Binational/Cross Cultural Health Enhancement Center (BiCCHEC) at IUPUI

poster abstractBiCCHEC fosters multidisciplinary research collaborations that address the biological, cultural, historical, legal, behavioral and demographic issues that impact the health status of communities where Latinos are born and where they live in Indiana. BiCCHEC has a commitment not only to research but also to teaching and service, and works always in partnership with communities. Current projects include: A microcredit project for residents of rural villages in Mexico, in partnership with the Indianapolis Rotary Club and ProMujer; a study on international service-learning outcomes of health professional students in the U.S., Latin America (Mexico), Africa (Kenya), and Asia (China), a partnership among IUSD, IUSM and IUSON faculty; a study on oral health disparities using community-based participatory research methodology, in partnership with La Plaza, and the Institute for Mexicans Abroad; and, a study on the dissemination of the Helping Babies Breath program in small rural communities, in partnership with the UAEH

Teeth With Mild and Moderate Enamel Fluorosis Demonstrate Increased Caries Susceptibility In Vitro

Subjects In this laboratory study, 49 human unerupted third molars extracted for clinical reasons and classified as scores 0-4 using the Thylstrup and Fejerskov (TF) index (n = 9 for TF0, n = 10 for TF1, n = 10 for TF2, n = 10 for TF3, and n = 10 for TF4) were included. TF1-TF4 teeth were collected in Colombia, and TF0 teeth were obtained from the University of Copenhagen. Ethical approval was obtained. Key Risk/Study Factor Teeth in the study were subjected to pH cycling to induce caries lesions. Main Outcome Measure The primary outcome measure was resistance to a cariogenic challenge determined using cross-sectional microhardness. A series of indentations, starting at 10 μm below the anatomic surface down to 200 μm, were placed in the teeth using a Knoop indenter. These measurements were performed before and after pH cycling, yielding baseline and demineralization areas, both calculated “by numerical integration of the hardness vs depth values using the trapezoidal rule.” The demineralization data were then normalized for differences at baseline and a “percentage reduction” was calculated, with higher numbers being indicative of greater susceptibility to caries lesion formation. Main Results Teeth with scores of TF3 and TF4 exhibited greater susceptibility to caries lesion formation than all other teeth, with no differences being observed between unaffected teeth (TF0) and teeth with scores of TF1 and TF2. Teeth with scores of TF3 and TF4 also displayed a lower mean baseline area than those with TF1 and TF2, although not compared to TF0 teeth, indicative of greater hypomineralization. Conclusions The authors concluded that the results of their study suggest that teeth with moderate fluorosis had an increased caries susceptibility when compared to teeth with very mild or no fluorosis. They hypothesized that these differences in caries susceptibility are mainly due to dissimilarities in porosity of the enamel—in fluorotic teeth, a greater subsurface mineral area is exposed to demineralization, and deeper acid diffusion through enamel is facilitated

Binational/Cross-Cultural Health Enhancement

poster abstractThe Binational/Cross-Cultural Health Enhancement Center (BiCCHEC) fosters multidisciplinary research collaborations that address the biological, cultural, historical, legal, behavioral and demographic issues that impact the health status of communities where Hispanics are born and where they live in Indiana. BiCCHEC, with a commitment not only to research but also to teaching and service, develops and utilizes approaches, programs, training, and applications that are culturally relevant, practical, just, reciprocal, and always in partnership with communities. As communities become more and more diverse, obstacles to health and wellbeing created by language and cultural differences emerge. Finding ways to improve the availability of health services and eliminate health disparities for an increasingly diverse and mobile community is a commitment of the center. Since its 2007, BiCCHEC members have submitted sixty three internal and external grants of which thirty one have been funded for over $900,000. They have published 31 peerreviewed articles or book chapters and presented their research findings in 81 symposiums, showcases, workshops or conferences as keynote speakers, panel discussants or speakers. BiCCHEC projects are multidisciplinary; approximately 80% of the projects involve two or more IUPUI schools. BiCCHEC projects are also collaborative; approximately 70% of the projects have one or more community partners. BiCCHEC’s main community partners are La Plaza, Inc., the Institute for Mexicans Abroad (IME), Friends of Hidalgo, and more recently the Indiana Latino Institute. BiCCHEC conducts research with a commitment to service and education. Members have mentored 111 students in research and service-learning projects

