The COVID-19 pandemic and its global effects on dental practice. An international survey

Objectives: A multicentre survey was designed to evaluate the impact of COVID-19 outbreak on dental practice worldwide, estimate the COVID-19 related symptoms/signs, work attitudes and behaviour and the routine use of protective measures and Personal Protective Equipment (PPE). Methods: A global survey using a standardized questionnaire with research groups from 36 countries was designed. The questionnaire was developed and pretested during April 2020 and contained three domains: 1) Personal data; 2) COVID-19 positive rate and symptoms/signs presumably related to the coronavirus; 3) Working conditions and PPE adopted after the outbreak. Countries’ data were grouped by the Country Positive Rate (CPR) during the survey period and by Gross-National-Income per capita. An ordinal multinomial logistic regression model was carried out with COVID-19 self-reported rate referred by dental professionals as dependent variable to assess the association with questionnaire items. Results: A total of 52,491 questionnaires were returned with a male/female ratio of 0.63. Out of the total respondents, 7,859 dental professionals (15%) reported symptoms/signs compatible with COVID-19. More than half of the sample (n = 27,818; 53%) stated to use FFP2/N95 masks, while 21,558 (41.07%) used eye protection. In the bivariate analysis, CPR and N95/FFP2 were significantly associated (OR = 1.80 95%CI = 1.60/2.82 and OR = 5.20 95%CI = 1.44/18.80, respectively), while Gross-National-Income was not statistically associated with CPR (OR = 1.09 95%CI = 0.97/1.60). The same significant associations were observed in the multivariate analysis. Conclusions: Oral health service provision has not been significantly affected by COVID-19, although access to routine dental care was reduced due to country-specific temporary lockdown periods. While the dental profession has been identified at high-risk, the reported rates of COVID-19 for dental professionals were not significantly different to those reported for the general population in each country. These findings may help to better plan oral health care for future pandemic events

An assessment of three contemporary dental caries epidemiological instruments: a critical review

Contains fulltext : 218292.pdf (Publisher’s version ) (Closed access)Aim Dental caries epidemiological surveys produce information that may be used to assist health policy makers in the planning of preventive and curative strategies. The detection instruments used in these surveys should be able to identify the correct, true stage of the disease or medical condition. This makes it essential that valid instruments are used. This study aimed to critically review commonly used visual/tactile caries assessment instruments in epidemiological surveys with respect to their manageability, reproducibility and validity, and how results are reported.Method A Pubmed search identified the following international visual/tactile instruments for caries detection more than once between 2013 and 2018: World Health Organisation (WHO), International Caries Detection and Assessment System (ICDAS) and Caries Assessment Spectrum and Treatment (CAST).Results The review revealed that the WHO instrument can be considered a screening instrument, that the ICDAS instrument lacks sufficient validity and takes time to apply and that the CAST instrument is promising, but requires further field testing before it can be considered a fully proven caries-assessment instrument in epidemiology. It is recommended that calculating caries prevalence should be based on the presence of cavitated dentine carious lesions, that the prevalence of enamel carious lesions be reported separately and that the dmf/DMF index not be used in its current form.Conclusion Researchers/dentists should be knowledgeable of the limitations and advantages of common caries assessment instruments. Caries prevalence should not be based on the dmf/DMF index but on cavitated dentine carious lesions (d/D-component) as the M- and F-component do not refer to a disease stage

Effect of Fluoridated Milk on Enamel and Root Dentin Demineralization Evaluated by a Biofilm Caries Model

