Evaluation of the effectiveness of different treatment approaches in preventing coronal discoloration caused by regenerative endodontic treatment.

OBJECTIVES: This study aimed to evaluate the effectiveness of Teethmate desensitizer, a dentin bonding agent (DBA), Nd:YAG laser, and Er:YAG laser, which provides dentin tubule occlusion in the pulp chamber with different mechanisms, in preventing tooth discoloration due to regenerative endodontic treatment. MATERIALS AND METHODS: One hundred five extracted maxillary human incisors with single roots and single canals were included in the study. The apical third of each tooth was resected below the enamel-cementum junction (CEJ) to obtain a standard root length as 10 ± 1 mm. Root canal preparation was performed using the ProTaper Next files up to X5. Root canals were prepared with Gates Glidden (# 2-4) burs to simulate the immature root apex and an apical diameter of 1.1 ± 0.1 mm was obtained. The teeth were randomly divided into 7 groups (n = 15): DBA, Teethmate, Nd:YAG, Er:YAG, Biodentine, Blood, and Negative Control. Relevant dentin tubule occlusion methods were applied to DBA, Teethmate, Nd:YAG, and Er:YAG groups. Following dentin tubule occlusion procedures, Biodentine was placed on the blood clot after filling the root canals with blood up to 4 mm below the CEJ. No dentin tubule occlusion procedure was applied for Blood and Biodentine groups. Color measurement was performed with the spectrophotometer Vita Easyshade Advance before treatment, immediately after treatment, and at days 7, 30, and 90. Data were converted to L*a*b color values of Commission International de I'Eclairage (CIE L*a*b) and ΔE values were calculated. Two-way ANOVA and post hoc Tukey test (p = 0.05) were performed for statistical analysis. RESULTS: A clinically detectable color change was observed in all groups except for the negative control (ΔE ≥ 3,3). It was observed that Biodentine used alone has a potential for discoloration. It was determined that as the contact time with blood increased, tooth discoloration increased. However, no significant difference was found between dentin tubule occlusion methods in preventing color change (p > 0.05). CONCLUSIONS: It was determined that no dentin tubule occlusion method could 100% prevent discoloration caused by RET. CLINICAL RELEVANCE: DBA and Teethmate, which do not have a significant difference in terms of preventing color change, are considered to be suitable for dentin tubule occlusion due to their ease of application and low cost compared to Nd:YAG laser and Er:YAG laser.

Effect of Propolis mouthwash on clinical periodontal parameters in patients with gingivitis: A double-blinded randomized clinical trial.

OBJECTIVES: Periodontal diseases have multifactorial aetiology and are primarily caused by pathogenic bacteria. Using antibacterial mouthwashes as an adjunct to mechanical plaque control can effectively improve the quality of oral hygiene maintenance at home. This study aimed to assess the clinical efficacy of a propolis-containing mouthwash in gingivitis treatment. METHODS: This clinical trial evaluated 32 patients with gingivitis in two groups (n=16). The intervention group received a mouthwash containing propolis extract while the control group received the same mouthwash without the propolis extract. The papillary bleeding index (PBI), plaque index (PI) and tooth discoloration were evaluated in each patient at baseline (before the intervention) and at 15 and 30 days, after treatment. To facilitate the follow-up evaluations, the measurements were recorded for the tooth with the most inflamed gingiva in each quadrant (n = 128). The two groups were compared using the Mann-Whitney test. RESULTS: The change in PI was 85.19 ± 51.6% in the propolis and 83.93 ± 36.1% in the placebo group with no significant difference between them (p = 0.91). The reduction in papillary bleeding index was significantly greater in the propolis group compared with the placebo group (p < 0.001). The change in tooth colour over time was significant in the placebo and insignificant in the propolis group (p = 0.14). CONCLUSIONS: Considering the current findings, it seems that propolis mouthwash can effectively decrease gingival inflammation and bleeding, without causing tooth discoloration or staining. Considering the limitations of this study such as small sample size (based on participants and also number of teeth included in the study), future studies are warranted on this topic.

Pre-application of dentin bonding agent prevents discoloration caused by mineral trioxide aggregate.

