Biomedical subjects
K J Toumba
Publications and source records attributed to K J Toumba.
Cost-effectiveness of a long-term dental health education program for the prevention of early childhood caries.
AIM: To evaluate the benefit-cost (B/C) and cost-effectiveness (C/E) of a long-term dental health education program to prevention early childhood caries (ECC) through home visits. METHODS: The data collected over a three year period in a dental health education programme (DHE), previously reported [Kowash et al., 2000] for infants aged 8 months at start were analysed for B/C and C/E. Dental caries indices (BASCD) for dmft and dmfs were used. Costs were based on British National Health Service (UK) fees for treating children by general dental practitioners and salaries for community dental officers in the Community Dental Services in the UK. Comparisons were made for B/C and C/E with results from a clinical trial of a slow releasing fluoride device (SRFD), community water fluoridation (CMF) and a school based fissure sealant program (FSP) using the hypothetical community of Niessen and Douglass, [1984]. RESULTS: The cavities, as ECC, saved over the three year period indicated a B/C ratio for the DHE of 5.21 compared with SRFD of 4.17; CWF of 1.15 and FSP of 0.42. The C/E results were 1.92, 2.40, 8.66 and 23.74 respectively. CONCLUSION: A dental health education program of home visits with mothers of young infants to prevent early childhood caries and starting at 8 months of age, gave better benefit-costs and costs effectiveness ratios than other preventive programs.
Slow-release fluoride glass devices: in vivo fluoride release and retention of the devices in children.
AIMS: To study the fluoride release and retention of new-shaped glass slow-release F devices (SRFD) in vivo in children. METHODS: A group of 15 children had a SRFD with 17.4% or 14.8 mgm F with a relative solubility of 294, attached intra-orally on the buccal surface of one of their maxillary permanent molars. The devices were monitored for six months. RESULTS: The retention rate of the devices was 93% and the mean salivary F levels in the child volunteers was 01.17+/-0.1 ppm F compared with 0.025 ppm F baseline levels. The difference was statistically significant (p<0.01). There were no systemic or local side effects. CONCLUSIONS: The devices were well tolerated by children and released fluoride intra-orally for the whole period of six months to a level consistent with inhibition of demineralisation.
Restoration of primary teeth: clinical criteria for assessment of the literature.
AIM: This is was to establish a system of clinically based criteria for the assessment of papers published in peer reviewed journals concerning the use of restorative techniques in primary teeth. BACKGROUND: Various publications that consider the approaches to be taken to setting up assessment criteria with the dental/medical literature were reviewed. These included the so called 'Cochrane criteria'. On the basis of this review a set of clinically based criteria were drawn up that were then used to produce a list of criteria to be used in a series of systematic reviews of the literature concerning the various restorative techniques, materials and medicaments for pulp therapy and the restoration of primary teeth. RESULTS: There were 23 criteria that were felt to be appropriate. The list of 23 criteria were deemed to be appropriate for pulp therapy and 21 for restorative techniques and materials. Conclusion.A set of clinically based criteria is suggested for the systematic review of publications on restorative techniques for primary teeth.
Enamel defects in children with coeliac disease.
AIM: This was to investigate the prevalence of enamel developmental defects in a group of children with a history of coeliac disease. METHODS: A study group of children attending the Dept. Paediatrics (Leeds General Infirmary), born between 1985 and 1986 and subsequently diagnosed and treated for coeliac disease (CD) were recruited. A group of age/sex-matched children attending the Paediatric Dentistry department were used as a control group (Cont). Examinations were carried out for enamel defects and opacities (DDE index), dmf, dmfs, DMF and DMFS (BASCD method), and a full medical and dental history were obtained. RESULTS: Significantly more children in the CD group had a greater number of enamel defects than controls for both primary (p=<0.02) and permanent (p=<0.001) dentitions. Opacities in both primary and permanent teeth were statistically significantly greater in the CD group than controls (p=<0.04 and p=<0.001 respectively). Dental caries in both primary and permanent dentitions was less in the CD group compared with the control group of children. CONCLUSION: Coeliac disease was associated with an increased prevalence of developmental enamel defects.