Giacaman, RA (reprint author), Univ Talca, Escuela Odontol, Dept Oral Rehabil, Cariol Unit, 2 Norte 685, Talca, Chile.Although some studies suggest an anticaries effect of fluoridated bovine milk (F-milk) on enamel, evidence is still considered weak. Even more uncertain, the effect of F-milk on root caries remains largely unknown. This study evaluated the effect of F-milk on enamel and on root dentin demineralization using a validated Streptococcus mutans biofilm model, simulating a high cariogenic challenge. S. mutans (UA159) biofilms were formed on bovine enamel and root dentin saliva-coated slabs after measuring initial surface microhardness (SH). Biofilms were exposed to 10% sucrose 8x/day and treated 2x/day with either: (1) 0.9% NaCl (negative control), (2) bovine milk, (3) F-milk (5.0 ppm F as NaF) or (4) NaF 0.05% (anticaries-positive control). Medium pH was monitored twice/day, as a biofilm acidogenicity indicator. After 5 days for enamel and 4 days for dentin, biofilms were recovered to analyze: biomass, soluble proteins, viable microorganisms, and extra- and intracellular polysaccharides. Enamel and dentin demineralization were estimated by percentage of SH loss. Results were compared by ANOVA and Tukey's test. Neither acidogenicity nor biofilm composition differed among treatment groups in biofilms formed on enamel or dentin (p > 0.05). F-milk, however, significantly reduced enamel and dentin demineralization when compared with the negative control (p 0.05), but not dentin demineralization (p < 0.05). These findings suggest that milk containing 5.0 ppm of fluoride is effective to control enamel caries and that it may be effective on root dentin caries prevention. Copyright (c) 2012 S. Karger AG, Base

Cariogenic potential of commercial sweeteners in an experimental biofilm caries model on enamel

Giacaman, RA (Giacaman, Rodrigo A.)[ 1 ] ; Campos, P (Campos, Pia)[ 1 ] ; Munoz-Sandoval, C (Munoz-Sandoval, Cecilia)[ 1 ] ; Castro, RJ (Castro, Ramiro J.)[ 1 ]. Univ Talca, Dept Oral Rehabil, Cariol Unit, Talca, ChileAbstract: Objective: Scarce evidence is available on the cariogenic potential of the widely used commercial sweeteners. The aim of this study was to evaluate the effect of several sweeteners on enamel demineralisation and on the cariogenic properties of Streptococcus mutans biofilms in an artificial caries model. Methods: S. mutans-UA159 biofilms were cultured on bovine enamel slabs and exposed to one of the following commercial sweeteners in tablet or powder form: stevia, sucralose, saccharin, aspartame or fructose. Ten percent sucrose and 0.9% NaCl were used as caries-positive and caries-negative controls, respectively. Slabs/biofilms were exposed to the sweeteners three times per day for 5 min each time. After 5 days, biofilms were recovered to determine: biomass, bacterial counts and intra- and extracellular polysaccharides. Surface microhardness was measured before and after the experiment to assess enamel demineralisation, expressed as percentage of surface hardness loss (%SHL). Data were analysed using analysis of variance (ANOVA) and Bonferroni (p < 0.05). Results: All tested commercial sweeteners, except fructose, showed less enamel demineralisation than sucrose (p < 0.05). Only saccharine showed less biomass and intracellular polysaccharides than the rest of the groups (p < 0.05). Stevia, sucralose and saccharine reduced the number of viable cells when compared with sucrose (p < 0.05). All sugar alternatives reduced extracellular polysaccharide formation when compared with sucrose (p < 0.05). Conclusions: Most commercial sweeteners appear to be less cariogenic than sucrose, but still retaining some enamel demineralisation potential. Products containing stevia, sucralose and saccharine showed antibacterial properties and seem to interfere with bacterial metabolism. Further studies are necessary to deepen these findings. (C) 2013 Elsevier Ltd. All rights reserved

Caries risk assessment by Dutch dental students

Objectives: Individual caries risk assessment (CRA) is essential for targeted caries management at both preventive and therapeutic levels. This study explores the knowledge and use of CRA by Dutch dental students.Methods: A total of 213 fifth-year dental students from three dental schools in the Netherlands (Amsterdam (n=119), Groningen (n=44) and Nijmegen (n=50)) were invited to participate. Data was collected using a survey.Results: This survey was completed by 118 students (55%). All respondents reported using CRA on a regular basis, although only part of them reported applying it on both primary/mixed and permanent dentitions (Amsterdam 67% vs. Groningen 45% vs. Nijmegen 86%; χ2=18.671, p&lt;0.001). Almost all respondents tailored the frequency of dental visits (96%) and preventive strategies (99%) based on CRA, while 18% of them indicated not to base individual treatment plans on CRA. Oral hygiene, diet as well as active and recent carious lesions were considered as the most important factors in CRA for all patients, regardless of their age (no statistical differences among schools). The interest for continuing education on CRA significantly differed among the three schools (Amsterdam 47% vs. Groningen 61% vs. Nijmegen 24%; χ2=14.597, p=0.006). Students that did not use CRA in all patient groups were more likely to express an interest for continuing education on CRA (χ2=3.928, p=0.047).Conclusions: Dutch dental students report a rather similar knowledge on CRA between schools. However, the recently intensified collaboration between the dental schools could homogenize the training of dental students even further

