Department of Comprehensive Care and Allied Professions Works

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An In-Vitro Study to Determine Anti-Caries Efficacy of Fluoride Varnishes
(Office of the Vice Chancellor for Research, 2013-04-05) Al Dehailan, Laila; Mier, E. Angeles Martinez; Lippert, Frank
Fundamental research on fluoride varnishes (FV) and how different formulations affect adherence to teeth, fluoride release into saliva and uptake by teeth is virtually non-existent. The objective of this in vitro study was to investigate the anti-caries efficacy of five commercially available FV: Enamel Pro® Varnish Clear, Flor-Opal® Varnish White, MI Varnish™, PreviDent® and Vanish™. Ninety bovine enamel specimens (4x4mm) were prepared and assigned to five groups (n=18). Early caries lesions were created in the specimens and characterized using Vickers microhardness (VHN). FV was applied to each group of specimens. Immediately afterwards, 7.5ml of artificial saliva (AS) were pipetted over each group, collected and renewed every 15min for 6h. AS samples were analyzed for fluoride using a ion-specific electrode and meter. FV was removed using chloroform and part of the specimens protected to determine enamel fluoride uptake (EFU) using the acid etch technique. Each group was then subjected to pH cycling consisting of a 4h/day acid challenge and two, one-minute treatments with Crest Cavity Protection. Post-pH cycling microhardness was measured and compared to baseline values to determine the ability of the FV to enhance remineralization/prevent demineralization. One-way ANOVA was used for data analysis (p<0.05). Specimens treated with Enamel Pro® revealed an increase in VHN that was significantly higher than all other groups. There was no significant difference in ΔVHN for Flor-Opal® compared to MI Varnish™, PreviDent® and Vanish™. Specimens treated with MI Varnish™ showed significantly higher ΔVHN than Vanish™ only. No significant difference in EFU was found among groups. Total fluoride release over 6h was MI Varnish™(303μg/ml) > Enamel Pro® (217μg/ml) > Flor-Opal® (153μg/ml) > PreviDent® (84μg/ml) > Vanish(28μg/ml). In conclusion, anti-caries efficacy (measured through EFU, fluoride release and VHN) differs among FV products and this difference may be attributed to different composition, fluoride source and other active ingredients.
Effectiveness and Mechanisms of Action of Whitening Dentifrices on Enamel Extrinsic Stains
(Office of the Vice Chancellor for Research, 2013-04-05) Alshara, Salem; Lippert, Frank; Hara, Anderson T.
Whitening dentifrices utilize different approaches for stain removal and/or prevention, including the use of abrasive, oxidizing and chemical cleaning agents. The objectives of this in vitro study were: 1. to compare the whitening effect of commercial whitening and non-whitening dentifrices; 2. to verify the mechanism of action of whitening dentifrices by contrasting two experimental models: chemical (toothpaste exposure only) and chemo-mechanical (toothpaste exposure with tooth brushing abrasion). Two hundred fifty six bovine enamel specimens (10x10mm) were prepared and partially stained. They were assigned to 8 groups: 6 whitening dentifrices, 1 non-whitening reference dentifrice and deionized water (control); and further divided in 2 subgroups (n=16) according to the experimental models: chemical or chemo-mechanical. Specimens were daily exposed to dentifrice slurries 2x/day for 1min and brushed or not, according to each model. In between dentifrice treatments, specimens were exposed to the staining solution for 5h. This protocol was repeated for 5 consecutive days and enamel color changes (Delta E) were measured by spectrophotometry, after each day. The abrasivity of the toothpastes was determined using standard test (ISO 11609). Significantly higher Delta E values (whitening effect) were observed for all groups (p<0.05), except control, when tested in the chemo-mechanical model. In this model, the whitening ability of the toothpastes was mainly determined by their abrasive levels. For the chemical model, no significant differences were observed among groups (p>0.05). Whitening dentifrices can be effective preventing/removing enamel surface staining, when associated to tooth brushing abrasion. This seemed to be modulated mainly by the abrasive level of the tested toothpastes, with no action attributed to the chemical agents.
