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Comments for Lecture 7

 

The research that I found to be really interesting was an actual discussion that I had with Dr Ziegler. I felt that with his clinical experience of over 30 years, he would have a great insight into the caries process. We discussed a family he had treated 20 years ago. They had three kids, each in different stages in the caries process. He showed me radiographs and talked of the follow up over the last 20 years with these children. It was interesting to note how each of the children, had the same area of lesions, with the oldest with the most severe case, that with the proper diagnosis those children needed no further tx in those areas over the next 20 years. This discussion proves that the caries process is dynamic and does follow a distinct pattern
Adam Curtis <curt0119@umn.edu>
- Friday, October 01, 2004 at 07:58:19 (CDT)

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The article that I read dealt with the ability of topical fluoride treatment to undermine composite resin restorations. They looked at the composites Brilliant DI, Heliomolar Ro, Herculite XRV, and P-50. The study found that the topical fluorides affected every composite tested. The fluorides increased the amount of loosely bound water in the composite matrix, which lead to increased surface degradation in the composite structure. This is something that should be taken into account when restoring a patient that has significant caries involvment. Papagiannoulis L, Tzoutzas J, Eliades G. Effect of topical fluoride agents on the morphologic characteristics and composition of resin composite restorative materials. J Prosthet Dent. 1998 Apr;77(4):405-13.
Marjorie Voelker <voel0020@umn.edu>
- Friday, October 01, 2004 at 07:37:08 (CDT)

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I wanted to find an article with more information about xylitol gum. The article I found: "Suppression of salivary Streptococcus mutans and lactobacilli by topical caries preventive agents." Cent Eur J Public Health. 2003 Dec;11(4):219-22. The purpose of this study was to look at the caries preventive values of certain preventive procedures in in vivo conditions (aminfluoride solution, Proxyt paste, chewing gum containing xylitol and fluoride and chlorhexidine solution). For period of two months five measurements for number of salivary Streptococcus mutans and lactobacilli were made. At the end of the study the best result in the reduction of the bacteria was achieved with the Proxyt paste and daily use of gum. Their results indicate that professional teeth cleaning and use of chewing gum with xylitol and fluorides on daily basis can be effective for cariogenic bacteria reduction and in caries prevention. Based on the articles I've seen and read, I'm surprised that we don't hear more about xylitol chewing gum in advertisements as a way to prevent caries.
Duane Van Nieuwenhuyzen <vann0086@umn.edu>
- Friday, October 01, 2004 at 07:25:00 (CDT)

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This study helps establish a scientific basis for dental healthy choices of between meal snacks. They used volunteer patients to examine incipient lesions for patterns of demineralization and remineralization in dentin and enamel when different snack foods were consumed between meals. Remineralization of enamel was observed when cheddar cheese, milk, chocolate milk, and orange juice were used as between meal snacks. Apple juice, cola, and sweetened yogurt snackers had progression of caries. "Assessment of the Effect of Selected Snack Foods on the Remineralization/Demineralization of Enamel and Dentin." The Journal of Contemporary Dental Practice, Vol 1, Number 3, August 15 2003.
Rhonda Senjem <senj0007@umn.edu>
- Friday, October 01, 2004 at 06:09:44 (CDT)

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This study investigated the ability of a vaccine, HDS< derived from S. mutans glucosyltransferase, to induc an immune response in rats. The researchers injected the vaccine into immune rats and then tested the rats for antibodies to HDS via ELISA, They then fed the rats a caries promoting diet and compared the number of carious lesion that developed to a control group. They found that fewer leasions developed in the control group, especially smooth surface lesions. The study of peptide vaccine HDS from S. mutans glucosyltransferase. Ding, Y., Ling J., et. al. Hua Xi Kou Qiang Yi Xue Za Zhi. 21(5): 353-5, 2003 Oct.
Lissa Warder <wilk0224@umn.edu>
- Friday, October 01, 2004 at 06:00:32 (CDT)

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In Dentistry, we deal with two main diseases. Patients can supplement their hygiene to battle Dental caries and Periodontal disease with a variety of mouth rinses. There are fluoride containing rinses with anti-caries action as well as essental oil rinses (listerine) to aid with periodontal disease. Which is right for our patients? What if patients suffer from both conditions? Is one better than the other? I discovered an article that is testing an Essential oil fluoride mouthrinse. Potentially the best of both worlds! The two week intraoral study tested enamel fluoride uptake and surface microhardness(SMH). The results after two weeks showed the percentage of SMH recovery was 42 percent in the test group, 36 percent in the positive control group and 16 percent in the negative control group. The fluoride uptake was 19 micrograms per square centimeter, 16 microg/cm2 and 3 microg/cm2 for the test mouthrinse, positive control and negative control groups, respectively. In terms of both percentage of SMH and fluoride uptake, the test mouthrinse and positive control mouthrinse were statistically higher than the negative control mouthrinse, and the test mouthrinse was "at least as good as" the positive control mouthrinse. The researchers concluded that this study provides evidence that an essential oil mouthrinse with 100 parts per million fluoride is effective in promoting enamel remineralization and fluoride uptake. This means that the combination of fluoride and essential oils in a mouthrinse may provide anticaries efficacy, in addition to essential oils' previously established antigingivitis efficacy. The remineralizing effect of an essential oil fluoride mouthrinse in an intraoral caries test. Zero DT, Zhang JZ, Harper DS, Wu M, Kelly S, Waskow J, Hoffman M. J Am Dent Assoc. 2004 May;135(5):566, 568.
Aaron Quitmeyer <quit0008@umn.edu>
- Thursday, September 30, 2004 at 23:16:24 (CDT)

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I believe that this whole classes major objective is to get us, as students, and soon to be the next generation of dentists, to think about dental caries as a disease caused by bacteria, however, in that a disease that we can manage and control. In my search on the web I found an interesting article that states: "In the 1940s and 1950s, caries was widespread in the U.S. When children went to the dentist, the question wasn't whether you had a cavity but how many cavities did you have?" That statement has radically changed in the years past and we, as young dentists, have to change our attitude about caries and caries risk. The article I found suggested that we try a more medical approach in how we look at carious lesion in that having a decaying lesion does not always have to lead to the morbitiy and mortality of the tooth in question, but rather that the disease can be reverse, cured, and very much prevented if we put forth our best efforts. With our research on fluoride supplementation, the use of Xylitol sweeteners, and continuing our research to treat caries with the minimum destruction of tooth structure, we will win this fight against oral disease. Reference: "A paradigm shift in the treatment of caries", General Dentistry, July/August 2002, Vol. 50 No. 4.
Jared Rediske <redi0028@umn.edu>
- Thursday, September 30, 2004 at 22:23:42 (CDT)

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Chlorhexidine gluconate mouthwash has long been a successful therapeutic treatment for the reduction of plaque. In the study conducted by Pai, a gel method of delivering chlorhexidine was studied. The results of this clinical study indicate that better therapeutic efficacy can be achieved using gels for treating oral infections than conventional treatments using mouthwash. Pai MR, Acharya LD, Udupa N. “The effect of two different dental gels and a mouthwash on plaque and gingival scores: a six-week clinical study.” Int Dent J. 2004 Aug;54(4):219-23.
Jared Homan <homa0023@umn.edu>
- Thursday, September 30, 2004 at 22:20:08 (CDT)

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In the previous lecture, various fluoride treatment options were presented. In the article “Caries management for institutionalized elders using fluoride and chlorhexidine mouthrinses “ the effectiveness of either a 0.2% neutral sodium fluoride solution or a 0.12% chlorhexidine solution as a daily mouthrinse for controlling caries was tested against a placebo rinse in this 2-year double-blind randomized clinical trial among elders in long-term care facilities. Interestingly, the authors found that a daily oral rinse with 15 ml of 0.2% neutral NaF solution by elderly residents was significantly better than either a 0.12% of chlorhexidine solution or a placebo rinse at reducing the net incidence of caries over 2 years. Reference: Wyatt, C., and MacEntee, M. “Caries management for institutionalized elders using fluoride and chlorhexidine mouthrinses”. Community Dent Oral Epidemiol 2004; 32: 322–8.
Melissa (Karter) Naidyhorski <kart0015@umn.edu>
- Thursday, September 30, 2004 at 22:17:39 (CDT)

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Jokela J, Pienihakkinen K. Economic evaluation of a risk-based caries prevention program in preschool children. Acta Odontol Scand. 2003 Apr;61(2):110-4. This study looked at the financial implications of applying a risk-based treatment in a general private practice. Although the study was done in Europe and the prices did not transmit clearly to me, it was obvious that their findings were positive. They determined that risk-based prevention not only reduced caries in young children, but also reduced the cost both to the practice and patient. The only catch in the outcome is that the cost was determined to be less only if the screening and risk-assessment was delegated to dental assistants.
Amber Cziok <czio0002@umn.edu>
- Thursday, September 30, 2004 at 22:17:29 (CDT)

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Researchers found that high dose in office fluoride treatments decrease demineralization of teeth and can lead to remineralization of incipient carious lesions. They found that the increase in fluoride content in teeth is measurable within the first 5 minutes of treatment, but does vary from person to person due to differences in saliva flow and other factors. Buchalla, Attin, Schulte-Mönting,and Hellwig. "Fluoride Uptake, Retention, and Remineralization Efficacy of a Highly Concentrated Fluoride Solution on Enamel Lesions in situ." J Dent Res 81(5): 329-333, 2002.
Katie Sealey <maes0008@umn.edu>
- Thursday, September 30, 2004 at 22:16:26 (CDT)

