Does caries risk assessment predict the incidence of caries for special needs patients requiring general anesthesia?

Objectives. The aim of this study was to correlate the caries-related variables of special needs patients to the incidence of new caries. Materials and methods. Data for socio-demographic information and dental and general health status were obtained from 110 patients treated under general anesthesia because of their insufficient co-operation. The Cariogram program was used for risk assessment and other caries-related variables were also analyzed. Within a defined follow-up period (16.3 ± 9.5 months), 64 patients received dental examinations to assess newly developed caries. Results. At baseline, the mean (SD) values of the DMFT (decayed, missing and filled teeth) and DT (decayed teeth) for the total patients were 9.2 (6.5) and 5.8 (5.3), respectively. During the follow-up period, new caries occurred in 48.4% of the patients and the mean value (SD) of the increased DMFT (iDMFT) was 2.1 (4.2). The patients with a higher increment of caries (iDMFT ≥3) showed significantly different caries risk profiles compared to the other patients (iDMFT <2) (p < 0.05). Close correlations existed between the caries increment and several caries-related variables; baseline DMFT, insufficient self-tooth-brushing and malocclusion were greatly associated with new caries development. Conclusions. Caries risk assessment could predict the incidence of future caries in hospital-based dentistry. Past caries experience and inadequate oral hygiene maintenance were largely related to caries development in special needs patients.     

Variation of posterior approximal caries incidence with consumption of sweets with regard to other caries-related factors in15–18-year-olds

The aim of this study was to analyze the relationships between caries incidence and a number of caries-related factors in 15-18-yr-olds, in order to estimate the explanatory value of consumption of sweets under different conditions. Sixty-nine 18-yr-olds were interviewed about consumption of sweets and other sugar-containing products during the past 3 yr. Data on oral hygiene, salivary counts of mutans streptococci and lactobacilli, salivary flow rate and oral sugar clearance time were collected when the individuals were 15 and 18 yr old. Caries incidence for the 3-yr period was expressed as a percentage of the number of caries-free approximal surfaces of premolars and molars at the age of 15. Simple linear correlations between caries incidence and the different variables showed that lactobacilli count ranked first (r = 0.26), sweets second (r = 0.25), and mutans streptococci count third (r = 0.24). The r value for caries incidence and consumption of sweets increased in subgroups with combinations of poor oral hygiene, a high intake of other sugary products and a low salivary flow rate (r = 0.67-0.70). In conclusion, consumption of sweets should still be considered an important caries-related factor and particularly harmful when oral hygiene is poor and consumption of other sugary products is high.     

Salivary biomarkers for dental caries

As a highly prevalent multifactorial disease, dental caries afflicts a large proportion of the world's population. As teeth are constantly bathed in saliva, the constituents and properties of this oral fluid play an essential role in the occurrence and progression of dental caries. Various inorganic (water and electrolytes) and organic (proteins and peptides) components may protect teeth from dental caries. This occurs via several functions, such as clearance of food debris and sugar, aggregation and elimination of microorganisms, buffering actions to neutralize acid, maintaining supersaturation with respect to tooth mineral, participation in formation of the acquired pellicle and antimicrobial defense. Modest evidence is available on the associations between dental caries and several salivary parameters, including flow rate, buffering capacity and abundance of mutans streptococci. Despite some controversial findings, the main body of the literature supports an elevated caries prevalence and/or incidence among people with a pathologically low saliva flow rate, compromised buffering capacity and early colonization or high titer of mutans streptococci in saliva. The evidence remains weak and/or inconsistent on the association between dental caries and other saliva parameters, such as other possible cariogenic species (Lactobacillus spp., Streptococcus sanguis group, Streptococcus salivarius, Actinomyces spp. and Candida albicans), diversity of saliva microbiomes, inorganic and organic constituents (electrolytes, immunoglobulins, other proteins and peptides) and some functional properties (sugar clearance rate, etc.). The complex interactions between salivary components and functions suggest that saliva has to be considered in its entirety to account for its total effects on teeth.     

