Similar to that which occurred in most developed countries, dental caries have shown a significant decline in Brazil over the last two decades. Water fluoridation, expansion of preventive programs at schools, and especially, the widespread use of fluoride dentifrice are discussed as factors related to this reduction in caries. Data from epidemiological surveys and historical facts are presented to support the importance of fluoride dentifrices to the current caries prevalence in Brazil.

Since in vitro and animal studies suggest that the combination of starch with sucrose may be more cariogenic than sucrose alone, the study assessed in situ the effects of this association applied in vitro on the acidogenicity, biochemical and microbiological composition of dental biofilm, as well as on enamel demineralization. During two phases of 14 d each, fifteen volunteers wore palatal appliances containing blocks of human deciduous enamel, which were extra-orally submitted to four groups of treatments: water (negative control, T1); 2 % starch (T2); 10 % sucrose (T3); and 2 % starch þ 10 % sucrose (T4). The solutions were dripped onto the blocks eight times per day. The biofilm formed on the blocks was analysed with regard to amylase activity, acidogenicity, and biochemical and microbiological composition. Demineralization was determined on enamel by cross-sectional microhardness. The greatest mineral loss was observed for the association starch þ sucrose (P,0·05). Also, this association resulted in the highest lactobacillus count in the biofilm formed (P,0·05). In conclusion, the findings suggest that a small amount of added starch increases the cariogenic potential of sucrose. Among dietary carbohydrates, starch has been pointed out as noncariogenic or slightly cariogenic when used as the sole source of carbohydrate in the diet. This observation has been supported by experiments on dental biofilm acidogenicity (Stephan, 1940;Imfeld, 1977;Lingström et al. 1989), experimental studies with animals (König & Grenby, 1965;Green & Hartles, 1967;Hefti & Schmid, 1979;Bowen et al. 1980), controlled studies in man (Gustaffson et al. 1954), epidemiological data (Marthaler & Froesch, 1967;Fisher, 1968;Newbrun et al. 1980) and in situ experiments (Lingström et al. 1994), which demonstrated that starch is less cariogenic than sucrose.However, while in primitive diets starch was consumed as the main energy source, in contemporary ones it is consumed simultaneously or interspersed with sucrose (Lingström et al. 2000). This combination, which is consumed by both adults and children, may influence dental biofilm composition and consequently dental caries. Thus, a greater prevalence of caries lesions was found in children who consume milk supplemented with a combination of cereal and sucrose (Mattos-Graner et al. 1998). Such observation in human subjects is supported by the results of experimental caries studies in animals (Firestone et al. 1982;Mundorff-Shrestha et al. 1994), suggesting that starch would enhance the cariogenic potential of sucrose.The explanation for the greater cariogenicity of the association of dietary starch with sucrose may reside in the dental biofilm formed. It is well known that the biofilm formed in the presence of sucrose is more cariogenic due to its high concentration of extracellular insoluble polysaccharides (IP), which alter the matrix of the biofilm, making it more porous (Dibdin & Shellis, 1988). These polysaccharides are produced from sucrose by bacterial enzymes named glucosyltransferases....

A high frequency of consumption of added sugars is associated with periodontal disease, independent of traditional risk factors, suggesting that this consumption pattern may contribute to the systemic inflammation observed in periodontal disease and associated noncommunicable diseases.

Since viable bacteria can persist in tooth cavities regardless of the technique used for caries removal, the objective of the present randomized clinical trial was to examine the microflora of primary teeth treated by complete or partial removal of carious dentin. Deciduous molars with acute carious lesions in the inner half of dentin and vital pulp were randomly divided into two groups of 16: complete removal, in which the carious dentin was completely removed with the help of a caries detector dye, and partial removal, in which the carious dentin was completely removed from the dentinoenamel junction and lateral walls, while the necrotic carious dentin from the cavity floor was only removed superficially. Dentin samples were obtained with a sterile No. 3 bur after caries removal and 3–6 months after protection with calcium hydroxide cement and restoration of the cavities with resin composite. The samples were stored in thioglycolate. Decimal dilutions were then prepared and seeded for the enumeration of Streptococcus spp., mutans streptococci, Lactobacillus spp. and total microorganisms. Before sealing, a larger number of microorganisms was detected in teeth submitted to partial caries removal compared to the complete removal group. However, after sealing the level of colonization was similar in the two groups for all microorganisms studied. The results suggest that persistence of bacteria does not seem to be a reason for reopening of cavities in deciduous teeth after partial caries removal.