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It is obvious that preventive measures are needed in an at risk patient for caries. However, difficulty arises in making a recommendation to patients with which preventive measures to take i.e. fluoride varnish, chlorhexidine rinses, APF gels etc. There is a lack of standardized studies looking at children, adolescents and adults as seperate at risk groups. There is also a lack of experimental protocols as well as study design issues. The study did indicate however, that occlusal sealants did show a significant reduction in caries progression as well as that xylitol chewing gum is suggestive for being effective at caries intervention. The article suggested that further research is necessary with standardized protocols as well as establishing the risk category that patients fall into with respect to caries. "A systematic review of selected caries prevention and management methods." Bader JD, Shugars DA, et al. Community Dent Oral Epidemiol 2001; 29:399-411.
Robin Donnelly <donn0086@umn.edu>
- Thursday, September 30, 2004 at 21:40:33 (CDT)

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Is the use of Xylitol really the cure to dental caries, or at least a step in the right direction and a proactive approach to the prevention of dental caries? Peldyak J, Makinen KK., Xylitol for caries prevention., J Dent Hyg. 2002 Fall;76(4):276-85. This review demonstrated that systematic xylitol use has the potential to lead to impressive reductions in caries incidence. Xylitol is used as a sucrose substitute, but the reason that it is not as widely available is due to the cost to produce it?
Atty Smith <smit1820>
- Thursday, September 30, 2004 at 21:39:24 (CDT)

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Xylitol chewing gum, as well as candies and other sugared snacks, can be a vital part of preventing tooth decay. Considering how much money has gone into research on different sugar alcohols, shouldn't there be an attempt from dentistry and government to offer incentives for companies using such sugar substitutes? "Xylitol and dental caries: an overview for clinicians." Journal of the California Dental Association. 31(3):205-9, 2003 Mar.
Steve Weith <weit0030@umn.edu>
- Thursday, September 30, 2004 at 21:14:46 (CDT)

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In the last lecture, Dr. Hildebrandt brought to light the issue of Xylitol chewing gum and the effects it had on decreasing caries activity. He also mentioned the xylitol might have a greater effect in the presence of fermentalable carbohydrates however, I found a paper that shows that when xylitol when combined with fructose showed that frucotose actually inhibits xylitols activity on caries activity. DATA TAKEN FROM: American Society for Microbiology Antimicrob Agents Chemother. 2001 January; 45 (1): 166–169 DOI: 10.1128/AAC.45.1.166-169.2001 Effect of Xylitol on Growth of Streptococcus pneumoniae in the Presence of Fructose and Sorbitol Terhi Tapiainen,1* Tero Kontiokari,1 Laura Sammalkivi,1 Irma Ikäheimo,2 Markku Koskela,2 and Matti Uhari1 1Department of Pediatrics, University of Oulu,1 and 2Clinical Microbiology Laboratory, Oulu University Hospital,2 Oulu, Finland * Corresponding author. Mailing address: Department of Pediatrics, University of Oulu, FIN-90220 Oulu, Finland. Phone: 358 8 3152011. Fax: 358 8 3155559. E-mail: ttapiai@paju.oulu.fi. Received June 5, 2000; Revisions requested July 5, 2000; Accepted October 14, 2000.
David Mach <machx004@umn.edu>
- Thursday, September 30, 2004 at 20:59:46 (CDT)

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Recommendations for the use of fluoride to prevent and control dental caries in the U.S. Denters for Disease Control and Prevention. MMWR Recomm Rep 2001 Aug17;50:1-42. Community water fluoridation is a safe, effective, and inexpensive way to prevent dental caries. This modality benefits persons in all age groups and of all SES. Community water fluoridation is also the most cost effective way to prevent tooth decay among populations living in areas with adequate community water supply systems. Continuation of community water fluoridation of these populations and its adoption in additional U.S. communities are the foundation for sound caries prevention programs.
Kris Phillips <phil0294@umn.edu>
- Thursday, September 30, 2004 at 20:35:12 (CDT)

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In exploring options for dental caries control measures; xylitol, a hard alcohol derived from birch and other hardwood trees, has shown in multiple trials such as Belize and Estonia to remineralize teeth. Xylital can be administered not only in gum, but also candy, cookies, ice pops, etc. Lynch H. Milgrom P. "Xylitol and dental caries: an overview for clinicians." Journal of the California Dental Association. 31(3):205-9, 2003 Mar.
Aimee Potasek <pota0013@umn.edu>
- Thursday, September 30, 2004 at 20:23:00 (CDT)

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Topical fluorides are applied as a foam and gel by dental professionals everyday. However, some believe that the application of fluoride varnish is becoming a more preferred method rather than the gels and foam in its effectiveness in caries prevention and may be preferred because less time is required and fluoride exposure can be better controlled. The study that I reviewed compared the costs and patient acceptability of using foam or varnish professionally applied topical fluorides. The results demonstrated that the varnish technique took significantly less time compared to foam. The cost per varnish application was also less than the cost per foam application. Varnish applications also showed fewer signs of discomfort because there was less gagging when varnish was applied. Journal of Public Health Dentistry. 64(2):106-10, 2004 Spring.
Marianna Elimelakh <elim0001@tc.umn.edu>
- Thursday, September 30, 2004 at 20:22:50 (CDT)

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A patient’s eating habits is an important of caries risk assessment. According to an article in JADA by Dye et al, “the most important dietary etiological factor in the promotion of dental caries is sugar consumption.” The article also mentioned that when a person’s sugar intake is more than 15-20 kg a year, such intake is directly associated with increase caries prevalence. One portion of this article was on the study of teenagers who often skipped breakfast. According to the article, when this occurs, the teens are most likely to snack during the day. Snacks were reported to have the highest sugar content of any type of meal. Having breakfast of whole grain and dairy products has been shown to decrease a person’s apatite while sugary snacks will leave them feeling hungry shortly after consumption. Promoting healthy eating habits, such as having breakfast, will have a positive effect on young peoples’ dental health. Dye, Bruce A. et al. The Relationship between Healthful Eating Practices and Dental Caries in Children Aged 2-5 Years in the United States, 1988-1994. JADA. Jan. 2004; 135: 55-65.
Mickey Moua <moua0114@umn.edu>
- Thursday, September 30, 2004 at 20:08:08 (CDT)

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I found a paper that examined clinical studies on the caries-preventive and therapeutic effects of sugar alcohols with emphasis on sorbitol and xylitol. They found in this study that chewing sugar free gum of any kind, (not just xylitol and sorbitol) reduce caries incidence. They claim that There is no evidence for a caries-therapeutic effect of xylitol and these conclusions are in line with those of recent reviews and with the conclusions of the Scientific Committee on Medicinal Products and Medical Devices of the EU Commission. I do not believe that they looked into the remineralization properties of Xylitol, but rather the caries incidence beign affected by salivary flow instead. They did not acknowledge the cariostatic nature of xylitol, but rather, mentioned that it "can't be excluded" Another bad study......and it was published.
Ben Selden <seld0013@umn.edu>
- Thursday, September 30, 2004 at 20:06:08 (CDT)

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I found a study that looked at children's consumption of beverages containing fructose and sucrose. It compared caries rates in children drinking either 100% fruit juice, soda, or milk. Although caries rates were somewhat high for the juice drinkers, they were not as high as the soda drinkers. The reasoning behind this is that fruit juice is composed of fructose whereas soda is primarily sucrose. Glucosyltransferases from Strep mutans feed on sucrose but not on fructose. Milk was the drink of choice in this study, followed by fruit juice, and soda was shown to be most detrimental to oral health. Teresa A. Marshall, et al. Dental Caries and Beverage Consumption in Young Children. Pediatrics Vol. 112 No. 3 September 2003, pp. e184-e191
Dan Connors <conn0295@umn.edu>
- Thursday, September 30, 2004 at 18:59:05 (CDT)

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The focus of the article I read was about the ability of xylitol gum and syrup to prevent acute otitis media . I found this article interesting because we've heard alot about xylitol and its effectiveness in preventing and remineralizing carious lesions, but it is interesting that other medicinal fields are finding a use for xylitol sugar. I'm surprised that more xylitol containing products are not sold OTC considering the positive uses for it. It will be interesting to see if the availability of xylitol will increase in the upcoming years. Xylitol in preventing acute otitis media Vaccine, Volume 19, Supplement 1, 8 December 2000, Pages S144-S147 Matti Uhari, Terhi Tapiainen and Tero Kontiokari
Andy Wilcox <wilc0094@umn.edu>
USA - Thursday, September 30, 2004 at 18:43:13 (CDT)

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I read an article that spoke of how promotion of sound dietary practices is an essential component of caries management, along with fluoride exposure and oral hygiene practices. Fermentable carbohydrates interact dynamically with oral bacteria and saliva, yet there are lifestyle behaviors to improve oral and general health. These include combining and sequencing foods which enhances mastication, saliva production, and oral clearance at each eating occasion. Also eating and drinking should be followed by cariostatic foods such as xylitol chewing gum. Knowledge of how bacteria use what we eat can help solve many of the problems that cause caries. "Nutrition and dental caries." Mobley CC. Dent Clin North Am. 2003 Apr;47(2):319-36.
Paul Schaus <scha0764@umn.edu>
- Thursday, September 30, 2004 at 18:03:46 (CDT)

