RCT on the effectiveness of the intraligamentary anesthesia and inferior alveolar nerve block on pain during dental treatment.

OBJECTIVE: To compare the effectiveness and complications of intraligamentary anesthesia (ILA) with conventional inferior alveolar nerve block (IANB) during injection and dental treatment of mandibular posterior teeth. MATERIALS AND METHODS: In this randomized, prospective clinical trial, 72 patients (39 males, 33 females), scheduled for dental treatment of mandibular posterior teeth, were randomly allocated to ILA group (n = 35) received ILA injection or IANB group (n = 37) received the conventional IANB. Our primary outcome was to assess pain and stress (discomfort) during the injection and dental treatment, using the numeric rating scale (NRS) from 0 to 10 (0 = no pain, 10= the worst pain imaginable), whereas recording 24-h postoperative complications was our secondary outcomes. RESULTS: Patients in ILA group reported significantly less pain during injection when compared with IANB group (p = 0.03), while pain during dental treatment was similar in both groups (p = 0.2). Patients in both groups also reported similar law values of discomfort during treatment (p = 0.7). Although no signs of nerve contact or any other postoperative complications were observed, five patients in IANB group (none in ILA group) reported temporary irritations. CONCLUSION: This study showed equivalent effectiveness of both intraligamentary anesthesia and conventional inferior alveolar nerve block, for pain control during routine dental treatment of mandibular posterior teeth. Nevertheless, ILA showed significantly less pain during injection. No major postoperative complications in both groups were observed. CLINICAL RELEVANCE: ILA could be considered as an effective alternative for routine dental treatment. TRIAL REGISTRATION: NCT04563351.

Improving Toothbrushing with a Smartphone App: Results of a Randomized Controlled Trial.

OBJECTIVES: Performing proper toothbrushing is a complicated process for children. Therefore, the aim of this study was to investigate the effect of a smartphone app for improving manual toothbrushing via a gravitation sensor. METHODS: In this prospective, controlled, single-blinded, randomized clinical trial, 49 children (mean age 5.1 ± 0.6 years, 27 female) were randomly assigned to test (n = 26) and control (n = 23) groups. All children were provided with manual toothbrushes with an integrated gravitation sensor and they received oral health instructions. Only the children of the test group got an additional smartphone app to visualize and reward proper brushing in form and time. At baseline and recalls after 6 and 12 weeks, plaque and gingival indices (QHI, PBI) were recorded for analysis between the two groups. RESULTS: At baseline, there were no significant differences between the test and control group regarding plaque and gingival indices (QHI: 2.36 ± 0.7 and 2.42 ± 0.8; p = 0.94; PBI: 0.42 ± 0.2 and 0.47 ± 0.3; p = 0.59). At the 6- and 12-week recalls, the test group showed statistically -significantly better oral health indices than the controls (6-week recall, QHI: 0.8 ±0.5 and 1.88 ± 0.9; p < 0.001; PBI: 0.08 ± 0.1 and 0.26 ± 0.2; p < 0.001; 12-week recall, QHI: 0.44 ± 0.5 and 1.49 ± 0.7; p < 0.001; PBI: 0.05 ± 0.18 and 0.21 ± 0.1; p < 0.001). CONCLUSION: The results highlight the enormous possibilities of a toothbrushing application via the smartphone, at least for medium-term oral hygiene improvement in preschool children and even after excluding the app. The long-term effect should also be investigated to exclude the expected novelty effect.

Use of stainless steel crowns to restore primary molars in Germany: Questionnaire-based cross-sectional analysis.

