The aim of the study was to assess caries prevalence in connection with salivary caries-related findings in 349 14- to 16-year-old Hungarian adolescents living in two different cities. DMFT, DMFS means, stimulated salivary flow, buffer capacity, mutans streptococci, lactobacilli and candida counts in saliva were determined. The ratio of caries-free adolescents was 4.6% in the total population sample, DMFT mean values were 7.24+/-4.86, DMFS means 10.50+/-8.35. Mean secretion rate of stimulated saliva was 0. 84+/-0.50; a low buffer capacity was found in 6.3% of the examined children. The ratio of carriers of mutans streptococci, lactobacilli and yeasts in saliva was 89.7, 73.9 and 47.7%, respectively. DMFT and DMFS values as well as mutans streptococci and candida counts were lower in the capital than in the other city. Statistically significant correlations were found between DMFT, DMFS mean values, and salivary microbiological counts.

Associations between microbiological and salivary caries activity tests and caries experience in Hungarian adolescents.

Traditional methods of assessing orthodontic treatment need using mainly clinical measures are inadequate and would be improved by integrating normative, oral health-related quality of life (OHRQoL), and behavioural propensity measures. This study aimed to develop and test a socio-dental system of orthodontic needs assessment, and to compare normative and socio-dental estimates of orthodontic need. The socio-dental system integrates three types of need: normative need (NN), impact-related need (IRN) and propensity-related need (PRN). A cross-sectional survey of all 1,126 children aged 11-12 years in Suphanburi, Thailand, was carried out to test the new system. The dental health component of the Index of Orthodontic Treatment Need was used to assess NN, and the simplified oral hygiene index for oral hygiene status. Oral impacts were assessed using the child-Oral Impacts on Daily Performances (child-OIDP) index. A self-administered questionnaire recorded information on demographic and oral health-related behaviour. Treatment needs were assessed according to the developed socio-dental system. The socio-dental approach to assess orthodontic needs was easy to use and readily accepted by the children. The estimates of orthodontic need assessed normatively and socio-dentally differed markedly. The prevalence of NN and IRN was 35.0 and 10.5 percent, respectively, thus representing a reduction of approximately 70 percent in the volume of treatment need according to the new method. Children with IRN had different levels of propensity for orthodontic treatment, and therefore required appropriate treatment plans according to their PRN. Of the 10.5 percent with IRN, 6.9 percent had high or medium-high PRN, while 3.6 percent were at medium-low and low levels of propensity.

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A socio-dental approach to assessing children's orthodontic needs

The aim of this 3-year field study was to assess the value of partial substitution of sucrose with peroral xylitol (14-20 g/day) as a caries-preventive measure (X group) in comparison with systemic administration of fluoride (F group) and restorative treatment procedures solely (C group). An F dentifrice was used unsupervised in the X and F groups, the former containing 10% xylitol. The C group used customary, predominantly F-free dentifrices distributed by the local health authorities. The final material consisted of 689 institutionalized children (6-11 years). Caries was scored yearly in duplicate by two continuously calibrated teams. At base line the X group had a significantly higher caries prevalence than the F and C groups. The 3-year DMFS increment was 4.2 in the X group, 6.5 in the F group, and 7.7 in the C group. The corresponding ratio (RS) between caries incidence and the tooth surface population at risk was RSx, 4.9; RSF, 6.6; and RSC, 8.6. It is concluded that dietary xylitol in solid sweets resulted in a lower increment of caries than obtained in the F and C groups (p less than 0.001, covariance analysis, with base-line prevalence, number of permanent teeth, and visible plaque index as covariants).

Collaborative WHO xylitol field studies in Hungary I. Three-year caries activity in institutionalized children

Xylitol has attracted much attention as an alternative sweetener. Essentially all clinical studies concerning the effect of xylitol on caries development consent to its non-cariogenicity and to the beneficial effect of substituting sucrose with xylitol in chewing gums and sweets. However, claims of anti-caries or therapeutic effects, and superiority of xylitol over other polyols are still to be confirmed by well designed and conducted studies from independent research groups.

Xylitol in caries prevention: what is the evidence for clinical efficacy?

