Oral health is essential to the general health and well-being of individuals and the population. Yet significant oral health disparities persist in the U.S. population because of a web of influences that include complex cultural and social processes that affect both oral health and access to effective dental health care.
This paper introduces an organizing framework for addressing oral health disparities. We present and discuss how the multiple influences on oral health and oral health disparities operate using this framework. Interventions targeted at different causal pathways bring new directions and implications for research and policy in reducing oral health disparities.
The need for appraisal of oral health-related quality of life has been increasingly recognized over the last decades. The aims of this study were to develop a Spanish version (OHIP-Sp) of the Oral Health Impact Profile and to evaluate its convergent and discriminative validity, and its internal consistency.
The original 49-items OHIP was translated to Spanish, revised for understanding and semantics by two independent dentists, and then translated back to English by an independent bilingual dentist. The data originated in a cross sectional study conducted among high school students from the Province of Santiago, Chile. The study group was sampled using a multistage random cluster procedure yielding 9,203 students aged 12–21 years. All selected students were invited to participate and all filled a questionnaire with information on socio-demographic factors; oral health related behaviors; and self-reported oral health status (good, fair or poor). From this group, 9,163 students also accepted to fill a detailed questionnaire on socio-economic indicators and to receive a clinical examination comprising direct recordings of clinical attachment levels (CAL) in molars and incisors, tooth loss, and the presence of necrotizing ulcerative gingival lesions.
The participation rate and the questionnaire completeness were high with OHIP-Sp total scores being computed for 9,133 subjects. Self-perceived oral health status was associated with the total OHIP-Sp score and all its domains (Spearman rank correlation). The OHIP-Sp total score was also directly associated with the 4 dental outcomes investigated (Mann-Whitney test) and the largest impact was found for the outcomes, 'tooth loss' with a mean OHIP-Sp score = 13.5 and 'CAL >= 3 mm' with a mean OHIP-Sp score = 13.0.
The OHIP-Sp revealed suitable convergent and discriminative validity and appropriate internal consistency (Cronbach's α). Further studies on OHIP-Sp warrant the inclusion of populations with a higher disease burden; and the use of test-retest reliability exercises to evaluate the stability of the test.
The human oral cavity contains a complex microbial community that, until recently, has not been well characterized. Studies using molecular tools have begun to enumerate and quantify the species residing in various niches of the oral cavity; yet, virtually every study has revealed additional new species, and little is known about the structural dynamics of the oral microbial community or how it changes with disease. Current estimates of bacterial diversity in the oral cavity range up to 700 species, although in any single individual this number is much lower. Oral microbes are responsible for common chronic diseases and are suggested to be sentinels of systemic human diseases. Microarrays are now being used to study oral microbiota in a systematic and robust manner. Although this technology is still relatively young, improvements have been made in all aspects of the technology, including advances that provide better discrimination between perfect-match hybridizations from non-specific (and closely-related) hybridizations. This review addresses a core technology using gel-based microarrays and the initial integration of this technology into a single device needed for system-wide studies of complex microbial community structure and for the development of oral diagnostic devices.
This study examined the content and general readability of pediatric oral health education materials for parents of young children.
Twenty-seven pediatric oral health pamphlets or brochures from commercial, government, industry, and private nonprofit sources were analyzed for general readability ("usability") according to several parameters: readability, (Flesch-Kincaid grade level, Flesch Reading Ease, and SMOG grade level); thoroughness, (inclusion of topics important to young childrens' oral health); textual framework (frequency of complex phrases, use of pictures, diagrams, and bulleted text within materials); and terminology (frequency of difficult words and dental jargon).