BACKGROUND: Stainless steel crowns (SSCs) have shown substantial clinical success and are the restoration of choice to treat multisurface carious primary molars. AIM: To evaluate the use of and views on SSCs for treating primary molars in Germany. METHODS: This is a questionnaire-based cross-sectional study, which assessed the views of dentists and dental schools on the use of SSCs (conventional and the Hall Technique [HT]) in Germany. Dentists were randomly selected (n = 267) and contacted by telephone, and a self-administered questionnaire was sent to all German dental schools (n = 27). RESULTS: A total of 104 (39%) dentists agreed to participate. The majority of respondents (66%) do not use SSCs, being the main drawbacks: technique complexity (29%) and aesthetic concerns (23%). The majority of respondents (77%) were not familiar with the HT. The response rate from the universities was 85%. In 96% of the dental schools, the value of using SSCs is taught; however, in 27%, no practical training is provided. In addition, the dental schools' questionnaire revealed that the HT was known (91%), but neither taught to nor used for most of the dental students (76%). CONCLUSION: Independent of the technique used, SSCs are considerably underutilized in the dental practice in Germany, although SSCs are well accepted by the universities, however, predominantly using the conventional approach.

Socio-behavioural aspects in the prevention and control of dental caries and periodontal diseases at an individual and population level.

AIM: Aim was to systematically review behavioural aspects in the prevention and control of dental caries and periodontal diseases at individual and population level. MATERIAL & METHODS: With regard to caries, MEDLINE/PubMed was searched on three subheadings focusing on early childhood, proximal and root caries. For periodontal diseases, a meta-review on systematic reviews was performed; thus, the search strategy included specific interventions to change behaviour in order to perform a meta-review on systematic reviews. After extraction of data and conclusions, the potential risk of bias was estimated and the emerging evidence was graded. RESULTS: Regarding early childhood, proximal and root caries, 28, 6 and 0 papers, respectively, could be included, which predominantly reported on cohort studies. Regarding periodontal diseases, five systematic reviews were included. High evidence of mostly high magnitude was retrieved for behavioural interventions in early childhood caries (ECC), weak evidence for a small effect in proximal caries and an unclear effect of specific informational/motivational programmes on prevention of periodontal diseases and no evidence of root caries. CONCLUSION: Early childhood caries can be successfully prevented by population-based preventive programmes via aiming at the change in behaviour. The effect of individual specific motivational/informational interventions has not yet been clearly demonstrated neither for the prevention of caries nor for periodontal diseases.

Alternative Caries Management Options for Primary Molars: 2.5-Year Outcomes of a Randomised Clinical Trial.

Less invasive caries management techniques for treating cavitated carious primary teeth, which involve the concept of caries control by managing the activity of the biofilm, are becoming common. This study aimed to compare the clinical efficacy (minor/major failures) and survival rates (successful cases without any failures) of 3 carious lesion treatment approaches, the Hall Technique (HT), non-restorative caries treatment (NRCT), and conventional restorations (CR), for the management of occlusoproximal caries lesions (ICDAS 3-5) in primary molars. Results at 2.5 years are presented. A total of 169 children (3- to 8-year-olds) were enrolled in this secondary care-based, 3-arm parallel-group, randomised controlled trial. Participants were allocated to: HT (n = 52; sealing caries with stainless-steel crowns without caries removal), NRCT (n = 52; opening up the cavity and applying fluoride varnish), CR (n = 65; control arm, complete caries removal and compomer restoration). Statistical analyses were: non-parametric Kruskal-Wallis analysis of variance, Mann-Whitney U test and Kaplan-Meier survival analyses. One hundred and forty-two participants (84%; HT = 40/52; NRCT = 44/52; CR = 58/65) had follow-up data of 1-33 months (mean = 26). Overall, 25 (HT = 2, NRCT = 9, CR = 14) of 142 participants (17.6%) presented with at least 1 minor failure (reversible pulpitis, caries progression, or secondary caries; p = 0.013, CI = 0.012-0.018; Mann-Whitney U test). Ten (HT = 1, NRCT = 4, CR = 5) of 142 participants (7.04%) experienced at least 1 major failure (irreversible pulpitis, abscess, unrestorable tooth; p = 0.043, CI = 0.034-0.045). Independent comparisons between 2 samples found that NRCT-CR had no statistically significant difference in failures (p > 0.05), but for CR-HT (p = 0.037, CI = 0.030-0.040) and for NRCT-HT (p = 0.011, CI = 0.010-0.016; Kruskal-Wallis test) significant differences were observed. Cumulative survival rates were HT = 92.5%, NRCT = 70.5%, and CR = 67.2% (p = 0.012). NRCT and CR outcomes were comparable. HT performed better than NRCT and CR for all outcomes. This study was funded by the Paediatric Dentistry Department, Greifswald University, Germany (Trial registration No. NCT01797458).

