Wednesday, August 30, 2017

Diet and Caries-associated Bacteria in Severe Early Childhood Caries

Resident’s Name: Michael Hatton DDS                                    Date: 8/30/2017

Article Title: Diet and Caries-associated Bacteria in Severe Early Childhood Caries
Author(s): C.A. Palmer, R. Kent, Jr., C.Y. Loo, C.V. Hughes, E. Stutius, N. Pradhan, M. Dahlan, E. Kanasi, S.S. Arevalo Vasquez, A.C.R. Tanner
Journal: Journal of Dental Research
Date: Sept 2010
Major Topic: Dental Caries, ECC, Prevention
Type of Article: Case controlled
Main Purpose: examine associations between diet and bacterial colonization in children with S-ECC, including children with and without new caries lesions post-treatment.
Key Points: (2 lines Max): Treatment for and prevention of S-ECC should include attention to putative food frequency, putative cariogenicity, and suppression of cariogenic bacteria
Hypothesis that data from a short diet survey would differentiate S-ECC from caries-free children based on frequency of foods, characterized by putative cariogenicity, and these dietary habits would be associated with detection of caries-associated bacteria.
Methods
1)      Dietary survey completed by parents or caregivers at baseline measurement visit – included demographics, beverage consumption, and 24-hour diet recall of previous day or typical day marked in hours
-          Diet information was obtained by clinicians trained to elicit information using non-directive interviewing approaches to obtain accurate reporting
2)      Microbial analysis performed using sterile toothpicks to collect plaque samples.
3)      S-ECC children scheduled for monitoring at 3 to 6 month intervals for 12 months.
Results
1)      Beverage survey
a.       S-ECC drank juice particularly btwn meals and drank milk at mealtimes vs caries-free children
b.      after tx – more children without new lesions drank milk btwn meals at baseline than did children with new lesions
2)      Food frequencies
a.       S-ECC consumed more food and beverage items a day and more frequently than did caries-free children
b.      no difference in baseline food frequencies btwn children w/ different post-op outcomes
c.       More S-ECC than caries-free reported bedtime snacks
d.      Vice-versa – more caries-free children reported no snacks or beverages during the night than S-ECC
3)      Putative Food Cariogenicity
a.       No difference for consumption of foods categorized as caries protective, non-cariogenic, or low in cariogenic potential
b.      S-ECC higher than caries-free for food or beverage cariogenicity
c.       Children without new lesions ate more putative caries-protective foods at baseline than children with new lesions

4)      Microbiology
a.       S. mutansS. sobrinus, and Bifidobacteria detected more frequently in S-ECC than caries-free children
b.      Mean putative food cariogenicity elevated in children with S. mutans (but no other species)
Discussion
1)      Findings of stronger association of between-meal juice and S-ECC compared with mealtimes juice and other beverages consistent with research indicating beverage intake during meals not a major risk factor
2)      S-ECC children without new lesions drank more milk between meals than those with new lesions consistent with suggested caries-protective properties of milk
3)      Food or beverage frequencies were independently associated with S-ECC
4)      Eating at bedtime and snacks during the night showed strong association with S-ECC (most caries-free children reported no nighttime snacks or beverages)
5)      Liquid and solid retentive sugars and starch/sugar combinations each significantly associated with S-ECC
6)      Children with new lesions reported lower intake of putative caries-protective foods at baseline consistent with controlled animal studies showing cariostatic effect of certain foods
7)      S. mutans and S. sobrinus significantly associated with S-ECC and with development of new lesions, particularly when detected together
Difficulties/Limitations
1)      Obtaining accurate diet history is difficult – survey and analysis in this study not tested for reliability and validity
2)      Loss of follow-up of S-ECC children
Conclusions
Treatment for and prevention of S-ECC should include attention to putative food frequency, putative cariogenicity, and suppression of cariogenic bacteria

Evidence-based clinical recommendations on the prescription of Dietary fluoride supplements for caries prevention: A report of the American Dental Association Council on Scientific Affairs.

Department of Pediatric Dentistry
Langone Medical Center
Resident’s Name: Albert Yamoah                                                                                                            Date: 08/30/2016
Article Title: Evidence-based clinical recommendations on the prescription of Dietary fluoride supplements for caries prevention: A report of the American Dental Association Council on Scientific Affairs.
Author(s): Rozier, R. G., et al
Journal: Journal of American Dental Association
Date: December 2010
Major TopicRecommendations on prescribing dietary fluoride supplements
Type of Article: Systematic review 
Main Purpose: Evidence-based clinical recommendations for the prescription of dietary fluoride supplements. 
Background:
The prevalence of fluorosis apparently has increased in US. This is because of an increase in the number of sources of exposure to fluoride, including ingestion of water, toothpastes, dietary fluoride supplements, beverages, foods and professional dental products. The ADA and CSA (council of scientific affairs) addressed when and for whom should fluoride supplements be prescribed, and what should the recommended dosage be.

