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Prevalence of dental caries among 12 and 15 year old school children in Government schools of Marathahalli area of Bangalore city Bhaskar Gupta, bds* N Vijayakumar, mds** Shobha M, mds*** Chaithanya Reddy, mds**** Priyadarshini HR, mds***** ABSTRACT Background: Dental caries continues to be a major public health problem and most prevalent oral disease, especially among children in developing countries like India. Aim: To assess the prevalence of dental caries among 12 and 15 year old school children in government schools of Marathahalli area o f Bangalore city. Methodology: A cross-sectional study was conducted among 312 children (155 boys and 157 girls) of age 12 and 15 year, chosen from government schools of Marathahalli area o f Bangalore city. Clinical examination was carried out and caries was recorded using DMFT index as per WHO criteria, 1997. Significant Caries Index (SiC index) was also calculated using DMFT data. Data was analysed using SPSS version 13. Chi-square a n d 't' test were used, p < 0.05 was considered significant. Results: The prevalence o f dental caries in the present study was 33.65%. The mean DMFT and SiC index values for 12 year olds were 0.51±0.95 and 1.52 and for 15 year olds were 0.80±1.27 and 2.16 respectively. The mean DMFT and SiC values for boys were 0.52±0.89 and 1.54 and for girls were 0.68±1.20 and 2.00 respectively. The decayed component DT (66%) constituted the main part of DMFT scores followed by filled FT (50 %) among 12 year old age group while filled component FT (50%) was higher than the decayed component DT (34%) among 15 year olds. Conclusion: The present study reveals a prevalence o f 33.65% of dental caries with a large amount of untreated carious lesions among these age groups. The results suggest formulation of preventive oral health policies and programs, which includes early identification of high-risk patients and individualized treatment needs. Key words: caries, prevalence, DMFT index, SiC index.
INTRODUCTION
The prevalence of dental caries among school children is highly variable among different population groups.1According to WHO, the mean DMFT for 12 year olds in USA during 1999-2004 was 1.192 and of United Kingdom during 20042005 was 0.73.3 In India, National Oral Health Survey and Fluoride Mapping conducted in 20022003 showed caries prevalence o f 52.5 % and 61.4 % among 12 and 15 year olds respectively.4A study
Dental caries is a major public health problem and is one of the most common chronic diseases especially in developing countries. It affects considerable proportions o f school children causing pain, discomfort and absenteeism from school. The high costs associated with its treatment poses great challenge to governments especially in countries without separate oral health budget.
* Post Graduate Student, ** Professor and HOD, *** Professor, **** Reader, ***** Reader, Dept, o f Public Health Dentistry, Dr. Syamala Reddy Dental College, Hospital and Research Centre, Bangalore, India
Address fo r correspondence : * Bhaskar Gupta, Final Year PG Student, Dept, o f Public Health Dentistry, Dr. Syamala Reddy Dental College, Hospital and Research Centre, 111/1, SGR College Main Road, Munnekolala, Marathahalli, Bangalore-56037, Contact No. - +91 9571332897 Email id-
[email protected]
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in Belgaum, Karnataka, (2002) showed caries prevalence of 45.12 % among 11-15 year old children.5 Another study in Mangalore city, Karnataka (2005) showed caries prevalence of 82.50 % among 11-13 year old children.6A recent study in Bagalkote, Karnataka, (2011) showed caries prevalence o f 63.57 % among 12 year old children.7
value for intra-examiner reliability was 0.8, showing a high degree of conformity in the observations. Statistical analysis
Since there was no baseline data on caries prevalence, the present study was undertaken to assess the caries status among 12 and 15 year old children in all the schools of Marathahalli area of Bangalore city.
Data was analysed using statistical software SPSS, version 13 to calculate mean, standard deviation and percentages and Excel software was used to calculate SiC index (www.whocollab. od.mah. se/expl/siccalculation.xls). Categorical data was analyzed using Chi-square test. Student't' test was used to find out significant mean differences. Significance for all statistical tests was predetermined at a probability value of0.05 or less.