Comparison Between Radiotracer and Surface Profile Methods for the Determination of Dentifrice
(Office of the Vice Chancellor for Research, 2013-04-05) Sabrah, Alaa; Lippert, Frank; Kelly, Adam B.; Hara, Anderson T.
Introduction: ISO11609 states that a surface profile (Sp) method can be used to determine dentifrice abrasivity in relation to dentin (RDA) as an alternative to the traditional radiotracer method (Rt). A comparison between both methods was performed in this study. Methods: Specimens from human root dentin were prepared for each method and randomly assigned to 8 dentifrice/abrasive groups (n=8), which represented a wide abrasivity range. Aqueous dentifrice slurries or abrasive suspensions in a solution containing 0.5% carboxymethylcellulose and 10% glycerin were used to brush specimens in a custom-made V-8 cross-brushing machine. Two independent studies (Sp, Rt) were carried out. For Rt, the specimen preparation, study design, analysis and calculation of the abrasive level (RDA) followed the ISO11609/Annex A guidelines. Similarly for Sp, the ISO11609/Annex B recommendations were followed, except by the number of brushing strokes, which was pre-determined to be 2000 strokes (instead of 10000) in a preliminary test. Data were analyzed using ANOVA and Tukey tests, with significance level set at 5%. The correlation between methods was also investigated. Results: Overall, higher variation and RDA values were observed for the Sp method compared to Rt. While good correlation was found between methods (R2=0.841), group ranking was dissimilar and better statistical differentiation among groups was observed in Rt. Conclusions: The Rt method showed to be a more standardized and robust method compared to Sp for the determination of RDA values of dentifrices/abrasives. Sp needs to be further developed before being considered as an equivalent test method for RDA. The determination of the abrasive levels of toothpastes using standard testing methods is important to guide oral care professionals and patients on the prevention of toothbrushing abrasive wear.
Network science and oral health research
(Wiley Blackwell (Blackwell Publishing), 2015) Maupome, Gerardo; McCranie, Ann; Department of Cariology, Operative Dentistry and Dental Public Health, IU School of Dentistry
The present overview of research methods describes a scientific enquiry paradigm that is well established in other disciplines, including health research, but that is fairly new to oral health research. Social networks analysis (SNA) or network science research is a set of relational methods purporting to identify and characterize the connections between members of a system or network, as well as the structure of the network. Persons and communities making up the members of networks have commonly been the focus of SNA studies but corporations or living organisms might just as well be organized in networks. SNA is grounded in both graphic imagery and computational models. SNA is based on the assumptions that features and structure of networks are amenable to characterization, that such information sheds light on the ways members of the network relate to each other (sharing information, diseases, norms, and so on), and that through these connections between members the overall network structure and characteristics are shaped. The overview resorts to examples specific to oral health themes and proposes a few general avenues for population-based research.
Segmentation of Mexican-Heritage Immigrants: Acculturation Typology and Language Preference in Health Information Seeking
(Springer, 2016) Shin, YoungJu; Maupome, Gerardo; Department of Cariology, Operative Dentistry and Dental Public Health, IU School of Dentistry
With the fast growing number of Mexican immigrants in the United States, more attention is needed to understand the relationship between acculturation and language preference in health information seeking. Latent class analysis provides one useful approach to understanding the diversity in sample of Mexican immigrants (N = 238). Based on 13 linguistic, psychological and behavioral indicators for acculturation, four discrete subgroups were characterized: (1) Less acculturated, (2) Moderately acculturated, (3) Highly acculturated, (4) Selectively bicultural. A Chi-square test revealed that three sub-groups were significantly different in language preference when seeking health information. Less acculturated and moderately acculturated groups sought health information in Spanish, whereas the highly acculturated group preferred English for health information. Selectively bicultural group preferred bilingual health information. Implications for health campaign strategies using audience segmentation are discussed.
