In Patients With Symptomatic Irreversible Pulpitis, Articaine is 3.6 Times More Efficacious Than Lidocaine in Achieving Anesthetic Success When Used for Supplementary Infiltration After Mandibular Block Anesthesia.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Does articaine provide an advantage over lidocaine in patients with symptomatic irreversible pulpitis? A systematic review and meta-analysis. Kung J, McDonagh M, Sedgley CM. J Endod 2015; 41(11):1784-94. SOURCE OF FUNDING: The study was supported by the OHSU Department of Endodontology Les Morgan Endowment Fund and a resident research grant from the American Association of Endodontists Foundation TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Interventions for prevention of herpes simplex labialis (cold sores on the lips).

BACKGROUND: Herpes simplex labialis (HSL), also known as cold sores, is a common disease of the lips caused by the herpes simplex virus, which is found throughout the world. It presents as a painful vesicular eruption, forming unsightly crusts, which cause cosmetic disfigurement and psychosocial distress. There is no cure available, and it recurs periodically. OBJECTIVES: To assess the effects of interventions for the prevention of HSL in people of all ages. SEARCH METHODS: We searched the following databases up to 19 May 2015: the Cochrane Skin Group Specialised Register, the Oral Health Group Specialised Register, CENTRAL in the Cochrane Library (Issue 4, 2015), MEDLINE (from 1946), EMBASE (from 1974), LILACS (from 1982), the China National Knowledge Infrastructure (CNKI) database, Airiti Library, and 5 trial registers. To identify further references to relevant randomised controlled trials, we scanned the bibliographies of included studies and published reviews, and we also contacted the original researchers of our included studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) of interventions for preventing HSL in immunocompetent people. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, extracted data, and assessed the risk of bias. A third author was available for resolving differences of opinion. MAIN RESULTS: This review included 32 RCTs, with a total of 2640 immunocompetent participants, covering 19 treatments. The quality of the body of evidence was low to moderate for most outcomes, but was very low for a few outcomes. Our primary outcomes were 'Incidence of HSL' and 'Adverse effects during use of the preventative intervention'.The evidence for short-term (≤ 1 month) use of oral aciclovir in preventing recurrent HSL was inconsistent across the doses used in the studies: 2 RCTs showed low quality evidence for a reduced recurrence of HSL with aciclovir 400 mg twice daily (risk ratio (RR) 0.26, 95% confidence interval (CI) 0.13 to 0.51; n = 177), while 1 RCT testing aciclovir 800 mg twice daily and 2 RCTs testing 200 mg 5 times daily found no similar preventive effects (RR 1.08, 95% CI 0.62 to 1.87; n = 237; moderate quality evidence and RR 0.46, 95% CI 0.20 to 1.07; n = 66; low quality evidence, respectively). The direction of intervention effect was unrelated to the risk of bias. The evidence from 1 RCT for the effect of short-term use of valaciclovir in reducing recurrence of HSL by clinical evaluation was uncertain (RR 0.55, 95% CI 0.23 to 1.28; n = 125; moderate quality evidence), as was the evidence from 1 RCT testing short-term use of famciclovir.Long-term (> 1 month) use of oral antiviral agents reduced the recurrence of HSL. There was low quality evidence from 1 RCT that long-term use of oral aciclovir reduced clinical recurrences (1.80 versus 0.85 episodes per participant per a 4-month period, P = 0.009) and virological recurrence (1.40 versus 0.40 episodes per participant per a 4-month period, P = 0.003). One RCT found long-term use of valaciclovir effective in reducing the incidence of HSL (with a decrease of 0.09 episodes per participant per month; n = 95). One RCT found that a long-term suppressive regimen of valaciclovir had a lower incidence of HSL than an episodic regimen of valciclovir (difference in means (MD) -0.10 episodes per participant per month, 95% CI -0.16 to -0.05; n = 120).These trials found no increase in adverse events associated with the use of oral antiviral agents (moderate quality evidence).There was no evidence to show that short-term use of topical antiviral agents prevented recurrent HSL. There was moderate quality evidence from 2 RCTs that topical aciclovir 5% cream probably has little effect on preventing recurrence of HSL (pooled RR 0.91, 95% CI 0.48 to 1.72; n = 271). There was moderate quality evidence from a single RCT that topical foscarnet 3% cream has little effect in preventing HSL (RR 1.08, 95% CI 0.82 to 1.40; n = 295).The efficacy of long-term use of topical aciclovir cream was uncertain. One RCT found significantly fewer research-diagnosed recurrences of HSL when on aciclovir cream treatment than on placebo (P < 0.05), but found no significant differences in the mean number of participant-reported recurrences between the 2 groups (P ≥ 0.05). One RCT found no preventive effect of topical application of 1,5-pentanediol gel for 26 weeks (P > 0.05). Another RCT found that the group who used 2-hydroxypropyl-ß-cyclo dextrin 20% gel for 6 months had significantly more recurrences than the placebo group (P = 0.003).These studies found no increase in adverse events related to the use of topical antiviral agents.Two RCTs found that the application of sunscreen significantly prevented recurrent HSL induced by experimental ultraviolet light (pooled RR 0.07, 95% CI 0.01 to 0.33; n = 111), but another RCT found that sunscreen did not prevent HSL induced by sunlight (RR 1.13, 95% CI 0.25 to 5.06; n = 51). These RCTs did not report adverse events.There were very few data suggesting that thymopentin, low-level laser therapy, and hypnotherapy are effective in preventing recurrent HSL, with one to two RCTs for each intervention. We failed to find any evidence of efficacy for lysine, LongoVital® supplementation, gamma globulin, herpes simplex virus (HSV) type I subunit vaccine, and yellow fever vaccine in preventing HSL. There were no consistent data supporting the efficacy of levamisole and interferon, which were also associated with an increased risk of adverse effects such as fever. AUTHORS' CONCLUSIONS: The current evidence demonstrates that long-term use of oral antiviral agents can prevent HSL, but the clinical benefit is small. We did not find evidence of an increased risk of adverse events. On the other hand, the evidence on topical antiviral agents and other interventions either showed no efficacy or could not confirm their efficacy in preventing HSL.