MATERIALS & METHODS
RESULTS
A cross-sectional study was conducted among 12 and 15 year old school children in government schools of Marathahalli area of Bangalore city. The list of government schools of Marathahalli was obtained from Deputy Director o f Public Instructions (DDPI) office, Bangalore. Ethical clearance was taken from the institution review board. Informed consent was taken from the parents o f the children before the study. All the eight government higher primary and one government high school present in Marathahalli area were considered for the study. One government higher primary school did not give permission for the study due to administrative problems, and thus was excluded. All the children aged 12 and 15 years present in school on the day of study were included, forming a total sample of 312 subjects.
Table 1 shows age and gender-w ise distribution of study subjects. Out of 312 children, 218 (69.87 %) were 12 year old and 94 (30.13 %) were 15 year old, 155 were boys and 157 were girls. Table 2 shows age and gender-wise prevalence of dental caries. The overall caries prevalence was 33.65 % while 66.35 % children were caries-free. No significant association was observed between dental caries prevalence and age and gender. Table. 1 Age and gender-wise distribution of subjects Age (Years)
Boys n 108
% 69.68
15
47
Total
155
12
Girls n
Total n 218
% 69.87
29.94
94
30.13
100
312
100
110
% 70.06
30.32
47
100
157
Table. 2 Prevalence of dental caries according to age and gender
Clinical examination
Total Age (Years) Gender examined
Demographic data about the child (gender, date and place o f birth) was collected from the school records. Clinical examination was carried out using a plane mouth mirror and CPI probe, by making the child sit on ordinary chair with back rest under natural day light. Caries was diagnosed using WHO criteria 1997 and DMFT was recorded.8 Calibration sessions were conducted before the start o f study and consisted of repeat examination of 10 children. The Kappa co-efficient
Boys 12 Girls Boys 15 Girls Total
108 110 47 47 312
Caries free n 76 76 28 27 207
% 70.37 69.09 59.57 57.45 66.35
Caries affected n 32 34 19 20 105
% 29.63 30.91 40.43 42.55 33.65
Table 3 shows distribution o f DMFT components, mean DMFT and SiC index values according to age. The mean DMFT and SiC index 2
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Table. 3 Distribution of DMFT components, mean DMFT and SiC index values according to age Age (Years)
No. of subjects examined
Decayed teeth (DT)
Missing teeth (MT)
n
%
n
%
n
%
Fille d teeth FT)
Mean DMFT
SiC Index Value
12
218
66
66.00
0
0
4
50.00
0.51 ±0.95
1.52
15
94
34
34.00
1
100
4
50.00
0.80+1.27
2.16
Total
312
100
100
1
100
8
100
0.60±1.06
1.78
Table. 4 Distribution of DMFT components, mean DMFT and SiC index values according to gender Gender
No. of subjects examined
Decayed teeth (DT)
Missing teeth (MT)
n
%
n
%
n
%
Fille d teeth FT)
Mean DMFT
SiC Index Value
Boys
155
49
49.00
1
100
4
50.00
0.52±0.89
1.54
Girls
157
51
51.00
0
0
4
50.00
0.68±1.20
2.00
Total
312
100
100
1
100
8
100
0.60±1.06
1.78
values were found to be 0.51±0.95, 1.52 and 0.80±1.27, 2.16 among 12 and 15 year olds respectively. The decayed component, DT (66 %) contributed the most of DMFT, followed by filled, FT (50 %) and missing, MT (0 %) component among the 12 year old age group, while filled, FT (50 %) was more than decayed component, DT (34 %) among the 15 year old children.
The study showed an overall caries prevalence of 33.65 % among both the age groups (Table 2). Kulkami et al (2002) observed dental caries prevalence o f 45.12% in Belgaum city of Karnataka in 11 -15 year old age group.5Hedge et al (2005) observed dental caries prevalence o f 59.60 % in Belgaum city of Karnataka among 13-15 year old children.9 A recent study in Bagalkote, Karnataka (2011) showed caries prevalence of 63.57 % among 12 year old children.7The present study showed lower levels of dental caries prevalence as compared to the above mentioned studies. This might be due to use of bore-well water by the school children of Marathahalli area.
Table 4 shows distribution o f DMFT components, mean DMFT and SiC index values according to gender. The mean DMFT and SiC index values were found to be 0.52±0.89,1.54 and 0.68±1.20, 2.0 among boys and girls respectively. The filled component, FT (50 %) was slightly more than the decayed component, DT (49%) among boys and decayed component, DT (51 %) was slightly more than the filled component, FT (50 %) among girls.
