Los cambios demográficos y epidemiológicos actuales determinarán un aumento en la prevalencia e incidencia de caries, específicamente lesiones de caries radicular (RCLs, por sus siglas en inglés) en personas mayores, por lo que la necesidad de tratamiento de mayor cobertura y efectividad será también cada vez mayor. Este artículo resume en español la evidencia actual disponible acerca de las recomendaciones clínicas para las intervenciones preventivas, no invasivas, micro o mínimamente invasivas e invasivas para el manejo de la caries dental en personas mayores, con especial énfasis en RCLs. La presente publicación se basa en un taller de consenso, seguido de un proceso de consenso e-Delphi, realizado por un panel de expertos nominados por la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ). El propósito de este artículo es presentar las principales conclusiones alcanzadas en el consenso de ORCA/EFCD/DGZ para permitir una mejor difusión del conocimiento y la aplicación de estos conceptos en la práctica clínica, orientando la correcta toma de decisiones en el manejo de la enfermedad y RCLs en las personas mayores.

Nutritional supplements have been recommended to cope with malnutrition in elderly persons. In Chile, the Supplementary Nutrition Program for the Elderly (PACAM, for its Spanish acronym) consists in a monthly distribution of a low-fat-milk-based drink that contains 8% sucrose. The aim of this study was to determine whether older persons consuming the milk-based drink have a higher caries experience when compared to those not receiving the supplement. A cross-sectional study was conducted in the Maule Region in Chile. The representative sample comprised two groups: (a) PACAM consumers (CS) (n = 60) and (b) nonconsumers (NCS) (n = 60). Participants received intraoral examination and coronal (DMFT/DMFS) and root caries (RCI index) experience were recorded. Additionally, questionnaires regarding acceptability and consumption habits of PACAM and a 24-h diet recall were applied. The influence of predictors was calculated using binary logistic regression for a dichotomized DMFS and Poisson Regression for root caries lesions. A p value <0.05 was considered significant. No differences were detected in food consumption patterns between study groups (p > 0.05). CS participants had increased dairy product consumption. Higher DMFS mean value was observed in the CS (85.35 ± 39.0) compared with NCS (77.28 ± 28.9) (p = 0.043). The multivariate analysis showed nonconsumers of the milk-based product (β = −0.41, p = 0.02) are less likely to have root surfaces affected by caries. Additionally, CS show higher RCI, compared to nonconsumers (β = −0.17, p = 0.02). Daily consumption of a PACAM’s milk-based drink supplement seems to increase coronal and root caries risk. Based on these results, composition modification of milk-based drinks with added sucrose appears mandatory.

New paradigms in caries conceptualization have emerged during the last decades, leading to intense debate and discussion on how to approach the disease, both from a preventive and a therapeutic perspective. Among many new ideas, research discoveries and technologies, one major concept can be highlighted that created a deep frontier between the old and the new paradigm in caries conceptualization; the non-communicable nature of the disease, firmly associated with behaviors and lifestyles. This article synthetizes the conceptual construction of dental caries as a non-communicable disease (NCD) based on the current evidence and discusses the appropriate management of the disease in this context. Dental caries has shifted from being considered transmissible and infectious to an ecological and non-communicable disease. Environmental factors such as frequent sugars intake, disrupt the symbiosis of the dental biofilm leading to a dysbiosis, which favors caries lesion initiation and progression. As an NCD, dental caries shares characteristics with other NCDs such as cardiovascular and chronic respiratory diseases, cancer and diabetes, including long duration and slow progression, not being transmissible from person-to-person, being strongly related to modifiable behavioral risk factors, and affecting preferentially disadvantaged populations with a strong inequality gradient. Given the high prevalence of dental caries, and its consequences on people's health and quality of life, a recognizable conceptual view of caries as a NCD is required to target an effective management. Current understanding of dental caries supports prevention through acting on the modifiable risk factors (behaviors) and involves management based on an interdisciplinary approach. Communicating these modern concepts among researchers, clinicians and policymakers is needed to decrease the global high burden of the disease.

