Clinical Evidence for Polyol Efficacy

Oral health: prevention is key

Introduction. Promoting a commitment to dental caries prevention in young children plays a vital role in establishing healthy lifestyle habits that ward off dental diseases. The initial dental visit is as a cornerstone for fostering parental motivation in preventing dental issues and providing optimal conditions for the development of healthy eating habits, oral care practices, and the use of fluoride toothpaste. The foundation of dental knowledge, habits, and skills is laid within the family as children emulate adult behavior. Pediatric dentists, pediatricians, and primary healthcare personnel should serve as the primary and reliable sources of knowledge. As the determinants of dental caries are influenced by family-related risk factors, such as oral hygiene practices, the use of fluoride toothpaste, and sugar and carbohydrate consumption from an early age, parents bear the responsibility for creating an environment conducive to effective prevention. Dental professionals act as key information sources for oral health within the population and primary healthcare workers.
 Objective. This study aims to analyze the awareness of senior dental students and interns regarding the prevention of dental caries in infants and young children.
 Materials and Methods. A questionnaire was designed to assess awareness of dental caries prevention in infants and young children. The questionnaire, consisting of 13 questions with multiple answer options, was distributed to senior dental students and dental interns using an online Google form. It focused on evaluating knowledge of dental disease prevention, including the relationship between dental caries and behavioral risk factors such as nutrition, recommendations for oral care in children, and the use of fluoride-containing toothpaste.
 Results. Analysis of the questionnaire responses revealed that all participants were aware of the cariogenic nature of sugar, with 82.5% recognizing the caries-causing potential of fruit juices. However, knowledge regarding the cariogenicity of other products, such as fruits (8.8%) and dietary carbohydrates (25.4%), was limited. While the benefits of breastfeeding for a growing child are well-known, only 25.4% of senior dental students and interns recognized that prolonged, unregulated breastfeeding beyond one year contributes to early childhood caries. Moreover, 38.6% believed that bottle-feeding with milk formula can lead to tooth decay. Recommendations for feeding children from a spoon and cup after the eruption of the first milk tooth were not provided by any respondents. Only two individuals (1.8%) acknowledged that co-sleeping with the mother can pose a risk factor for childhood caries. Regarding oral hygiene recommendations for parents, only 12.3% of senior dental students and medical interns suggested the use of toothpaste and a brush, while guidance on selecting appropriate toothpaste for infants and young children was disregarded by all respondents. Additionally, the quantity of toothpaste to be applied and the age at which children should start brushing their teeth were not considered, with 53.5% of respondents believing that brushing with a toothbrush alone is sufficient.
 Conclusion. The survey exposed insufficient knowledge among senior dental students and medical interns regarding risk factors and evidence-based methods for preventing dental caries in infants and young children.

The aim of this study was to evaluate the effect of maternal use of chewing gums containing combinations of xylitol, sorbitol, chlorhexidine, and fluoride on salivary mutans streptococci (MS) counts and caries prevalence in the mothers' 3-year-old children. After screening 416 women with newborn babies, 173 mothers with high counts of salivary MS were randomly assigned into 3 experimental chewing gum groups containing (A) xylitol (n=61), (B) chlorhexidine/xylitol/sorbitol (n=55), and (C) sodium fluoride/xylitol/sorbitol (n=57). Mothers with low or medium MS counts formed a reference group (D) without any intervention (n=232). The participants in the experimental groups were instructed to chew one piece of the gum for 5 min 3 times a day. The chewing regimen started when the child was 6 months old and was terminated 1 year later. The outcome measures were salivary MS counts and caries prevalence at the age of 3 years. Bacterial enumeration was carried out with a chair-side technique and caries (defs) was scored by clinical examination. Medium and high counts of salivary MS were found in 13%, 16%, and 22% in groups A, B, and C, respectively. The mean defs was 0.1 in group A, 0.2 in group B, and 0.4 in group C. The differences concerning salivary MS and caries were not statistically significant. The MS counts and caries prevalence in children of mothers with low MS counts (group D) were similar to those found in groups A and B. In conclusion, lower but non-significant levels of salivary MS and dental decay were observed in 3-year-old children to mothers who used high-content xylitol gums compared with those who used lower amounts of xylitol. The efficiency of this type of targeted intervention in a low-caries community may be questioned.