Intrasalivary gland injection of botulinum toxin type A is known to treat sialorrhea effectively in children with cerebral palsy. However, oral health may be compromised with escalating dose. In this randomized, double-blind, and placebo-controlled pilot trial, the authors aim to determine the therapeutic effect of low-dose, ultrasonography-controlled botulinum toxin type A injection to bilateral parotid and submandibular glands on oral health in the management of sialorrhea. Twenty children diagnosed with cerebral palsy were randomly assigned to 2 groups. The treatment group received botulinum toxin type A injections, whereas the control received normal saline in the same locations. The authors evaluated subjective drooling scales, salivary flow rate, and oral health (salivary compositions and cariogenic bacterial counts). A significant decrease was found in salivary flow rate at the 1- and 3-month follow-up in the botulinum toxin-treated group. The authors suggest that current protocol can effectively manage sialorrhea while maintaining oral health.

Botulinum toxin type A on oral health in treating sialorrhea in children with cerebral palsy: a randomized, double-blind, placebo-controlled study.

The levels of salivary lactobacilli and yeasts were determined annually in half of the subjects of the xylitol (X) and fluoride (F) groups of a 3-year caries study. These measurements were carried out with Dentocult (DC) and Oricult (OC) dip-slide methods. A high level of lactobacilli prevailed throughout the study in these subjects. Significant changes were registered in some subgroups–that is, improvement in one of the X institutions and worsening in one of the F and one of the X institutions. At base line the counts of OC were worse in the X than in the F group. In the total material some improvement occurred during the course of the study, mainly in the X group. The changes associated with the preventive program should also be considered as related to the improvement in oral hygiene, restorative treatment, and the mere study effect.

Collaborative WHO xylitol field studies in Hungary. III. Longitudinal counts of lactobacilli and yeasts in saliva.

Introduction Besides the main etiological factors other factors are also involved in development of caries. Bacteria (Streptococcus mutans, lactobacilli) and saliva (its buffering capacity, and rate of secretion) are also risk factors in the development of caries. Material, method, results The authors were the first in Hungary to use the Dentocult kits for assessing the number of lactobacilli in saliva, to use the Oricult-N plate for the determination of the number of Candida, and the medium containing Dentocult-SM plates in the assessment of the number of Streptococcus mutans colonies in saliva. Children in Fot were divided into two groups: children who consumed sorbitol-containing sweets, and another consisting of children who consumed sucrose-containing sweets. The number of lactobacilli, as well as the caries-index was determined. The proportion of children with high lactobacillus counts was significantly lower in the sorbitol group than in the sucrose group. Caries prevalence and salivary lactobacillus counts were determined in 140 second and third graders and 150 adults. The difference between caries-active and caries-inactive subjects was statistically significant in both age groups. A relationship between lactobacillus and Candida albicans counts was found in 396 children between the ages of 6 and 11 living in children's homes. The microbiological assessment of the saliva of 269 children, from seven different children's home, all between the ages of 7 and 12, who were included in the WHO's three-year xylitol caries-preventive program, was also done. Cariological, saliva and microbiological investigations were carried out on 349 adolescents secondary school students. The amount of bacteria and yeasts showed a strong relationship with the caries mean values. The saliva of 210 fixed orthodontic appliances wearing--using amine fluoride-containing products--children, was investigated. According to the results, amine fluoride has a pronounced effect on the mouth's microflora, especially on the number of lactobacilli and Candida.

Significance of assessing risk factors for caries in their prevention

No data are available on the direct acute vascular effect of dental bonding materials on the dental pulp. This study investigated the effects of the components of a composite resin-bonding system on pulpal vascular diameter. Three groups of 10 male Sprague-Dawley rats (weighing 330 +/- 51 g) were used for this investigation. The first lower incisor of the rats was prepared for vitalmicroscopy. Changes in vessel diameter were recorded prior to, and at 5, 15, 30 and 60 minutes after the bonding agents (with/without etching) or saline (control) were administered on dentin as recommended by the manufacturer. In control rats, the vessel diameter was elevated slightly (2.96 +/- 4.08%) during the whole experiment. However, in the presence of bonding materials, an enhancement of 12.58 +/- 7.1% without etching and 13.11 +/- 8.6% with acid etching was registered as the increase in vascular diameter. There were significant (p < 0.05) differences between the control group and those treated with bonding agent components. Results suggested that resin composite bonding agents applied to a thin layer of dentin have an acute vasodilating effect on the dental pulp. The clinical significance of this vascular alteration in the dental pulp requires further study.

In vivo examination of the Scotchbond Multi-Purpose Dental Adhesive System in rat (vitalmicroscopic study).