Minimal intervention dentistry for managing dental caries - a review: report of a FDI task group.

This publication describes the history of minimal intervention dentistry (MID) for managing dental caries and presents evidence for various carious lesion detection devices, for preventive measures, for restorative and non-restorative therapies as well as for repairing rather than replacing defective restorations. It is a follow-up to the FDI World Dental Federation publication on MID, of 2000. The dental profession currently is faced with an enormous task of how to manage the high burden of consequences of the caries process amongst the world population. If it is to manage carious lesion development and its progression, it should move away from the 'surgical' care approach and fully embrace the MID approach. The chance for MID to be successful is thought to be increased tremendously if dental caries is not considered an infectious but instead a behavioural disease with a bacterial component. Controlling the two main carious lesion development related behaviours, i.e. intake and frequency of fermentable sugars, to not more than five times daily and removing/disturbing dental plaque from all tooth surfaces using an effective fluoridated toothpaste twice daily, are the ingredients for reducing the burden of dental caries in many communities in the world. FDI's policy of reducing the need for restorative therapy by placing an even greater emphasis on caries prevention than is currently done, is therefore, worth pursuing.

Kovanaze Intranasal Spray vs Traditional Injected Anesthetics: a Study of Pulpal Blood Flow Utilizing Laser Doppler Flowmetry.

OBJECTIVE: An ideal local anesthetic would be effective, minimally reduce pulpal blood flow (PBF), and not require injection. This study compared the effects of 3% tetracaine plus 0.05% oxymetazoline nasal spray (Kovanaze; KNS) and injections using 2% lidocaine with 1:100,000 epinephrine (LE) or 3% mepivacaine plain (MP) on PBF, anesthetic efficacy, and participant preference. METHODS: In a double-blind cross-over design, 20 subjects randomly received a test anesthetic and placebo at each of 3 visits (KNS/mock infiltration; mock nasal spray/LE; or mock nasal spray/MP). Nasal sprays and infiltration apical to a maxillary central incisor were delivered ipsilaterally. PBF was evaluated by laser Doppler flowmetry, and local anesthetic success was assessed with electric pulp testing. Postoperative pain levels, participant preference, and adverse events were also assessed. RESULTS: LE injections demonstrated significant reductions in PBF at all time intervals compared with baseline (P < .05), whereas KNS and MP did not. Pulpal anesthesia success rates were higher for LE (85%) compared with MP (35%) and KNS (5%). Participants reported significantly higher postoperative pain levels for KNS compared with LE and MP. Additionally, KNS was the least preferred of the anesthetics administered and resulted in more reported adverse events. CONCLUSION: Although KNS showed no significant effect on PBF, it was not effective in achieving pulpal anesthesia as used in this study.