Readability of the written texts ranged from 2nd to 9th grade. The average Flesch-Kincaid grade level for government publications was equivalent to a grade 4 reading level (4.73, range, 2.4 – 6.6); F-K grade levels for commercial publications averaged 8.1 (range, 6.9 – 8.9); and industry published materials read at an average Flesch-Kincaid grade level of 7.4 (range, 4.7 – 9.3). SMOG readability analysis, based on a count of polysyllabic words, consistently rated materials 2 to 3 grade levels higher than did the Flesch-Kincaid analysis. Government sources were significantly lower compared to commercial and industry sources for Flesch-Kincaid grade level and SMOG readability analysis. Content analysis found materials from commercial and industry sources more complex than government-sponsored publications, whereas commercial sources were more thorough in coverage of pediatric oral health topics. Different materials frequently contained conflicting information.
Pediatric oral health care materials are readily available, yet their quality and readability vary widely. In general, government publications are more readable than their commercial and industry counterparts. The criteria for usability and results of the analyses presented in this article can be used by consumers of dental educational materials to ensure that their choices are well-suited to their specific patient population.
Oral health status in India is traditionally evaluated using clinical indices. There is growing interest to know how subjective measures relate to outcomes of oral health. The aims of the study were to assess the prevalence and correlates of self-reported state of teeth in 12-year-old schoolchildren in Kerala, India.
Cross-sectional survey data were used. The sample consisted of 838 12-year-old schoolchildren. Data was collected using clinical examination and questionnaire. The clinical oral health status was recorded using Decayed, Missing and Filled Teeth (DMFT) and Oral Hygiene Index – Simplified (OHI-S). The questionnaire included questions on sociodemographics, self reports of behaviour, knowledge and oral problems and a single-item measuring self-reported state and satisfaction with appearance of teeth. The Kappa values for test-retest of the questionnaire ranged from 0.55 to 0.97.
Twenty-three per cent of the schoolchildren reported the state of teeth as bad. Multivariate logistic regression showed significant associations between schoolchildren who reported to have bad teeth and poor school performance (Odds Ratio (OR) = 2.5), having bad breath (OR = 2.4), food impaction (OR = 1.7) dental visits (OR = 1.6), being dissatisfied with appearance of teeth (OR = 4.2) and caries experience (OR = 1.7). The explained variance was highest when the variables dental visits, bleeding gums, bad breath, food impaction and satisfaction with appearance were introduced into the model (19%).
A quarter of 12-year-olds reported having bad teeth. The self-reported bad state of teeth was associated with poor school performance, having bad breath and food impaction, having visited a dentist, being dissatisfied with teeth appearance and having caries experience. Information from self-reports of children might help in planning effective strategies to promote oral health.
The aim of this study was to determine which behavioral factors to include in guidelines for the Japanese public to achieve an acceptable level of oral healthiness. The objective was to determine the relationship between oral health related behaviors and symptoms related to oral disease and tooth loss in a Japanese adult community.
Oral health status and lifestyle were investigated in 777 people aged 20 years and older (390 men and 387 women). Subjects were asked to complete a postal questionnaire concerning past diet and lifestyle. The completed questionnaires were collected when they had health examinations. The 15 questions included their preference for sweets, how many between-meal snacks they usually had per day, smoking and drinking habits, presence of oral symptoms, and attitudes towards dental visits. Participants were asked about their behaviors at different stages of their life. The oral health examinations included examination of the oral cavity and teeth performed by dentists using WHO criteria. Odds ratios were calculated for all subjects, all 10 year age groups, and for subjects 30 years or older, 40 years or older, 50 years or older, and 60 years or older.
Frequency of tooth brushing (OR = 3.98), having your own toothbrush (OR = 2.11), smoking (OR = 2.71) and bleeding gums (OR = 2.03) were significantly associated with number of retained teeth in males. Frequency of between-meal snacks was strongly associated with number of retained teeth in females (OR = 4.67). Having some hobbies (OR = 2.97), having a family dentist (OR = 2.34) and consulting a dentist as soon as symptoms occurred (OR = 1.74) were significantly associated with number of retained teeth in females. Factors that were significantly associated with tooth loss in both males and females included alcohol consumption (OR = 11.96, males, OR = 3.83, females), swollen gums (OR = 1.93, males, OR = 3.04, females) and toothache (OR = 3.39, males, OR = 3.52, females).
