Kaisu Pienihäkkinen

Occurrence of Dental Decay in Children after Maternal Consumption of Xylitol Chewing Gum, a Follow-up from 0 to 5 Years of Age

Studies have shown that prevention of mutans streptococci (MS) colonization in early childhood can lead to prevention of dental decay. In the microbiological part of the present study in Ylivieska, Finland, with 195 mothers with high salivary MS levels, regular maternal use of xylitol chewing gum resulted in a statistically significant reduction in MS colonization in their childrens teeth at the age of 2 years compared with teeth in children whose mothers received fluoride or chlorhexidine varnish treatment. The children did not chew gum or receive varnish treatments. For the present study, the children were examined annually for caries occurrence by experienced clinicians who did not know whether the children were colonized with MS. Regardless of the maternal prevention group, the presence of MS colonization in children at the age of 2 years was significantly related to each childs age at the first caries attack in the primary dentition. In children at the age of 5 years, the dentinal caries (dmf) in the xylitol group was reduced by about 70% as compared with that in the fluoride or chlorhexidine group. We conclude that maternal use of xylitol chewing gum can prevent dental caries in their children by prohibiting the transmission of MS from mother to child.

Influence of Maternal Xylitol Consumption on Mother–Child Transmission of Mutans Streptococci: 6–Year Follow–Up

Xylitol is effective as a noncariogenic or even cariostatic sugar substitute. Habitual xylitol consumption appears to select for mutans streptococci (MS) which shed easily into saliva from plaque. We have earlier shown that habitual xylitol consumption of mothers was associated with a statistically significant reduction in the probability of mother–child transmission of MS assessed at 2 years of age. The aim of the present study was to assess the children’s MS counts 1 and 4 years after the maternal xylitol consumption had been discontinued. At baseline, during pregnancy, all mothers (n = 195) showed high salivary levels of MS. The mothers were randomly assigned to xylitol, fluoride (F) and chlorhexidine (CHX) groups. In the xylitol group, the mothers chewed xylitol–sweetened gum, for 21 months, starting 3 months after delivery. In the two control groups, the mothers received CHX or F varnish treatments at 6, 12 and 18 months after delivery. At the 2–year examination, 169 mother–child pairs participated. At the 3–year and 6–year examinations, there were 159 and 147 children in the study, respectively. For children’s MS analyses, visible plaque was collected using toothpicks at the age of 3 and paraffin–stimulated saliva at the age of 6. The persons involved in the collection and analysis of the microbiological samples were blinded as to the study design and group. Both the plaque and salivary MS were cultured on Mitis salivarius agars containing bacitracin. In all groups, the colonization percentages increased during the follow–up. At the 3–year examination, the children’s risk of having MS colonization was 2.3–fold in the F group (95% CI 1.3–4.2) compared to the xylitol group. This difference was statistically significant. Even at 6 years of age, the salivary MS levels were significantly lower in the xylitol group than in the other groups (ANOVA, p<0.001). In conclusion, the earlier demonstrated, xylitol–associated reduction in the probability of mother–child transmission of MS was still found in the children’s MS counts at the age of 3 and 6 years.

Bifidobacterium animalis subsp. lactis BB-12 in reducing the risk of infections in infancy

The impact of controlled administration of Bifidobacterium animalis subsp. lactis BB-12 (BB-12) on the risk of acute infectious diseases was studied in healthy newborn infants. In this double-blind, placebo-controlled study, 109 newborn 1-month-old infants were assigned randomly to a probiotic group receiving a BB-12-containing tablet (n 55) or to a control group receiving a control tablet (n 54). Test tablets were administered to the infants twice a day (daily dose of BB-12 10 billion colony-forming units) from the age of 1-2 months to 8 months with a novel slow-release pacifier or a spoon. Breastfeeding habits, pacifier use, dietary habits, medications and all signs and symptoms of acute infections were registered. At the age of 8 months, faecal samples were collected for BB-12 determination (quantitative PCR method). The baseline characteristics of the two groups were similar, as was the duration of exclusive breastfeeding. BB-12 was recovered (detection limit log 5) in the faeces of 62% of the infants receiving the BB-12 tablet. The daily duration of pacifier sucking was not associated with the occurrence of acute otitis media. No significant differences between the groups were observed in reported gastrointestinal symptoms, otitis media or use of antibiotics. However, the infants receiving BB-12 were reported to have experienced fewer respiratory infections (65 v. 94%; risk ratio 0·69; 95% CI 0·53, 0·89; P = 0·014) than the control infants. Controlled administration of BB-12 in early childhood may reduce respiratory infections.

Sucrose Intake since Infancy and Dental Health in 10-Year-Old Children

The dental health of children in western countries has improved without a concomitant decrease in the mean sucrose consumption. Our aim was to analyse the association of long-term sucrose consumption with dental health in children representing the highest (n = 33, 18 boys) and the lowest 5 percentiles (n = 33, 21 boys) of sucrose intake, in a study where food consumption was prospectively recorded from infancy to 10 years of age. The sum of decayed, missing and filled teeth in the primary (dmft) and permanent (DMFT) teeth was assessed. Children’s sucrose intake in the high intake group was constantly higher than in their counterparts (p < 0.001), and already exceeded 10% of energy intake (E %) at 2 years of age. The mean ± SD of the dmft + DMFT scores was higher in the high than in the low sucrose intake group (3.9 ± 3.9 and 1.9 ± 2.5, respectively; p = 0.032). We conclude that a persistently high sucrose intake increases the risk of dental caries in children.

