Before treatment of 181 patients with bone marrow transplantation (BMT) for leukemia, severe aplastic anemia, or metabolic disorders, the oral condition was examined clinically and roentgenologically. Fifty-three patients (29%) had chronic dental infections (osteitis) that needed treatment before BMT. In 10 of 181 cases (6%), BMT was postponed because of oral infections. Septicemia during the neutropenic phase was caused by oral microorganisms (alpha streptococci) in 24 of 59 (41%) patients with microbiologically proven septicemia. Septicemia with alpha streptococci was associated with graft-versus-host disease prophylaxis with methotrexate and subsequent increased frequency of oral ulcerations. No difference was observed in the frequency of reactivation of latent herpes simplex virus infection between different graft-versus-host disease prophylaxis regimens. Reactivation was more frequent in patients conditioned with total body irradiation than in patients conditioned without total body irradiation. Antiviral prophylaxis, with subsequent decreased frequency of oral herpes simplex reactivation, appeared to contribute to a low frequency of septicemia with alpha streptococci.

Disturbances in dental development after total body irradiation in bone marrow transplant recipients

The dental status of 16 children who had been treated with bone marrow transplantation (BMT) for serious bone marrow diseases was followed for up to 6 years. Several types of disturbances in dental development were observed in children who had been conditioned with total body irradiation (TBI) at 10 Gy before BMT. Thus, impaired root development that caused short V-shaped roots was found in all patients, a complete failure of root development and premature apical closure were found in five patients, enamel hypoplasia was observed in four patients, and microdontia was observed in three patients conditioned with TBI. Patients younger than 6 years of age at BMT exhibited the most severe and extensive dental aberrations. The TBI at 10 Gy appeared to be the major cause of the disturbances found.

Caries prevalence in 2.5-year-old children.

The prevalence of caries and gingivitis was determined clinically in 2.5-year-old children (n = 832) living in the southern suburbs of Stockholm. The occurrence of mutants streptococci and lactobacilli was determined in samples taken from the tongue and the buffer capacity of the saliva was measured. The parents answered a structured questionnaire concerning their childrens dietary habits, oral hygiene, fluoride exposure and their social and ethnic background. Initial or manifest caries was diagnosed in 11.7 and 6.4% of the subjects, respectively. Seventy-two percent of the total number of caries lesions were localized to the maxillary incisors. Caries prevalence in children with an immigrant background was significantly higher (p < 0.001) than in children without. In the multivariate analysis, the variables significantly associated with caries were: colonization with mutans streptococci (p < 0.001), lactobacilli (p < 0.01) and children with immigrant background (p < 0.01). The study demonstrates an association between early colonization of cariogenic microflora and an increased risk of developing dental caries in very young children.

Correlation between TNFa in gingival crevicular fluid and body mass index in obese subjects

The aim of this study was to investigate the relationship between body mass index (BMI kg/m[Formula: See Text]), the inflammatory mediator tumor necrosis factor α (TNFα), and interleukin-8 (IL-8) in gingival crevicular fluid (GCF) from 32 obese subjects aged between 13 and 24 years. Gingival inflammation (GBI %), pathological pocket depths, and alveolar bone loss diagnosed on radiographs were recorded. The GCF was collected from six sites per subject using periopaper, and the volume was determined using Peritron 8000. The levels of TNFα and IL-8 were determined using ELISA kits. Within the whole group, there was no significant relationship between BMI and the variables age, GBI %, number of periodontal pockets, smoking, and the levels of TNFα or IL-8. In subjects with BMI ≥40, however, there was a statistically significant correlation (r=0.74, P<0.01) between the level of TNFα in GCF and BMI. The correlation coefficient between BMI and TNFα in subjects with BMI ≥40 differed significantly (P<0.05) compared to that between subjects with BMI <40. The level of TNFα in GCF was positively correlated (P<0.05) with BMI in subjects with no periodontal pathological pocket. No significant correlation was found between the level of IL-8 and BMI. The results indicate that BMI positively correlates with TNFα in GCF in the group of young subjects with BMI ≥40 as well as in the subjects with no pathological periodontal pocket (≥4 mm) and that TNFα in GCF may be affected by the obese condition through a systemic effect.

