OBJECTIVES:Oral health in Down syndrome children has some peculiar aspects that must be considered in the follow-up of these patients. This study focuses on characterizing the environmental and host factors associated with dental caries in Portuguese children with and without Down syndrome.METHODS:A sibling-matched, population-based, cross-sectional survey was performed.RESULTS:Down syndrome children presented a significantly greater percentage of children without caries, 78% vs. 58% of non-Down syndrome siblings. This difference in the DMFT index (number of decayed, missing and filled teeth) essentially reflects data obtained from treated teeth, for which 91% of children with Down syndrome had never had a tooth treated vs. 67% of siblings. This result was statistically significant, whereas results for decayed and lost teeth did not differ between Down syndrome children and their unaffected siblings. Additionally, in Down syndrome children, a delayed eruption of the second molar occurs. Down syndrome children and their siblings have similar oral hygiene habits, but a higher percentage of Down syndrome children visit a dentist before the age of three years, in comparison to their siblings. Bruxism was also more common in Down syndrome children compared to their siblings.CONCLUSIONS:Our results show that Portuguese children with Down syndrome have lower caries rates than children without Down syndrome. This reduced prevalence may be associated with the parents' greater concern about oral health care in Down syndrome children, resulting in their taking them sooner to visit a dentist, as well as to a higher bruxism prevalence and delayed tooth eruption.

OBJECTIVES:Although individuals with Down syndrome have considerable oral disease, the prevalence of dental caries in this group is low. The present study aimed to compare known risk factors for dental caries development in children with Down syndrome and a matched population (siblings). In both populations, the number of acidogenic microorganisms, such as mutans streptococci, lactobacilli and Candida species, and the paraffin-stimulated pH, flow rate and IgA concentration in whole saliva were evaluated and compared.METHOD:Saliva was collected, and the caries index was evaluated in 45 sibling pairs aged between 6 and 18 years old. The salivary IgA concentration was determined by immunoturbidimetry. Salivary mutans streptococci, lactobacilli and Candida species were quantified on mitis salivarius agar containing bacitracin and 20% sucrose, rogosa agar supplemented with glacial acetic acid and sabouraud agar supplemented with chloramphenicol, respectively.RESULTS:Down syndrome children had a higher caries-free rate (p<0.05) and lower salivary mutans streptococci counts (p<0.03) compared to their siblings. Similar numbers of lactobacilli and Candida species were found in both groups. Salivary flow rates were 36% lower in Down syndrome children compared to their siblings (p<0.05). The salivary pH did not differ between Down syndrome children and controls. The Down syndrome children had an IgA secretion rate 29% lower than that of their siblings, but this difference was not statistically significant.CONCLUSIONS:In conclusion, the lower number of mutans streptococci in the saliva may be one of the factors contributing to the lower caries rate observed in Down syndrome children, despite evidence of hyposalivation.

This paper is part of a series outlining a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a process starting in 2006 and culminating in a joint workshop of the European Organization for Caries Research (ORCA) together with the Association for Dental Education in Europe (ADEE), held in Berlin from 27 to 30 June 2010. For the areas of risk assessment, diagnosis, detection, activity, monitoring and synthesis Cariology, the present paper outlines the key competencies required and the related areas in which knowledge of and familiarity with are needed for dentists graduating at the beginning of 21st century. Three major competencies were identified: Risk Assessment– competent at identifying and estimating the probability for a patient of developing new caries lesions or progression of existing lesions during a specified period of time; Diagnosis– competent through collecting, analysing and integrating data on signs and symptoms of dental caries and assess activity status of a lesion on a tooth surface to arrive at an identification of past or present occurrence of the disease caries; and Synthesis– competent at synthesising all relevant information by combining and interpreting findings from: risk assessment and diagnostic processes; from patients’ needs, preferences and best interests; and from monitoring, review and re‐assessment findings, when available. Similar competencies were identified for erosion and non‐erosive wear. Issues that were felt by the working group panel to be important in this field are discussed, as are approaches to aid curriculum implementation.

Evidence suggests that oral diseases might be more prevalent in Portuguese adults than the European average. Efforts should be made to promote good oral-hygiene habits among older people and people from lower social classes.

Based on evidence-based dentistry (EBD) being a relatively new concept in dentistry, the attitudes, perceptions and level of awareness of dentists regarding EBD, and perceived barriers to its implementation into daily practice, were comparatively analysed in six countries of the FDI (World Dental Federation-Federation Dentaire Internationale)-European Regional Organization (ERO) zone (France, Georgia, Poland, Portugal, Slovakia and Turkey). For this purpose, a questionnaire, 'The Relationship Between Dental Practitioners and Universities', was developed by the FDI-ERO Working Group and applied by National Dental Associations (NDAs). A total of 850 valid responses were received, and cumulative data, comparisons between countries and potential impact of demographic variables were analysed. Regarding EBD, similar percentages of respondents reported that they 'know what it is' (32.8%) and 'they practice' (32.1%). Most respondents believed that 'EBD is beneficial' (89.1%); however, they had different thoughts regarding 'who actually benefited from EBD'. Of the participants, 60% believed that 'dentists experience difficulties in implementing EBD'. Although lack of time, lack of education and limited availability of evidence-based clinical guidelines were among the major barriers, there were differences among countries (P<0.05). Significant differences were also observed between countries regarding certain questions such as 'where EBD needed to be taught' (P<0.05), as both undergraduate and continuing education were suggested to be suitable. Age, practice mode and years of practice significantly affected many of the responses (P<0.05). There was a general, positive attitude toward EBD; however, there was also a clear demand for more information and support to enhance dentists' knowledge and use of EBD in everyday practice and a specific role for the NDAs.