Behavioral factors that were associated with tooth retention were frequency of eating snacks between meals, tooth brushing frequency, having one's own toothbrush, smoking and drinking habits, having hobbies, having a family dentist and when they had dental treatment. Clinical factors included bleeding gums, swollen gums, and toothache.
Understanding caries etiology and distribution is central to understanding potential opportunities for and likely impact of new biotechnologies and biomaterials to reduce the caries burden worldwide. This review asserts the appropriateness of characterizing caries as a "pandemic" and considers static and temporal trend reports of worldwide caries distribution. Oral health disparities within and between countries are related to sugar consumption, fluoride usage, dental care, and social determinants of health. Findings of international and U.S. studies are considered in promoting World Health Organization's and others' recommendations for science-based preventive and disease management interventions at the individual, clinical, public health, and public policy levels.
In Tanzania, oral health services are mostly in the form of dental extractions aimed at alleviating acute dental pain. Conservative methods of alleviating acute dental pain are virtually non-existent. Therefore, it was the aim of this study to determine treatment success of emergency pulpotomy in relieving acute dental pain.
Setting: School of Dentistry, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Study design: Longitudinal study.
Participants: 180 patients who presented with dental pain due to acute irreversible pulpitis during the study period between July and August 2001.
Treatment and evaluation: Patients were treated by emergency pulpotomy on permanent posterior teeth and were evaluated for pain after one, three and six week's post-treatment. Pain, if present, was categorised as either mild or acute.
Of the patients with treated premolars, 25 (13.9%) patients did not experience pain at all while 19 (10.6%) experienced mild pain. None of the patients with treated premolars experienced acute pain. Among 136 patients with treated molars 56 (31%) did not experience any pain, 76 (42.2%) experienced mild pain and the other 4 (2.2%) suffered acute pain.
The short term treatment success of emergency pulpotomy was high being 100% for premolars and 97.1% for molars, suggesting that it can be recommended as a measure to alleviate acute dental pain while other conservative treatment options are being considered.
Children receive dental general anaesthetic (DGA) care when standard dental treatment is not possible. Receipt of DGA care is resource-intensive and not without risk. This study examines trends in receipt of DGA care among Australian children.
Child DGA data were obtained from the Australian Institute of Health and Welfare Hospital Morbidity Database for 1993–2004. Poisson regression modelling was used to examine DGA rates in relation to age, sex, Indigenous status, location, year and procedure.
There was a 3-fold increase in DGA rates from 1993–1994 (215.8 ± 2.9 per 100,000) to 2003–2004 (731.4 ± 5.3 per 100,000) (P < 0.001). Across all years, children who were aged 0–4 years, male or rural/remote-dwelling had higher DGA rates than their 5–9-year-old, female or metropolitan-dwelling counterparts respectively. There was a 7.0-fold increase in the rate of Indigenous admissions from 1993–1994 (116.5 ± 10.2 per 100,000) to 2003–2004 (806.6 ± 25.7 per 100,000). Extraction rates increased 4.9-fold from 1993–1994 (109.2 ± 2.9 per 100,000) to 2003–2004 (540.0 ± 4.5 per 100,000), while restoration rates increased 3.3-fold in the same observation period (139.5 ± 2.3 per 100,000 in 1993–1994 to 462.6 ± 4.2 per 100,000 in 2003–2004). For admissions in which one or more extractions were received, Indigenous rates were 47% greater than non-Indigenous rates after adjusting for other covariates.
Child DGA rates in Australia are increasing. Children who are pre-school-aged, male, Indigenous or living in a rural/remote location are disproportionally represented among those receiving such care. There are higher rates of extractions as opposed to more conservative procedures, particularly among Indigenous children.
