Leonor Sánchez-Pérez

Cigarette Smoking and Dental Caries among Professional Truck Drivers in Mexico

Background: Professional truck drivers are at high risk of chronic diseases. Further examination of tobacco use and its impact on oral health is warranted – both in terms of the direct association between tobacco use and poor oral health, and in terms of tobacco use being an indicator of poor health behaviors. Objective: To estimate the possible association between smoking and dental caries experience in a population with high tobacco use. Methods: Drivers’ licenses are periodically re-issued by the Mexican government and as part of the licensing process a physical exam takes place. We administered a free, standardized questionnaire together with an oral examination (WHO criteria) included in the physical exam, targeting a random sample of applicants in Mexico City. Results: A total of 824 dentate males (mean age 35.5 ± 10 years) took part in the study, of whom 49.2% were current smokers and 23.2% were former smokers. Caries experience was mean DMFT 8.95 (± 6.05). Only 18.0% of participants had ‘excellent’ or ‘good’ oral hygiene. The prevalence of ‘large’ cavities increased as the number of cigarettes/day increased from 14.6% (1–3 cigarettes/day) to 33.3% (≧10 cigarettes/day). Using multiple linear regressions, we found that older age, poorer oral hygiene, higher education, and greater tobacco exposure were significantly associated with higher caries experience (DMFT). An interaction was observed with oral hygiene and tobacco: drivers that smoked and had ‘poor’ oral hygiene showed the highest number of large cavities and missing teeth. Health promotion interventions are needed in this at-risk population group.

Caries risk assessment from dental plaque and salivary Streptococcus mutans counts on two culture media

This study attempted to determine which combination of plaque or saliva, and tryptic soy agar, bacitracin (TSY20B) or mitis salivarius, bacitracin media, yielded the highest caries-predictive values for mutans counts in children with different caries prevalence. Sixty children were divided into three equally sized groups: caries free, low caries and high caries. Eighteen months later, their caries incidence and initial mutans count were compared. Fissure plaque on TSY20B yielded a high correlation between mutans counts and caries prevalence (P<0.009, r=3346) and incidence (P<0.003, r=4521). The caries-predictive values obtained demonstrate that the coefficient of variation of mutans counts from lower first-molar fissure plaque on TSY20B accounts for 20.4% of the variation in final caries index. This strong correlation provides a valuable tool for the identification of caries-prone individuals.

Malocclusion and TMJ disorders in teenagers from private and public schools in Mexico City

Objective: To identify, among Mexican teenagers from public and private schools, the frequency, severity of malocclusion and orthodontic treatment needs, and their possible association with temporomandibular joint disorders. Material and Methods: Fifteen-year-old students were recruited from public and private schools. Clinical findings were registered as follows: oral hygiene status with the Oral Hygiene Index-Simplified, malocclusion using the Dental Aesthetic Index (DAI), and TMJ disorders following WHO criteria. Negative binomial and logistic regression models were constructed for data analysis. Results: A total of 249 fifteen-year old students were included in the study (118 female 47.4%). 68% had a DAI score ≤ 25 (minor or no occlusal anomalies), 18% scored 26-30 (mild anomalies), 7% scored 31-35 (evident anomalies), and 6% scored ≥ 36 (major malocclusion). The most frequent anomalies were dental crowding in 50%, maxillary dental irregularity in 44.6%, mandible irregularity in 41.2% and excessive maxillary overjet in 37.8%. Among the students, 26.1% had clicking/muscle or TMJ pain, of these 12.3% showed pain during palpation. OHI-S > 1 was found in 34% of the participants. The negative binomial model showed an association between DAI score and TMJ disorders (P=0.041). Also the logistic regression model showed an association between malocclusion (DAI>25) and TMJ disorders (OR=2.58, p=0.002). Malocclusion was associated also with poor oral hygiene (OR=1.65, p=0.007), and with attendance to public schools (OR=1.97, p=0.039). Conclusions: TMJ disorders and DAI scores were significantly associated. Screening/Diagnostic programs for ortho-dontic and TMJ-disorders are needed, to identify and offer treatment to teenagers with major malocclusion and TMJ/muscle pain. Key words:Dental Aesthetic Index, DAI, crowding, Temporo Mandibular Joint disorders (TMJ disorders), Temporo Mandibular Disorders (TMD), occlusal anomalies, OHI-S.

The relationship between body mass index and body fat percentage and periodontal status in Mexican adolescents.