Supplementary Material for: Effect of CPP-ACP added to Milk, Chewing Gum and Candy on Dental Caries: a Systematic Review

Casein is one of the most studied proteins with activity against dental caries. In particular, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has shown promising remineralizing properties. In vivo evidence on the anticaries potential of CPP-ACP added to foodstuffs is elusive, nonetheless. Hence, this systematic review aimed at determining whether the use of CPP-ACP added to foodstuffs has a remineralizing or inhibitory action on dental demineralization either in vivo or in situ. The review protocol followed the PRISMA-P criteria and was registered in PROSPERO. PubMed, SCOPUS, and Web of Science databases were searched using predefined criteria, based on the PICO question; Is there an effect on dental caries upon adding CPP-ACP to milk, chewing gums, or candies? No year or language limits were applied. Article selection and data extraction were carried out independently by 2 investigators. Two hundred-ten titles were examined, 23 selected for full-text review and 16 studies included (2 in vivo, and 14 in situ). In 2 studies, CPP-ACP was added in candy, in 2 to milk and in 12 to chewing gum. The main outcomes included enamel remineralization and activity against dental biofilm. The overall quality of the evidence was classified as moderate. The available evidence suggests that CPP-ACP added to milk, chewing gum or candy has a potential remineralizing activity on tooth enamel, with some additional antibacterial activity on the dental biofilm. Further clinical studies are needed to verify if this effect is clinically significant in reducing the caries lesion incidence or to revert the demineralizing process

Fluoride content in toothpastes commercialized for children in Chile and discussion on professional recommendations of use

Giacaman, RA (Giacaman, Rodrigo A.)[ 1 ] ; Carrera, CA (Carrera, Carola A.)[ 1 ] ; Munoz-Sandoval, C (Munoz-Sandoval, Cecilia)[ 1 ] . Univ Talca, Cariol Unit, Dept Oral Rehabil, Talca, ChileInternational Journal of Paediatric Dentistry 2013; 23: 7783 Background. In Chile, no information is available regarding the soluble fluoride (F) content in the toothpastes commercialized for children and the country's guidelines recommend the use of F in toothpastes in an age-dependent concentration. No global consensus has been reached on this subject. Aim. To determine the soluble F concentration in dentifrices for children sold in Chile and to discuss Chilean guidelines and professional recommendations of use. Design. Three samples of twelve different dentifrices were purchased from drugstores. Toothpastes were analysed in duplicate using an ion-specific electrode. The concentrations of total F (TF) and total soluble F (TSF) were determined (g F/g). Results. Measured TF was consistent with that declared by the manufacturer in eight products. Two dentifrices showed lower TF and two higher F concentrations than declared. A toothpaste, marketed as low-F (450ppm), showed F concentration threefold higher. Most dentifrices exhibited TSF concentrations similar to the TF content, except one sample that displayed considerably lower TSF than TF. Recommendations on F toothpastes use in children widely vary from country to country. Conclusions. Most dentifrices for children match F content in the labelling, but recommendations are not supported by the best evidence available on the benefit/risk of F toothpastes use

Supplementary Material for: Effect of CPP-ACP added to Milk, Chewing Gum and Candy on Dental Caries: a Systematic Review