Objective: This study aimed to evaluate the anti-caries effect of a fluoridated milk-based drink on a root caries model by assessing mineral loss and both biofilm microbial viability and acidogenicity under increasing concentrations of fluoride supplementation. Design: Streptococcus mutans UA159 biofilms were grown on root dentin slabs for five days. The slabs were randomly assigned to following groups: milk-based drink (G1) and milk-based drink supplemented with 5-ppm NaF (G2), 10 ppm NaF (G3), and 20 ppm NaF (G4). A 10% sucrose and 0.9% NaCl solution were used as positive and negative-caries controls, respectively. Slabs/biofilms were exposed to the different treatments 3 times/day for 5 min. To estimate biofilm acidogenicity, the pH of the spent media was serially measured to calculate the area above the curve. Viable bacteria and dentin demineralization were assessed after the experimental phase. Results were compared using ANOVA followed by the Tukey test. Results: G1 exhibited slightly lower acidogenicity than the positive caries control group (p <0.05). G2, G3, and G4 induced lower acidogenicity than 10% sucrose and the non-supplemented milk-based drink. The lowest acidogenicity was found in G4 (p < 0.05). Fluoride-supplemented milk-based drinks (G2, G3, and G4) resulted in lower bacterial counts (p < 0.05) and induced lower demineralization (p < 0.05) than the positive caries control and non-supplemented milk-beverage (G1). There was a dose-dependent inhibition of demineralization with fluoride-supplemented milk-based drinks. Conclusions: Fluoride supplementation of a milk-based drink for older adults may reduce its cariogenicity in mot dentin.

Objetivo: Creación de un currículo de competencias mínimas en Cariología, para la formación de los Cirujano-Dentistas egresados de las escuelas de Odontología de Chile.

The aim of this study was to evaluate the cariogenicity of a milk-based drink intended for older adults that was used as part of a governmental initiative in Chile to improve their nutritional conditions. This drink contains a high concentration of sugars, which can contribute to root caries development. To test this hypothesis, an experimental biofilm/caries model was used. Dentin slabs were used to grow biofilms of Streptococcus mutans UA159. Slabs/biofilms were exposed 3× per day to bovine milk with different fat content, the milk-based drink, and the milk-based drink supplemented with 10 g of sucrose added per serving. Slabs exposed to 10% sucrose or 0.9% NaCl were used as positive and negative controls, respectively. Biofilms were analyzed for bacterial counts and acidogenicity. Dentin demineralization was estimated by the loss of surface microhardness and integrated mineral loss. Results were compared by analysis of variance and Tukey’s test. The milk-based drink showed higher acidogenicity than milk with its entire (whole) or reduced total fat content (skim). The milk-based drink supplemented with ­sucrose had similar acidogenicity as the 10% sucrose positive control (p = 0.506). Whole milk exposure elicited lower bacterial counts than the positive control, the milk-based drink, and the milk-based drink supplemented with sucrose (p = 0.002; 0.006 and 0.014 respectively). Although skim milk induced higher demineralization than whole milk, both milk types produced lower demineralization than the milk-based drink. Regarding integrated mineral loss, demineralization induced by the milk-based drink and the milk-based drink supplemented with sucrose was similar to that induced by the positive control and skim milk (p > 0.05). Sugar-containing milk-based drinks used as dietary supplements for older adults may be highly cariogenic and could represent a potential risk for root caries.