In the present study, the mean DMFT score was higher in girls (0.68) as compared to boys (0.52) (Table 4). The results were in accordance with the studies conducted by Dhar et al10, Sarvanan et al11, Goel et al12and Chitke et al13, also reported that DMFT scores were high in girls compared to boys. The reasons might be due to increased exposure of susceptible tooth to poor oral hygiene conditions10,11'12and earlier eruption time of the permanent teeth in girls may have been responsible for the higher caries experience.13
DISCUSSION The present study was carried out to assess the prevalence of dental caries among 12 and 15 year old school children in government schools of Marathahalli area o f Bangalore city. The purpose of the study was to collect baseline data for caries prevalence and to plan and evaluate school oral health programs in the future for these age groups. 3
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In the present study, the decayed component, DT (66%) contributed the most to the DMFT values followed by filled component, FT (50%) and missing component, MT (0%), among 12 year old age group, indicating an unmet need for treatment (Table 3). The results were in accordance with the result of the study in Belgaum city of Karnataka in 2002, where decayed part (DT) contributed to 92.20 % o f the total DMFT.5 The difference between the 'D' and 'F' components indicated poor dental health awareness and low priority placed on oral health care among 12-year old children. Also, in the present study, among 15 year olds, the filled component, FT (50%) was more than the decayed component, DT (34%) which indicated better oral health awareness and high priority placed on oral health care among this population (Table 3).
these age groups by inclusion o f factors like sugar consumption, oral hygiene practices, fluoride exposure, socio-economic factors etc. which play an important role in caries development.
REFERENCES
In the present study, SiC index was used to draw attention to those individuals with the highest caries scores since the caries distribution was observed to be generally skewed.14 The present study showed an overall SiC index value of 1.78 for both the age groups. For 12 year and 15 year olds, the SiC index values were 1.52 and 2.16 respectively (Table 3). In Karnataka, the results of National Oral Health Survey and Fluoride Mapping, 2002-2003 showed SiC index values of 6.0 and 3.8 among 12 and 15 year olds.15 The present study showed low levels o f SiC index values as compared to the above mentioned study. However, the SiC index values in the present study were well below the upper limit of SiC value o f 3 set by WHO as a global average.
1.
Souza ML, Bastos JLD, Peres MA. Trends in dental caries rates in 12- and 13-year-old school children from Florianopolis (Brazil) between 1971 and 2005. Oral Health & Prev Dent. 2006;4(2):187192.
2.
The WHO Oral Health “Country/Area Profile Programme” (The CAPP) for AMRO region http://www.mah.se/CAPP/Country-Oral-HealthProfiles/AMRO/Accessed on Sept. 19,2011.
3.
The WHO Oral Health “Country/Area Profile Programme” (The CAPP) for EURO region http://www.mah.se/CAPP/Country-Oral-HealthProfiles/EURO/ Accessed on Sept. 19,2011.
4.
Bali RK, Mathur VB, Talwar PP, Chanana HB. National Oral Health Survey and Fluoride Mapping [India], 2002-03 (Summary), Dental Council of India, New Delhi: 2004.
5.
Kulkami SS, Deshpande SD. Caries prevalence and treatment needs in 11-15 year old children of Belgaum city. J Indian Soc Pedod Prev Dent. 2002 Mar;20(l): 12-15.
6.
Sudha P, Bhasin S, Anegundi RT. Prevalence of dental caries among 5-13-year-old children of Mangalore city. J Indian Soc Pedod Prev Dent. 2005 Jun;23(2):74-79.
7.
Bhaskar DJ, Sardana V, Aswini YB, Aruna DS. Prevalence of dental caries and treatment needs among 12 year old school going children in rural Bagalkote, Karnataka. JIDA. 2011 Jan;5(l):85-86.
8.
WHO. Oral health surveys, basic methods. 4th ed. Geneva. World Health Organization; 1997.
9.
Hedge PP, Ashok KB, Ankola VA. Dental caries experience and salivary levels o f Streptococcus mutans and Lactobacilli in 13-15 years old children of Belgaum city, Karnataka. J Indian Soc Pedod Prev Dent. 2005 Mar;23(l):23-26.
