Background Over the last two decades, progress in prevention and treatment of caries and periodontal diseases has been translated to better oral health and improved tooth retention in the adult population. The ageing population and the increasing expectations of good oral health‐related quality of life in older age pose formidable challenges to clinical care and healthcare systems. Aims The objective of this workshop was to critically review scientific evidence and develop specific recommendations to: (i) prevent tooth loss and retain oral function through prevention and treatment of caries and periodontal diseases later in life and (ii) increase awareness of the health benefits of oral health as an essential component of healthy ageing. Methods Discussions were initiated by three systematic reviews covering aspects of epidemiology of caries and periodontal diseases in elders, the impact of senescence on caries and periodontal diseases and the effectiveness of interventions. Recommendations were developed based on evidence from the systematic reviews and expert opinion. Results Key messages included: (i) the ageing population, trends in risk factors and improved tooth retention point towards an expected increase in the total burden of disease posed by caries and periodontal diseases in the older population; (ii) specific surveillance is required to monitor changes in oral health in the older population; (iii) senescence impacts oral health including periodontitis and possibly caries susceptibility; (iv) evidence indicates that caries and periodontal diseases can be prevented and treated also in older adults; (v) oral health and functional tooth retention later in life provides benefits both in terms of oral and general quality of life and in terms of preventing physical decline and dependency by fostering a healthy diet; (vi) oral healthcare professionals and individuals should not base decisions impacting tooth retention on chronological age but on level of dependency, life expectancy, frailty, comfort and quality of life; and (vii) health policy should remove barriers to oral health care for vulnerable elders. Conclusions Consensus was reached on specific actionable priorities for public health officials, oral healthcare professionals, educators and workforce planners, caregivers and relatives as well as for the public and ageing patients. Some priorities have major implications for policymakers as health systems need to adapt to the challenge by systemwide changes to enable (promote) tooth retention later in life and management of deteriorating oral health in increasingly dependent elders.

BackgroundThere is a long-lasting need for non-invasive, more accurate diagnostic techniques when evaluating primary Sjögren’s syndrome (pSS) patients. Incorporation of additional diagnostics involving screening for disease-specific biomarkers in biological fluid is a promising concept that requires further investigation. In the current study we aimed to explore novel disease biomarkers in saliva and tears from pSS patients.MethodsLiquid chromatography-mass spectrometry (LC-MS) was performed on stimulated whole saliva and tears from 27 pSS patients and 32 healthy controls, and salivary and tear proteomic biomarker profiles were generated. LC-MS was also combined with size exclusion chromatography to isolate extracellular vesicles (EVs) from both fluids. Nanoparticle tracking analysis was conducted on joint fractions from the saliva and tears to determine size distribution and concentration of EVs. Further EV characterisation was performed by immunoaffinity capture of CD9-positive EVs using magnetic beads, detected by flow cytometry. The LC-MS data were analysed for quantitative differences between patient and control groups using Scaffold, and the proteins were further analysed using the Database for Annotation, Visualization and Integrated Discovery (DAVID), for gene ontology overrepresentation, and the Search Tool for the Retrieval of Interacting Genes/Proteins for protein-protein interaction network analysis.ResultsUpregulation of proteins involved in innate immunity (LCN2), cell signalling (CALM) and wound repair (GRN and CALML5) were detected in saliva in pSS. Saliva EVs also displayed biomarkers critical for activation of the innate immune system (SIRPA and LSP1) and adipocyte differentiation (APMAP). Tear analysis indicated overexpression of proteins involved in TNF-α signalling (CPNE1) and B cell survival (PRDX3). Moreover, neutrophil gelatinase-associated lipocalin was upregulated in saliva and tears in pSS. Consistently, DAVID analysis demonstrated pathways of the adaptive immune response in saliva, of cellular component assembly for saliva EVs, and of metabolism and protein folding in tears in pSS patients.ConclusionsLC-MS of saliva and tears from pSS patients, solely and in combination with size-exclusion chromatography allowed screening for possible novel biomarkers encompassing both salivary and lacrimal disease target organs. This approach could provide additional diagnostic accuracy in pSS, and could possibly also be applied for staging and monitoring the disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-017-1228-x) contains supplementary material, which is available to authorized users.