Salivary antimicrobial proteins associate with age‐related changes in streptococcal composition in dental plaque

Secretion of antimicrobial proteins (AMPs) and salivary antibodies can modify biofilm formation at host body surfaces. In adolescents, associations have been reported between dental caries and salivary AMPs. AMPs demonstrate direct antimicrobial effects at high concentrations, and at lower more physiological concentrations they mediate changes in host cell defenses, which may alter the local environment and indirectly shape local biofilm formation. The expression of salivary AMPs in preschool children, at an age when the oral bacteria are known to change, has not been investigated. We sought to investigate salivary AMP expression in the context of previously well‐documented changes in the oral cavities of this age group including salivary immunoglobulin A (IgA), oral bacteria and dental caries. Dental plaque and saliva were collected from 57 children aged 12–24 months at baseline, of whom 23 children were followed‐up at 3 years of age. At each time, saliva was assessed for LL37, human neutrophil peptides 1–3, calprotectin, lactoferrin, salivary IgA, total plaque bacteria and Streptococcus mutans. Over time, concentrations of AMPs, S. mutans and bacteria‐specific salivary IgA increased. Caries experience was also recorded when children were 3 years old. Concentrations of AMPs were highest in the saliva of 3‐year‐old children with the greatest burden of S. mutans. These data suggest that salivary AMPs are variable over time and between individuals, and are linked with bacterial colonization. At follow up, the majority of children remained caries free. Larger longitudinal studies are required to confirm whether salivary AMP levels are predictive of caries and whether their modulation offers therapeutic benefit.     

Oral environmental factors affecting number of microbes in saliva of complete denture wearers

Summary The purpose of this study was to clarify which oral environmental factors affected number of microbes in saliva in an edentulous environment. We enrolled 68 edentulous subjects in the study. Numbers of total anaerobic bacteria and Candida species in saliva were determined. Age, sex, un‐stimulated salivary flow rate, pH and viscosity of saliva, histatin level in saliva, tongue coating status, tongue pressure, denture plaque status, material of denture base, duration of edentulism, frequency of self oral health care and number of cigarettes per day were also investigated as oral environmental factors. Correlation between number of total anaerobic bacteria or Candida species and each oral environmental factor was determined with the Spearman rank correlation coefficient. Stepwise logistic regression analysis was used to identify which factors were significantly associated with level of total anaerobic bacteria and Candida species. Correlation and stepwise logistic regression analyses revealed associations between un‐stimulated salivary flow rate, tongue coating status, denture plaque status or frequency of self oral health care and number of total anaerobic bacteria. The correlation analysis showed a significant correlation between age and number of total anaerobic bacteria. Stepwise logistic analysis revealed associations between pH of saliva or viscosity of saliva and level of anaerobic bacteria; it also revealed associations between histatin level in saliva or un‐stimulated salivary flow rate and level of Candida species. We conclude that salivary flow rate, in particular, affects number of salivary microbes in an edentulous environment.     

Development and validation of an instrument to assess oral health literacy in Norwegian adult dental patients

Abstract

Objective. To develop and validate an interview instrument to assess oral health literacy in Norwegian adult dental patients. Materials and methods. The instrument, Adult Health Literacy Instrument for Dentistry (AHLID), was based on an OECD instrument used to assess general literacy in adults. One hundred and thirty Norwegian adults (mean age = 48 years; 57% women) participated. AHLID included a selection of oral health-related printed texts that ranged from 1–5 with respect to difficulty. A questionnaire regarding socio-demographic variables and knowledge of risk factors for oral disease was used. DMFT, stimulated salivary flow rate and streptococcus mutans and lactobacillus in saliva was also examined. Results. The Cronbach’s alpha values of AHLID were 0.98 for internal consistency reliability (p < 0.01) and 0.81 for test–re-test reliability (p < 0.05). AHLID score 3 was most frequent while very few fulfilled the criteria for score 1 and 5. Linear multiple regression analysis showed that lactobacillus in saliva and knowledge of risk factors for periodontitis and caries were predictor variables of AHLID score. Conclusions. AHLID appears to be reliable and valid to assess oral health literacy in Norwegian adults and suggests a method for country-specific health literacy instruments.     