Relative fluoride response of caries lesions created in fluorotic and sound teeth studied under remineralizing conditions

Objectives The present in vitro pH cycling study investigated potential differences between caries lesions created in fluorosed and sound enamel with regards to their responsiveness to fluoride under remineralizing conditions. Methods 360 human first molars (sound and fluorosed) were divided into four groups based on their Thylstrup–Fejerskov score (TF0-3). Each group was further divided into two treatment groups (n = 45): deionized water or 383 ppm fluoride. Artificial enamel caries lesions were created and pH cycled for 20 d using an established net remineralization model. Quantitative light-induced fluorescence was used throughout the study to investigate lesion severity and changes thereof. Data were analyzed using two-way ANOVA. Results There were no differences in lesion severity between all groups after lesion creation (plesion = 0.1934). The TF score vs. treatment interaction was significant at all other time points (p10 d = 0.0280; p20 d ≤ 0.0001; psecdemin = 0.0411). Relative differences in responsiveness to fluoride vs. deionized water increased with increasing TF scores. In comparison to lesions created in sound enamel, lesions created in enamel with moderate fluorosis (TF 2/3) were more prone to remineralization in the presence than in the absence of fluoride. Furthermore, lesions created in enamel with moderate fluorosis exhibited more remineralization in the presence of fluoride than lesions created in sound teeth, whereas the opposite was true for deionized water. Conclusion Bearing in mind the limitations of laboratory research, the extent of enamel fluorosis severity may directly impact subsequent lesion re- and progression as well as the lesion's responsiveness to fluoride. Clinical relevance Caries lesions in fluorotic teeth are more vulnerable to progression but respond more strongly to fluoride than those in non-impacted teeth

An In-Vitro Study to Determine Anti-Caries Efficacy of Fluoride Varnishes

poster abstractFundamental research on fluoride varnishes (FV) and how different formulations affect adherence to teeth, fluoride release into saliva and uptake by teeth is virtually non-existent. The objective of this in vitro study was to investigate the anti-caries efficacy of five commercially available FV: Enamel Pro® Varnish Clear, Flor-Opal® Varnish White, MI Varnish™, PreviDent® and Vanish™. Ninety bovine enamel specimens (4x4mm) were prepared and assigned to five groups (n=18). Early caries lesions were created in the specimens and characterized using Vickers microhardness (VHN). FV was applied to each group of specimens. Immediately afterwards, 7.5ml of artificial saliva (AS) were pipetted over each group, collected and renewed every 15min for 6h. AS samples were analyzed for fluoride using a ion-specific electrode and meter. FV was removed using chloroform and part of the specimens protected to determine enamel fluoride uptake (EFU) using the acid etch technique. Each group was then subjected to pH cycling consisting of a 4h/day acid challenge and two, one-minute treatments with Crest Cavity Protection. Post-pH cycling microhardness was measured and compared to baseline values to determine the ability of the FV to enhance remineralization/prevent demineralization. One-way ANOVA was used for data analysis (p Enamel Pro® (217μg/ml) > Flor-Opal® (153μg/ml) > PreviDent® (84μg/ml) > Vanish(28μg/ml). In conclusion, anti-caries efficacy (measured through EFU, fluoride release and VHN) differs among FV products and this difference may be attributed to different composition, fluoride source and other active ingredients

An In Situ Caries Study on the Interplay between Fluoride Dose and Concentration in Milk