The role of fluoride in erosion therapy has long been questioned. However, recent research has yielded positive results. In this chapter, an overview of the literature is provided regarding the application of fluorides in the prevention and treatment of erosion and erosive wear. The results are presented and discussed for different fluoride sources such as monovalent and polyvalent fluorides, and for different vehicles such as toothpastes, solutions and rinses, as well as varnishes and gels. It is concluded that fluoride applications are very likely to be of use in the preventive treatment of erosive wear. Most promising are high-concentration, acidic formulations and the polyvalent fluoride sources, with the best evidence available for stannous fluoride. However, the evidence base for clinical effectiveness is still small.The role of fluoride in the prevention and treatment of erosion and erosive wear has long been questioned. In caries, in addition to the effect of fluoride ions diffusing into the enamel (sub)surface and adhering to the hydroxyapatite crystal surfaces, fluoride present in the plaque fluid will greatly increase supersaturation and speed up remineralization at pH levels over 4.5 [1]. As the pH level of the acidic substances causing erosion lies in the range of 2-5, it was thought that the fluoride erosion preventive effect could be marginal at best. This hypothesis was coupled with the knowledge that erosion, unlike caries, occurs on clean surfaces, thereby eliminating a possible diffusion barrier effect of the plaque biofilm.When some fluoride applications were shown to be effective, at least in an in vitro environment, the mechanism with which fluoride could prevent erosive wear was reconsidered. In erosion, the demineralization is largely limited to the surface layer, unlike caries where the demineralization will result in subsurface lesions with an initially relatively intact surface. When the erosive challenge continues, the increasingly softened tooth surface is easily lost -a wear process promoted by mechanical factors such as abrasion. This leaves little time and opportunity for fluoride to act through remineralization, and the predominant effect of preventive treatments should be surface protection instead of remineralization [2]. There are some observations to support thisin situ studies evaluating fluoride toothpaste and/ or rinses showed either no significant rehardening after 4 h [3] or limited extra rehardening compared to a non-fluoride control but considerable

Our understanding of erosive tooth wear and its contributing factors has evolved considerably over the last decades. New terms have been continuously introduced, which frequently describe the same aspects of this condition, whereas other terms are being used inappropriately. This has led to unnecessary confusion and miscommunication between patients, professionals, and researchers. A group of 15 experts, selected by the European Organization for Caries Research (ORCA) and the Cariology Research Group of the International Association for Dental Research (IADR), participated in a 2-day workshop to define the most commonly used terms in erosive tooth wear. A modified Delphi method was utilized to reach consensus. At least 80% agreement was achieved for all terms discussed and their definitions related to clinical conditions and processes, basic concepts, diagnosis, risk, and prevention and management of erosive tooth wear. Use of the terms agreed on will provide a better understanding of erosive tooth wear and intends to enable improved communication on this topic.

The aim of this in situ study was to compare the protective effect of TiF₄, SnF₂ and NaF on the development of erosion-like lesions in human enamel. Fourteen human molars were each divided into 4 specimens, mounted on acrylic mouth appliances and worn by 7 volunteers for 9 days. In order to mimic a feasible treatment procedure for patients with voluntary or involuntary gastric reflux, the specimens were etched for 2 min twice a day (0.01 M HCl) and fluoride applications were performed every third day (2 min). The controls were treated as the other specimens except for the fluoride applications. Etch depths and surface roughness changes (R_q) were measured by white light interferometry. Compared with the control, TiF₄ and SnF₂ reduced the etching depth by 100% (p < 0.001) and 91% (p < 0.001), respectively, and both treatments resulted in an observable surface layer. NaF had no significant protective effect (p = 0.46). It can be concluded that although SnF₂ provided significant protection for the enamel surfaces, TiF₄ showed the best protection against acid attack, while NaF had no significant protective effect in this study.