Italian Deprivation Index and Dental Caries in 12-Year-Old Children: A Multilevel Bayesian Analysis

Evidence from the literature has shown that people with a lower socioeconomic status enjoy less good health than people with a higher socioeconomic status. The Italian deprivation index (DI) was used with the aim to evaluate the association between the DMFT index and risk factors for dental caries, including city population and DI. The study included 4,305 12-year-old children living in 38 cities classified by demographic size as small, midsize and large. Zero-inflated negative binomial multilevel regression models were used to assess risk factors for DMFT and to address excess of zero DMFT and overdispersion through a Bayesian approach. The difference in the average level of DMFT among children living in cities with different DI quintile was not statistically significant (p = 0.578). The DI and ln(population), included as city-level fixed effects in the two-level variance components model, were not statistically significant. Consuming sweet drinks on average increased the mean DMFT of a susceptible child, while having a highly educated mother reduced it. Un-observed heterogeneity among cities was detected for the probability to be non-susceptible to caries (city-level variance = 0.26 with 95% credibility interval 0.09–0.57), while no territorial effect was found for the mean DMFT of the susceptible children. Our results suggest that the DI and city population did not play a role in explaining between-city variability. Interventions against social deprivation can be influential on the perception of oral health in Italian 12-year-old children to the extent that they can also affect individual level factors

Concentration in saliva and antibacterial effect of xylitol chewing gum : in vivo and In vitro study

Purpose. The saliva concentration of xylitol released from two chewing gums was recorded, the first containing xylitol as the only sweetener (100% xylitol) and the second containing only 22% of the polyol. In addition, the in vitro antibacterial effect of the two chewing gums was evaluated. Materials and Methods. The salivary concentration of Xylitol in 32 subjects was determined before and at 0.30, 1.00, 2.00, 5.00, and 10.00 min while using the chewing gums, and at 15.00, 20.00, and 25.00 min after the gums were discarded. In vitro antibacterial activity was determined on a pooled subgingival plaque sample obtained from four patients with periodontal disease. Cariogenic and periodontal bacteria were evaluated before and 15 min, 60 min, and 24 h after gum contact. Results. Using the 100% xylitol chewing gum, saliva levels increased bimodally, one peak after 30 s (1.49 \ub1 1.41 log\u3bcg/L) and a second one at a 10-min evaluation (1.41 \ub1 1.11 log\u3bcg/L); the 22% chewing gum peaked only two minute after contact (1.21 \ub1 1.24 log\u3bcg/L). Overall, a statistically significantly higher salivary concentration of xylitol was detected using the 100% xylitol gum. All bacteria decreased after the addition of the two chewing gums; the 100% gum achieved a greater decrease than the 22% gum. Conclusion. The use of both chewing gums increased the concentrations of xylitol in saliva, with a statistically significantly higher concentration using the 100% xylitol gum. Cariogenic and periodontal bacteria were reduced by both chewing gums; 100% xylitol gum produced the highest and longest lasting effect. This study opens up to the use of xylitol against periodontal disease

Comparison of ICDAS, CAST, Nyvad’s Criteria, and WHO-DMFT for Caries Detection in a Sample of Italian Schoolchildren

Caries measurement methods vary considerably in terms of the stages of lesion considered making the comparison problematic among different surveys. In this cross-sectional study, four caries measurement methods, the WHO-DMFT, the International Caries Detection and Assessment System (ICDAS), the Caries Assessment Spectrum and Treatment (CAST), and the Nyvad Criteria were tested in a sample of children. Five-hundred 12-year old children (236 males and 264 females) were examined four times by four calibrated examiners. The calibration process showed that Cohen\u2019s Kappa exceeded the criterion of K = 0.75 and K = 0.80 for inter/intra-examiner agreement, respectively. In the survey, the total number of misclassification errors for the four methods amounted to 312 observations (67.94% regarding enamel lesions). The greatest difference among methods was shown by number of sound teeth (p < 0.01): WHO-DMFT n = 9505, 74.14%; ICDAS n = 2628, 20.49%; CAST n = 5053, 39.41%; and Nyvad Criteria n = 4117, 32.11%. At the level of dentinal Distinct/Active Cavity lesions, no statistically significant difference was observed (p = 0.40) between ICDAS (n = 1373, 10.71%), CAST (n = 1371, 0.69%), and Nyvad Criteria (n = 1720, 13.41%). In the severe caries levels, all methods were partially in agreement, while no accordance was found for the initial (enamel) lesions. A common language in caries detection is critical when different studies are compared

Xerostomia induced by radiotherapy: an overview of the physiopathology, clinical evidence, and management of the oral damage

