Peter Lingström

Caries-preventive effect of fluoride toothpaste: a systematic review

With a questionnaire addressed to general dental practitioners in Sweden, the Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on various caries preventive methods. The aim of this article was to report findings concerning the caries preventive effect of fluoride toothpastes in various age groups, with special emphasis on fluoride concentration and supervised versus non‐supervised brushing. A systematic search in electronic databases for articles published between 1966 and April 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years follow‐up and caries increment in the permanent (ΔDMFS/T) or primary (Δdmfs/t) dentition as endpoint. Out of 905 articles originally identified, 54 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A–C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF), expressed as percent. The results revealed strong evidence (level 1) (i) for the caries preventive effect of daily use of fluoride toothpaste compared to placebo in the young permanent dentition (PF 24.9%), (ii) that toothpastes with 1,500 ppm of fluoride had a superior preventive effect compared with standard dentifrices with 1,000 ppm F in the young permanent dentition (PF 9.7%), and (iii) that higher caries reductions were recorded in studies with supervised toothbrushing compared with non‐supervised (PF 23.3%). However, incomplete evidence (level 4) was found regarding the effect of fluoride toothpaste in the primary dentition. In conclusion, this review reinforced the importance of daily toothbrushing with fluoridated toothpastes for preventing dental caries, although long‐term studies in age groups other than children and adolescents are still lacking.

Caries-preventive effect of fissure sealants: a systematic review

The objectives of this study were to evaluate systematically the evidence of the caries‐preventive effect of fissure sealing of occlusal tooth surfaces and to examine factors potentially modifying the effect. The search strategies included electronic databases, reference lists of articles, and selected textbooks. Inclusion criteria were randomized or quasi‐randomized clinical trials or controlled clinical trials comparing fissure sealing with no treatment or another preventive treatment in children up to 14 years of age at the start; the outcome measure was caries increment; the diagnostic criteria had been described; and the follow‐up time was at least 2 years. Inclusion decisions were taken and grading of the studies was done independently by two of the authors. The main measure of effect was relative risk reduction. Thirteen studies using resin‐based or glass ionomer sealant materials were included in the final analysis. The results showed that most studies were performed during the 1970s and a single application had been utilized. The relative caries risk reduction pooled estimate of resin‐based sealants on permanent 1st molars was 33% (relative risk=0.67; CI=0.55-0.83). The effect depended on retention of the sealant. In conclusion, the review suggests limited evidence that fissure sealing of 1st permanent molars with resin‐based materials has a caries‐preventive effect. The evidence is incomplete for permanent 2nd molars, premolars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations with a low and a high caries risk, respectively.

The Use of Probiotic Strains in Caries Prevention: A Systematic Review

This paper aims to provide a systematic review of the caries-prevention effect of probiotics in human. The hypothesis was that the administration of probiotic strains might play a role in caries lesion prevention and in the control of caries-related risk factors. The main relevant databases (Medline, Embase) were searched. Quality of the Randomized Clinical Trials (RCTs) was classified using the “Consolidated Standards of Reporting Trials” (CONSORT) checklist and the Impact Factor (IF) value of each journal was recorded. Sixty-six papers were identified, and 23 fulfilled the inclusion criteria. Only three studies had caries lesion development as outcome, all the others reported caries risk factors as interim evaluation. Using the CONSORT Score, the papers were coded as 4 excellent, 9 good and 10 poor. The mean IF value recorded was 1.438. Probiotics may play a role as antagonistic agent on mutans streptococci (MS), acidogenic/aciduric bacteria that contributes to the caries process. In two-thirds of the selected papers, probiotics have demonstrated the capacity to reduce MS counts in saliva and/or plaque in short-term. The effect of probiotics on the development of caries lesion seems encouraging, but to date, RCTs on this topic are insufficient to provide scientific clinical evidence.

