Sotiria Gizani

The microbiota on different oral surfaces in healthy children

INTRODUCTION Knowledge of the early oral colonization patterns could provide a better understanding of oral biofilm development and disease initiation that in turn could be the basis for early preventive programmes. METHODS Microbial samples were collected from five different oral habitats from a total of 93 children (age 3-12 years), attending the Dental School of the University of Athens, who were split into three age groups. A total of 38 microbial species were sought out by the checkerboard DNA-DNA hybridization technique. RESULTS All of the test species, except Parvimonas micra and Porphyromonas gingivalis, differed significantly among sample locations providing quite distinct microbial profiles for the different oral surfaces. Supragingival and subgingival plaque had similar profiles and exhibited higher proportions of Actinomyces species and Green complex while soft tissue samples were dominated by streptococci of the Yellow complex. The profiles of the tongue dorsum and saliva were also similar. Many of the species were in similar proportions in all three age groups for a given location. Periodontal pathogens showed increases in proportions with increasing age. Specifically, the Red complex species (Tannerella forsythia, P. gingivalis, Treponema denticola) showed a significant increase in proportion with age (P < 0.05) in all sample locations. CONCLUSIONS The results showed a pattern of colonization in children similar to that previously found in adults. Differences in the profile between age groups suggest a gradual maturation of the oral microbiota, with it being made up of an increasing number of Orange and Red complex species.

Adhesion of Streptococcus mutans to Different Types of Brackets

OBJECTIVE To examine the difference in the adhesion of Streptococcus mutans to three different types of orthodontic brackets and the effect of the presence of an early salivary pellicle and Streptococcus sanguis on adhesion. MATERIALS AND METHODS Three adhesion experiments were performed using stainless steel, ceramic, and plastic orthodontic brackets. In the first experiment a clinical strain of S mutans adhered to the three different types of brackets (n = 6 for each). For the second, the brackets were treated with saliva before adhesion of S mutans (n = 6 per type of bracket). Finally, the third experiment concerned saliva coated brackets (n = 6 per type of bracket), but before S mutans, S sanguis bacteria were allowed to adhere. The bacteria were always allowed to adhere for 90 minutes in all the experiments. Adhesion was quantitated by a microbial culture technique by treating the brackets with adhering bacteria with trypsin and enumerating the total viable counts of bacteria recovered after cultivation. RESULTS There were consistently no differences in the adherence to stainless steel, ceramic, or plastic brackets. The presence of an early salivary pellicle and S sanguis reduced the number of adhering S mutans to all three types of brackets. CONCLUSIONS Adhesion of bacteria to orthodontic brackets depends on several factors. The presence of a salivary pellicle and other bacterial species seem to have a significant effect on the adhesion of S mutans, reducing their numbers and further limiting any differences between types of brackets.

Distribution of selected cariogenic bacteria in five different intra-oral habitats in young children.

BACKGROUND Knowledge of the colonization patterns and composition of the oral microbiota can lead to a better understanding of disease initiation. AIM The aim of this study was to examine the distribution of selected cariogenic bacteria in samples from five different oral habitats in young Greek children. DESIGN Ninety-three children 3-12 years old (mean + SD 7.9 +/- 2.5) (60.2% male, 39.8% female) participated and split into three different age groups: primary (3-6 years), early mixed (6-9 years), and mixed dentition (9-12 years). Samples for bacterial enumeration were taken from saliva, supragingival and subgingival plaque, tongue dorsum, and soft tissues from each child, and were further analysed using checkerboard DNA-DNA hybridization. RESULTS Mean counts and proportions of all the test bacteria differed significantly among sample locations. Cariogenic bacteria were present in almost all healthy children. Mean proportions of Streptococcus mutans isolated from soft tissue and Streptococcus sanguinis from soft tissue, subgingival and saliva samples increased significantly with age, whereas the opposite was seen for Lactobacillus acidophilus. CONCLUSIONS Cariogenic bacteria were present in almost all young children. Soft tissues, saliva, and tongue were more often colonized by cariogenic streptococcal species than teeth. These surfaces may serve as reservoirs for oral pathogens, requiring attention during preventive interventions.

Oral health status and behaviour of Greek patients with cleft lip and palate.