Influence of the microbiological component of Cariogram® for evaluating the risk of caries in children

Objective: To compare the risk for caries in children as determined by Cariogram^® software (CS; Stockholm, Sweden) with and without its microbiological component and by a form based on Cariogram^® (FBC).

Methods: Children (n?=?28) aged 3–9 years were included. Data were collected clinically and from anamnesis. The salivary levels of Streptococcus mutans (SM) were evaluated. A linear regression model was used to determine which variables were predictive for each type of risk analysis. Caries risk was the dependent variable and the independent variables were caries experience, related disease, plaque amount, diet frequency, salivary levels of SM, fluoride sources and clinical judgment. A paired Student t-test was used for the following comparisons: (a) CS with and without SM; (b) CS without SM and FBC; (c) CS with SM and FBC.

Results: The mean dmft/DMFT was 5.56?±?2.51. There was no difference between the methods (p?p?=?.889). Caries experience, plaque amount, diet frequency and fluoride sources were predictors of caries risk in all assessment methods. Clinical judgment was a significant predictor in CS.

Conclusions: Caries experience, plaque amount, diet frequency and fluoride sources are valuable predictors of caries risk; microbiological tests are not necessary for evaluating caries risk in children, which can be assessed similarly by CS without SM and FBC.     

Streptococcus mutans strains recovered from caries-active or caries-free individuals differ in sensitivity to host antimicrobial peptides

Antimicrobial peptides (AMPs) are among the repertoire of host innate immune defenses. In the oral cavity, several AMPs are present in saliva and have antimicrobial activities against oral bacteria, including Streptococcus mutans, a primary etiological agent of dental caries. In this study, we hypothesized that unique S. mutans strains, as determined by DNA fingerprinting from sixty 13‐year‐old subjects with or without experience of caries, would have different susceptibilities to α‐defensins‐1–3 (HNP‐1–3), β‐defensins‐2–3 (HBD‐2–3) and LL‐37. The salivary levels of these peptides in subjects were also measured by enzyme‐linked immunosorbent assays. We found that S. mutans strains from children with active caries showed greater resistance to salivary HNP‐1–2, HBD‐2–3 and LL‐37 at varying concentrations than those from caries‐free subjects. In addition, combinations of these peptides increased their antimicrobial activity against S. mutans either additively or synergistically. The salivary levels of these peptides were highly variable among subjects with no correlation to host caries experience. However, the levels of a number of these peptides in saliva appeared to be positively correlated within an individual. Our findings suggest that the relative ability of S. mutans to resist host salivary AMPs may be considered a potential virulence factor for this species such that S. mutans strains that are more resistant to these peptides may have an ecological advantage to preferentially colonize within dental plaque and increase the risk of dental caries.     

Oral sugar clearance and other caries-related factors of stimulated whole saliva in patients with secondary Sj?gren syndrome.

OBJECTIVE: To compare oral sugar clearance, salivary flow rate, buffer capacity, salivary counts of mutans streptococci and lactobacilli in whole saliva, and root caries in subjects with secondary Sj?gren syndrome with those of healthy subjects. METHOD AND MATERIALS: Twenty subjects with secondary Sj?gren syndrome and 20 healthy subjects (age 30 to 55 years; all women) rinsed their mouth with a 20% sucrose solution. Before the rinse and 2, 5, 10, and 30 minutes after the rinse, 2 paper disks were soaked with saliva, 1 under the tongue and 1 in the mandibular vestibule. The salivary sucrose concentration was determined enzymatically. The clearance time and the area under the sugar clearance curve (AUC) were calculated. RESULTS: Patients with secondary Sj?gren syndrome and with low salivary flow had longer sugar clearance times in the mandibular buccal vestibule and sublingual regions than did healthy individuals (P = .000 and P = .000, respectively). Significant differences of AUC values between the groups for the buccal and sublingual regions were also found (P = .000 and P = .003, respectively). CONCLUSION: Subjects with secondary Sj?gren syndrome had longer sugar clearance time, related to low salivary flow, high counts of cariogenic microorganisms, and decayed and filled surfaces in the root.     

