The effect of professional tooth cleaning or non-surgical periodontal therapy on oral halitosis in patients with periodontal diseases. A systematic review.

OBJECTIVE: The aim of this systematic review was to give the best available evidence on the impact of professional tooth cleaning (PTC) and scaling and root planing (SRP) on oral halitosis in patients with periodontal diseases. MATERIAL AND METHODS: Three databases were screened for relevant studies. Only randomized controlled trials (RCTs) or controlled clinical trials (CCT) were included. The primary outcome in all included studies was volatile sulphur compounds (VSC) measured by Halimeter or OralChroma and organoleptic scores as secondary outcome. Only studies investigating healthy adults except for periodontitis or gingivitis were included. The considered intervention strategies were professional tooth cleaning and non-surgical periodontal treatment. For both strategies, additional oral hygiene instructions (OHI) were possible. Two independent reviewers performed the study selection and quality assessment. SEARCH RESULTS: After abstract and title screening and subsequent full-text reading of potential papers, a placebo-controlled RCT could not be found. However, eight studies or particular arms used PTC or SRP as sole interventions and were included in this review. All trials or study arms included showed a positive effect on VSC levels or organoleptic scores after intervention. CONCLUSIONS: Based on best available evidence, PTC and SRP in combination with oral hygiene instructions reduced VSC values in patients with oral halitosis and/or periodontal diseases, independent of tongue cleaning and the use of mouth rinses.

Efficacy and acceptance of a high-velocity microdroplet device for interdental cleaning in gingivitis patients-A monitored, randomized controlled trial.

OBJECTIVES: To compare in a randomized clinical trial the efficacy of a high-velocity microdroplet device for interdental cleaning vs dental floss at reducing plaque and gingivitis. METHODS: Sixty participants with an irregular interdental home cleaning regime were randomly assigned to use either a microdroplet device (n=40, test) or dental floss (n=20, control) for 4 weeks. At baseline and reassessment, the papilla bleeding index, the modified proximal plaque index and the amount of gingival crevicular fluid (GCF) were recorded. At the second appointment, participants completed a questionnaire regarding their assigned interdental cleaning option. The process quality of this investigator-initiated trial was ensured by independent scientific observers and media representatives. RESULTS: Improvement in the interdental cleaning routine reduced gingivitis in both groups (P<.05). The microdroplet device was more effective at reducing plaque (P=.003). The GCF amount remained the same in both groups. Comfort of use was greater with the microdroplet device. However, self-reported effectiveness was superior with dental floss. About 85% of participants using the microdroplet device said they would continue daily use. CONCLUSION: Improving the interdental cleaning routine with the microdroplet device or dental floss reduced gingivitis and plaque in both groups. Acceptance regarding comfort of use was higher with the microdroplet device. Dental floss remained the first choice for narrow interdental spaces, yet the microdroplet device offers an effective and well-accepted alternative for patients who fail the proper flossing routine.

Hyposalivation and xerostomia among Parkinson's disease patients and its impact on quality of life.

OBJECTIVE: Parkinson's disease (PD) adversely affects oral health (OH). However, the informative value of xerostomia compared to objective parameters and its impact on quality of life (QoL) are still unclear. This study aimed to explore whether xerostomia correlates with hyposalivation and to define its impact on OH-related QoL. MATERIALS AND METHODS: Whole stimulated saliva (WSS) was collected from 30 patients with PD and 30 matched healthy controls. Objective parameters (community periodontal index of treatment needs, plaque/gingivitis index, mucosa situation and cheilitis angularis) and questionnaires (German Oral Health Impact Profile [OHIPG]-14, visual analogue scale [VAS], xerostomia [yes/no] and the Unified Parkinson's Disease Rating Scale-II) were assessed. RESULTS: Eighty-seven per cent of patients with PD showed hyposalivation vs 50% of controls (P = 0.001); 50% of patients with PD reported xerostomia, and none of controls (P < 0.001). The OHIPG-14 was impaired in patients with PD compared to controls (P < 0.001), PD patients with xerostomia reported mean VAS values of 4.1 (s.d.: 2.2). WSS did not correlate with VAS values. CONCLUSIONS: Half of the patients with PD reported xerostomia and underestimated their xerostomic status, with higher probability than healthy controls. WSS did not reflect the grade of xerostomia. Patients with PD suffered from impaired OH-related QoL. Dental teams should not overlook these oral health risks.

Pocket-depths-related effectiveness of an intrapocket anaesthesia gel in periodontal maintenance patients.