BACKGROUND: To evaluate tooth discoloration by newly developed calcium silicate-based materials, and to examine the pre-application of dentin bonding agent (DBA) for preventing discoloration caused by mineral trioxide aggregate (MTA). METHODS: The roots of 50 premolars were randomly divided into five groups (n = 10) and cavities were prepared from resected root surfaces. MTA was placed in the cavities of teeth belonging to the ProRoot MTA (MTA) and RetroMTA (RMTA) groups. For teeth belonging to the ProRoot + DBA (MTA-B) and RetroMTA + DBA (RMTA-B) groups, DBA was first applied to the cavities prior to the addition of MTA. Teeth in the control group were restored with composite resin only (i.e., without MTA). After 12 weeks, MTA was removed from the MTA and RMTA groups and bleaching agents were applied for 3 additional weeks. Color assessments were recorded at baseline, and 1, 4, and 12 weeks, as well as after bleaching. A one-way ANOVA was performed to assess the differences between the two types of MTAs and color changes following DBA pre-application in each MTA group. A p-value of < 0.05 was considered indicative of statistical significance. RESULTS: Following 12 weeks of MTA treatment, there was a significant difference between the discoloration in the MTA and RMTA groups (p < 0.05). However, no significant difference was observed between the RMTA and RMTA-B groups (p > 0.05). Following bleaching, the color changes (ΔE values) of the MTA group were not significantly different from those of the MTA-B group (p > 0.05). The difference of ΔE between the RMTA group after internal bleaching and the RMTA-B group was also not significant (p > 0.05). CONCLUSIONS: RetroMTA caused significantly less discoloration than ProRoot MTA. Pre-application of DBA reduced discoloration caused by ProRoot MTA. MTA discoloration was improved equally well between DBA pre-application and post-bleaching.

[Medicaments and oral healthcare 5. Adverse effects of -medications and over-the-counter drugs on teeth]. / Serie: Medicamenten en mondzorg 5. Bijwerkingen van medicamenten en zelfzorg­middelen op gebitselementen.

Intrinsic tooth discoloration may occur as an adverse effect of fluoride and tetracyclines. Extrinsic tooth discoloration may occur as superficial staining or as discoloration of the superficial pellicle and/or biofilm due to chlorhexidine, liquid iron salts, essential oils, some antibiotics and stannous fluoride. Inhibition of orthodontic tooth movement has been reported due to the use of prostaglandin synthetase inhibitors. If medications or over-the-counter drugs induce hyposalivation or contain much sucrose, caries may develop. Erosion may occur if the acidity of medications or over-the-counter drugs is excessive. Attrition is a well-known adverse effect of serotonin reuptake inhibitors, antiparkinson agents, and antipsychotics. Congenital dysplasia is observed following childhood treatment with cytostatic drugs. External cervical root resorption is an adverse effect of internal teeth-whitening products. Prenatal exposure to antiepileptic drugs and childhood treatment with cytostatic drugs may cause dental agenesis. Antiseptic drugs applied for external teeth-whitening and toothpastes with additional ingredients to prevent extrinsic discoloration and creation of calculus, may cause tooth hypersensitivity.

Chlorhexidine mouthwash more effective than dentifrice or gel.

DATA SOURCES: Medline, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). STUDY SELECTION: Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) in adults 18 years of age comparing CHX DF/gel with CHX MW written in English or Dutch were considered. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently selected studies, abstracted data and assessed risk of bias. Where possible, a meta-analysis was performed. Difference in means values between test and control at both baseline and end was calculated using a fixed-effects model. RESULTS: Five RCTs were included, four had a parallel design and one was a cross-over trial. Three studies showed a positive score in favour of the mouthwash. Three studies contributed to a meta-analysis of the effect on 'de novo' plaque formation. There was a difference in means of 0.27 [95% CI: 0.14; 0.39] (P < 0.0001) in favour of CHX MW. One study assessed tooth staining finding more staining with the use of CHX MW compared to the CHX DF/gel. CONCLUSIONS: Chlorhexidine gel can be successfully formulated and will inhibit plaque growth to some degree, but not to the same extent, as a CHX MW. When CHX DF/gel is used in a non-brushing model, it is significantly less effective in plaque inhibition compared to CHX MW. Based on one study when CHX gel was applied with a finger after brushing, it is significantly more effective on plaque scores and the gingival index. The only brushing study also with a long follow-up showed that there is no significant difference between CHX DF and CHX MW. However, as a corollary, significantly more tooth discoloration was observed with the CHX MW. Altogether, the data show that when daily oral hygiene cannot be performed, CHX MW is the first product of choice.