Background and objectives: The protective function of saliva against dental caries achieved through its physico-chemical properties The purpose of this comparative study was to evaluate the relationship between some risk factors such as salivary flow rate, pH, oral hygiene (plaque index), buffering capacity, salivary level of lacto bacilli, streptococcus mutans and candida, with dental caries also aimed to determining which salivary factors correlate significantly to dental caries experience in children and adolescents. Methods: In this study, salivary factors were measured in resting saliva. Resting saliva was collected to determine flow rate, pH, buffering capacity, microorganism level of lactobacilli, streptococcus mutans and candida of (400) healthy school student, (200) children (6-12) years and (200) adolescents (13-16) years in twenty schools in Erbil city of different socioeconomic status. Their teeth were examined to measure the caries experience using decay, missing, and filled teeth index (DMFT), and oral hygiene (plaque index) level using (Silness and Loe 1964) method. Results: The mean DMFT in children was (5.35), while the mean DMFT in adolescents was (5.54). The mean oral hygiene in children was scored (1.21), while the mean oral hygiene in adolescents was (1.19). The factors showing significant relation ship to dental caries in children were flow rate, pH, oral hygiene (plaque index), lactobacilli, streptococcus mutans and candida, while the salivary factors showing a significant relation ship to dental caries in adolescent were pH, oral hygiene and count of lactobacilli. Conclusion:Evidence from the current research support a central role of the salivary flow rate, pH, oral hygiene, count of salivary streptococcus mutans, lactobacilli and candida albicans in the increasing of dental caries in children. While in adolescent there was relation between dental caries and salivary pH, oral hygiene and count of lactobacilli.

Streptococcus mutans is important in dental caries. Although the role of cytokines in the pathogenesis of dental caries is not clear, components of S. mutans were found to stimulate production of pro-inflammatory cytokines. We examined the associations of interleukin (IL)-1β, IL-1 receptor antagonist (IL-1ra), and IL-10 with dental caries. Unstimulated whole saliva and blood samples were obtained from 108 children aged 6-12 years with high caries (decayed, missing, or filled teeth [dmft/DMFT] index >4, n = 37), moderate caries (dmft/DMFT = 1-4, n = 37), or caries-free (dmft/DMFT = 0, n = 34). S. mutans level was classified as low (<10(5) colony-forming units [CFU]/mL) or high (≥10(5) CFU/mL). Saliva and serum concentrations of IL-1β, IL-1ra, and IL-10 were determined by ELISA. IL-1β, IL-1ra, and IL-10 gene polymorphisms were genotyped using PCR and restriction fragment length polymorphism analysis. The chi-square, Mann-Whitney U, one-way ANOVA, posthoc, Fisher's exact, and t tests were used in statistical analysis. Dental caries was not correlated with salivary or serum concentrations of the studied cytokines. S. mutans level positively correlated with saliva IL-1β concentration and inversely correlated with saliva IL-1ra concentration. There was no correlation of IL-1β, IL-1ra, or IL-10 gene polymorphisms with dental caries. S. mutans is important in stimulating saliva IL-1β and inhibiting IL-1ra. Future studies of associations between cytokines and dental caries should investigate additional cytokines and enroll a larger number of participants.