AIM: The aim of this study was to determine the impact of the pocket depth on the effectiveness of an intrapocket anaesthesia gel during SRP in periodontal maintenance patients. Effectiveness was measured by pain levels during SRP via visual analogue scale (VAS) and verbal rating scale (VRS). Secondary endpoint was the evaluation of patients' preferred choice of anaesthesia for SRP. METHODS: A total of 638 patients undergoing the periodontal maintenance programme and with the need for SRP participated in this observational study. After SRP, patients filled in questionnaires to record pain levels experienced and anaesthesia preference for future use. Mann-Whitney U-test was used to analyse intergroup difference in pain perception and anaesthesia choice. RESULTS: Overall, increasing pocket depths were accompanied by higher pain levels, irrespective of maximum or commonest pocket depths (P < 0.05). For SRP procedures, patients definitely prefer the anaesthesia gel (72.4%). CONCLUSIONS: In this study, an effectiveness of local anaesthesia gel (lidocaine/prilocaine) related to pocket depths was found in periodontal maintenance patients during SRP. Increasing pocket depths were accompanied by increasing procedural pain levels. Nevertheless, the anaesthesia gel is well accepted and in the majority of cases was found to be the preferred option for future SRP treatments.

Does the use of a visualised decision board by undergraduate students during shared decision-making enhance patients' knowledge and satisfaction? - A randomised controlled trial.

OBJECTIVES: Aim of this RCT was to evaluate whether the added use of a decision board (DB) during shared decision-making improves patients' knowledge as for different treatment options and overall satisfaction with the consultation. METHODS: Forty-nine undergraduate students were trained in shared decision-making (SDM) and evaluated by an Objective Structured Clinical Examination (OSCE). According to their test results, all participants were randomly allocated to either the test- (DB) or the control-group (Non-DB). Both groups performed SDM with patients showing a defect in a posterior tooth (Class-II defect). Prior to the interview, patients of the DB group were given the decision aid for review. In the Non-DB group, patients were consulted without additional aids. After treatment decision, a questionnaire was completed by all patients to measure knowledge (costs, survival rate, characteristics and treatment time) and overall satisfaction with the consultation. Fifty DB patients and 31 Non-DB patients completed the questionnaire. RESULTS: DB patients (n = 50) demonstrated a statistically significant increase in knowledge compared to the Non-DB group (n = 31) (Mann-Whitney U-test; DB group = 10.04; Non-DB group = 4.16; P = 0.004). There was no significant difference between groups regarding satisfaction with the consultation (t-test; P > 0.05). CONCLUSIONS: During the shared decision-making process, the use of a decision board yielding information about Class-II treatment options leads to a significantly higher patient knowledge compared to knowledge gained through consultation alone. It is therefore desirable to provide DBs for dental diagnoses with several treatment options to increase transparency for the patient.

Comparison of three forms of teaching - a prospective randomized pilot trial for the enhancement of adherence.

OBJECTIVE: Adherence of young adults to preventive programmes is low. The following study compares three different educational concepts to increase toothbrushing adherence in young adults. METHODS: Nine vocational school classes (157 young adults) were randomly assigned to three different 60-min approaches: (I) Education by a dentist, (II) Peer-teaching and (III) 'Adherence triangle concept' uniting dentists, teachers and participants as equal partners in intervention planning combined with peer teaching. Follow-up was 1 week for approaches I and II, and 1 week, 3 and 9 months for approach III. Adherence was defined as reported change from the childhood toothbrushing technique to adult technique. Adherence was evaluated using anonymous questionnaires and by diary analysis. RESULTS: After instruction, 90% of participants (approaches I-III) showed the desired behaviour in practice and theory. Reported adherence after 1 week with approach I was 28.5%, with approach II 39% and with approach III 95%. Prolonged follow-up of approach III yielded 76% after 3 months and 68% after 9 months. Adherence using approach III was significantly higher (P ≤ 0.001) than using approach I and II after 1 week. Adherence rates with approach III after 9 months were still higher than those of approaches I and II after 1 week. CONCLUSIONS: The 'adherence triangle' concept enhanced reported adherence significantly in comparison with previous studies and the one-dimensional concepts of approaches I and II. The tools of the adherence triangle concept seem worthwhile to be considered when planning new preventive action.

Retrospective investigation of organization and examination results of the state examination in restorative dentistry, endodontology and periodontology under simulated conditions in times of Covid-19 compared to standard conditions when treating patients.

