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The microbiology of primary dental caries in humans.

A systematic literature review from 1966 to 2000 revealed 2,730 English-language publications on the role of bacteria in human primary dental caries in vivo. The most pertinent 313 papers were analyzed in evidence tables accessible online (http://www.nidcr.nih.gov). The search targeted all bacterial types implicated previously in caries and asked two questions. First, what is the association of specific bacteria with tooth decay and can causation be attributed to any of those bacteria? Retrieved studies were categorized as randomized-blinded-interventional, longitudinal, case-control, and cross-sectional and were weighted in descending order in terms of significance. Although many studies, due to ethical requirements, had confounding variables, they still indicate strongly: 1) the central role of the mutans streptococci in initiation of caries of smooth surfaces and fissures of crowns of teeth and suggests their potent role in induction of root surface caries; and 2) that lactobacilli are implicated as important contributory bacteria in tooth decay, but their role in induction of lesions is not well supported. Second, what is the source of infection by cariogenic bacteria? Molecular/genetic studies of implicated bacteria isolated from humans, randomized-blinded-interventional, and longitudinal studies indicate that mutans streptococci are spread vertically among humans, mostly from mothers to their children. Implications of these conclusions are briefly discussed. The most significant problems of literature interpretation include the benefits/shortcomings of salivary and plaque monitoring of the flora, the role of sugar(s) in decay as it influences the flora, and modeling strategies to predict lesion score increments as distinct from determination of the etiological role of specific bacteria. Future directions for microbiological clinical caries research are suggested, and the use of the term "caries" to describe the disease, not its lesions, is urged.

Case-Control Studies↗

[Caries and fluoride].

The cariostatic effect of fluoride is well documented, but the exact mechanisms of action are still subject of many studies. Re-evaluations of the clinical data of water fluoridation studies have confirmed that fluoride can have a pre-eruptive effect. But in general, the post-eruptive effects of low concentrations of fluoride on the de- and remineralisation processes are regarded to be of greater importance. Infrequent applications of concentrated fluoride solutions may only be effective in demineralised enamel. The Dutch national recommendations for the use of fluorides correspond well with the present views on the mechanisms of action of fluoride.

Cariostatic Agents↗

Caries prevalence in Africa and the People's Republic of China.

Problems arise when attempting to compare caries data collected in both Africa and the People's Republic of China. These difficulties are not only the result of differences in the criteria used for the diagnosis of caries but are also due to the diversity of cultural and social conditions existing within each of the geographical areas. However, interpreted with caution, the data seem to suggest that caries experience among children is still fairly stable and at a low level, in contrast to the predictions of a decade ago. When comparing data from adult and elderly cohorts, however, caries is seen to be a widespread disease with continuing slow progression throughout life.

Adolescent↗

Hard-tissue substrates for evaluation of cariogenic and anti-cariogenic activity in situ.

Hard-tissue substrates include primarily human and bovine enamel and human dentin. They have been used for in situ studies in a natural or sound condition, as well as flattened or containing an in vitro-formed caries-like lesion. Human enamel and dentin are generally the substrates of choice for studies of coronal and root-surface caries, respectively, but bovine enamel appears to offer a suitable alternative for many studies of enamel caries. Substrates with caries-like lesions will respond more rapidly to changes in the intra-oral mineral equilibrium and will allow both demineralization and remineralization to be determined. Findings from some studies suggest that caries-like lesions may respond somewhat differently, depending upon the degree of mineralization of the surface layer. Because in vitro findings with dentin show it to be significantly more soluble in acid than enamel, results from a study that used dentin may not be directly applicable to enamel. Both enamel and dentin substrates can be used in thin-section models. Hard-tissue substrates can also differ, depending upon their intra-oral location. Locations that result in the accumulation of plaque will behave differently from those that are plaque-free. So that plaque would accumulate, substrates have been placed approximally, beneath a fabric or steel mesh, in a protected trough, beneath a metal band or within a depression on the buccal surface. For studies requiring a determination of both demineralization and remineralization, human enamel or dentin containing a surface-softened caries-like lesion and covered with a uniform natural plaque are the substrates of choice.

Animals↗

The condition of teeth in the UK in 1998 and implications for the future.

The latest of the decennial surveys of the United Kingdom was undertaken in 1998 by the Office of National Statistics in collaboration with the dental schools of the Universities of Birmingham, Dundee, Newcastle and Wales. Dentate adults in 1998 have fewer missing teeth and more sound and untreated teeth on average than in 1978. The average number of decayed teeth has dropped significantly from 1.9 in 1978 to 1.1 in 1998. The average number of filled teeth has remained fairly constant over the same time but its distribution has changed quite markedly towards older adults having more filled teeth than people of a similar age in the past whilst the reverse is true for younger adults. The overall trends are encouraging, but there is a need to review the way disease is managed in adults in the United Kingdom.