Xylitol research has been conducted since the early 70's; at the beginning of 2009 there were almost 500 PubMed-indexed papers on "xylitol and dental". Xylitol research was initiated in Finland, but nowadays the majority of papers are published by non-Finnish authors. Xylitol studies have been criticized mainly by European researchers. This criticism is reflected for example in the most recent textbook of cariology, Dental Caries -The Disease and its Clinical Management (2008), used by students in all Nordic countries. It shows a figure with reduction in caries occurrence in the Turku Sugar Studies as an example, not of the effect of total substitution of dietary sugars with xylitol, but rather "indicating the importance of removal of sugar from the diet, rather than starch, in caries control". Moreover, a frequently cited review in Caries Research in 2004 came to the conclusion that "there is no evidence for a cariestherapeutic effect of xylitol". 1 Xylitol studies are easy to criticize especially by authors who have never been involved in field trials. For example, to avoid exchange of test products between children of the same class randomisation has to be done by schools or school classes. This is rarely recognized by the critics of xylitol studies. In addition, it is hard to find volunteers to comply with 2-3 years chewing of a hard and tasteless gum base, which is the control often suggested for chewing gum trials. Polyols like maltitol and sorbitol are by no means inert and are thus not valid controls for xylitol. ] For example, the inclusion criteria for a Swedish systematic review on methods of caries prevention (SBU; www.sbu.se) were so strict that hardly any

As regular administration of xylitol had been effective in preventing acute otitis media (AOM) in children, we tested whether xylitol administered only at times of acute respiratory infection (ARI) reduces the occurrence of AOM. Healthy children (N = 1277) were recruited from child care centers and randomized after screening with tympanometry to receive either control mixture (n = 212), xylitol mixture (n = 212), control chewing gum (n = 280), xylitol chewing gum (n = 286), or xylitol lozenges (n = 287) during an ARI. The trial was randomized and double blinded within the mixture and chewing gum groups. The parents began administering the products to their children at the onset of symptoms of ARI. The follow-up lasted until resolution of the symptoms or up to 3 weeks. A total of 1253 of the 1277 randomized children were eligible for the analysis. Altogether, 980 (78%) of 1253 children had at least 1 episode of ARI during the 4 months that the trial lasted. The occurrence of AOM during this episode was 34 (20.5%) of 166 in the xylitol mixture group, as compared with 32 (20.4%) of 157 among the children who received the control mixture. Among the older children who received control chewing gum, xylitol chewing gum, or xylitol lozenges, AOM was experienced by 24 (11.0%) of 218, 31 (14.1%) of 220, and 34 (15.5%) of 219, respectively. None of the differences between the groups was statistically significant. Xylitol administered only during an ARI was ineffective in preventing AOM.

The purpose of this survey was to examine the association of general characteristics, oral health knowledge, attitudes, behavior, and dental caries status among adolescents in Jiangxi Province and to provide a basis for future prevention of dental caries among middle school students. A total of 8,160 adolescents aged 12 to 15 years were invited to participate in this survey by a stratified random cluster sampling method from 30 schools in five counties in Jiangxi Province. A self-administered questionnaire was used to understand their basic characteristics, including oral health behaviors, knowledge, and attitudes. Chi-square tests were used to compare dental caries status and general characteristics. Univariate and multivariate logistic regression analyses were used to study the effects of oral health knowledge, attitudes, and behavior on dental caries. The prevalence of dental caries in permanent teeth was 25.8 percent, and the mean DMFT score of 12- to 15-year-old adolescents was 0.48 ± 1.04. The prevalence in rural areas was higher than that in urban areas (P < 0.001). The prevalence was higher in girls than in boys (P < 0.001). No significant age differences were observed (P > 0.05) in the prevalence of dental caries. The multivariate logistic regression analysis indicated that the variables associated with dental caries were tooth brushing frequency, use of toothpaste, frequency of sugary milk intake, smoking, and oral health attitudes. This study revealed that adolescent oral health behaviors and attitudes were associated with dental caries. It is important to implement targeted oral disease prevention and control measures among adolescents.

