Publications by authors named "Jorge L Castillo"

17 Publications

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Do viscosity and wettability of fluoride varnishes affect their fluoride release?

J Clin Exp Dent 2021 Mar 1;13(3):e221-e226. Epub 2021 Mar 1.

Professor, Universidad Peruana Cayetano Heredia, School of Stomatology, Department of Dentistry for Children and Adolescents,Lima, Peru.

Background: There are several brands of fluoride varnishes in the market, but the dynamics of fluoride release from each one might be different. The purpose of this study was to evaluate in vitro the release of fluorides by fluoride varnishes and to determine the correlation with viscosity and wettability.

Material And Methods: Forty four enamel blocks 5x5 mm were randomly divided into 4 groups (n=11) ((Duraphat®, Clinpro™ White Varnish, Flúor Protector® and control). We applied 30 milligrams of fluoride varnish to each specimen. The specimens were immersed in a Calcium Phosphate solution at a pH= 6.0. We evaluated the release of fluoride, by using a selective fluoride electrode, during 6 weeks. Viscosity was measured using an Oswald Viscosimeter and the wettability was determined by measuring the contact angle between the varnish and the enamel slab. The statistical analysis was performed using Analysis of variance.

Results: Duraphat showed the highest fluoride release from the second weekend beyond (<0.001) and Clinpro the greatest rate of release. Duraphat release was the steadiest throughout the experiment. Duraphat showed the highest viscosity and the lowest wettability (<0.001) and Fluor Protector showed the highest wettability (<0.001). There was a positive correlation between the release of fluoride and the viscosity and a negative correlation between fluoride release and wettability (r>0.7).

Conclusions: Viscosity and wettability influence the release of fluoride from fluoride varnishes. Fluorides topical, viscosity, wettability.
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http://dx.doi.org/10.4317/jced.56985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920555PMC
March 2021

Perceived Preparedness of Dental Academic Institutions to Cope with the COVID-19 Pandemic: A Multi-Country Survey.

Int J Environ Res Public Health 2021 02 4;18(4). Epub 2021 Feb 4.

Department of Prosthodontics, University of Dental Medicine, Mandalay 05041, Myanmar.

Dental academic institutions are affected by COVID-19. We assessed the perceived COVID-19 preparedness of these institutions and the characteristics of institutions with greater perceived preparedness. An international cross-sectional survey of dental academics was conducted from March to August 2020 to assess academics' and institutional attributes, perceived preparedness, and availability of infection prevention and control (IPC) equipment. Principal component analysis (PCA) identified perceived preparedness components. Multilevel linear regression analysis assessed the association between perceived preparedness and fixed effect factors (academics' and institutions' attributes) with countries as random effect variable. Of the 1820 dental academics from 28 countries, 78.4% worked in public institutions and 75.2% reported temporary closure. PCA showed five components: clinic apparel, measures before and after patient care, institutional policies, and availability of IPC equipment. Significantly less perceived preparedness was reported in lower-middle income (LMICs) (B = -1.31, = 0.006) and upper-middle income (UMICs) (B = -0.98, = 0.02) countries than in high-income countries (HICs), in teaching only (B = -0.55, < 0.0001) and in research only (B = -1.22, = 0.003) than teaching and research institutions and in institutions receiving ≤100 patients daily than those receiving >100 patients (B = -0.38, < 0.0001). More perceived preparedness was reported by academics with administrative roles (B = 0.59, < 0.0001). Academics from low-income countries (LICs) and LMICs reported less availability of clinic apparel, IPC equipment, measures before patient care, and institutional policies but more measures during patient care. There was greater perceived preparedness in HICs and institutions with greater involvement in teaching, research, and patient care.
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http://dx.doi.org/10.3390/ijerph18041445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913785PMC
February 2021

Knowledge of dental academics about the COVID-19 pandemic: a multi-country online survey.

BMC Med Educ 2020 Nov 2;20(1):399. Epub 2020 Nov 2.

Department of Pediatric Dentistry, Seoul National University Dental Hospital, Seoul, South Korea.

Background: COVID-19 is a global pandemic affecting all aspects of life in all countries. We assessed COVID-19 knowledge and associated factors among dental academics in 26 countries.