CONCLUSION The present study demonstrated low dental caries prevalence as compared to the previous studies in Karnataka. However, there was a large amount of untreated carious lesions among these age groups. The data may be of importance in the planning and evaluation of the future school oral health programs, especially targeting the high risk groups among these populations. Further studies are required to assess dental caries status among
10. Dhar V, Jain A, Van dyke TE, Kohli A. Prevalence of dental caries and treatment needs in the school going children of rural areas in Udaipur District. J Indian Soc Pedod Prev Dent.2007 Jul-Sep;25(3): 119-121.
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11. Saravanan S, Kalyani V, Vijayarani MP, Jaya Kodi P, Felix JW, Arunmozhi P, et al. Caries prevalence and treatment needs of rural school children in Chidambaram Taluk,Tamil Nadu, South India. Indian J Dent Res. 2008; 19:186-190.
14. Bratthall D. Introducing the significant caries index together with a proposal for a new global oral health goal for 12-year olds. Int Dent J 2000;50:378-384. 15. Mathur VB, Talwar PP, Bali RK, Hiremath SS, Puranik MP, Chanana HB. National oral health survey and fluoride mapping 2002-2003, Karnataka. Dental Council of India, New Delhi: 2004.
12. Goyal A, Gauba K, Chawla HS, Kaur M, Kapur A. Epidemiology of dental caries in Chandigarh school children and trends over the last 25 years. J Indian Soc Pedod Prev Dent. 2007; 25:115-118. 13. Chitke UME, Rudolph MJ. Caries patterns in Gazankulu. J Dent Res. 1990;69:1087.
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Impact of An Effective Tongue Cleaner- A Randomized Double-blind, Parallel Design Study Mansi Atri, mds* Anup N, MDS** ABSTRACT Introduction: In order to remove tongue biofilm and improve breath odor, specific instruments (tongue scrapers) or toothbrushes are used. Material & Methods: This study compared the effectiveness of a manual toothbrush that has a tongue scraper on the back o f its head and two commercially available tongue scrapers in reducing the tongue coating and aerobic and anaerobic microbiota o f the tongue dorsum. A randomized, negative controlled, double-blind, parallel design study for three different treatment interventions was conducted. Results: All tongue cleaners showed a significant reduction in Winkel's tongue coating scores with significant values o f reduction (p23 Total
6 (30.00) 5 (25.00) 11 (55.00)
7 (35.00) 2(10.00) 9 (45.00)
of aerobic and anaerobic bacterial count when was compared between the three intervention products used in the study, a highly significant value was obtained when the mean reduction of bacterial count of brush scraper was compared to plastic scraper. Mean reduction o f bacterial load with plastic scraper in comparison to the others showed significant reduction. (Table 5 and 5a).
13(65.00) 7 (35.00) 20 (100.00)
Mean age (Male)= 24.18 + 3.38 Mean age (Female)= 23.44 + 3.97
Table. 2 Mean WTCI Scores of three tongue cleaning Aids Mean Pre Post difference WTCI-I (Brush) WTCI-II (plastic scraper) WTCI-III (Metal scraper)
After each intervention the subjects were assessed on the usage and effects o f the products provided to the subjects. Eighty percent o f the study subjects reported reduction of halitosis with brush and plastic tongue scraper. About fifty percent of the subjects reported change in taste alteration after usage of plastic tongue scraper. More than three fourth of the subjects using plastic tongue scraper reported increased gagging reflex and discomfort level. (Table 6).
5.55 + 2.73 1.85 + 2.68* 3.70 + 2.68 5.57 + 2.67 2.90 + 1.73* 2.80 + 2.29 6.35 + 1.95 3.35 + 1.96* 3.00 + 1.55
*p < .001
The mean values of pre and post intervention scores o f the aerobic bacterial count were compared for the three different tongue cleaning aids used and all aids showed a significant reduction. The mean reduction scores were highly significant (p 106 colony-forming units/ml o f saliva and /or lactobacilli at > 105 colony-forming units/ml of saliva place an individual at high risk for caries development.10 Thus, antimicrobial action of certain salivary constituents brings down the microbial count and in turn reduces the risk for development of dental caries. Saliva as a Deleterious Factor in Dental Caries Bacterial plaque is a biofilm that covers all the oral structures. It is partly cellular, fundamentally
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and anaerobic m icroorganism s b egin to predominate in the deeper layers.