Incidence of caries lesions among patients treated with comprehensive orthodontics.

INTRODUCTION: Dental caries, specifically decalcified white-spot lesions (WSL), is a well-known side-effect of orthodontic treatment. The incidence of labial incipient caries lesions and its relationship with various patient and treatment variables was investigated in patients treated with comprehensive orthodontics. METHODS: Randomly selected orthodontic patient records (n = 350) were examined to determine incipient caries lesion development. Labial surfaces on pretreatment and posttreatment photographs were scored with a standardized scoring system. Independent variables were collected by chart abstraction. RESULTS: The incidence of patients who developed at least 1 new WSL during treatment was 72.9%, and this incidence was 2.3% for cavitated lesions. Treatment duration was significantly associated with new WSL development (P = 0.03). Development of WSL and cavitated lesions increased (both, P <0.00) despite increased attention to oral hygiene during treatment. Sex, age, extraction therapy, and various fluoridation sources were not associated with WSL development, but initial oral-hygiene score was moderately associated (P <0.06). CONCLUSIONS: The incidence of WSL in patients treated with comprehensive orthodontics was significantly high, and the preventive therapy provided appeared to be ineffective. This widespread problem is alarming and warrants significant attention from both patients and providers that should result in greatly increased emphasis on effective caries prevention.

FDI World Dental Federation - clinical criteria for the evaluation of direct and indirect restorations. Update and clinical examples.

In 2007, new clinical criteria were approved by the FDI World Dental Federation and simultaneously published in three dental journals. The criteria were categorized into three groups: esthetic parameters (four criteria), functional parameters (six criteria), and biological parameters (six criteria). Each criterion can be expressed with five scores, three for acceptable and two for non-acceptable (one for reparable and one for replacement). The criteria have been used in several clinical studies since 2007, and the resulting experience in their application has led to a requirement to modify some of the criteria and scores. The two major alterations involve staining and approximal contacts. As staining of the margins and the surface have different causes, both phenomena do not appear simultaneously. Thus, staining has been differentiated into marginal staining and surface staining. The approximal contact now appears under the name "approximal anatomic form" as the approximal contour is a specific, often non-esthetic issue that cannot be integrated into the criterion "esthetic anatomical form". In 2008, a web-based training and calibration tool called e-calib (www.e-calib.info) was made available. Clinical investigators and other research workers can train and calibrate themselves interactively by assessing clinical cases of posterior restorations, which are presented as high quality pictures. Currently, about 300 clinical cases are included in the database which is regularly updated. Training for 8 of the 16 clinical criteria is available in the program: "Surface luster"; "Staining (surface, margins)"; "Color match and translucency"; "Esthetic anatomical form"; "Fracture of material and retention"; "Marginal adaptation"; "Recurrence of caries, erosion, abfraction"; and "Tooth integrity (enamel cracks, tooth fractures)". Typical clinical cases are presented for each of these eight criteria and their corresponding five scores.

FDI World Dental Federation: clinical criteria for the evaluation of direct and indirect restorations-update and clinical examples.

In 2007, new clinical criteria were approved by the FDI World Dental Federation and simultaneously published in three dental journals. The criteria were categorized into three groups: esthetic parameters (four criteria), functional parameters (six criteria) and biological parameters (six criteria). Each criterion can be expressed with five scores, three for acceptable and two for non-acceptable (one for reparable and one for replacement). The criteria have been used in several clinical studies since 2007, and the resulting experience in their application has led to a requirement to modify some of the criteria and scores. The two major alterations involve staining and approximal contacts. As staining of the margins and the surface has different causes, both phenomena do not appear simultaneously. Thus, staining has been differentiated into marginal staining and surface staining. The approximal contact now appears under the name "approximal anatomic form" as the approximal contour is a specific, often non-esthetic issue that cannot be integrated into the criterion "esthetic anatomical form". In 2008, a web-based training and calibration tool called e-calib ( www.e-calib.info ) was made available. Clinical investigators and other research workers can train and calibrate themselves interactively by assessing clinical cases of posterior restorations which are presented as high-quality pictures. Currently, about 300 clinical cases are included in the database which is regularly updated. Training for eight of the 16 clinical criteria is available in the program: "Surface lustre"; "Staining (surface, margins)"; "Color match and translucency"; Esthetic anatomical form"; "Fracture of material and retention"; "Marginal adaptation"; "Recurrence of caries, erosion, abfraction"; and "Tooth integrity (enamel cracks, tooth fractures)". Typical clinical cases are presented for each of these eight criteria and their corresponding five scores.