Methods: We invited dental academics to participate in a cross-sectional, multi-country, online survey from March to April 2020. The survey collected data on knowledge of COVID-19 regarding the mode of transmission, symptoms, diagnosis, treatment, protection, and dental treatment precautions as well as participants' background variables. Multilevel linear models were used to assess the association between dental academics' knowledge of COVID-19 and individual level (personal and professional) and country-level (number of COVID-19 cases/ million population) factors accounting for random variation among countries.

Results: Two thousand forty-five academics participated in the survey (response rate 14.3%, with 54.7% female and 67% younger than 46 years of age). The mean (SD) knowledge percent score was 73.2 (11.2) %, and the score of knowledge of symptoms was significantly lower than the score of knowledge of diagnostic methods (53.1 and 85.4%, P <  0.0001). Knowledge score was significantly higher among those living with a partner/spouse than among those living alone (regression coefficient (B) = 0.48); higher among those with PhD degrees than among those with Bachelor of Dental Science degrees (B = 0.48); higher among those seeing 21 to 30 patients daily than among those seeing no patients (B = 0.65); and higher among those from countries with a higher number of COVID-19 cases/million population (B = 0.0007).

Conclusions: Dental academics had poorer knowledge of COVID-19 symptoms than of COVID-19 diagnostic methods. Living arrangements, academic degrees, patient load, and magnitude of the epidemic in the country were associated with COVD-19 knowledge among dental academics. Training of dental academics on COVID-19 can be designed using these findings to recruit those with the greatest need.
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http://dx.doi.org/10.1186/s12909-020-02308-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605331PMC
November 2020

Behavior change due to COVID-19 among dental academics-The theory of planned behavior: Stresses, worries, training, and pandemic severity.

PLoS One 2020 29;15(9):e0239961. Epub 2020 Sep 29.

Orthodontics and Pediatric Dentistry Department, Faculty of Dentistry, Arab American University, Jenin, Palestine.

Objective: COVID-19 pandemic led to major life changes. We assessed the psychological impact of COVID-19 on dental academics globally and on changes in their behaviors.

Methods: We invited dental academics to complete a cross-sectional, online survey from March to May 2020. The survey was based on the Theory of Planned Behavior (TPB). The survey collected data on participants' stress levels (using the Impact of Event Scale), attitude (fears, and worries because of COVID-19 extracted by Principal Component Analysis (PCA), perceived control (resulting from training on public health emergencies), norms (country-level COVID-19 fatality rate), and personal and professional backgrounds. We used multilevel regression models to assess the association between the study outcome variables (frequent handwashing and avoidance of crowded places) and explanatory variables (stress, attitude, perceived control and norms).

Results: 1862 academics from 28 countries participated in the survey (response rate = 11.3%). Of those, 53.4% were female, 32.9% were <46 years old and 9.9% had severe stress. PCA extracted three main factors: fear of infection, worries because of professional responsibilities, and worries because of restricted mobility. These factors had significant dose-dependent association with stress and were significantly associated with more frequent handwashing by dental academics (B = 0.56, 0.33, and 0.34) and avoiding crowded places (B = 0.55, 0.30, and 0.28). Low country fatality rates were significantly associated with more handwashing (B = -2.82) and avoiding crowded places (B = -6.61). Training on public health emergencies was not significantly associated with behavior change (B = -0.01 and -0.11).

Conclusions: COVID-19 had a considerable psychological impact on dental academics. There was a direct, dose-dependent association between change in behaviors and worries but no association between these changes and training on public health emergencies. More change in behaviors was associated with lower country COVID-19 fatality rates. Fears and stresses were associated with greater adoption of preventive measures against the pandemic.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239961PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523990PMC
October 2020

Association between early childhood caries and poverty in low and middle income countries.

BMC Oral Health 2020 01 6;20(1). Epub 2020 Jan 6.

Department of Pediatric Dentistry, Universidade Luterana do Brasil, Canoas, Brazil.

Background: The aim of this study was to assess the relationship between early childhood caries (ECC) in 3-5-year-old children, seven indicators of poverty and the indicator of monetary poverty in low- and middle-income countries (LICs, MICs).

