Unusual presentation of idiopathic osteosclerosis: a case report.

Idiopathic osteosclerosis (IO) typically manifests as an incidentally discovered, well-defined homogenous radiopacity that blends in with the surrounding bone. Once the condition is diagnosed, treatment is neither indicated nor necessary; however, atypical variants of osteosclerosis have been described and may pose a diagnostic and management dilemma for the clinician who encounters them. This case report discusses the differential conditions that should be considered when an atypical variant of IO is encountered. While the diagnosis in this case was fortuitously confirmed by biopsy, routine follow-up is the recommended course of action.

A controlled 6-month clinical trial to study the effects of a stannous fluoride dentifrice on gingivitis.

OBJECTIVES: This study was conducted to assess anti-plaque and anti-gingivitis benefits of a stabilized stannous fluoride (SnF(2))/sodium hexametaphosphate (SHMP) dentifrice versus a negative control. MATERIAL AND METHODS: This was a randomized, 6-month, stratified, single-centre, double-blind, parallel group, clinical study conducted in harmony with the guidelines for evaluating chemotherapeutic products for the control of gingivitis outlined by the American Dental Association. A stabilized 0.454% SnF(2)/SHMP dentifrice was tested against a commercially available negative control dentifrice. Following baseline measurements, subjects received a dental prophylaxis. Subjects were instructed to brush twice daily for 60 s using their assigned product. Efficacy measurements were obtained at baseline, 3 and 6 months post treatment using the Modified Gingival Index, Gingival Bleeding Index and the Turesky Modified Quigley-Hein Plaque Index. Oral tissue examinations were performed at all visits. RESULTS: A total of 140 subjects were enroled and 128 completed the study. RESULTS after 6 months showed the SnF(2) dentifrice delivered a 16.9% reduction in gingivitis (p<0.001), a 40.8% reduction (p<0.001) in gingival bleeding, and an 8.5% reduction in plaque (p=0.001) versus the negative control. Both treatments were well tolerated. CONCLUSIONS: Twice daily use of the SnF(2)/SHMP dentifrice over 6 months provided statistically significant anti-plaque and anti-gingivitis benefits relative to a negative control.

Drugs and the elderly patient.

The rational use of drugs in older persons is a challenging area of clinical practice. The increased incidence of multiple chronic illnesses contributes to disproportionately high use of prescription and over-the-counter (OTC) medications, which in turn leads to more adverse drug events among the elderly. Inadequate nutrition and poor patient compliance also may contribute to the problem. Drug studies that use young adult subjects cannot be extrapolated accurately to apply to the elderly because physiologic changes that occur with age affect the pharmacokinetics and pharmacodynamics of drugs. In addition, therapeutic target concentrations of drugs are impossible to define due to marked interindividual variation in the elderly population. Drugs should be administered to elderly patients only when absolutely necessary. The dosages should be titrated to a clearly defined clinical response and dentists should avoid drugs that are known to be problematic for older adults.

Clinical evaluation of the stain removal efficacy of a novel stannous fluoride and sodium hexametaphosphate dentifrice.

PURPOSE: Recently, sodium hexametaphosphate has been introduced in dentifrice formulations to aid in the control of extrinsic stain. Two independent studies were conducted to evaluate the stain removal efficacy of a novel 0.454% stannous fluoride and sodium hexametaphosphate dentifrice (Crest Pro-Health) relative to a positive control whitening dentifrice (Colgate Total + Whitening) over a 2-week period in a subject population with pre-existing natural extrinsic stain. METHODS: These studies were randomized, positive-controlled, parallel groups, double-blind, 2-week trials. Each study involved approximately 30 healthy adults with visible stain of the facial surfaces of the 12 anterior teeth. After baseline examination, subjects were randomly assigned to a treatment and instructed to brush unsupervised with the assigned dentifrice at least twice daily as they normally do. Efficacy was evaluated by modified Lobene examination on anterior teeth at baseline and end-of treatment (Week 2). RESULTS: 59 subjects, 29 in Study 1 and 30 in Study 2, were evaluable and included in the Week 2 analyses. Subjects ranged from 21-68 years of age. In each study, the positive control dentifrice statistically significantly (P < 0.0001) reduced stain scores following 2 weeks of brushing with median reductions of 61.9% and 94.4%. Similarly, the experimental 0.454% stannous fluoride and sodium hexametaphosphate dentifrice statistically significantly (P < 0.0001) reduced stain scores by 61.8% and 96.6% following 2 weeks of brushing. The adjusted mean changes between treatment groups did not differ significantly between the two dentifrice groups (P > 0.70 in each study). Both dentifrices were well tolerated. No subject discontinued treatment due to an adverse event.