Referral patterns and general anesthesia in a specialized paediatric dental service.

OBJECTIVES: The caries patterns of child populations in Germany have changed during the last 20 years. This affects the referrals and provision of specialist dental care for children. This study has two aims: first, to investigate referrals received by a specialized pediatric dental institution in 1995 and 2008, and second, to assess the treatments performed during full oral rehabilitations under general anesthesia in this institution from 2007 to 2008. METHODS: All data of referred patients were evaluated for 1995 and 2008 separately. Comparisons were carried out for different socio-demographic, medical, and dental parameters. All patients treated under general anesthesia (GA) between March/2007 and December/2008 were examined retrospectively and their data were analyzed. RESULTS: In 1995 (n = 191), significantly older children were referred to specialized pediatric dental care compared to 2008 (n = 179). In addition, a shift of surgical referrals to very young children with high caries levels was clearly noticed, resulting in considerably more oral rehabilitation performed under GA in 2008 (n = 73). Thus, the mean values of 6.4 fillings and 2.7 extractions per child were quite high. CONCLUSIONS: Preventive treatment approaches for primary dentition in Germany need further improvement by focusing on high caries-risk groups, as specialized pediatric dentistry bears the great burden of providing oral rehabilitations under GA in young children.

Acceptability of different caries management methods for primary molars in a RCT.

BACKGROUND: More conservative techniques for managing dental caries including 'partial' and 'no caries removal' have been increasingly of interest. AIM: To compare children's behaviour and pain perception, also technique acceptability (parents and dentists), when approximal dentinal lesions (ICDAS 3-5) in primary molars (3-8-year-olds) were managed with three treatment strategies; conventional restorations (CR), hall technique (HT), and non-restorative caries treatment (NRCT). DESIGN: Secondary care-based, three-arm parallel-group, randomised controlled trial, with 169 participants treated by 12 dentists. OUTCOME MEASURES: child's pain perception (Visual Analogue Scale of Faces); behaviour (Frankl scale); and parents' and dentists' treatment opinions (5-point Likert scales). RESULTS: Children showed more negative behaviour in the CR group (37%) compared to NRCT (21%) and HT (13%) (P = 0.047, CI = 0.41 to 0.52). Pain intensity was rated 'very low' or 'low' in 88% NRCT, 81% HT, and 72% CR (P = 0.11, CI = 0.10 to 0.12). NRCT and HT were 'very easy' or 'easy' to perform for >77% of dentists, compared to 50% in CR group (P < 0.000). There were no statistically significant differences in parents' rating of their child's level of comfort (P = 0.46, CI = 0.45 to 0.48). CONCLUSIONS: Dentists reported more negative behaviour in CR group. For all techniques, children's pain perception and dentist/parent acceptability were similar.

Musculoskeletal disorders and risk indicators for pain chronification among German dentists: A cross-sectional questionnaire-based study.

OBJECTIVES: The aim of this study was to determine the prevalence of musculoskeletal (MS) disorders in practicing German dentists and identify risk factors for pain chronification. METHODS: This was a cross-sectional, quantitative, questionnaire-based study in which the validated German version of the Örebro Musculoskeletal Pain Questionnaire was sent out to practicing German dentists. RESULTS: Of the 8,072 questionnaires sent out, 576 dentists responded (60.2% men, 39.8% women; mean [SD] age, 50 [10.1] years; response rate, 7.1%). Overall, 344 dentists had current pain at 719 pain sites (point prevalence, 59.7%). The risk of chronic pain in dentists with current MS pain was high in 28.5% (n = 98), moderate in 30.5% (n = 105), and low in 41% (n = 141). The multivariate logistic regression analysis showed that specialization in restorative dentistry was associated with a significantly higher risk of experiencing pain chronification (odds ratio [OR], 3.94; P = .008), followed by specialization in pediatric dentistry (OR, 0.35; P = .048). A history of current pain, particularly current leg pain, was predictive of higher chronification risk (OR, 22.0; P < .001) and neck pain (OR, 4.51; P = .001). CONCLUSIONS: Almost two-thirds of practicing German dentists have MS pain, and one-third of these have a moderate through high risk of developing pain chronification. These health problems have an adverse impact on their ability to successfully perform dental services, with the potential for prolonged sick leave, disability, and early retirement. Accordingly, these problems deserve greater attention from the scientific community (identification of risk factors), universities (sensitization and education), and policy makers (development and implementation of appropriate countermeasures for MS disorders in the dental profession). PRACTICAL IMPLICATIONS: Knowing the risk factors associated with acute and chronic MS pain may help dentists take preventive measures and thereby improve their physical well-being and work-related quality of life.