Cite as: Castro RJ & Giacaman RA. Dietary supplements for older adults; risk versus benefits for oral health. J Oral Res 2018; 7(6):228-230. doi:10.17126/joralres.2018.058 In addition to the growing number of older adults worldwide, malnutrition in this age group presents itself as an important challenge. According to the World Health Organization (WHO), the term malnutrition covers two groups of conditions related to the lack of and excess of nutrients. The excess is linked to being "overweight" and to "obesity", while being "undernourished" or "malnourished" is related to the lack of nutrients. According to reports originating in different parts of the world, malnutrition among older adults could affect up to 50% or more of the subjects belonging to this population group. The evidence indicates that an inadequate nutritional status is related to the presence of critical systemic or degenerative diseases. During the aging process, the nutritional status of the subject is an important modulator of the physical and physiological changes that this stage of life entails. Particularly during old age, a poor nutritional status is directly associated with frailty, increasing the risk of suffering geriatric syndromes such as falls, fractures, depression, muscular fatigue, functional impairment and depressed immunity, among others. Related to the above, older adults have poor oral health.1 In this population, the most prevalent disease and the main cause of tooth loss is dental caries, characterized by lesions that affect the crown, as well as the root surface of the tooth.2 Dentin is the tissue that, together with a very thin and sometimes non-existent layer of cement, covers the roots of the teeth. As people age, roots become increasingly exposed to the buccal environment, representing an initiation site for root caries lesions, mostly affecting older people.3 Since the root dentin has a higher content of organic matrix compared to enamel, is more susceptible to rapid demineralization due to the action of the acids produced by the dental biofilm in response to sugars metabolism. For demineralization to occur in enamel, a pH decrease to 5.5 (known as critical pH) is necessary, meanwhile only a slight decrease in the local pH in dentin to about 6.7 is enough to start demineralization.4 Dental caries negatively compromises quality of life in many aspects, ranging from self-esteem to functional capacity during mastication.5 Tooth loss predisposes to reduced functionality, which has been associated with a restriction in the variety and consistency of ingested food. This is mainly because these people can hardly chew foods of Dietary supplements for older adults; risk versus benefits for oral health.

Objective: A high number of proteins has been described in saliva. Scarce evidence allows to speculate about the variations on protein content associated with aging. The aim was to determine if there is a difference in total protein concentration between adults and older adults. Methods: Samples were collected from unstimulated and stimulated saliva of individuals from two age groups, adults (A) (n=30) (mean age 25 years) and older adults (OA) (n=30)

It has been argued that specific salivary proteins could have a protective effect against caries, but data from the many available studies are rather contradictory. The purpose of this study was to analyze whether there is a relationship between protein concentration, electrophoretic profile and concentration of salivary IgA and the presence or absence of caries in adults. Adults with high caries activity (HC) and without caries lesions (CF), assessed by ICDAS criteria, were asked to provide unstimulated saliva samples. Protein concentration (μg/mL) was determined using the Bradford method. Western blotting was used to detect IgA. Data were compared using Student's t test at p<0.05. Total protein concentration in CF was higher (50.65±7.5 μg/mL) than in HC individuals (26.80±2.5 μg/mL) (p=0.001). More protein bands were visualized in the gels from CF than the HC group (p=0.001). CF subjects showed higher salivary IgA concentration (11.27±0.5 μg) than HC individuals (1.71±0.2μg) (p=0.001).Salivary composition in high caries experience and cariesfree young adults seems to differ in terms of the type and amount of proteins. Further research is needed to expand these findings.