AIM: This was to record the oral health profile and more specifically the prevalence of carious and hypoplastic lesions in children and adolescents with cleft lip and palate (CLP). STUDY DESIGN AND METHODS: The study group consisted of 41 children and adolescents (4–18 years-old) with CLP group while a similar number of non-cleft persons (HLP) matched for sex, age and orthodontic treatment (75.6%), was used as the control group. Information regarding the oral health habits, medical and dental history were collected using a questionnaire. Stimulated saliva was collected to evaluate the flow rate and buffering capacity as well as the levels of mutans streptococci and lactobacilli using the chair-test CRT® (Ivoclar -3Vivadent). Oral hygiene (OH) was assessed using the index of Silness and Loe [1964]. The prevalence of initial/white spot and cavitated carious lesions as well as hypoplasia was evaluated based on the criteria by ICDAS [2005] and Nyvad et al [2008] as well as Koch et al [1987] respectively. The statistical analysis was carried out using the t-test and the chisquare test. RESULTS: Approximately half of the CLP and HLP subjects were brushing their teeth 2 × per day. Both groups reported an average of 3 main and 2 snack meals per day. Levels of mutans streptococci and lactobacilli as well as the quality of the saliva were similar for both groups. The plaque index score was significantly higher in the CLP than in the control group (p=0.0003). The prevalence of cavitated carious lesions was similar in both groups but that of the initial/white spot lesions, especially at the area of maxillary incisors, was higher in the CLP group (85%, p=0.000). CONCLUSIONS: The increased numbers of initial/white spot lesions combined with poor OH found in the CLP group predispose for an increased risk of further development to carious cavitated lesions. Taking into consideration that the majority of those patients were under orthodontic treatment, the application of an intensive individualized oral health preventive program, focused on remineralisation of the initial caries, is imperative.

Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece

BACKGROUND The abuse and neglect of children constitutes a social phenomenon that unfortunately is widespread irrespective of geographic, ethnic, or social background. Dentists may be the first health professionals to recognize signs of child maltreatment (CM) and have an important role in dealing with such incidents. AIM To describe the training, experience, and personal views of dentists practicing in the Prefecture of Attica regarding the recognition and referral of abused and neglected children. DESIGN A random sample was drawn from a target population of dentists registered with two of the largest dental associations in Greece. The dental practitioners were interviewed by two paediatric dentists using a specially designed questionnaire. Information was collected regarding their awareness on child maltreatment, the frequency of suspected incidents as well as the reasons for not reporting them. RESULTS With a response rate of 83%, findings are reported from 368 interviews (54% male, mean age 43 years). Only 21% of respondents had received training on child protection at undergraduate level. Suspected abuse was 13% and suspected neglect was 35%. Only six of the 368 respondents made an official report of a suspected case of child maltreatment. The most common reason that might prevent a dentist from reporting a case was doubt over the diagnosis (44%). Ninety-seven per cent of dentists believed that recognition and referral of incidents should be part of undergraduate training. CONCLUSIONS Dental practitioners did not feel adequately informed on recognizing and referring child abuse and neglect cases. The low percentage of reported incidents and the lack of legislation indicate a great need for continuously educating dentists on child maltreatment as well as for setting up an organized system in Greece for reporting such incidents to protect the dentist referring the case as well as the child being victimized.

Progression of proximal caries in children with different caries indices: A 4-year radiographic study

Aim: This was to investigate survival rate, median survival time and differences in the progression of different stages of proximal caries in 196 children, aged 6 to 8 years old, with different caries index at baseline examination. Methods: Based on DMFS/dmfs values, children were categorized as low, moderate and high caries index groups. Subjects with DMFS/dmfs smaller or equal to half of a child’s age were classified as low caries index group; children with DMFS/dmfs greater than half and smaller than, or equal to, the child’s age as moderate; those with DMFS/dmfs greater than the child’s age as high. Proximal caries and its progression were diagnosed from bitewing radiographs taken at 1 — year intervals over a period of 4 years. The mesial surface of the first permanent molars, mesial and distal surfaces of the first and second primary molars and distal surfaces of the primary canines were examined. Sound surfaces, caries lesions in the external and internal half of the enamel and external, middle, internal third of the dentine as well as filled, extracted and exfoliated teeth were recorded. Statistics: A life table analysis was performed to estimate survival rate and median survival time of each state of proximal caries and differences between the groups in the progression of the proximal lesions were tested with the Wilcoxon pairwise comparison statistic. Results: There were statistically significant differences in the caries rate of the sound proximal surfaces of the primary teeth between the low and high caries index groups. Also, statistically significant differences between these two groups were found in the progression of the external half of the enamel caries in the first permanent molars and in the primary teeth. Conclusions: A high caries index increases the risk of developing caries in the sound proximal surfaces of posterior primary teeth and causes faster progression of the external half of the enamel lesions in the first permanent molars and posterior primary teeth.

Management of post-orthodontic white spot lesions: an updated systematic review

Background/objectives The management of post-orthodontic white spot lesions is based on remineralization strategies or a minimal-invasive camouflage of the lesions. Aim The aim of this systematic review was to identify and assess the quality of evidence for the various clinical technologies. Search methods Four databases were searched for relevant literature published in English between 2011 and 31 October 2015 according to a pre-determined PICO. Only controlled clinical studies were considered. Abstract lists and the selected full-text papers were independently examined by two reviewers and any differences were solved in consensus. The Cochrane handbook and the AMSTAR tool were used for grading the risk of bias. The quality of evidence was rated according to GRADE. Results Out of 280 identified publications, seven studies on remineralization, micro-abrasion and resin infiltration met the inclusion criteria. Two of them were assessed with low risk of bias. No pooling of results was possible due to study heterogeneity. The quality of evidence for all technologies was graded as very low. Limitations Only papers published in English with more than 20 adolescents or young adults were considered. Furthermore, a follow-up period of at least 8 weeks was required. The publication bias could not be assessed due to the paucity of included trials. Conclusions/clinical implications There is a lack of reliable scientific evidence to support re-mineralizing or camouflaging strategies to manage post-orthodontic white spot lesions. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.