transmissible disease was first demonstrated by Keyes in the year I960.19 Since then, a group of phenotypically similar bacteria, collectively known as Mutans Streptococci, has been implicated as the principal bacterial component responsible for the initiation and the development o f dental caries.20 The current concept of dental c a rie s fo cu ses on th e fe rm e n ta tio n o f carbohydrates by cariogenic bacteria producing organic acids. Plaque bacteria produce a variety of end-products that may differ depending on the diet. When fermentable carbohydrates are present, the main organic acids produced are lactic, formic, and acetic acid.21,22 These acids coincide with a pH drop in plaque, resulting in demineralization of the tooth20,23 and creating an environment which is advantageous for further growth of Streptococcus mutans.24'25 In addition to acid production, mutans streptococci express a wide range o f virulence factors that are responsible for the cariogenicity of the dental plaque. However, saliva provides the main host defense system against these virulence factors and the balance between demineralization and remineralization is continuously affected by the interaction of bacterial virulence factors and host defense.1
Salivary constituents in enamel pellicle act as a source of energy for certain bacteria. Cariogenic organisms like streptococci and lactobacilli within dental plaque possess several properties like rapid transport o f fermentable carbohydrates and conversion to organic acids, production of intracellular and extracellular polysaccharides and maintenance of carbohydrate metabolism under adverse conditions and stress.10Furthermore, alpha amylase, a constituent of acquired enamel pellicle derived from saliva may facilitate dietary starch hydrolysis to provide additional glucose for metabolism by plaque microorganisms in close proximity to the tooth surface. The resulting organic acids produced may be added to the pool of acid in p la q u e to c o n trib u te to to o th demineralization. Salivary glucose in normal concentration is not believed to have an influence in the development of dental caries. However, high salivary glucose levels found in case o f persons with diabetes mellitus would provide a continuous source of cariogenic substrate for glycolytic bacteria which might favor dental caries formation.
The m ost im portant caries-preventive functions of saliva are the flushing and neutralizing effects, commonly referred to as “salivary clearance” or “oral clearance capacity”.26 In general, the higher the flow rate, the faster the clearance27 and the higher the buffer capacity.28 According to Brown et al (1978) and Scully (1986), it is believed that dental caries is the most common consequence of hyposalivation.29,30 Caries lesions start developing rapidly and also on tooth surfaces that are usually not susceptible to dental caries. Subjects with impaired salivary flow rate often show high caries incidence31,32 or caries susceptibility.33A couple of studies have reported that no linear relationship exists among salivary secretion rate, caries activity, and DMFS/DMFT values.28,34 Only weak or no association between salivary secretion rates and caries incidence has
The main contributor to salivary viscosity is the mucous glycoprotein (MUC5B), secreted primarily by minor mucous glands. It has been found that mucoid saliva results in reduced clearance o f ingested material from the oral cavity when compared to serous saliva.1,4 1317 Thus, mucous nature o f saliva and constituents of acquired enamel pellicle acting as source of energy and facilitating the adherence o f microorganisms to the tooth surfaces, high amounts of salivary glucose and lipids can be considered to be deleterious factors favoring formation o f dental caries.
DISCUSSION Dental caries is a unique multifactorial infectious disease with complex etiology. The notion that dental caries in animals is an infectious,
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In addition to the three major buffer systems in saliva, urea molecule and sialic acid are believed to act as buffers. There seems to be no conclusive evidence that the salivary content of urea will influence caries, even though increased salivary levels of urea are found in subjects with low caries prevalence.45 Eggers-Lura found in the year 1961 that sialic acid, an implicated chelating agent found in saliva, was positively associated with active dental caries.46 Later, in the year 1967, a study conducted by W illiams did not find any relationship between sialic acid and dental caries.47 Recently, it has been reported by Yarat et al that sialic acid levels were higher in Down’s syndrome subjects who are believed to have low prevalence o f dental caries.48 Thus, further investigations are warranted to document the role of sialic acid in dental caries.