Objective: Primary outcome of this retrospective study was the comparison of state examination results under simulated treatment conditions in times of Covid-19 versus patient treatment under non-pandemic conditions. Additionally, correlation analysis was performed between students' self- and examiners' assessment of the treatment results. Methods: Within 4 hours, 22 examinees each had to place a multi-surface adhesive anterior and posterior restoration, performed an endodontic treatment on a maxillary premolar and a periodontal debridement of one quadrant. All treatments were performed on a model fixed in a phantom head. Compliance with the prescribed hygiene and social distancing guidelines and self-assessment of the practical performance was part of the practical examination as well. One examiner per examination part evaluated anonymously the final results. The historical control was based on the exam results of a cohort from 2019. Mean values (standard deviation), non-parametric correlations (Spearman's Rho) and group comparisons (Mann-Whitney) were calculated for statistical analysis. Results: Examination results under simulated treatment conditions were significantly worse (p<0.05) than in the cohort that took their state exam in patients, with exception of the endodontic partial exam. The overall scores in restorative dentistry and periodontology of both groups, which include a structured theoretical examination, did not differ. The majority of the candidates rated their performance worse than the examiners, and there was no correlation between self- and third-party assessment. Conclusion: In the comparison of two years, a simulated practical examination without patients in restorative dentistry, endodontics and periodontology resulted in matchable results compared with an examination on patients. Equal conditions for the candidates resulting in better comparability and avoidance of ethical dilemmas of patient treatment under examination conditions could also be arguments towards a state examination under phantom conditions in the future.

Efficacy of differently concentrated chlorhexidine varnishes in decreasing Mutans streptococci and lactobacilli counts.

The objective of the present prospective trial was to compare the efficacy of differently concentrated chlorhexidine varnishes (EC40) = 40% chlorhexidine and Cervitec = 1% chlorhexidine + 0.1% thymol) on levels of Mutans streptococci (ms), lactobacilli (lb) and plaque formation in interproximal plaque and saliva. Twenty-four volunteers with a high level of ms in saliva were randomized into two groups and treated with the experimental varnishes. Varnish applications were performed in accordance with literature. Over a period of 2 weeks Cervitec was applied three times and EC40 once or twice, depending on ms counts after first application. Four and 12 weeks after final varnish application ms in plaque and saliva were evaluated. Furthermore, lactobacilli (lb) counts in saliva and the effect on plaque formation were recorded. Both varnishes revealed a reduction of ms in interproximal plaque and saliva after 4 and 12 weeks. The highly concentrated varnish revealed a significantly stronger reduction of ms in plaque and saliva compared with the lowly-concentrated varnish. No effect could be demonstrated on lb counts and plaque formation. The results indicate that the chlorhexidine varnishes tested may reduce ms in both interproximal plaque and saliva. However, the application of the highly concentrated varnish EC40 results in a higher decrease of ms in plaque sites and saliva.

Margin quality of Class III and IV composites in vitro.

Polymerization shrinkage and thermal expansion/contraction of composites counteract marginal bonding. The purpose of this study was to determine the margin quality of Class III and IV microfilled and hybrid composite restorations placed with adhesive techniques. Two experiments were conducted. In experiment 1, small, beveled Class III cavities were prepared in 24 incisors. Twelve cavities were filled with an experimental microfilled composite (COMPAFILL) and 12 with a control microfilled material (DURAFILL). In experiment 2, standardized large, beveled Class IV cavities were prepared in 24 incisors. Twelve of these incisors were filled with DURAFILL and 12 with the hybrid composite HERCULITE XR. The teeth were stored in water for 21 days. Before and after the restorations were thermocycled (5 degrees C-55 degrees C), replicas were obtained for quantitative analysis in the SEM. Statistical analysis (non-parametric tests, p less than 0.05) revealed that the two microfilled materials behaved very well (greater than 95% excellent margins) in Class III restorations before being thermocycled. After the restorations were thermocycled, the margin quality of DURAFILL decreased to 90% excellence, due to the increase in restoration fractures. Thermocycling did not affect the margin quality in the Class IV cavities, and the hybrid composite showed superior margin qualities (89% excellent). Better margin qualities were obtained in Class III cavities. Class IV restorations showed more overhangs (12%) and submargination (6%) which were technique-related. In no cases were greater than 1% marginal openings found.

Radiopacity of composites compared with human enamel and dentine.

A 99.5 per cent pure aluminium step-wedge served as reference for evaluating the radiopacity of 55 anterior and posterior composites. The radiopacity of all materials evaluated was compared with the radiopacity of human enamel and human dentine of equivalent sample thickness. Seventeen composites exhibited a radiopacity significantly greater than that of enamel. Some composites intended for posterior use lack the radiopacity required for posterior composite restorations.

