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Item Anti-Caries Efficacy of Fluoride at Increasing Maturation of a Microcosm Biofilm(2019-08) Ayoub, Hadeel Mohammed; Lippert, Frank; Gregory, Richard L.; Martinez Mier, E. Angeles; Anderson, GregoryDental biofilm is a main contributing factor in the initiation and progression of dental caries. The maturation of dental biofilms is expected to alter the anti-caries efficacy of fluoride compounds. In the first aim, we conducted a series of modeldevelopment experiments to test different variables to standardize a reproducible in-vitro microbial caries model. We evaluated: surface conditioning using saliva; sucrose concentrations and caries lesion severity; growth media conditions and mineral saturation; dental substrate types; pH cycling protocol characteristics. In the second aim, we used the developed model to evaluate the changes in the anti-caries efficacy of three fluoride compounds (Sodium fluoride (NaF); Stannous fluoride (SnF2); Amine fluoride (AmF); and deionized water (DIW- negative control)) at increasing maturation of a microcosm biofilm. We continued the pH cycling protocol for 4 days, 8 days, and 12 days. We tested biofilm cariogenicity and carious lesion severity at each maturation stage. In the third aim, we used the developed model to test the effect of different exposure periods (early vs. late exposure) of the biofilm to three fluoride compounds (NaF, SnF2, AmF, DIW) in comparison to DIW. We also evaluated the recovery of biofilm cariogenicity with each exposure period. We evaluated, for each exposure period and recovery stage, biofilm cariogenicity and carious lesion severity. We analyzed the relationships between different variables (biofilm age, fluoride compound type, exposure period) using ANOVA models. In conclusion: 1. The present model allows testing the effect of biofilm maturation on the anti-caries efficacy of fluoride compounds. 2. Biofilm maturation plays an important role in increasing biofilm tolerance against fluoride treatment; it could also influence the selection of fluoride compounds to achieve optimum cariostatic effect. 3. Exposure period, and type of fluoride compound, both influence the biofilm tolerance to fluoride anti-caries effect; they may also result in a sustainable release of fluoride over time.Item Antibacterial Activities of Methanol and Aqueous Extracts of Salvadora persica against Streptococcus mutans Biofilms: An In Vitro Study(MDPI, 2021-12-01) Balhaddad, Abdulrahman A.; Mokeem, Lamia; Melo, Mary Anne S.; Gregory, Richard L.; Biomedical Sciences and Comprehensive Care, School of DentistryThe use of herbal products in oral hygiene care has a long history, and their use is popular today. A tree stick, named Salvadora persica (S. persica), is commonly used to remove dental plaque and clean teeth in many countries. In addition, extracts of S. persica can be used as a mouthwash, as they demonstrate antimicrobial properties. This study aimed to investigate the antibacterial effect of S. persica methanol and aqueous extracts against Streptococcus mutans (S. mutans) biofilm. A S. mutans biofilm formation assay was conducted using different concentrations of S. persica methanol or water extracts in tryptic soy broth (TSB) supplemented with 1% sucrose. The biofilm was stained with crystal violet dye, and the absorbance was assessed to examine biofilm formation. One-way analysis of variance (ANOVA) and Tukey tests were used to analyze the results. The S. persica methanol extract displayed a significant inhibition (p ≤ 0.001) against the S. mutans biofilm. The 10 mg/mL concentration of the S. persica methanol extract was determined as the minimum biofilm inhibitory concentration (MBIC). The used methanol concentration, mixed with TSB supplemented with 1% sucrose and without the S. persica extract, did not inhibit the S. mutans biofilm. The S. persica aqueous extract did not demonstrate any biofilm inhibition at any concentration (p ≥ 0.05). The findings of this study suggest the potential of using S. persica methanol extract as a mouthwash or adjunctive to oral hygiene tools.Item Are dental patients able to perceive erosive tooth wear on anterior teeth? An internet-based survey assessing awareness and related action(Elsevier, 2020) Goldfarb, Micah B.; Hara, Anderson T.; Hirsh, Adam T.; Carvalho, Joana C.; Maupomé, GerardoBackground. Erosive tooth wear (ETW) is irreversible loss of dental hard tissue. The authors examined patients’ ability to recognize ETW relative to sound teeth and teeth with dental caries. Methods. Using Amazon’s crowdsourcing service, the authors recruited participants (N=623) to view standardized images of buccal surfaces of teeth (sound, ETW, or caries). Participants reported whether a dental condition existed (yes/no), likelihood to seek care, and esthetic attractiveness for teeth with no, initial, moderate, or severe signs of ETW/caries. Results. Dental patients demonstrated poor recognition of cases of ETW, especially compared to sound and caries-affected teeth at each level of severity. Patients were less likely to schedule a dental appointment for