Nowadays dental caries and periodontal diseases are among the most pressing problems in Paediatric Dentistry. Young patients with psychoneurological disorders are a special category among children with somatic pathology. At the same time, the issue of providing dental care to such children is underrepresented. Today, traditional schemes used for the prevention and treatment of caries and periodontal disease in children with mental retardation requires further improvement taking into account the clinical status of children with particular forms of mental retardation, including oligophrenia. Thus, the aim of our study was to develop and evaluate the effectiveness of a complex of measures to prevent dental caries in children with oligophrenia.&#x0D; To assess the effectiveness of the elaborated preventive complex, 56 children aged 12 years with the diagnosis of oligophrenia of I degree of severity (mild mental backwardness) were under observation during 2 years; 27 children received the complex we developed. The group of comparison included 29 children; caries prevention measures for these children were based on regional protocols (hygienic education, keeping oral hygiene, use of fluoride toothpastes).&#x0D; The effectiveness of the developed preventive complex was evaluated 6, 12 and 24 months after the beginning of its implementation according to the following criteria: the growth of dental caries intensity; reduction in the growth of dental caries intensity; level of oral hygiene (OHI-S index); changes in the biocenosis of the oral cavity (in 1 and 6 months of the observation).&#x0D; The results of the examination after the 6 month observation period have shown the dental caries intensity in children of the main group is 6.65 ± 0.45 teeth that is 1.02 times lower than in the children of the comparison group (6.79 ± 0.26 teeth, p ˃0.05). Thus, the growth of dental caries intensity in the children of the main group is, on average, 0.41 ± 0.05 tooth, which is significantly lower than in children of the comparison group (0.58 ± 0.06 tooth, p &lt;0.05 ).&#x0D; The reduction in the growth of caries intensity in children who received the developed preventive complex was 41.46%. Thus, during two years of the observation, the growth of caries intensity in children of the main group is 1.52 ± 0.08 tooth that is 1.74 times lower than in children of the comparison group (2.64 ± 0.9 tooth, p &lt;0, 05). The reduction in the growth of caries intensity in children who received this preventive complex is, on average, 42.42%.&#x0D; The effectiveness of the proposed preventive complex for children with oligophrenia and carious lesions was also evaluated by using the hygienic Green-Vermillion index. According to the data obtained, at the period of inclusion into the study, the children in both groups demonstrated nearly the same indices of the oral hygiene. However, over the period of the study, the indices of the hygiene index between the children of the main group and the comparison group differed significantly. The application of preventive complex in children with oligophrenia resulted in better oral hygiene than in that the children of the comparison group. This can be explained by professional hygiene, quality control of toothbrushing and hygiene education of children and their parents. The effectiveness of the elaborated complex of preventive measures was also evidenced by changes in the oral biocenosis in the children of the main group in 1 and 6 months of the observation. The findings of microbiological studies showed that the microbial spectrum of the oral cavity changed toward the healthier balance in the children of the main group during the observation period: there was gradual decrease in pathogenic microflora and an increase in symbiotic microflora.&#x0D; Thus, the analysis of findings obtained over the two year observation period in children with oligophrenia, who received the complex of measures to prevent dental caries prevention has confirmed its effectiveness by reducing the growth of caries intensity, the reduction in the growth of caries intensity, hygiene improvement and normalization of oral microbiocenosis.

Objectives: This systematic review aimed to investigate the association between depression and oral health outcomes, including periodontitis, gingivitis, dental caries, partial tooth loss, and edentulism (complete tooth loss). Methods: A comprehensive search was conducted across seven major databases and two gray literature sources, including only studies with probabilistic samples, clinical assessment of oral outcomes, validated measuring of depression, and analyses statistically controlled for confounders. Two reviewers independently performed study selection, data extraction, risk of bias assessment (Newcastle-Ottawa scale), and evaluation of evidence certainty. Results: From 5865 unique records identified, 53 studies were included (44 cross-sectional and 9 cohort studies), with low risk of bias in 45 studies. Depression was significantly associated with the outcomes of periodontitis (OR = 1.30, 95%CI 1.07-1.57, I2 = 56%), dental caries (PR = 1.32, 95%CI 1.12-1.52, I2 = 0%), and edentulism (OR = 1.26, 95%CI 1.16-1.37, I2 = 35%). Individuals with edentulism were more likely to have the outcome of depression compared to controls (OR = 1.37, 95%CI 1.15-1.64, I2 = 69%). Meta-analyses demonstrated very low to low certainty of evidence. Conclusions: This systematic review and meta-analysis found significant associations between depression and oral health outcomes, such as periodontitis, dental caries and edentulism. These findings reinforce the interconnection between oral health and psychological factors.