Methods: This ecologic study utilized 2007 to 2017 country-level data for LICs and MICs. Explanatory variables were seven indicators of poverty namely food, water, sanitation, health, shelter, access to information, education; and monetary poverty. The outcome variable was the percentage of 3-5-year-old children with ECC. A series of univariate general linear regression models were used to assess the relationship between the percentage of 3-5 year-old children with ECC and each of the seven indicators of poverty, and monetary poverty. This was followed by multivariable regression models to determined the combined effect of the seven indicators of poverty, as well as the combined effect of the seven indicators of poverty and monetary poverty. Adjusted R measured models' ability to explain the variation among LICs and MICs in the percentage of 3-5-year-old children with ECC.

Results: Significantly more people had food, sanitation, shelter, access to information, education and monetary poverty in LICs than in MICs. There was no difference in the prevalence of ECC in 3-5-year-old children between LICs and MICs. The combination of the seven indicators of poverty explained 15% of the variation in the percentage of 3-5-year-old children with ECC compared to 1% explained by monetary poverty. When the seven indicators of poverty and the indicator for monetary poverty were combined, the amount of variation explained by them was 10%. Only two of the poverty indicators had a direct relationship with the percentage of children with ECC; there was a higher percentage of ECC in countries with higher percentage of population living in slums (B = 0.35) and in those countries with higher percentage of the population living below poverty lines (B = 0.19). The other indicators had an inverse relationship.

Conclusion: The use of multiple indicators to measures of poverty explained greater amount of variation in the percentage of 3-5-year-olds with ECC in LICs and MICs than using only the indicator for monetary poverty.
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http://dx.doi.org/10.1186/s12903-019-0997-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945445PMC
January 2020

Early Childhood Caries in Peru.

Front Public Health 2019 15;7:337. Epub 2019 Nov 15.

Department of Dentistry for Children and Adolescents, Universidad Peruana Cayetano Heredia, Lima, Peru.

Early Childhood Caries (ECC) is a global oral health problem, and Peru may be one of the countries with high prevalence of untreated ECC in South America. In this study, we constructed an epidemiologic profile of ECC in Peru through a comprehensive review of published data. The prevalence of ECC, risk factors for it, its impact on child development, and public oral health interventions on ECC have been included. The study revealed extremely high rates of ECC in Peru and significant oral-health disparities. Risk factors for ECC were poverty, high sugar consumption, and low oral health literacy. However, the number of studies is limited and their quality questionable. Oral health has not received high public-health priority in Peru. However, in recent years, new regulations and evidence-based documents (the first Clinical Practice Guideline for the Prevention, Diagnosis, and Management of Caries in Children; the Guideline for Children's healthy Growth and Development; the Law on Healthy Diet; and the Manual on Food Advertising) give hope for the future of infants' oral health in the nation.
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http://dx.doi.org/10.3389/fpubh.2019.00337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873793PMC
November 2019

Prevalence and Data Availability of Early Childhood Caries in 193 United Nations Countries, 2007-2017.

Am J Public Health 2018 08 21;108(8):1066-1072. Epub 2018 Jun 21.

Maha El Tantawi and Balgis O. Gaffar are with the Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Morenike O. Folayan is with the Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria. Mohamed Mehaina is with Bibliotheca Alexandrina, Alexandria, Egypt. Ana Vukovic is with the Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Republic of Serbia. Jorge L. Castillo is with the Department of Paediatric Dentistry and Orthodontics, Universidad Peruana Cayetano Heredia, Lima, Peru. Arheiam Arheiam is with the Department of Community and Preventive Dentistry, Faculty of Dentistry, University of Benghazi, Libya. Ola B. Al-Batayneh is with the Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Arthur M. Kemoli is with the Department of Paediatric Dentistry and Orthodontics, College of Health Sciences, University of Nairobi, Kenya. Robert J. Schroth is with the Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba. Gillian H. M. Lee is with Paediatric Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong.

Objectives: To assess the relationship between health care system and economic factors and early childhood caries (ECC) data availability and prevalence.

Methods: We estimated ECC data for 193 United Nations countries from studies published between 2007 and 2017. We obtained other variables from the World Health Organization and the World Bank databases. We assessed association with ECC data availability by using logistic regression and with ECC prevalence by using linear regression.

Results: We included 190 publications from 88 (45.6%) countries. The mean ECC prevalence was 23.8% and 57.3% in children younger than 36 months and children aged 36 to 71 months, respectively. The odds of ECC data availability were significantly higher for countries with more physicians and more dentists. In children younger than 36 months, ECC prevalence was associated with universal health coverage (B = -6.56). In children aged 36 to 71 months, it was associated with growth of gross national income (B = 0.27).

