Pentti Alanen

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.

Occlusal treatments in temporomandibular disorders: a qualitative systematic review of randomized controlled trials.

Occlusal treatments (occlusal splints and occlusal adjustment) are controversial but widely used treatment methods for temporomandibular disorders (TMD). To investigate whether studies are in agreement with current clinical practices, a systematic review of randomized controlled trials (RCTs) of occlusal treatment studies from the period 1966 to March 1999 was undertaken. Eighteen studies met the inclusion criteria, 14 on splint therapy, and 4 on occlusal adjustment. The trials were scored using the quality scale presented by Antczak et al., 1986a (A.A. Antczak, J. Tang, T.C. Chalmers, Quality assessment of randomized control trials in dental research. I. Methods, J. Periodontal Res. 1986a;21:305-314). The overall quality of the trials was fairly low, the mean quality score was 0.43/1.00 (range 0.12-0.78). The most obvious methodological shortcomings were inadequate blinding, small sample sizes, short follow-up times, great diversity of outcome measures and numerous control treatments, some of unknown effectiveness. Splint therapy was found superior to 3, and comparable to 12 control treatments, and superior or comparable to 4 passive controls, respectively. Occlusal adjustment was found comparable to 2 and inferior to one control treatment and comparable to passive control in one study. Because of the methodological problems, only suggestive conclusions can be drawn. The use of occlusal splints may be of some benefit in the treatment of TMD. Evidence for the use of occlusal adjustment is lacking. There is an obvious need for well designed controlled studies to analyse the current clinical practices.

Xylitol chewing gum in caries prevention: a field study in children

As the prevalence of dental caries decreases in industrialized nations like the United States, it simultaneously increases in developing nations and Third World countries. The decrease in the West is attributed to increased use of fluorides, but the increase in developing countries has been explained by an increase in the consumption of sugar. As this information continues to propel researchers to find sucrose substitutes, xylitol has been singled out as a proposed sucrose replacement. The question tackled by this study was: Can the daily use of chewing gum containing xylitol increase the efficacy of the existing caries-preventive measures now regularly used for 11- to 15-year-old children in most industrialized western countries?

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.

Determinants of tension-type headache in children.

The objective of this study was to study the prevalence, characteristics and predisposing factors of tension-type headache in children. An unselected population-based questionnaire study was carried out in 1409 Finnish schoolchildren aged 12 years. Of them, 1135 (81%) returned an acceptably completed questionnaire. The prevalence of episodic tension-type headache in children was 12% (138 of 1135). Children with episodic tension-type headache also often reported characteristics of pain typical for migraine. Children with frequent and persistent episodic tension-type headache reported stabbing and severe occipital pain, phonophobia and abdominal pain significantly more often than children with infrequent episodic tension-type headache. Neck-shoulder symptoms, symptoms of depression and oromandibular dysfunction were each independently associated with episodic tension-type headache. The fathers occupation of a lower-level white-collar worker put the child at a four-fold risk for episodic tension-type headache. We conclude that episodic tension-type headache is as common as migraine in children. It can be associated with depression, oromandibular dysfunction and muscular stress. Especially children with frequent and persistent episodic tension-type headache report characteristics of pain typical for migraine.

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.

Occlusal adjustment and the incidence of demand for temporomandibular disorder treatment

STATEMENT OF PROBLEM Contrary to clinical opinion, the structural risk from dental occlusion in temporomandibular disorders has been questioned or considered to be insignificant in clinical practice. PURPOSE This study tested the effect of elimination of occlusal interference through occlusal adjustment, on the incidence of temporomandibular disorders. MATERIAL AND METHODS In a controlled clinical trial of 146 healthy children and adolescents, half of the subjects underwent occlusal adjustment aimed at elimination of the presumed structural risk, and the other half underwent mock adjustment. Adjustments were repeated every 6 months over a period of 4 years. The outcome variable was the incidence of temporomandibular disorders, operatively defined as request for treatment of symptoms characteristic of the disorders with presence of clinical signs demonstrated in the muscles of mastication and/or jaw joint. RESULTS The cumulative incidence rate was 9/67 in the mock adjustment group and 1/60 in the real adjustment group, for a relative risk of 8.06. The difference between groups was statistically significant (p = 0.019). CONCLUSIONS Elimination of the presumed structural risk from the dental occlusion appeared to significantly reduce the incidence of temporomandibular disorders in a select group of young subjects.

Effect of artificial occlusal interferences depends on previous experience of temporomandibular disorders

Studies on artificial interferences in subjects with no temporomandibular (TMD) history have shown adaptation to the interference within a fairly short period of time. The role of occlusal factors in the etiology of TMD has therefore been questioned. The results might have been different, however, if subjects with a prior TMD history had been included in the study groups. To test this assumption in a randomized double-blind clinical set-up, we included healthy women without (n = 26) as well as with (n = 21) an earlier TMD history. Both groups were randomly divided into true and placebo interference groups. Artificial interferences were introduced in the true interference groups and simulated in the placebo groups. The subjects were followed for 2 weeks, after which the interferences were removed. The subjects without a TMD history showed fairly good adaptation to the interferences, but the subjects with a TMD history and true interferences showed a significant increase in clinical signs compared to the other groups. We suggest that the etiological role of occlusal interferences in TMD may not have been correctly addressed in previous studies with artificial interferences and allow no conclusions as regards TMD etiology.

The Finnish Family Competence Study: The Relationship between Caries, Dental Health Habits and General Health in 3-Year-0ld Finnish Children

The aim of this study was to examine how dental health related habits, infectious diseases and long-term illness are associated with dental health at the age of 3 in first-born children resident in a Finnish province. The study was designed as a survey using stratified randomised cluster sampling, confidential questionnaires and clinical dental examinations. The results were analysed using polytomous logistic models. In the stepwise analysis the only statistically significant explanatory factors were the use of juice at night and dental cleanliness. Antibiotic treatment or long-term illness was not significantly associated with dental health.

Long-Term Effect of Xylitol Chewing Gum in the Prevention of Dental Caries: A Follow-Up 5 Years after Termination of a Prevention Program

About 65% of the original 258 children who participated in 1982-1984 in a caries prevention program involving the use of xylitol chewing gum were retrieved in 1989 for a follow-up study. Ninety-five subjects from the original xylitol (X) group and 70 subjects from the original control (no-gum, C) group were available. In 1984, when the children completed the program at the age of 13-14 years, the caries scores were significantly lower in children who had used xylitol gums daily, compared with the C group. In 1989, 5 years after the discontinuation of the gum program, the difference between the X and C groups had continued to increase in favor of the X group. These effects were explained by assuming that the X gum program had facilitated the establishment of a low-virulent bacterial flora on the surfaces of the teeth, and especially on those teeth that erupted during the trial proper. This type of results are possibly helpful when evaluating cost-benefit ratios of caries prevention.