Background: The irradiation of head and neck cancer (HNC) often causes damage to the salivary glands. The resulting salivary gland hypofunction and xerostomia seriously reduce the patient\u2019s quality of life. Purpose: To analyze the literature of actual management strategies for radiation-induced hypofunction and xerostomia in HNC patients. Methods: MEDLINE/PubMed and the Cochrane Library databases were electronically evaluated for articles published from January 1, 1970, to June 30, 2013. Two reviewers independently screened and included papers according to the predefined selection criteria. Results: Sixty-one articles met the inclusion criteria. The systematic review of the literature suggests that the most suitable methods for managing the clinical and pathophysiological consequences of HNC radiotherapy might be the pharmacological approach, for example, through the use of cholinergic agonists when residual secretory capacity is still present, and the use of salivary substitutes. In addition, a modified diet and the patient\u2019s motivation to enhance oral hygiene can lead to a significant improvement. Conclusion: Radiation-induced xerostomia could be considered a multifactorial disease. It could depend on the type of cancer treatment and the cumulative radiation dose to the gland tissue. A preventive approach and the correct treatment of the particular radiotherapeutic patient can help to improve the condition of xerostomia

Efficacy of nano-hydroxyapatite on caries prevention-a systematic review and meta-analysis.

Introduction/objectives: The review systematically explored in vivo or in situ studies investigating the efficacy of nano-hydroxyapatite (nHA) to reduce initiation of or to remineralize initial caries lesions. Data: Prospective controlled (non-)randomized clinical trials investigating the efficacy of a nHA compared to any other (placebo) treatment or untreated/standard control. Sources: Three electronic databases (Central Cochrane, PubMed-MEDLINE, Ovid EMBASE) were screened. Outcomes were, e.g., ICDAS score, laser fluorescence, enamel remineralization rate, mineral loss, and lesion depth. No language or time restrictions were applied. Risk of bias and level of evidence were graded using the Risk of Bias 2.0 tool and GRADE profiler. Study selection/results: Five in vivo (and 5 in situ) studies with at least 633 teeth (1031 specimens) being assessed in more than 420 (95) patients were included. No meta-analysis could be performed for in vivo studies due to the high heterogeneity of the study designs and the variety of outcomes. In situ studies indicate that under demineralization conditions, NaF was able to hinder demineralization, whereas nHA did not; simultaneously, nHA did not differ from the fluoride-free control. In contrast, under remineralizing conditions, nHA and NaF show the same remineralizing potential. However, the level of evidence was very low. Furthermore, six studies showed a high risk of bias, and six studies were funded/published by the manufacturers of the tested products. Conclusion: The low number of clinical studies, the relatively short follow-up periods, the high risks of bias, and the limiting grade of evidence do not allow for conclusive evidence on the efficacy of nHA. Clinical relevance: No conclusive evidence on the efficacy of nHA could be obtained based on the low number of clinical studies, the relatively short follow-up periods, the high risks of bias, the limiting grade of evidence, and study conditions that do not reflect the everyday conditions

Root canal morphology of the mandibular second premolar: a systematic review and meta- analysis

Background: The aim of this paper was to systematically review the root canal configuration (RCC) and morphology literature of the mandibular second premolar (Mn2P). Methods: Systematic research of five electronic databases was performed to identify published literature concerning the root canal configuration (RCC) of the Mn2P up through July 2020. Studies were selected according to predefined search terms and keywords inclusion criteria: “root canal configuration”, “root canal system”, “root canal morphology”, “mandibular second premolar”, “mandibular premolars”, “morphology” and “anatomy”. Further possible studies were identified by cross-referencing and screening the bibliographies of the selected articles. Results: From 1622 retrieved studies, 44 studies investigating the internal morphology of 17,839 Mn2Ps were included. Most examined Mn2Ps were single-rooted (89.5–100%); two-rooted (0.1–8%) and three-rooted (0.1–3.5%) Mn2Ps at lower frequency. Most frequent RCCs reported were 1–1–1/1 (55.3–99.6%) followed by 1–1–2/2 (0.5–57%) and 2–2–2/2 (0.6–18%). The meta-analysis of seven studies demonstrated that a significantly higher number of RCC type 1–2–1/1 (OR [95%CI] = 2.05 [1.27, 3.33]) and 2–2–2/2 (OR [95%CI] = 2.32 [0.65, 8.63]) were observed in male than in female patients. Conclusions: Different RCC research methods have been reported. Whereas clearing and radiographs were com- monly used in the past, CBCT has been prevalent in recent years. A globally high frequency of a 1–1–1/1 RCC in the Mn2P has been reported. Nevertheless, the probability that different, more complicated RCCs can appear in Mn2Ps should not be underestimated and, thus, should be taken into consideration when making decisions during an endo- dontic treatment

The role of vitamins in oral health. A systematic review and meta-analysis

The association between vitamins and oral health have recently been discussed, yielding increased attention from medical and dental perspectives. The present review aimed to systematically evaluate and appraise the most recently scientific papers investigating the role of vitamins in the prevention and treatment of the main oral diseases as hard dental pathological processes and gum/periodontal disease. Randomized controlled trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, reporting associations between vitamins and oral diseases or the use of vitamins to prevent or treat oral diseases in patients of any age were included. PubMed, Embase and Scopus were searched to November 2019 using an ad hoc prepared search string. All the papers meeting the inclusion criteria were subjected to a quality assessment. The search identified 1597 papers; 741 were selected after removing duplicates. A total of 334 articles were excluded after title and abstract evaluation; 407 were assessed and 73 papers were full-text assessed; other 14 papers were discharged after full text evaluation, leaving finally 58 papers included. In general, there is weak evidence supporting the association between vitamins and both gingival/periodontal disease and hard dental pathological processes

Systematic review and meta-analysis on physical barriers to prevent root dentin demineralization.