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For this lecture I chose an article that had to do with xylitol chewing gum. The title of the paper is "Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland." The problem that they were trying to solve was that toothbrushes in daycare centers hve been questioned because of the possibility of spreading of infections through unsupervised brushing. They wanted to determine if the use of xylitol chewing gum could be a practical way of taking care of oral hygiene during daycare hours without brushing. The methods used were to include a community trial, conducted in Savonlinna Finland, to test the caries-preventive effect of xylitol chewing gum at these centers. 921 children were recruited. The daycare centers were randomly distributed to xylitol chewing gum or brushing groups. An additional 270 children who had not been in daycare centers were later organized into an external reference group in order to check whether the children in the daycare centers were representative of all children in Savonlinna. The results revealed a statistically significant but clinically small difference between the xylitol and brushing groups in favor of the xylitol group. However, oral health status in the xylitol group was a little bit better than in the control group. They conclude that the use of xylitol can be recommended, especially if the personnel do not have the possibility to supervise the brushing. I think that the results they got could have been predicted, I mean there is several studies out there that have proven that xylitol chewing gum is beneficial. However, I do think that it is good that this study did prove that xylitol gum can be beneficial if children, or adults, have no time to brush during the day. The fact that the xylitol group had better oral hygiene skills probably did skew the data, but I think if it were the other way (toothbrushing group with better oral hygiene) the results would have been the same. Reference: Acta Odontol Scand. 2003 Dec;61(6):367-70. Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland. Kovari H, Pienihakkinen K, Alanen P.
Joby Jaberi <jabe0002@umn.edu>
- Thursday, September 30, 2004 at 18:01:46 (CDT)

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The previous lecture touched on the use of gum containing 100% xylitol for it's anti-caries effects. The article I read did a study on the effects of xylitol tablets in a population of orthodontic patients. The mechanism of action of xylitol is suggested to be the incorporation of xylitol 5-phosphate with the inhibition of bacterial glycolytic enzymes resulting in impaired growth and acid production. Much of the debate over xylitol's benefits has been whether it's the enhanced saliva stimulation from chewing the gum or the sugar alcohol itself. In this paper the study group chosen had low caries experience and an average level of oral hygiene. The study had a short-term decrease in salivary s. mutans while the plaque levels remained unchanged. The researchers believe that the poor results were due to the low daily xylitol doses and the fractioned method of administration. The maximal dose at each single intake did not exceed 1 gram. They speculated that a more continuous presence of xylitol combined with "peak" concentrations maybe needed to exert a more effective antibacterial effect. I'm in agreement with Dr. Hildebrandt's lecture in that products with 100% xylitol given in the proper dosages will be effective in reducing caries incidents in compliant patients. (Steckson-Blicks, C., et al., "Effect of xylitol on mutans streptococci and lactic acid formation in saliva and plaque from adolescents and young adults with fixed orthodontic appliances." European journal of oral sciences. 2004 vol:112 iss:3 pg:244-248.)
Sarah A Nelson <nels2267@umn.edu>
- Thursday, September 30, 2004 at 17:17:42 (CDT)

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Xylitol chewing gum and sweetened products are associated with an impressive reduction in caries in both kids and adults. Xylitol chewing gum can have many beneficial effects- including hyposalivation relief, stabilization of rampant caries, prevention of root caries, the mothe-child cariologic relationship and the ability to implement school prevention programs. It also has been shown that xylitol has medical uses that can reduce the need for antibiotics. The article I read cited that the use of xylitol chewing gum or syrup medications in daycare centers are associated with a reduced rate of middle ear infections and a lowered nasopyharyngeal carriage rate of pneumococci. The article also mentions that while xylitol is as sweet as regular table sugar, its initial utilization by humans does not require insulin, so therefore is an accepted part of the diabetic diet. Peldyak, J., Makinen, K. Xylitol for Caries Prevention. The JOurnal of Dental Hygiene. 76(4);276-285. Fall 2002.
Michelle Olson <olso1984@umn.edu>
- Thursday, September 30, 2004 at 16:57:24 (CDT)

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The article I reviewed stated that the use of xylitol gum on a regular basis can supress the number of MS and lactobacilli in the oral environment. Combining xylitol chewing gum with regular dental cleanings can significantly reduce the amount of decay-causing bacteria. (Juric H. Dukic W. Jankovic B. Karlovic Z. Pavelic B. Suppression of salivary Streptococcus mutans and lactobacilli by topical caries preventive agents. [Journal Article] Central European Journal of Public Health. 11(4):219-22, 2003 Dec.)
Paul Amundson <amun0141@umn.edu>
- Thursday, September 30, 2004 at 16:15:03 (CDT)

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Often times the reason why we send our elderly into long-term care hospitals is because they no longer can do the daily activities required to take care of themselves. We put our trust and large amounts of money into the hands of nurses to take care of them. In this study by CC. Wyatt, the researchers noted the higher than normal incidence of caries present in their patients. The startaling finding in the research was that most of the patients were seeing dentists for treatment. This study stressed the importance of caries prevention strategies in cronic cases as opposed to treatment alone. Elderly Canadians residing in long-term care hospitals: Part II. Dental caries status. Journal (Canadian Dental Association). 68(6):359-63, 2002 Jun.
Conor Casey <case0155@umn.edu>
- Thursday, September 30, 2004 at 14:59:00 (CDT)

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I found a study that researched the possible use of a low dose xylitol supplement in a dialy diet on s. mutans. They used a small sample of idividuals and divided them into three groups. One control, and two Xylitol groups at different amounts. The subjects were given tablets twice daily. They then compared s. mutans levels before and after the administration of the tablets at 6, 12, and 18 weeks. The results showed lactic acid production decreased by about 10 percent in the xylitol groups compared to the base. However there was no significant decrease in the long trem s. mutans counts. Stecksen-Blicks C. "Effect of xylitol on mutans streptococci and lactic acid formation in saliva and plaque from adolescents and young adults with fixed orthodontic appliances." European Journal of Oral Sciences. 112(3):244-8, 2004 Jun.
Eric Scotland <scot0223@umn.edu>
- Thursday, September 30, 2004 at 14:19:41 (CDT)

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Inaba D. Kawasaki K. Iijima Y. Taguchi N. Hayashida H. Yoshikawa T. Furugen R. Fukumoto E. Nishiyama T. Tanaka K. Takagi O. Enamel fluoride uptake from mouthrinse solutions with different NaF concentrations. Community Dentistry & Oral Epidemiology. 30(4):248-53, 2002 Aug. The researchers in this study wanted to test the hypothesis that fluoride uptake during remineralization of enamel depends more on the frequency of application than the fluoride dosage. The route of fluoride administration was a NaF mouthrinse. They formed three groups of Japanese schoolchildren. The first group used a daily 0.05% NaF rinse for 2-5 years. The second group rinsed daily with a 0.025% NaF rinse for two years. The third group didn't use any rinse. They found that the children from both the first and second groups reached the same enamel fluoride concentration which was significantly higher than the concentration found in the children who didn't use a rinse. Thus the concentration of fluoride in the mouthrinse was less important than the frequency of administration.
Nicole Little <littlej@umn.edu>
- Thursday, September 30, 2004 at 14:16:22 (CDT)

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"Evaluation of the dental plaque pH recovery effect of a xylitol lozenge on patients with fixed orthodontic appliances." Angle Orthodontist 74(2); 240-4, 2004 Apr. This study measured pH at specific intervals following a rinse with sucrose in patients before and then after two weeks of regular xylitol lozenge use. The mean minimum pH and final pH 1 hour after sucrose rinse both increased following the two weeks of xylitol use. This information suggests that xylitol lozenges could be helful in reducing demineralization around fixed orthodontic appliances with broader implications for caries reduction in general.
Scott Stadsklev <stad0040@umn.edu>
- Thursday, September 30, 2004 at 12:26:16 (CDT)

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The use of xylitol as a sweetener has been tested in many situations, but the study I viewed tested the prevention of caries between xylitol and unsupervised brushing in daycare centers. They had found a small but clinically significant difference favoring the xylitol chewing gum for preventative purposes. The thought behind the results is that children that aren’t supervised while brushing in areas with multiple children may pass bacteria between one another, and the gum is an acceptable alternative in certain instances. Kovari H. Pienihakkinen K. Alanen P. Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland. [Clinical Trial. Journal Article. Randomized Controlled Trial] Acta Odontologica Scandinavica. 61(6):367-70, 2003 Dec.
Scott Larson <lars1686@umn.edu>
- Thursday, September 30, 2004 at 12:15:04 (CDT)

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I looked up an article dealing with the effects of xylitol on the suppression of Step mutans. This article specifically looked at preschool children and their Strep mutans counts at the baseline and after 3 weeks of chewing xylitol gum 3 times a day. There was also a control group for comparison. The results showed a greater decrease in Strep mutans counts in the group that chewed xylitol gum 3 times a day. This is important since it shows there are new ways to control dental caries other than simply removal and filling the tooth. Reference: Autio JT., "Effect of xylitol chewing gum on salivary Streptococcus mutans in preschool children." Journal of Dentistry for Children. 69(1):81-6, 13, 2002 Jan-Apr.
David Maki <dmaki1@umn.edu>
- Thursday, September 30, 2004 at 12:02:52 (CDT)