Children overweight or obese, as well as children exhibiting being thin/very thin, were associated with ECC independent of socioeconomic variables and a high frequency of sugar consumption.

Chronic oral diseases are rarely studied together, especially with an emphasis on their common risk factors. This study examined the association of added sugar consumption on "chronic oral disease burden" among adolescents, with consideration of obesity and systemic inflammation pathways through structural equation modeling. A cross-sectional study was conducted of a complex random sample of adolescent students enrolled at public schools in São Luís, Brazil ( n = 405). The outcome was chronic oral disease burden, a latent variable based on the presence of probing depth ≥4 mm, bleeding on probing, caries, and clinical consequences of untreated caries. The following hypotheses were tested: 1) caries and periodontal diseases among adolescents are correlated with each other; 2) added sugar consumption and obesity are associated with chronic oral disease burden; and 3) chronic oral disease burden is linked to systemic inflammation. Models were adjusted for socioeconomic status, added sugar consumption, oral hygiene behaviors, obesity, and serum levels of interleukin 6 (IL-6). All estimators of the latent variable chronic oral disease burden involved factor loadings ≥0.5 and P values <0.001, indicating good fit. Added sugar consumption (standardized coefficient [SC] = 0.212, P = 0.005), high IL-6 levels (SC = 0.130, P = 0.036), and low socioeconomic status (SC = -0.279, P = 0.001) were associated with increased chronic oral disease burden values. Obesity was associated with high IL-6 levels (SC = 0.232, P = 0.001). Visible plaque index was correlated with chronic oral disease burden (SC = 0.381, P < 0.001). Our finding that caries and periodontal diseases are associated with each other and with added sugar consumption, obesity, and systemic inflammation reinforces the guidance of the World Health Organization that any approach intended to prevent noncommunicable diseases should be directed toward common risk factors.

Since there is no consensus on the anticaries effectiveness of low-fluoride (F) dentifrice, this randomized clinical trial evaluated its effect in children at different caries activity status. One hundred and twenty 2- to 4-year-old children, half with and half without active caries lesions, were randomly divided into 2 groups which used 500- or 1,100-µg F/g (NaF) dentifrices during 1 year. Caries progression or regression were evaluated as the number of lesions becoming active/cavities or inactive, respectively. The anticaries effect of the low-F dentifrice was similar to the conventional F dentifrice when used by caries-inactive children. However, in children with active caries lesions the low-F dentifrice was less effective than the 1,100-µg F/g dentifrice in controlling the progression of lesions. The data suggest that the child caries activity may be taken into account to recommend a low-F dentifrice.

Objectives This study was conducted to investigate the association between prolonged breastfeeding and early childhood caries(ECC) with adjustment for important confounders, using hieraschical approach. Methods This retrospective cohort study involved 260 low‐income children (18–42 months). The number of decayed teeth was used as a measure of caries. Following a theoretical framework, the hierarchical model was built in a forward fashion, by adding the following levels in succession: level 1: age; level 2: social variables; level 3: health variables; level 4: behavioral variables; level 5: oral hygiene–related variables; level 6: oral hygiene quality measured by visible plaque; and level 7: contamination by mutans streptococci. Sequential forward multiple Poisson regression analysis was employed. Results Breast‐feeding was not a risk factor for ECC after adjustment for some confounders (incidence density ratio, 1.15; 95% confidence interval, 0.84–1.59, P = 0.363). Conclusion Prolonged breast‐feeding was not a risk factor for ECC while age, high sucrose comption between main meals and the quality of oral higiene were associated with disease in children.