The effect of toothbrushing regimens on the plaque inhibitory properties of an experimental cetylpyridinium chloride mouthrinse.

OBJECTIVE: The objective of this study was to determine the effect of various toothbrushing regimens with a standard fluoride dentifrice on the plaque inhibitory properties of an alcohol-free, high bioavailable 0.07% cetylpyridinium chloride (CPC) mouthrinse. MATERIALS AND METHODS: The study was a randomized, single-centre, examiner blind, four-period cross-over study involving 29 healthy subjects. Four treatment regimens were evaluated: (1) Toothbrushing with dentifrice followed by a water rinse (B-W, negative control); (2) Toothbrushing with dentifrice followed by a CPC mouthrinse use (B-CPC); (3) Toothbrushing with dentifrice followed by a water rinse and then a CPC mouthrinse use (B-W-CPC); and (4) Toothbrushing with dentifrice and waiting 60 min. prior to a CPC mouthrinse use (B-60 min.-CPC). Three days before the baseline exam of treatment periods, subjects were instructed to brush only the lingual surfaces of their teeth for up to 60 s twice daily. At baseline, subjects received a plaque exam using the Turesky modification of the Quigley-Hein index (MQH) followed by a polishing on the lingual and buccal surfaces of their teeth. During treatment periods, subjects were asked to brush only the lingual surfaces of their teeth with a standard fluoride dentifrice. Rinsing with 20 ml of the experimental CPC solution was done for 30 s twice daily. The evening before the last day of treatment periods (Day 4), subjects were asked to refrain from any oral hygiene, eating, and drinking after brushing. On Day 4, plaque was scored using the MQH Index. A 10-day wash-out of normal oral hygiene was allowed between each of the four treatment periods. The data were analysed using analysis of covariance for cross-over designs. RESULTS: Twenty-five to 29 subjects were evaluable at any given visit. With respect to unbrushed buccal and brushed lingual surfaces, all three CPC regimens had highly significantly (p < or = 0.0006) lower mean plaque scores than the B-W regimen, reductions ranging from 20% to 38% in magnitude. With respect to unbrushed surfaces, there was a significant difference between the B-CPC regimen and the B-60 min.-CPC regimen (p < 0.01) in favour of the latter regimen. No other pairwise treatment comparisons were statistically significant for unbrushed sites. Results for brushed surfaces and all sites combined showed that both the B-W-CPC and the B-60 min.-CPC groups reduced mean plaque levels significantly (p < or = 0.013) more than B-CPC. There were no statistically significant differences between B-W-CPC and B-60 min.-CPC for measurements of brushed, unbrushed, or all sites combined. CONCLUSIONS: Results show that the alcohol-free, 0.07% high bioavailable CPC rinse provides an additive anti-plaque benefit beyond toothbrushing with a standard fluoride dentifrice regardless of the regimen. Of the regimens, a water rinse between toothbrushing and CPC rinsing enhances therapeutic efficacy while fitting into the patient's typical oral hygiene routine.

Squamous cell carcinoma of the oral tissues: a comprehensive review for oral healthcare providers.

North Americans in 2004 were projected to die from oral and pharyngeal cancer at a rate of 1.2 per hour. Oral healthcare providers can be instrumental in reducing the incidence of oral and pharyngeal premalignant and malignant lesions by identifying patients with high-risk behavior, educating their patients about the consequences of their high-risk behavior, and by early detection of premalignant and malignant conditions. The fact only 34% of the cancers of the oral cavity and larynx are localized at the time of diagnosis and evidence that at least one third of the patients diagnosed with an oral or pharyngeal malignancy have undergone oral cancer screening within the past three years suggests the current protocol for the early detection of pre-malignant or malignant changes appears to be deficient. To facilitate early diagnosis, oral healthcare providers must take into consideration the capriciousness of oral cancer and must be familiar with the availability and application of diagnostic modalities beyond conventional visual inspection and palpation of oral soft tissues. This article provides a comprehensive review of the disease for healthcare professionals.

Comparative clinical trial of two antigingivitis mouthrinses.