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In our lecture on Wednesday, Dr. Hildebrandt discussed and evidence-based approach to caries risk assessment. This is an important topic in dentistry today because there has been a paradigm shift from the traditional "drill and fill" method to preventing the symptoms of the disese dental caries. This preventive strategy consists of a multifactorial approach which includes: diet analysis, microbial sampling, prescription mouthrinses and fluoridated toothpastes, and patient education. The article I reviewed studied the anti-plaque efficacy of a chlorhexidine mouthrinse used in combination with toothbrushing. The study concluded that the anti-plaque efficacy of a chlorhexidine mouthrinse prior to brushing did not seem to be reduced in combination with normal oral hygiene procedures. "The anti-plaque efficacy of a chlorhexidine mouthrinse used in combination with toothbrushing with dentifrice." Journal of Clinical Periodontology. 31(8):691-5, 2004 Aug.
Brandon Bussler <buss0099@tc.umn.edu>
- Thursday, September 30, 2004 at 11:50:47 (CDT)

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xylitol chewing gum has been shown to prevent the adherence of bacteria to the outer enamel surface. it is recently gaining popularity with gum chewers on the sugar-free gum mainstream. xylitol was approved by the fda in 1986 and is now present in gums, mints, and toothpastes. (Gum-chewers have new reason to smile; Academy of General Dentistry. www.agd.org/consumer/topics/decay/gum.html)
rian suihkonen <suih0002@umn.edu>
- Thursday, September 30, 2004 at 11:42:41 (CDT)

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The study I read for this lecture discussed nutrition and diet in relation to dental caries. Nutrition affects the developement of teeth where diet affects the teeth locally in the oral cavity. They found that foods such as sucrose containing candies and soft drinks can lead to an increase in dental caries and fluoride keeps the caries in check. Moynihan P. Petersen PE. Diet, nutrition and the prevention of dental diseases. Public Health Nutrition. 7(1A):201-26, 2004 Feb.
Jessica Allison <alli0086@umn.edu>
- Thursday, September 30, 2004 at 11:35:01 (CDT)

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The study compaired the arrestment of Primary root caries using a 5000ppm and 1500ppm tooth pastes. After 6 months nearly 50% of patients had at least 1 PRCL harden(5000ppm), nearly double that of 1500ppm. The problem that I see with the study is that there was really no control. Reversal of primary root caries using dentifrices containing 5,000 and 1,100 ppm fluoride. Baysan A, Lynch E, Ellwood R, Davies R, Petersson L, Borsboom P. Department of Adult Oral Health, St. Bartholomew's and the Royal London School of Medicine and Dentistry, UK. a.baysan@mds.qmw.ac.uk
Jeff Moos <moos0021@umn.edu>
- Thursday, September 30, 2004 at 11:31:26 (CDT)

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Dental caries, not unlike periodontal diseases, is now recognized as an infectious, transmissible, multifactorial disease of bacterial origin. Current evidence-based emphasis is on the need to recognize a carious lesion in its earliest stage before demineralization has produced a cavitated lesion that requires restoration by a dentist. As a result of current understanding of caries control, the dental hygienist s role as a prevention specialist is to determine the dental caries risk factors for patients of all ages and to introduce remineraiization strategies into the patient's dental hygiene care plan. Conservative strategies of a concentrated program include initial infection control with a chlorhexidine rinse; extra daily fluoride exposures; placement of pit and fissure sealants where indicated; control of sucrose exposures; use of sugar substitutes, particularly xylitol-containing sugarfree chewing gum; and an emphasis on a daily bacterial plaque removal routine. Evidence supports the management and monitoring of dental caries. Caries risk level must be reevaluated at each maintenance appointment. Appropriate in-office strategies to preserve tooth structure should be carried out and followed by applicable home regimens that are based on need, not age. Journal of Dental Hygiene; Fall2002, Vol. 76 Issue 4, p270
Matt Hendrickson <hend0485@umn.edu>
- Thursday, September 30, 2004 at 11:24:42 (CDT)

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For this comment I used the keywords "caries risk assessment" and found the article "The role of risk factors in the identification of appropriate subjects for caries clinical trials: design considerations." The aricle states that in order to assess caries risk, studies should focus on a group of high risk patients with a limited amount of time. This paper basically reviewed other literature that was already out there and by looking at the results that were found decided that evaluating only high-risk patients was the most successful way to study caries risk. The authors were also convince that the new advantages in technology will lead to an earlier detection of caries and this will help control the problem. Citation: J Dent Res. 2004;83 Spec No C:C116-8.
Justin Hagen <hage0449@umn.edu>
- Thursday, September 30, 2004 at 11:22:28 (CDT)

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Dr. Hildebrant spoke about xylitol gum and its role in preventing and arresting dental caries. The article I found also addressed this issue. They found that children of mothers treated with xylitol chewing gum had lower levels of S. mutans than children of mothers treated with fluoride varnish or chlorhexidine mouth rinse. Could there be indications in high-risk caries populations for treatment of mothers and their children with xylitol from early on? Lynch H., Milgrom P. "Xylitol and dental caries: an overview for clinicians." J Calif Dent Assoc. 2003 Mar;31(3):205-9.
Alicia Berger <berg1305@umn.edu>
- Thursday, September 30, 2004 at 11:03:47 (CDT)

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I read an article that looked into the possibility of physicians providing a dental screening in young children and the possibility of them delivering fluoride to at-risk kids. I don't think it's a good idea for GP's to be delivering fluoride. However, I think it would be a good idea for them to have more awareness as to the risk factors involved in rampant caries and to be able to identify these symptoms in their patients. They would then be able to refer their patients to dentists for the application of fluoride and other preventive measures. Bader JD, Rozier RG, Lohr KN, Frame PS. "Physicians' roles in preventing dental caries in preschool children: a summary of the evidence for the U.S. Preventive Services Task Force." Am J Prev Med. 2004 May;26(4):315-25.
Jeff J. Johnson <john2990@umn.edu>
- Thursday, September 30, 2004 at 10:18:42 (CDT)

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I read an article outlining a Swedish study about geriatric patients. The aim was to determine if the elderly were more at risk for caries. They looked at 65, 75, and 85 year old patients over a 10 year period. What they found that of the remaining living patients, 95% had developed at lease one carious lesion (mostly secondary). They believe this has to do a lot with lower salivary secretion rates. What it tells us is that we need to pay special attention to the older generations and perhaps have more recalls with them. "Ten-year cross-sectional and incidence study of coronal and root caries and some related factors in elderly Swedish individuals." Fure S. Gerodontology. 2004 Sep;21(3):130-40.
Dan Lunstad <lund0724@umn.edu>
- Thursday, September 30, 2004 at 10:12:30 (CDT)

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Tinanoff N. Douglass JM. Clinical decision making for caries management in children. [Review] [56 refs] [Journal Article. Review. Review, Tutorial] Pediatric Dentistry. 24(5):386-92, 2002 Sep-Oct. The article discussed that current evidence regarding the carious process and caries risk assessment allows the practitioner to go beyond traditional surgical management of dental caries. Therapy should focus on patient-specific approaches that include disease monitoring and preventive therapies supplemented when necessary by restorative care. The type and intensity of these therapies should be determined utilizing clinical data as well as knowledge of the caries process for that child. Changes in the management of dental caries will require health organizations and dental schools to educate students, practitioners, and patients in evidence- and risk-based care.
Shawn Knorr <knor0011@umn.edu>
- Thursday, September 30, 2004 at 10:11:14 (CDT)

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The keyword I used from Dr. Hildebrandt's lecture was xylitol. As he mentioned in class, it is used as a sweetener to prevent dental caries. The following article dealt with xylitol doing a study with 857 children. Their findings over a 3 month period concluded that "Xylitol sugar, when given in a syrup or chewing gum, was effective in preventing AOM and decreasing the need for antimicrobials", where AOM is acute otitis media . The title of this article was "A novel use of xylitol sugar in preventing acute otitis media" and can be found in Pediatrics. 102(4 Pt 1):879-84, 1998 Oct.
joshua vang <vang0335@umn.edu>
- Thursday, September 30, 2004 at 10:08:18 (CDT)

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Going along with the topic of risk assessment and prevention, I read an article on the primary care physician's role in preventing caries in preschool children. The article was published by the US Preventive Services Task Force. The recommendations that the task force made where based on the fact that most preschool aged children do not visit the dentist, eventhough the recommended age is 1 year old. As a healthcare provider that is seeing the children earlier, the task force thought the most important step was for the primary care physician to prescribe fluoride to children that did not get enough in their water supply. They also touched on the importance of fluoride varnishes. They, however, didn't have enough data to support recommendations for completing risk assessments on the children. U.S. Preventive Services Task Force. Prevention of dental caries in preschool children. American Journal of Preventive Medicine. Vol 26, Iss 4, May 2004, p.326-329.
Jessica Johnson <johjessi@yahoo.com>
- Thursday, September 30, 2004 at 10:06:17 (CDT)