While our knowledge of the dental caries process and its prevention has greatly advanced over the past fifty years, it is fair to state that the management of this disease at the level of the individual patient remains largely empirical. Recommendations for fluoride use by patients at different levels of caries risk are mainly based on the adage that more is better. There is a general understanding that the fluoride compound, concentration, frequency of use, duration of exposure, and method of delivery can influence fluoride efficacy. Two important factors are (1) the initial interaction of relatively high concentrations of fluoride with the tooth surface and plaque during application and (2) the retention of fluoride in oral fluids after application.
Fluoride dentifrices remain the most widely used method of delivering topical fluoride. The efficacy of this approach in preventing dental caries is beyond dispute. However, the vast majority of currently marketed dentifrice products have not been clinically tested and have met only the minimal requirements of the FDA monograph using mainly laboratory testing and animal caries testing. Daily use of fluoride dental rinses as an adjunct to fluoride dentifrice has been shown to be clinically effective as has biweekly use of higher concentration fluoride rinses. The use of remineralizing agents (other than fluoride), directed at reversing or arresting non-cavitated lesions, remains a promising yet largely unproven strategy. High fluoride concentration compounds, e.g., AgF, Ag(NH3)2F, to arrest more advanced carious lesions with and without prior removal of carious tissue are being used in several countries as part of the Atraumatic Restorative Treatment (ART) approach.
Most of the recent innovations in oral care products have been directed toward making cosmetic marketing claims. There continues to be a need for innovation and collaboration with other scientific disciplines to fully understand and prevent dental caries.
We describe the risk indicators for oral mucositis (OM) in paediatric oncology patients hospitalised in the Institut Gustave Roussy (Villejuif-Paris) and treated with alkylant chemotherapy with autologous peripheral blood progenitor cells.
The sample was selected using PIGAS software. Three groups of subjects received different chemotherapy regimens: A. Melphalan, B. Busulfan and C. other alkylant protocols. The degree of mucositis was recorded by CTC version 2.0 (Common Toxicity Criteria). Descriptive statistics were performed. The association between mucositis and risk indicator variables was tested using a χ2 test. The association between case status and covariates was tested using unconditional logistic regression analysis.
Of the 337 children enrolled, 241 showed mucositis (group 1) and 96 did not show mucositis (group 2) during alkylant chemotherapy. There was a higher prevalence of male patients in both groups. The three different chemotherapy regimen groups are correlated with the appearance of oral mucositis (χ2 = 22.42, p < 0.01). Weight loss was higher in group 1 (χ2 = 6.31, p = 0.01). The duration of aplasia was lower in the Busulfan protocol (7.5 days) than in the Melphalan group (9.3 days) or the other regimens (8.6 days). The use of Bufulfan® was directly associated with case status (presence of oral mucositis): odds ratio [OR] = 2.1 and confidence interval [95%CI] = 1.3–3.0. Also, occurrences of germinal tumours and secondary bacterial infections were directly linked with case status: [OR] = 1.4 and 1.8, confidence interval [95%CI] = 1.2 – 1.7 and 1.1 – 2.5, respectively.
The presence of OM was associated with the three different chemotherapy regimens considered; in particularly patients treated with Busulfan had the highest prevalence.
The aim of the study was to compare the prevalence and types of HIV-related oral lesions between children and adult Tanzanian patients on HAART with those not on HAART and to relate the occurrence of the lesions with anti-HIV drug regimen, clinical stage of HIV disease and CD4+ cell count.
Participants were 532 HIV infected patients, 51 children and 481 adults, 165 males and 367 females. Children were aged 2–17 years and adults 18 and 67 years. Participants were recruited consecutively at the Muhimbili National Hospital (MNH) HIV clinic from October 2004 to September 2005. Investigations included; interviews, physical examinations, HIV testing and enumeration of CD4+ T cells.
