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Glycogen synthetic and degradative activities by Actinomyces viscosus and Actinomyces naeslundii of root surface caries and noncaries sites.

The relative glycogen synthetic and degradative activities of Actinomyces viscosus and Actinomyces naeslundii, freshly isolated from root surface caries and noncaries sites, were compared. The glycogen synthetic activity was measured by incubating glucose-(or sucrose-)grown resting cells with 100 mM glucose (or sucrose) and U-[14C]-glucose (or U-[14C]-sucrose) on a pH-stat maintained at 5.0, 6.0, and 7.0 for 1 h under anaerobic conditions. For the glycogen degradation assays, after the 1-hour incubation period, the cells were reincubated under similar conditions, but in the absence of external carbon sources. Carbohydrate utilization and total acid formation were also monitored. Both the glucose- and sucrose-grown cells of A. viscosus and A. naeslundii strains originating from root surface caries lesions synthesized approximately twice as much glycogen as the strains of noncaries origin. Although there were significant differences in the rates of glycogen synthesis, the rates of glycogen degradation were essentially the same for the Actinomyces strains from both caries and noncaries sites. However, the time required for glycogen degradation by the strains from caries sites was much longer. This study suggests that the abilities of A. viscosus and A. naeslundii originating from root surface caries lesions to synthesize large amounts of glycogen and to degrade this stored polymer slowly under conditions of starvation, particularly in an acidic environment, may be one of the factors contributing to the cariogenic potential of these organisms in root surface caries.

Actinomyces↗

[Dental root surface caries prevalence among adults and senior citizens in southeast São Paulo State, Brazil].

In recent decades there has been an increase in the occurrence of dental root surface caries, especially among adults and senior citizens. This study aimed to identify root surface caries prevalence in adults and seniors from southeast São Paulo State, Brazil. An epidemiological survey was carried out among 1,475 dentate adults, ages 35 to 44 and 65 to 74, respectively, according to WHO criteria. Root surface caries prevalence was 15.6% and 31.8%, for the 35-44 and 65-74-year groups, respectively. The average rate for decayed and/or filled roots was 0.36 for the middle-aged adult group and higher in males (p < 0.01), as compared to 0.82 for seniors, with no difference by gender. The average rate of decayed roots was 0.18 and 0.53 for middle-aged adults and seniors, respectively; in both groups the levels were higher among men (p < 0.01). Further studies on oral health, mainly on root surface conditions, are essential in both middle-aged adults and senior citizens.

Adult↗

Microflora associated with experimental root surface caries in humans.

This study describes the microflora from actively progressing root surface caries lesions, in which mineral loss had been determined by quantitative microradiography. The caries lesions were produced experimentally in root surface specimens from human molars inserted in lower partial dentures carried for 3 months by six elderly individuals. A total of 780 bacterial isolates were identified from 13 plaque samples, collected with a punch technique, and six dentin samples. The composition of the microflora showed distinct individual differences. The microflora from plaque samples associated with the highest mineral loss was dominated by either Actinomyces viscosus or a combination of mutans streptococci (serotypes c, d, and f) and Lactobacillus species (L. casei and L. brevis). Plaque from root surfaces with less pronounced mineral loss harbored a more complex microflora comprising gram-positive rods, mutans streptococci, Streptococcus mitis biovar 1, Veillonella spp., gram-negative rods, and low numbers of lactobacilli. In the latter samples, individual variations in the proportions of mutans streptococci (serotypes c, d, and g), Actinomyces species (A. viscosus and A. naeslundii), and Veillonella parvula biotypes were observed. These findings suggest that certain species or combinations of species are more cariogenic than others and that dominance of single acidogenic species in particular is conducive to high caries activity.

Aged↗

Treating root-surface caries.