Biomimetic Enamel Regeneration Using Self-Assembling Peptide P11-4.

The recent understanding of the etiology and pathology of dental caries has shifted its treatment from invasive drill and fill conventional strategies to noninvasive and/or minimally invasive approaches. Guided tissue regeneration (GTR) is a well-established therapeutic approach in medicine and periodontal and oral surgery. Recently, the concept of biomimetic regeneration has been further expanded to treat the loss of hard dental tissues. Self-assembling peptides have emerged as a promising biomaterial for biomimetic regeneration due to their ability to construct a protein scaffold in the body of early carious lesions and provide a matrix that promotes remineralization. This review article accompanies the development of self-assembling peptide P11-4 for the treatment of initial carious lesions. In vitro and in vivo studies on the safety, clinical applicability, and efficacy of P11-4 are discussed. Furthermore, different treatment options and potential areas of application are presented.

Treatment success of carious primary molars with marginal breakdown: comparison of three treatment approaches in a real-world clinical setting (using decision tree analysis).

OBJECTIVES: Treatment of carious primary molars is always indicated, especially on young children; however, there are no clear guidelines that precisely explain the best treatment approach for Class II carious molars with marginal breakdown (International Caries Detection and Assessment System [ICDAS] 5). The objective of this prospective observational clinical study was to assess the efficacy of three restorative techniques in treating ICDAS 5 Class II lesions in primary molars: compomer fillings (CF), preformed metal crowns (PMC), and pulpotomy and conventional preformed metal crowns (PMC+P). The secondary goal was to evaluate the impact of some cofactors on the course of treatment. METHOD AND MATERIALS: Overall, 92 children (female, n = 50, 54.3%; male, n = 42, 45.7%) aged 2 to 9 years old (mean age = 5.9 ± 1.9 years) with 166 treated teeth were included. The average number of decayed, missing, or filled teeth (d3mft) of the whole sample was 8.0 ± 3.4. The distribution of the sample according to type of treatment was CF = 53 (31.9%), PMC = 64 (38.6%), and PMC+P = 49 (29.5%). Paired t test, nonparametric Friedman ANOVA test, and decision tree analysis were used as the basis for the statistics. RESULTS: After 12 months, data from 75.8% (72/95) treated patients, corresponding to 62.0% (103/166) of the treated teeth (CF = 42/53, 79.2%; PMC = 38/64, 59.4%; PMC+P = 23/49, 46.9%) were available for analysis. The mean patients age was 6.8 ± 1.8 years; 32 (47.1%) boys and 36 (52.9%) girls. The mean d3mft of the remaining sample was 7.8 ± 3.35. PMC and PMC+P arms showed the highest success rates (> 91%) as compared to the CF arm, which showed the lowest success rates (61.9%), with 9/42 teeth of the CF group (21.4%) presenting with minor failures, and 7/42 teeth (16.7%) with major failures (P < .0001). CONCLUSION: According to the decision tree analysis, PMC and PMC+P had a success rate of 99%, whereas CF had a success rate of only 69%. Some cofactors (treatment decision, Approximal Plaque Index, and tooth number) had a higher impact on the decision tree analysis than others (age, dmfs, and dmft values), especially when the treatment selection was CF. In future studies it is necessary to examine the impact of other cofactors on the outcomes of conventional fillings using a larger sample size.