Xylitol is a naturally occurring polyol sweetener that has been used in chewing gum and lozenges as a modality to prevent dental caries. In a double-blind trial, researchers examined the efficacy of xylitol oral syrup for the prevention of dental caries in 100 children (age range, 9–15 months) in the Republic of …

Survival analyses have been used to overcome some of the limitations encountered with other statistical analyses. Although extended Cox hazard modeling with time-dependent variables has been utilized in several medical studies, it has never been utilized in assessing the complex relationship between mutans streptococci (MS) acquisition (time-dependent covariate) and time to having dental caries (outcome). This study involved secondary analyses of data from a prospective study conducted at the University of Alabama at Birmingham. Low socioeconomic status, African-American preschool children from Perry County, AL, USA (n = 95) had dental examinations at age 1 year and annually thereafter until age 6 years by three calibrated dentists. Salivary MS tests were done at ages 1, 1.5, 2, 2.5, 3, and 4 years. The patterns of and relationship between initial MS detection (time-dependent covariate) and dental caries experience occurrence were assessed, using extended Cox hazard modeling. The median time without MS acquisition (50% of the children not having positive MS test) was 2 years. Approximately 79% of the children had positive salivary MS tests by the age of 4 years. The median caries experience survival (50% of the children not having dental caries) was 4 years. During the follow-up period, 65 of the children (68.4%) had their initial primary caries experience. Results of the extended Cox hazard modeling showed a significant overall/global relationship between initial caries experience event at any given time during the follow-up period and having a positive salivary MS test at any time during the follow-up period (hazard ratio = 2.25, 95% CI 1.06-4.75). In conclusion, the extended Cox modeling was used for the first time and its results showed a significant global/overall relationship between MS acquisition and dental caries. Further research using causal mediation analysis with survival data is necessary, where the mediator “presence of MS” is treated as a time-dependent variable.

Dental caries remains a public health threat of concern among children. About 2.3 billion people are affected by dental caries, of which 530 million are children globally. This study was carried out to identify sugar fermenting bacteria in the oral cavity and their antibiotic susceptibility pattern, assess the association with sugar fermenter bacteria and dental caries and evaluate dental caries outcomes among children. This was a cross-sectional study conducted between October 2021 and February 2022 at Ruhengeri Referral Hospital. About 136 oral swab samples were collected from children with and without dental caries at 1:1 ratio. The samples were put in Stuart sterile container and transported to INES-clinical microbiology laboratory for microbial identification. Logistic regression analysis of demographic characteristics was performed to study the relationship between demographic variables and dental caries. Chi-square test was performed for the association between variables. About 67.6% were male, while children of age 7-9 years (64.7%) dominated the age groups. Lactobacilli spp (15.29%) and Streptococcus mutans (12.94%) were the most predominant microorganisms observed in the oral cavity among children with dental caries. The S. mutans (x2 = 27.03, P < 0.00001, 95% confidence interval [CI]=0.2901-0.5785), S. aureus (x2 = 34.59, P < 0.00001, 95% CI = 0.3541-0.6292), Enterobacter aerogenes (x2 = 13.5, P = 0.000239, 95% CI = 0.151-0.4622), Serratia marcescens (x2 = 11.64, P = 0.00645, 95% CI = 0.1275-0.4418) and Klebsiella pneumonia (x2 = 13.51, P = 0.000237, 95% CI = 0.1511-0.4623) were significantly associated with dental caries. Teeth loss (x2 = 51.04, P < 0.00001, 95% CI = 0.4757-0.7205), teeth pain (x2 = 5.05, P = 0.0246, 95% CI = 0.0249-0.33499), and infection (x2 = 4.73, P = 0.02964, 95% CI = 0.0186-0.3441) were dental outcomes associated with tooth decay. Ciprofloxacin, clindamycin, and amoxicillin were the most sensitive antibiotics, while vancomycin and chloramphenicol were the most resistant. Sugar consumption favours the growth of sugar fermenter bacteria that cause dental caries among children. Dental caries is associated with adverse oral health outcomes among children. Oral health education is recommended for children. Parents are advised to reduce the consumption of sugary food for their children for oral health safety.