This article summarizes the effectiveness of restorative materials used to restore root surfaces, the mechanisms by which these materials reduce caries, and placement techniques for restoring root-surface lesions. Patients may be classified into low, medium, and high caries risk groups for root caries, and specific dental restorative material recommendations are made for each category. Effective plaque control, xylitol-containing chewing gums, antimicrobial agents, fluoride-releasing restorative materials, topically applied fluoride, and fluoride-containing toothpastes provide maximum protection for the high caries risk patient.

Age Factors↗

Effects of fluoride and chlorhexidine on the microflora of dental root surfaces and progression of root-surface caries.

The effects of fluoride and chlorhexidine varnishes on the microflora of dental root surfaces and on the progression of root-surface caries were studied. Forty-four patients, surgically treated for advanced periodontal disease, were distributed at random among three groups. All patients received a standardized preventive treatment. Furthermore, the dentition of the patients in the two experimental groups was treated, at three-month intervals, with chlorhexidine and fluoride varnish, respectively. Patients in the control group received no additional treatment. In the experimental groups, plaque samples were collected from selected sound and carious root surfaces at baseline and at three, six, and nine months after the onset of the study. The presence of root-surface caries was scored at baseline and after one year. In addition, the texture, depth, and color of the root-surface lesions were monitored. Mutans streptococci on root surfaces were suppressed significantly (p less than 0.05) during the whole experimental period in the chlorhexidine varnish group, but not in the fluoride varnish group. A non-significant increase in the number of Actinomyces viscosus/naeslundii was noted after treatment with chlorhexidine and fluoride varnish. The increase in the number of decayed and filled root surfaces after one year was significantly lower in the experimental groups than in the control group. After treatment with chlorhexidine varnish, significantly more initial root-surface lesions had hardened than in the other groups.

Actinomyces↗

Active root surface caries converted into inactive caries as a response to oral hygiene.

The clinical characteristics of 24 active root surface lesions on buccal surfaces were recorded through 18 months after implementation of meticulous toothbrushing with a fluoride toothpaste (F congruent to 0.1%). Within a period of 2-6 months all lesions had changed from soft, greasy and yellowish to leathery or hard, darkly discoloured tissue, indicating a gradual transition from active into inactive stages of caries. The observations stress the dynamic nature of the root caries process. It is concluded that when dealing with root surface caries it is essential to distinguish between active and inactive lesions and that classical operative treatment to a great extent can be avoided.

Adult↗

Clinical profiles of individuals with and without root surface caries.

As part of a collaborative multidisciplinary investigation of root surface caries (RSC), 273 subjects (median age = 57) were clinically evaluated for coronal caries, debris, calculus, gingivitis, periodontal pocketing, recession, abrasion, as well as RSC. The entire study group was divided into three subgroups: (1) subjects whose exposed root surface were without lesions or restorations (non-diseased individuals, n = 43); (2) subjects whose exposed root surfaces had one or more lesions and may or may not have had restorations (diseased individuals, n = 110); (3) subjects with one or more restorations but no lesions, since it was not known whether these restorations were preceded by RSC or abrasion the disease status of these individuals was unclear (n = 120). A comparison of Subgroup 1 (unequivocally non-diseased) and Subgroup 2 (unequivocally diseased) revealed that subjects without RSC had more teeth, less coronal caries, less recession, less debris, less calculus, less gingivitis, and more abrasion. We infer that the common factor underlying most if not all of the subgroup differences is oral hygiene which must therefore be a major disease determinant.

Dental Calculus↗

Dental caries prevalence and dental care utilization among the very old.