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The topic I chose to investigate further after our lecture is xylitol and its role in preventative dentistry. The article I found is . Miake Y. Saeki Y. Takahashi M. Yanagisawa T. Remineralization effects of xylitol on demineralized enamel. [Journal Article] Journal of Electron Microscopy. 52(5):471-6, 2003. The investigators of this study placed demineralized enamel in two solutions, one with only a remineralizing solution and the other with a remineralizing solution with xylitol. From this study it was found that xylitol works by remineralizing deeper enamel layers of enamel via calcium movement. The layers of remineralization were more substantial in middle and deep layers at a depth of 50-60 micrometers with xylitol versus the remineralization that occurred without the xylitol.
Karrie Powell <powe0033@umn.edu>
- Thursday, September 30, 2004 at 10:04:16 (CDT)

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After Dr. Hildebrandt spoke on Wed., I found an article that talked about xylitol products being able to reduce the transmission of S. mutans from mother to child. The article also made the point that all of the results were also associated with other dental therapies: "Xylitol is a naturally occurring, low-calorie sugar substitute with anticariogenic properties. Data from recent studies indicate that xylitol can reduce the occurrence of dental caries in young children, schoolchildren, and mothers, and in children via their mothers. Xylitol, a sugar alcohol, is derived mainly from birch and other hardwood trees. Short-term consumption of xylitol is associated with decreased Streptococcus mutans levels in saliva and plaque. Aside from decreasing dental caries, xylitol may also decrease the transmission of S. mutans from mothers to children. Commercial xylitol-containing products may be used to help control rampant decay in primary dentition. Studies of schoolchildren in Belize and Estonia, along with data from the University of Washington, indicate that xylitol gum, candy, ice pops, cookies, puddings, etc., in combination with other dental therapies, are associated with the arrest of carious lesions. A prospective trial in Finland has demonstrated that children of mothers treated with xylitol had lower levels of S. mutans than children of mothers treated with chlorhexidine or fluoride varnish." Lynch H. Milgrom P. "Xylitol and dental caries: an overview for clinicians." Journal of the California Dental Association. 31(3):205-9, 2003 Mar.
Matt Bruzek <bruz0012@umn.edu>
- Thursday, September 30, 2004 at 10:01:19 (CDT)

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Woops, I forgot to list my reference.[Evaluation of the dental plaque pH recovery effect of a xylitol lozenge on patients with fixed orthodontic appliances.Angle Orthodontist. 74(2):240-4, 2004 Apr]
Stacey Vogt <vogt0056@umn.edu>
- Thursday, September 30, 2004 at 09:56:01 (CDT)

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This study determined the effects of using two dose regimens of xylitol-containing tablets on dental plaque and saliva with patients who had fixed orthodontic appliances. The levels of streptococci mutans in plaque and saliva and the proportion of xylitol sensitive strains in saliva were measured at baseline, 6, 12, and 18 wk intervals. All participants of this study were low caries risk and average level of oral hygiene. The compliance of the xylitol regimen was checked with a questionnaire. The proportion of xylitol sensitive strains of streptococci Mutans decreased after 6 wks. The xylitol regimen does not reduce carcinogenicity in the dental plaque but an increased plaque accumulation adjacent to orthodontic brackets. The results of this study suggests that the xylitol containing tablets could affect the bacterial composition in saliva, but there were no long term alterations in the levels of streptococci mutans or lactic acid formation rate in low-caries patients. Although orthodontic patients are one risk level higher than normal populations, the researchers should use a population that is at a higher risk group and see if the xylitol made a difference since it has been shown in other studies that xylitol can arrest the formation of caries. The researchers should also increase the research time intervals. This is a short term study, but a long term study should be researched in the effects of xylitol. Stecksen-Blicks C, Holgerson PL, Olsson M, Bylund B, Sjostrom I, Skold-Larsson K, Kalfas S, Twetman S. Effect of xylitol on mutans streptococci and lactic acid formation in saliva and plaque from adolescents and young adults with fixed orthodontic appliances. Eur J Oral Sci. 2004 Jun;112(3):244-8.
Chia-Yin Lo <loxx0048@umn.edu>
- Thursday, September 30, 2004 at 09:55:52 (CDT)

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Orthodontic patients often have greater difficulty with oral hygeine and are at a higher caries risk. Research has shown that xylitol chewing gum is an effective way limiting caries, but for ortho patients chewing gum is contraindicated. A study done looking at a different route of administration of xylitol. Orthodontic patients were asked to refrain from brushing for 48 hours and were then administered a sucrose solution. Using the touch method for measuring pH, levels were measured after the patients were given a xylitol lozenge. The results show that the lozenge is a good option for ortho patients following ingestion of sucrose.
Stacey Vogt <vogt0056@umn.edu>
- Thursday, September 30, 2004 at 09:53:18 (CDT)

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During Dr. Hildebrandt's lecture today he discussed the efficacy of xylitol chewing gum in reducing carious lesions by reducing the amount of Strep. mutans. One study that I found analyzed the effect of the chewing gum in preschool children and supports this claim. Sixty one preschool children were put into a xylitol and control group. For three weeks, the children chewed the gum three times per day. Both groups showed a shift from greater to lesser Strep. mutans scores. However, this shift was larger for the xylitol group. This adds to the notion that xylitol can reduce caries by reducing S. mutans scores, and therefore could potentially be a useful anti-cariogenic agent for children. "Effect of xylitol chewing gum on salivary Streptococcus mutans in preschool children" Journal of Dentistry for Children. 69(1):81-6, 13, 2002 Jan-Apr.
Timothy J. Neuner <neun0004@umn.edu>
- Wednesday, September 29, 2004 at 22:19:01 (CDT)

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As discussed in lecture, caries risk assessment needs to be taken into consideration when deciding upon treatment. In the article entitled “Oral Health Risk Assessment Timing and Establishment of the Dental Home,” in the case of infants and toddlers it is also necessary to assess caries risk in the mother or other primary caregiver of the child. This article outlines the need for oral health risk assessment by 6 months of age by a qualified pediatrician, looking for high caries risk factors in mothers such as frequent sugar intake, fluoride exposure, poor oral hygiene practice, etc . in order to properly refer both mother and infant to a proper dental home (i.e. primary pediatric dental care). Reference: Pediatrics Vol. 111 No. 5 May 2003: 1113-6.
Anh Kov <vuong0016@umn.edu>
- Wednesday, September 29, 2004 at 22:16:33 (CDT)

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In today's lecture by Dr. Hildebrandt, one of the many topics brought up on caries risk and assesment was that one of the main 4 etiologies or major risk factors is certain medications and its effect on hyposalivation. In the study I reviewed, it compared three groups with different levels of unstimulated salivary flow rate. Group 1 being the lowest at less than .16 mL/min and the highest(Group 3) with being great than .30 mL/min. Group 1 had the largest percent of medication (not specified for what condition) that contributed to hyposalivation. The study used microradiology as its diagnostic tool to analyze the amount of demineralization that occurred after 62 days in situ between these 3 groups. The results showed that all groups had some level of demineralization, but 85% of subjects in group 1 had a certain standard of caries (not specified) compared with nearly 0% in group 3. So once again this study confirms the significance of saliva and especially unstimulated salivary output being that this occurs for most the day. The study suggested that .16 mL/min be the new standard for defining hyposalivation vs. the current less than .10 mL/min level. [A. Bardow, , a, B. Nyvadb and B. Nauntoftea. Relationships between medication intake, complaints of dry mouth, salivary flow rate and composition, and the rate of tooth demineralization in situ. Archives of Oral Biology. Vol. 46, Issue 5 , May 2001; 413-423.]
Adam Beers <beer0033@umn.edu>
- Wednesday, September 29, 2004 at 22:07:46 (CDT)

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Dr. Hilldebrandt talked a lot about the effectiveness of xylitol, especiallyin the form of chewing gum. The article I found in the journal Acta Odontol Scand. 2003 Dec;61(6):367-70 called "Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland." by Kovari H, Pienihakkinen K, Alanen P. This study questions the caries-preventive effect of xylitol chewing gum. A community trial was conducted in Savonlinna, Finland to test the caries-preventive effect of xylitol chewing gum versus toothbushing. "The results revealed a statistically significant but clinically small difference between the xylitol and brushing groups in favor of the xylitol group." It was determined that the oral health status in the xylitol group was a some what better than in the brushing group. The use of xylitol should be recommended, especially in situations where no one is supervising the children's brushing.
Emma Otis <otis0025@umn.edu>
- Wednesday, September 29, 2004 at 21:47:14 (CDT)

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I choose this little section of an article conerning soda pop and caries in children... I know the point of the comments is not just to cut and paste but there is no way i could say it any better... I just goes to show what the american way of life is driven by money and is not worried in any way about what damage it is going to cause... Check it out...Baby bottle with popular soda pop and soft drink logos are on marked shelves. A descriptive study was conducted to determine their prevalence among families and to determine whether the logos could be influencing what families put in baby bottles. A convenience sample of 314 mothers (and grandmothers if they were primary caregivers) with children using baby bottles was interviewed in three California counties. The results were analyzed for significance, using the chi-square test for independence. The ethnicities and educational levels of the sample population matched the distribution of the State. Overall, 31 percent of the children drank either soda pop or Kool-Aid from baby bottles. Forty-six percent of the respondents owned a baby bottle with a soda pop logo and 17 percent owned a bottle with a Kool-Aid logo. Families who owned bottles with popular beverage logos were four times more likely to give children the respective beverage in bottles than families with "logo bottles." Populations most likely to drink these beverages were those in the black and Hispanic ethnic groups, in the youngest age-group (15-20 years of age), and those without a high school diploma. Health professionals are concerned that the logos could cause an increase in children's consumption of sweetened beverages in baby bottles and consequently an increase in Baby Bottle Tooth Decay and nutritional problems.... I hope that is will come to an end or the practice of dentitstry is in for a real challenge in treating these patients as the grow older in our practices.... Siener K, Rothman D, Farrar J. ASDC J Dent Child. 1997 Jan-Feb; 64 (1): 55-60
Charles Duchsherer <duch0041@umn.edu>
- Wednesday, September 29, 2004 at 20:47:49 (CDT)