The renewal of gingival epithelium in marmosets (Callithrix Jacchus) as determined through autoradiography with thymidine-H3

Abstract

Aim. To investigate selected lifestyle factors in relation to active caries and restored root surface lesions in adults. Materials and methods. Based on clinical examinations and questionnaires, data on root caries, socioeconomic status, body mass index, dietary habits, alcohol consumption, tobacco use and oral hygiene routines were collected from 4369 adults aged 21–89 who took part in a survey covering 13 municipalities across Denmark. Uni- and multivariate logistic regression analyses were applied to analyse the relationship between the independent lifestyle variables and active caries and restored root surface lesions, respectively. Results. The prevalence of active root caries was 4%, while 26% displayed restored root surfaces. The sugar intake was not related to root caries. A multivariate logistic regression analysis revealed that, in subjects aged 45 or over, smoking and wearing dentures were significantly associated with presence of active root caries (p < 0.01). The intake of 15 drinks or more per week was associated with higher odds of root surface restorations compared with no alcohol intake (OR = 1.7; p < 0.001). Conclusions. Lifestyle factors such as tobacco use and alcohol consumption, as well as wearing dentures, were significantly associated with the occurrence of untreated caries and restored root surface lesions, especially in persons over 45. Thus, such lifestyle factors should be taken into consideration, identifying persons with a need of preventive dental services. In addition, oral health education should focus on the possible risks of smoking and a high alcohol intake.     

Maternal perception about child oral health is associated to child dental caries and to maternal self-report about oral health

Objective: To test the association between maternal perception about child’s oral health and child dental caries experience and maternal self-perception about oral health.

Materials and methods: A cross-sectional study was performed with mothers and their children aged six to 13 years. A questionnaire was applied to mothers. Children were dentally examined using the DMF-T/dmf-t Index. For analysis, Poisson regression models with robust variance were employed for each variable of interest (child dental caries experience and maternal self-report about oral health). Magnitudes of associations were estimated through Prevalence Ratio (PR) as effect measure with 95% confidence intervals (CI). A significant level of p?≤?.05 was adopted.

Results: Overall, 131 mothers-children dyads were included. Most of children were girls (52.7%) and aged between 10 to 13 years (60.3%). Negative maternal perception about child’s oral health was associated to maternal negative self-perception about oral health (PR 2.54; 95%CI 1.54–4.30) and to higher child dental caries experience (PR 2.21; 95%CI 1.41–3.47).

Conclusion: Maternal perception about child oral health was associated to child dental caries and to maternal self-report about oral health.     

Saliva viscosity as a potential risk factor for oral malodor

Objectives. The objective of this study was to assess whether saliva viscosity, measured by a viscometer, was a predictor of oral malodor. Materials and methods. The subjects were 617 patients who visited an oral malodor clinic. The organoleptic test (OT) was used for diagnosis of oral malodor. An oral examination assessed the numbers of teeth present and decayed teeth as well as the presence or absence of dentures. Further, periodontal pocket depths (PD), gingival bleeding, dental plaque and tongue coating were investigated. Unstimulated saliva were collected for 5 min. Saliva viscosity was measured with a viscometer. Logistic regression analysis with oral malodor status by OT as a dependent variable was performed. Possible confounders including age, gender, number of teeth present, number of decayed teeth, number of teeth with PD ≥ 4 mm, number of teeth with bleeding on probing, presence or absence of dentures, plaque index, area of tongue coating, saliva flow rate, saliva pH and saliva viscosity were used as independent variables. Results. Saliva viscosity (p = 0.047) along with the number of teeth with PD ≥4 mm (p = 0.001), plaque index (p = 0.037) and area of tongue coating (p < 0.001) were significant variables for oral malodor. Subjects with a higher number of teeth with PD ≥ 4 mm (OR = 1.32), plaque index (OR = 2.13), area of tongue coating (OR = 3.17) and saliva viscosity (OR = 1.10) were more likely to have oral malodor compared to those with lower values. Conclusions. The results suggested that high saliva viscosity could be a potential risk factor for oral malodor.     

