Jussi Furuholm

Gastric Reflux is a Significant Causative Factor of Tooth Erosion

Dental erosion is caused by dietary or gastric acid. This study aimed to examine the location and severity of tooth erosion with respect to causative factors, and to determine whether the clinical pattern of erosion reflected the dominant etiological factor. The study involved 249 Icelandic individuals and included: a detailed medical history; clinical oral examination; salivary sampling, and analysis for flow rate, pH, and buffering capacity. Reflux was assessed in 91 individuals by gastroscopy, esophageal manometry, and 24-hour esophageal-pH monitoring. Reflux symptoms were reported by 36.5% individuals. Manometry results were abnormal in 8% of study participants, abnormal esophageal pH in 17.7%, and a pathological 24-hour pH recording in 21.3%. 3.6% were positive for Helicobacter pylori. Normal salivary flow was found in 92%, but low salivary buffering (10.4%) was associated with erosion into dentin (P < 0.05). Significant associations were found between erosion and diagnosed reflux disease (OR 2.772; P < 0.005) and daily consumption of acidic drinks (OR 2.232; P < 0.005).

Postpartum oral health parameters in women with preterm birth

Objective. It has been suggested that poor oral health and periodontal disease, in particular, associate with adverse birth outcomes. However, previous reports on the topic are conflicting. The objective of the present cross-sectional study was therefore to compare the oral health parameters of a racially and socio-economically homogeneous group of women who gave birth before 259 gestational days (37 weeks) with those of women who went full-term. Material and Methods. We studied various dental parameters, including prevalence of dental caries, gingival bleeding on probing, the probing periodontal pocket depths, and the carriage of periodontal pathogens in 328 all-Caucasian women with singleton births. Seventy-seven of the women had preterm births, while 251 had full-term. Dental data were recorded within 2 days postpartum and analyzed with data from medical history, prenatal care, and delivery records. Results. Preterm mothers had more dental caries (93.5%) than full-term mothers (85.3%) when assessed as carious teeth in the mouth (p=0.06). In clinical and microbiological periodontal health parameters, however, no differences could be seen between the preterm and full-term mothers. Primiparity, low weight-gain, and antimicrobial drug use during pregnancy were the significant predictors for preterm birth. Conclusions. Although we cannot make any causal linkage, the oral health parameters were no different in women who experienced preterm births compared with those who had full-term births in this cohort. Only established systemic risk factors explained the preterm birth.

Periodontal disease-associated micro-organisms in peri-menopausal and post-menopausal women using or not using hormone replacement therapy. A two-year follow-up study

BackgroundDespite conflicting results on the use of hormone replacement therapy (HRT) there is no doubt that many women benefit from it. Women using HRT are known to be more health conscious in general with putative positive implications in the mouth. However, we observed recently in our cohort hardly any difference in oral health status between HRT-users and non-users. There are only a few studies about HRT and oral microbiota. We hypothesized that counts of periodontal micro-organisms are lower in health-conscious HRT-users than non-users.MethodsTwo-year open follow-up study was conducted on originally 200 HRT-users and 200 non-users from age cohorts of 50-58 years. After clinical examination pooled subgingival plaque samples were taken for polymerase chain reaction analyses. The results of finally 135 women meeting the inclusion criteria were analyzed with cross-tabulation and chi-square test. Explanatory factors were studied by step-wise logistic regression analysis.ResultsIn HRT group, the numbers of positive samples for Porphyromonas gingivalis (P. gingivalis, p < 0.07), Prevotella intermedia (P. intermedia, p < 0.05)and Tannerella forsythia (T. forsythia, p < 0.01) decreased in women with ≥ 4-mm-deep pockets. Respectively in HRT users with ≥ 6-mm-deep pockets the numbers of positive samples for P. gingivalis (p < 0.05) and T. forsythia (p < 0.01) were decreased. No corresponding differences were observed in the non-HRT group. In logistic regression, the existence of deep periodontal pockets explained the majority of cases harboring specific micro-organisms in both groups.ConclusionAlthough use of HRT did not correlate with periodontal health status, HRT led to decreasing numbers of positive samples of the periodontal pathogens P. gingivalis and T. forsythia. Further studies with longer observation time are needed to observe the clinical relevance of the results.

Oral health care patterns and the history of miscarriage.

OBJECTIVE Oral infections can trigger the production of pro-inflammatory mediators that may be risk factors for miscarriage. We investigated whether oral health care patterns that may promote or alleviate oral inflammation were associated with the history of miscarriage in 328 all-Caucasian women. MATERIALS AND METHODS Of 328 women in this cross-sectional cohort, 74 had history of miscarriage (HMC). Medical, dental and sociodemographic data were collected through clinical examinations, medical record searches and structured questionnaires. RESULTS The multivariate regression analyses indicated that urgency-based dental treatment demonstrated a significant association [odds ratio (OR) = 2.54; 95% confidence interval (CI): 1.21-5.37; P = 0.01] and preventive dental treatment demonstrated a marginally significant inverse association (OR = 0.53; CI: 0.26-1.06; P = 0.07) with HMC. Self-rated poor oral health had a non-significant positive association with HMC (OR 1.60; CI: 0.88-2.90). CONCLUSION Our results provide sufficient evidence for hypothesis generation to test whether other precise measures of oral inflammation are associated with adverse birth outcomes.

Oral Health and Mortality in Patients With Chronic Kidney Disease.