care/treatment of teeth with ETW than caries at each level of severity. Patients also found ETW more esthetically attractive than caries at each level of severity and found initial ETW more attractive than sound teeth. Conclusions. Dental patients struggle recognizing ETW, in general and compared to caries, at each level of severity and particularly for early stages of ETW. These recognition difficulties likely arise, in part, from tooth esthetic attractiveness standards (smooth and shiny teeth look more esthetic), possibly leading to lack of appropriate care-seeking behavior. Practical Implications. This internet-based tool may be used to assess dental patients’ awareness and ability to recognize cases of ETW. Improved patient awareness might lead to seeking professional care to prevent and/or delay ETW progression.Item Association of added sugar intake and caries-related experiences among individuals of Mexican origin(Wiley, 2018) Vega-López, S.; Lindberg, N.M.; Eckert, G.J.; Nicholson, E.L.; Maupomé, GerardoObjective: Determine the association between key dental outcomes and added sugar intake using a survey instrument to assess added sugars, which was specifically tailored to immigrant and US-born adults of Mexican origin. Methods: Hispanic adults of Mexican origin (n = 326; 36.2 ± 12.1 years) completed a self-administered survey to gather acculturation, self-reported dental experiences and self-care practices (eg brushing, flossing, pain, bleeding gums), and socio-demographic information. The survey included a culturally tailored 22-item Added Sugar Intake Estimate (ASIE) that assessed added sugar intake from processed foods and sugar-sweetened beverages in a semiquantitative food frequency questionnaire format. Linear regression, 2-sample t test, and ANOVA were used to evaluate associations of demographic and dental outcomes with daily added sugar intake. Results: Of the mean total daily added sugar intake (99.6 ± 94.6 g), 36.5 ± 44.4 g was derived from sugar-containing foods and snacks, and 63.1 ± 68.2 g from beverages. Participants who reported greater added sugar intake were more likely to have reported the presence of a toothache in the preceding 12 months, having been prescribed antibiotics for dental reasons, being less likely to floss daily, have reported eating or drinking within 1 hour before bed and have lower psychological acculturation (P < .05 for all). Results were comparable when assessing intake from sugar-containing foods/snacks and sugar-sweetened beverages. Conclusions: This study confirmed the association between added sugar intake and self-reported dental outcomes among adults of Mexican origin and points to an urgent need to improve dietary behaviours in this population.Item Blood levels of lead and dental caries in permanent teeth(Wiley, 2020) Yepes, Juan F.; McCormick-Norris, Jayme; Vinson, LaQuia A.; Eckert, George J.; Hu, Howard; Wu, Yue; Jansen, Erica C.; Peterson, Karen E.; Téllez-Rojo, Martha M.; Martinez Mier, Esperanza Angeles; Pediatric Dentistry, School of DentistryObjectives: The purpose of this study was to determine whether there is an association between lead exposure within the ages of 1-4 years and dental caries in the permanent dentition between ages 9-17 among Mexican youth. Methods: Data were collected for the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) cohort from a group of 490 children born and reared in Mexico City. Among ages 1-4 years, blood lead levels were measured in micrograms of lead per deciliter of blood (μg/dL) and the presence of caries in adolescence was determined using the International Caries and Detection and Assessment System (ICDAS). The relationship between blood levels of lead and decayed, missing, or filled surfaces (DMFS) was examined using negative binomial regression. Covariates were selected based on previous studies and included age, gender, socioeconomic status, oral hygiene, body mass index, and diet. The nonlinear relationship between lead and DMFS was examined using smoothing splines. Results: The mean overall blood lead level (BLL) was 4.83 μg/dL (S.D. of 2.2). The mean overall caries level (DMFS) was 4.1. No statistically significant association was found between early childhood blood lead levels and dental caries in adolescence. Conclusion: This study shows a lack of association between exposure to lead between the ages of 1-4 years of age and dental caries in permanent dentition later in life. Other covariates, such as age and sugar consumption, appeared to play a more prominent role in caries development.Item Caries lesion remineralization with fluoride toothpastes and chlorhexidine - effects of application timing and toothpaste surfactant(SciELO, 2018-06-11) Almohefer, Sami A.; Levon, John A.; Gregory, Richard L.; Eckert, George J.; Lippert, Frank; Restorative Dentistry, School of DentistryINTRODUCTION: Habitual toothbrushing with fluoridated toothpaste followed by rinsing with antibacterial mouthwashes is a method to maintain good oral hygiene and to diminish the occurrence and severity of dental caries and periodontal disease. However, our understanding of how antimicrobial