Marginal adaptation of four tooth-coloured inlay systems in vivo.

This study investigates the margin quality of four different tooth-coloured inlay systems using computer-aided quantitative margin analysis under scanning electron microscopy. Three types of restorations involved chairside procedures using a commercial CAD-CAM apparatus: one type of inlay restoration was milled from preformed glass ceramic blocks, the other two inlay types were milled from preformed porcelain blocks. The fourth system was based on an experimental indirect composite inlay system. Each inlay type was luted with its respective dual-curing luting composite, which was supplied with the system. After 6 months of clinical service, all four systems revealed a significant percentage of submargination indicating occlusal wear of the luting composite. The porcelain inlays and the composite inlays luted with their respective experimental luting composite showed the best marginal adaptation. Luted glass ceramic inlays, in particular, suffered from a significantly higher percentage of inlay margin fractures (9 per cent) and marginal openings (4 per cent) than the other systems. A possible explanation is that the glass ceramic subsurface structure at the inlay-lute interface was weakened by etching with ammonium bifluoride.

Criteria for substituting amalgam with composite resins.

In recent years patients' aesthetic requirements have increased as knowledge of new materials and techniques has spread. Enamel etching and composite filling materials have enabled dentists to meet high functional and aesthetic standards in the placing of anterior and, latterly, posterior restorations. There has been a dramatic growth in the use of posterior composites and the aim of this paper is to provide the practising dentist with guidelines for the use of these materials.

Marginal adaptation with glass-ceramic inlays adhesively luted with glycerine gel.

The purpose of this study was to examine the effectiveness of glycerine gels in preventing the formation of an oxygen-inhibition layer during the polymerization of composite resin materials. Sixteen glass-ceramic inlays were adhesively luted with and without the application of glycerine gels on the inlay margins before the polymerization of the luting composite resin material. To remove the oxygen-inhibition layer, the inlays were brushed with acetone. Replicas were obtained before and after acetone brushing, and a computerized quantitative marginal analysis was carried out under the scanning electron microscope. Statistical analysis revealed significant differences between the polymerization with and the polymerization without the use of a glycerine gel. The inlay margins polymerized after the application of a glycerine gel showed better marginal adaptation than did the inlay margins polymerized without it, suggesting that oxygen inhibition during polymerization can be prevented by the application of glycerine gels to the surface of composite resin materials.

[Erosions of hard tooth substance]. / REM-Untersuchungen an Erosionen der Zahnhartsubstanzen in vivo.

Lemon juice was applied to intact and eroded tooth surfaces in vivo to demonstrate the development of erosions based on morphological changes. Under the influence of the fruit acid the protecting pellicles are removed and the enamel demonstrates the typical etch lesion with a honeycomb surface structure. In the dentin the acid works mainly on the peritubular area. Abrasive brushing techniques wear down the already damaged tooth surfaces.

Tooth-colored inlays.

There is an increasing need for conservative treatment with tooth-colored inlay restorations due to esthetic concerns and the decreasing acceptance of amalgam. The use of ceramic materials has become possible by using adhesive luting techniques, in which enamel and ceramic inlays are etched and luted with composite resins. The weakest point is still the poor tensile strength of brittle inlay materials, so most efforts are concentrated on strengthening porcelains by ion exchange, tempering, or improving the composition. Despite the fact that adhesively luted inlays show good marginal adaptation, the luting composite layer is worn out because of the low filler fraction of the resins. For composite inlays, the same resins are used as for direct placement. Despite more effective curing techniques, the wear behavior of composite inlays may have been improved, but it is still less than ideal. In clinically orientated studies, it is clearly demonstrated that the luting procedure is technically sensitive with all systems. The clinical experience is limited to only a few years, so to assess the longevity of adhesively luted inlays, more clinical studies must be done. However, tooth-colored inlays are the most esthetic, conservative restorations dentistry has ever offered its patients.

Does chemomechanical caries removal affect dentine adhesion?