Asthma inhalers and subsurface enamel demineralisation: an in situ pilot study.
AIM: The purpose of this pilot study was to identify the subsurface enamel demineralising potential of two possible acidogenic lactose-based powders and their corresponding generic pump inhalers. METHODS: Ten healthy non-asthmatic adults participated in a 5- leg randomised crossover study including a 10% sucrose control. A twice-daily 400 microg dose of inhaler was applied in vitro to a demineralised enamel slab on the buccal flange of a mandibular removable appliance before in situ placement for 14 days each. Lesion parameters were determined using transverse microradiography and digitised image analysis. RESULTS: Minimal demineralisation occurred with sucrose, both pump and one powder inhaler. The remaining powder was associated with remineralisation (p = 0.29). Overall, mean lesion depth increased (p = 0.12). CONCLUSION: Asthma inhalers failed to demonstrate a significant acidogenic/cariogenic effect.
Prevalence of enamel defects and MIH in non-fluoridated and fluoridated communities.
AIM: This was to study the prevalence of enamel defects and molar incisor hypomineralisation (MIH) in children attending Leeds Dental Institute (UK) and Westmead Dental Hospital, Sydney (Australia). METHODS: Prospective dental examinations were carried out on 25 children referred to two orthodontic departments. A questionnaire was completed to obtain background information and about previous fluoride (F) exposure followed by an oral examination. First permanent molars and permanent incisors were examined for presence, type and severity of enamel defects using the modified DDE screening index. Chi square tests were used to compare results. RESULTS: Data for 24 children in Sydney and 20 in Leeds presented with at least one enamel defect. Of 300 teeth examined, 155 in Sydney and 82 in Leeds had a defect (p < 0.005). Severity of enamel defects was higher in Sydney. The children presenting with any type of enamel defect in at least one incisor or molar were 21 in Sydney and 10 in Leeds. However, if only demarcated defects were considered, the number in Sydney dropped to 11 and in Leeds remained at 10. CONCLUSIONS: There was a higher prevalence of enamel defects in those children living in F Sydney than in non-F Leeds, but the prevalence of MIH was the same supporting the view that F is not associated with the aetiology of MIH.
In vitro and in vivo assessment of a glass slow fluoride releasing device: a pilot study.
AIMS: The aims were to evaluate a) whether a slow release fluoride-glass pellet (SFG) would be retained in the mouth and release fluoride (F) over a long period of time, b) what concentrations of F in the glass would provide ideal intra-oral saliva F concentrations and c) whether an SFG would affect blood plasma concentrations of F after swallowing compared with ingestion of a commercial NaF tablet. METHODS: a) A prototype SFG was attached to a maxillary molar of a volunteer. Baseline saliva F concentrations were measured prior to glass placement, daily in week one; one day a week for weeks two to three and then one day a month up to 18 months. Four subjects had the SFG for six months with saliva F concentration assessments at periodic intervals. b) SFGs containing F at 13.3%, 18.3% and 21.9%, and an improved solubility, were tested using three volunteers and saliva F concentrations measured. c) Five volunteers each swallowed either a SFG or a NaF tablet. Blood plasma samples were taken at baseline and F measured at time intervals of 2.5, 5, 10, 20, 30, 45, 60, 90 and 120 mins post-ingestion. RESULTS: a) The prototype SFG were successfully retained and released F into saliva; mean concentrations of 0.035 mg L(-1) were achieved lasting for over 18 months. Overall saliva F concentrations were approximately doubled. Analysis of the pellet at the end of use showed it still contained some F possibly indicating a recharging effect. b) The 13.3% F concentration SFG produced significantly higher saliva F levels than the two other concentrations tested. The two higher concentration F glasses contained aluminium as part of the formulation of the glass structure, which is known to bind F whereas the 13.3% glass contained F alone. c) While blood plasma F levels increased after ingestion of the NaF tablet there was no increase in F when the SFG was swallowed. CONCLUSION: A slow release F containing glass device showed promise as a means to enhance intra-oral F saliva concentration.