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Glassman P. Anderson M. Jacobsen P. Schonfeld S. Weintraub J. White A. Gall T. Hammersmark S. Isman R. Miller CE. Noel D. Silverstein S. Young D. Practical protocols for the prevention of dental disease in community settings for people with special needs: the protocols. Special Care in Dentistry. 23(5):160-4, 2003 Sep-Oct. Today we discussed the effectiveness of xylitol chewing gum. In searching for literature I encountered an interesting topic....how to treat special needs pts. People with special needs have more dental disease and more missing teeth than the general population. They also have reduced access to oral health diagnostic, preventive, interceptive and treatment services. If services are available, they can be complicated and costly. It is critical to prevent dental diseases in these individuals. This article presented a set of practical protocols for preventing dental disease in people with special needs. Xylitol is a very good preventative action to examine with special needs pts.
Marika Middag <midd0058@umn.edu>
- Wednesday, September 29, 2004 at 20:20:23 (CDT)

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Dr. Hildebrant got me thinking about xylitol chewing gum so I decided to read a bit more about it. I read about a study conducted at a daycare in Finland that tested the effectiveness of xylitol in preventing caries and/or its progression. There were xylitol gum groups and brushing groups and the study showed slightly more favorable results in the xylitol groups than the brushing groups. "Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland." Kovari H. Pienihakkinen K. Alanen P. Acta Odontologica Scandinavica. 61(6):367-70, 2003 Dec.
jack fiedler <fied0017@umn.edu>
- Wednesday, September 29, 2004 at 19:48:31 (CDT)

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The article I read looked at whether oral strains of lactobacilli unable to utilize xylitol could adapt and use this sugar to produce acid. Twenty-eight oral strains and six ATCC strains of lactobacilli were tested. None of the strains were initially able to produce acids from xylitol. Media containing only xylitol was used in order to see if an adaptation was possible. Badet et al. found that after a 15-day culture, 10 strains produced acids. After a 40-day culture, a total of 22 strains produced acid. When acid production occurred, lactic, formic, acetic, propionic, and butyric acids were the acids formed by all the strains. This study concluded that adaptation of oral strains of lactobacilli to xylitol can occur in vitro. Badet C, Richard B, Castaing-Debat M, de Flaujac PM, Dorignac G. Adaptation of salivary Lactobacillus strains to xylitol. Arch Oral Biol. 2004; 49:161-4.
Steve Clifford <clif0047@umn.edu>
- Wednesday, September 29, 2004 at 19:47:41 (CDT)

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After Dr. Hildebrandt's lecture on caries risk and caries risk assessment, I researched xylitol gum and found an article discussing research conducted by Dr. Hildebrandt here at the University. His group studied the effects of rinsing with chlorhexidine and chewing xylitol gum on the levels of streptococcus mutans in the patients' mouths. They found that those patients who follwed a regiment of rinsing with chlorhexidine twice a day and chewing xylitol gum three times a day for a least five minutes each time for three months had much lower levels of salivary step mutans than the participants who chew sorbitol gum or no gum at all. They concluded that chewing xylitol gum helps extend the effectiveness of chlorhexidine and would be clinically applicable. Hildebrandt GH. Sparks BS. "Maintaining mutans streptococci suppression with xylitol chewing gum." Journal of the American Dental Association. 131(7):909-16, 2000 Jul.
Brian Pelsue <pels0003@umn.edu>
- Wednesday, September 29, 2004 at 17:36:23 (CDT)

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Dr. Hilldebrandt briefly mentioned today that SnF2 is useful tool in fluoride delivery. According to Minnesota Departmnent of Health, there is not support for the concept that 0.4% stannous fluoride gels are the preferred preventive or treatment agents for hypersensitivity, plaque, gingivitis, or periodontitis. The only clinically proved, cost-beneficial indications for use of these materials are for the prevention of enamel decalcification in patients wearing banded orthodontic appliances and for the prevention of dental caries in patients who have had head and neck radiation therapy. Even for these applications, other fluoride products may have equal effectiveness. J Am Dent Assoc. 1989 Jul;119(1):10, 12, 172-4.
Max Barsky <bars0040@umn.edu>
- Wednesday, September 29, 2004 at 17:19:22 (CDT)

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In the lecture today, the topic of caries prevention was discussed with regards to both diet and fluoride. In the article, "Diet, nutrition and the prevention of dental diseases" the author talked about the influence that nutrition has on oral infectious diseases. This can also relate to a patients self esteem and quality of life. With regards to nutrition, erosion of the dental tissues from soda and citrus fruits was mentioned. As mentioned in both the lecture and the paper there is an association between the amount and frequency of sugar intake and dental caries. Fluoride was also mentioned to help reduces caries risk but is not able to eliminate the overall carious disease. This article helped enforce what we discussed in class and also help describe some guidelines to ive to patients concerning their diet. Public Health Nutr. 2004 Feb;7(1A):201-26. Moynihan P, Petersen PE.
Aliya Elmajri <elma0014@umn.edu>
- Wednesday, September 29, 2004 at 16:41:08 (CDT)

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I chose to research the idea of caries risk assessment in very young children. The article I read focused on the prevention of early childhood caries through many different mechanisms. One I found particularily interesting was placing children in caries risk groups before six months of age. This is an aggressive goal, but a very appropriate one. The means to do this mentioned in the article included bacterial samplings and caries activity in the mother, as well as more traditional things such as fluoride exposure and exposure to fermentable carbohydrates. Oral Health Risk Assessment Timing and Establishment of the Dental Home , By: Weiss, Paul A., Czerepak, Charles S., Hale, Kevin J., Keels, Martha Ann, Thomas, Huw F., Webb, Michael D., Nathan, John E., Stewart, Ray E., Kirk, Chelsea L. V., Pediatrics, 0031-4005, May 1, 2003, Vol. 111, Issue 5
Liz Martin <mart1185@umn.edu>
- Wednesday, September 29, 2004 at 16:34:42 (CDT)

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This article discusses caries risk assessment and treatment options for elderly patients. The author points out that although we have seen a marked decline in the caries prevalence in children in the last 30 years, the same is not true for persons who are 70 years and older. Although about 30 percent of adults past age 65 will not have any permanent teeth, many older adults are retaining their natural dentition. The article discusses some additional caries risk factors older adults may contend with, including low salivary flow, poor oral hygiene, frequent sugar consumption, Asian ethnicity, and presence of partial dentures. Antibacterial treatments, high-fluoride toothpastes and oral rinses, patient education, and shorter recall periods are a few of the steps for managing elderly patients identified as having a high caries risk. Anusavice KJ. “Dental caries: risk assessment and treatment solutions for an elderly population.” Compendium of Continuing Education in Dentistry. 23(10 Suppl):12-20, 2002 Oct.
Tara Regenold <davi0497@umn.edu>
- Wednesday, September 29, 2004 at 16:06:35 (CDT)

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In regards to the lecture today I looked at a study on caries risk assessment in children. The journal article went over information regarding treatment, prevention, and pattern of caries in young children. The preventative model discussed today in class is the same as used in the article and their is research tied into this study that implies that it should be the standard of care. Fadavi S. Management of early childhood caries. Gen Dent. 2003 Jan-Feb;51(1):38-40.
Ryan Dunlavey <dunl0060@umn.edu>
- Wednesday, September 29, 2004 at 15:55:46 (CDT)

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It is well established that consistancy and frequency of fermentable carbohydrates in ones diet correlates with caries activity. However, today in industrialized nations this correlation is strongest in a small subset of the general population which is why caries risk assessment is an important aspect of the dental Tx plan. Dietary analysis is a good tool to asses caries risk. The following paper looks into dietary analysis and the role of sugars in caries etiology. Sugars - the arch criminal,Caries Res. 2004 May-Jun;38(3):277-85.
Chris Sampair <samp0106@umn.edu>
- Wednesday, September 29, 2004 at 15:53:31 (CDT)

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Dr Hildebrandt talked briefly about the ever popular Vipeholm study. This is the study of how sticky sugar-containing between meal products can be associated with high caries activity. The question they raised was "Sugar substitutes - one consequence of the Vipeholm Study?" This study answered this question with a resounding yes. They found that there was a difference in the caries development between people who ate one toffee a day and up to 24 a day. This study shows that even in everyday life the Vipeholm study is present and effects daily."Sugar substitutes--one consequence of the Vipeholm Study?"Birkhed D.Department of Cariology, Lund University, School of Dentistry, Malmo, Sweden
chris mcgrew <mcgr0181@umn.edu>
- Wednesday, September 29, 2004 at 15:36:33 (CDT)