been shown.35'37 However, a systematic review done by Leone et al in 2001 showed that salivary flow rate had a strong association with caries risk.38 Buffering capacity o f saliva is an indicator of caries susceptibility. The buffer capacity of both unstimulated and stimulated saliva involves three major buffer systems: the bicarbonate, the phosphate, and the protein buffer systems. These systems have different pH ranges o f maximal buffer capacity,39 the bicarbonate and phosphate systems having pKa values of 6.1-6.3 and 6.8-7.0 respectively.1 According to Wah Leung (1951), about 85% of the total buffering capacity of the saliva comes from the bicarbonate system.40 The phosphate and protein buffer systems make a minor contribution to the total salivary buffer capacity, relative to the bicarbonate system. Phosphate buffer system is likely to be important at unstimulated flow rates.26
An inverse relationship between buffer capacity and caries experience is well-established according to Ericsson (1959), who evaluated 21 reports published up to 1956.49 On a population level, salivary flow rate and buffer effect show an inverse correlation with caries susceptibility.33 Among the elderly, an inverse relationship of salivary buffer capacity in stimulated saliva has been established for both enamel50 and root caries.51, 52 The salivary buffer effect in unstimulated saliva is sparsely documented. However, Larsen and co-workers have emphasized that the buffering capacity of unstimulated saliva varies so much that single measurements are not reliable for caries prediction.53
Carbonic anhydrase (CA VI) catalyzes the reversible reaction by which bicarbonate ions neutralize the acids formed by plaque bacteria. Kivela and co-workers have shown that salivary CA VI correlates negatively with DMFT values, especially in individuals with poor oral hygiene.41 In 1974, Szabo reported higher CA activity levels in caries-free children than in children with active caries.42 Since there is a positive correlation between CA VI concentration and salivary flow rate, and a negative correlation with the DMFT index, it was believed that salivary CA VI plays a role in protecting the teeth from caries.41,43Contrary to earlier predictions, CA VI does not seem to be directly involved in the regulation of actual salivary pH or buffer capacity, and no correlation has been found between salivary CA VI concentration and mutans streptococci or lactobacilli levels.41 CA VI has been reported to bind to the enamel pellicle and retain its enzymatic activity on the tooth surface.44 In the enamel pellicle, CA VI may catalyze the conversion of salivary bicarbonate and microbe-delivered hydrogen ions to carbon dioxide and water.1
Acquired enamel pellicle is a thin film consisting mainly of salivary proteins selectively adsorbed to the surface of the enamel. The pellicle protects the enamel from dissolution. Diffusion fluxes are reduced by 50% in the presence of pellicle 54 leading to a decreased demineralization potential of the acids secreted by bacteria.55 The pellicle is also a base to which the bacteria can adhere to the tooth surfaces. The binding of bacteria is mediated by non-specific electrostatic and van der Waals forces, but also by specific
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interactions between bacteria and the proteins on the salivary pellicle. Thus, colonization of microbial flora on the tooth surface is strongly modified by salivary proteins.56 Several proteins like parotid saliva agglutinins, alpha-amylase, statherins, mucins, acidic PRPs, and salivary immunoglobulins are reported to bind with oral streptococci.57These proteins are also found in the salivary pellicle, and therefore, they are likely to mediate the specific adhesion o f bacteria to tooth surfaces. It has been suggested that highmolecular-weight parotid saliva agglutinins, and sim ilar proteins found in subm andibularsublingual saliva, are the most important salivary p ro te in s in p ro m o tin g the ad h esio n o f Streptococcus mutans.58'60
salivary defense against oral microbial flora, including mutans streptococci. The most abundant immunoglobulin in saliva is dimeric slgA, which is produced by plasma cells located in the salivary glands. Immunoglobulins act by neutralizing various microbial virulence factors, limiting microbial adherence, and agglutinating the bacteria, as well as by preventing the penetration of foreign antigens into the mucosa. The ability of secretory IgA to inhibit bacterial adherence appears to be related to its ability to bind to surface adhesins of bacteria as well as to neutralize their negative charge. It has also been shown to bind to Mutans Streptococci facilitating bacterial aggregation and removal from the oral cavity. Secretory IgA m olecules are m ultivalent antibodies and can prevent the adverse effects of bacterial toxins and enzymes. IgGs are also capable o f opsonizing bacteria for phagocytes, which are reported to remain active in dental plaque and saliva.67'68 Phagocytosis may be especially important in modifying microbial flora during tooth eruption when high amounts of IgGs and neutrophils exist in close contact with the teeth. Extensive review done by Marcotte and Lavoie revealed conflicting results for relationship between salivary IgA and dental caries.69