Multicenter RCT on intensive caries prevention for children undergoing dental general anaesthesia: Intensive caries prevention for children undergoing dental general anesthesia.

OBJECTIVES: Early childhood caries is a persistent problem often leading to dental treatment under general anesthesia (GA). Thus, this study investigated the effect of two additional individual caries prevention appointments before and after GA. MATERIALS AND METHODS: In this multi-center, 2-arm randomized, controlled clinical trial, 408 children (age 2-5 years, mean 4.2 ± 1.04) intended for GA were recruited and randomly assigned to the intervention and control groups with or without two additional intensive oral hygiene appointments before and after the GA. At baseline and at 6-/12-months follow-ups, approximal plaque index (API), gingival sulcus bleeding index (SBI), caries experience (dmft/s) and initial caries were recorded. RESULTS: Participants in test group and control group (ITT; n = 161 vs. n = 147) as well as drop-outs in test and control groups (n = 40 vs. n = 58) showed no statistical significant difference in baseline characteristics. Test and control groups showed equivalent baseline oral health parameters (API: 78 and 77%, SBI: 22.6 and 23.5%, dmft: 8.5 and 8.2, respectively), which continuously improved during the study. The test group exhibited statistically significant greater improvement (API: 42%, SBI: 7%) than the control (API: 54%, OR: 0.48; P = 0.003; SBI: 12%, OR=0.44; P = 0.005). Due to the robust rehabilitation with predominantly stainless steel crowns and extractions, caries incidence was minimal and, therefore, without statistical significance (mean increase dt, test: 0.5, control: 0.6; P = 0.68), which was also true for new initial carious lesions (mean increase test: 0.8 vs. CONTROL: 0.9; P = 0.55). CONCLUSIONS: Additional preventive sessions for children undergoing treatment under GA improved their oral hygiene parameters signifiqantly. CLINICAL SIGNIFICANCE: Intensive caries prevention appointments for children receiving dental treatment under GA improved their oral hygiene and might reduce their caries risk.

Sealing proximal surfaces with polyurethane tape: three-year evaluation.

The purpose of this investigation was to test the safety and clinical effect of a new material for the treatment of proximal caries. In 50 patients with two proximal initial lesions, one of the lesions was randomly chosen and sealed with a thin polyurethane-dimethacrylate foil using bonding. The other lesion received oral home care and was left as the control. In clinical follow-ups after 6 and 12 months and X-ray evaluation after 2 and 3 years, the sealants showed good retention, marginal adaptation, and color. No relevant significant differences in plaque accumulation or gingival status were found between sealed and control teeth. On the radiographs, almost all sealed and control lesions appeared stable, indicating an arrest of the lesion. In conclusion, sealing initial proximal lesions showed no clinical problems and mostly arrest of caries on bitewing radiographs.

Dental status and prosthetic treatment needs among adult refugees in Germany.

OBJECTIVE: Due to the current global situation of refugees, Europe has experienced increased migration from African, Middle Eastern, and Eastern European countries. The objective of this study was to explore oral health, especially prosthetic status and treatment needs, in adult refugees, and to compare these findings with German cohorts. METHOD AND MATERIALS: This representative, multicenter, cross-sectional survey on oral health and treatment needs among refugees was carried out in 10 registration centers for asylum seekers aged 18 to 75 years across Germany in 2016 to 2017. The clinical examination included past caries experience (DMFT) and both existing and necessary prosthetic measures. These measures were registered according to the National German Health Survey 2016 and compared to the German resident population. RESULTS: A high untreated caries experience (DT 3.9 ± 4.6) was found among refugees (n = 288, age 37 ± 12), in addition to the expected increase of caries experience with getting older (DMFT 7.4 ± 5.7 to 14.9 ± 7.7). In contrast to the German resident population, extractions were the preferred past caries treatment, resulting in a considerable number of missing teeth (MT 7.6 ± 7.3, FT 3.6 ± 4.3, 45- to 64-year-olds). Existing prosthetic treatments such as partial and full removable dental prostheses were very rare among refugees (2% to 4%). Fixed dental prostheses were mostly required in the mandible of young adults (25%, 18- to 44-year-olds), while elderly refugees required more often removable dental prostheses (45 to 64 years, 39.7% maxilla, 38.4% mandible). CONCLUSIONS: Newly arrived refugees in Germany exhibit higher dental treatment needs in general and prosthetic treatment needs in particular due to former extractions, which were performed as a main caries treatment.