Tooth-Loss Experience and Associated Variables among Adult Mexicans 60 Years and Older
(2016-06) Islas-Granillo, Horacio; Borges-Yañez, Aida; Medina-Solis, Carlo Eduardo; Lucas-Rincón, Salvador Eduardo; Navarrete-Hernández, José de Jesus; Villalobos-Rodelo, Juan José; Casanova-Rosado, Juan Fernando; Maupome, Gerardo; Department of Cariology, Operative Dentistry and Dental Public Health, IU School of Dentistry
Objective: This study was conducted to determine the experience of tooth loss, as well as its associated variables, in a sample of adult Mexicans, aged 60 years and older. Materials and Methods: This cross-sectional study was part of a larger project to measure diverse oral health indicators in a convenience sample: it included 139 adult Mexican seniors (69.1% of whom were women), ages 60 years and older, either living in long-term care facilities or living independently and participating in adult day care services. Each participant underwent an oral examination to determine the number of missing teeth. Questionnaires were administered to collect sociodemographic, socioeconomic, and behavioral data. Statistical analyses were performed using nonparametric tests and negative binomial regression. Results: The mean age was 79.06 (±9.78 years). The mean number of missing teeth was 20.02 (±8.61; median, 24); 99.3% of the participants had at least 1 missing tooth, and only 14 had 20 teeth or more. Using a negative binomial regression multivariate model, we found that for each year’s increase in age, the mean number of teeth lost increased by 1% (p<0.05). In individuals who brushed their teeth fewer than two times a day, who had received radiotherapy, or who were currently smokers, the average tooth loss increased 49.2%, 22.6%, and 19.0%, respectively (p<0.01). Conclusion: Tooth-loss experience in these Mexican seniors was very high (20.02±8.61). Older age (within the range of this group of seniors), tooth-brushing patterns, the receipt of radiation therapy, and (current) tobacco use were associated with higher experience of tooth loss.
Urinary and Plasma Fluoride Levels in Pregnant Women from Mexico City
(Elsevier, 2016-10) Thomas, Deena B.; Basu, Niladri; Martinez-Mier, E. Angeles; Sánchez, Brisa N.; Zhang, Zhenzhen; Liu, Yun; Parajuli, Rajendra; Peterson, Karen; Mercado-Garcia, Adriana; Bashash, Morteza; Hernández-Avila, Mauricio; Hu, Howard; Téllez-Rojo, Martha Maria; Department of Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
Background There is need to assess the developmental neurotoxicity of fluoride. Our knowledge of prenatal fluoride exposure is challenged as few population-based studies have been conducted and these generally date back several decades, provide incomplete data on sociodemographic variables, and have methodological limitations. Objective To measure urinary and plasma fluoride levels across three time points in pregnant mothers who were enrolled in the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) birth cohort study. Methods Fluoride levels were characterized in archived urine and plasma from 872 pregnant mothers sampled from the ELEMENT cohort. Various statistical methods were used to analyze the fluoride data with particular consideration for changes across three stages of pregnancy and against sociodemographic variables. Results All samples had detectable levels of fluoride. The mean urinary and plasma fluoride levels were 0.91 and 0.0221 mg/L respectively, and these were not statistically different across three stages of pregnancy. Fluoride levels correlated across the stages of pregnancy studied, with stronger correlations between neighboring stages. Urinary fluoride changed as pregnancy progressed with levels increasing until ~23 weeks and then decreasing until the end of pregnancy. For plasma fluoride, there was a decreasing trend but this was not of statistical significance. Creatinine-adjusted urinary fluoride levels did not associate consistently with any of the sociodemographic variables studied. Conclusions This study provides the most extensive characterization to date of fluoride exposure throughout pregnancy. These results provide the foundation to explore exposure-related health outcomes in the ELEMENT cohort and other studies.
Midwestern Latino caregivers’ knowledge, attitudes and sense making of the oral health etiology, prevention and barriers that inhibit their children’s oral health: a CBPR approach
(BioMed Central, 2017) Walker, Kimberly K.; Martínez-Mier, E. Angeles; Soto-Rojas, Armando E.; Jackson, Richard D.; Stelzner, Sarah M.; Galvez, Lorena C.; Smith, Gabriela J.; Acevedo, Miriam; Dandelet, Laura; Vega, Dulce; Department of Cariology and Opperative Dentistry, IU School of Dentistry
Using community-based participatory research, the Health Protection Model was used to understand the cultural experiences, attitudes, knowledge and behaviors surrounding caries etiology, its prevention and barriers to accessing oral health care for children of Latino parents residing in Central Indiana.
