Cariostatic Agents Research Articles

Serum vitamin D level and female teenage caries experience: a cross-sectional study in Iran

Aims: This study aimed to assess Serum Vitamin D level and female teenage caries experience. Methods: This study evaluated 330 healthy female Iranian students between 13 to 19 years residing in Rey city. A questionnaire collected their demographic information. They underwent clinical dental examination to determine the number of decayed (D), missing (M) and filled (F) teeth (DMFT index). The nutritional status was evaluated using the food frequency questionnaire(FFQ) by assessing the consumption of cariostatic, cariogenic, remineralizing, sticky foods and carbohydrates. The serum samples were collected to measure the serum vitamin D level using high-performance liquid chromatography(HPLC). Data were analyzed by multiple logistic regression and independent samples t-test. Results: The mean DMFT was 5.34±3.94. Of all, 69.3% had severe vitamin D deficiency, 20.3% had moderate vitamin D deficiency and 10.4% had normal level of vitamin D. Cariostatic agents consumption had a significant inverse correlation with DMFT (P=0.006). An increase in serum level of vitamin D by more than 10.27 ng/mL was associated with a reduction in prevalence of dental caries by 22%. Increased consumption of cariostatic agents by more than 89.30 g/day decreased the prevalence of dental caries by 32%. No significant association was noted between the prevalence of dental caries and level of parent’s education, consanguinity of parents, level of income, place of residence, frequency of tooth brushing, dental flossing, and dental visits (P>0.05). Conclusions: While the serum vitamin D level had no significant effect on DMFT, the nutritional regimen seemed to play a more important role in caries control.

Evaluation of the cytotoxicity of new formulations of cariostatic agents containing nano silver fluoride: an in vitro study.

The objective of the study was to assess the indirect cytotoxicity of 600ppm and 1500ppm nano silver fluoride (NSF) compared to other commercial cariostatic agents. 56 dentin discs with 0.4mm in thickness were obtained from intact human molars and adapted to artificial pulp chambers (APCs). The discs were divided into seven groups according to treatment (n = 8): no treatment (positive control-PC), 29% hydrogen peroxide (negative control-NC), 30% Cariestop (CS30), 38% Riva Star (RS38), 38% Advantage Arrest (AA38), 600ppm NSF (NSF600), and 1500ppm NSF (NSF1500). The cariostatic agents were applied on the occlusal surface of the dentin discs (facing upward), and the pulp surface (facing downward) remained in contact with the culture medium. Immediately after the treatments, the extracts (DMEM + cariostatic agent components diffused through the discs) were collected and applied to MDPC-23 cells, which were assessed for viability (CV-alamarBlue, live/dead), adhesion/spreading (F-actin), alkaline phosphatase (ALP) activity, and mineralization nodule (MN) formation. The data were statistically analyzed by ANOVA/Games-Howell (p = 0.05). CV and ALP activity in CS30, RS38, AA38, and NSF600 were similar to PC (p > 0.05). MN formation significantly decreased only in NC, CS30, RS38, and AA38 compared to PC (p < 0.001). Only NSF600 and NSF1500 did not differ from PC (p > 0.05) with mineralization nodules, and this specific cell activity significantly decreased in all other groups (p < 0.05). NSF solutions (600ppm and 1500ppm) did not cause transdentinal toxicity on MDPC-23 cells.

Bibliometric Analysis of Clinical Trials on the Effect of Sugar Alcohol Consumption on Oral Health: Trends, Insights, and Future Directions (1967-2024).