Sealing of proximal surfaces with polyurethane tape: a two-year clinical and radiographic feasibility study.

PURPOSE: Proximal carious lesions comprise a constant clinical problem. The aim of this investigation was to test the safety and clinical effect of a new treatment for proximal caries. MATERIALS AND METHODS: In 50 patients with two proximal initial lesions (D1-3 without cavitation, bitewing radiograph), orthodontic rubber rings were applied to gain access to the interproximal space. One of the lesions was sealed with a thin polyurethane-dimethacrylate foil using a bonding agent; the other lesion received oral home care with dental floss and fluoridated toothpaste, and was left as control. RESULTS: In clinical follow-ups after 6 and 12 months and radiographic evaluation after two years, clinical retention of proximal tape and the underlying sealant, marginal adaptation, discoloration, tooth vitality, proximal plaque, and gingivitis were checked. In addition, carious lesions were assessed clinically and radiographically. The sealants showed good retention, marginal adaptation, and color. After two years, vitality of all teeth was still positive and no relevant differences in plaque accumulation or gingival status were found between sealed and control teeth. Nine sealed lesions showed caries regression and 2 progression. In contrast, only 4 control lesions regressed and also 2 showed progression. The loss of tape had no significant influence on the lesion progression, indicating the effect of the underlying bond. All other sealants and control lesions were stable, indicating an arrest of the lesion. CONCLUSION: Sealing initial proximal lesions showed no clinical problems and mostly arrest of initial carious lesions on bitewing radiographs.

Obliteration after recurrent dental trauma in a 7-year-old patient: 4-year follow-up.

Traumatic dental injuries are reported to have a high prevalence regardless of the region or the age group. Concussion injuries are considered as moderate, but very frequent injuries. They are associated with a wide spectrum of pulpal reactions. Pulp canal obliteration in spite of negative sensitivity proves ongoing pulp vitality. This case report presents multiple traumatic dental injuries in both maxillary central incisors with two different pulpal reactions during a follow-up period of 4 years in a healthy 7-year-old girl. The initial trauma with a concussion required no invasive treatment. Three days later, the child presented again with a new dental trauma. At the follow-up appointments after 3, 4, 6, 12, and 18 months, the traumatized teeth were functional and asymptomatic, but the radiograph after 1 year showed partial obliteration in the coronal part of the maxillary right central incisor. After 4 years, the periapical radiograph showed complete apical closure, and increase in root length and dentin thickness for both maxillary central incisors, with almost complete root canal obliteration in the right central incisor, whereas the left central incisor showed no signs of obliteration. Thus, this case showed different pulpal reactions to traumatic dental injury and that the loss of clinical sensitivity of the obliterated tooth does not automatically mean the loss of vitality and the need for endodontics. Regular follow-ups are essential in concussion cases to observe the pulp vitality and root formation.

Clinical applicability of resin infiltration for proximal caries.

OBJECTIVE: Resin infiltration is a new microinvasive treatment to arrest the progress of proximal initial caries lesions. This study evaluated the clinical applicability of proximal caries infiltration. METHOD AND MATERIALS: In the study population of 50 children, adolescents, and young adults (mean age, 17.3 ± 6.4 years), 10 dentists at the University of Greifswald, Greifswald, Germany, applied the infiltration material Icon on noncavitated proximal lesions in permanent and primary teeth as described by the manufacturer. The applicability was evaluated using two questionnaires filled out by clinicians and patients assessing the comfort, complexity, time, and difficulties of the application in comparison to a filling. RESULTS: The results showed good patient satisfaction with the procedure. The mean time for infiltration (24.3 ± 7.4 minutes), which included rubber dam application (7.7 ± 4 minutes) and the effort were perceived to be comparable to or even easier than a composite filling by clinicians. In three patients (6%), it was not possible to gain sufficient proximal space for the application of an infiltration. The location of the infiltrated tooth, separation problems, and the routine of clinicians with the infiltration technique had an effect on the duration of the infiltration. A clear learning curve with a reduction of treatment time for subsequent treatments was observed (P < .001). CONCLUSION: Resin infiltration of initial noncavitated proximal lesion showed good clinical applicability for clinicians and very high acceptance by patients.