High-resolution 1H NMR investigations of the oxidative consumption of salivary biomolecules by oral rinse peroxides

Abstract

Background. A multicomponent evaluation of the oxidative consumption of salivary biomolecules by a tooth-whitening oral rinse preparation has been performed using high-resolution proton (¹H) nuclear magnetic resonance spectroscopy (NMR). Methods. Unstimulated human saliva samples (n = 12) were treated with aliquots of the oral rinse tested and 600 MHz ¹H NMR spectra acquired on these samples demonstrated that hydrogen peroxide (H₂O₂) and/or peroxodisulphate (S₂O₈ ^2–) present in this product gave rise to the oxidative decarboxylation of the salivary electron-donor pyruvate (to acetate and CO₂), and also oxidized methionine (a precursor to volatile sulphur compounds responsible for oral malodour), and malodourous trimethylamine to methionine sulphoxide and trimethylamine-N-oxide, respectively (reductions observed in the salivary concentrations of each biomolecular peroxide-scavenging agent were all extremely statistically significant, p < 0.005). Results. Experiments conducted on chemical model systems confirmed the consumption of pyruvate by this product, and also revealed that the amino acids cysteine and methionine were oxidatively transformed to cystine and methionine sulphoxide, respectively. Conclusions. High-field ¹H NMR analysis provides much valuable molecular information regarding the fate of tooth-whitening oxidants in human saliva and permits an assessment of the mechanisms of action of oral healthcare products containing these agents. The biochemical and potential therapeutic significance of the results obtained are discussed.     

Salivary innate defense system in type 1 diabetes mellitus in children with mixed and permanent dentition

Abstract

Objective. It should be expected that type 1 diabetes mellitus may disturb innate and acquired immunity. There are no data on type 1 diabetes mellitus-related changes in the salivary flow and the protein output responsible for the innate immunity of saliva depending on the quality of dentition reflecting the age of child. The aim of this work was the evaluation of parameters responsible for the innate immunity of saliva in children and adolescents with type 1 diabetes mellitus. Materials and methods. In diabetic children, adolescent and healthy volunteers, the salivary flow, the output and the concentration of the activity of peroxidase (colorimetry), lysozyme (radial immunodiffusion) and lactoferrin (ELISA) were determined. Results. In children with mixed and permanent dentition, type 1 diabetes mellitus significantly decreases (as compared with the appropriate controls) the unstimulated salivary flow, the output, concentration of peroxidase and the output of the lysozyme and lactoferrin. Conclusion. In conclusion, it may be stated that type 1 diabetes mellitus causes functional changes in the salivary glands, resulting in a decrease of the salivary flow and weakening of the salivary innate defense system, thus creating a threat to the oral and general health of type 1 diabetes mellitus children. The results showed that the salivary glands of younger children, when compared to adolescents with type 1 diabetes mellitus, are more susceptible to the injurious effects of the disease.     

Sweets and other sugary products tend to be the primary etiologic factors in dental caries

The aim of this study was to analyze the relationships between caries incidence and each of seven caries-related factors in a group of 15- to 18-yr-olds as well as in single and combined subgroups representing favorable or less favorable fractions of six of the factors. Sixty-nine 18-yr-olds were interviewed about consumption of sweets and other sugar-containing products during the past 3 yr and examined for oral hygiene, salivary counts of mulans streptococci and lactobacilli, salivary flow rate and oral sugar clearance time at the ages of 15 and 18. Simple linear correlations and a stepwise multiple regression analysis were used to compare ranks and explanatory values. The highest correlations were obtained for intake of sweets and intake of other sugary products, with r values increasing from 0.25 and 0.16, respectively, in the total material to 0.70 and 0.67 in less favorable fractions of oral hygiene, salivary flow rate and other sugary products in the former case, sweets in the latter. The stepwise multiple regression analysis revealed that sweets and other sugary products contributed 12 percentage points to the total explanatory value, which was as low as 19%.     