In recent years, the quest for healthier alternatives to sugar has led to the widespread use of sugar alcohol in various food and beverage products. Sugar alcohols, such as xylitol, sorbitol, and erythritol, are popular substitutes due to their sweet taste and lower calorie content than sucrose. Beyond their role in calorie reduction, sugar alcohols have garnered attention for their potential impact on oral health. The bibliometric analysis of clinical trials on sugar alcohol and oral health in PubMed reveals a dynamic and multifaceted research landscape shaped by various factors. Fluctuations in publication rates over time suggest influences such as shifts in research interests, technological advancements, regulatory changes, and evolving consumer behaviors. Key authors like Makinen KK, Makinen PL, and Soderling E emerge as prolific contributors with collaborative solid networks within the research community. The University of Turku in Finland has been identified as the highest contributing university, while Caries Research is the most contributing journal based on the number of clinical trials published. The country-wise analysis highlights Italy and the United States as substantial contributors, with diverse trajectories of research activity observed across nations. The subject-specific words with the highest cooccurrence are xylitol, dental caries, chewing gum, Streptococcus mutans, and saliva. Thematic analysis dives deep into how sugar alcohols relate to oral health, using different methods to study their effectiveness, safety, and how they affect the oral microbiome. The analysis of topic trends indicates ongoing exploration of sorbitol and xylitol, with an increasing emphasis on the potential advantages of xylitol. Additionally, there is notable attention on cariostatic agents, strategies for dental caries prevention, and the emergence of novel research domains like probiotics and erythritol, showcasing the dynamic evolution of oral health research focuses and developments. Overall, this analysis provides valuable insights into the distribution and trends of clinical trial publications, contributing to a nuanced understanding of the research landscape in sugar alcohol and oral health.

Amelioration Strategies for Silver Diamine Fluoride: Moving from Black to White.

Topical cariostatic agents have become a reasonable alternative for managing dental caries in young children. Silver diamine fluoride (SDF) is a practical topical approach to arrest caries and avoid extensive and risky dental treatment. However, the literature demonstrates a parental hesitation towards accepting SDF because of black unaesthetic tooth discolouration following application. The rapid oxidation of ionic silver darkens demineralised tooth structure permanently. In this regard, nano-metallic antimicrobials could augment or substitute for silver, and thereby enhance SDF aesthetic performance. Recently, biomedical research has drawn attention to selenium nanoparticles (SeNPs) due to their antimicrobial, antioxidant, and antiviral potencies. Various in vitro studies have examined the effect of SeNPs on the virulence of bacteria. This narrative review explores practical issues when using SDF and suggests future directions to develop it, focusing on antimicrobial metals. Several methods are described that could be followed to reduce the discolouration concern, including the use of nanoparticles of silver, of silver fluoride, or of selenium or other metals with antimicrobial actions. There could also be value in using remineralising agents other than fluoride, such as NPs of hydroxyapatite. There could be variations made to formulations in order to lower the levels of silver and fluoride in the SDF or even to replace one or both of the silver and fluoride components completely. Moreover, since oxidation processes appear central to the chemistry of the staining, adding SeNPs which have antioxidant actions could have an anti-staining benefit; SeNPs could be used for their antimicrobial actions as well. Future research should address the topic of selenium chemistry to optimise how SeNPs would be used with or in place of ionic silver. Incorporating other antimicrobial metals as nanoparticles should also be explored, taking into account the optimal physicochemical parameters for each of these.

Propolis and Diet Rich in Polyphenols as Cariostatic Agents Reducing Accumulation of Dental Plaque.

Conducted studies indicate the relationship between oral health and systemic diseases. Moreover, the latest research indicated that cariogenic bacteria may severely influence the course of SARS-CoV-2 infection and increase risk of COVID-19 complications. This article aims to review various applications of propolis and pay attention to a healthy diet rich in polyphenols, which may allow the reduction of dental plaque accumulation. A literature review has been conducted from June until November 2021. It showed that propolis could be a useful agent in decreasing the accumulation of dental plaque. Moreover, a diet rich in polyphenols prevents cariogenic bacteria and reduces the accumulation of dental plaque. A reduction of a dental plaque may influence the risk of a severe course of COVID-19. Therefore, propolis and a diet rich in polyphenols may play an important role in prophylaxis of systemic diseases. Recently, it has been proven that oral infection may affect cardiovascular system, musculoskeletal system, respiratory system, nervous system, as well as may be a risk factor for diabetes mellitus. These aspects should stimulate clinicians to further research about polyphenols.

