Sára Karjalainen

A prospective study on sucrose consumption, visible plaque and caries in children from 3 to 6 years of age

OBJECTIVES As data on the association of sugar consumption and dental caries in the industrialized countries give mixed results, we prospectively studied this association in 135 healthy Finnish children (71 boys, 64 girls). METHODS The dental health and oral hygiene of the children was first examined at the mean age (+/-SD) of 37.4 (+/-2.1) months and again at 73.7 (+/-2.6) months. On both occasions the parents were interviewed about the childs sweet intake and toothbrushing habits, and sucrose consumption was analyzed using 4-day food diaries. RESULTS The proportion of children with caries experience, enamel and dentin lesions combined, increased from 16% to 40%. Daily sucrose intake of children who developed caries by 6 years of age, whether expressed as absolute (g) or as relative (E%) amounts, was already higher at 3 years of age than that of children who stayed caries-free (P<0.05 and P<0.03, respectively). Furthermore, children who used sweets more than once a week at 3 years of age, consumed more sucrose 3 years later (P<0.01) than those who used sweets once a week or less. The proportion of children with a combination of a sweet intake more than once a week and visible plaque, increased (P<0.05) during the follow-up. The risk ratio of children with the combined risk habit at 3 years of age to develop carious lesions by 6 years of age was 1.7 compared to the rest of the children (95% confidence interval 0.9-3.0). CONCLUSIONS We conclude that the manifestation of dental caries at 6 years of age seemed to be associated with a higher daily sucrose intake that had started already at 3 years of age. Moreover, a combination of sweet intake more than once a week and visible plaque at 3 years of age may be predictive of dental health 3 years later.

Sucrose Intake since Infancy and Dental Health in 10-Year-Old Children

The dental health of children in western countries has improved without a concomitant decrease in the mean sucrose consumption. Our aim was to analyse the association of long-term sucrose consumption with dental health in children representing the highest (n = 33, 18 boys) and the lowest 5 percentiles (n = 33, 21 boys) of sucrose intake, in a study where food consumption was prospectively recorded from infancy to 10 years of age. The sum of decayed, missing and filled teeth in the primary (dmft) and permanent (DMFT) teeth was assessed. Children’s sucrose intake in the high intake group was constantly higher than in their counterparts (p < 0.001), and already exceeded 10% of energy intake (E %) at 2 years of age. The mean ± SD of the dmft + DMFT scores was higher in the high than in the low sucrose intake group (3.9 ± 3.9 and 1.9 ± 2.5, respectively; p = 0.032). We conclude that a persistently high sucrose intake increases the risk of dental caries in children.

The effect of hormone replacement therapy on salivary calcium concentrations in menopausal women.

Hormone replacement therapy in menopausal women is known to affect the general calcium turnover of the body. No information is available about the effects of hormone therapy on salivary electrolytes and on calcium in particular. A group of 16 healthy peri- and postmenopausal women, all recommended to start hormone replacement therapy, were studied longitudinally for 5 months. Paraffin-stimulated whole saliva was collected at baseline, at 3 and at 5 months after the onset of therapy, and analysed for calcium, sodium and potassium concentrations. In response to hormone replacement therapy, calcium concentration decreased (p = 0.037), that of sodium increased (p = 0.019), while no change was observed in the potassium concentrations during the follow-up period.

Validation and inter‐examiner agreement of mutans streptococci levels in plaque and saliva of 10‐year‐old children using simple chair‐side tests