Objectives This randomized, cross-over in situ study investigated the impact of sodium fluoride dose and concentration in milk on caries lesion rehardening, fluoridation and acid resistance. Methods Twenty-eight subjects wore two gauze-covered enamel specimens with preformed lesions placed buccally on their mandibular partial dentures for three weeks. Participants used fluoride-free dentifrice throughout the study and consumed once daily one of the five study treatments: no fluoride in 200 ml milk (0F-200), 1.5 or 3 mg fluoride in either 100 (1.5F-100; 3F-100) or 200 ml milk (1.5F-200; 3F-200). After three weeks, specimens were retrieved. Knoop hardness was used to determine rehardening and resistance to a secondary acid challenge. Enamel fluoride uptake (EFU) was determined using a microbiopsy technique. Results A linear fluoride dose–response was observed for all study variables which exhibited similar overall patterns. All the treatments resulted in rehardening, with 0F-200 inducing the least and 3F-100 the most. Apart from 1.5F-200, all the treatments resulted in statistically significantly more rehardening compared to 0F-200. The fluoride doses delivered in 100 ml provided directionally although not statistically significantly more rehardening than those delivered in 200 ml milk. EFU data exhibited better differentiation between treatments: all fluoridated milk treatments delivered more fluoride to lesions than 0F-200; fluoride in 100 ml demonstrated statistically significantly higher EFU than fluoride in 200 ml milk. Findings for acid resistance were also more discerning than rehardening data. Conclusions The present study has provided further evidence for the anti-caries benefits of fluoridated milk. Both fluoride dose and concentration appear to impact the cariostatic properties of fluoride in milk

Effects of fluoride concentration and temperature of milk on caries lesion rehardening

Objectives The aim of the present in vitro study was to investigate the effects of fluoride concentration and temperature of milk on caries lesion rehardening under pH cycling conditions. Methods Incipient caries-like lesions were formed in human enamel specimens, characterized using Vickers surface microhardness (VHN) and assigned to seven treatment groups (n = 18 per group): fluoride was tested at five levels (0, 2.5, 5, 10, 20 mg/l, all 22 °C) and milk temperature at three levels (4, 22, 60 °C), but only for 10 mg/l F. Lesions were pH cycled for 15d (4×/daily 10 min milk treatments, 1×/daily 4 h acid challenge, remineralization in human/artificial saliva mixture). VHN of specimens were measured again and changes from lesion baseline were calculated. Subsequently, enamel fluoride uptake (EFU) was determined using the micro drill technique. Results Lesions responded to fluoride in a dose–response manner with higher fluoride concentrations resulting in more lesion rehardening (20 > 10 ≥ 5 ≥ 2.5 > 0 mg/l F). Furthermore, fluoridated milk at 60 °C was found to be more efficacious than at 4 °C (60 ≥ 22 > 4 °C). EFU results were similar (20 > 10 > 5 > 2.5 ≥ 0 mg/l F; 60 > 22 ≥ 4 °C). Conclusions Both fluoride concentration and milk temperature are likely to contribute to the anti-caries potential of fluoridated milk

PILOT APPRAISAL OF VARIABLES AMONG MEXICAN-AMERICANS FOR SOCIAL NETWORKS ANALYSIS

poster abstractHispanics in the USA often suffer poor oral health. More appropriate solutions may be designed if we move beyond the simplistic interpretation of poor oral outcomes being associated with 1-2 variables, e.g., language; such an approach has failed to provide consistent interpretations, and offers no points for intervention. We propose to examine a constellation of variables interwoven into multilevel strategies under a new(er) paradigm, social network theories (http://cmol.nbi.dk/models/infoflow/infoflow.html). Objectives: To qualitatively identify domains of variables modulating oral health outcomes among 1st-2nd generation MexicanAmerican immigrants. Methods: Through key informant interviews, we ascertained KAB variables in immigrant families originating in Jalisco, Mexico. This community has had a strong, revolving presence for decades in a well-delimited location in Indianapolis, IN, around St. Patrick’s parish. We did not conduct clinical exams but used questions from American national surveys to document health perceptions, availability of dental services/insurance, presence of dental pain and impaired function in adults and children, and family structure and sociodemographic profiles during a Catholic festival (no incentives, no appointments). Data were content-analyzed. Results: Data were collected from 22 parent-child dyads (15 female adults, 7 male; mean age 24±6.3yrs; data from the oldest child and the interviewee). Frequencies of dental emergencies and acute problems varied markedly, with recurrence patterns. A minority exhibited consistent dental attendance, often enabled by public/private dental insurance. Time in the USA varied considerably, with 1st and 2nd generation immigrant parents and children sharing the household. Occupations ranged from manual to clerical, and education from elementary to college among adults. Conclusion: Interviews were feasible and acceptable, and the experience informed future fieldwork considerations. We are using the variables to design a social networks study to characterize the evolution of patterns between families in Indianapolis and among peers living in Jalisco, aiming to measure impacts ascribable to immigration along acculturation spectra

