Thomas Modéer

Stepwise Prediction of Dental Caries in Children up to 3.5 Years of Age

The present study is a part of a prospective, longitudinal investigation of caries development in children (n = 692) living in the southern suburbs of Stockholm. The aim was to evaluate, longitudinally, the caries-predictive ability of variables describing social and immigrant background, dietary habits, microbial and oral hygiene factors, and fluoride exposure in children at 1 and 2.5 years of age with respect to caries development before the age of 3.5. The predictors for caries development in children before 2.5 years of age were mutans streptococci (p < 0.01), immigrant background (p < 0.01), and consumption of candy (p < 0.01). The predictors for developing manifest caries between 2.5 and 3.5 years of age were mutans streptococci (p < 0.001), mothers education (p < 0.001), immigrant background (p < 0.01), and consumption of candy (p < 0.05) and sugar-containing beverages (p < 0.05). The caries incidence at 2.5 years of age as well as the caries increment between 2.5 and 3.5 years of age were significantly higher in children with immigrant background compared to non-immigrants. This study indicates that the possibility of identifying children at risk for caries development increases longitudinally from 1 to 3.5 years of age and there was a synergistic effect between age and each predictor.

Caries Development in Children from 2.5 to 3.5 Years of Age: A Longitudinal Study

The development of dental caries from the age of 2.5 to 3.5 years was studied longitudinally in 692 children living in the southern suburbs of Stockholm. The parents answered a structured questionnaire concerning the familys social and immigrant background as well as the dietary habits, oral hygiene and fluoride exposure of their children. Furthermore, the occurrence of mutans streptococci and lactobacilli was determined in samples taken from the tongue of the children, and the buffer capacity of the saliva was measured. At baseline examination, 11.3% of the children exhibited dental caries. At follow-up, 1 year later, decayed and/or filled surfaces were registered in 36.7% of the subjects. The majority of the new lesions were located on the occlusal surfaces of the second molar. Ninety-two percent of the children with caries at baseline developed new carious lesions during the 1-year period, compared to 29% of the children who were caries-free at baseline (p < 0.001). Of the lesions diagnosed at baseline as initial caries, 64% progressed to manifest lesions during the 1-year period. The study indicates that children with early caries development exhibit high caries progression as well as a high risk for further development of an extensive number of new carious lesions.

Prediction of Dental Caries Development in 1-Year-Old Children

Dietary habits, oral hygiene, fluoride exposure and occurrence of mutans streptococci were studied in 1-year-old children (n = 786) as well as the socio-economic and immigrant background of their parents. The purpose was to evaluate the predictive ability of variables studied in 1-year-old children that could be used to identify children at risk for early caries development. In a multivariate logistic regression analysis, the variables significantly associated with caries at 3.5 years of age were immigrant background (p < 0.001), mothers education (p < 0.001), consumption of sugar-containing beverages (p < 0.001), mutans streptococci (p < 0.05) and candy (p < 0.05). The probability of caries development was 87% when all the variables associated with caries were present at 1 year of age. The relative risk (odds ratio) of those children to develop manifest caries at 3.5 years of age was estimated to be 32 times higher than in the children where corresponding risk factors were not present. The results indicate that prediction at 1 year of age, built on risk factors associated with dental caries, can provide an indication of possible preventive interventions.

Disturbances in dental development after total body irradiation in bone marrow transplant recipients

The dental status of 16 children who had been treated with bone marrow transplantation (BMT) for serious bone marrow diseases was followed for up to 6 years. Several types of disturbances in dental development were observed in children who had been conditioned with total body irradiation (TBI) at 10 Gy before BMT. Thus, impaired root development that caused short V-shaped roots was found in all patients, a complete failure of root development and premature apical closure were found in five patients, enamel hypoplasia was observed in four patients, and microdontia was observed in three patients conditioned with TBI. Patients younger than 6 years of age at BMT exhibited the most severe and extensive dental aberrations. The TBI at 10 Gy appeared to be the major cause of the disturbances found.

Caries prevalence in 2.5-year-old children.