[Keep an eye on the side effects]. / Nebenwirkungen im Auge behalten.

A 52-year-old man presented with a progressive grey-black pigmentation of facial skin, sclera and teeth. The cause was long-term ingestion of minocycline, as confirmed by history and skin biopsy. Minocycline-induced hyperpigmentation can be divided into four main patterns based on clinical appearance, distribution, light- and electron microscopic characteristics. Some patterns can manifest within weeks of initiating therapy. One must be alert to the early signs and warn the patient about the often cosmetically disturbing and persistent minocycline-induced hyperpigmentation.

The effect of an oxygenating agent on chlorhexidine-induced extrinsic tooth staining: a systematic review.

BACKGROUND: Although chlorhexidine digluconate (CHX) is currently the most effective mouthwash for reducing plaque and gingivitis, one of its side effects is extrinsic tooth staining. Interestingly, oxygenating agents may reduce this staining. OBJECTIVE: The aim of this review was to systematically search the literature for data concerning the inhibiting effect of an oxygenating agent (OA) on CHX-induced tooth staining. METHODS: MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE and other relevant electronic databases were searched for articles that were published up to November 2011. Articles were included if they were randomized controlled trials or controlled clinical trials conducted with healthy subjects ≥ 16 years of age that compared the effects of CHX mouthrinse combined with an OA with the effects of CHX alone. RESULTS: An independent screening of 1183 titles and abstracts resulted in 4 publications that met the inclusion criteria. The extracted data allowed meta-analyses of intermediate length studies and showed that combining an OA with CHX mouthrinses led to a significant reduction in tooth staining (mean difference: 0.27; P = 0.02) and plaque scores (mean difference: 0.10; P = 0.003) when compared with CHX alone. One of the included studies reported a side effect for one participant. The present review was limited by the availability of data, and the included studies were methodologically and clinically heterogeneous, which affected the quality and interpretation of the evidence. CONCLUSION: There is moderate evidence that a combination of CHX and an OA reduces tooth staining without interfering with plaque growth inhibition.

Adverse effects associated with the clinical use of 4% TiF4 on teeth enamel: case report.

Titanium tetrafluoride (TiF4) has been studied in dentistry as a promissory alternative for prevention and treatment of carious lesions. However, there are few in vivo studies concerning the consequences of its use on tooth enamel. The goal of this study was to report the effects of a 4% TiF4 application on the remineralization of an incipient carious lesion of a permanent tooth. This research found an unexpected clinical outcome. A patient with active white spots had two of these lesions treated with 4% TiF4 associated with fluoridated dentifrice and another lesion treated with fluoridated dentifrice only, thus the remineralization of the two kinds of treatment administered could be observed and compared. An extrinsic pigment appeared in the regions that received the TiF4 treatment, which was partially removed by professional prophylaxis. Also, regular recidivists of this pigmentation in the review consultations were noted. The authors concluded that although the use of 4% TiF4 was effective in treating incipient carious lesions on enamel, it was also responsible for an undesired pigmented layer on the tooth to which it was applied. Beyond the varied fluoridated materials used in dentistry, titanium tetrafluoride (TiF4) deserves attention. This compound has the common properties of fluorides, and researchers are exploring its role in carious lesion prevention, fissure sealing, and tooth erosion prevention in in vitro and in situ studies. Research is also exploring its use for microinfiltration prevention in tooth restoration and hypersensitivity treatment. However, when compared to other fluoridated products TiF4 demonstrates additional, specific particularities, such as the formation of a titanium dioxide (TiO2) layer, which is tough, hydrophobic, and resistant in acidic environments. Nevertheless, there are insufficient in vivo studies concerning the consequences of TiF4-containing products affecting tooth enamel. Thus, the goals of this study were to report the effects of a 4% TiF4 application on the remineralization of an incipient carious lesion of a permanent tooth and to show the results of a backscattered scanning electron (BSE) analysis that was performed on the primary tooth. The clinical outcome was unexpected.