In vitro caries lesion rehardening and enamel fluoride uptake from fluoride varnishes as a function of application mode

PURPOSE: To study the laboratory predicted anticaries efficacy of five commercially available fluoride varnishes (FV) by determining their ability to reharden and to deliver fluoride to an early caries lesion when applied directly or in close vicinity to the lesion (halo effect). METHODS: Early caries lesions were created in 80 polished bovine enamel specimens. Specimens were allocated to five FV groups (n = 16) based on Knoop surface microhardness (KHN) after lesion creation. All tested FV claimed to contain 5% sodium fluoride and were: CavityShield, Enamel Pro, MI Varnish, Prevident and Vanish. FV were applied (10 +/- 2 mg per lesion) to eight specimens per FV group (direct application); the remaining eight specimens received no FV but were later exposed to fluoride released from specimens which received a FV treatment (indirect application). Specimens were paired again and placed into containers (one per FV). Artificial saliva was added and containers placed into an incubator (27 hours at 37 degrees C). Subsequently, FV was carefully removed using chloroform. Specimens were exposed to fresh artificial saliva again (67 hours at 37 degrees C). KHN was measured and differences to baseline values calculated. Enamel fluoride uptake (EFU) was determined using the acid etch technique. Data were analyzed using two-way ANOVA. RESULTS: The two-way ANOVA highlighted significant interactions between FV vs. application mode, for both deltaKHN and EFU (P < 0.001). All FV were able to reharden and deliver fluoride to caries lesions, but to different degrees. Furthermore, considerable differences were found for both variables between FV when applied either directly or in close vicinity to the lesion: MI Varnish and Enamel Pro exhibited greater fluoride efficacy when applied in vicinity rather than directly to the lesion, whereas CavityShield and Vanish did not differ. Prevident exhibited a higher EFU when applied directly, but little difference in rehardening

Fluoride concentration in saliva and biofilm fluid following the application of three fluoride varnishes

Objective Most of the commercially available fluoride varnishes (FV) have not been evaluated for their cariostatic properties. Consequently, the aim of this in vivo study was to investigate intra-oral fluoride retention and clearance patterns from three different FV. Methods Eighteen subjects (7–11 years) participated in a laboratory analyst-blinded, randomized, crossover study comparing the ability of 5% sodium fluoride varnishes (CavityShield-CS, Enamel Pro-EP, Vanish-V) to enhance fluoride concentrations in biofilm fluid, centrifuged and whole saliva over a period of 48 h after a single FV application. Results Similar fluoride concentration × time patterns were noted for all investigated FV and studied variables, with the highest fluoride concentrations observed for the first biological sample collected after FV application (30 min). Mean ± SE (area under fluoride clearance curve) values were (μg F/g or ml × min): biofilm fluid − CS (472 ± 191), EP (423 ± 75), V (1264 ± 279); centrifuged saliva − CS (42 ± 7), EP (19 ± 3), V (41 ± 8); whole saliva − CS (68 ± 11), EP (64 ± 10), V (60 ± 7). V delivered more fluoride to biofilm fluid than CS (p = 0.0116) and EP (p = 0.0065), which did not differ (p = 0.27). For centrifuged saliva, CS and V were not significantly different (p = 0.86), but resulted in higher fluoride retention than EP (p < 0.0008). No significant differences among FV were observed for whole saliva (p = 0.79). Conclusion The present study has shown that FV vary in their ability to deliver fluoride intra-orally potentially related to formulation differences. To what extent the present findings relate to clinical efficacy remains, however, to be determined. Clinical significance Clinical research that investigates fluoride release patterns into saliva and biofilm fluid from different FV products is insufficient. More research is needed to investigate different FV formulations for their efficacy in order to help clinicians make better evidence based treatment choices