An evaluation of the acidogenic potential of asthma inhalers.
AIM: The aims of the present study were firstly to investigate the inherent pH and titratable acidity of commercially available paediatric asthma inhalers in the United Kingdom and secondly to assess their in vivo acidogenic potential (saliva pH and plaque pH (PpH) tests) in a group of healthy adult volunteers. MATERIALS AND METHODS: Manually actuated metered dose inhaler (MDI) and dry powder inhaler (DPI) formulations of all available preventor (glucocorticoids, disodium chromoglycate), reliever (beta(2) agonists) and combination asthma medication were investigated. The inherent pH and titratable acidity of 18 inhalers were determined and analysed using t-tests, ANOVA and post hoc Tukey's tests. Following this the oral pH responses after inhaler use were assessed in 14 healthy adult volunteers (complying with the FNDH criteria, 1985) who participated in a random blind study to determine both the salivary pH (SpH) and plaque pH following inhaler use. Non-parametric tests of significance (Mann-Whitney and Wilcoxon Signed-Ranked Tests) were used to analyse pH responses according to vehicle of delivery (MDI/DPI), lactose content and generic drug. RESULTS: The inherent pH of the DPIs (n=8, mean pH=5.06) was significantly lower (P<0.005) than that of the MDIs (n=10, mean pH=6.45) and the titratable acidity of the lactose-based DPIs was twice that of the non-lactose-based DPIs (P<0.000). Lactose-based DPIs produced significantly lower salivary pH and plaque pH readings, greater maximum pH drops from baseline pH and larger areas below baseline pH in comparison with that of all other inhalers tested (P<0.05). All inhalers, however, failed to depress plaque pH below pH 6. CONCLUSIONS: Although none of the inhalers were able to demonstrate an acidogenic response below the "critical" pH, the substantial pH drops observed with the lactose-based DPIs may be an important consideration for enamel demineralisation.
A study investigating the formation of artificial sub-surface enamel caries-like lesions in deciduous and permanent teeth in the presence and absence of fluoride.
OBJECTIVES: Clinical and in situ studies have shown that caries formation and progression is faster in primary than in permanent teeth. Ambient levels of fluoride are also known to influence the processes of carious lesion formation. The aims were, firstly to investigate the incidence of artificial sub-surface caries lesion formation in the enamel of deciduous and permanent teeth in vitro. Secondly, to compare quantitatively the mineral content and distribution of these lesions and assess the possible influence of fluoride upon the lesion parameters. METHODS: Twenty primary molars and 20 permanent premolars were randomly assigned to one of four experimental groups. Samples in each experimental group were immersed in a 0.05M lactic acid gel (6% w/v hydroxyethyl cellulose, pH 4.5) either in the absence or presence of fluoride for 7 days. Subsequently, lesion parameters of mineral loss (vol x % microm) and lesion depth (microm) were assessed by transverse microradiography and image analysis. RESULTS: No significant differences existed between the lesion parameters of permanent and primary teeth (P=0.20). Irrespective of tooth type, lesion parameters were significantly reduced in samples demineralised in the presence of fluoride (P< or =0.002). CONCLUSIONS: Fluoride significantly reduces the severity of sub-surface caries lesions formed in vitro and in contrary to previous studies, there were no significant differences in lesions parameters between permanent and primary teeth.
Clinical performance of a compomer and amalgam for the interproximal restoration of primary molars: a 24-month evaluation.