Conclusions: Countries with more physicians and more dentists were more likely to have ECC data. Among those with data, countries with higher economic growth had higher ECC prevalence.
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http://dx.doi.org/10.2105/AJPH.2018.304466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050821PMC
August 2018

Family Impact Scale (FIS): Cross-cultural Adaptation and Psychometric Properties for the Peruvian Spanish Language.

Acta Odontol Latinoam 2015 Dec;28(3):251-7

Department of Pediatric Dentistry, Dental School, Universidad Científica del Sur, Peru.

The lack of a Family Impact Scale (FIS) in Spanish language limits its use as an indicator in Spanish-speaking countries and precludes comparisons with data from other cultural and ethnic groups. The purpose of this study was therefore to adapt the FIS cross-culturally to the Peruvian Spanish language and assess its reliability and validity. In order to translate and adapt the FIS cross-culturally, it was answered by 60 parents in two pilot tests, after which it was tested on 200 parents of children aged 11 to 14 years who were clinically examined for dental caries experience and malocclusions. Internal consistency was assessed by Cronbach's alpha coefficient while repeat administration of the FIS on the same 200 parents enabled the test-retest reliability to be assessed via intraclass correlation coefficient (ICC). Construct and discriminant validity were based on associations of the FIS with global ratings of oral health and clinical groups, respectively. Mean (standard deviation) FIS total score was 5.20 (5.86). Internal consistency was confirmed by Cronbach's alpha 0.84. Test-retest reliability revealed excellent reproducibility (ICC = 0.96). Construct validity was good, demonstrating statistically significant associations between total FIS score and global ratings of oral health (p=0.007) and overall wellbeing (p=0.002), as well as for the subscale scores (p<0.05) with exception of the financial burden subscale. The FIS was also able to discriminate between children with and without dental caries experience and malocclusions (p<0.05). Satisfactory psychometric results for the Peruvian Spanish FIS confirm it as a reliable, valid instrument for assessing the impact on the family caused by children's oral conditions.
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December 2015

Milk Sweetened with Xylitol: A Proof-of-Principle Caries Prevention Randomized Clinical Trial.

J Dent Child (Chic) 2016 Sep;83(3):152-160

Department of Stomatology for Children and Adolescents, Universidad Peruana Cayetano Heredia, Lima, Peru.

Purpose: To evaluate the efficacy of xylitol-sweetened milk as a caries-preventive strategy.

Methods: In this nine-month prospective proof-of-principle trial, Peruvian schoolchildren were randomized to one of five different milk groups: (1) eight g of xylitol per 200 mL milk once per day; (2) four g of xylitol per 100 mL milk twice per day; (3) eight g of sorbitol per 200 mL milk once per day; (4) four g of sorbitol per 100 mL milk twice per day; or (5) eight g of sucrose per 200 mL milk once per day. The primary outcome was plaque mutans streptococci (MS) at nine months. A secondary outcome was caries incidence. We hypothesized that children in the xylitol groups would have a greater MS decline and lower caries incidence.

Results: One hundred fifty-three children were randomized in the intent-to-treat analyses. Children receiving xylitol had a greater decline in MS than children receiving sucrose (P=0.02) but were not different from children receiving sorbitol (P=0.07). Dental caries incidence for xylitol once per day or twice per day was 5.3±3.4 and 4.3±4.0 surfaces, respectively, compared to sorbitol once per day, sorbitol twice per day, or sucrose (4.1±2.8, 3.7±4.2, and 3.2±3.4 surfaces, respectively). There were no differences in caries incidence between xylitol and sucrose (rate ratio [RR] = 1.51; 95 percent confidence interval [CI] = 0.88, 2.59; P=0.13) or between xylitol and sorbitol (RR = 1.28; 95 percent CI = 0.90, 1.83; P=0.16).

Conclusion: Xylitol-sweetened milk significantly reduced mutans streptococci levels compared to sucrose-sweetened milk, but differences in caries incidence were not detected.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364522PMC
September 2016

Short term serum pharmacokinetics of diammine silver fluoride after oral application.