Effect of Urea in Sugar-Free Chewing Gums on pH Recovery in Human Dental Plaque Evaluated with Three Different Methods

The aim of this investigation was to study the effect of sugar-free chewing gums containing various amounts of urea on the pH recovery in dental plaque. Three plaque-measuring methods were used, i.e., the telemetric, the microtouch, and the sampling methods. The subjects who had refrained from toothbrushing for 3-7 days rinsed with either 10 or 50% (w/v) sucrose solutions and then chewed for 10 min: (1) one piece of chewing gum in a series of six tests in which the urea content increased from 10 to 80 mg per piece of gum: (2) one or two pieces of gum containing 20 mg urea, and (3) one, two, or three pieces of gum, one after the other, containing 20 mg urea. In some of the test series, a conventional sugarless gum was used as a control. A quick rise in plaque pH was found with all urea-containing chewing gums within the first minutes of chewing, and neutralization continued during the whole 10-min chewing periods. Higher concentrations of urea resulted in more pronounced pH recovery. Slightly higher plaque pH values were found when chewing on two pieces at a time of a 20-mg urea gum was compared with only one piece. Significantly higher pH values were recorded when using three pieces of chewing gum, one after the other (10 + 10 + 10 min), as compared with two pieces (10 + 10 min) or just one piece (10 min). In conclusion, all sugar-free chewing gums tested, particularly the urea-containing ones, initiated a pronounced pH recovery in dental plaque when chewed after a sucrose rinse.(ABSTRACT TRUNCATED AT 250 WORDS)

Economic evaluation of dental caries prevention: a systematic review.

The aim of the present study was to perform a systematic review of economic evaluations of caries prevention. A search in Medline from 1966 until May 2003 and a manual search in a number of journals identified 154 references, 74 of which were included. There were 17 original studies including an economic evaluation, and these form the basis of the present article. The rest were reviews, model studies and reports concerning economic practice in dentistry. The results show that the reviewed original studies on economic evaluation of caries prevention do not provide support for the economic value of caries prevention. The scarcity of well‐conducted studies, as well as contradictory evidence in the reviewed articles, makes it difficult to judge the health‐economic effect of the studied caries‐prevention methods.

Evaluation of Carisolv™ for the Chemo–Mechanical Removal of Primary Root Caries in vivo

The objective of this study was to evaluate a new chemo–mechanical method (Carisolv™) for the removal of primary root caries in vivo in terms of efficiency, treatment time and patient perception. Thirty–eight patients participated in an open, randomised and controlled study. Of the 60 root carious lesions included, 34 were randomised for chemo–mechanical treatment and 26 for drilling. A within–subject comparison was used whenever the patient had two cavities, which was the case for 22 subjects. All the Carisolv–treated cavities became caries free, as did all but one of those treated with drilling, as judged by an independent examiner. Only 4 of 34 patients asked for anaesthesia in the Carisolv group compared with 6 of 26 patients in the drilling group. Of those who did not use anaesthesia, 12 individuals in the drilling group experienced some pain compared with none in the chemo–mechanical group (p<0.001). The mean treatment time for the Carisolv method was 5.9 ± 2.2 min, compared with 4.5 ± 2.0 min for drilling; time for anaesthesia excluded (p<0.05). No negative reactions or adverse effects were recorded during the study. All 55 teeth examined in the 1–year follow–up were found to be sensitive using an electric pulp tester, and there was no difference regarding the condition of fillings between the lesions treated with Carisolv and drilling. It can be concluded that root caries can be effectively removed using the Carisolv method. The longer treatment time was compensated by less need for anaesthesia.

pH Measurements of Human Dental Plaque after Consumption of Starchy Foods Using the Microtouch and the Sampling Method

The aim was to study the effect of different starch-containing food items on pH changes in dental plaque. The pH was, in 10 subjects, simultaneously measured at various occasions up to 60 min in: (1) two approximal spaces in the premolar-molar region with the microtouch method, and (2) pooled samples of dental plaque with the sampling method. Six starchy products were tested: (1) spaghetti, (2) macaroni, (3) potato, (4) rice, (5) unsweetened bread, and (6) sweetened bread. A glucose chewing tablet and a mouthrinse with 10% sucrose served as controls. Saliva was collected for HPLC analysis of maltose and maltotriose when testing the spaghetti, rice and unsweetened bread. The glucose tablet and the sucrose solution resulted in the greatest pH drops. However, all starchy products resulted in obvious pH falls, which were most pronounced for sweetened bread, followed, in order, by unsweetened bread and potato. Significantly more maltose and maltotriose were found in saliva after consumption of unsweetened bread compared to spaghetti. There seemed to be a relationship between the amount of starch hydrolysates in saliva and the area of the plaque pH curve (AUC). The microtouch method gave consistently lower pH values than the sampling method. Both methods, however, ranked the eight test products roughly in the same order with respect to minimum pH, maximum pH decrease and AUC.