Efficacy of semiannual topical fluoride application in schoolchildren.

OBJECTIVE: Fluoride is the most important factor in the decline of caries in children and adolescents. The aim of this observational study, begun in 2000, was to assess the effect of semiannual topical fluoride application in schoolchildren. METHOD AND MATERIALS: Due to limited resources, only 334 of all first and second grade schoolchildren (6 to 8 years of age, 0.32 ± 1.02 decayed/missing/filled surface [DMFS], schools randomly selected) in Greifswald received a semiannual application of elmex fluid, while the remaining 442 children served as the control group (0.36 ± 1.15 DMFS). In 2002 and 2004, 230 and 349 of these children were re-examined according to WHO criteria by one calibrated examiner (DMFT/S). The parents filled out questionnaires on additional fluoride use, which was summarized as fluoride scores. In the dropout analysis, a selection bias among the dropout, fluoride, and control group regarding age, baseline caries prevalence, additional fluoride use, and sealants was excluded. RESULTS: During the entire study, no adverse effects were recorded with the use of elmex fluid. The caries increment was almost identical in the intervention and control groups (0.81 ± 1.74 and 0.78 ± 1.81 DMFS) with 72% and 69% of the children, respectively, showing no caries increment. The effect of only two applications of elmex fluid might have been overridden by the high background fluoride use. The participants had high mean values of the fluoride scores, reflecting the regular use of fluoride toothpaste and additional fluoride sources, without a polarization within the sample (intervention, 1.40 ± 0.60; control, 1.33 ± 0.60). CONCLUSION: Further studies should examine the effect of semiannual topical fluoride applications after caries decline.

Effect of xylitol and sorbitol on plaque acidogenesis.

OBJECTIVE: To evaluate the in vivo potential of xylitol to reduce plaque acidogenicity in comparison to sorbitol. METHOD AND MATERIALS: After completing a questionnaire on general health, smoking, diet, and oral hygiene habits, 61 dentate adults refrained from oral hygiene for 3 days before the clinical baseline examination, which included decayed, missing, and filled teeth (DMFT) index, mutans streptococci and lactobacilli counts, and plaque acidogenicity (cH) index after a sucrose rinse. Then the participants were randomly allocated to consume either sorbitol or xylitol lozenges (5 pieces/day, 2 g each) for 4 weeks and were asked to refrain from oral hygiene for the 3 days prior to the final examination (cH, area < pH 7, bacterial counts). RESULTS: The variation of acidogenicity in different individuals was considerable at baseline (range: 0.2 to 446.6 min micromol/L) with a mean value of 37.9 +/- 58.9 min micromol/L for the sorbitol group and 60.6 +/- 87.6 min micromol/L for the xylitol group. At the end of the study, the reduction in the xylitol group (42.9 +/- 80.6 min micromol/L) was statistically significantly higher than in the sorbitol group (6.0 +/- 69.4 min micromol/L, P = .034), which was also confirmed in an additional analysis excluding 2 participants with extreme values (reduction for xylitol: 29.5 +/- 36.9 min micromol/L; sorbitol: 1.7 +/- 57.0 min micromol/L; P = .019). Statistically significant differences were also found for the area below pH 7 (reduction for xylitol: 10.8 min pH; sorbitol, 0.2 min pH; P = .0025). CONCLUSION: The regular consumption of xylitol lozenges modifies dental plaque, resulting in a marked reduction in the plaque acidogenicity, which could not be detected using sorbitol lozenges. Therefore, xylitol could have an additional benefit in caries prevention.