The present review systematically analyzed in vitro and in situ studies investigating physical diffusion barriers (sealants, desensitizer or adhesives) to prevent the development or the progression of root (dentin) demineralization. Three electronic databases (PubMed-Medline, CENTRAL, Ovid-EMBASE) were screened for studies from 1946 to 2022. Cross-referencing was used to identify further articles. Article selection and data abstraction were done in duplicate. Languages were not restricted. The type of outcome was not restricted, and their mean differences (MD) were calculated using fixed- or random-effects models. Risk of Bias was graded using Risk of Bias 2.0 tool. From 171 eligible studies, 34 were selected for full-text analysis evaluating 69 different materials, and 17 studies-still evaluating 36 different materials-were included (3 in situ and 14 in vitro). Ten studies evaluated desensitizers; 8 adhesives; and 1 infiltration. Meta-analyses were possible for all 17 studies. Meta-analyses revealed that lesion depth after no treatment was significantly higher than after the application of single-step adhesives (MD[95%CI] = - 49.82[- 69.34; - 30.30]) and multi-step adhesives (MD[95%CI]=-60.09 [-92.65, -27.54]). No significant differences in the lesion depth increase between single- and multi-step adhesives could be observed (MD[95%CI]=30.13 [-21.14, 81.39]). Furthermore, compared to no treatment the increase of the lesion depth was significantly hampered using desensitizers (MD[95%CI] = - 38.02[- 51.74; - 24.31]). Furthermore, the included studies presented unclear or high risk. A physical diffusion barrier can significantly hamper the increase of lesion depth under cariogenic conditions. Furthermore, multi-step adhesives seem not to be more effective than single-step adhesives. However, this conclusion is based on only few in vitro and in situ studies

Topical application of chlorhexidine gel with brush-on technique in the tailored treatment of plaque induced gingivitis

Aim: This study aimed to assess the action of a chlorhexidine-based brush-on gel application in the treatment of plaque-related gingivitis. Methods: The enrollment involved consecutive patients diagnosed with plaque-induced gingivitis. Each participant's full mouth plaque score and gingival index were recorded at the first appointment (t0) and at follow ups after 1 week (t1), 2 weeks (t2) and 3 weeks (t4). All patients were randomly sorted into two groups: A study group, who was given instruction to brush their gums daily with a chlorhexidine gel, and a control group who received a placebo gel. The two groups' data at baseline were compared using a chi-square test, while the t-Student and Mann-Whitney tests were employed to analyze the index's trends, both separately and compared. Results: In total, 30 patients were enrolled, 15 referring to the study group and 15 to the control group. The study group had an 87% decrease in their plaque score and an 84% decrease in their gingival index (p < 0.05). The control group displayed a reduction in plaque score and gingival index of 74% and 84%, respectively (p < 0.05). The plaque score decreased statistically more significantly in the study group than in the control group. Conclusion: Topical employment of a chlorhexidine-containing brush-on gel appears to be a useful home tool in the treatment of plaque-induced gingivitis, associated with professional debridement

Changing trend of caries from 1989 to 2004 among 12-year old Sardinian children

BACKGROUND: During the past decades, the prevalence of caries disease in the population of Western industrialized countries has decreased markedly. In children also, a reduction of dental caries experience has been reported by many authors. The aim of this paper was to evaluate the trend of dental caries prevalence in 12-year-old children living in the city of Sassari, (Italy), by five cross-sectional studies conducted in 1989, 1992, 1995, 1998 and 2004. METHODS: In all cohorts, dental caries (DMFT and SiC Index according to WHO indications), was measured. For each variable measured (DMFT and sub-indices, SiC Index), differences in proportions among the five cohorts during the fifteen years were tested using chi2-square test. RESULTS: The mean DMFT index decreased from 4.3 +/- 3.1 in 1989 to 0.8 +/- 1.5 in 2004. The prevalence of untreated caries (DT) had a notable decrease between 1992 and 1995, increased slightly between 1995 and 1998 and had the greatest decrease in 2004. The number of filled teeth remains low. The percentage of caries-free children increased from 10% to 64%, whereas the percentage of untreated caries changed from 44% in 1989 to 62% in 2004. SiC Index decreased from 7.8 in 1989 to 3.9 in 2004. CONCLUSION: On the basis of the results of DMFT and SiC Index, caries experience has been reduced. The vigilance and the promotion of a higher standard of personal oral hygiene and dental check-ups are necessary to obtain an improvement of oral status in the future adult population and to reach the new WHO global goals