Rita Nõmmela

Similarity of the Effects ofErythritol and Xylitol on SomeRisk Factors of Dental Caries

Several sugar alcohols (polyols) have been promoted as potential sugar substitutes in caries limitation. However, differences in the effects of simple alditol-type sugar alcohol homologues on dental plaque have not been compared in clinical tests. The effects of 6-month use of erythritol (a sugar alcohol of the tetritol type), xylitol (a pentitol) and D-glucitol (sorbitol, a hexitol) were investigated in a cohort of 136 teenage subjects assigned to the respective polyol groups or to an untreated control group (n = 30–36 per group). The daily use of the polyols was 7.0 g in the form of chewable tablets, supplemented by twice-a-day use of a dentifrice containing those polyols. The use of erythritol and xylitol was associated with a statistically significant reduction (p < 0.001 in most cases) in the plaque and saliva levels of mutans streptococci. The amount of dental plaque was also significantly reduced in subjects receiving erythritol and xylitol. Such effects were not observed in other experimental groups. Chemical analyses showed D-glucitol to be a normal finding in dental plaque while xylitol was less consistently detected. Erythritol was detected in measurable amounts only in the plaque of subjects receiving this polyol. Erythritol and xylitol may exert similar effects on some risk factors of dental caries, although the biochemical mechanism of the effects may differ. These in vivo studies were supported by cultivation experiments in which xylitol, and especially erythritol, inhibited the growth of several strains of mutans streptococci.

Effect of Erythritol and Xylitol on Dental Caries Prevention in Children

Objective: The aim of this study was to test the efficacy of long-term, daily intake of erythritol and xylitol candy, compared with sorbitol candy, on the development of enamel and dentin caries lesions. Methods: The study was a double-blind randomized controlled prospective clinical trial. Altogether 485 primary school children, first- and second-graders at baseline, from southeastern Estonia participated in this 3-year intervention. Each child consumed four erythritol, xylitol or sorbitol (control) candies three times per school day. The daily intake of polyol was about 7.5 g. The International Caries Detection and Assessment System (ICDAS) was used in the clinical examinations by four calibrated examiners at baseline and at 12, 24 and 36 months. Results: The annual examination analyses and the follow-up analyses confirmed that the number of dentin caries teeth and surfaces at 24 months follow-up and surfaces at 36 months follow-up was significantly lower in the mixed dentition in the erythritol group than in the xylitol or control group. Time of enamel/dentin caries lesions to develop and of dentin caries lesions to progress was significantly longer in the erythritol group compared to the sorbitol and xylitol groups. Also the increase in caries score was lower in the erythritol group than in the other groups. Conclusions: In the follow-up examinations, a lower number of dentin caries teeth and surfaces was found in the erythritol group than in the xylitol or control groups. Time to the development of caries lesions was longest in the erythritol group. Trial registration: ClinicalTrials.gov Identifier NCT01062633.

Effect of three-year consumption of erythritol, xylitol and sorbitol candies on various plaque and salivary caries-related variables

OBJECTIVE The objective of the present paper is to report results from oral biologic studies carried out in connection with a caries study. METHODS Samples of whole-mouth saliva and dental plaque were collected from initially 7- to 8-year-old subjects who participated in a 3-year school-based programme investigating the effect of the consumption of polyol-containing candies on caries rates. The subjects were randomized in three cohorts, consumed erythritol, xylitol, or sorbitol candies. The daily polyol consumption from the candies was approximately 7.5 g. RESULTS A significant reduction in dental plaque weight from baseline (p<0.05) occurred in the erythritol group during almost all intervention years while no changes were found in xylitol and sorbitol groups. Usage of polyol candies had no significant or consistent effect on the levels of plaque protein, glucose, glycerol, or calcium, determined yearly in connection with caries examinations. After three years, the plaque of erythritol-receiving subjects contained significantly (p<0.05) lower levels of acetic acid and propionic acid than that of subjects receiving xylitol or sorbitol. Lactic acid levels partly followed the same pattern. The consumption of erythritol was generally associated with significantly (p<0.05) lower counts of salivary and plaque mutans streptococci compared with the other groups. There was no change in salivary Lactobacillus levels. CONCLUSION Three-year consumption of erythritol-containing candies by initially 7- to 8-year old children was associated with reduced plaque growth, lower levels of plaque acetic acid and propionic acid, and reduced oral counts of mutans streptococci compared with the consumption of xylitol or sorbitol candies.

Long-Term Effect of Erythritol on Dental Caries Development during Childhood: A Posttreatment Survival Analysis.

