Katerina Kavvadia

Distribution of selected cariogenic bacteria in five different intra-oral habitats in young children.

BACKGROUND Knowledge of the colonization patterns and composition of the oral microbiota can lead to a better understanding of disease initiation. AIM The aim of this study was to examine the distribution of selected cariogenic bacteria in samples from five different oral habitats in young Greek children. DESIGN Ninety-three children 3-12 years old (mean + SD 7.9 +/- 2.5) (60.2% male, 39.8% female) participated and split into three different age groups: primary (3-6 years), early mixed (6-9 years), and mixed dentition (9-12 years). Samples for bacterial enumeration were taken from saliva, supragingival and subgingival plaque, tongue dorsum, and soft tissues from each child, and were further analysed using checkerboard DNA-DNA hybridization. RESULTS Mean counts and proportions of all the test bacteria differed significantly among sample locations. Cariogenic bacteria were present in almost all healthy children. Mean proportions of Streptococcus mutans isolated from soft tissue and Streptococcus sanguinis from soft tissue, subgingival and saliva samples increased significantly with age, whereas the opposite was seen for Lactobacillus acidophilus. CONCLUSIONS Cariogenic bacteria were present in almost all young children. Soft tissues, saliva, and tongue were more often colonized by cariogenic streptococcal species than teeth. These surfaces may serve as reservoirs for oral pathogens, requiring attention during preventive interventions.

Clinical performance of a diode laser fluorescence device for the detection of occlusal caries in primary teeth

OBJECTIVES To correlate the DIAGNOdent readings (LF) with those of direct visual (DV) examination, indirect visual (IDV) examination, bitewing radiography (BWR), and pit and fissure opening (PFO) for the detection of occlusal caries in primary teeth; to determine the validity of this device using PFO as reference; and to evaluate its reliability. METHODS Two calibrated operators examined 130 teeth with 405 examination sites using DV, IDV and radiographic examinations, and LF. Of the 405 sites, 155 were visually scored for caries after pit and fissure opening. RESULTS Pit and fissure opening was found to significantly correlate with all methods (rhoLF = 0.48, rhoBWX = 0.48, rhoDV = 0.44, rhoIDV = 0.41). For enamel lesions, higher sensitivity (0.76) was found with DV, while higher specificity (0.88) with the LF. For lesions into dentin, however, higher sensitivity (0.78) was found with the LF, while higher specificity (0.98) with the BWR. The devices accuracy was found to be 0.61 for enamel lesions, while for lesions into dentin 0.70, and its reliability was excellent (ICC = 0.97). CONCLUSION The LF device presented high reliability in the detection of occlusal caries in primary teeth and its performance was similar to DV and radiographic examinations.

Caries-preventive effectiveness of fluoride varnish as adjunct to oral health promotion and supervised tooth brushing in preschool children: a double-blind randomized controlled trial.

OBJECTIVES To evaluate the effect of biannual fluoride varnish applications in preschool children as an adjunct to school-based oral health promotion and supervised tooth brushing with 1000ppm fluoride toothpaste. METHODS 424 preschool children, 2-5 year of age, from 10 different pre schools in Athens were invited to this double-blind randomized controlled trial and 328 children completed the 2-year programme. All children received oral health education with hygiene instructions twice yearly and attended supervised tooth brushing once daily. The test group was treated with fluoride varnish (0.9% diflurosilane) biannually while the control group had placebo applications. The primary endpoints were caries prevalence and increment; secondary outcomes were gingival health, mutans streptococci growth and salivary buffer capacity. RESULTS The groups were balanced at baseline and no significant differences in caries prevalence or increment were displayed between the groups after 1 and 2 years, respectively. There was a reduced number of new pre-cavitated enamel lesions during the second year of the study (p=0.05) but the decrease was not statistically significant. The secondary endpoints were unaffected by the varnish treatments. CONCLUSIONS Under the present conditions, biannual fluoride varnish applications in preschool children did not show significant caries-preventive benefits when provided as an adjunct to school-based supervised tooth brushing with 1000ppm fluoride toothpaste. CLINICAL SIGNIFICANCE In community based, caries prevention programmes, for high caries risk preschool children, a fluoride varnish may add little to caries prevention, when 1000ppm fluoride toothpaste is used daily.