In Vivo Evaluation of Micronucleus Frequencies in Buccal Mucosal Cells of Orthodontic Patients with and Without Fluoride Use

Introduction: Fluoride agents to prevent white spot lesions are used often during orthodontic treatment. The beneficial effects of fluoride, when consumed within permissible limits on dental structures, are well known. Their implications on underlying biological tissues, however, are unknown. Mouthwashes and dentifrices with fluorides are associated with metal ion release into the mouth with possible cell genotoxicity. Since these cariostatic agents are frequently used during orthodontic therapy, a deeper understanding of the effects of fluoride on oral tissues was considered necessary. Methodology: Three groups of patients (30 each)—group 1 (untreated controls), group 2 (non-fluoridated), and group 3 (Fluoridated) were analyzed. Patients in groups 2 and 3 were bonded with the same bracket prescription and treated with similar archwire sequences. Buccal mucosal cells at 4 specific time periods (before treatment, 1 week, 30 days, and 6 months) were collected, using a wooden tongue depressor, and assessed for any nuclear abnormalities. Comparisons of changes were made with an untreated control group and also between the non-fluoridated and fluoridated groups. Relevant conclusions were drawn after analysis of the results. Results: Greater number of nuclei were observed at the 30-day time interval in the fluoridated group, which was statistically significant at P &lt; .001. Conclusion: Use of fluoridated oral hygiene products in patients undergoing fixed orthodontic treatment with NiTi archwires could increase the risk of micronuclei formation in buccal mucosal cells.

Inhibitory effects of sodium new houttuyfonate on growth and biofilm formation of Streptococcus mutans

The present study aimed to assess the impact of sodium new houttuyfonate (SNH) on growth and biofilm formation of Streptococcus mutans, and the combinatorial effects of SNH with cariostatic agents. The effects of SNH on S. mutans planktonic cultures were assessed by growth curve assay. The effects of SNH on S. mutans biofilm and extracellular polysaccharides (EPS) production were observed via crystal violet (CV) assay, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, colony-forming unit (CFU) counting assay, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). Quantitative real-time polymerase chain reaction (qPCR) was applied to investigate the regulatory effects of SNH on the expression of virulence genes of S. mutans. Checkerboard microdilution assay was performed to investigate the combinatorial effects of SNH with two common cariostatic agents. SNH acted as an inhibitor on planktonic cell growth, biofilm formation and EPS production of S. mutans. SNH also downregulated the expression of gtfBCD and comDE systems and exhibited synergism with chlorhexidine (CHX). In conclusion, this study indicated a possibility for SNH to become an anticaries agents by its antimicrobial activity and synergistic effects with CHX against S. mutans.

Effect of application time and concentration of silver diamine fluoride on the enamel remineralization.

BackgroundSilver diamine fluoride has attracted attention because of its clinical success in arresting dental caries. Thus, the aim of this study was to evaluate the effect of different application times and concentrations of silver diamine fluoride (SDF) on deciduous tooth enamel remineralization. Material and MethodsBlocks of deciduous tooth enamel were categorized into six groups of 11 each: 2 control groups: intact enamel, and demineralized enamel; 38% SDF and 30% SDF which were subdivided according to application times (1 and 3 min). The microhardness of samples was determined, and all groups except the intact enamel group were subjected to pH cycling to produce initial carious lesions. The 38% and 30% SDF solutions were applied to the enamel for 1 or 3 min. After pH cycling and SDF treatments, the microhardness was again determined. Samples were sectioned to evaluate the cross-sectional microhardness. Furthermore, internal porosity of the samples was examined using micro-CT. Data were statistically analyzed by analysis of variance followed by Tukey’s test, and linear regression analyses were performed. ResultsThere was no difference in enamel remineralization based on surface and cross-sectional microhardness. The 30% SDF solution applied for 3 min promoted significantly less pores than the other groups. ConclusionsThe 1-min application time promoted enamel remineralization regardless of the SDF concentration (30% or 38%). Key words:Cariostatic agents, dental caries, primary tooth, tooth remineralization.