BMC Oral Health 2012 Dec 31;12:60. Epub 2012 Dec 31.

Area of Pediatric Dentistry, Universidad Catolica Santa Maria de Arequipa, San Jose S/N, Arequipa, Peru.

Background: There is growing interest in the use of diammine silver fluoride (DSF) as a topical agent to treat dentin hypersensitivity and dental caries as gauged by increasing published research from many parts of the world. While DSF has been available in various formulations for many years, most of its pharmacokinetic aspects within the therapeutic concentration range have never been fully characterized.

Methods: This preliminary study determined the applied doses (3 teeth treated), maximum serum concentrations, and time to maximum serum concentration for fluoride and silver in 6 adults over 4 h. Fluoride was determined using the indirect diffusion method with a fluoride selective electrode, and silver was determined using inductively coupled plasma-mass spectrometry. The mean amount of DSF solution applied to the 3 teeth was 7.57 mg (6.04 μL).

Results: Over the 4 hour observation period, the mean maximum serum concentrations were 1.86 μmol/L for fluoride and 206 nmol/L for silver. These maximums were reached 3.0 h and 2.5 h for fluoride and silver, respectively.

Conclusions: Fluoride exposure was below the U.S. Environmental Protection Agency (EPA) oral reference dose. Silver exposure exceeded the EPA oral reference dose for cumulative daily exposure over a lifetime, but for occasional use was well below concentrations associated with toxicity. This preliminary study suggests that serum concentrations of fluoride and silver after topical application of DSF should pose little toxicity risk when used in adults.

Clinical Trials Registration: NCT01664871.
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http://dx.doi.org/10.1186/1472-6831-12-60DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538059PMC
December 2012

Bonding failure is similar if brackets are bonded either with resin-modified glass ionomer cements (RM-GICs) or composite resin cements (CRCs).

Authors:
Jorge L Castillo

J Evid Based Dent Pract 2012 Dec;12(4):193-5

Department of Dentistry for Children and Adolescents, Universidad Peruana Cayetano Heredia, Lima, Peru.

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http://dx.doi.org/10.1016/j.jebdp.2012.09.010DOI Listing
December 2012

Maxillary expansion may increase airway dimensions and improve breathing.

Authors:
Jorge L Castillo

J Evid Based Dent Pract 2012 Mar;12(1):14-7

Department of Dentistry for Children and Adolescents, Universidad Peruana Cayetano Heredia, Lima, Peru.

Purpose/question: Does rapid maxillary expansion have long-term effects on airway dimensions and breathing?

Source Of Funding: Information not available.

Type Of Study/design: Systematic review.

Level Of Evidence: Level 2: Limited-quality, patient-oriented evidence.

Strength Of Recommendation Grade: Grade B: Inconsistent or limited-quality patient-oriented evidence.
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http://dx.doi.org/10.1016/j.jebdp.2011.12.007DOI Listing
March 2012

Rapid maxillary expansion treatment may maintain long-term dental changes in patients with constricted arches.

Authors:
Jorge L Castillo

J Evid Based Dent Pract 2011 Mar;11(1):21-3

Department of Dentistry for Children and Adolescents, Universidad Peruana Cayetano Heredia, Lima, Peru.

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http://dx.doi.org/10.1016/j.jebdp.2010.11.015DOI Listing
March 2011

Children's acceptance of milk with xylitol or sorbitol for dental caries prevention.

BMC Oral Health 2005 Jul 22;5. Epub 2005 Jul 22.

Departamento Academico de Estomatología del Niño y del Adolescente, Universidad Peruana Cayetano Heredia, Honorio Delgado 430, Lima 34, Peru.

Background: Xylitol, a polyol sugar, has been shown to reduce dental caries when mixed with food or chewing gum. This study examines the taste acceptability of xylitol in milk as a first step toward measuring the effectiveness of xylitol in milk for the reduction of dental caries in a public health program.

Methods: Three different types of milk (Ultra High Temperature (UHT), powder and evaporated) were tested for acceptability by 75 Peruvian children (25 per milk group, ages 4 to 7 years). Each group evaluated xylitol and sorbitol in one type of milk. In the first phase, each child was presented with a tray of four plastic cups containing 50 ml of milk with 0.021 g/ml xylitol, 0.042 g/ml xylitol, 0.042 g/ml sorbitol or no sugar. Each child was asked to taste the samples in a self-selected order. After tasting each sample, the child placed the milk cup in front of one of three cartoon faces (smile, frown or neutral) representing the child's response to the taste of each sample. In the second phase, the child was asked to rank order the milk samples within each category (smile, frown or neutral). Ranks within categories were then combined to obtain a rank ordering for all the test samples.