A total of 237 HIV-associated oral lesions were observed in 210 (39.5%) patients. Oral candidiasis was the commonest (23.5%), followed by mucosal hyperpigmentation (4.7%). There was a significant difference in the occurrence of oral candidiasis (χ2 = 4.31; df = 1; p = 0.03) and parotid enlargement (χ2 = 36.5; df = 1; p = 0.04) between children and adults. Adult patients who were on HAART had a significantly lower risk of; oral lesions (OR = 0.32; 95% CI = 0.22 – 0.47; p = 0.005), oral candidiasis (OR = 0.28; 95% CI = 0.18 – 0.44; p = 0.003) and oral hairy leukoplakia (OR = 0.18; 95% CI = 0.04 – 0.85; p = 0.03). There was no significant reduction in occurrence of oral lesions in children on HAART (OR = 0.35; 95% CI = 0.11–1.14; p = 0.15). There was also a significant association between the presence of oral lesions and CD4+ cell count < 200 cell/mm3 (χ2 = 52.4; df = 2; p = 0.006) and with WHO clinical stage (χ2 = 121; df = 3; p = 0.008). Oral lesions were also associated with tobacco smoking (χ2 = 8.17; df = 2; p = 0.04).
Adult patients receiving HAART had a significantly lower prevalence of oral lesions, particularly oral candidiasis and oral hairy leukoplakia. There was no significant change in occurrence of oral lesions in children receiving HAART. The occurrence of oral lesions, in both HAART and non-HAART patients, correlated with WHO clinical staging and CD4+ less than 200 cells/mm3.
Children with special needs (CSN) are reported to receive less adequate dental care due to various behavioral problems and barriers created by dental professionals. This study was carried out to determine the knowledge and behaviour of Nigerian dentists concerning the treatment of CSN.
Questionnaires consisting of open and closed ended questions requesting socio-demographic information, type of practice, undergraduate and postgraduate training, self-rated knowledge and behaviour concerning care of CSN, were hand delivered to 359 dentists in the 3 geographical zones of Nigeria over a period of 8 weeks. Responses were compared across age groups, gender, type of practice and training received.
Two hundred and eighty questionnaires were returned completed, constituting 79.9% response rate. Most of the respondents were aged 30 – 39 years (44.3%). There were more males (56.1%) and more recent graduates of 10 years and below (78.5%). Over 80% of respondents had treated children with disabilities, those with physical disabilities being most encountered. Only 19.3% of respondents rated their knowledge of management of CSN as adequate, with no significant difference across age groups and gender, but with a significantly higher number of older graduates reporting to have adequate knowledge (p < 0.05). Those who had undergraduate training in care of CSN were 69.5% compared with only 12.8% who had post graduate training. Only 11.8% rated their undergraduate training as adequate. Thirty seven percent of respondents rated the CSN they had treated as very challenging. A higher proportion of older graduates (of more than 10 years post graduation) and those who rated their undergraduate training as inadequate used sedation and general anaesthesia. Seventy one percent of respondents were willing to treat CSN, with no significant difference across age groups, gender and training, but with a significantly higher percentage among those who had rated their knowledge as adequate. Most of those who were unwilling to treat CSN felt their management was tedious and challenging.
From this study, very few dentists reported to have adequate knowledge of management of CSN, irrespective of age, gender and place of practice. A significant number of those with more experience rated their knowledge as adequate. Although most dentists rated the children's behaviour as challenging, they indicated their willingness to treat them in their practices.
It was the aim of this study to investigate the effect of four different toothpastes with differing fluoride compounds on enamel remineralization.
A 3 × 3 mm window on the enamel surface of 90 human premolars was demineralized in a hydroxyethylcellulose solution at pH 4.8. The teeth were divided into 6 groups and the lower half of the window was covered with varnish serving as control. The teeth were immersed in a toothpaste slurry containing: placebo tooth paste (group 1); remineralization solution (group 2); Elmex Anticaries (group 3); Elmex Sensitive (group 4); Blend-a-med Complete (group 5) and Colgate GRF (group 6). Ten teeth of each group were used for the determination of the F- content in the superficial enamel layer and acid solubility of enamel expressed in soluble phosphorus. Of 6 teeth of each group serial sections were cut and investigated with polarization light microscopy (PLM) and quantitative energy dispersive X-ray analysis (EDX).