Relation of salivary antioxidant status and cytokine levels to clinical parameters of oral health in pregnant women with diabetes

Objective

Both pregnancy and diabetes are thought to predispose to the impairment of oral health. As saliva contributes to oral homeostasis, we have characterised its properties and flow rate in pregnant women with or without diabetes.

Design

Unstimulated whole mixed saliva was collected from 63 women in the first trimester of pregnancy and analysed for the concentration of selected antioxidants, cytokines, and growth factors.

Results

Pregnant women with diabetes were found to have markedly increased indexes of caries activity, plaque formation, gingival and periodontal status, as well as increased salivary antioxidant capacity and pro-inflammatory cytokine levels. These changes were more pronounced in patients with long-term disease and systemic diabetic complications, but only partly correlated with the level of blood glycated haemoglobin. Of the cytokines examined, salivary VEGF and HGF concentrations in diabetic pregnant women correlated in a positive and negative manner, respectively, with the prevalence of caries. Moreover, VEGF levels in this group correlated inversely with the probing depth and clinical attachment levels. All such associations did not occur in healthy individuals. In contrast, the salivary pH and flow rate correlated inversely with several parameters of caries and plaque formation irrespectively of whether the pregnant women were diabetic or not.

Conclusions

Diabetes in pregnant women significantly changes saliva properties, which may contribute to accelerated deterioration of the oral status in this population.     

Dentin caries risk indicators in 1-year-olds. A two year follow-up study

Background: Early childhood caries (ECC) risk factors are suspected to vary between regions with different caries prevalence.

Aim: Identify ECC risk factors for 1-year-olds predicting dentin caries at 3 years of age in a region with low caries prevalence.

Design: Caries risk was assessed by dental hygienist or dental assistant in 779 one-year-olds. The oral mutans streptococci (MS) score was performed from a tooth surface or (in pre-dentate children) from oral mucosa. A parental questionnaire with questions regarding family factors (siblings with or without caries), general health, food habits (night meals, breastfeeding, other beverage than water), oral hygiene habits and emerged teeth were answered by parents of the 1-year-olds. Dentin caries was assessed when the children were 3-year-olds. Simple and multiple logistic regression analyses were used for identification of caries-associated factors.

Results: An increased caries risk was assessed in 4.4% of the 1-year-olds. Dentin caries was found in 2.6% of the 3-year-olds. Caries risk at 1 year was associated with caries at 3 years (OR?=?6.5, p?=?.002). Multiple regression analysis found the variables Beverages other than water (OR?=?7.1, p?Caries in sibling (OR?=?4.8, p?=?.002), High level of MS (score 2–3) (OR?=?3.4, p?=?.03) and Night meal (OR?=?3.0, p?=?.03) to be associated with caries. The single variables Beverage other than water between meals and Caries in sibling were more reliable than Caries risk assessed performed by dental personnel.

Conclusions: Behavioural, family and microbial factors are important when assessing caries risk among 1-year-olds in a region with low caries experience.     

Risk profile of adults with several dental restorations using the Cariogram model