Comparison of staining potential of silver diamine fluoride versus silver diamine fluoride and potassium iodide under tooth-colored restorations: An in vitro study.

Silver diamine fluoride (SDF) is one of the effectual cariostatic agents widely used in minimal intervention dentistry. However, the major drawback of SDF is dark staining after its application. In the present study, the staining of 38% SDF alone and 38% SDF and potassium iodide (KI) was compared after restoration with glass-ionomer cement (GIC) and resin composite using ImageJ software. Forty extracted carious primary teeth were sorted into four groups. In Group I and II, SDF was applied and restored with GIC and composite restorations, respectively. In Group III and IV, SDF application was followed by KI and restored with GIC and composite restorations, respectively. Images were captured after initial applications on day 1 and day 14 after restoration. The captured images were imported to ImageJ software and mean gray values were calculated. The mean gray values obtained were subjected to statistical analysis using paired t-test and independent sample t-test. There was statistically significant if P < 0.05. Following the application of SDF and RIVA STAR, the baseline mean gray values showed no statistical significance. On day 1, the mean gray values were highest in Group IV (208.30) and lowest in Group I (178.51). Similarly, on day 14, the highest mean gray values were observed in Group IV (208.45) and lowest in Group I (147.6) which were statistically significant. The restorations after SDF application attained dark stain eventually, whereas with the application of SDF followed by KI (RIVA STAR), the restorations showed the least staining.

Prevention of enamel demineralization around orthodontic brackets – An in vitro study

Introduction: Despite extensive research in various preventive technologies over the years, white spot lesion (WSL) development in association with orthodontic treatment with fixed appliances remains an unwanted clinical problem. Materials and Methods: This study was conducted to compare the efficacy of various cariostatic products available commercially that would help in prevention of white spot lesions. Total 120 healthy extracted premolars were taken and divided into a sample of four groups. GC Tooth Mousse, Clin pro and Anticay were compared for their protective efficiency. Three test groups had three different topical agents applied and the fourth group acted as a control. After the test materials were applied they were subjected to pH cycling using artificial saliva with a pH of 4.5 that acted as a demineralization agent and fluorescence was assessed using spectroscopy. Results: One way Anova and Student‘t’ test revealed the efficacy of all the three materials as cariostatic agents, GC Tooth Mousse and Anticay were revealed to have the best protective efficiency. Conclusion: GC Tooth Mousse and Anticay can be used by the orthodontic patients as an in home application product for the prevention of development of white spot lesions. Keywords: White spot lesions, Spectroscopy, Artificial Saliva, CPP-ACP, CaSP.