BACKGROUND: This article reports on coronal and root caries prevalence and dental care utilization patterns of elderly Iowans aged 79 years or older. METHODS: The sample for this study was 449 people who were surviving members of the Iowa 65+ Rural Health Study cohort originally recruited in 1981. The authors focused their analyses on the 342 of these who were dentate. Examinations were conducted in subjects' homes by trained and calibrated examiners, using a halogen headlight, a mouth mirror, a color-coded periodontal probe and a no. 23 explorer. RESULTS: The mean age of subjects was 85.1 years (range 79-101 years), and they had a mean of 19.4 remaining teeth. Nearly all subjects (96 percent) had coronal decay experience, while 23 percent of the subjects had untreated coronal decay, about one-fourth of which was recurrent. Nearly two-thirds (64 percent) of the sample had root caries experience, with 23 percent having untreated root caries. Utilization of dental services was high among the dentate elderly, with nearly three-quarters reporting having visited a dentist within the past year. Nearly all reported that they paid for dental care themselves with no third-party coverage. CONCLUSIONS: The findings from this study of the very old suggest that coronal and root caries remain prevalent, with high levels of dental care utilization among those who have retained natural teeth. CLINICAL IMPLICATIONS: As the U.S. population ages, and more teeth are retained, demand for dental services in the population of the oldest elderly people is likely to increase.

Aged↗

Macroscopic and radiographic examination of proximal root surface caries.

The purpose of the study was to compare macroscopic and radiographic examination of proximal root surface caries of extracted teeth from patients aged 65-95 years. Although the study conditions for macroscopic and radiographic diagnosis favored more sensitive evaluations than routine clinical conditions, there was a 24% disagreement in diagnosis. This finding indicates that under routine clinical conditions it is difficult to register with certainty all superficial root carious lesions. Even in the absence of clinically detectable root surface caries, preventive measures should be considered for elderly people with exposed root surfaces.

Aged↗

Imaging caries lesions and lesion progression with polarization sensitive optical coherence tomography.

New diagnostic tools are needed for the characterization of dental caries in the early stages of development. If carious lesions are detected early enough, they can be arrested without the need for surgical intervention. The objective of this study was to demonstrate that polarization sensitive optical coherence tomography (PS-OCT) can be used for the imaging of early caries lesions and for the monitoring of lesion progression over time. High-resolution polarization resolved images were acquired of natural caries lesions and simulated caries lesions of varying severity created over time periods of 1 to 14 days. Linearly polarized light was incident on the tooth samples and the reflected intensity in both orthogonal polarizations was measured. PS-OCT was invaluable for removing the confounding influence of surface reflections and native birefringence necessary for the enhanced resolution of the surface structure of caries lesions. This study demonstrated that PS-OCT is well suited for the imaging of interproximal and occlusal caries, early root caries, and for imaging decay under composite fillings. Longitudinal measurements of the reflected light intensity in the orthogonal polarization state from the area of simulated caries lesions linearly correlated with the square root of time of demineralization indicating that PS-OCT is well suited for monitoring changes in enamel mineralization over time.

Animals↗

Caries prevalence and associated predisposing conditions in recently hospitalized elderly persons.

The prevalence of caries and caries risk factors was studied among 120 consecutively hospitalized elderly persons. Coronal caries was recorded using the WHO criteria, and active and inactive root caries in accordance with Fejerskov et al. The CPITN was used to evaluate the periodontal state and plaque accumulation in accordance with Löe & Silness. Of the 1212 teeth examined 5% had active coronal caries (2% inactive), 14% active root caries (2% inactive), and 10% fillings with recurrent caries. No relationship was found between caries prevalence, degree of dependence, number of medicaments, age, and gender. Patients with psychiatric diseases had increased caries prevalence (P < 0.01), and lower caries prevalence was associated with frequent tooth brushing (P < 0.05). At the tooth level root caries was associated with high plaque scores (P < 0.001), degree of gingival recession (P < 0.001), presence of coronal caries (P < 0.001), and increased pocket depth (P < 0.01). The results strongly indicate that oral hygiene measures should be introduced immediately after hospitalization of these patients.

Aged↗

Clinical evaluation of tunneled molars: a retrospective study.