Results: The ranking from best to worst for the samples across categories (UHT, powder, evaporated) was xylitol (0.0.042 g/ml), sorbitol (0.042 g/ml), xylitol (0.021 g/ml) and milk alone (Friedman's ANOVA). Xylitol and sorbitol were preferred over milk alone, and xylitol (0.042 g/ml) was preferred to sorbitol (0.042 g/ml)(p < .05 sign test).

Conclusion: Milk sweetened with xylitol is well accepted by Peruvian children ages 4-7 years.
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http://dx.doi.org/10.1186/1472-6831-5-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1183221PMC
July 2005

Fluoride release from varnishes in two in vitro protocols.

J Am Dent Assoc 2004 Dec;135(12):1696-9

University of Washington, Seattle, USA.

Background: The authors conducted a study to evaluate fluoride released from fluoride varnishes that had been applied with two different protocols. Fluoride release information for these two approaches may allow clinicians to vary application intervals to better meet the needs of their patients.

Methods: The authors painted enamel slabs from exfoliated primary molar teeth either in a single application (five samples) or three times within a single week (five samples) with fluoride varnish (Duraphat, Colgate-Palmolive, New York). The samples were immersed in buffered calcium phosphate solution (pH 6) to simulate the oral environment; the amount of fluoride released was measured during a span of six months.

Results: The total release of fluoride was significantly higher in the three-application regimen (34.9 micromoles) than in the single application (23.7 micromol). The rate of release was slower using the three-application regimen. Thus, applying fluoride-release varnish three times in a single week produced greater and longer release of fluoride than did one application.

Clinical Implications: Massed application of fluoride varnish during a single period during the year may be as effective as spaced single applications. This method can be a good alternative to delivering fluoride varnish to high-caries-risk patients who are mobile or difficult to recall.
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http://dx.doi.org/10.14219/jada.archive.2004.0121DOI Listing
December 2004

How xylitol-containing products affect cariogenic bacteria.

J Am Dent Assoc 2002 Apr;133(4):435-41; quiz 492-3

Department of Pathobiology, University of Washington, Seattle, USA.

Background: The authors examined the effect of xylitol, a naturally occurring sweetener, on levels of Streptococcus mutans and S. sobrinus. They also investigated xylitol's mechanism of action.

Methods: The authors compared cariogenic bacteria levels before and after exposure to xylitol products in children and adults. In the first study, 187 children received xylitol-containing snacks in school for four weeks. In the second study, two adults received xylitol candy for four weeks. Unstimulated saliva samples were taken from all subjects. Gingival samples also were taken from the adults. The authors plated the samples on selective microbiological media. Individual isolates were plated on media with varying concentrations of xylitol, and were identified using specific DNA probes. Genetic relatedness was determined via pulse-field gel electrophoresis.

Results: The children's salivary S. mutans levels remained stable before and after xylitol exposure. Further analysis of the S. mutans isolates was conducted for seven children. Bacteria from five of these children grew with 10 percent or less xylitol at baseline, while the bacteria from all seven children grew with 15 percent xylitol after exposure to the xylitol-containing snacks, suggesting that the S. mutans increased in tolerance to xylitol during exposure. Six children had isolates with the same genotype at both time points. S. mutans and S. sobrinus levels were reduced in one of the adults as a result of xylitol exposure, and the bacterial isolates became more xylitol tolerant. In the second adult, S. mutans and S. sobrinus levels increased, while the subject maintained the same proportion of susceptible and tolerant strains as that at baseline.

Conclusions: Overall, consumption of xylitol-containing snacks and candy did not reduce S. mutans levels. However, bacteria from five children and one adult became more xylitol tolerant.

Clinical Implications: These results provide a basis on which xylitol-containing products can be recommended and xylitol's mechanism of action can be explained to patients.
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http://dx.doi.org/10.14219/jada.archive.2002.0201DOI Listing
April 2002