Objective. The aims of the study were: 1) to evaluate the caries profile in a group of Saudi adults with several dental restorations by assessing various caries-related factors using the Cariogram model, and 2) to correlate the Cariogram data, expressed as “the chance of avoiding caries”, with initial caries lesions (DiS), total initial and manifest caries lesions (Di+mS), and filled surfaces (FS). Material and Methods. 175 individuals in Saudi Arabia, aged between 18 and 56 years, were included. All were interviewed about their oral health, dietary habits, and use of fluoride, and were examined for dental caries, both clinically and radiographically. Salivary and microbiological factors, including the number of mutans streptococci and lactobacilli, buffer capacity, and secretion rate, were obtained using chair-side tests. Results. The number of teeth, total Di+mMFS, Di+mS, and FS were 26.0, 53.8, 19.3, and 22.6, respectively. The mean chance of avoiding caries was 31%±19.7. The individuals were divided according to Cariogram data “the chance of avoiding caries” into four risk groups: 0–20% (n=66) “high-risk”, 21–40% (n=43) “medium-risk”, 41–60% (n=50) “low-risk”, and 61–100% (n=16) “very low-risk”. ANOVA revealed statistically significant differences between the high-risk group and the other three groups with respect to Di+mS (p<0.01) and FS (p<0.05). The mean DiS of the high-risk group differed significantly from that of the low-risk group (p<0.05). Conclusions. The Cariogram model can identify the caries-related factors that could be the reasons for the estimated future caries risk. There is a direct association between the categorized outcomes of the Cariograms and the DiS and Di+mS indices.     

Type 1 diabetes mellitus, xerostomia, and salivary flow rates

OBJECTIVE: The Oral Health Science Institute at the University of Pittsburgh has completed a cross-sectional epidemiologic study of 406 subjects with type 1 diabetes and 268 control subjects without diabetes that assessed the associations between oral health and diabetes. This report describes the prevalence of dry-mouth symptoms (xerostomia), the prevalence of hyposalivation in this population, and the possible interrelationships between salivary dysfunction and diabetic complications. STUDY DESIGN: The subjects with diabetes were participants in the Pittsburgh Epidemiology of Diabetes Complications study who were enrolled in an oral health substudy. Control subjects were spouses or best friends of participants or persons recruited from the community through advertisements in local newspapers. Assessments of salivary function included self-reported xerostomia measures and quantification of resting and stimulated whole saliva flow rates. RESULTS: Subjects with diabetes reported symptoms of dry mouth more frequently than did control subjects. Salivary flow rates were also impaired in the subjects with diabetes. Regression models of potential predictor variables were created for the 3 self-reported xerostomia measures and 4 salivary flow rate variables. Of the medical diabetic complications studied (ie, retinopathy, peripheral and autonomic neuropathy, nephropathy, and peripheral vascular disease), only neuropathy was found to be associated with xerostomia and decreased salivary flow measures. A report of dry-mouth symptoms was associated with current use of cigarettes, dysgeusia (report of a bad taste), and more frequent snacking behavior. Xerogenic medications and elevated fasting blood glucose concentrations were significantly associated with decreased salivary flow. Resting salivary flow rates less than 0.01 mL/min were associated with a slightly higher prevalence of dental caries. Subjects who reported higher levels of alcohol consumption were less likely to have lower rates of stimulated salivary flow. CONCLUSIONS: Subjects with type 1 diabetes who had developed neuropathy more often reported symptoms of dry mouth as well as symptoms of decreased salivary flow rates. Because of the importance of saliva in the maintenance and the preservation of oral health, management of oral diseases in diabetic patients should include a comprehensive evaluation of salivary function.     

Antimicrobial systems of human whole saliva in relation to dental caries, cariogenic bacteria, and gingival inflammation in young adults

The association of salivary antibody (total IgA, IgG, and IgM and antibodies reactive with Streptococcus mutans) and non-antibody (lysozyme, lactoferrin, salivary peroxidase, myeloperoxidase, hypothiocyanite, thiocyanate) defense factors with oral health (past and present dental caries, gingival bleeding, the number of salivary S. mutans and lactobacilli) were studied in 50 naval recruits. Dental caries was significantly associated with large amounts of S. mutans, lactobacilli, and total salivary immunoglobulins and with low salivary flow rate and buffer capacity. Salivary anti-S. mutans antibodies did not correlate with dental caries or S. mutans levels. Moreover, none of the salivary non-antibody factors alone had any strong relationship to dental caries or S. mutans levels. Gingival inflammation was associated with elevated levels of lysozyme in whole saliva. It is concluded that in adults the associations between single-point measurements of most salivary antimicrobial constituents and the factors describing oral health are weak.