PURPOSE: To compare the safety and the antiplaque and antigingivitis efficacy of two oral rinses. METHODS: A randomized, double-blind, parallel groups, single-center study was conducted to evaluate the safety and efficacy of a high bioavailable, alcohol-free 0.07% cetylpyridinium chloride (CPC) rinse (Crest Pro-Health Rinse) and a positive control rinse containing essential oils (EO) and 21.6% ethyl alcohol (Cool Mint Listerine). Seventy-eight healthy adults were enrolled in a modified experimental gingivitis clinical trial. Four weeks before the baseline visit, subjects received a prophylaxis and were instructed to brush twice daily in a manner to approach optimum gingival health. At the end of the 4-week period, subjects were randomly assigned to treatment and instructed to use 20 ml of their assigned product for 30 seconds after brushing twice daily during a 21-day treatment phase. Plaque removal by brushing was prevented during the treatment phase for one mandibular quadrant (experimental gingivitis region) by means of a specially-manufactured tooth shield. Safety and efficacy measurements were obtained at baseline and at the end-of-treatment using the Modified Gingival Index (MGI), Gingival Bleeding Index (GBI), and Modified Quigley-Hein Plaque Index (MQH). At all visits, an oral soft tissue examination was performed for each subject. The efficacy data obtained in the experimental gingivitis region were analyzed with analysis of covariance. RESULTS: Seventy-five subjects completed the study and were included in the data analyses. No statistically significant differences were detected between the two treatment groups for MGI, GBI or MQH measures. Results were similar for shielded interproximal sites. Both treatments were well-tolerated. CLINICAL SIGNIFICANCE: This randomized, controlled comparative clinical trial demonstrated that rinsing twice daily with the experimental alcohol-free 0.07% CPC rinse provides antiplaque and antigingivitis efficacy similar to that of the positive control EO rinse, a recognized antiplaque and antigingivitis mouthrinse that contains alcohol.

A 6-month clinical trial to study the effects of a cetylpyridinium chloride mouthrinse on gingivitis and plaque.

PURPOSE: To evaluate the effects of a novel mouthrinse containing 0.07% high bioavailable cetylpyridinium chloride (Crest Pro-Health Rinse) on the development of gingivitis and plaque versus a placebo control over a period of 6 months. METHODS: This was a randomized, 6-month, placebo-controlled, parallel groups, double blind, single center clinical trial. One hundred thirty-nine generally healthy adults with mild-to-moderate gingivitis were enrolled in the study. Subjects were given Modified Gingival Index (MGI), Gingival Bleeding Index (GBI) and Modified Quigley-Hein Plaque Index (MQH) examinations followed by a dental prophylaxis. Subjects were then randomly assigned to either the cetylpyridinium chloride (CPC) rinse or placebo rinse and instructed to begin rinsing twice a day with 20 ml of their assigned mouthrinse for 30 seconds after brushing their teeth. Subjects were assessed for MGI, GBI and MQH scores after 3 and 6 months of product use. Oral hard and soft tissue examinations were also performed at all visits. RESULTS: 124 subjects were evaluable at Month 3 and 119 at Month 6. After 6 months, subjects rinsing with the CPC rinse showed 15.4% less gingival inflammation, 33.3% less gingival bleeding, and 15.8% less plaque relative to the placebo group. All reductions were highly statistically significantly different (P< 0.01). Results were similar at 3 months. Both treatments were well-tolerated. CLINICAL SIGNIFICANCE: This study demonstrates that the Crest Pro-Health 0.07% CPC mouthrinse provided significant antiplaque and antigingivitis benefits when used twice daily for 6 months as an adjunct to toothbrushing.

Plaque removal efficacy of a prototype manual toothbrush versus an ADA reference manual toothbrush with and without dental floss.

OBJECTIVE: The objective of this study was to compare the plaque removal efficacy of a prototype manual Deep Clean toothbrush versus an American Dental Association (ADA) manual toothbrush and the ADA manual toothbrush in conjunction with floss. METHODS: This study was a randomized, examiner-blind, six-period cross-over, single-center study conducted in 60 adult subjects that examined plaque removal with a prototype Deep Clean manual toothbrush, an ADA reference manual toothbrush, and an ADA reference manual toothbrush followed by floss. During the course of this study, subjects used each treatment two times. Plaque was scored before and after brushing using the Rustogi Modification of the Navy Plaque Index. A mixed model analysis of covariance (ANCOVA) for a crossover design with baseline plaque score as the covariate was applied to the baseline minus one-minute post-brushing differences in average whole-mouth plaque scores. Supplemental analyses were also performed using the ANCOVA model separately for average gingival margin scores and for average interproximal scores, using the appropriate baseline score as the covariate. All comparisons were two-sided at the 0.05 level of significance. RESULTS: The prototype Deep Clean manual toothbrush delivered an adjusted (via ANCOVA) mean difference between baseline and post-brushing plaque scores of 0.245, while the ADA manual toothbrush plus floss delivered an adjusted mean difference of 0.207 versus 0.196 for the ADA manual toothbrush alone. The prototype Deep Clean manual toothbrush demonstrated a statistically significantly greater reduction in plaque than the ADA manual toothbrush plus floss (p<0.001), which in turn had a statistically significantly greater reduction in plaque than the ADA manual toothbrush alone (p<0.001). The prototype Deep Clean manual toothbrush group had, on average, 25.2% and 18.3% greater plaque removal scores than the ADA manual toothbrush alone and the ADA manual toothbrush plus floss groups, respectively. Results for the interproximal and gingival margin regions also demonstrated statistically significantly (p<0.001) greater plaque removal for the prototype Deep Clean manual toothbrush group relative to the other groups. CONCLUSIONS: The prototype manual Deep Clean toothbrush was found to deliver greater plaque removal by 25.2% and 18.3% compared to the control manual toothbrush group (ADA reference manual toothbrush) and ADA manual toothbrush plus floss group.