Contribution of prosthetic treatment considerations for dental extractions of permanent teeth
(2016-07) Fernández-Barrera, Miguel Ángel; Medina-Solís, Carlo Eduardo; Casanova-Rosado, Juan Fernando; Mendoza-Rodríguez, Martha; Escoffié-Ramírez, Mauricio; Casanova-Rosado, Alejandro José; Navarrete-Hernández, José de Jesús; Maupome, Gerardo; Department of Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
Background. Tooth loss is an easily identifiable outcome that summarizes a complex suite of factors in an individual’s history of dental disease and its treatment by dental services over a lifetime. Assessment of overall tooth loss data is essential for epidemiologically evaluating the adequacy of dental care provided at a systems level, as well as for placing in context tooth loss for non-disease causes. For example, when derived from prosthetic treatment planning, the latter may unfortunately lead to some teeth being extracted (pulled) for the sake of better comprehensive clinical results. The objective of the present manuscript was to identify the contribution to overall tooth loss, by extraction of permanent teeth because of prosthetic treatment reasons. Material and Methods. A cross-sectional study included sex, age, total number of extractions performed by subject, sextant (anterior vs. posterior), group of teeth (incisors, canines, premolars and molars), upper or lower arch, and the main reason underlying extraction (extraction for any reason vs. prosthetic treatment), in patients 18 years of age and older seeking care at a dental school clinic in Mexico. A multivariate logistic regression model was generated. Results. A total of 749 teeth were extracted in 331 patients; 161 teeth (21.5% of total) were extracted for explicit prosthetic treatment indications. As age increased, the likelihood of having an extraction for prosthetic reasons increased 3% (OR = 1.03, p < 0.001). Women (OR = 1.57, p < 0.05) were more likely to be in this situation, and molars (OR = 2.70, p < 0.001) were most at risk. As the total number of extractions increased, the risk of having an extraction for prosthetic reasons decreased (OR = 0.94, p < 0.05). Conclusions. A significant amount (21.5%) of the extractions of permanent teeth were performed for prosthetic reasons in this dental school clinical environment; age, sex, type of tooth, and the total number of extractions moderated such pattern.
Psychological and behavioral acculturation in a social network of Mexican Americans in the United States and use of dental services
(Wiley, 2016-12) Maupome, Gerardo; McConnell, William R.; Perry, Brea L.; Mariño, Rodrigo; Wright, Eric R.; Department of Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
Objectives We used data from the TalaSurvey study to examine associations between dental health experiences, social network characteristics, and levels of behavioral and psychological acculturation in one location in the American Midwest. Methods Starting in parishes and community organizations, we identified adults of Mexican origin living in Indianapolis, who were 1st- or 2nd-generation immigrants from Tala, Mexico. Using a social networks methodology and following extensive formative research, we created an egocentric social network survey and administered it via face-to-face interviews. We identified the peers (alters) in interviewees’ (egos) personal networks. We asked egos about multiple oral health and dental care variables for self and for alters. Acculturation (psychological and behavioral) was measured with a validated tool. Through logistic and negative binomial regression, we examined the effects of acculturation and network composition on ego's dental insurance status, dental office visits, and the reason for most recent dental office visit. Results A total of 332 egos (mean age 36; 63% female) were interviewed: 90% were born in Mexico; 45% had completed elementary school or lower; and most had low income. Each ego named 3.9 (SD±1.9) alters in his/her personal network, for a total of 1299 alters (mean age 39; 61% female). Both behavioral acculturation and psychological acculturation were moderately associated with dental insurance coverage, and greater behavioral acculturation predicted more frequent dental care. More psychologically acculturated egos were more likely to seek preventive care. Further, egos with more highly educated networks sought care more frequently and for preventive purposes, net of ego's own education and acculturation. Conclusions This study contextualizes acculturation of Mexican Americans within the personal networks in which oral health discussion takes place. The findings underscore the critical importance of acculturation and social network factors in shaping a subgroup of Latinos’ orientation toward dental care.

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