The purpose of this study was to determine whether shear bond strengths (SBS) to chemomechanically excavated dentine (Carisolv) differed from the SBS after conventional caries removal (bur). The following adhesive systems were used: Dyract AP/NRC/Prime & Bond NT; Dyract AP/Prime & Bond NT; Tetric Ceram/ Syntac SC; Tetric Ceram/Syntac SC (no etch) (TC 2); Definite/Etch & Prime 3.0; Definite/experimental. One-hundred and twenty human molars with occlusal caries were assigned to 12 groups. Sequential caries removal was controlled with laser fluorescence. After water storage, the samples were tested in a single-plane shear test assembly. The results demonstrated differences between the bonding systems, whereas the mode of caries removal had no consistent effect. If total etch technique was neglected, the results of the composite resin (TC 2) indicated a tendency to higher SBS in the Carisolv group (18.6 +/- 4.6 MPa) compared with conventional treatment (14.1 +/- 3.9 MPa). The present data demonstrate that chemomechanical caries removal has no adverse effect on bonding of modern adhesive systems to dentine. Smear layer-dissolving or -modifying bonding systems could potentially benefit from chemomechanical pretreatment.

[Opacity of composites and hard tooth substance on X-ray]. / Die Röntgenopazität von Kompositmaterialien und Zahnhartsubstanzen.

The opacity of eleven composites, enamel, and dentin was determined quantitatively using densitometric measurements of X-rays. The reference material was aluminium 99.5% which was exposed with each film. Opacity values were 215% for enamel and 118% for dentin. Three of the composite materials demonstrated an opacity similar to enamel, one similar to dentin. The other materials showed higher values than enamel. Consequently, the majority of composites reaches opacity values necessary for the diagnosis of secondary caries.

[Effect of cavity design on the marginal fit of Class I composite fillings]. / Der Einfluss der Kavitätenform auf das Randverhalten von Klasse-I-Kompositfüllungen.

16 butt joint (Group A) and 16 beveled (Group B) class I cavities were prepared in extracted molars and filled with two hybrid composite resin materials using the enamel etching technique. Replicas were obtained before and after thermocycling (TC) and a computerized quantitative margin analysis was carried out in the SEM. Statistical analysis revealed significant differences (p less than 0.01) between the two groups only after TC. Group B showed significantly less marginal openings than Group A (A: 50.7%, B: 8.4%) after TC. Class I cavities for hybrid composite resin materials should be beveled.

Conventional, digital and contrast-enhanced bitewing radiographs in the decision to restore approximal carious lesions.

The purpose of the present investigation was to compare the accuracy of treatment decisions in proximal sites using three intra-oral radiographic systems. Additionally, the impact of an automated non-linear grey-level display was evaluated. Ten observers assessed 84 surfaces on bitewing radiographs for their requirement of restorative treatment using a 6-rank confidence scale. Radiographs were taken with conventional film images (Ultraspeed), a storage phosphor plate (Digora) and a CCD system (Dexis). Additionally, the Dexis software was expanded by a contrast enhancement routine (Dexis+). The restorative treatment threshold was defined as presence of macroscopic cavitation. Regarding the areas below mean ROC curves no significant differences were detected between the groups (p>0.05). Likelihood ratios for positive test results were: 5.29 (Ultraspeed), 8.14 (Digora), 9.67 (Dexis) and 11.37 (Dexis+). The accuracy of restorative treatment decisions based on digital and conventional radiographs is comparable. If a dichotomous treatment decision was requested, the digital systems demonstrated a notable tendency towards higher likelihood of true-positive decisions.

Influence of room lighting on grey-scale perception with a CRT-and a TFT monitor display.

OBJECTIVES: To determine the influence of ambient lighting on grey-scale perception using a cathode-ray tube (CRT) and a thin film transistor (TFT) computer display. METHODS: A cathode ray tube (Nokia XS 446) and a liquid crystal display (Panasonic LC 50S) were used at reduced room lighting (70 lux) and under conditions recommended for a dental operatory (1000 lux). Twenty-seven observers examined twice a modified SMPTE test pattern [0 to 255; 255 to 0] grey-scale values. The corresponding contrast differences were allocated to four ranges of grey levels (I: 0-63; II: 64-127; III: 128-191; IV: 192-255). The influences of monitor type, grey-scale range and illumination were evaluated by means of repeated measures analysis of variance. RESULTS: Detection of differences in monochromatic intensity was significantly earlier with reduced lighting (P<0.0001). When full ambient lighting was used, the TFT display was superior compared to the CRT monitor in ranges II and III (P<0.0001), whereas no differences could be detected for grey intensities between 0 and 63 (P=0.71) and between 192 and 255 (P=0.36). CONCLUSIONS: Background lighting hampers grey-scale perception on computer displays. In this study of one TFT and one CRT monitor, the TFT in full ambient lighting was associated with earlier detection of grey scale differences than CRT.