Objective. Describes the prevalence and severity of dental caries in Colombian preschool children with primary dentition. Methods. Cross-sectional study, using a random sample by clusters of 336 children between 3 and 5 years of age, examined during 2010. Dental caries lesion detection was carried out by visual criteria (ICDAS). A questionnaire was answered by the parents. Examiner´s calibration in ICDAS assessment method was carried out with a benchmark examiner, and the inter-examiner and intra-examiner reliability was calculated. The association exploration was analyzed parting from the prevalence ratio (PR; 95 percent confidence interval CI). The multivariate analysis was done using poisson regression model, obtaining adjusted values by age and gender. Results. Dental caries prevalence was 88.9 %, (51.4 % for experience and 37.5 % for non cavitated lesions). The average dmf-t was 1.7 +/-2.5. The most commonly present lesions were non cavitated, being the smooth surfaces in cervical area the most affected. For caries experience there was significance with a cariogenic diet, tooth brushing parent supervision and the use of a high fluoride content toothpaste, while the severity of dental caries was associated with dental consultations per year, mother´s schooling and school behavior. Conclusions. The dental caries prevalence and severity was associated with different risk factors ( weekly cariogenic diet consumption, no parental tooth brushing supervision, use of high fluoride content toothpaste, visit to the dentist less than one/year, mother schooling less than high school and inadequate school behavior) , which at this age can be oriented by parents through a change in behavior.

Employment can affect a mother's role, as working mothers may have less time to oversee oral hygiene and diet, potentially leading to higher rates of dental caries. In contrast, non-working mothers often have more time for health routines and nutritious meal preparation, resulting in better dental outcomes. This comparative cross-sectional study evaluates body mass index (BMI), dental caries, and sugar consumption among 3-5-year-old schoolchildren with working and non-working mothers in Mysuru city. The study included 75 children of working mothers and 75 children of non-working mothers. Data on oral hygiene and sugar consumption were collected using a validated questionnaire, and clinical examinations and BMI measurements were conducted by a trained dentist. Statistical tests like Student "t" test, ANOVA, and logistic regression analysis were used. A p-value <0.05 was considered statistically significant. Results showed that children of working mothers had a slightly lower mean BMI (15.45 ± 2.15) than those of non-working mothers (15.65 ± 2.007). Children of working mothers had higher decayed, missing, and filled teeth/decayed, extracted, and filled teeth (dmft/deft) scores, indicating more dental caries. More children of working mothers were classified as normal weight or underweight (64 and 22.7%, respectively), while more children of non-working mothers were overweight (25.3%). Both groups had similar sugary snack and dairy intake rates, but children of working mothers had higher caries rates and lower BMIs, illustrating the complex impact of maternal employment on children's oral health. This study explores how maternal employment impacts children's BMI and dental caries, highlighting connections between employment, income, nutrition, and health. Understanding these links helps develop public health interventions to improve children's health and family well-being. Paramasivam K, Manjunathappa TH, SampathKumar B, et al. Employability of Mothers and its Impact on Body Mass Index and Dental Caries of their Preschool Children: A Cross-sectional Study. Int J Clin Pediatr Dent 2025;18(1):91-99.