Adolescent↗

Adjustment of the M-component of the DMFS index for prevalence studies of older adults.

Cross-sectional studies of caries in older adults report a substantial number of missing teeth, making it difficult to estimate caries experience accurately. The goal of this study was to improve the method of estimating caries experience as expressed by the DMFS index in population groups with missing teeth. The adjustment was demonstrated with reference to the Piedmont 65+ Dental Study conducted on a random sample of 363 community-dwelling older adults in North Carolina who were followed for 5 years. These older dentate adults had a mean (+/-SE) of 11.7 +/- 0.5 teeth missing at baseline, 56.1 +/- 2.5 missing surfaces and a DMFS of 86.7 +/- 2.0. A predicted caries prevalence was determined from the DFS at 5 yrs plus the 5-yr DFS incidence and the baseline DFS of teeth lost during the study period. Then a formula was developed that would estimate the predicted caries prevalence as a function of the observed 5-yr DMFS. This formula provided a good estimation of caries prevalence at 5 yrs (DMFSadj) when compared with the predicted prevalence (paired t-test, p > 0.05), while prevalence was underestimated by the DFS and greatly overestimated by the traditional DMFS index. Subgroup analyses by race, sex, and periodontal status also indicated that the DMFSadj resulted in patterns of estimates similar to the predicted prevalence, while the DFS and the DMFS were likely to result in different findings. The DMFS from the time of tooth eruption also was adjusted using this formula. The resulting analyses of subgroup differences in caries were not different from the previous estimates based on the 5-yr historical data, indicating that the adjustment of all M surfaces avoids the biases inherent in the traditional DMFS and DFS indices. This study showed that predicted caries prevalence could be estimated by adjusting the M component of the DMFS. It appears that this adjustment formula can be used without obvious bias, but additional studies are needed to provide adjustment figures for populations with different caries prevalences.

Black or African American↗

Composition and flow rate of saliva and caries development in young rats following administration of lithium.

Lithium carbonate (Li2CO3), an antipsychotic medication, was investigated to determine the effects on the stimulated flow and composition of saliva and on caries development in rats. Lithium carbonate was delivered via osmotic pumps at 10, 15 and 60 mg/kg/day. All animals were infected with Streptococcus sobrinus 6715 and fed a cariogenic diet. Lithium administration exerted a caries-protective effect on sulcal surfaces, though the reduction in caries scores was statistically significant only for the groups receiving Li2CO3 at 10 and 60 mg/kg/day compared to control animals (p +/- 0.05, ANOVA). There were no detectable alterations in protein concentration, electrophoretic profiles, or flow rates of stimulated parotid and submandibular saliva associated with the decreased sulcal caries incidence. Weight gain, water consumption and the populations of total cultivable flora recovered were not influenced by the administration of lithium. Investigation into the mechanisms of the sulcal caries reduction will require further exploration of changes caused by lithium on salivary gland function.

Animals↗

Effect of a two-solution fluoride mouth rinse on deposition of loosely bound fluoride on sound root tissue and remineralization of root lesions in vitro.

A constant-composition fluoride (F) titration method was used to measure the amount of leachable F deposited on root surfaces in vitro by a 1-min rinse with a 12 mmol/l sodium fluoride (228 micrograms/g F) solution or a two-solution rinse that contained 2 mmol/l sodium fluorosilicate (228 micrograms/g total F ) and 10 mmol/l calcium chloride. The mean +/- standard deviations (n = 3) F uptake from the two rinse treatments were 0.70 +/- 0.24 micrograms/cm2 and 3.25 +/- 0.74 micrograms/cm2, respectively. In a separate experiment, the effects of sodium fluoride and the two-solution rinses on remineralization of root lesions were evaluated in an in vitro pH cycling model. The results showed that the average decrease in mineral loss (delta Z) in the two-solution rinse group (60%) was significantly greater than that obtained in the NaF rinse (41%) or the control (9%) group.

Aluminum Compounds↗

Dental caries in Quebec adults aged 35 to 44 years.

BACKGROUND: The purpose of this study was to assess the prevalence of dental caries in Quebec adults aged 35 to 44. METHODS: A stratified sample was used. The participation rate was 77% for the questionnaire and 44.5% for the oral examination. A total of 2,110 people were examined. The World Health Organization's caries criteria were used. Examiner agreement with gold standard dentist was excellent at the end of the nine-day training session (Kappa index > 0.8). RESULTS: The level of caries experience is very high in Quebec adults aged 35 to 44. Almost half of dental surfaces (65 of 148) have been affected. These surfaces are mostly missing (39.3) or filled (23.9). However, there were 1.8 decayed surfaces in need of treatment per adult, and more than half the people (55.5%) had no untreated decayed surfaces. Almost three-quarters of decayed surfaces were present in only 14% of the people; lower family income and lower education are risk factors. CONCLUSION: Comparison between Quebec and industrialized countries (United States, England and the Netherlands) shows that in adults 35 to 44, the mean number of decayed teeth is low (between 1.0 and 2.2) and the mean number of filled teeth is relatively similar (between 9.6 and 11.1); however, Quebec has a higher percentage than the United States of edentulous people. As well, in dentate adults, there are 1.6 times more missing teeth among Quebecers than among Americans.