On the other hand, when the same proteins exist in the liquid phase, they may promote bacterial aggregation and hence the clearance of bacteria from the oral cavity. The two most abundant agglutinins in saliva are high-molecularweight agglutinin from parotid saliva and mucins. O f the mucins, the low-molecular weight form, MG2, is more efficient in bacterial aggregation and clearance than the high-molecular weight form, MG1.61In addition to the bacterial aggregation and clearance, mucin was considered to be the main contributor to viscosity o f saliva, particularly MG1. Mucoid saliva results in reduced clearance of ingested material from the oral cavity1,4,1417when compared to serous saliva. In the saliva o f cariesresistant patients, MG2 predominates, whereas the level o f MG1 is higher in caries-susceptible patients.62 On the contrary, mucin protease activity in the saliva of caries-resistant individuals is 3.8 fold greater than that in caries-susceptible individuals.62 However, several studies have reported an inverse relationship between the aggregating activity of saliva and colonization o f S. mutans 6365and also a positive correlation between the adhesion-promoting activity o f saliva and dental caries.66
C o m p a riso n o f d iffe re n t stu d ie s is complicated, since different samples are collected, and in some studies the immunoglobulins levels are correlated with DMFT/DMFS scores (that is, past experience of caries), whereas in other studies they are correlated with the presence of active caries (a situation which may take several months to develop), or with the levels o f mutans streptococci in the oral cavity. It must also be noted that the presence of active caries lesions may induce the formation of specific IgG s,70,71 and that they may remain at a higher level for several weeks or months after eradication o f the lesions. Further, it has been postulated that part of the detected IgAs against mutans streptococci is generated by cross reactivity with antigens from other bacteria. C ertain d iseases, such as selective IgA immunodeficiency, were believed to provide a
The im m unoglobulins IgG, IgM, and secretory IgA (slgA) form the basis of the specific
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unique model for the evaluation of the role o f slgA in the colonization of mutans streptococci and also dental caries. However, even these results are contradictory, and an increased, decreased, or lack of correlation between IgA deficiency and caries susceptibility has been reported.72 In a systematic review, it was concluded that specific slgA levels against mutans streptococci has a weak-tomoderate association with caries risk.38 There is insufficient evidence regarding the role of IgG and IgM in determination of caries risk.
other salivary host defense proteins by having a specific function, i.e., the maintenance of the homeostasis of the supersaturated state of saliva. Statherins, the acidic PRPs, cystatins, and histatins in saliva help to m aintain a stable and supersaturated environment. Supersaturation suppresses any tendency for the tooth enamel to dissolve, and under the right conditions, enables demineralized enamel to remineralize. These proteins are too large to penetrate enamel pores and therefore remain on the surface, bound to hydroxyapatite, to aid in controlling crystalline growth of enamel by allowing the penetration of minerals into the enamel for remineralization and by limiting mineral egress.88,89In other words, they maintain the pathways through which calcium phosphate ions can diffuse into the tooth enamel thereby favoring remineralization of tooth surface. However, these components are also present in the acquired enamel pellicle which are known to favor the adhesion of microorganisms to the tooth surface and can also act as source o f energy for microorganisms in dental plaque.
The main oral innate defense factors are the peroxidase systems, lysozyme, lactoferrin, and histatins. In vitro, these proteins are known to limit bacterial or fungal growth, interfere with bacterial glucose uptake or glucose metabolism, and promote aggregation and thus the elimination of bacteria. The data obtained so far are mainly from in vitro studies, and there is only limited information on how these molecules act in vivo.73,74 Twetman et al reported statistically significant higher lysozyme concentration in paraffinstimulated whole saliva of caries-free children as compared to caries-susceptible children75 whereas no correlation was reported in studies conducted by Mandel, Bowen, Cole et al, Stuchell, Mac Kay et al.76'80 There are no reports regarding relationship between lactoferrin and dental caries. With respect to peroxidase system, conflicting results were obtained. Positive correlation was seen by Wolfe and Turner81 whereas negative correlation was reported in two other studies.82'83 No correlation between peroxidase system and dental caries was reported in studies conducted by Mandel et al and Lamberts et al.84'85However, none of these innate defense components singly have been found to have a significant relationship with dental caries.