Best clinical practice guidance for management of early caries lesions in children and young adults: an EAPD policy document.

AbstractBackgroundThe European Academy of Paediatric Dentistry (EAPD) encourages prevention and arrest of active dental caries. Therefore, the present guidance provides evidence- and clinically-based recommendations for detecting and diagnosing early/non-cavitated caries lesions, risk assessment and disease management.MethodsA search of different databases was conducted using all terms related to the subject. Relevant papers were identified after a review of their titles, abstracts or full texts. Three workshops were held during the corresponding EAPD interim seminar in Brussels in 2015. Several statements were agreed upon and, furthermore, gaps in our knowledge were identified.ResultsFollowing the systematic reviews and outcomes of the seminars, it was concluded that visual and radiographic caries detection should be utilised as a basic diagnostic approach to locate, assess and monitor non-cavitated caries lesions in primary and permanent teeth. As another important evaluation step, a caries risk assessment should be performed at a child’s first dental visit, and reassessments should be performed on a regular basis. It is widely accepted that non-cavitated caries lesions can be managed non-invasively in the majority of cases. The spectrum of measures includes a low cariogenicity tooth-friendly diet, daily and appropriate management of the biofilm, home and within the dental office/surgery usage of fluorides as well as sealing techniques.ConclusionThe detection and management of non-cavitated caries is an essential aspect of preventive dentistry. Therefore, the EAPD encourages oral health care providers and caregivers to implement preventive practices that can arrest early caries and improve individual and public dental health.

Cariogram caries risk profiles in adolescent orthodontic patients with and without some salivary variables.

OBJECTIVE To compare the Cariogram caries risk profiles with and without salivary buffer capacity and mutans streptococci (MS) counts in adolescents with fixed orthodontic appliances. MATERIALS AND METHODS The sample consisted of 90 healthy Greek adolescents who were undergoing orthodontic treatment. The Cariogram risk model was applied through a questionnaire and clinical and salivary examinations. The actual chance of avoiding new caries was calculated, and participants were categorized into three groups (0-40%  =  high caries risk, 41-60%  =  medium caries risk, and 61-100%  =  low caries risk) using a nine-item Cariogram or by excluding either salivary buffer capacity or MS or both. Cohens Kappa statistical analysis was used for comparing the Cariogram outcome with and without salivary variables. The distribution of variables was compared by nonparametric marginal homogeneity tests. RESULTS Using the Cariogram with nine variables, 62% of the patients were assigned to the high caries risk category, 13% to the medium risk category, and 24% to the low risk category. Omission of salivary buffer capacity did not alter the risk categories significantly, while more subjects were assigned to the medium risk category when MS counts were excluded. The difference between the nine-item Cariogram and the MS-reduced version, however, was not statistically significant (P  =  .07). CONCLUSIONS The Cariogram model may be used both with and without salivary tests for risk grouping in orthodontic practice.

Therapeutic management of a case of generalised aggressive periodontitis in an 8-year old child: 18-month results

BACKGROUND: Generalised aggressive periodontitis (GAP) is a rare condition associated with rapid periodontal destruction, in multiple teeth. The paper aims to present a case of an 8-year old with GAP and discuss his response to treatment. CASE REPORT: An 8-year old male was referred to the postgraduate clinic of paediatric dentistry of the University of Athens due to increased mobility in his primary dentition. At initial clinical examination, plaque accumulation, gingival inflammation and temporary restorations were noted. Detailed periodontal examination revealed bleeding on probing, pocket depths of up to 9 mm and second degree mobility in primary teeth. Radiographic examination showed advanced bone loss and carious lesions. Microbiological analysis revealed increased percentages of peri-opathogens in pooled subgingival samples. Final diagnosis of GAP was made after ruling out any underlying systemic disorder. TREATMENT: Periodontal therapy involved non-surgical subgingival debridement, systemic administration of antibiotics and retention of periodontally involved teeth. FOLLOW-UP: This was based on a monthly recall program for the first 6 months and a 3-monthly regime thereafter. At 18-months after initial examination, a substantial improvement in clinical parameters was seen, while levels of periodontal pathogens were sustained at low levels. CONCLUSION: Non-surgical root debridement along with systemic administration of antibiotics and retention of the periodontally involved teeth, can be successful in achieving improvement and maintenance of periodontal health in the mixed dentition.