BACKGROUND Factors related to mortality of patients with chronic kidney disease (CKD) were investigated to find out whether oral disease inflammatory burden or different etiology (diabetes nephropathy vs. other etiologies) of CKD could be associated with mortality. METHODS This prospective cohort study comprised 144 adults at the predialysis stage. Clinical oral and radiologic examination was made from 2000 to 2005. Patients were followed up until August 2015 (complete follow-up time: 157 months). Cause of death could be verified from 62 of 65 patients. Clinical health data were combined with mortality records obtained from the Finland national statistics database. Number of teeth, total dental index (TDI), and periodontal inflammatory burden index were calculated to describe degree of oral inflammation. RESULTS Primary causes of death were cardiovascular diseases, infection, and cancer. There was a statistically significant difference in survival between diabetic nephropathy (23.8%) and other patients with CKD (59.9%; log-rank test P <0.001). A Cox regression model showed fewer teeth, higher age, and diabetes mellitus were statistically significant independent risk factors for death. Deceased patients had fewer teeth (P <0.001) and higher TDI (P <0.05). CONCLUSIONS Risk of death was higher among patients with diabetic nephropathy. The deceased had fewer teeth and more oral infections. However, indices used failed to show independent association with survival.

Periodontal Inflammatory Burden and Salivary Matrix Metalloproteinase-8 Concentration Among Patients With Chronic Kidney Disease at the Predialysis Stage

BACKGROUND The aim of the present study is to compare periodontal inflammatory burden related to the salivary matrix metalloproteinase (MMP)-8 concentration among patients with chronic kidney disease (CKD) at the predialysis stage. METHODS Salivary samples from 118 predialysis patients were assayed for MMP-8 by immunofluorometric assay. Of the patients, 43 (36%) had diabetic nephropathy, whereas 75 (64%) had other kidney disease. Clinical and radiographic oral health examination was made at Helsinki University Hospital. Oral and general health data including laboratory findings were recorded from hospital records, and the periodontal inflammatory burden index (PIBI) and the total dental index (TDI) were calculated. Results were analyzed with cross tabulation, Pearson χ(2) test, and Mann-Whitney U test. RESULTS Results included elevated PIBI, increased TDI, and two or more sites with ≥ 6 mm or deeper periodontal pocket, associated with elevated salivary MMP-8 concentrations (P < 0.05 in all associations). The diabetic nephropathy group and patients with high hemoglobin A1c (HbA1c) values (≥ 6.5%, ≥ 48 mmol/mol) exerted slightly elevated median salivary MMP-8 values compared with the other CKD group or regarding patients with HbA1c values < 6.5%, but these differences were not statistically significant. CONCLUSIONS Elevated salivary MMP-8 associated significantly with more severe oral/periodontal inflammatory burden among patients with CKD at the predialysis stage. Thus, salivary MMP-8 analysis could give adjunctive information regarding oral health.

Salivary constituents and acidogenic microbial counts in coronary artery bypass graft patients from baseline to three-years after operation.

Data on saliva in coronary artery bypass graft (CABG) surgery patients are sparse. Understanding salivary parameters, however, may aid clinical decision making. We hypothesized that cardiac surgery might affect patients’ salivary flow rates and buffering, salivary proteins, and microbial counts. A 3-year, open follow-up study was conducted examining salivary flow, its chemical composition, and acidogenic microbial counts in 89 CABG surgery patients. The changes in salivary flow and proteins between baseline and 3-year post-CABG surgery were assessed using paired t-test and, with respect to the median of number of drugs used daily, by use of a nonparametric rank sum test. The results showed no long-term change in salivary flow rates and buffering capacity. With the exception of salivary urea, IgA and IgM concentration, and lysozyme output, the differences in salivary proteins between baseline and 3-year post-CABG were not statistically significant. No difference was observed in saliva values between patients taking drugs below or above the median number of drugs. Acidogenic microbial counts remained the same throughout the study. In conclusion, the salivary flow rates and constituents did not practically change in patients who underwent CABG surgery during the 3-year follow-up.

Survival of extensive restorations in primary molars: 15-year practice-based study

BACKGROUND Caries decline in the western world is accompanied by strong polarization among children; 8% of Finnish 5-year-olds having 76% of untreated caries. This high caries risk group needs preventive and restorative strategies. AIM To explore survival of extensive restorations in primary molars. DESIGN This study was based on health records from 2002 to 2016 of children under 18 years. RESULTS Of severely affected primary molars (n = 1061), 41% were restored with preformed metal crowns (PMCs), 38% with glass-ionomer cement (GIC)/polyacid-modified resin composite (PAMRC)/resin-modified GIC (RMGIC), and 21% with resin composites (RC). Younger children (3-8) received 97% of the PMCs and 86% of GIC/PAMRC/RMGIC; older ones (≥9) 91% of the RC restorations. Neither amalgam nor indirect restorations were registered. General dentists (GDs) engaged in primary care restored with GIC/PAMRC/RMGIC (52%) or RC (48%). GDs in general anesthesia care service placed 66% and specializing/specialized dentists 31% of PMCs. PMCs had lower failure rate (1.4% vs 3.0%) than GIC/PAMRC/RMGIC (P = 0.001). Choosing PMCs reduced patient visits compared to other restorations (P < 0.001). CONCLUSIONS Severely affected primary molars of children at high caries risk are better managed, using PMCs to optimize the resources in public oral health services.