Despite great progress in the production of new dental polymers, application of these products is still controversial. The unlined utilization of cytotoxic adhesive materials on pulpal dentin can adversely influence the pulp, leading to alterations in local microcirculation that can be an early sign of pathological changes. In a previous study by the authors, the effect of an acetone-free bondmaterial was examined on the vascular diameter of pulpal vessels by means of vitalmicroscopy. In this study, experiments comparing experimental data provided by an acetone-containing bondmaterial to these earlier findings with acetone-free ones have been performed. Thirty male Sprague-Dawley rats (weighing 333+/-9 g) were used for this investigation. The first lower incisor was prepared for vitalmicroscopy. Changes in vessel diameter were recorded prior to and 5, 15, 30 and 60 minutes after the investigated materials (Scotchbond Multi-Purpose Dental Adhesive System or Prime & Bond 2.1) were administered on dentin as recommended by the manufacturer. In control rats (saline administration), the vessel diameter was stable during the experiment. In the presence of acetone-free bondmaterial (Scotchbond), the vessel diameter was increased during the experimental period in relation to the baseline (12.15+/-2.85%; 16.36+/-2.39%; 14.16+/-3.48%; 12.12+/-3.72%). In the presence of acetone-containing bondmaterial (Prime & Bond 2.1), a similar result was observed (10.56+/-2.27%; 16.13+/-2.94%; 17.88+/-2.54%; 14.54+/-3.16%). The differences between the control values and those registered with test groups were significant (p<0.05; ANOVA). There was no significant difference among the test groups. The results of this study suggest that dental bond materials applied on a very thin layer of dentin may affect the blood supply to the dental pulp. However, no stasis or prestasis has been detected, indicating a possible reversible effect. The authors could not show any statistical difference between the vasodilatation caused by the acetone-containing and the acetone-free bond material.

Comparative analysis of pulpal circulatory reaction to an acetone-containing and an acetone-free bonding agent as measured by vitalmicroscopy.

Conditioning agents used on dentin with composite materials are biologically active and may have deleterious effects on the pulpal microcirculation. No data are available on the immediate vascular effect of etching materials applied on a constant thin pulpal dentin. In this study the authors examined whether the application of 36% phosphoric acid (Conditioner 36, 15 seconds) or itakonic acid with 10% maleic acid (NRC Non-Rinse Conditioner, 20 seconds), as recommended by the manufacturers, alters the blood circulation in the pulp of the rat's lower incisors. The effect of prolonged etching time (60 seconds) was also assessed (Conditioner 36). The application of saline served as the untreated control. The technique of vitalmicroscopy was used on the first lower incisor of 40 (10-10 in each group) male Sprague-Dawley rats (weighing 350 +/- 8 g SE) to record the changes in vessel diameter prior to and at 5, 15, 30 and 60 minutes after the test materials were administered on the dentin. In the control rats, the vessel diameter was stable during the entire experiment. Acid conditioning as recommended by the manufacturers tended to cause vasodilatation, though these alterations were statistically not significant when compared to the control group (ANOVA, p > 0.05). After prolonged etching time (Conditioner 36, 60 seconds) significant vasoconstriction (-14.4 +/- 6.13; -10.59 +/- 4.2; -11.96 +/- 6.75; -5.49 +/- 5.78%) was observed (ANOVA, p < 0.05). In this group, stasis developed in pulpal blood circulation in 40% of rats (Cochran's-Q test, p < 0.05), gas-bubble formation was observed in 30% and the disappearance of the pulpal wall occurred in 20%. These results suggest that exposition time with acid is crucial to the pulpal microcirculation. That is, acid conditioning applied as indicated (for 15-20 seconds) onto a very thin layer of dentin only slightly affects the blood supply to the dental pulp; however, prolonged etching time (for 60 seconds) results in immediate failure of microcirculation in the dental pulp of rats.

Nyárasdy I

Papers

Collaborative WHO xylitol field studies in Hungary. III. Longitudinal counts of lactobacilli and yeasts in saliva.

Significance of assessing risk factors for caries in their prevention

In vivo examination of the Scotchbond Multi-Purpose Dental Adhesive System in rat (vitalmicroscopic study).

Comparative analysis of pulpal circulatory reaction to an acetone-containing and an acetone-free bonding agent as measured by vitalmicroscopy.

The effect of acid etching on vascular diameter of pulp-vessels in rat incisor (vitalmicroscopic study).