Objective: To assess the effect of daily consumption of erythritol, xylitol, and sorbitol candies on caries development in mixed dentition during a 3-year intervention and 3 years after the intervention. Methods: 485 Estonian first- and second-grade primary school children participated. Children were randomly allocated to an erythritol, xylitol, or sorbitol (control) group. Polyol-containing candies were administered on school days with a daily polyol consumption of 3 × 2.5 g. Yearly, caries development was assessed by calibrated dentists using the ICDAS criteria. Six years after initiation of the study and 3 years after cessation of daily polyol consumption, 420 participants were re-examined to identify potential long-term effects of polyol consumption. Survival curves were generated at the end of the intervention period and 3 years after intervention. The model included age of the subjects, schools, tooth surface ages and years of surface exposure to intervention. ICDAS scoring system-based events included enamel/dentin caries development, dentin caries development, increase in caries score, and dentist intervention. Results: At the end of the intervention, time to enamel/dentin caries development, dentin caries development, increase in caries score, and dentist intervention were significantly longer in the erythritol group as compared to the sorbitol group. Except for increase in caries score, all effects persisted 3 years after cessation of daily polyol consumption. Conclusions: A caries-preventive effect of 3-year erythritol consumption as compared to sorbitol was established in children with mixed dentition. The effect persisted up to 3 years after the end of the intervention.

Caries experience in the permanent dentition among first- and second-grade schoolchildren in southeastern Estonia

Abstract Objective. This study aims to assess the caries experience among first- and second-grade children in the elementary schools of southeastern Estonia. Materials and methods. A representative sample of 485 children was studied. The mean age of children in the first grade was 7.8 years (SD = 0.35) and in the second grade 8.8 years (0.38). The clinical examinations using ICDAS criteria were completed by four calibrated examiners. The inter- and intra-examiner consistency of the examiners was high (surface and tooth-based kappa >0.9). Results. The mean caries experience of dentinal caries lesions was 0.8 (D4–6MFT) and 1.6 (D4–6MFS) among the first graders and 1.1 (D4–6MFT) and 1.6 (D4–6MFS) among the second graders. The mean caries enamel lesions among the first graders was 1.6 (D1–3T) and 2.2 (D1–3S) and among the second graders 2.1 and 3.0, respectively. The most affected surfaces were the occlusal surfaces of the lower first molars. The prevalence of sealants was very low—only 2.4% of the first molars were sealed among the first graders and 3.9% among the second graders. There were no statistically significant differences in caries experience or in the provision of restorative treatment between the schools. Conclusions. Caries experience is high in southeastern Estonia. Preventive programs are urgently needed.

Hambaarstide koolitusest ja erialaorganisatsioonide tegevusest Eestis 1918-2017. Dental Education and Dental Organisations in Estonia from 1918 to 2017

Over the previous hundred years, immense developments in health care management and medical education have taken place in Estonia. The first dental school was founded in Tartu by D. Levinovich in 1909, providing education for students of many nationalities. The majority of the lecturers were private associate professors from the University of Tartu. Dentistry was first taught to medical students in the medical faculty of the University of Tartu in 1935 when Valter Hiie was appointed associate professor. When he was elected adjunct professor, the Chair of Dentistry was founded in 1938. This article gives a detailed overview of the developments in Estonian dentistry from the first associate professorship to the establishment of the Institute of Dentistry in 2016, including the changes in curriculum, infrastructure and staff. Research, including students’ scientific activity, an inseparable part of instruction at the University, is also explored. The first registered dental organisation called the Estonian Society for Dentists was founded in 1921 in Tartu to represent the interests of dental practitioners. Activities of Estonian non-profit dental organisations have been described in the article in four periods that differ from one other in view of activity and essence. Despite differences, the main aim of these organisations was to stand for excellent and easily accessible treatment, dental education and health policy development. University lecturers have always been actively involved in the activities of dental organisations in Estonia as proponents of well-rounded continuous education and dental practice. Over the previous hundred years, constant active intervention in the development of the Estonian society with a focus on the health care system has led to modern high-quality dental care in Estonia.

Ülevaade Tartu linna laste hambaravi korraldusest ja hambahaiguste levimusest 5–7aastastel lastel

Aastatel 2005 ja 2006 uuriti Tartu eelkooliealiste ja esimese klassi laste hammaste tervist. Tulemustest selgus, et kuigi laste hambaravi uldine kattesaadavus oli paranenud, oli piimahammaste kaariesest haaratus siiski suur, viidates sellele, et vanemad ei pea piimahammaste ravi oluliseks. Suuhugieeni naitajad osutusid halvemaks neil, kel esines enam piimahammaste kaariesekahjustusi. Samas oli jaavhammaste kahjustatus selles vanuseruhmas veel vaike, mistottu jatkuv aktiivne hambahaiguste profulaktika on aarmiselt oluline. Eesti Arst 2008; 87(5):342−346