REVIEW ON ROLE OF METAL SALT IN THE RE-MINERALIZATION OF DENTAL CARIES

Dental caries is a most common disease that affects large number of people. It is a worldwide public health problem, affecting numerous urban and rural communities. White-spot lesions (WSL) are the earliest macroscopic evidence of enamel caries. Typically, the enamel surface layer stays intact during subsurface demineralization, but, without treatment, will eventually collapse into a full cavity. Near-neutral pH of saliva is endowed with a natural buffering capacity. Natural demineralization of tooth at an early stage is reversed by saliva, which contains calcium ions, phosphate ions, buffering agents, fluoride, and other substances. The strategy for aided remineralisation is to have ions directly delivered to where and when they are needed the most. Several mechanisms are available for aided remineralisation. The most well known is the delivery of topical and systemic fluoride, which has been proven to be a highly effective measure for prevention of caries. However limitations and risks associated with the use of fluoride as a remineralising agent fuelled the need to develop newer non-toxic techniques that deliver calcium and phosphate ions directly into subsurface lesion and/or boost remineralising properties of saliva. Encouraging microscopic changes in the demineralized enamel surface following the treatment with different concentration of metal salts, involving zinc, strontium, magnesium, in addition to stannous fluoride, many metal salts are in use for the treatment of dental caries. Microscopic examination was conducted on teeth samples before and after pH-cycling procedure and following the treatment with the selected metal salt under polarized microscope (100X). The best obvious remineralisation was found following treatment with stannous fluoride, followed by zinc chloride. The stannous fluoride was the best in the remineralisation of initial caries, results for other metals seem to be promising if used for prevention of dental caries. Mineralization of teeth is determined by major inorganic elements as calcium, phosphorous in addition to other elements that occur in traces within tooth structure (Thylstrup and Fejerskov, 1996 Murry, 1996 Peter, 2004). Fluoride now a day is widely used either systemically or topically to increase resistance of teeth surface, it has been well documented as a major contributing factor in the decline of the incidence and severity of dental caries in many countries (Murry, 1996 Curzon,1999).So far fluoride has been considered to play an almost unique role in the prevention of dental caries however there is no reason to dismiss the role of other elements as being potential cariostatic agents. Different concentrations of different metal ions as zinc and copper have been tested for better effect on remineralisation in vitro (Dedhiya, et al., 1974 Fang et al., 1980). However controversy is present in the literature concerning their effectiveness in prevention of dental caries when used topically at effective concentrations (Torredo et al., 2004 Elzbieta et al., 2008 Curzon, 1983).

Silver diamine fluoride as a proactive anti-caries tool: A review

The management of ECC by the regular stereotyped restorative methods alone is incapable, particularly in a vast community or developing countries like India, where we lack free availability of dental equipment and manpower. The announcement of silver diamine fluoride (SDF) as another fluoride delivery system is a breakthrough therapy with evidences of caries lesion arrest rates of about 70 percent. SDF presents as an advantageous modality and is favoured as a satisfactory interim treatment option for its less invasive nature and its inexpensiveness. Most of the researchers have reported SDF to be undeniably more potent cariostatic agent than the fluoride varnishes in arresting caries. Its anti -caries effectiveness was found to be alike on incipient dental caries, non-cavitated and cavitated lesions and no severe pulpal damage after SDF application has been reported. Hence it is justified to state that SDF is a competent, efficient, secure and a reasonable caries preventive tool which is time saving and also patient oriented. Keywords: Silver diamine fluoride (SDF), Cariostatic agents, Fluoride delivery systems, Early childhood caries (ECC), Caries prevention, Fluoride varnishes.

Dentin Staining Caused by Nano-silver Fluoride: A Comparative Study.

The new formulations of nano-silver fluoride caused less dentin staining than the already available commercial agents 35% silver fluoride and silver diamine fluoride at 30% and 38%. The objective of this study was to evaluate the dentin staining potential of nano-silver fluoride (NSF 600 and 1500 ppm) compared with the following commercially available cariostatic agents: Advantage Arrest (Elevate Oral Care, West Palm Beach, FL, USA), Riva Star (SDI, Victoria, Australia), and Cariestop (Biodinâmica, Paraná, Brazil). Seventy-five extracted human molars were sectioned at the cementoenamel junction, and the occlusal enamel was removed for exposure of coronary dentin. The samples were divided among the five agents tested (n=15). The dentin staining (ΔE/ΔL) was analyzed with a digital spectrophotometer (VITA Easyshade, VITA Zahnfabrik, Bad Säckingen, Germany) at three different time points (before application, after two weeks, and after four weeks). Photographic images were also performed. The Kruskal-Wallis and Mann-Whitney tests compared the mean ΔE and ΔL values between groups. The NSF 600 and 1500 ppm resulted in the smallest color change (ΔE=1.02 and 1.53) and dentin staining after four weeks (ΔL=-0.76 and -1.2). The new formulations differed significantly from the commercial cariostatic agents (p<0.001). NSF might be an alternative to silver diamine fluoride since it does not compromise esthetics.

Cytotoxicity of the Ingredients of Commonly Used Toothpastes and Mouthwashes on Human Gingival Fibroblasts.