A four-year longitudinal study of palatal plate therapy in children with Down syndrome: effects on oral motor function, articulation and communication preferences.

The orofacial function in 20 children with Down syndrome was evaluated after 4 years of palatal plate therapy in 9 of the children (PPG); the remaining 11 were untreated age-matched controls (CG). All 20 children had received continuous orofacial physical therapy from their speech therapist during the treatment period. A clinical extra- and intraoral examination was performed, including oral motor function, facial expression, the occurrence of malocclusions, and hypertrophic tonsils. A questionnaire requesting data on breathing patterns, drooling, eating problems, and communicative preferences was answered by the parents. An articulation assessment was performed by two speech and language pathologists blinded to the treatment status of the children in order to find out whether the palatal plate had stimulated to improved oral speech behavior. The results for oral motor function showed significant differences between the groups in favor of the PPG for the summary variables for: visible tongue (P < 0.01), visible tongue during non-speech periods (P < 0.05), and lip-rounding during spontaneous speech (P < 0.01). During non-speech time, the PPG had their mouths open significantly less than the CG (P < 0.05). Expressivity of facial expression on a visual analog scale in the PPG scored 75.6 ± 13.3 compared to 51.8 ± 25.7 in the CG (P < 0.05). The intraoral examination showed that 6/9 children in the PPG and 7/11 in the CG had enlarged tonsils, resulting in more than 50% inter-tonsillary space reduction. Despite these findings, and no significant differences between the groups with respect to mouth/nose breathing, nocturnal snoring was significantly less in the PPG than in the CG (P < 0.05), according to the parental questionnaire. After 4 years of palatal plate therapy, orofacial function had improved significantly in the 9 PPG children and specifically in terms of tongue position and lip activity.

A comparative immunological analysis of the oral mucosa in chronic graft-versus-host disease and oral lichen planus

Oral mucosal biopsies of 12 allogeneic marrow transplant recipients with chronic graft-versus-host disease (GVHD) involving the mouth were compared with biopsies taken before transplantation. They were also compared with biopsies from otherwise healthy patients with oral lichen planus, and with those from a control group of normal individuals. Biopsies from chronic GVHD exhibited a low number of infiltrating T lymphocytes (CD3 cells) compared with those from oral lichen planus, which showed intense cell infiltration (p less than 0.005). The ratio of CD4 to CD8 cells in biopsies taken after the manifestation of chronic GVHD exhibited no consistent variation compared with those taken before transplantation or with biopsies of oral lichen planus. The CD4/CD8 ratio in all groups investigated varied between 4:1 and 6:1. The number of natural killer cells (CD57), was increased in biopsy specimens taken before transplantation compared with the other groups. The frequency of homing receptor, Leu-8 bearing T cells was low in the biopsy specimens of all groups, compared with the corresponding frequency in peripheral blood (10-45 and 60-90%, respectively; p less than 0.001). In the biopsies from chronic GVHD and oral lichen planus the number of lymphocytes with transferrin receptors was increased compared with the pretransplant and control groups. Virtually no infiltrating cells were carrying interleukin-2 receptors (CD25) in any of the groups studied. Langerhans cells (CD1) were more frequently found in the specimens from chronic GVHD and oral lichen planus than in the pretransplant specimens and the control group (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of the phenytoin metabolite p-HPPH on proliferation of gingival fibro-blasts in vitro

The effect of the major phenytoin metabolite-5-(parahydroxyphenyl)-5-phenylhydantoin (p-HPPH) was studied on cultures on human fibroblast-like cells grown out from explanted gingival biopsies. The explants were taken from children undergoing phenytoin medication. The results showed that the number of cells per culture decreased whereas the protein and DNA-contents remained relatively unaffected. This effect was most pronounced at the concentrations of 0.20 micrograms/ml p-HPPH. The results indicate that the metabolite interfere with cell division without affecting protein or DNA synthesis.