The role of chlorhexidine in caries prevention.

The use of chlorhexidine for caries prevention has been a controversial topic among dental educators and clinicians. In several reviews, it has been concluded that the most persistent reduction of mutans streptococci have been achieved by chlorhexidine varnishes, followed by gels and, lastly, mouth rinses. Also, the evidence for using different chlorhexidine modes or a combination of chlorhexidine-fluoride therapy for caries prevention has been "suggestive but incomplete". Variable study designs and lack of data in high-risk children and adults support the need to continue conducting randomized, well-controlled clinical trials and to search for a practical, effective mode of antimicrobial treatment that augments the known effect of fluoride treatments. Currently, the only chlorhexidine-containing products marketed in the United States (US) are mouthrinses containing 0.12 percent chlorhexidine. Based on the available reviews, chlorhexidine rinses have not been highly effective in preventing caries, or at least the clinical data are not convincing. Due to the current lack of long-term clinical evidence for caries prevention and reported side effects, chlorhexidine rinses should not be recommended for caries prevention. Due to the inconclusive literature and sparse clinical data on gels and varnishes, their use for caries prevention should also be studied further to develop evidence-based recommendations for their clinical role in caries prevention. Since dental caries is a disease with a multifactoral etiology, it is currently more appropriate to use other established, evidence-based prevention methods, such as fluoride applications, diet modifications and good oral hygiene practices. Recent findings also indicate that the effect of an antimicrobial agent for reducing the levels of mutans streptococci or plaque reduction may not always correlate with eventual caries reduction. The clinically important outcome is proven reductions in caries. Many advances in the treatment and prevention of dental caries have been introduced over the past century. The use of chlorhexidine in caries prevention has been referred to as a nonsurgical management of dental caries and has represented the modern medical model of caries treatment. However, there is a lack of consensus on evidence-based treatment protocols and controversy regarding the role of chlorhexidine in caries prevention among dental educators and clinicians. There is a need to standardize guidelines to optimize evidence-based non-surgical disease management to provide appropriate care. This paper reviewed the literature on the effectiveness of different modes of chlorhexidine delivery for caries prevention and provides guidelines for chlorhexidine use in caries management. A literature search was conducted using the PubMed and Evidence-Based Medicine Reviews databases and the keywords "chlorhexidine" and "caries", limiting the search to "humans", "reviews" and "English". Based on the published reviews, it was concluded that chlorhexidine rinses, gels and varnishes or combinations of these items with fluoride have variable effects. Additionally, the sparse clinical data that was reported weakens the conclusions. Due to the current lack of evidence on long-term clinical outcomes and reported side effects, chlorhexidine rinse, which is currently the only treatment mode available in the US, should not be recommended for caries prevention. Clinical evidence on gels and varnishes is also inconclusive. For the treatment of dental caries, there are alternative evidence-based prevention methods available, such as fluoride applications, diet modifications and good oral hygiene practices.

Treating tetracycline staining in the adult dentition: a case report.

Tetracycline staining in the adult dentition has presented an esthetic challenge for many years. Many clinicians have treated the problem by utilizing invasive techniques that may involve crowns, veneers, and composite bonding. Some major disadvantages to these invasive techniques include the cost involved and the need to cut on sound tooth structures. This article showcases a protocol for treating tetracycline staining non-invasively.

Alternative to Avoid Tooth Discoloration after Regenerative Endodontic Procedure: A Systematic Review.