Objectives:Toothpastes and mouthwashes contain ingredients that may be toxic for oral mucosal tissues. This study aimed to assess the cytotoxicity of the ingredients of commonly used toothpastes and mouthwashes.Materials and Methods:This experimental study was performed on 16 toothpastes and four mouthwashes widely available in the Iranian market. First, the concentration of six main ingredients of these products, namely sodium fluoride (NaF), sodium lauryl sulfate, cocamidopropyl betaine, zinc lactate, paraben, and sodium benzoate, was determined. The methyl thiazolyl tetrazolium (MTT) assay was used to assess the cytotoxicity of these materials for human gingival fibroblasts (HGFs). The MTT assay was performed at 1, 15, and 30 minutes following exposure to five concentrations of each material in triplicate (according to the concentrations obtained in the isolation step). Data were analyzed using three-way analysis of variance (ANOVA).Results:The difference in the cytotoxicity of the materials was statistically significant (P<0.001). Cytotoxicity was time- and concentration-dependent; by an increase in the concentration of the materials, their cytotoxicity increased over time. The cytotoxicity of sodium lauryl sulfate and cocamidopropyl betaine was >90%. The cytotoxicity of NaF varied from 25% to 70%, and the cytotoxicity of all concentrations of zinc lactate and sodium benzoate was <50% for HGFs.Conclusion:To decrease the cytotoxic effects of toothpastes, sodium lauryl sulfate and cocamidopropyl betaine should be replaced with safer detergents, and the concentration of fluoride should be decreased to 400 parts per million (ppm). Alternatively, fluoride may be replaced with other antibacterial and cariostatic agents.

In Vitro Evaluation of the Remineralizing Potential and Antimicrobial Activity of a Cariostatic Agent with Silver Nanoparticles.

Cariostatic treatment has been shown to successfully arrest caries. However, it blackens the carious tooth structure. This study evaluated the effects of an experimental cariostatic agent with silver nanoparticles (Ag-Nano) using microhardness (MH) and microbiological tests. The cariostatic agents tested were: Saforide®, Cariestop®, Ancarie® and Ag-Nano. Sixty-six samples from deciduous enamel were submitted to initial (after pH cycling to obtain initial caries-like lesion) and final (after cariostatic application) MH testing and %MH values were calculated. After longitudinal sectioning, internal (I) MH was evaluated. Strains of Streptococcus mutans, Escherichia coli, and Enterococcus faecalis in brain-heart infusion culture were treated with the cariostatic agents. Agar diffusion tests (ADTs) were performed and minimum inhibitory concentrations were determined. The statistical tests used were: Kruskal-Wallis and Dunn (%MD; ADT; MIC) and ANOVA followed by Tukey's test (I-MH) (p<0.05). The %MH of Saforide® was significantly greater than that of Ag-Nano (p<0.05). Internal MH showed progressive improvement in the enamel remineralization for all cariostatic tested. In ADTs showed greater inhibition of S. mutans, E. faecalis, and E. coli by Saforide® than by Ancarie® and Ag-Nano. Ag-Nano was able to inhibit 100% microorganism growth at a lower concentration than required for the other agents. It was concluded that Ag-Nano treatment promoted remineralization of deciduous tooth enamel with initial caries-like lesion and bactericidal activity.