In-vitro evaluation of various treatments to prevent demineralization next to orthodontic brackets.

INTRODUCTION: One common negative side effect of orthodontic treatment with fixed appliances is the development of incipient caries lesions around brackets, particularly in patients with poor oral hygiene. Bio-available minerals from cement containing amorphous calcium phosphate (ACP) might facilitate remineralization and inhibit lesion development. Our objective was to compare the potential of ACP-containing resin cement, fluoride varnish, resin sealer, and MI Paste (GC America, Alsip, Ill) under similar in-vitro conditions to prevent incipient caries lesions next to brackets on teeth. METHODS: One hundred extracted premolars were randomly allocated to 5 groups (n = 20). Brackets were bonded with ACP cement (Aegis-Ortho, Bosworth, Skokie, Ill), resin (Transbond XT [3M Unitek, Monrovia, Calif], control), or resin followed by application of fluoride varnish (Vanish, 3M, St Paul, Minn), resin sealer (Pro-seal, Reliance Orthodontic Products, Itasca, Ill), or casein phosphopeptide-ACP paste (MI Paste). All groups were cycled for 15 days in demineralization solution for 8 hours a day, rinsed, placed in artificial saliva (30 minutes), brushed, and stored overnight in artificial saliva. The extent of demineralization in each group was assessed by using quantitative light-induced fluorescence and confocal laser scanning microscopy. RESULTS: Only the Pro-seal and Vanish groups showed significantly smaller lesions than the controls (Kruskal-Wallis test, P <0.05) for both quantitative light-induced fluorescence and confocal laser scanning microscopy measurements. Fluorescence loss of Aegis-Ortho was similar to Vanish; Aegis-Ortho, MI Paste, and the controls were not different from each other. CONCLUSIONS: Both light-cured filled resin (Pro-seal) and fluoride varnish (Vanish) might prevent enamel demineralization next to orthodontic brackets exposed to cariogenic conditions, but the observed positive effects of Aegis-Ortho and MI Paste were not significant.

Influence of occlusal access on demineralized dentin removal in the atraumatic restorative treatment (ART) approach.

PURPOSE: To verify the influence of cavity access diameter on demineralized dentin removal in the ART approach. METHODS: 40 non-carious human premolars were randomly divided into four groups. The occlusal surface was ground flat and the teeth were sectioned mesio-distally. The hemi-sections were reassembled and occlusal access preparations were carried out using ball-shaped diamonds. The resulting size of the occlusal opening was 1.0 mm, 1.4 mm, 1.6 mm and 1.8 mm for Groups A, B, C, and D, respectively. Standardized artificial carious lesions were created and demineralized dentin was excavated. After excavation, the cavities were analyzed using: (a) the tactile method, (b) caries-detection dye to stain demineralized dentin, as proposed by Smales & Fang, and (c) Demineralized Tissue Removal index, as proposed in this study. Statistical analysis was performed using Fisher, Spearman correlation coefficient, kappa, Kruskal-Wallis and Miller tests (P < 0.05). RESULTS: The three methods of evaluation showed no significant difference between Groups A vs. B, and C vs. D, while statistically significant differences were observed between Groups A vs. C, A vs. D, B vs. C and B vs. D. Based on the results of this study, the size of occlusal access significantly affected the efficacy of demineralized tissue removal.

Resin infiltration: An effective adjunct strategy for managing high caries risk-A within-person randomized controlled clinical trial.

OBJECTIVES: Micro-invasive resin-infiltration has shown to inhibit lesion progression of proximal non-cavitated carious lesions, suggesting an alternative to early operative treatment. This split-mouth, randomized placebo-controlled clinical trial evaluated the effects of proximal lesion infiltration supplementary to standard-of-care management in high caries risk (HCR)-patients. METHODS: Forty-two HCR-subjects with two similar interproximal posterior lesions received professional HCR-regimen including repeated F-varnish applications. Two affected E2/D1-surfaces were randomized and concurrently treated by resin-infiltration or mock-infiltration (control). Individually standardized digital radiographs provided visual determination of lesion-size distribution at baseline and 2-year follow-up. Data were analyzed by logistic regression and McNemar's test. RESULTS: Thirty-two lesion pairs (76%) were evaluated after 2 years. Categorical lesion depths were not different between groups (P > .5). Comparative pairwise assessment (image sets BL-2 yr) showed significantly more progression in control (7) versus infiltration (1) lesions (P = .035). Cumulative prevented fraction after two years was 97% for infiltrated lesions versus 74% for control lesions. CONCLUSIONS: Two-year follow-up showed resin infiltration to be a highly efficacious (RRR: 86-89%) therapy. Long-term follow-up is needed to strengthen the evidence for efficacy of resin-infiltration as an adjunct to standard-of-care HCR-regimen including F-varnish. CLINICAL SIGNIFICANCE: Showing 24% more stabilized lesions, the resin-infiltrated group performed significantly better than their controls, confirming successful early lesion management. Adjunct resin-infiltration provided an effective micro-invasive approach to inhibit short-term lesion progression.