Since there are few validation studies of chair‐side tests of oral mutans streptococci, we compared a commercially available strip test with the conventional laboratory assay. Two plaque samples obtained from the mesial surfaces of the upper right and lower left permanent molars of sixty‐five 10‐year‐old children (boys = 38, girls = 27) were cultured and incubated using chair‐side site strip tests (Dentocult SM, Orion Diagnostica). Two plaque sampling tools, namely dental floss and micro‐brush, were compared, and inter‐examiner agreement between recordings of three examiners was assessed. Paraffin‐stimulated saliva was then collected for laboratory and chair‐side assays. The plaque and saliva chair‐side tests correlated well with each other (Spearman rho, r=0.72) and with the laboratory method, showing coefficients of 0.76 and 0.80 for saliva and plaque, respectively. Compared to the laboratory method, the sensitivity (Sn), specificity (Sp), accuracy (A), and kappa (K) values of the salivary and plaque chair‐side tests were 0.63, 0.75 (Sn), 0.93, 0.90 (Sp), 0.82, 0.85 (A), and 0.58, 0.66 (K), respectively. Agreement between the two plaque sampling techniques was good (0.91). Inter‐examiner agreement of plaque scores ranged between 0.65 and 0.86 when all density categories were analysed separately; when dichotomized into low and high categories, complete agreement was found. Agreement between the plaque and saliva chair‐side tests and the laboratory salivary assay was good, and in terms of sensitivity, accuracy, and kappa values, the site strip plaque test surpassed the salivary chair‐side test.

Influence of Sympathetic Nerve Stimulation on Flow Velocity in Pulpal Vessels

Using a modification of the flying spot method for estimation of flow velocity in micro vessels, comparative observations were made on arterioles, venules and capillaries in the pulp of the rat incisor by vital microscopy. It was found that stimulation of the sympathetic nerves to the tooth, either at its apex or in the cervical sympathetic trunk, produced marked reduction of flow which was followed by a return to normal velocities at the cessation of stimulation. Direct stimulation of the sympathetic trunk produced very rapid reduction of flow velocity. Changes were also observed in response to administration of anesthetics and other procedures.

Prevention of temporomandibular disorder-related signs and symptoms in orthodontically treated adolescents: A 3–year follow-up of a prospective randomized trial

Recommendations about the need for occlusal adjustment after malocclusion therapy are inconclusive. A total of 123 orthodontically treated healthy adolescents (88 girls, 35 boys; 14.8 +/- 1.7 years old) agreed to participate in the present study. The subjects were interviewed and examined for signs and symptoms related to temporomandibular disorder (TMD) and were randomly allocated to intervention (n = 63) and control (n = 60) groups. At base line, occlusal adjustment was carried out for the intervention group and repeated every 6 months thereafter as needed. Mock adjustments were performed for the control group. At the end of the 3rd year 118 subjects (96%) turned up for re-examination. The number of subjects with palpatory pain of the masticatory muscles, and with occlusal centric slides decreased significantly in the intervention group but not in the control group (P < 0.001). In conclusion, occlusal adjustment therapy may prevent the occurrence of TMD signs in orthodontically treated healthy adolescents.

Effect of Age on Flow-Rate, Protein and Electrolyte Composition of Stimulated Whole Saliva in Healthy, Non-Smoking Women

As relatively little is known about the effect of age on salivary electrolytes we studied the composition of saliva as function of age to provide reference values for healthy non-smoking women. All non-medicated and non-smoking 30-59-year-old subjects (n=255) selected from among 1030 women participating in a screening program formed the material of the present study. Salivary calcium, inorganic phosphate, magnesium, sodium, potassium, protein and flow-rate of stimulated whole saliva were measured. We found age-related changes in salivary calcium and phosphate concentrations (p=0.001 and p=0.004, respectively, one-way ANOVA). Peak values occurred at around 50-54 years of age. Age had no effect on flow-rate, magnesium, sodium, potassium or proteins. The concentration of sodium correlated positively, while phosphate, potassium, magnesium and protein correlated negatively with the salivary flow-rate. Calcium was the only electrolyte which had no association with flow-rate. Our study provides reference values for salivary electrolytes of 30-59-year-old women.