agents in mouthwashes affect fluoride-mediated caries lesion remineralization is still poor. OBJECTIVE: The objectives of this in vitro study were a) to determine the effects of the waiting period of chlorhexidine (CHX) rinsing after fluoride toothpaste use and b) to further determine the effect of the type of toothpaste surfactant [sodium dodecyl sulfate (SDS) or cocamidopropyl betaine (CAPB)] on caries lesion remineralization associated with CHX rinsing. MATERIAL AND METHODS: Caries lesions were formed in bovine enamel specimens and assigned to 10 treatment groups (n=18) based on Vickers surface microhardness (VHN). Lesions were then pH-cycled for 10 days with daily regimen comprised of twice daily toothpaste slurry treatments (1150 ppm fluoride, with SDS or CAPB), followed by CHX solution treatments [0, 15, 30 or 60 minutes following slurry treatment or no CHX treatment (negative control)]. VHN was measured again and the extent of lesion remineralization calculated (∆VHN). RESULTS: ∆VHN with SDS-toothpaste was significantly lower than with CAPB-toothpaste, indicating more remineralization for the CAPB-toothpaste. ∆VHN with 0-minute waiting time was significantly lower than with 30-minute waiting time and with negative control. CONCLUSIONS: The absence of CHX as an adjunct to fluoride toothpastes led to greater remineralization of enamel lesions compared with the immediate use of CHX treatment for both SDS- and CAPB-toothpastes. CAPB-toothpastes indicated significantly greater remineralization than SDS-toothpastes, and can be suggested for patients at high risk of caries. A 30-minute waiting time for CHX treatment is recommended after brushing.Item Caries risk assessment using different Cariogram models. A comparative study about concordance in different populations—Adults and children(Public Library of Science, 2022-06-24) Cagetti, Maria Grazia; Bontà, Giuliana; Lara, Juan Sebastian; Campus, Guglielmo; Cariology, Operative Dentistry and Dental Public Health, School of DentistryThis methodological survey aimed to verify whether there is concordance among several Cariogram different risk models at different thresholds, comparing both children and adult populations and how each risk/protective factor weight on the overall caries risk profile. Three groups' data (two in children and one in adults) were obtained from previous studies, while a fourth, in young adults, was ad hoc enrolled. Different caries risk levels were assessed: a) three risk categories with two different thresholds as: "low risk" = 61-100% or 81-100% chance to avoid caries, "moderate risk" = 41-60% or 21-80% and "high risk" = 0-40% or 0-20%, named model 1 and 2; b) four risk categories with two different thresholds as: "low risk" = 61-100% or 76-100%, "moderate/low risk" = 41-60% or 51-75%; "moderate/high risk" = 21-40% or 26-50% and "high risk" = 0-20% or 0-25%, model 3 and 4; c) five risk categories as: "very low risk" = 81-100%; "low risk" = 61-80% "moderate risk" = 41-60%; "high risk" = 21-40% and "very high risk" = 0-20%, model 5. Concordance of the different Cariogram risk categories among the four groups was calculated using Cohen's kappa. The weight of the association between all Cariogram models toward the Cariogram risk variables was evaluated by ordinal logistic regression models. Considering Cariogram model 1 and 2, Cohen's Kappa values ranged from 0.40 (SE = 0.07) for the young adult group to 0.71 (SE = 0.05) for the adult one. Cohen's Kappa values ranged from 0.14 (SE = 0.03 p<0.01) for the adult group to 0.62 (SE = 0.02) for the two groups of children in models 3 and 4. Statistically significant associations were found for all Cariogram risk variables excepting Fluoride program in models 4 and 5 and the overall risk on children's samples. Caries experience showed a quite variable weight in the different models in both adult groups. In the regression analyses, adult groups' convergence was not always achievable since variations in associations between caries risk and different risk variables were narrower compared to other samples. Significant differences in caries risk stratification using different thresholds stands out from data analysis; consequently, risk assessments need to be carefully considered due to the risk of misleadingly choosing preventive and research actions.Item Comparison of Two Types of Pit and Fissure Sealants in Reducing the Incidence of Dental Caries Using a Split-Mouth Design(2021) Fernandez-Barrera, Miguel Angel; Saucedo-Mlina, Teresita de Jesus; Scougall-Vilchis, Rogelio Jose; Marquez-Corona, Maria de Lourdes; Medina-Solis, Carlo Eduardo; Maupome, GerardoObjectives: To evaluate the effectiveness of two pit and fissure sealants (PFS) in reducing the incidence of dental caries in schoolchildren. Material and Methods: A randomized split-mouth experimental design was used in a sample of 140 subjects assigned to two groups. The sealants used were Clinpro©3M and BeautiSealant©Shofu placed in first permanent molars (FPMs). Each sealant was compared to molars in the controls to determine effectiveness over a period of 6 months. The study had a 12.9% loss to follow-up. No