Efficacy of Articaine versus Lidocaine in Supplemental Infiltration for Mandibular First versus Second Molars with Irreversible Pulpitis: A Prospective, Randomized, Double-blind Clinical Trial.

INTRODUCTION: Profound pulpal anesthesia is difficult to achieve in mandibular molars with irreversible pulpitis (IP). However, there are no published randomized controlled clinical trials comparing the success of supplemental buccal infiltration (BI) in mandibular first versus second molars with IP. The purpose of this prospective, randomized, double-blind study was to compare the efficacy of 4% articaine with 2% lidocaine for supplemental BIs in mandibular first versus second molars with IP after a failed inferior alveolar nerve block (IANB). This study's sample was combined with data from a previous trial. METHODS: One hundred ninety-nine emergency subjects diagnosed with IP of a mandibular molar were selected and received an IANB with 4% articaine. Subjects who failed to achieve profound pulpal anesthesia, determined by a positive response to cold or pain upon access, randomly received 4% articaine or 2% lidocaine as a supplemental BI. Endodontic access was begun 5 minutes after infiltration. Success was defined as less than mild pain during endodontic access and instrumentation on the Heft-Parker visual analog scale. RESULTS: There was a 25% IANB success rate with 4% articaine. The success rate for articaine supplemental BI in first molars was 61% versus 63% for second molars (P > .05). The success of lidocaine in first molars was 66%, but for second molars it was 32% (P = .004). CONCLUSIONS: The success rate for IANB with 4% articaine was 25%. Articaine and lidocaine had similar success rates for supplemental infiltration in first molars, whereas articaine was significantly more successful for second molars. However, because BI often did not provide profound pulpal anesthesia, additional techniques including intraosseous anesthesia may still be required.

Recommendations for conducting controlled clinical studies of dental restorative materials. Science Committee Project 2/98--FDI World Dental Federation study design (Part I) and criteria for evaluation (Part II) of direct and indirect restorations including onlays and partial crowns.

About 35 years ago, Ryge provided a practical approach to the evaluation of the clinical performance of restorative materials. This systematic approach was soon universally accepted. While that methodology has served us well, a large number of scientific methodologies and more detailed questions have arisen that require more rigor. Current restorative materials have vastly improved clinical performance, and any changes over time are not easily detected by the limited sensitivity of the Ryge criteria in short-term clinical investigations. However, the clinical evaluation of restorations not only involves the restorative material per se but also different operative techniques. For instance, a composite resin may show good longevity data when applied in conventional cavities but not in modified operative approaches. Insensitivity, combined with the continually evolving and nonstandard investigator modifications of the categories, scales, and reporting methods, has created a body of literature that is extremely difficult to interpret meaningfully. In many cases, the insensitivity of the original Ryge methods leads to misinterpretation as good clinical performance. While there are many good features of the original system, it is now time to move on to a more contemporary one. The current review approaches this challenge in two ways: (1) a proposal for a modern clinical testing protocol for controlled clinical trials, and (2) an in-depth discussion of relevant clinical evaluation parameters, providing 84 references that are primarily related to issues or problems for clinical research trials. Together, these two parts offer a standard for the clinical testing of restorative materials/procedures and provide significant guidance for research teams in the design and conduct of contemporary clinical trials. Part 1 of the review considers the recruitment of subjects, restorations per subject, clinical events, validity versus bias, legal and regulatory aspects, rationales for clinical trial designs, guidelines for design, randomization, number of subjects, characteristics of participants, clinical assessment, standards and calibration, categories for assessment, criteria for evaluation, and supplemental documentation. Part 2 of the review considers categories of assessment for esthetic evaluation, functional assessment, biological responses to restorative materials, and statistical analysis of results. The overall review represents a considerable effort to include a range of clinical research interests over the past years. As part of the recognition of the importance of these suggestions, the review is being published simultaneously in identical form in both the Journal of Adhesive Dentistry and Clinical Oral Investigations. Additionally, an extended abstract will be published in the International Dental Journal, giving a link to the web full version. This should help to introduce these considerations more quickly to the scientific community.