Abstract Objective. To assess the association between obesity indicators and the periodontal status of high school students. Materials and methods. High school students (15-year-olds) in Mexico City participated in the survey (n = 257). International Obesity Task Force cut-off values (ISO-BMI) were applied to identify overweight and obesity. Also, bioelectrical impedance analysis was performed to estimate body fat percentage (BF%). The simplified detritus index (DI-S) was used to evaluate oral hygiene. The periodontal community index (CPI) was obtained to assess the periodontal status of the participants. Results. Overweight/obesity was identified in 30.0% of the students. BF% was 37.5% in women and 21.2% in men and 16.7% of the participants smoked and 33.5% of the students presented DI-S >1. Based on CPI, 59.5% of the participants showed good periodontal status (CPI = 0); bleeding on probing without further periodontal involvement was found in 13.6% of the participants (CPI = 1), 23.8% showed a CPI = 2 (dental calculus) and a CPI = 3 (shallow periodontal pockets) was detected in 3.1% of the participants. The results of the multinomial logistical regression model fitting CPI ≥2 identified an association BF% (OR = 1.06), having poor oral hygiene (OR = 20.09) and smoking (OR = 2.49). Similarly, overweight/obesity was associated with CPI ≥2 (OR = 1.78) adjusting for school attended (public school OR = 0.35), oral hygiene (DI-S >1, OR = 23.92) and tobacco consumption (smoker OR = 1.81). Conclusions. Excess body fat indicators were associated with bleeding on probing and dental calculus in adolescents. The relationship between overweight/obesity and periodontal status in adolescents should be considered in oral health preventive programs.

Stability of unstimulated and stimulated whole saliva flow rates in children

OBJECTIVE To analyze the stability of the unstimulated saliva flow rate (USFR) and the stimulated saliva flow rate (SSFR) in children followed from age 7 to 12 years old. METHODS Longitudinal study. Whole saliva samples were collected from school children (50 girls and 50 boys). Forty-four girls and 32 boys remained in this cohort for 6 years (dropout rate 24%). Variables that could influence USFR or SSFR patterns were analyzed in a repeated-measures manova. RESULTS Over a 6-year follow-up, the childrens USFR ranged from 0.41 to 0.46 mL/min in the initial and final observation, respectively, and showed no significant differences (P = 0.4455) during the follow-up. The children consistently belonged to one of three distinct SSFR groups (P < 0.0001). A repeated-measures manova model showed that USFR and SSFR were not associated with sex, body mass index, or indoor temperature during sampling. CONCLUSION These results indicate that USFR and SSFR patterns were stable from 7 to 12 years old. This finding may be useful in oral health prevention or treatment and in the search for biomarkers in saliva for screening or diagnostic purposes.

Impact of Dental Fluorosis, Socioeconomic Status and Self-Perception in Adolescents Exposed to a High Level of Fluoride in Water

Objective: To identify adolescents’ self-perception of dental fluorosis from two areas with different socioeconomic levels. Methods: A cross-sectional, descriptive study was conducted with 15-year-old youths by applying a questionnaire designed and validated to assess self-perceptions of dental fluorosis in two areas with different socioeconomic statuses (SESs). Fluorosis was clinically evaluated by applying the Thylstrup and Fejerkov (TF) index on the upper front teeth. Results: A total of 308 adolescents were included in the study. The medium-SES population, which was exposed to 2.5 ppm of fluoride in water, and the low-SES population, which was exposed to 5.1 ppm, presented the following levels of dental fluorosis: TF 2–3 (50%), TF 4–5 (45.6%) and TF 6–7 (4.4%) for medium SES and TF 2–3 (12.3%), TF 4–5 (67.1%) and TF 67 (20.6%) for low SES. A significant association was found between self-perception and dental fluorosis in those with medium and low SESs (p < 0.05). The multiple regression model found differences between TF levels and self-perception, with a 6–7 TF level for concerns about color (OR = 1.6), smile (OR = 1.2) and appearance (OR = 3.36). Conclusions: Self-perceptions of dental fluorosis affect adolescents such that adolescents with a medium SES have more negative perceptions than those with a low SES. Such perceptions increase as the TF index increases.

Comparación de barnices y dentífrico con flúor en la prevención de caries en escolares

Objective To compare preventive effect on dental caries of two frequencies of fluoridated varnish (FV) applications and a group given brushing instructions and using fluoridated toothpaste. Materials and Methods Follow-up study of 203 children attending an elementary school in the municipality of Tláhuac, Mexico City. The children were followed for 22 months. The students were randomly assigned to one of the following groups: 1) brushing instructions with fluoridated toothpaste, 2) FV every six months, 3) three FV applications per week per year. The FV contained fluorosilane (1000 ppm F) and NaF dentifrice (1450 ppm F). The DMFT-caries index and the presence of white spots were recorded (ICDAS, International Caries Detection and Assessment System). Results At baseline, the mean age of the children was 9.3 (SD 0.76) years, white lesions 0.63 (SD 1.48) and DMFT =0.70 (SD 1.11). Averages of the initial and final DMFT scores in the three groups were 0.67 and 1.17 for the toothpaste group, 0.77 and 1.46 for FV twice a year group, and 0.67 y 1.03 for the three-applications-FV group. According to the results of the GEE (Generalized-Estimating Equations) model, there were no significant differences in the rate of white lesions or the increase of the DMFT index. The results for the DMFT were: for bi-annual applications of FV, RR=1.24 (p=0.178) and for the three consecutive applications of FV, RR=0.83, (p=0.298) in comparison with the brushing-instructions group using fluoridated toothpaste, among the three treatment groups, controlling for age, sex, and initial-caries index in primary teeth and brushing frequency. Conclusions Schoolchildren showed a low incidence of caries using any of the three preventive regimens applied.