OBJECTIVES: To evaluate the clinical performance of a compomer material (Dyract) in comparison with dental amalgam (Contour) for management of proximal caries in primary molars in young children. SETTING: General dental practice, and a dental hospital paediatric clinic. METHOD: This was a prospective study. A split mouth design was used with identical pairs of minimal Class II cavities, of matched tooth type in the same dental arch, usually diagnosed with the use of bitewing radiographs. Seventy-eight pairs of restorations were completed of which 60 pairs were available for evaluation after 24 months. RESULTS: Comparable retention rates were observed for both Dyract and amalgam. The retention rates were high for both materials, with only four amalgam and two Dyract restorations failing over 24 months. Significantly better marginal integrity (P < 0.05) was observed for Dyract compared with amalgam with no significant differences between the two materials for recurrent caries, wear or surface texture. CONCLUSIONS: Dyract seemed to be a suitable alternative to amalgam for proximal restorations in primary molars of young children for use in general dental practice.
The prevalence of developmental enamel defects in permanent molars in a group of English school children.
AIM: An epidemiological study was designed to determine the prevalence of enamel defects in first permanent molars in English children of ethnic backgrounds. MATERIALS AND METHODS: A population of school children aged seven years, living in the low water fluoride City of Leeds (UK) were examined for the presence of developmental enamel defects in first permanent molars. The examination criteria were based on the DDE index for screening surveys. The ethnic background to the children examined was determined by school records, name and visual assessment. RESULTS: The results for 307 children (154 females) showed an overall prevalence of defective enamel in first permanent molars of 14.5% and tooth prevalence of 7.2%. There were effects of gender or tooth site. There was no significant difference in prevalence between White-Caucasian (17%) or Asian-Caucasian (10%) children. The demarcated opacity was the most frequent type of defect seen, followed by diffuse opacities and hypoplasia. The occlusal and buccal surfaces were the most commonly affected. CONCLUSION: As there were no significant differences in prevalence between children of different ethnic groups it was concluded that the aetiology of enamel defects in permanent molars was most likely affecting all children.
An evaluation of the acidogenic potential of maltodextrins in vivo.
Maltodextrins are a group of oligosaccharides, which are being increasingly used as a source of carbohydrate in many commercially available foods and drinks. This study investigated the effect of three different maltodextrins on the pH of dental plaque, in vivo, in 10 adult volunteers using the plaque harvesting method. The three maltodextrins tested in this study were DE=5.5, 14.0 and 18.5 (DE=dextrose equivalents), made up as 10% solutions. Also, three commercially available maltodextrin containing children's drinks were evaluated for their acidogenicity. 10% sucrose and 10% sorbitol solutions were used as positive and negative controls, respectively. The minimum pH achieved for DE=5.5, 14.0 and 18.5 was 5.83+/-0.30, 5.67+/-0.24 and 5.71+/-0.29, respectively, and were significantly higher as compared with that for 10% sucrose (5.33+/-0.17). The area under the curve was the least for DE=5.5 (12.03+/-4.64), followed by DE=18.5 (13.13+/-8.87) and DE=14.0 (17.35+/-6.43), but were all significantly smaller as compared with 10% sucrose (24.50+/-8.64). The minimum pH achieved for the infant drinks was 6.01+/-0.24, 5.99+/-0.28 and 5.8+/-0.19 for the Lemon Barley and Camomile Herbal baby drink, Mixed Citrus and Hibiscus baby drink, and Infant Milk, respectively. It was concluded that though maltodextrins appeared to be significantly less acidogenic than 10% sucrose, they can lead to a substantial drop in plaque pH and may, therefore, have a potential to cause demineralisation of enamel.
Slow-release devices for fluoride delivery to high-risk individuals.