BACKGROUND: The main concern associated with the tunneling procedure is the development of root caries on the furcation area post-treatment. The objective of this study was to evaluate the periodontal conditions and the prevalence of root caries in tunneled molars. METHODS: The study sample comprised 30 tunneled teeth (mean tunneling age = 3.6 years) in 18 subjects who had received periodontal treatment and were enrolled in a maintenance program that included the application of fluoride to the exposed root surfaces. Plaque index (PI), pocket depth (PD), bleeding on probing (BOP), decayed, missing, filled or sound teeth (DMFT) and demographic characteristics were assessed. Statistical analysis was performed using the Friedman and Mann-Whitney tests and multiple linear regression analyses. RESULTS: Four teeth (13.4%) showed active root caries inside the tunnels. Six (5.4%) of the 109 root surfaces facing the furcation region (inner surfaces) were affected by carious lesions, similar to the amount of root caries observed on the outer tunnel root surfaces, where 10 (5.3%) of the 189 surfaces studied were restored (p > 0.05). The interior of the tunnels had a higher percentage of sites with PD > or =6 mm then the exterior (p > 0.05). However, the plaque indexes and BOP scores were low for both the internal and external surfaces of the tunnels. Regression analysis indicated that the only positive association with the development of caries inside the tunnels was previous root caries experience (beta = -0.671; p = 0.01). CONCLUSION: The results show that tunneling is a suitable technique to treat periodontal furcation lesions in individuals following a regular maintenance program.

Adult↗

Effect of amine fluoride (AmF)/stannous fluoride (SnF2) toothpaste and mouthwashes on dental plaque accumulation, gingivitis and root-surface caries.

The aim of the study was to assess the effect of a toothpaste and mouthwashes containing amine fluoride (AmF) and stannous fluoride (SnF2) on dental plaque, gingivitis and root-surface caries. Forty-four adults participated in a five-month double-blind study. The following combinations of toothpastes and mouthwashes were used: (1) AmF/SnF2 toothpaste and AmF/SnF2 (Meridol) mouthwash (20 patients, mean age 45.7 years), (2) sodium fluoride (NaF) toothpaste and NaF mouthwash (24 patients, mean age 48.8 years). The mean values for dental plaque (Silness-Löe index) were clinically and statistically significantly reduced in both groups, the difference being greater in the AmF/SnF2 group. Sulcus-bleeding index values were clinically and statistically significantly decreased in both groups. There was no marked difference between the groups. The root caries index (RCl, Katz) had decreased by the end of the experiment by 10% in the NaF group and by 47.4% in the AmF/SnF2 group.

Amines↗

Arrest of root surface caries in situ.

This study tests the hypothesis that daily oral hygiene combined with topical fluoride arrests active root-surface caries lesions without changing the mineral content of the lesions. Therefore, changes in mineral content and distribution were studied in root surfaces during caries lesion development and subsequent arrest of lesion progression in situ. In 18 subjects, lesions were developed during 3 months in sound root-surface specimens inserted into lower partial dentures. After 3 months, ground sections were prepared from each lesion prior to re-insertion of the specimens into the dentures. In addition, one sound root specimen was added per subject. During the following 3 months, half of the subjects cleaned both sound and carious specimens once a day with an 1100-ppm fluoride toothpaste, and the specimens were treated twice with 2% NaF for 2 min in situ. The other half of the subjects continued the experiment without cleaning. During the initial three-month period, all specimens developed subsurface lesions extending 187 to 583 microm into the dentin. Lesion depth increased somewhat in both experimental groups during the following 3 months (P > or = 0.1). There was a non-significant increase in mineral loss in the plaque-covered specimens (P = 0.08). However, the total mineral content of specimens subjected to plaque removal and topical fluoride did not change. This treatment resulted in an increased mineral content in the surface layer (P < 0.01) and formation of a zone of higher mineral content within the body of the lesion. The sound root surfaces which had been cleaned for a three-month period showed mineral uptake in the surface layer, occasionally associated with subsurface demineralization extending 20 to 70 microm into the tissue. The mineral loss of these specimens was significantly smaller than that of plaque-covered surfaces (P < 0.001). It is concluded that daily plaque removal and topical fluoride use influence the distribution of mineral in sound and carious root surfaces and may arrest lesion progression without affecting the total mineral content.