Collaborative WHO xylitol field studies in Hungary I. Three-year caries activity in institutionalized children

The aim of this 3-year field study was to assess the value of partial substitution of sucrose with peroral xylitol (14-20 g/day) as a caries-preventive measure (X group) in comparison with systemic administration of fluoride (F group) and restorative treatment procedures solely (C group). An F dentifrice was used unsupervised in the X and F groups, the former containing 10% xylitol. The C group used customary, predominantly F-free dentifrices distributed by the local health authorities. The final material consisted of 689 institutionalized children (6-11 years). Caries was scored yearly in duplicate by two continuously calibrated teams. At base line the X group had a significantly higher caries prevalence than the F and C groups. The 3-year DMFS increment was 4.2 in the X group, 6.5 in the F group, and 7.7 in the C group. The corresponding ratio (RS) between caries incidence and the tooth surface population at risk was RSx, 4.9; RSF, 6.6; and RSC, 8.6. It is concluded that dietary xylitol in solid sweets resulted in a lower increment of caries than obtained in the F and C groups (p less than 0.001, covariance analysis, with base-line prevalence, number of permanent teeth, and visible plaque index as covariants).

Assessment of single risk indicators in relation to caries increment in adolescents

Base-line data on a series of risk indicators were related to 11-month caries increment in 181 subjects with a mean age of 13 years and 3 months. A caries increment equalling or exceeding one tooth surface was recorded in 21% of the subjects. The risk indicators consisted of past caries experience, white spot lesions, visible plaque and gingivitis, and six salivary tests: secretion rate, buffer effect, sucrase, mutans streptococci, lactobacilli, and Candida. Significant associations between caries increment and past caries experience (p = 0.002), white spot lesions (p = 0.01), lactobacilli (p = 0.02), Candida (p = 0.006), and sucrase (p = 0.02) were observed. The ensuing odds ratios were thus recorded: past caries experience, 3.6; white spot lesions, 2.9; salivary sucrase activity, 2.9; lactobacilli, 2.5; and Candida, 2.8.

Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland.

The use of toothbrushes in daycare centers has been questioned because of the possibility of infections spreading through unsupervised brushing. Several field studies have demonstrated a caries‐preventive effect of xylitol chewing gum—a measure that could be a practical way of taking care of oral hygiene during daycare hours without brushing. A community trial was conducted in Savonlinna, Finland to test the caries‐preventive effect of xylitol chewing gum at these centers. A total of 921 children were recruited. The daycare centers were randomly distributed to xylitol chewing gum or brushing groups. An additional 270 children who had not been in daycare centers were later organized into an external reference group in order to check whether the children in the daycare centers were representative of all children in Savonlinna. The results revealed a statistically significant but clinically small difference between the xylitol and brushing groups in favor of the xylitol group. Many families used the daycare services irregularly. Changes in workplace, periods of unemployment, the birth of other children in the family, etc., affect the likelihood of families keeping their children in a daycare center for many years. Despite the fact that conditions were not optimal, oral health status in the xylitol group was a little bit better than in the control group. The use of xylitol can therefore be recommended, especially if the personnel do not have the possibility to supervise the brushing.

Sealants and xylitol chewing gum are equal in caries prevention

Sealants and xylitol have been demonstrated to prevent dental decay, but their effect has never been compared in the same study. Regular use of xylitol chewing gum during 2 or 3 school years was compared with application of occlusal sealants in a randomized study. The reliability of the clinical observations was controlled by examining the presence of dental decay in the same teeth from bitewing radiographs in a blind study. After 5 years, no statistically significant differences between the sealant and xylitol groups were found. The results were in line with the results from separate studies with sealants or xylitol. There were no great differences between the costs of the measures. The selection between the compared preventive measures has to be made on the basis of practical aspects such as caries occurrence, availability of personnel and other resources, opportunity costs, cooperation with schools, and other local conditions.

Factors Associated with Caries Increment: A Longitudinal Study from 18 Months to 5 Years of Age

Background: Identifying the early determinants of risk for dental caries would be useful in its primary prevention. Subjects and Methods: All children at the age of 18 months in one health care area were invited in the screening test for mutans streptococci (MS) and their caretakers interviewed for the study purposes. The 366 children who met the inclusion criteria were clinically examined after 42 months. Results: At the age of 5 years ± 6 months, in 79 (21.6%) children the 42-month caries increment was >0. In the multivariate regression analysis, the strongest correlation was found with MS detected in the oral biofilm. Of the reported background factors the blue-collar occupation of the caretaker, child’s sugar use, night feeding, use of other thirst quenchers than water and father’s reported poor oral health were significantly correlated with the child’s caries increment. Conclusion: The oral health of a child is strongly related to the lifestyle and the oral health habits of the caretakers during the first years.

Assessment of Caries Risk in Preschool Children

The study aimed to assess the additional caries-predictive value of visible plaque, gingival bleeding, and the reported use of fluorides and candies, when combined with the information about mutans streptococci (MS) and incipient carious lesions. The subjects were 2 years of age at the baseline examination (n = 226), and they were all given conventional prevention during the 3-year follow-up period. None of the studied single risk indicators reached an accuracy of 80% in predicting the 3-year caries increment. At best, the accuracy was 75% for the MS strip. Use of candies and incipient caries lesions had additional caries-predictive value (multiple logistic regression analysis). The combined use of these three risk indicators resulted in an accuracy of 81%. The present results indicate that in 2-year-old children, the combination of two or three risk indicators (MS strip, incipient caries lesions, and use of candies) might have caries-predictive power enough for clinical implications.