The PLM results showed an increased remineralization of the lesion body in the Elmex Anticaries, Elmex Sensitive and Colgate GRF group but not in the Blend-a-med group. A statistically significant higher Ca content was found in the Elmex Anticaries group. The fluoride content in the superficial enamel layer was significantly increased in both Elmex groups and the Blend-a-med group. Phosphorus solubility was significantly decreased in both Elmex groups and the Blend-a-med group.
It can be concluded that amine fluoride compounds in toothpastes result in a clearly marked remineralization of caries like enamel lesions followed by sodium fluoride and sodium monofluorophosphate formulations.
The goal of this workshop is to develop a consensus within the biomaterials/bioengineering community for a research agenda focused on creating technologies that will address the current dental caries pandemic. The workshop will bring together expertise from academia, industry, and the NIH institutes in the areas of oral biofilm microbiology and innovative biomaterials. The rationale for the workshop is that science and technology have not produced sufficient practical tools for public health practitioners and the private delivery system to address the pandemic in dental caries that exists for children and adults from families with low incomes and for numerous ethnic minority and racial groups. Moreover, it is unclear whether the barriers are remediable bioengineering and technical problems or fundamental science questions. Nevertheless, the obligation to address the gap between scientific research and practical application is especially relevant today. The U.S. and state governments bear the majority of the cost of trying to control this pandemic through Medicaid, the Public Health Service, Indian Health Service and other similar programs. These costs continue to escalate as continued applications of existing technology are unlikely to markedly reduce disparities. The mainstays of caries prevention, topical and systemic fluorides and pit and fissure sealants, are technologies developed in the 1950s and 1960s.
Strains of viridans group streptococci that initiate colonization of the human tooth surface typically coaggregate with each other and with Actinomyces naeslundii, another member of the developing biofilm community. These interactions generally involve adhesin-mediated recognition of streptococcal receptor polysaccharides (RPS). The objective of our studies is to understand the role of these polysaccharides in oral biofilm development.
Different structural types of RPS have been characterized by their reactions with specific antibodies and lectin-like adhesins. Streptococcal gene clusters for RPS biosynthesis were identified, sequenced, characterized and compared. RPS-producing bacteria were detected in biofilm samples using specific antibodies and gene probes.
Six different types of RPS have been identified from representative viridans group streptococci that coaggregate with A. naeslundii. Each type is composed of a different hexa- or heptasaccharide repeating unit, the structures of which contain host-like motifs, either GalNAcβ1-3Gal or Galβ1-3GalNAc. These motifs account for RPS-mediated recognition, whereas other features of these polysaccharides are more closely associated with RPS antigenicity. The RPS-dependent interaction of S. oralis with A. naeslundii promotes growth of these bacteria and biofilm formation in flowing saliva. Type specific differences in RPS production have been noted among the resident streptococcal floras of different individuals, raising the possibility of RPS-based differences in the composition of oral biofilm communities.
The structural, functional and molecular properties of streptococcal RPS support a recognition role of these cell surface molecules in oral biofilm formation.
The risk for caries development in children varies significantly for different age groups, individuals, teeth, and surfaces. Thus from a cost-effectiveness point of view, caries preventive measures must be integrated and based on predicted risk from age group down to individual tooth surfaces. Based on this philosophy and experiences from continuously ongoing research on evaluating and reevaluating separate and integrated caries preventive measures, as well as methods for prediction of caries risk, a needs-related caries preventive program was introduced for all 0–19-year-olds in the county of Värmland, Sweden, in 1979. The goals for the subjects following the program from birth to the age of 19 years were:
1. To have no approximal restorations.
2. To have no occlusal amalgam restorations.
3. To have no approximal loss of periodontal attachment.
4. To motivate and encourage individuals to assume responsibility for their own oral health.
The effect of the program is evaluated once every year on almost 100% of all 3–19-year-olds in a computer-aided epidemiologic program from 1979. Most of the individualized preventive program was carried out by dental hygienists or prophy dental assistants at clinics in the elementary schools. During the 20-year period the percentage of caries-free 3-year-olds increased from 51% to 97%. In 1999 as many as 86% of the 12-year-olds were caries free. Caries incidence was reduced more than 90% in all age groups. More than 90% did not develop any new caries lesions in 1999. As a consequence, caries prevalence was dramatically reduced. In 12- and 19-year-olds, the mean number of Decayed and Filled Surfaces (DFS) per individual was reduced from 6 to 0.3 and from 23 to 2 respectively. In 19-year-olds the mean number of approximal DFS was <1, and only 0.5 had to be filled. The mean number of occlusal DFS was <1. Since 1995 we have not been allowed to use amalgam in 1–19-year-olds in Sweden. As an effect of our high quality plaque program, approximal attachment loss was prevented, and by efficient education in self-care based on self-diagnosis, needs-related self-care habits were established. Thus it can be concluded that nearly 100% of our goals had been achieved.
Possibilities for biomaterials to impact the dental caries epidemic are reviewed with emphasis placed on novel delivery biomaterials and new therapeutic targets.
Despite remarkable reduction in the prevalence of dental caries in the United States, dental caries is still a highly prevalent disease among children who are socially disadvantaged (racial/ethnic minority, poor, rural, immigrants). Consequently, caries sequelae such as dental pain, need for dental treatment under general anesthesia, and future orthodontic treatment, are also concentrated among the most socially disadvantaged children. To make the situation more appalling, those children who need treatment the most are the ones least likely to visit the dentist. Low income children are less likely to visit the dentist in part because of family's competing needs for limited resources, shortage of pediatric dentists, and dentists not taking uninsured or publicly insured patients. In the same vein, if these children do not have access to dental care, they are deprived from effective caries preventive measures that are dentist-dependent such as sealants and professionally applied fluoride. Dentistry has done well at devising caries preventive and treatment strategies; but these strategies have missed the most needed segment of society: disadvantaged children. The challenge now is to develop innovative strategies to reach these children.
The importance of Streptococcus mutans in the etiology of dental caries has been well documented. However, there is growing recognition that the cariogenic potential of dental plaque may be determined by the composite interactions of the total plaque bacteria rather than solely the virulence properties of a single organism. This study will examine how the interactions of S. mutans with other biofilm constituents may influence the cariogenicity of plaque samples.
In order to begin to investigate the effects of nonmutans streptococci on the cariogenic potential of S. mutans, we have examined the effects of Streptococcus gordonii on the virulence properties of the former organisms. These studies have indicated that S.gordonii can attenuate several potential virulence properties of S. mutans including bacteriocin production, genetic transformation, and biofilm formation. Therefore, modulation of the interactions between plaque bacteria might be a novel approach for attenuating dental caries initiation.
The number of new technologies emerging each year in the realm of dental caries management is growing at an exponential rate. Examining the patent literature, one can see that this growth rate will likely continue, with the outcome that dentistry will see an expanded growth in managing dental caries by risk assessment with medicinal therapeutic interventions. Restorative dentistry solutions, treating the results of dental caries, will continue to grow, while technologies to identify the caries process at its earliest stages will soon invade practices everywhere. The most interesting aspect of these changes will be how industry responds to the inexorable, yet slow change in dental professional demand for these new technologies, while trying to be the "first to market" within the various categories of this business opportunity. This paper will take a close look at how businesses with the core competence to be key players in this emerging growth category will assess the marketplace, and match up their business interests with the changing needs of the dental profession. The paper will also address the strategic planning and business processes that the dental industry will undertake to bring new technologies to market, and how these technologies will be positioned to health care professionals and consumers. The results of the key interactions between industry and the dental profession will determine the extent to which dental caries is managed as a disease, in addition to being managed by surgical restorative interventions.