The prevalence of caries and gingivitis was determined clinically in 2.5-year-old children (n = 832) living in the southern suburbs of Stockholm. The occurrence of mutants streptococci and lactobacilli was determined in samples taken from the tongue and the buffer capacity of the saliva was measured. The parents answered a structured questionnaire concerning their childrens dietary habits, oral hygiene, fluoride exposure and their social and ethnic background. Initial or manifest caries was diagnosed in 11.7 and 6.4% of the subjects, respectively. Seventy-two percent of the total number of caries lesions were localized to the maxillary incisors. Caries prevalence in children with an immigrant background was significantly higher (p < 0.001) than in children without. In the multivariate analysis, the variables significantly associated with caries were: colonization with mutans streptococci (p < 0.001), lactobacilli (p < 0.01) and children with immigrant background (p < 0.01). The study demonstrates an association between early colonization of cariogenic microflora and an increased risk of developing dental caries in very young children.

Correlation between TNFa in gingival crevicular fluid and body mass index in obese subjects

The aim of this study was to investigate the relationship between body mass index (BMI kg/m[Formula: See Text]), the inflammatory mediator tumor necrosis factor α (TNFα), and interleukin-8 (IL-8) in gingival crevicular fluid (GCF) from 32 obese subjects aged between 13 and 24 years. Gingival inflammation (GBI %), pathological pocket depths, and alveolar bone loss diagnosed on radiographs were recorded. The GCF was collected from six sites per subject using periopaper, and the volume was determined using Peritron 8000. The levels of TNFα and IL-8 were determined using ELISA kits. Within the whole group, there was no significant relationship between BMI and the variables age, GBI %, number of periodontal pockets, smoking, and the levels of TNFα or IL-8. In subjects with BMI ≥40, however, there was a statistically significant correlation (r=0.74, P<0.01) between the level of TNFα in GCF and BMI. The correlation coefficient between BMI and TNFα in subjects with BMI ≥40 differed significantly (P<0.05) compared to that between subjects with BMI <40. The level of TNFα in GCF was positively correlated (P<0.05) with BMI in subjects with no periodontal pathological pocket. No significant correlation was found between the level of IL-8 and BMI. The results indicate that BMI positively correlates with TNFα in GCF in the group of young subjects with BMI ≥40 as well as in the subjects with no pathological periodontal pocket (≥4 mm) and that TNFα in GCF may be affected by the obese condition through a systemic effect.

Association Between Obesity, Flow Rate of Whole Saliva, and Dental Caries in Adolescents

In a cross‐sectional study design, we test the hypothesis whether childhood obesity is associated with reduced flow rate of stimulated whole saliva and dental caries. Obese adolescents (n = 65) with a mean age of 14.5 years and normal weight subjects (n = 65) with a mean age of 14.2 years were clinically examined with respect to dental caries, visible plaque accumulation (visible plaque index (VPI%)), gingival inflammation in terms of bleeding on probing (BOP%) as well as answered a questionnaire concerning medical history, medication, oral hygiene habits, smoking habits, and sociodemographic background. The flow rate of stimulated whole saliva (ml/min) was determined. BMI was calculated and adjusted for age and gender (BMI‐sds). The obese subjects exhibited higher number of decayed surfaces (DS), 0.7 vs. 0.1 (P = 0.008) and lower flow rate of stimulated whole saliva 1.2 vs. 2.0 ml/min (P < 0.001). Of obese patients, 17 subjects had VPI% >25 and 21 had BOP% >25, both compared to only 5 subjects of the normal weight with P values of 0.005 and <0.001, respectively. In a multivariate logistic regression model BMI‐sds was significantly associated with the flow rate of stimulated whole saliva less than the median value 1.5 ml/min (P < 0.001; odds ratio (OR) 1.36) as well as with DS (DS >0) (P = 0.002; OR 1.31) and the associations were not found to be confounded by any of the studied variables. The results indicate that childhood obesity is associated with reduced flow rate of stimulated whole saliva and dental caries and further strengthens obesitys negative effect on childrens oral health.