This systematic review aimed to evaluate whether alternative materials to conventional triple antibiotic paste (TAP - metronidazole, ciprofloxacin, and minocycline) and grey mineral trioxide aggregate (GMTA) could avoid tooth discoloration in teeth submitted to Regenerative Endodontic Procedure (REP). It was also investigated if dental bleaching is able to reverse the color of darkened teeth due to REP. The search was conducted in four databases (Medline via PubMed, Scopus, ISI Web of Science and BVS - Virtual health library), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The retrieved papers were uploaded in the software EndNoteTM and two reviewers independently selected the studies and extracted the data. Only studies in humans (case reports, case series, clinical trials) were included in the review. From 1,122 potentially eligible studies, 83 were selected for full-text analysis, and 38 were included in the review. The included studies were mainly case reports (76.3 %). The studies described a total of 189 teeth submitted to REP. From these, about 54% of teeth presented some degree of discoloration. Most teeth presenting color alteration were treated with TAP, especially when combined with GMTA. Only three studies performed dental bleaching to restore the color of teeth and neither bleaching technique was able to restore the original color of the crowns. The use of alternative materials to TAP and GMTA, such as double antibiotic paste or Ca(OH)2 pastes and white mineral trioxide aggregate or BiodentineTM, reduces the occurrence of tooth discoloration.

Potential iatrogenic tetracycline staining of endodontically treated teeth via NaOCl/MTAD irrigation: a preliminary report.

This study reported red-purple staining of light-exposed, root-treated dentin when root canals were rinsed with 1.3% NaOCl as initial rinse followed by the use of BioPure MTAD as final rinse. This intrinsic dentin staining occurred irrespective of whether the root canals were filled, and could be observed even in crown dentin when the latter was sequentially immersed in NaOCl and MTAD. Bench-top reproductions of the phenomenon revealed that the exothermic reaction is not an acid-base reaction. Conversely, the reaction is of a redox nature that highly resembled the previously reported mechanism of tetracycline staining, in which photo-oxidation of tetracycline resulted in a red-purple tetracycline degradation product that has a high affinity for hydroxyapatite. This photo-oxidative degradation process is probably triggered by the use of NaOCl as an oxidizing agent, and may be prevented by rinsing the NaOCl-treated dentin with ascorbic acid, a reducing agent, before the application of MTAD.

Effects of Novel 3-dimensional Antibiotic-containing Electrospun Scaffolds on Dentin Discoloration.

INTRODUCTION: Although intracanal application of the triple antibiotic paste (TAP) may offer advantages (eg, disinfection), this practice has been associated with significant drawbacks, including tooth discoloration. In this study, the color change of dentin was monitored during treatment with distinct TAP pastes and novel tubular-shaped 3-dimensional electrospun scaffolds containing minocycline (MINO) or doxycycline (DOX). METHODS: Two TAP pastes (TAPMINO [MINO, metronidazole, and ciprofloxacin] and TAPDOX [DOX, metronidazole, and ciprofloxacin]), 4 scaffold-based groups containing MINO or DOX at distinct concentrations, 1 antibiotic-free scaffold, and 1 untreated group (control) were investigated. Human canines were sectioned at the cementoenamel junction and tubular-shaped scaffolds or paste were placed into the root canals and sealed. Color measurements (CIEL(*)a(*)b(*) parameters) were performed at baseline and after 1, 3, 7, 14, 21, and 28 days. Color changes were expressed as ΔE(*) values. In addition, scanning electron microscopy and energy-dispersive X-ray spectroscopy were also performed on the specimens after treatment. Data were analyzed using repeated measures analysis of variance (alpha = 0.05). RESULTS: All antibiotic-containing groups led to greater discoloration than the antibiotic-free groups. A severe discoloration occurred after 1 day. At the end of the experiment, antibiotic-treated samples exhibited crusts/agglomerates over the dentin surface, which totally or partially obliterated the dentinal tubules. The presence of MINO resulted in a greater color change than DOX. CONCLUSIONS: Scaffolds containing MINO or DOX produced similar color change to dentin when compared with their respective TAP systems, although DOX-related discoloration was less pronounced.

Cariostatic activity of (1,6-bis-[2-ethylhexylbiguanido]-hexane) in conventional rats.