In the dynamic balance of the caries process, supersaturation of the saliva with calcium and phosphate provides a barrier to demineralization and tips the balance towards remineralization. Presence of fluoride assists this balance. Among salivary electrolytes, several studies have shown that calcium and phosphate have a modest inverse association with dental caries38whereas two studies have found no such relationship.90,91 Salivary fluoride has a consistent inverse relationship with caries experience.92There is limited evidence about other electrolytes like sodium, potassium and magnesium to document their role in relation to dental caries. Studies related to trace elements in saliva and dental caries is very limited and hence its role remains uncertain.
Human salivary secretions are supersaturated with respect to calcium and phosphate86'87 but spontaneous precipitation from saliva to dental enamel does not normally occur. This unexpected stability is mediated by a group of salivary proteins, namely, statherins, the acidic PRPs, cystatins, and histatins. These proteins differ from
In reality, saliva has a complex chemistry and a wide array o f biochemical actions which may significantly affect plaque chem istry and microbiology. Protective functions of saliva are clearance o f food, buffering action, antibacterial
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REFERENCES
activity and maintenance o f integrity o f tooth structure. Despite the enormous protective functions, there exist very few components in saliva mediating the adhesion of microorganisms to the tooth surfaces and acting as substrates for their survival, which may be unfavorable for the host. However, there are certain agents in saliva whose role in relation to dental caries has not been clearly investigated. Further research has to be carried out to determine the association of such components with dental caries. Furthermore, in areas where controversial reports are reported, further studies have to be conducted with appropriate methodology and study design in order to obtain conclusive evidence.
CONCLUSIONS Dental caries remains as the major public health problem. In developing countries where resources are limited, it is essential that screening has to be carried out at population level and high risk individuals should be identified in order to direct the preventive interventions towards them. Past caries experience has been the most powerful single predictor for future caries incidence. However, caries risk prediction should be done even before there are any signs o f past caries experience. For this purpose, a cost-effective risk m arker w ith 100% sensitivity and 100% specificity, is highly warranted. Unfortunately, there is no such ideal risk marker. It is also emphasized that caries risk cannot be assessed accurately by using one single risk marker owing to its multifactorial and complex etiology. However, analysis o f the quantity and quality o f saliva can be considered as one o f the risk prediction methods since saliva collection is simple, non-invasive and feasible at population level. It is said that saliva is the “magic mirror o f the body” and research is directed towards diagnosing systemic diseases, and monitoring of drugs and hormones with this fluid. Thus, saliva is the most valuable and noninvasive diagnostic tool for oral as well as systemic diseases.
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Oral hygiene practices, Oral hygiene and Periodontal status among prisoners in Lucknow-A Cross Sectional Study Sanjay Kumar Singh, mds* Sabyasachi Saha, mds** G.V. Jagannatha, mds*** Priyanka singh, mds**** ABSTRACT Introduction: Oral health is an integral part o f general health. It has long been recognized that preventive oral care is important in the prevention of oral diseases, which also has significant impact on general health. The prisoners also deserve equal rights for their health attention. Aim and objective : To assess the Oral hygiene practices and oral hygiene and periodontal status ofprisoners of Lucknow city. Methodology : A cross sectional survey, with a sample size of 1011 (826 males and 185 females) prisoners was conducted. Prisoners who were in the jail for more than 3 years were included in this study. Results : Inmates belonged to the age range of 18-80 years, with the mean age of 37.3±11.8 years. About 62% inmates were using tooth brush and toothpaste for cleaning their teeth followed by those using finger with tooth paste/powder (24.3%). In general most of them (97.7%:988) were using tooth brush. On the whole the mean CPI code of the inmates was 2.1±0.9 and mean loss of attachment o f the inmates was 0.32±0.5. The mean OHI-S score was significantly higher for males than female across all age groups (p