Aged↗

Double blind clinical trial of a remineralizing dentifrice in the prevention of caries in a radiation therapy population.

OBJECTIVES: The purpose of this study is to determine the efficacy and safety of a specially formulated remineralizing toothpaste in controlling caries in a group of high risk, head and neck radiation patients. DESIGN: The study compares the performance of the remineralizing toothpaste with a leading conventional fluoride dentifrice using double-blind randomization. TEST PRODUCTS: The products compared both contain equivalent quantities of fluoride (1150 ppm). The remineralizing toothpaste also delivers soluble calcium and phosphate ions, the essential components of teeth. SUBJECTS: On completion, 50 subjects who received > 50 Gy of radiation to the head and neck. MEASUREMENTS: Examinations include coronal and root caries using the Pitts Diagnostic Criteria, salivary flow rate, plaque and gingival indices and microbiological counts over one year. RESULTS: At this point subjects are enrolled in the study at various phases. However, the current average for the net increment per month per subject is -0.12 (+/- 1.30) for coronal caries and 0.06 (+/- 0.73) for root caries in subjects using the remineralizing toothpaste and 0.53 (+/- 1.62) for coronal caries and 0.45 (+/- 0.98) for root caries in subjects using the conventional fluoride dentifrice. Non-parametric analysis of rank scores for net root surface increments/month was statistically significant (p = 0.02), suggesting lower net root surface increment/month for the remineralizing toothpaste relative to the conventional toothpaste. No significant differences were noted on coronal surfaces. CONCLUSIONS: The results to date indicate that the remineralizing toothpaste is significantly superior to the conventional fluoride dentifrice in preventing root caries in high risk patients.

Adult↗

Caries experience in existing and new nursing home residents in Adelaide, Australia.

OBJECTIVES: The Adelaide Dental Study of Nursing Homes was instigated to provide comprehensive information concerning oral disease experience, incidence and increments in a random sample of those older South Australians residing in Adelaide nursing homes. METHODS: This paper presents caries experience results for existing and new nursing home residents, and caries incidence and increments for existing residents, from dental inspections conducted at the baseline and one-year data collections. RESULTS: The residents in this study were very functionally dependent, medically compromised, cognitively impaired and behaviourally difficult older adults, the great majority of whom had moderate to severe cognitive impairment. Residents gave their carers many complex and challenging behavioural problems during oral hygiene care provision. Existing and new residents had similar dental history, oral hygiene, and sociodemographic characteristics, and similar cognitive, medical, functional, and nutritional status. Oral disease experience was high in both existing and new residents. There were no significant differences between existing and new residents for their dentate status, tooth status, coronal caries experience, or root caries experience, with the exceptions that new residents had significantly greater mean number of teeth, more filled coronal and root surfaces, and also new residents had significantly fewer decayed retained roots. Large numbers of tooth surfaces were covered in plaque and debris that negated more precise assessment of caries. The existing residents had caries increments on both coronal (2.5 surfaces) and root surfaces (1.0 surfaces) over the one-year period. Coronal caries incidence was 64% and root caries incidence was 49% of existing residents. CONCLUSIONS: Oral disease experience was high in both existing and new residents. There were few significant differences between existing and new residents' oral health status. New residents were being admitted to nursing homes with a compromised oral health status. Coronal and root caries increments and incidence were high for existing residents over the one-year period.

Activities of Daily Living↗

[Caries decline and changing pattern of dental therapy].

The most striking feature of some industrialized countries is a dramatic reduction of the prevalence of dental caries among school-aged children. As a result, teeth are being retained longer than before and it is possible that the incidence of caries--especially root caries--is increasing. It is an error of judgement that dentistry becomes simplier. With the increase of life span there will be an increase of needs for restorative dentistry in the older age groups of the population. The dentist of the future has to be a flexible practitioner who has had a broader based education.

Dental Care↗