Methods: 
A MEDLINE search was conducted to identify publications that addressed the research questions: Systematic reviews as well as clinical studies published since the systematic reviews were conducted (June 1, 2006). Total of 23 full text articles were reviewed

Results:
- For children at low risk of developing caries, dietary fluoride supplements are not recommended and other sources of fluoride should be considered as a caries-preventive intervention
- For children at high risk of developing caries, dietary fluoride supplements are recommended according to the schedule presented in the table below
- When fluoride supplements are prescribed, they should be taken daily to maximize the caries-preventive benefit
- Systemic fluoride has an indirect topical effect when redistributed in the oral environment by means of saliva.  Supplements that are chewed or lozenges are the best and supplementation can be beneficial after the completion of amelogenesis.
- Recommendation emphasizes the need for caries risk assessment and judicious prescription of dietary fluoride supplements with consideration of total fluoride intake.

Remarks:
1.
Assessment of Article:  Level of Evidence: I


Tuesday, August 29, 2017

The association between enamel fluorosis and dental caries in U.S. school children

Department of Pediatric Dentistry
Lutheran Medical Center
           
Resident’s Name: Brian Darling                                                                                             Date: 8/30/2017

Article Title: The association between enamel fluorosis and dental caries in U.S. school children
Author(s): Iida, H and Kumar, JV
Journal: JADA
Date: 2009; 140 (7): 855-65
Major Topic: Fluorosis
Type of Article: Primary research – cross-sectional study
Main Purpose:  This study aimed to determine the association between caries and fluorosis.
Key Points: Teeth with fluorosis appear to be more caries-resistant than teeth without fluorosis.  
·      The National Research Council’s 2006 report titled Fluoride in Drinking Water: A Scientific Review of EPA’s Standards recommended that severe enamel fluorosis be considered an adverse health effect based on the hypothesis that severe fluorosis was associated with increased caries. Also, severe fluorosis on anterior teeth is less esthetic.
·      Previous studies have reported higher levels of caries in patients with severe fluorosis. These studies suggest that this is due to pitting of teeth with severe fluorosis
·      Milder forms of fluorosis are not noticeable to the public
·      DMFS decreased as fluoride content in school water increased up to 0.7mg/L, after that there was no significant benefit of increasing the water fluoride levels  
·      DMFS decreased as severity of fluorosis increased
·      Younger age, African-American compared to white race, and presence of sealants were associated with having less caries regardless of school water fluoride levels
·      Children attending schools in the Southwest US had fewer caries
·      Teeth with fluorosis consistently had lower caries experience than teeth without fluorosis
·      It is speculated that the pits/fissures of molars receive a less beneficial effect from post-eruptive fluoride due to anatomy
·      Prevalence of severe fluorosis is essentially zero below 2 mg/L fluoride in water
·      Fluorosis in 4-5 permanent first molars in a population may be associated with an average of about one fewer DMFS in that population. This equates to needing to seal and maintain 4-15 permanent first molars, which is a more costly and timely process, to get the same effect. 

Remarks:
1- Data used in the study was from the 1980s and only looked at #3’s
2-
Assessment of Article:  Level of Evidence/Comments: II-3

Impact of pharmacological interventions in expectant mothers resulting in altered mutans streptococci levels in their children

Department of Pediatric Dentistry
Lutheran Medical Center
           
Resident’s Name: Brian Darling                                                                                 Date: 8/30/2017
Article Title: Impact of pharmacological interventions in expectant mothers resulting in altered mutans streptococci levels in their children
Author(s): Satta Muthu M et al
Journal: Pediatric Dentistry
Date: 2015; 37: 422-28
Major Topic: Prenatal pharmacological interventions and mutans streptococci levels in children
Type of Article:  Systematic review  
Main Purpose: This study aimed to elucidate if prenatal use of fluoride, chlorhexidine, or xylitol could decrease mutans streptococci (MS) levels in children.
Key Points: Because of the lack of high quality evidence, the ability to make any recommendations regarding pharmacological interventions in pregnant mothers in hopes of reducing ECC in their infants is questionable.
·      ECC  = 1 or more decayed (cavitated or noncavitated), missing due to caries, or filled tooth surfaces in a primary tooth in a child under age 6
·      The 2 principal microbes for causing ECC are Streptococci mutans and Streptococci sobrinus
·      MS colonization of an infant ma occur as early as the time of birth
·      Infant caries risk is directly proportional to bacterial load of the mother
·      Fluoride supplementation prenatally and postpartum have no significant impact on caries incidence
·      Xylitol reduces MS in plaque in saliva by disrupting the energy production process of MS and leading to a futile energy consumption cycle and cell death. It also decreases the synthesis of insoluble extracellular polysaccharides, thus reducing risk of MS adhesion to enamel and thus MS transmission.
·      Maternal MS levels can be reduced by use of chlorhexidine and/or fluoride.
·      3 main caries-preventive mechanisms of fluoride
o   Promotes remineralization
o   Inhibits demineralization
o   Interferes with bacterial growth and metabolism
·      Only 2 studies were included in the systematic review and the studies were of poor quality
o   One study on xylitol use reported significant results in being able to reduce MS levels in infants
o   The second study also reported significant results in the combination of chlorhexidine and 0.05% NaF reducing the levels of MS in infants
·      Because of the lack of high quality evidence, no conclusion could be reached regarding the use of prenatal pharmacological interventions on ECC incidence and MS transmission
·      The efficacy of prenatal pharmacological interventions targeting a single bacterium (MS) remains controversial.



Remarks:
1-
2-
Assessment of Article:  Level of Evidence/Comments: I but only 2 studies were included