The antimicrobial and cariostatic activities of the dihydrochloride and dihydrofluoride salts of alexidine (1,6-bis-[2-ethylhexylbiguanido]hexane) were compared to those of chlorhexidine acetate and sodium fluoride in rats implanted orally with Streptococcus mutans 6715 and fed a cariogenic diet. Experimental caries was significantly reduced by the continuous administration of low concentrations of biguanides via the drinking water, but this was accompanied by increased staining of the molars. Very high biguanide concentrations, applied infrequently, directly to the molars, effectively reduced caries and resulted in less staining. A combination of alexidine dihydrochloride and sodium fluoride offered no advantage over either drug alone. Alexidine salts prevented the progressive increase in implanted S. mutans, whereas chlorhexidine acetate practically eliminated the micro-organism from the oral cavity. Sodium fluoride had no effect on the implanted flora. It was concluded that alexidine salts are comparable in cariostatic activity to chlorhexidine. The tooth staining accompanying the use of bisbiguanides can be reduced by adjusting the concentration of the drug and its frequency of application.

Evaluation of an oligomer or an oligomer plus cetyl pyridinium chloride against plaque, stain, calculus, and gingivitis.

A low molecular weight oligomer of sulfoacrylic acid (ND-2) was effective in inhibiting hydroxyapatite formation in vitro at 33 ppm from a saturated solution of calcium and phosphate. The oligomer did not damage or etch human dental enamel in vitro at pH 5.0 and 7.5. It significantly reduced calculus formation when applied topically in beagles at a concentration of 1% in a rinse. In a second study using 30 beagle dogs, the rinses containing 0.1% CPC and 0.1% CPC + 2% ND-2 significantly reduced (alpha less than 0.05) plaque and gingivitis for 12 wk when compared to a placebo rinse. One-tenth percent CPC rinse induced more discoloration of teeth than the placebo, while the rinse containing 0.1% CPC + 2% ND-2 had significantly less discoloration than CPC rinse or the placebo rinse in beagles. Thus the oligomer was effective in reducing CPC-induced discoloration in beagles.

A comparison of three delivery methods of chlorhexidine in handicapped children. I. Effects on plaque, gingivitis, and toothstaining.

In handicapped groups, the maintenance of oral hygiene can be a major problem, and chemical plaque control offers many advantages. This study compared the effectiveness of chlorhexidine gluconate, delivered as a 0.2% mouthrinse, a 0.2% spray, and a 1% gel in trays, in controlling dental plaque and gingival bleeding in a group of 49 spastic children. All three delivery methods produced an improvement in plaque and gingival bleeding scores. However, the gel was significantly more effective than either the mouthwash or the spray. There was no significant difference between delivery methods in the amount of tooth staining.

A comparison of three delivery methods of chlorhexidine in handicapped children. II. Parent and house-parent preferences.

As part of a study of chlorhexidine used for plaque control in handicapped children, preferences and difficulties with the three delivery methods were evaluated by questionnaire. The delivery methods were a 0.2% mouthwash, 0.2% spray, and 1% gel in trays. Responses from parents and house parents revealed the least preference for, and most difficulties with, the gel in trays. The spray was the most popular and 96% of the respondents would be prepared to use this indefinitely as a method of oral hygiene. The most effective method was the gel in trays, but results of the questionnaire suggested that the respondents would be unwilling to use it for prolonged periods. The importance of user acceptance and compliance to the long-term success of oral hygiene methods was evident.

The effect of an alexidine mouthwash on dental plaque and gingivitis.

The alexidine mouthrinse used in this study (CP-101) is effective in reducing plaque. There was a reduction in gingivitis after 6-months use but not at a statistically significant level. An extrinsic brown stain occurred at a significant level on the teeth of participants using the active mouthrinse. Blood and urine laboratory results indicated that alexidine can be safely used over a 6-month period.

Promotion of oral health and prevention of common pediatric dental problems.

Many effective methods currently are available for preventing oral diseases and promoting oral health. The responsibility for ensuring the optimal use of these approaches is shared by members of the dental profession and other primary care providers in the present health care delivery system. Recognition of each provider's role and greater collaborative efforts could enhance the gains that already have been made with respect to improving the oral health status of children and adolescents.

A review of the literature on use of chlorhexidine in dentistry.

In addition to its plaque-inhibiting effect, chlorhexidine possesses other properties beneficial for use in dentistry. These effects are outlined, and specific recommendations are given regarding chlorhexidine's use by general practitioners. The side effects of long-term use, such as staining, and the availability of chlorhexidine also are discussed.