Objective: Scarce evidence is available on the cariogenic potential of the widely used commercial sweeteners. The aim of this study was to evaluate the effect of several sweeteners on enamel demineralisation and on the cariogenic properties of Streptococcus mutans biofilms in an artificial caries model.Methods: S. mutans-UA159 biofilms were cultured on bovine enamel slabs and exposed to one of the following commercial sweeteners in tablet or powder form: stevia, sucralose, saccharin, aspartame or fructose. Ten percent sucrose and 0.9% NaCl were used as caries-positive and caries-negative controls, respectively. Slabs/biofilms were exposed to the sweeteners three times per day for 5 min each time. After 5 days, biofilms were recovered to determine: biomass, bacterial counts and intra- and extracellular polysaccharides. Surface microhardness was measured before and after the experiment to assess enamel demineralisation, expressed as percentage of surface hardness loss (%SHL). Data were analysed using analysis of variance (ANOVA) and Bonferroni (p < 0.05).Results: All tested commercial sweeteners, except fructose, showed less enamel demineralisation than sucrose (p < 0.05). Only saccharine showed less biomass and intracellular polysaccharides than the rest of the groups (p < 0.05). Stevia, sucralose and saccharine reduced the number of viable cells when compared with sucrose (p < 0.05). All sugar alternatives reduced extracellular polysaccharide formation when compared with sucrose (p < 0.05).Conclusions: Most commercial sweeteners appear to be less cariogenic than sucrose, but still retaining some enamel demineralisation potential. Products containing stevia, sucralose and saccharine showed antibacterial properties and seem to interfere with bacterial metabolism. Further studies are necessary to deepen these findings. (C) 2013 Elsevier Ltd. All rights reserved.

Objective: A high number of proteins has been described in saliva. Scarce evidence allows to speculate about the variations on protein content associated with aging. The aim was to determine if there is a difference in total protein concentration between adults and older adults. Methods: Samples were collected from unstimulated and stimulated saliva of individuals from two age groups, adults (A) (n=30) (mean age 25 years) and older adults (OA) (n=30) (mean age: 68 years). Subjects with oral/systemic diseases or consuming medications that alter salivary flow were excluded from the study. Each sample was centrifuged and 10 μl of the supernatant was added to 190 μl of Bradford solution. Protein concentration was obtained by spectrophotometry (595 nm) Protein concentration was compared between the groups using student’s t test (p<0.05). Results: Total protein concentration from unstimulated saliva was higher in OA (5.5±2.6 ug/ul) than in A (3.2 ± 1.7 ug/ul) (p<0.05). Total protein concentration of stimulated saliva was higher in OA (4.9±0.4 ug/ul) than in A (4.0±0.3 ug/ul) (p<0.05). Conclusion: Salivary protein concentration increases in older adults. Further studies are suggested to characterize these changes. Rev. Clin. Periodoncia Implantol. Rehabil. Oral Vol. 5(1); 25-28, 2012.

Altered salivary flow is key for the onset of dental caries, periodontal disease and opportunistic infections. Salivary flow is determined by various stimuli on several receptors, including joint mechanoreceptors. Some studies show that loads on the TMJ affect these receptors causing changes on the quality and quantity of saliva secretion. The aim of this study was to determine whether a relation exists between controlled load application and changes on salivary flow and pH. Thirty volunteer subjects were recruited after excluding by inclusion criteria. A total coverage intraoral appliance was made with 1 mm acrylic buttons on tooth 1.5 and 2.5. The buttons were intentioned to direct the force vectors to apply a reversible load on the TMJ. Before using it, the Unstimulated salivary flow (USF), the Stimulated salivary flow (SSF) and the pH from each flow was obtained from each subject. After an adaptation period of a day, each volunteer used the appliance exerting steady moderate loads 1 hour/day for one week. Under the supervision of the examiner, the USF, SSF and both pH were daily registered for the entire week. There was not an apparent association between applying controlled loads on the TMJ and volumetric changes of the salivary flow. Women, however, showed lower USF and SSF than men. Load application through an oral appliance is associated with SSF pH drop from the third day. Rev. Clin. Periodoncia Implantol. Rehabil. Oral Vol. 4(1); 13-16, 2011.