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I found an article pertaining to the "best current evidence on xylitol chewing gum" and caries prevention vs. chlorhexidine and caries prevention. I think that this could be a fairly useful article in the comparison and respective outcomes of each therapy. "Chlorhexidine and xylitol gum in caries prevention." Special Care in Dentistry. 23(5):173-6, 2003 Sep-Oct
Mike Hom <homx0008@umn.edu>
- Wednesday, September 29, 2004 at 15:31:29 (CDT)

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This paper talked about the efficiency of various caries prevention methods. Caries prevention is the key to improving dental health and improving access to care, but is it really an emphasis in dental offices or here at school? I didn’t see the pt education or fluoride Tx check off/competency so realistically no one is going to do it. It would be nice if things were geared more towards pt health, rather than numbers of materials placed in mouths. J Dent Res. 2004;83 Spec No C:C95-8. Efficiency issues among statistical methods for demonstrating efficacy of caries prevention. Mancl LA, Hujoel PP, DeRouen TA.
Nick Lowe <lowe0082@umn.edu>
- Wednesday, September 29, 2004 at 15:23:28 (CDT)

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Dr. Hildebrandt discussed the importance of risk assessment for dental caries. As discussed, soft drinks have a negative impact on oral health. The more recent increase in soft drink consumption has accompanied a decrease in dairy intake. This change as been attributed to an "increase (in) the risk for dental caries and a host of systemic complications." The research article stressed the importance for dentists to adopt a risk assessment tool and applying this tool to their patients. Shenkin JD. Heller KE. Warren JJ. Marshall TA. Soft drink consumption and caries risk in children and adolescents. General Dentistry. 51(1):30-6, 2003 Jan-Feb.
Whitney Hustad <hust0040@umn.edu>
- Wednesday, September 29, 2004 at 15:14:00 (CDT)

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I read an article studying the production of xylitol from xylose. Xylitol, a natural food sweetener, prevents otitis, osteoporosis, and inflammatory processes in addition to caries prevention. It is also metabolized independent of insulin. These are reasons for the increased interest in producing more xylitol but in larger quatities and greater cost effectiveness. The xylitol yield from cell recycle fermentation produced higher yields than batch fermentation. Either fermentation method produced higher yields by using chemically defined medium rather than a complex medium. The chemically defined medium consisted of xylose, urea, vitamins, and minerals. The complex medium consisted of xylose, yeast extract, and minerals. Although the cell recycle fermentation process worked well on a small scale, it is not yet favored on a large, industrial scale using the cell recycle fermentation method in chemically defined medium due to some of the steps required which are laborious and time consuming. However, it is promising to see research continue in this area as xylitol could be substituted for sucrose in more products. Biotechnol Lett. 2004 Apr;26(8):623-7.Increased xylitol production rate during long-term cell recycle fermentation of Candida tropicalis. Kim TB, Lee YJ, Kim P, Kim CS, Oh DK.
Judy Schmidt <schm1244@umn.edu>
- Wednesday, September 29, 2004 at 14:09:25 (CDT)

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In regards to caries preventive measures, xylitol chewing gum proves to be an effective treatment component. In addition to the general population usage of it, the pregnant and post-partum mothers should be tageted in order to prevent or reduce transmission of S. mutans to her children. I think this simple addition to oral hygiene could have drastic, positive results in reducing caries in children. The dental team along with other health professionals should encourage and educate patients on the benefits and usage of xylitol. Oral health care for pregnant and postpartum women.Goldie, M. PernoInternational Journal of Dental Hygiene; Aug2003, Vol. 1 Issue 3, p174, 3p
Kristen Manolovits <olso1985@umn.edu>
- Wednesday, September 29, 2004 at 13:33:05 (CDT)

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The paper I read compared the effects of sealants vs. the effects of xylitol chewing gum in the prevention of caries. It found that both helped prevent caries to the same effect. Neither method was more effective than the other. They wrote to choose between the two that other factors should be weighed such as caries occurrence, availability of personnel and other resources, opportunity costs, cooperation with schools, and other local conditions. Reference: Alanen P. Holsti ML. Pienihakkinen K. Sealants and xylitol chewing gum are equal in caries prevention. [Clinical Trial. Journal Article. Randomized Controlled Trial] Acta Odontologica Scandinavica. 58(6):279-84, 2000 Dec.
Cory Larson <clarson5@umn.edu>
- Wednesday, September 29, 2004 at 13:24:54 (CDT)

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Dr. Hildebrandt talked about xylitol chewing gum and remineralizing carious teeth. The study I read evaluated xylitol chewing gum and its effect on Streptococcus Mutans which is a microoganism responsible for caries. The study was done on children separated into a xylitol group who chewed 100% xylitol gum and a contol group. The xylitol group chewed gum three times a day for three weeks. At the end of the study S. mutans were measured and the results were a decrease in S. mutan levels. The author concluded, xylitol chewing gum may provide a feasible caries prevention method for preschool children. (Autio, JT. Effect of xylitol chewing gum on salivary Streptococcus mutans in preschool children.ASDC J Dent Child. 2002 Jan-Apr;69(1):81-6, 13.
Jackie Jensen <jens0657@umn.edu>
- Wednesday, September 29, 2004 at 12:33:35 (CDT)

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Dr. Hildebrandt discussed the relationship between oral dryness and dental caries. I was curious about the benefits of increasing salivary function using systemic therapy such as Pilocarpine. Pilocarpine has been shown to improve symptoms of oral dryness and to increase salivary output in patients with Sjogren's syndrome and postradiation xerostomia but little research or clinical trials have been done that look at the effect systemic therapies have of caries rate. In all of the studies that I looked at they only measure flow rate and the patients subjective reaction to the therapy. I found an article that discusses the need for more objective studies done on the relationship of secretagogues and dental caries. The article also discusses the need for secretagogues with fewer side effects, increased duration of activity and greater potency. Fox PC. "Salivary enhancement therapies" CARIES RESEARCH 38 (3): 241-246 2004
Jill Biles <bile0009@tc.umn.edu>
- Wednesday, September 29, 2004 at 12:14:25 (CDT)

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Caries risk assessment is very important. Dr. Hildebrandt gave many examples of the importance of prophylactic and preventative treatment especially in children. Determining the risk that a patient has for caries development is important so that proper preventative care can be given allowing the teeth to be healthier, needing fewer restorations. This study that I looked at showed that 1st molars are very susceptible to caries as they are in the mouth from an early age when oral hygiene is not very good yet. Prophylactic fluoride treatments greatly reduce the rate of caries and reduce the associated risk. This shows the importance of preventative measures in lowering caries risk. Folia Med (Plovdiv). 2001;43(1-2):12-5. Dynamics of caries activity and caries reduction in group prophylaxis with fluoride gel. Kukleva MP, Kondeva VK.
Joshua Hiller <hill0672@umn.edu>
- Wednesday, September 29, 2004 at 12:05:11 (CDT)

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The article that I found tests effectiveness of chewing gums containing xylitol and chlorohexidine acetate in prevention of caries. There were two groups of subjects; one who used gums containing xylitol only and one who used a combination of xylitol and chlorohexidine acetate. Gums were chewed twice daily for 15 min and no other oral hygiene procedures were conducted by subjects. This study was 5 day trial with 9 day washout. The study concluded that plaque index were significantly lower for subjects who used combination chewing gums compared to who used xylitol gums only. The effect of xylitol and chlorohexidine acetate/ xylitol chewing gums on plaque accumulation and gingival inflammation. J Clin Periodontol. 1999 Jun; 26(6): 388-91.
Rachana Patel <pate0108@umn.edu>
- Wednesday, September 29, 2004 at 12:04:24 (CDT)

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This article studied the use of caries risk assessment with children from the ages of 1 to 6. They found that chairside evaluation of caries risk could provide knowledge of the child's fulture dental health, and the need for saliva testing is not the only way to assess caries risk. They also found that early caries risk assessment, before caries activity starts, tended to result in good oral health care earlier in the caries process, and could be beneficial to society for public dental health care of children. However, they also mentioned that more research need to be done to improve the caries risk assessment system. Wendt LK. Carlsson E. Hallonsten AL. Birkhed D. Early dental caries risk assessment and prevention in pre-school children: evaluation of a new strategy for dental care in a field study. [Clinical Trial. Controlled Clinical Trial. Journal Article] Acta Odontologica Scandinavica. 59(5):261-6, 2001 Oct.
Carly Grothe <grot0072@umn.edu>
- Wednesday, September 29, 2004 at 11:54:38 (CDT)

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The lecture today concerning how to control dental caries in a clinical case based on diet, fluoride, oral hygeine habits and risk assessment was informative. I just came to wonder how we can predict the future caries activity of people for prevention. After all, if caries could be prevented there would be no need for caries control. The following article focused on improving caries-prevention programs. It stressed the approach of targeting at risk "groups" as opposed to at risk individuals especially when it comes to fluoride because it eliminated the costs of screening individuals. Also, it recommended multiple applications of fluoride, free toothpaste for children and more focused education at dental offices and in communities. It is important to note, as the article did, that communities and populations can change rapidly, so assessing the group in relation to these changes is needed to consistenly reassess the fluoride caries-preventive program. Hausen H.How to improve the effectiveness of caries-preventive programs based on fluoride. Caries Res. 2004 May-Jun;38(3):263-7. Review.
Gary Plotz <plot0010@umn.edu>
- Wednesday, September 29, 2004 at 11:25:11 (CDT)

