Prevention Of Dental Decay And Research On Dental Microbiology Genetic Profiling Of High Risk Individuals By Dr Tina Mohindra
In 2006 I completed my Ph.D. research which I undertook at The University of Liverpool Dental School and Kings College London. The aim of my research was to investigate how a new in-school dental regime can improve the occurrence of dental caries (decay) in adolescence who are at a high risk of developing this dental disease. This research was funded by Gaba International which is now part of Colgate. I was specifically looking at how the use of a novel fluoride gel can effect the bacteria present in the mouth of high risk individuals.
For teeth to decay, there are four factors involved:
Dental decay is a preventable disease, however some people can be at an increased risk. As most of us know, the more sugar we have in our diet, the more likely we are to develop dental decay. This is because the bacteria that reside on our teeth flourish and multiply in the presence of sugar and then produce acid which erodes the enamel on our teeth. Tiny parts of erosion create ideal crevices on the tooth surface for bacteria to live and thrive. Certain bacteria are known specifically to increase the risk of dental decay than other. The most commonly known decay causing bacteria are Steptococcus Mutans, Lactobacilli and Candida Albicans (fungi).
My research was part of a randomised double blind clinical trial looking at the effect that brushing with elmex gel in addition to normal oral hygiene routine, has on the microbiology of the mouth and consequently the onset of dental decay. For this research I carried out genetic profiling of oral biofilms to see how this changes with the use of elmex gel.
Scientist and dentists, here is an abstract to our research:
Randomised Controlled Trial of the Efficacy of a High-Fluoride Gel Self-Applied by Toothbrushing in Children at High Caries Risk
E Stokes, CM Pine, A Ashcroft, G Burnside, T Mohindra. September 2011
The primary objective of this clinical trial was to assess the caries-preventive efficacy of 2 years of twice weekly supervised brushing with a self-applied gel containing 12,500 ppm fluoride on schooldays compared with weekly supervised use in children at high caries risk (with prior caries experience on first permanent molars). The secondary objective was to assess efficacy compared with similar children who continued with their usual oral hygiene care. This was a single-centre, single-blind, randomised, parallel-groups trial comprising two test groups and one untreated control group. 1,075 pupils aged 12-13 years at baseline received a baseline and final examination 2 years later. For all children completing the trial no significant difference was found between groups. For children compliant with study protocol no significant difference was found in the primary outcome (D(1)FS caries increment), but significant differences were found between the three groups overall in the secondary outcome, D(3)FT caries increment, with a significant pairwise difference between control and twice per week gel brushing (29%, p = 0.023 D(3)FT visual + fibre-optic transillumination). Analysis of the relationship between number of gel applications and caries showed that children who brushed with the gel at least 60 times over a 2-year period developed significantly fewer carious lesions into dentine than children who followed their usual oral hygiene routine. Some caution is needed as greatest benefit was shown by compliant children. Where schools are co-operative, it is recommended that the gel be used twice a week within a school-based programme over a 2-year period.
The findings were very interesting. While the extra brushing with the high fluoride gel significantly reduced the onset of dental caries, it did not have a huge effect on the dental microbiology. There was little change in the genetic profiling of the biofilms and little change in the occurrence of dental caries causing bacteria. The fluoride gel therefore works directly by re-mineralising the tooth surface after a bacterial acid attack. There was a reduction on dental bacteria from the extra tooth brushing sessions whether or not the fluoride gel was used, but not enough to significantly reduce the onset of dental decay.
Our research shows importance of good oral hygiene and the use of a fluoride to prevent the onset of dental decay.
The White Bridge Clinic is committed to promoting prevention of dental problem by encouraging people to have regular dental examinations and hygiene visits. Our appointments always include advice on looking after your teeth and we can recommend a range of tested products to help you with this.
I hope you enjoyed reading a very brief description of my research.
Dr Tina Mohindra
Director and Manager
The White Bridge Clinic
For further information please call 01865 951 861 or email us on firstname.lastname@example.org