Adult↗

Preventive strategies for the older dental patient.

The purpose of this article is to review preventive strategies with regards to caries, periodontal disease, xerostomia, and oral cancer which may be helpful in treating the older patient. Dramatic demographic changes projected for the older population will have a direct impact on the type and quantity of dental services delivered in the future. It will be advantageous for tomorrow's oral health professional to recognize these changes and to adapt preventive and treatment regimens accordingly.

Aged↗

Effects of a 12-month prophylactic programme on selected oral bacterial populations on root surfaces with active and inactive carious lesions.

In 15 caries-active patients, with a total of 770 exposed root surfaces, the effect of fluoride therapy and professional tooth cleaning was studied during a 1-year period. Dental plaque from 92 of the root surfaces and whole saliva samples were analysed at baseline and after 12 months for the presence of specific bacteria. The results showed that the number of active carious lesions had decreased from 99 to 46, while the inactive lesions had increased from 69 to 124. Of the active lesions which had been converted into inactive lesions, most were on the buccal and fewest were located on the distal surfaces. Lower plaque scores were found on sound and inactive root surfaces compared to active surfaces. The salivary concentrations of mutans streptococci and lactobacilli remained constant during the 12-month observation period. There was a tendency for higher levels of Streptococcus mutans in plaque from active lesions compared with sound root surfaces, whereas an inverse relationship was noted for the Streptococcus oralis group. No significant differences in the Actinomyces naeslundii counts were detected. In conclusion, the 12-month prophylactic programme had an effect on the clinical surface characteristics of root caries, but the components of the oral microflora selected for study seemed to be relatively unaffected during the observation period.

Actinomyces↗

Epidemiology of dental caries. A broad review.

There is evidence from many sources that dental caries is an ancient disease; it has been found all over the world in skulls from the time humans replaced hunting with agriculture as the main source of food for survival. This article examines the epidemiology of dental caries with a specific focus on the twentieth century and high-risk groups.

Adult↗

Teeth for the future.

The main dietary influences on teeth are, with the exception of ingested fluoride, local rather than systemic. The frequent use of carbohydrates which can be rapidly fermented by dental plaque micro-organisms is the major factor in dental decay. Sweetened and/or highly acidic soft drinks or medicines sweetened with sugars may damage the teeth. Similarly infant's comforters also have their dangers if they provide prolonged exposure of the teeth to cariogenic conditions. Although dental caries is primarily a disease of children many adults still develop new lesions and adults who have lost gingival tissue through periodontal disease may develop root surface caries. Pathological conditions of the oral mucosa can arise from nutritional disorders or inappropriate dietary habits. Health education is most effective when it carries a positive message so encouraging patients to eat the right kind of tasty snacks and to round off meals with sugar-free products or a modicum of cheese should in healthier eating without conflicting with general health guidelines.

Adult↗

Two-year incidence of tooth loss among South Australians aged 60+ years.

UNLABELLED: Tooth loss diminishes oral function and quality of life, and national health targets aim to reduce population levels of tooth loss. OBJECTIVES: The purpose of this study was to determine tooth loss incidence and predictors of tooth loss among older adults in South Australia. METHODS: Data were obtained from a cohort study of a stratified random sample of community-dwelling dentate people aged 60+ years. Interviews and oral examinations were conducted among 911 individuals at baseline and among 693 of them (76.1%) 2 years later. Incidence rates and relative risks were calculated for population subgroups and multivariate logistic regression was used to construct risk prediction models. A method was developed to calculate 95% confidence intervals (95% CI) for relative risks (RR) from logistic regression models using a Taylor series approximation. RESULTS: Some 19.5% (95% CI = 15.4-23.6%) of people lost one or more teeth during the 2 years. Men, people with a recent extraction, people who brushed their teeth infrequently, smokers and people born outside Australia had significantly (P < 0.05) greater risk of tooth loss. Baseline clinical predictors of tooth loss included more missing teeth, retained roots, decayed root surfaces, periodontal pockets and periodontal recession. In a multivariate model that controlled for baseline clinical predictors, former smokers (RR = 2.55, 95% CI = 1.48-4.40) and current smokers (RR = 2.06, 95% CI = 0.92-4.62) had similarly elevated risks of tooth loss compared with non-smokers. CONCLUSIONS: The findings from this population suggest that a history of smoking contributes to tooth loss through mechanisms in addition to clinical disease processes alone.

Cohort Studies↗