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Just as we educated dental students would expect this study showed that remineralization occurs throughout the depth of the lesion and that more remineralization was achieved with the toothpaste and gel as compared to the gel alone. The aim of this in situ experiment was to determine the maximum amount of enamel remineralisation that can be achieved with daily applications of very high concentrations of fluoride. For this purpose they compared a daily application of fluoridated topical gel in combination with a fluoridated toothpaste with fluoridated toothpaste alone. The mineral content profiles showed remineralisation of the lesions throughout the depth of the lesion. The enhancement of remineralisation by the high amounts of fluoride was most pronounced in the surface layer. Similarliy, there was an increase in remineralisation and higher fluoride concentrations in the toothpaste + gel group compared to the toothpaste-only group. Remineralisation of enamel lesions with daily applications of a high-concentration fluoride gel and a fluoridated toothpaste: an in situ study. Caries Research. 36(4):270-4, 2002 Jul-Aug.
Mesa Ulwelling <ulwe0007@umn.edu>
- Wednesday, September 29, 2004 at 11:14:47 (CDT)

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The paper I read looked at the effectiveness of Xylitol lozenges on plaque pH in patients with orthodontic appliances. The study showed a marked increase in the plaque pH with the use of Xylitol after sucrose exposure compared to those without Xylitol. Given that ortho patients have difficulty with plaque removel, Xylitol can be a helpful adjuct to their oral hygeine regiment. Angle Orthod. 2004 Apr;74(2):240-4
Paul Kocian <koci0005@umn.edu>
- Wednesday, September 29, 2004 at 11:09:20 (CDT)

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In a meta-analysis of recent clinical studies on the caries-preventive and therapeutic effects of sugar alcohols used in chewing gum, Van Loveren (2004) noted that a number of clinical trials claim greater caries reduction from chewing xylitol-sweetened gum than from sorbitol-sweetened gum. However, in 2 of the 4 clinical studies he reviewed, the superiority of xylitol for its caries-preventive effect was not confirmed. The key, Van Loveren (2004) concluded, was that chewing sugar-free gum, no matter the sugar alcohol type it contains, 3 or more times daily for prolonged periods of time may reduce the incidence of caries, because these gums primarily therapeutically function to stimulate salivary flow. However, this does not mean that the potential antimicrobial effect of the gums can be discounted. Van Loveren's (2004) study seems to indicate that more studies are needed to bolster (or debunk) claims for the therapeutic anti-caries superiority of xylitol over other sugar alcohols in chewing gum. Van Loveren C. 2004. Sugar alcohols: what is the evidence for caries-preventive and caries-therapeutic effects? Caries Res. 38(3):286-93. Keyword: xylitol - chewing - gum
Lipschultz, Joshua G. <lips0033@umn.edu>
- Wednesday, September 29, 2004 at 10:13:43 (CDT)

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I read this and thought that it made a lot of sense. In daycare centers children are not able to brush their teeth due to the possibility of spreading disease during unsupervised brushing. There are field studies being conducted to demonstrate the caries-preventive effect of xylitol chewing gum used in the daycare setting to replace tooth brushing when it comes to oral hygiene. The studies seemed to be slightly challenged in that it was hard to get a group of children that were going to stay in the same daycare long term due to changes in workplace, periods of unemployment, the birth of other children in the family, etc. However, the groups that used the xylitol gum did show a small difference in their oral hygiene than the control groups. The use of xylitol can therefore be recommended, especially if the personnel do not have the possibility to supervise the brushing. Acta Odontol Scand. 2003 Dec;61(6):367-70.
Sara Palokangas <palo0030@umn.edu>
- Wednesday, September 29, 2004 at 10:10:46 (CDT)

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Today's lecture pointed out the importance of caries risk assessment and the risk factors involved in dental caries. In today's world, it is interesting to note how much sugar is being consumed and the effect that this may have on dental caries. Although not so with the entire population, diet and nutrition has a synergistic effect with oral health and disease within an individual. The article I found discussed this topic; the prerequisites for dental caries are more complex now, however, fermentable carbohydrates (or something for the bacteria to feed on) are still a part of the cause of dental caries. Diet and nutrition interfere with the balance of the actions of demineralization and remineralization on tooth structure by altering pH. Healthy People 2010 desire a further reduction in dental caries; through education and prevention and fluoridation this could occur. The US Food Guide Pyramid promotes a diet that includes whole grains, fruits, vegetables and the like. These foods, however, contain fermentable carbohydrates either naturally or through processing. Even though foods we eat are inevitably going to contain fermentable carbohydrates, the choice of foods (food form and consistency), the amount of oral clearance we have, the frequency of consumption, and the acid content of the food are all things that each individual can assess. This can then, hopefully, make a wise choice in possibly altering a diet that is full of the wrong kinds of foods. The importance of this matter is that we need to educate our patients that there must be a balance between proper oral hygiene, preventative measures, and a moderation in certain food items. Touger-Decker, Riva and Loveren, Corven. Sugars and dental caries. American Journal of Clinical Nutrition, Vol.78, No.4, 881-892, Oct.2003.
Christy Bulman <holu0021@umn.edu>
- Wednesday, September 29, 2004 at 10:09:11 (CDT)

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Dr. Hidlebrandt discussed xylitol chewing gum in lecture today. Studies have demonstrated that xylitol chewing gum is noncariogenic and anticariogenic. In this study, differing concentrations of xylitol were used to see what concentration is required to inhibit the growth of 3 strains of oral streptococcus. All three strains (S. mutans, S. salivarius, and S. sanguis) show significant inhibition at concentrations of 12.5% or higher. The authors found that only S. mutans was inhibited at a xylitol concentration of 1.56%. In vitro testing of xylitol as an anticariogenic agent. Gen Dent. 2002 Jul-Aug;50(4):340-3.
petr0212@umn.edu <Joey Petrino>
- Wednesday, September 29, 2004 at 10:05:11 (CDT)

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After Dr. Hildebrandt's lecture on risk assessment, I decided to look further into the assessment of young children. I found a studying looking at pre-school children."The present results indicate that in 2-year-old children, the combination of two or three risk indicators (MS strip, incipient caries lesions, and use of candies) might have caries-predictive power enough for clinical implications."Pienihakkinen K, Jokela J, Alanen P.Assessment of caries risk in preschool children. Caries Res. 2004 Mar-Apr;38(2):156-62. Related Articles, Links
Breynne Fordahl <ford0107@umn.edu>
- Wednesday, September 29, 2004 at 09:44:26 (CDT)

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In Dr. Hildebrandt's lecture the topic of xylitol was discussed. In a recent article, many sugar-alcochols were tested against each in an effort to determine which "sugar-free" gum is most beneficial. This study stems from the idea that xylitol has been deemed superior. This paper examines clinical studies on the caries-preventive and therapeutic effects of sugar alcohols, emphasizing sorbitol and xylitol. It was concluded that chewing sugar-free gum 3 or more times daily for prolonged periods of time may reduce caries incidence, however, this study noted that any sugar-alcohol could provide these results. The article claims that xylitol irrespective of the type of sugar alcohol used and that there is no evidence for a caries-therapeutic effect of xylitol. The problem with the study is that xylitol was only tested in 4 trials, two of which it failed. I believe a broader study with more randomized trials is required to make any claim regarding xylitol (good or bad). The positive aspect of this study is that is evidence that sugar-free gum can help reduce the possibility of dental caries if it is used for the proper amount of time. Though strep mutans can still survive on other sugar alcohols, this study did not find superior effects with xylitol, which is not metabolized by s. mutans Reference: Loveren, C. "What Is the Evidence for Caries-Preventive and Caries-Therapeutic Effects?" Caries Research 2004;38:286-293.
Andrew Pearson <pear0235@umn.edu>
- Wednesday, September 29, 2004 at 09:24:50 (CDT)

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when studying biofilms intraorally, one must consider the location, and it's tendency to accumulate plaque. it has been showed in this study that buccal surfaces of teeth seem to accumulate the most, especially in the maxillary teeth. there were no measurements of plaque accumulation on the lingual of the the mandibular teeth. (Impact of the intraoral location on the rate of biofilm growth; clinical oral investigations. 8(2):97-101,2004 Jun.)
rian suihkonen <suih0002@umn.edu>
- Friday, September 10, 2004 at 10:40:35 (CDT)

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As far as dental caries detection goes, I found a research artical that comparied senior dental students with senior dental hygiene students. It stated that no significant differance could be found in detecting carious lesions with bite wing radiograph evaluation only. To no surprize, the paper showed that the accuracey of detection is mainly dependent on the depth of the lesion. Obviously, the specificity and sensitivity accuracey of carries detection varries greatly when no cavitation has occured. As Dr. Zidan pointed out, treating the symptoms is not enough. But it is difficult when you can not detect the disease. "Radiographic Detection of Approximal Caries" Wojtowicz, P. The Journal of Dental Hygiene Vol 77 Issue IV Fall 2003
Eric Scotland <scot0223@umn.edu>
- Friday, September 10, 2004 at 10:18:18 (CDT)

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