Liquorice root extracts as potent cariostatic agents in pediatric practice

The present study was designed to evaluate the in vitro as well as in vivo cariostatic efficacy of aqueous and ethanolic extracts of liquorice and assess their acceptability among child patients. Minimum bactericidal concentrations of aqueous and ethanolic extracts of liquorice against mutans streptococci were evaluated and their toxicity profiles were tested using the model organism Caenorhabditis elegans. The clinical trial was conducted as a double-blind pilot study where pediatric patients (N = 60), aged 7-14 years, were equally divided by randomization into three groups, namely, Group 1 using aqueous liquorice mouthwash (15%), Group 2 using ethanolic liquorice mouthwash (3.75%), and Group 3 using chlorhexidine gluconate (0.156%) as positive control. A baseline pre-rinse and three post-rinse saliva samples were evaluated for the changes in pH and mutans streptococci colony counts. Palatability of liquorice extracts was assessed through a self-designed questionnaire having structured categorical responses. Parametric evaluations were done using Analysis of Variance (ANOVA) and Dunnett's "t" test. The mean mutans streptococci colony counts in all three groups decreased significantly (P < 0.001) immediately after the oral rinsing. The reduction in colony counts was significant in ethanolic liquorice group as compared to the control (P < 0.01). Liquorice extracts also led to an immediate rise in salivary pH. The results showed an immediate antimicrobial action of liquorice extracts, with limited retentivity. The study affirms that both aqueous and ethanolic liquorice extracts are potent cariostatic agents and are found to be palatable by child patients.

Combinations of phosphates as cariostatic agents.

Combinations of phosphates as cariostatic agents.

A comparison of selected evidence reviews and recommendations on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries

Medical Subject Headings (MeSH): cariostatic agents, community dentistry, community health planning, community health services, decision making, dental caries, evidencebased medicine, facial injuries, fluoridation, intervention studies, meta-analysis, mouth protectors, oral health, pharyngeal neoplasms, pit and fissure sealants, practice guidelines, preventive dentistry, preventive health services, public health dentistry, public health practice, review literature, tooth injuries

Oral hygiene measures and promotion: review and considerations.

Current mechanical and chemotherapeutic approaches to oral hygiene aim to modify the oral microflora to promote healthy periodontal and dental tissues. Current oral hygiene measures, appropriately used and in conjunction with regular professional care, are capable of virtually preventing caries and most periodontal disease and maintaining oral health. Toothbrushing and flossing are most commonly used, although interdental brushes and wooden sticks can offer advantages in periodontally involved dentitions. Chewing sugar-free gums as a salivary stimulant is a promising caries-preventive measure. Despite new products and design modifications, mechanical measures require manual dexterity and cognitive ability. Chemotherapeutic supplementation of mechanical measures using dentifrices, mouthrinses, gels and chewing gums as delivery vehicles can improve oral hygiene. The list includes anticalculus, antibacterial and cariostatic agents. For the population at large to make effective use of these oral hygiene measures, oral hygiene promotion needs to be implemented. Considerations include the role of parents, school and the media for children and the workplace, social environments. nursing homes and trained carers for adults and the elderly. Community oral hygiene promotion must attempt to maximise opportunities for oral health for all and reduce inequalities by removing financial and other barriers. Oral health approaches should be tailored to lifestyles and abilities of children, adults and the elderly in order to enable them to make decisions to improve personal oral hygiene and oral health.

Release of cariostatic agents from a new buffering fluoride- and xylitol-containing lozenge to human whole saliva in vivo.

A new buffering lozenge (sucking tablet) was developed for patients susceptible to dental caries and erosion, in particular for those with reduced salivary secretion. As active ingredients this lozenge comprises of a combination of xylitol, fluoride, calcium, phosphate, zinc and buffering compounds. To test the lozenge's activity in vivo, the release of ingredients was monitored in 19 healthy subjects for 22 min after sucking the lozenge was completed. In subjects with a normal salivary secretion rate the lozenge caused only a slight stimulation of saliva flow, but a significant elevation both in salivary pH and buffer effect was observed. Furthermore, fluoride, calcium and phosphate were effectively released into whole saliva with peak values 2-4 min after use. The same salivary parameters were also quantitated after 1 month's regular use (3 lozenges/day) but no consistent long-term changes were found. Salivary mutans streptococci and total anaerobic microflora did not change significantly during the long-term use. The results show that the buffering fluoride- and xylitol-containing lozenge, which also releases calcium and phosphate, is active in vivo but its serviceability as a remineralizing agent, in particular for elderly patients with reduced salivary flow rate, has to be analysed separately.