Cariogram Validity in Schoolchildren: A Two-Year Follow-Up Study

The validity of Cariogram in relation to caries increment over a 2-year period was evaluated. In 2007, the caries risk profile in a group of Sardinian schoolchildren (957) aged 7–9 years was assessed using the Cariogram software. A re-examination using the same criteria was performed 2 years later on 861 individuals from the original sample (drop-out 10.0%). The possible correlated variables were analyzed using the principal component analysis (PCA). The performances of Cariogram in predicting caries increment were evaluated by receiver operating characteristic (ROC) analysis. At follow-up examination, 54.4% of the sample had developed new carious lesions (mean DFS 1.6, 95% CI 1.5–1.8). The mean caries increment (ΔDFS) was 0.5, 95% CI 0.4–0.5. PCA showed that Cariogram, gingival status and dietary sugar frequency, both at baseline and at follow-up, tend to form a separate cluster (goodness of fit ≧0.75). Sensitivity and specificity measured by ROC analysis were 0.83 and 0.85, respectively, so the gain in certainty was 1.68, while the area under the ROC curve was 0.93. A strong correlation between caries risk profiles at baseline and caries incidence in the permanent teeth after 2 years was found. The validity of Cariogram was confirmed, the software fulfilling the criteria for a good risk assessment model: precision, accuracy and ease of use.

Plaque pH and Oral Retention After Consumption of Starchy Snack Products at Normal and Low Salivary Secretion Rate

The effect of plain potato chips, sugar-free cheese doodles, and sweetened crackers on plaque pH and oral retention was tested in 10 volunteers and compared with 5% starch and 5% sucrose, during both normal and low salivary secretion rate. The first 30 min 5% sucrose gave the most and 5% starch the least attenuated pH drop, but the three snack products reached or even passed the level seen by sucrose during the second 30-min phase. All products resulted in greater pH falls and remained at a low level for a longer period during low secretion rate. There were no differences in concentration of carbohydrates in saliva after consumption of potato chips, cheese doodles, and a cracker. However, low secretion rate increased the oral retention for all three products. To conclude, this study showed that low salivary secretion rate accentuated the pH decrease in dental plaque and prolonged the oral retention of carbohydrates.

Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases

Periodontal diseases and dental caries are the most common diseases of humans and the main cause of tooth loss. Both diseases can lead to nutritional compromise and negative impacts upon self-esteem and quality of life. As complex chronic diseases, they share common risk factors, such as a requirement for a pathogenic plaque biofilm, yet they exhibit distinct pathophysiologies. Multiple exposures contribute to their causal pathways, and susceptibility involves risk factors that are inherited (e.g. genetic variants), and those that are acquired (e.g. socio-economic factors, biofilm load or composition, smoking, carbohydrate intake). Identification of these factors is crucial in the prevention of both diseases as well as in their management. AIM To systematically appraise the scientific literature to identify potential risk factors for caries and periodontal diseases. METHODS One systematic review (genetic risk factors), one narrative review (role of diet and nutrition) and reference documentation for modifiable acquired risk factors common to both disease groups, formed the basis of the report. RESULTS & CONCLUSIONS There is moderately strong evidence for a genetic contribution to periodontal diseases and caries susceptibility, with an attributable risk estimated to be up to 50%. The genetics literature for periodontal disease is more substantial than for caries and genes associated with chronic periodontitis are the vitamin D receptor (VDR), Fc gamma receptor IIA (Fc-γRIIA) and Interleukin 10 (IL10) genes. For caries, genes involved in enamel formation (AMELX, AMBN, ENAM, TUFT, MMP20, and KLK4), salivary characteristics (AQP5), immune regulation and dietary preferences had the largest impact. No common genetic variants were found. Fermentable carbohydrates (sugars and starches) were the most relevant common dietary risk factor for both diseases, but associated mechanisms differed. In caries, the fermentation process leads to acid production and the generation of biofilm components such as Glucans. In periodontitis, glycaemia drives oxidative stress and advanced glycation end-products may also trigger a hyper inflammatory state. Micronutrient deficiencies, such as for vitamin C, vitamin D or vitamin B12, may be related to the onset and progression of both diseases. Functional foods or probiotics could be helpful in caries prevention and periodontal disease management, although evidence is limited and biological mechanisms not fully elucidated. Hyposalivation, rheumatoid arthritis, smoking/tobacco use, undiagnosed or sub-optimally controlled diabetes and obesity are common acquired risk factors for both caries and periodontal diseases.