Risk stratification and dental management of the patient with cardiovascular diseases. Part II: Oral disease burden and principles of dental management.

Cardiovascular diseases are the leading cause of death in the United States and most other Western countries. In the United States alone, more than 1 million annual deaths and as many as three times that number of serious consequences can be attributed to these conditions. To provide care to patients with cardiovascular disease, oral health care providers must understand the disease, its treatment, and its impact on the patient's ability to undergo and respond to dental care.

Risk stratification and dental management of the patient with cardiovascular diseases. Part I: Etiology, epidemiology, and principles of medical management.

The heart pumps blood through a system of blood vessels under the control of an electric conduction system to deliver oxygen to all cells of the body. When the blood volume becomes greater than the limited volume capacity of the vascular system, the patient develops hypertension. When the myocardium does not get enough oxygen because of coronary artery disease, the patient will experience angina pectoris. If oxygen deprivation to the myocardium persists, the patient may develop myocardial infarction. When the conduction system malfunctions, arrhythmias occur and the heart is unable to pump blood through the vascular system at a regular rate and rhythm. When the heart is no longer able to pump enough blood to meet the metabolic demands of the body for oxygen, the patient is said to have developed heart failure. In addition, many of the above conditions can lead to thromboembolic complications. These cardiovascular diseases are the leading cause of death in the United States and most other Western countries. In the United States alone, more than 1 million annual deaths and as many as three times that number of serious consequences can be attributed to these conditions. To provide care to patients with cardiovascular disease, oral health care providers must understand the disease, its treatment, and its impact on the patient's ability to undergo and respond to dental care.

Vitamin C in health and disease.

Vitamins are essential to maintain normal metabolic processes and homeostasis within the body. The amount of a specific vitamin required by an individual varies considerably and it is influenced by such factors as body size, growth rate, physical activity, and pregnancy. Most vitamins are stored minimally in human cells, but some are stored in liver cells to a greater extent. Vitamins A and D, for example, may be stored in sufficient amounts to maintain an individual without any intake for 5 to 10 months and 2 to 4 months, respectively. However, a deficiency of vitamin B compounds (except vitamin B12) may be noted within days, and the lack of vitamin C will manifest within weeks and may result in death in 5 to 6 months. The current recommended dietary allowance (RDA) of vitamin C is 75 mg for woman and 90 mg for men, based on the vitamin's role as an antioxidant as well as protection from deficiency. High intakes of the vitamin are generally well tolerated, however, a Tolerable Upper Level (TUL) was recently set at 2 g based on gastrointestinal upset that sometimes accompanies excessive dosages. Several populations warrant special attention with respect to vitamin C requirements. These include patients with periodontal disease, smokers, pregnant and lactating women, and the elderly.

Acetic acid wash and chemiluminescent illumination as an adjunct to conventional oral soft tissue examination for the detection of dysplasia: a pilot study.

Population-based oral cancer screening appears to be a promising health promotion strategy (especially in high-risk individuals) with significant increases in quality-adjusted life years saved. However, the current protocol, conventional visual inspection, and palpation of oral soft tissues for the early detection of pre-malignant or malignant changes, appears to be deficient. The adjunctive application of technology to highlight such lesions may increase the diagnostic yield. The purpose of this pilot study was to collect data, which might support the hypothesis that oral soft tissues exhibit features similar to the cervical epithelium following an acetic acid wash and visual inspection under chemiluminescent illumination. The data provides strong evidence to support the hypothesis. Epithelium with hyperkeratinization, hyperparakeratinization, and/or chronic inflammatory infiltrate reflects the diffuse, low-level, blue-white chemiluminescent light more strongly and appears amplified. Similarly, epithelium with an altered nuclear-cytoplasmic ratio also reflects the diffuse, low-level, blue-white chemiluminescent light. In such cases, the lesions become clinically discernible and appear "acetowhite." Large-scale studies are required to further refine issues related to the selectivity and specificity of the technology.