The latest fluoride research is investigating the use of slow-release devices for the long-term intra-oral provision of fluoride. 174 children aged 8 years with fluoride slow-releasing glass devices were shown to develop 67% fewer new carious teeth and 76% fewer new carious surfaces in a 2-year double-blind caries study. There were 55% fewer new occlusal fissure carious cavities showing that occlusal surfaces were also protected by the fluoride released from the devices. The fluoride devices release low levels of fluoride for at least 2 years and have great potential for use in preventing dental caries in high-caries-risk groups and irregular dental attenders in addition to a number of other applications.
Enamel demineralization in situ with various frequencies of carbohydrate consumption with and without fluoride toothpaste.
There is little information in the literature on the relationship among the frequency of carbohydrate consumption, the use of fluoride toothpaste, and enamel demineralization. The aim of this investigation was to compare the extent of demineralization of enamel slabs in situ, with a sugar-based solution, consumed in constant amounts but with various frequencies in subjects both with and without the use of fluoride (F) toothpaste. Eight subjects wore removable mandibular appliances carrying an enamel slab cut from white-spot lesions. The subjects were required to drink 500 mL of a 120-gm/L sugar solution either once, 3, 5, 7, or 10 times/day for 30 sec on each occasion, for a period of 5 days while brushing their teeth twice daily with either a F (1450 ppm NaF) or a F-free toothpaste. Mineral analysis revealed that when the subjects used a F toothpaste, net demineralization was evident only with the seven- and 10-times/day regime (ns). When F-free toothpaste was used, statistically significant demineralization was observed when the frequency exceeded 3 times/day. This study demonstrates the importance of F-containing toothpaste in enamel re-/demineralization by varying the frequency of carbohydrate challenge
Primary pulpotomies.
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Fluoride pit and fissure sealants: a review.
There are two methods of fluoride incorporation into fissure sealants. In the first method, fluoride is added to the unpolymerized resin in the form of a soluble fluoride salt that releases fluoride ions by dissolution, following sealant application. In the second method, an organic fluoride compound is chemically bound to the resin and the fluoride is released by exchange with other ions (anion exchange system). This report reviews the literature on the effectiveness of all the fluoride-releasing sealants--commercial and experimental--that have been prepared using either the former or the latter method of fluoride incorporation. There is evidence for equal retention rates to conventional sealants and for ex vivo fluoride release and reduced enamel demineralization. However, further research is necessary to ensure the clinical longevity of fluoride sealant retention and to establish the objective of greater caries inhibition through the fluoride released in saliva and enamel.
Effect on plaque pH of fruit drinks with reduced carbohydrate content.
OBJECTIVES: To assess the acidogenic response in dental plaque after challenge with four fruit drinks, including two blackcurrant drinks newly formulated, with low levels of carbohydrate. METHODS: 24 adult volunteers rinsed, in randomised order, with each of two new formulations of a blackcurrant drink (7% juice with 0.49% and 10% juice with 0.65% carbohydrate concentration respectively), an apple and blackcurrant drink with no added sugar (0.8%), and a mixed citrus fruit drink with a higher carbohydrate concentration (4.5% w/v). Solutions of 10% sucrose and 10% sorbitol were used as controls. Plaque pH was assessed, in vivo, before and after the acidogenic challenge using the plaque-harvesting technique. RESULTS: Results showed that the minimum plaque pH after the subjects rinsed with the new blackcurrant drinks was higher as compared with all the other test products and significantly so compared with the mixed citrus drink (P = 0.0001). It was also found that with the 7% blackcurrant juice drink none of the subjects and with 10% blackcurrant juice drink only one subject recorded a pH drop below the pH of 5.7. Ten minutes after consumption, both the new formulation blackcurrant drinks produced significantly higher plaque pH than the mixed citrus drink. In addition, overall change in the hydrogen ion concentration over the study period (sigma delta cH) was significantly less with both new blackcurrant drinks compared with the mixed citrus drink. CONCLUSIONS: It was concluded that the two new formulations with low levels of carbohydrate had a low acidogenic potential and did not depress the plaque pH below the critical level and their consumption could not be considered to pose a significant risk for enamel demineralisation.