Casein is one of the most studied proteins with activity against dental caries. In particular, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has shown promising remineralizing properties. In vivo evidence on the anticaries potential of CPP-ACP added to foodstuffs is elusive, nonetheless. Hence, this systematic review aimed at determining whether the use of CPP-ACP added to foodstuffs has a remineralizing or inhibitory action on dental demineralization either in vivo or in situ. The review protocol followed the PRISMA-P criteria and was registered in PROSPERO. PubMed, SCOPUS, and Web of Science databases were searched using predefined criteria, based on the PICO question; Is there an effect on dental caries upon adding CPP-ACP to milk, chewing gums, or candies? No year or language limits were applied. Article selection and data extraction were carried out independently by 2 investigators. Two hundred-ten titles were examined, 23 selected for full-text review and 16 studies included (2 in vivo, and 14 in situ). In 2 studies, CPP-ACP was added in candy, in 2 to milk and in 12 to chewing gum. The main outcomes included enamel remineralization and activity against dental biofilm. The overall quality of the evidence was classified as moderate. The available evidence suggests that CPP-ACP added to milk, chewing gum or candy has a potential remineralizing activity on tooth enamel, with some additional antibacterial activity on the dental biofilm. Further clinical studies are needed to verify if this effect is clinically significant in reducing the caries lesion incidence or to revert the demineralizing process

Supplementary Material for: Effect of CPP-ACP added to Milk, Chewing Gum and Candy on Dental Caries: a Systematic Review

Casein is one of the most studied proteins with activity against dental caries. In particular, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has shown promising remineralizing properties. In vivo evidence on the anticaries potential of CPP-ACP added to foodstuffs is elusive, nonetheless. Hence, this systematic review aimed at determining whether the use of CPP-ACP added to foodstuffs has a remineralizing or inhibitory action on dental demineralization either in vivo or in situ. The review protocol followed the PRISMA-P criteria and was registered in PROSPERO. PubMed, SCOPUS, and Web of Science databases were searched using predefined criteria, based on the PICO question; Is there an effect on dental caries upon adding CPP-ACP to milk, chewing gums, or candies? No year or language limits were applied. Article selection and data extraction were carried out independently by 2 investigators. Two hundred-ten titles were examined, 23 selected for full-text review and 16 studies included (2 in vivo, and 14 in situ). In 2 studies, CPP-ACP was added in candy, in 2 to milk and in 12 to chewing gum. The main outcomes included enamel remineralization and activity against dental biofilm. The overall quality of the evidence was classified as moderate. The available evidence suggests that CPP-ACP added to milk, chewing gum or candy has a potential remineralizing activity on tooth enamel, with some additional antibacterial activity on the dental biofilm. Further clinical studies are needed to verify if this effect is clinically significant in reducing the caries lesion incidence or to revert the demineralizing process

Supplementary Material for: Effect of CPP-ACP added to Milk, Chewing Gum and Candy on Dental Caries: a Systematic Review

Casein is one of the most studied proteins with activity against dental caries. In particular, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has shown promising remineralizing properties. In vivo evidence on the anticaries potential of CPP-ACP added to foodstuffs is elusive, nonetheless. Hence, this systematic review aimed at determining whether the use of CPP-ACP added to foodstuffs has a remineralizing or inhibitory action on dental demineralization either in vivo or in situ. The review protocol followed the PRISMA-P criteria and was registered in PROSPERO. PubMed, SCOPUS, and Web of Science databases were searched using predefined criteria, based on the PICO question; Is there an effect on dental caries upon adding CPP-ACP to milk, chewing gums, or candies? No year or language limits were applied. Article selection and data extraction were carried out independently by 2 investigators. Two hundred-ten titles were examined, 23 selected for full-text review and 16 studies included (2 in vivo, and 14 in situ). In 2 studies, CPP-ACP was added in candy, in 2 to milk and in 12 to chewing gum. The main outcomes included enamel remineralization and activity against dental biofilm. The overall quality of the evidence was classified as moderate. The available evidence suggests that CPP-ACP added to milk, chewing gum or candy has a potential remineralizing activity on tooth enamel, with some additional antibacterial activity on the dental biofilm. Further clinical studies are needed to verify if this effect is clinically significant in reducing the caries lesion incidence or to revert the demineralizing process