Altered salivary flow is key for the onset of dental caries, periodontal disease and opportunistic infections. Salivary flow is determined by various stimuli on several receptors, including joint mechanoreceptors. Some studies show that loads on the TMJ affect these receptors causing changes on the quality and quantity of saliva secretion. The aim of this study was to determine whether a relation exists between controlled load application and changes on salivary flow and pH. Thirty volunteer subjects were recruited after excluding by inclusion criteria. A total coverage intraoral appliance was made with 1 mm acrylic buttons on tooth 1.5 and 2.5. The buttons were intentioned to direct the force vectors to apply a reversible load on the TMJ. Before using it, the Unstimulated salivary flow (USF), the Stimulated salivary flow (SSF) and the pH from each flow was obtained from each subject. After an adaptation period of a day, each volunteer used the appliance exerting steady moderate loads 1 hour/day for one week. Under the supervision of the examiner, the USF, SSF and both pH were daily registered for the entire week. There was not an apparent association between applying controlled loads on the TMJ and volumetric changes of the salivary flow. Women, however, showed lower USF and SSF than men. Load application through an oral appliance is associated with SSF pH drop from the third day. Rev. Clin. Periodoncia Implantol. Rehabil. Oral Vol. 4(1); 13-16, 2011.

Una alteración del flujo salival es clave en el desarrollo de caries, enfermedad periodontal e infecciones oportunistas. El flujo salival está determinado por diversos estímulos que actúan sobre receptores de distinta naturaleza, entre ellos mecanoreceptores articulares. Algunos estudios demuestran que las cargas articulares actúan sobre estos receptores, modificando cualitativa y cuantitativamente la secreción salival. El objetivo de este estudio fue determinar si existe una relación entre la aplicación controlada de cargas articulares y cambios en el flujo y pH salival. 30 voluntarios fueron seleccionados según criterios de inclusión establecidos. Se elaboró un dispositivo interoclusal que en relación a piezas 1.5 y 2.5, tenía botones acrílicos de 1mm de espesor, los que al ejercer fuerzas sobre ellos provocan cargas reversibles sobre la ATM. Antes de usar el dispositivo, en cada individuo se midió flujo salival no estimulado (FSNE) el flujo salival estimulado (FSE) y el pH de ambos. Tras un periodo de adaptación diaria por una semana, cada participante usó el dispositivo durante 1 hora, ejerciendo fuerza masticatoria sostenida. Luego se midieron ambos flujos y el pH correspondiente. El procedimiento fue repetido por 7 días, bajo supervisión. No se observó una relación aparente entre la aplicación controlada de cargas articulares y cambios volumétricos de flujo salival. Las mujeres tuvieron un FSE y FSNE menor al de los hombres. La aplicación de sobrecargas articulares por un breve período de tiempo provoca una caída del pH del FSE luego de 3 días de aplicación.

OBJETIVOEvaluar el efecto hipoglicemiante del Calophylum brasiliense.MATERIAL Y MÉTODOPreparamos los extractos atomizado, acuoso, hexánico, diclorometánico, metanólico y etanólico de las hojas de Calophyllum brasiliense. La diabetes experimental fue inducida por administración intraperitoneal de 100 mg/kg de estreptozotocina. El efecto hipoglicemiante de Calophyllum brasiliense fue evaluado en ratas hiperglicémicas, con niveles de glucosa superiores a 300 mg/dLy la dosis usada fue 250, 500, 1000 y 1500 mg/kg, comparándolo con el grupo control negativo que recibió 10 ml de agua destilada vía oral y un grupo control positivo al que se le administró Glibenclamida a la dosis de 10 mg/Kg. Los valores de glucosa fueron determinados a las 1, 2, 3 y 4 horas, después de administrar los extractos y los controles. Finalmente el extracto atomizado fue fraccionado con el fin de caracterizar los principios activos de la planta.RESULTADOSObservamos efecto hipoglicemiante una hora después de administrados los extractos. El mayor efecto observado con la dosis de 1000 mg/Kg, fue 69.28% superior a la Glibenclamida, duró todo el tiempo del experimento (4 horas), y demostramos la presencia de Calanólidas por Resonancia Magnética Nuclear (RMNH/RMNC).CONCLUSIONESEl extracto atomizado de Calophyllum brasiliense posee un buen efecto hipoglicemiante a la dosis de 1000 mg/Kg (100%), en comparación con Glibenclamida..