Histological validation of a laser fluorescence device for occlusal caries detection in primary molars

AIM: This was to validate in vitro a laser fluorescence device, DIAGNOdent™ 2095-DD, on the detection of occlusal caries in primary molars using the histological examination as the gold standard and to compare the laser fluorescence findings to the results of the conventionally used diagnostic methods. STUDY DESIGN AND METHODS: 111 occlusal pits in 24 extracted primary molars were examined for caries by one trained operator (Intra-examiner Reliability K>0.83), using direct visual (DV), indirect visual (IDV), radiographic (XR) and fluorescence (DD) examinations and then the extent of caries was determined histologically. Sensitivity, specificity, accuracy and the area under the ROC curve — AUC were calculated for all methods, using the histological evaluation as the gold standard. STATISTICS: Differences between examination methods were estimated by pair-wise comparison of their respective AUC. RESULTS: DD’s sensitivity for enamel and for dentine lesions respectively was 0.90 and 0.36, its specificity 0.36 and 0.91 and its accuracy 0.61 and 0.65. The DD device exhibited better sensitivity than specificity for enamel lesions and better specificity than sensitivity for lesions into dentine. The DD device was found to have the highest sensitivity for lesions into enamel, specificity and accuracy and as well as the largest AUC compared with all other methods. For lesions into dentine however, according to AUC values the DD was not statistically significant different from the other methods. CONCLUSION: Compared with the other methods, the DD had the highest validity for enamel caries while its validity for caries into dentine was not statistical different from the other methods.

Combined validity of DIAGNOdent™ and visual examination for in vitro detection of occlusal caries in primary molars

The purpose of this in vitro investigation was to compare in primary molars, the validity of DIAGNOdent™ 2095 on occlusal caries diagnosis used either separately or in combination with direct and/or indirect visual examinations, based on histological examination as the reference method. In 24 extracted primary molars, 111 occlusal pits were examined for caries by one trained operator (intra-examiner reliability k > 0.80), using the following examination methods: direct visual (DV), indirect visual (IDV), radiographic (XR), and fluorescence (DD) with the DIAGNOdent™. The extent of caries was then determined histologically. Sensitivity, specificity, accuracy, and the area under the ROC curve (AUC) were calculated for each method separately as well as for the combination of DD with DV and/or IDV. The DD accuracy was found both for lesions into enamel and into dentin to be 0.70 while the accuracy of the DD combination with DV and IDV was found to be 0.89. The DD AUC for lesions into enamel and into dentin, 0.68, were not statistically significant different from the other methods (p > 0.5), however the AUC of the combination of DD with DV and IDV, found to be 0.82, was higher than all the other methods, and this was statistically significant for enamel lesions. The validity of DIAGNOdent™ for occlusal caries diagnosis in primary molars was much higher when the DD was used in combination with direct and indirect visual examination, than when used by itself.

Cariogram caries risk profiles in adolescent orthodontic patients with and without some salivary variables.

OBJECTIVE To compare the Cariogram caries risk profiles with and without salivary buffer capacity and mutans streptococci (MS) counts in adolescents with fixed orthodontic appliances. MATERIALS AND METHODS The sample consisted of 90 healthy Greek adolescents who were undergoing orthodontic treatment. The Cariogram risk model was applied through a questionnaire and clinical and salivary examinations. The actual chance of avoiding new caries was calculated, and participants were categorized into three groups (0-40%  =  high caries risk, 41-60%  =  medium caries risk, and 61-100%  =  low caries risk) using a nine-item Cariogram or by excluding either salivary buffer capacity or MS or both. Cohens Kappa statistical analysis was used for comparing the Cariogram outcome with and without salivary variables. The distribution of variables was compared by nonparametric marginal homogeneity tests. RESULTS Using the Cariogram with nine variables, 62% of the patients were assigned to the high caries risk category, 13% to the medium risk category, and 24% to the low risk category. Omission of salivary buffer capacity did not alter the risk categories significantly, while more subjects were assigned to the medium risk category when MS counts were excluded. The difference between the nine-item Cariogram and the MS-reduced version, however, was not statistically significant (P  =  .07). CONCLUSIONS The Cariogram model may be used both with and without salivary tests for risk grouping in orthodontic practice.

Oral Hygiene Facilitators and Barriers in Greek 10 Years Old Schoolchildren.

