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C2 ◊Page C1 HYGIENE TRIBUNE Dental Tribune Middle East & Africa Edition | 2/2017 The Child Dental Benefits Schedule (CDBS), which ena- bles eligible recipients to access dental care for their children, has recently been lowered from a subsidy of A$1,000 per child over two years to A$700. Who will the changes to the CDBS primar- ily affect? These changes to the CDBS mean that one in five children will not be able to have all their treatment needs met. For children with high dental care needs, this will mean that their parents will be out of pocket in many cases and may lead to chil- dren not receiving the care they de- serve. While the Australian Dental Association was supportive of an adjustment to the cap based on the findings in the Report on the Third Review of the Dental Benefits Act 2008, there seems to be no evidence supporting a 30 per cent drop. It is not clear what will happen to chil- dren who need treatment costing more than A$700 over two years. Processes need to be put in place to ensure these children do not end up being part of long dental waiting lists in the public dental system. How important is prevention in seeking a lifetime of good oral health? The maintenance of oral health is a vital part of overall health. Oral diseases such as dental caries and periodontal disease often have ir- reversible effects on the teeth and gingivae. That is why early detection of disease risk and prevention before such damage occurs is so important. Once a tooth develops caries, it will be weaker, even after the caries is treated. Deep lesions may lead to problems with the dental pulp and result in root canal therapy or ex- traction. Periodontal disease that is allowed to progress will lead to the destruction of the supporting bone of the tooth and may eventually lead to the loss of the tooth. Preventative care includes the estab- lishment of a healthy diet, regular brushing of teeth with a fluoridated toothpaste, flossing, application of pit and fissure sealants, professional cleaning of teeth if required, appli- cation of concentrated fluoride var- nishes and scheduled dental exami- nations to detect disease early. This is why establishment of a home orien- tated to dental health by 12 months of age and development of healthy eating and oral hygiene habits are so important in children, as they lead to healthy habits that can last a life- time. Researchers find link between oral bacteria, cerebral microbleeds and stroke By DTI KYOTO, Japan: Cerebral microbleeds (CMBs) have attracted attention as an important predictive marker of stroke in several studies. Research further suggests that cnm-positive Streptococcus mutans, a type of oral bacteria associated with dental car- ies, is involved in the development of CMBs. Seeking to clarify the con- nection, a team of Japanese research- ers has now found evidence that cnm-positive S. mutans is a novel factor of cognitive impairment asso- ciated with CMBs and therefore may be linked to disorders such as stroke and dementia. Aiming to understand the clini- cal significance of CMBs and the mechanisms of their production, researchers from Kyoto Prefectural University of Medicine examined 279 patients (average age of 70) for the presence or absence of the collagen-binding surface Cnm pro- tein expressed on cnm-positive S. mutans in the saliva. In addition, cognitive function, dental health status and the prevalence of CMB were assessed. Oral examination included the number of remaining teeth, presence or absence of dental caries, and periodontal status of the participants. In the study group, 94 per cent test- ed positive for S. mutans and 33 per cent for cnm-positive S. mutans, and 25 per cent showed collagen-binding activity associated with S. mutans. Magnetic resonance imaging of the brain detected CMBs in 73 partici- pants (26 per cent). As for the dental examination, 31 per cent of the par- ticipants had dental caries and 28 per cent scored a Code 3 or higher on the Community Periodontal Index of Treatment Needs. The mean number of remaining teeth was 22.7 ± 7.5. The analyses showed that cnm-pos- itive S. mutans was detected more often among participants with CMBs than those without. Furthermore, the percentage of dental caries pa- tients was significantly higher in the collagen-binding activity group, the study found. According to the researchers, the findings suggest a molecular mecha- nism for the interaction between chronic oral infections and geriatric disorders, such as stroke and cogni- tive impairment. In order to clarify the causality, an intervention study focused on oral care and the micro- biota in CMB subjects would be of interest, they emphasised. As the current data supports the important influence of the oral microbiota on neurological disease, they further called for improved collaboration between dental and medical re- searchers. The study, titled “Oral cnm-positive Streptococcus mutans expressing collagen binding activity is a risk fac- tor for cerebral microbleeds and cog- nitive impairment”, was published online on 9 December in the Scien- tific Reports journal. Interview: “Communities without fluoridated water have a higher incidence of dental caries” By DTI CAIRNS, Australia: Once a manda- tory measure, the fluoridation of lo- cal water supply in Queensland is no longer compulsory due to legislative measures put in place between 2012 and 2014. Due to pressure from anti- fluoridation campaigners, many lo- cal councils have chosen to abandon the addition of fluoride to water, despite its proven health benefits. Professor John Abbott is the Director of Clinical Dentistry at Cairns’ James Cook University and he recently spoke with Dental Tribune Interna- tional about this on-going issue. DTI: What prompted the Queensland Government to make the fluoridation of wa- ter supply non-compulsory? Professor Abbott: On 5 Decem- ber 2007, the Labor government’s Premier, Anna Bligh, made it manda- tory that all water supply in Queens- land be fluoridated. However, in November 2012 the Liberal Party government reversed this decision. The reversal seemed to stem from Evidence has repeatedly shown that long-term exposure to optimally fluoridated water results in decreased levels of dental caries in both children and adults. (Photograph: kruszyzna0/pixabay) consideration of the greater area that is called regional Queensland. There are many communities in Queens- land, including far north Queens- land, that never had fluoride in their water supply and there was quite a bit of unrest that water fluoridation had been forced onto these commu- nities. What benefits does water fluoridation present? Fluoride in the water supply is con- sidered by tertiary dental schools to be a very good public health initia- tive. There is clear evidence that long- term exposure to an optimal level of fluoride results in diminishing levels of dental caries in both child and adult populations. The level of fluo- ride in drinking water supplies is also just 1-1.5 parts per million (ppm). Which groups does non-fluoridated water affect most? Simply put, communities without fluoridated water have a higher inci- dence of dental caries. There has been some discus- sion centring on ‘alternative solutions’ to compulsory wa- ter fluoridation. What type of solutions would these be and what limitations do they have? Alternatives to fluoridated water include toothpaste and fluoride added to bottled water. The best-case scenario is the actual incorporation of fluoride into developing teeth in- utero, by the mother drinking fluori- dated water. This enables fluoride to be incorporated into the developing teeth so that, on eruption, they are strongly protected against acid at- tack and dental caries. Bottled fluoridated water could be used in schools, but would require extensive management of the pro- gramme, which may be costly. Fluor- idated toothpaste from the super- market contains around 1000ppm of fluoride, but most of this is washed down the sink with vigorous rinsing of the teeth after brushing. Are there currently any incen- tives for councils to fluoridate their water supply? As far as I am aware, there are cur- rently not any incentives for coun- cils to do this. Professor Abbott, thank you for speaking with us.