Long-term physical inactivity and oral health in Finnish adults with intellectual disability

Physical inactivity is prevalent among patients with intellectual disability. Because little is known about the oral effects of poor mobility, we reviewed the medical and dental charts of institutionalized dentate patients (n = 214;40.2 years - 12.1) of the Special Welfare District of Southwestern Finland. The number of decayed, missing, and filled teeth (DMFT), the number of retained teeth, dental treatment visits, and the type of the first treatment visit were recorded. Physical activity was good in 55% and severely reduced or completely absent in 45% of the patients. The degree of intellectual disability was mild or moderate in 40% and severe or profound in 60% of the patients. The walking patients weighed more (64.3 (19.6)versus 44.4 (14.4) kg; P < 0.001), had fewer secondary diagnoses (1.4 (1.3) versus 2.2 (1.4); P < 0.001), fewer daily medications (4.0 (2.1) versus 4.8 (2.4); P < 0.02), higher DMFT scores (18.5 (8.2) versus 14.8 (9.2); P < 0.05), and more dental treatment visits (2.7 (2.4) versus 2.0 (1.3); P < 0.03) than patients with poor physical activity. Periodontal treatment given as the primary type of dental care was more common among subjects with poor mobility than among those with good motor activity (P < 0.002). Poor physical activity was related to better dental health, higher need for periodontal therapy, and fewer dental visits than in patients with good motor activity.

Effect of variations in sucrose consumption on salivary lactobacillus count and sucrase activity in man

Dental students (n = 31) with either high salivary lactobacillus count (greater than 10(4) CFU/ml) or high salivary sucrase activity (greater than or equal to 10 mumol/min X mg protein X 10(-3), or both, were selected to participate in this dietary experiment. For 2 weeks the students avoided sucrose in their diet. Stimulated saliva samples were collected before and after the diet. An additional follow-up sample was collected after 2 weeks of normal diet. The lactobacillus count of undiluted saliva was determined by the Dentocult dip-slide technique. The sucrase activity was determined spectrophotometrically by measuring the sucrose-cleaving activity of centrifuged saliva supernatant. Both the reduction in dietary sucrose and the return to normal diet caused a significant change in these values.

Oral Health of 3-Year-Old Children and Their Parents after 29 Months of Child-Focused Antiatherosclerotic Dietary Intervention in a Prospective Randomized Trial

A long-term prospective, randomized dietary intervention to prevent exposure of children to the known atherosclerosis risk factors (the STRIP baby project) was started when the age of the children was 7 months. The aim of this substudy was to analyze the oral effects of the dietary intervention in the children and their parents when the children had reached the age of 3 years. Every fifth family of the main study was invited to this substudy (n = 179). Those studied (n = 148) represented well the intervention and the control groups and both genders in terms of intake of saturated fatty acids, the dietary polyunsaturated fatty acid to saturated fatty acid (PUFA/SAFA) ration and serum cholesterol and HDL cholesterol concentrations. Though no difference was found in sucrose consumption between the intervention and the control groups, the intervention children received relatively (in E%) more energy from carbohydrates than the control children (p < 0.005), used absolutely (in g) and relatively (in E%) less fat (p < 0.05) and had a higher PUFA/SAFA ratio in their diet (p < 0.001). Of the 3-year-old children 93% were caries free, and dental decay was a prevalent in the intervention as in the control children. Control children brushed their teeth unassisted more often than the intervention children (p < 0.05). The intervention fathers also received more energy (in E%) from carbohydrates (p < 0.01), the intervention mothers used less fat (p < 0.05) and had a higher PUFA/SAFA ratio in the diet (p < 0.05) than the control fathers and mothers, respectively. Dental and periodontal health of the intervention and control parents (n = 250, 84% attending, mean +/- SD age: 34.2 +/- 54.5 years also showed no differences even though the control parents had more commonly last visited a dentist over 3 years before this examination (p < 0.05). We conclude that a 29-month period of a low-saturated-fat, low-cholesterol but high-carbohydrate diet as advocated in the STRIP baby trial does not seem to have harmful effects on the oral health of the children or their parents. Minor untoward differences had occurred in the dental health behavior of the control children and their parents.