Dental plaque is a structurally- and functionally-organized biofilm. Plaque forms in an ordered way and has a diverse microbial composition that, in health, remains relatively stable over time (microbial homeostasis). The predominant species from diseased sites are different from those found in healthy sites, although the putative pathogens can often be detected in low numbers at normal sites. In dental caries, there is a shift toward community dominance by acidogenic and acid-tolerating species such as mutans streptococci and lactobacilli, although other species with relevant traits may be involved. Strategies to control caries could include inhibition of biofilm development (e.g. prevention of attachment of cariogenic bacteria, manipulation of cell signaling mechanisms, delivery of effective antimicrobials, etc.), or enhancement of the host defenses. Additionally, these more conventional approaches could be augmented by interference with the factors that enable the cariogenic bacteria to escape from the normal homeostatic mechanisms that restrict their growth in plaque and out compete the organisms associated with health. Evidence suggests that regular conditions of low pH in plaque select for mutans streptococci and lactobacilli. Therefore, the suppression of sugar catabolism and acid production by the use of metabolic inhibitors and non-fermentable artificial sweeteners in snacks, or the stimulation of saliva flow, could assist in the maintenance of homeostasis in plaque. Arguments will be presented that an appreciation of ecological principles will enable a more holistic approach to be taken in caries control.
Humans love the taste of sugar and the word "sweet" is used to describe not only this basic taste quality but also something that is desirable or pleasurable, e.g., la dolce vita. Although sugar or sweetened foods are generally among the most preferred choices, not everyone likes sugar, especially at high concentrations. The focus of my group's research is to understand why some people have a sweet tooth and others do not. We have used genetic and molecular techniques in humans, rats, mice, cats and primates to understand the origins of sweet taste perception. Our studies demonstrate that there are two sweet receptor genes (TAS1R2 and TAS1R3), and alleles of one of the two genes predict the avidity with which some mammals drink sweet solutions. We also find a relationship between sweet and bitter perception. Children who are genetically more sensitive to bitter compounds report that very sweet solutions are more pleasant and they prefer sweet carbonated beverages more than milk, relative to less bitter-sensitive peers. Overall, people differ in their ability to perceive the basic tastes, and particular constellations of genes and experience may drive some people, but not others, toward a caries-inducing sweet diet. Future studies will be designed to understand how a genetic preference for sweet food and drink might contribute to the development of dental caries.
New research developments frequently are neither adopted by providers nor utilized by patients. This dual problem of impacting the behaviors of providers and patients presents a challenge. This paper will present behavioral theories and technologies that can be utilized to impact both provider and patient behaviors.
The presence of antimicrobial peptides (AMPs) in saliva may be a biological factor that contributes to susceptibility or resistance to caries. This manuscript will review AMPs in saliva, consider their antimicrobial and immunomodulatory functions, and evaluate their potential role in the oral cavity for protection of the tooth surface as well as the oral mucosa. These AMPs are made in salivary gland and duct cells and have broad antimicrobial activity. Alpha-defensins and LL37 are also released by neutrophils into the gingival crevicular fluid. Both sources may account for their presence in saliva. A recent study in middle school children aimed to determine a possible correlation between caries prevalence in children and salivary concentrations of the antimicrobial peptides human beta-defensin-3 (hBD-3), the cathelicidin, LL37, and the alpha-defensins. The levels of these AMPs were highly variable in the population. While levels of LL37 and hBD-3 did not correlate with caries experience, the mean alpha-defensin level was significantly higher in children with no caries than in children with caries (p < 0.005). We conclude that several types of AMPs that may have a role in oral health are present in unstimulated saliva. Low salivary levels of alpha-defensin may represent a biological factor that contributes to caries susceptibility. Our observation could lead to new ways to prevent caries and to a new tool for caries risk assessment.