ABSTRACT Aim: The aim of this study was to determine the oral hygiene facilitators and barriers for 10 years old Greek children, via a questionnaire and clinical examination. Materials and methods: This was a cross-sectional study of 266, 10 years old, children recruited from schools in 3 locations in Greece. Data were collected via questionnaires and clinical examination. Questionnaires referred to Children’s oral hygiene knowledge, behavior and attitude as well as parents’ oral hygiene behavior and educational level. Children were clinically examined by two calibrated pediatric dentists using a WHO probe and artificial light to assess dental plaque (hygiene index-HI), gingivitis (simplified gingival index-GIs) and dental caries (DMFT-BASCD criteria). Results: Regarding oral hygiene knowledge, although 80% of the children were literate of the proper means of oral hygiene, only 58.64% brushed their teeth twice daily and 36.84% used dental floss. Children’s oral hygiene knowledge was positively correlated with both parental brushing frequency (ρ = 0.175, p < 0.05) and educational level (ρ = -0.216, p < 0.05). Toothpaste use was reported by 92.11% of the children. Regarding Children’s attitude, 62.28% were concerned whether their teeth were clean, with girls showing greater concern than boys (p < 0.001). Their reported beliefs regarding brushing avoidance were boredom (84.06%), low oral health literacy (73.91%) and forgetfulness (56.52%). Conclusion: Oral hygiene facilitators were found to be the concern about how clean were their teeth, oral health literacy of both children and parents and toothpaste appeal to children. Oral hygiene barriers were Children’s boredom, low oral health literacy, forgetfulness and low socioeconomic level. How to cite this article: Angelopoulou M, Kavvadia K, Oulis C, Reppa C. Oral Hygiene Facilitators and Barriers in Greek 10 Years Old Schoolchildren. Int J Clin Pediatr Dent 2015;8(2):87-93.

BEN/DM-GRASP/SC1 expression during mouse facial development: differential expression and regulation in molars and incisors

The cell adhesion molecule BEN/DM-GRASP/SC1 is expressed in a variety of tissues during embryogenesis. Here, we studied the expression pattern of BEN/DM-GRASP/SC1 in different organs involved in facial mouse development, especially in the developing teeth. BEN/DM-GRASP/SC1 was expressed in nose, whisker, gland, and tongue epithelia, as well as in myogenic mesenchyme. In molars, BEN/DM-GRASP/SC1 was firstly expressed in the condensed mesenchyme and thereafter expression was confined to mesenchymal cells of the dental follicle. In contrast, in incisors, transient BEN/DM-GRASP/SC1 expression was restricted to epithelium. In tissue recombination experiments, BEN/DM-GRASP/SC1 expression in mesenchyme was activated by molar, but not incisor epithelium.

Experiential learning in oral health education

Experiential learning is an innovative learning method that knowledge is gained through experience. The aim of this paper was to review the application of experiential learning in health education and suggest an oral health education program using experiential learning. Experiential learning has been used in the past successfully in health education mostly in university curricula. In oral health education, its use is limited and without following a comprehensive structure. An experiential learning oral health education program, implemented in the classroom by a trained teacher, is proposed to be integrated in the schools curriculum. Initially, using brainstorming students express their opinions and feelings toward oral health. Then, students are allocated to working groups to develop oral health projects. The outcome of these projects is presented in the classroom to their peers through role playing, posters, songs, games, etc., Finally, a discussion is stimulated by the teacher to encourage children to express their feelings about oral health issues and thus experientially recognize the importance of oral health. Experiential learning has been effectively used in health education and can be a successful method for oral health education. For optimal results, a predetermined experiential method structure has to be followed.

The effect of resin infiltration on proximal caries lesions in primary and permanent teeth. A systematic review and meta-analysis of clinical trials

INTRODUCTION/OBJECTIVES This systematic review aimed to critically appraise the evidence on resin infiltration for the clinical management of proximal caries lesions in primary and permanent teeth. DATA Search terms included resin infiltration, micro-invasive and proximal caries. Potentially eligible studies involved proximal caries lesions treated with resin infiltration. Risk of bias assessment was performed using the Cochrane risk of bias tool and the quality of evidence was assessed with GRADE. SOURCES Electronic Database search of published and unpublished literature was performed in April 22, 2018 within the following databases: MEDLINE via Pubmed, Cochrane Central Register of Controlled Trials, LILACS via BIREME, Open Grey, Clinical Trials.gov and National Research Register. STUDY SELECTION Of 135 articles initially retrieved, 10 were eligible for inclusion in the systematic review comprising the results of 9 studies, while 5 randomized controlled trials (RCTs) (6 articles) with unclear risk of bias contributed to the meta-analyses. Random effects meta-analyses were implemented and lesion progression treatment effects were estimated through Odds Ratios (ORs) along with associated 95% Confidence Intervals (95% CIs). CONCLUSIONS Overall, there was strong evidence that proximal caries lesion progression was less likely to occur in permanent teeth following treatment with resin infiltration plus oral hygiene measures as compared to non- invasive methods (oral hygiene instructions) for follow up 18 months to 2 years (3 studies: OR = 0.14; 95% CI: 0.08, 0.25; P < 0.001) as well as 3 years (4 studies: OR = 0.15; 95% CI: 0.06, 0.36; P < 0.001). The quality of the evidence was rated as moderate to low respectively.