Lifelong Prevention_ and Maintenance of Oral Health by sofiaie

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									Lifelong Prevention, and
Maintenance of Oral Health
Dr Sára Karjalainen, Institute of Dentistry
University of Turku
                                              1
                    Contents

• Lifelong prevention
  • xylitol and dental health
  • probiotics and gastro-intestinal health


• Maintenance of oral health
  • fibre reinforced composites



                                              2
   Xylitol and dental health
      The mechanism of action
• Sweet 5-carbon polyol       Xylitol:C5
• Can be used in food
  products, sweets, chewing
  gum etc…
• No acid production
• Reduced adherence of
  mutans streptococci
• Less plaque


                                           3
         Xylitol and dental health

DMFS Increment             Control   Xylitol

    12


     8


     4


     0


    -4
         Hungary   Finland 1   Finland 2       Canada      Belize
          1982       1982        1982          1985       1989
          1984       1984        1984          1986       1993
                                                                        4
                                                    Modified from Levine 2000
Initial colonization of the oral cavity




                                                  5
                                Carlsson et al, 1975
   Xylitol and the transmission
of mutans streptococci from mother to child



• Mothers’ use of xylitol for 2 years can prevent
  transmission of mutans streptococci from
  mother to child




                                                                       6
                        Söderling et al., 2000, Thorild et al. 2004?
Xylitol and mutans colonization
            in the oral cavity of toddlers

                                             After 2 years’ of mothers’ use

• One fifth of the                           50
  children in the xylitol
  group was colonized                        40

  as compared to the


                            Colonisation %
                                             30
  control group
                                             20

• Long-term effect of
                                             10
  6 years at least
                                              0

                                                    Control    Xylitol
                                                                                 7
                                                              Söderling et al., 2000
…..and subsequent dental health
                              Xylitol   Control
                  dmf
                  3


                  2
  Dental health




                  1


                  0
                        2   3 Age (years) 4       5
                                                                        8
                                                      Isokangas et al., 2000
Optimizing Gut Flora with
       Probiotics



                            9
Factors affecting balanced microbial
        flora of the gut system


    Disease          Change of diet

       Antibiotics          Age

                Stress

                                      10
        Definitions of probiotics
• A live microbial food supplement which beneficially
  affects the host by improving the intestinal microbial
  balance (Fuller, 1989)

• Microbial cell preparations or components of microbial
  cells that have a beneficial effect on the health and well-
  being of the host (Salminen et al. 1999)

• Live micro-organisms which when administered in
  adequate amounts confer a health benefit on the host
  (FAO / WHO 2002)




                                                           11
   The normal gut flora
                                     • Stomach (10-103 CFU/ml)
                                       Very few bacteria – perhaps Helicobacter
                                       pylori

                                     • Duodenum- Jejunum
                                       (< 105 CFU/ml), Primarily Streptococci,
                                       Lactobacilli, Bacteroides and
                                       Bifidobacteria

                                     • Ileum (~ 107 CFU/ml)
                                       Lactobacilli, Bifidobacteria, Bacteroides,
                                       Enterococceae, Clostridia

                                     • Colon (1011 – 1012CFU/ml)
                                       Heavy and diverse flora Bacteroides,
                                       Bifidobacteria, Streptococci, Clostridia
                                       and Enterobacteriaceae

                                                                                 12
Courtesy of Dr Nexman Larsen, 2005
Probiotics used in food products are for
       example: Lactobacilli and
             bifidobacteria




                                           13
       Probiotics can be used to
        prevent or to treat many chronic diseases

•   Travellers’ diarrhea
•   Atopic dermatitis (asthma eczema)
•   Rota-virus diarrhea, Antibiotic associated diarrhea
•   Lactose intolerance
•   Modulation of the immune system
•   Crohns/ulcerative colitis
•   Constipation / colon irritable
•   Helicobacter pylori
•   Cancer
•   High serum cholesterol
•   Caries (3-4 year old)
•   Malnutrition



                                                                       14
                                       Courtesy of Dr Nexman Larsen, 2005
    Bifidobacteria in small children

- Breast feeding promotes bifidobacterial growth
  compared to formula-feeding (Harmsen et al. 2000)

- Children suffering from atopy seem to have reduced
  gastrointestinal content of bifidobacteria (Watanabe et
  al. 2003)

- Infants with low number of bifidobacteria have an
  increased risk of developing atopy (Kalliomäki et al.
  2001; Björksten et al. 2001)



                                                            15
        Probiotics in treatment of atopia in
                        infants

                15

                                                                  Placebo
                10
Atopia scores




                                                                  Bifidobacteria

                5                                                 Lactobacillus
                                                                  rhamnosus


                0
                     Before therapy   After 2 months
                                                                                  16
                                                Modified from Isolauri E et.al. 2000
Probiotics in prevention of "tourist-
        diarrhea” in adults
     70

     60          No diarrhea
                 Diarrhea
     50

 N   40                     n=165
     30

     20

     10

      0
          Probiotics             Placebo

                                                                    17
                       Modified from Black et al., 1989 and Black 1995
Combination of xylitol and probiotics


• ”Pocket" - pacifier (Alanen & Söderling; US patent 2000)

• For slow release of food supplement (Probiotics +
  Xylitol)


• The novel pacifier is soft and broad (Alanen &
  Varrela; US patent 1999)




                                                               18
                                     Courtesy of Dr Söderling, 2005
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       Aspects of treatment

•   Expectations of patient / society
•   Aesthetics
•   Function
•   Minimally Invasive Therapy
•   Cost of the treatment




                                        20
            New biomaterials
        Fiber-reinforced composite (FRC)


• Conventional composites
  resin base + filler particles
• Do not meet all biomechanical requirements
  necessary in dentistry
• FRC = composites + glass fibres




                                                                 21
                                   Courtesy of prof. Vallittu, 2005
Fiber-reinforced composites and
       missing front teeth

    Glass fibers      Building up the missing tooth




The missing tooth       Replacement of the
with two thin wings     missing tooth attached

                                                      22
Fiber-reinforced composites and
         a worn dentition




                                  23
          To conclude …
Innovations which have been invented, or
markedly improved at the Turku University
in Finland:
– how to promote dental health with xylitol
– how to prevent atopia and many other
  diseases by using probiotics
– how to maintain good oral function using fiber-
  reinforced composites

                                               24
Japanese - Finnish Collaboration
Japanese collaborative        Finnish
organizations                 collaborators
• Nippon Dental University    Prof. Pentti Alanen
• Fukuoka Dental School       Prof. Kauko Mäkinen
• Tohoku University           Prof. Seppo Salminen
                              Doc. Eva Söderling
• Tohoku Fukushi University
                              Prof. Pekka Vallittu
• RIKEN
                              Prof. Juha Varrela
• JCM
• Japanese Association
   for Preventive Dentistry
• Oral Care
• Lotte, Combi Corporation

                                                     25
More possibilities for collaboration

• The Finnish Institutes of higher education
  provide some 400 programs in English
  and…
• about a 100 of these are leading to PhD-
  degrees




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