statistically significant differences (p>0.05) were observed for sex, age, baseline dmft, or type of sealants. Nonparametric tests were used for statistical analysis. Results: Average dmft index at baseline was 4.10±3.16. Lower incidence of caries was observed in FPMs with pit and fissure sealants (p<0.01), regardless of the type used. When sealants remained intact there was a lower caries incidence compared to sealants partially or completely missing – but differences were only significant for FPM 16. Caries incidence was higher for BeautiSealant sealed teeth than for Clinpro’s, but only statistically significant in FPMs 16, 36 and 46 (p< 0.05). Caries incidence was higher in those cases with a higher baseline dmft but it only reached statistical significance in FPMs 26 and 36. Relative risks for dental caries were lower in sealed teeth (p<0.01). Conclusions: Pit and fissures sealants are an effective preventive treatment to reduce caries during a 6-month follow-up in schoolchildren 6 to 8 years of age, regardless of the type of sealant used. The sealant brand that showed greater effectiveness in terms of prevention and retention was Clinpro©3M.Item Dental pain prevalence associated with caries experience in pediatric patients in a clinical sample in Mexico(Sociedade Brasileira de Pesquisa Odontológica(SBPqO), 2021) Hernandez-Martinez, Cesar Tadeo; Jimenez-Gayosso, Sandra Isabel; Lucas-Rincon, Salvador Eduardo; Robles-Bermeo, Norma Leticia; Maupome, GerardoThe aim of this study was to identify if the prevalence of dental pain (past and / or present) is associated with caries experience in Mexican children, as well as to characterize factors associated with dental pain. A cross-sectional study was conducted in a consecutive sample of 309 children 2 to 12 years old who were patients at a dental school clinic in Toluca, Mexico. Data were collected from clinical records. The dependent variable had three categories: 0 = have never had dental pain, 1 = had dental pain before the appointment, and 2 = current dental pain. Non-parametric statistical tests were used in the analysis. A multivariate multinomial logistic regression model was generated in Stata 11.0. Average age was 5.71 ± 2.43 years and 50.8% were boys. The joint dmft+DMFT index was 9.11 ± 4.19. It was observed that 56.6% of children did not report having experienced dental pain, 30.7% reported having previously had dental pain, and 12.6% had pain when the clinical appointment took place. In the multivariate model, variables associated (p < .05) with previous dental pain were age (OR = 1.13); the dmft + DMFT index (OR = 1.13), having had a last dental visit for curative/emergency reasons (OR = 2.41) and prior experience of dental trauma (OR = 2.59). For current pain, only the joint dmft + DMFT index (OR = 1.10, p < 0.05) had significant associations. Almost half of the children had experienced dental pain in their lifetime. Since caries experience is a factor associated with dental pain, decreasing caries levels may ameliorate suffering from dental pain in children.Item Dental plaque, preventive care, and tooth brushing associated with dental caries in primary teeth in schoolchildren ages 6–9 years of Leon, Nicaragua(International Scientific Information, 2013) del Socorro Herrera, Miriam; Medina-Solis, Carlo Eduardo; Minaya-Sánchez, Mirna; Pontigo-Loyola, América Patricia; Villalobos-Rodelo, Juan José; Islas-Granillo, Horacio; de la Rosa-Santillana, Rubén; Maupomé, GerardoBackground: Our study aimed to evaluate the effect of various risk indicators for dental caries on primary teeth of Nicaraguan children (from Leon, Nicaragua) ages 6 to 9, using the negative binomial regression model. Material/Methods: A cross-sectional study was carried out to collect clinical, demographic, socioeconomic, and behavioral data from 794 schoolchildren ages 6 to 9 years, randomly selected from 25 schools in the city of León, Nicaragua. Clinical examinations for dental caries (dmft index) were performed by 2 trained and standardized examiners. Socio-demographic, socioeconomic, and behavioral data were self-reported using questionnaires. Multivariate negative binomial regression (NBR) analysis was used. Results: Mean age was 7.49±1.12 years. Boys accounted for 50.1% of the sample. Mean dmft was 3.54±3.13 and caries prevalence (dmft >0) was 77.6%. In the NBR multivariate model (p<0.05), for each year of age, the expected mean dmft decreased by 7.5%. Brushing teeth at least once a day and having received preventive dental care in the last year before data collection were associated with declines in the expected mean dmft by 19.5% and 69.6%, respectively. Presence of dental plaque increased the expected mean dmft by 395.5%. Conclusions: The proportion of students with caries in this sample was high. We found associations between dental caries in the primary dentition and dental plaque, brushing teeth at least once a day, and having received preventive dental care. To improve oral health, school programs and/or age-appropriate interventions need to be developed based on the specific profile of caries experience and the associated risk indicators.