Bradykinin B1 and B2 receptor agonists synergistically potentiate interleukin-1-induced prostaglandin biosynthesis in human gingival fibroblasts

The interactions between bradykinin (BK) and interleukin-1 (IL-1) on prostaglandin formation in human gingival fibroblasts have been studied. IL-1α and IL-1β stimulated prostaglandin E2 (PGE2) formation in the gingival fibroblasts with IL-1β being the most potent agonist. The effects of both IL-1α and IL-1β on PGE2 biosynthesis was synergistically potentiated by BK, in a dose-related manner. The synergistic interaction between IL-1β and BK on PGE2 production was seen both with B1 (des-Arg9-BK) and B2 (BK, Lys-BK) BK receptor agonists. No synergistic interaction between BK and IL-1β was seen on arachidonic acid release. These data suggest that BK and IL-1 act in concert to enhance prostanoid formation in inflammatory lesions and that the level of interaction is distal to phospholipase activity.

Signal Transduction Pathways Involved in the Synergistic Stimulation of Prostaglandin Production by Interleukin-1β and Tumor Necrosis Factor a in Human Gingival Fibroblasts

Accumulating evidence indicates that prostaglandins play an important role in the pathogenesis of periodontal disease. In this study, the effects and interactions between IL-1β and TNFa on prostaglandin production and its regulation were investigated. The cytokines IL-1β and TNFa stimulated prostaglandin E2 (PGE2) and prostacyclin (PGI2) production in gingival fibroblasts. Simultaneous treatment of the cells with IL-1β and TNFa resulted in a synergistic stimulation of PGE2 and PGI2 formation. IL-1β and, to a lesser extent, TNFa stimulated the release of 3H-arachidonic acid (3H-AA), and simultaneous addition of IL-1β and TNFa further increased the release of 3H-AA from pre-labeled gingival fibroblasts. Furthermore, IL-1β and, to a lesser extent, TNFa induced the expression of cyclooxygenase-2 (COX-2) mRNA. Simultaneous addition of IL-1β and TNFa synergistically enhanced COX-2 mRNA levels, accompanied by a corresponding stimulation of PGE2 synthesis. Neither IL-1β, TNFa, nor the combination of these two cytokines affected COX-1 mRNA levels. PMA, known to activate protein kinase C (PKC), enhanced the stimulatory effect of IL-1β, TNFa, and the combination on COX-2 mRNA levels accompanied by a corresponding increase in PGE2 production. The phospholipase A2 (PLA2) inhibitor, BPB, and the PKC inhibitor, BIS, reduced PGE2 production, whereas dexamethasone, indomethacin, and NS-398 completely abolished PGE2 production induced by IL-1β, TNFa, and the combination. The study indicates that the synergistic stimulation of prostaglandin production by IL-1β, and TNFa is mediated partly at the level of COX-2 and partly at the level of PLA2 and that PKC is involved in the signal transduction of the synergy between the two cytokines. The synergy between IL-1β and TNFa may play an important role in the inflammatory processes in gingival tissue in vivo.

Risk factors and risk indicators associated with high caries experience in Swedish 19-year-olds

Objective. To study the risk factors and risk indicators associated with high caries experience (DMFS ≥ 10) in 19-year-olds. Material and Methods. The subjects (n=800) lived in seven suburbs of Stockholm and answered a structured questionnaire about their parents’ education, occupation, and country of birth, as well as their dietary habits, oral hygiene habits, and attitudes to dental care. Dental caries was assessed by clinical and radiographic examination using the decayed, missing, filled teeth (DMFT), and surfaces (DMFS) indices. Dental plaque (VPI%) and gingival bleeding (GBI%) indices were recorded. Results. A total of 696 subjects (364 M, 332 F) participated in the study. The mean DMFT and DMFS were 3.9 and 5.1, respectively. In 81% of subjects, the DMFT was ≥ 1 and 15% had DMFS ≥ 10. In the multivariate analysis, the variables significantly associated with high caries experience were: dental fear (p<0.001, odds ratio (OR) 2.8), GBI ≥ 15% (p=0.003, OR 2.1), mother born abroad (p=0.007, OR 2.0) and irregular toothbrushing at night (p=0.008, OR 1.9). When all significant variables in the multivariate analysis were present, the cumulative probability of DMFS ≥ 10 was 52%. Conclusions. Dental fear, gingival inflammation, a foreign-born mother, and irregular toothbrushing at night are variables that are strongly associated with high caries experience in 19-year olds. The study indicates that foreign-born parents, oral hygiene habits, and behavioral factors still have a strong impact on dental health in late adolescence.