Chemomechanical caries removal in children: an operator's and pediatric patients' responses.

BACKGROUND: This study investigated an operator's and pediatric patients' responses to chemo-mechanical caries removal (CMCR) versus the traditional method (TM) of caries removal using a handpiece and a round bur when treating dentinal-depth occlusal lesions with minimal enamel access in primary molars. METHODS: Data were collected from 50 children at baseline and before, during and after caries removal using CMCR or TM. The subjects in the CMCR group were on average younger than the subjects in the TM group and had more deep lesions. RESULTS: The operator rated CMCR as needing more clinical and technical effort and more total effort than TM. He was less satisfied with CMCR than with TM. Subjects in the CMCR group perceived the time needed for treatment as significantly longer than did the subjects in the TM group. Fear of the dentist decreased in subjects in the TM group from before to after the operative appointment, while it increased in subjects in the CMCR group. CONCLUSIONS: The authors found no direct advantage in using CMCR over using TM. CLINICAL IMPLICATIONS: CMCR cannot be recommended as an alternative to TM when treating dentinal depth occlusal lesions with minimal access in primary molars.

Treating patients with herpes simplex virus infections: dental and dental hygiene students' knowledge, attitudes, and professional behavior.

Dental and dental hygiene students frequently interact with patients with herpes simplex virus (HSV) infections, often simply referred to as cold sores. The objectives of this study were to assess dental and dental hygiene students' knowledge, attitudes, and professional behavior concerning the treatment of patients with HSV infections and to investigate the relationships among knowledge, attitudes, and professional behavior. Questionnaire data were collected from 337 dental and seventy-three dental hygiene students at regularly scheduled classes. Dental and dental hygiene students did not differ in their overall knowledge concerning HSV infections. Dental hygiene students were more apprehensive about treating patients with these infections, but used more appropriate professional behavior compared to dental students. Dental students' knowledge and appropriateness of professional behavior increased over the course of their education. Overall, it was found that an increase in student knowledge was associated with increased apprehension related to treating these patients. However, the more apprehensive they were, the more they engaged in appropriate professional behavior. Educating future health care providers about the treatment of patients with infectious and communicable diseases can potentially increase the students' apprehension/negative attitudes concerning providing care, while at the same time increasing appropriate professional behavior during their education. Addressing students' apprehensions might be a crucial moderator that will determine whether they will provide the best possible care for these patients in their future professional lives.

Caries management by risk assessment: implementation guidelines.

ACT This consensus statement supports implementation of caries management by risk assessment in clinical practice by using the following principles: modification of the oral flora, patient education, remineralization, and minimal operative intervention. The statement includes a list of supporters.

In vitro antibacterial effects of the dentin primer of Clearfil Protect Bond.

OBJECTIVES: This study aimed to investigate the antibacterial effects of the dentin primer of a commercially available self-etching adhesive system, Clearfil Protect Bond, which contains antibacterial monomer 12-methacryloyloxydodecylpyridinium bromide (MDPB). METHODS: Inhibitory effects against Streptococcus mutans, Lactobacillus casei, or Actinomyces naeslundii were examined by an agar-disc diffusion method using the Clearfil Protect Bond primer containing 5% MDPB and an acidic adhesion-promoting monomer MDP, the primer only with MDP, and the primer with 1% cetylpyridinium chloride. The minimum inhibitory/bactericidal concentrations (MIC/MBC) of each primer for the three bacterial species were determined by serial microdilution assays. For testing the bactericidal effects seen in dentin, the primer was applied to demineralized dentin blocks in which S. mutans had been impregnated, and numbers of viable bacteria were counted. RESULTS: For all three bacteria, the sizes of the inhibition zones produced by Clearfil Protect Bond primer were significantly greater than for the other primers (p<0.05, ANOVA and Scheffe's F-test). The MIC/MBC values of Clearfil Protect Bond primer were less than those of the primer without MDPB, and comparable to those of the primer containing cetylpyridinium chloride. No bacterial recovery was obtained after application of Clearfil Protect Bond primer to the bacteria-impregnated dentin, although the primer without MDPB showed some bactericidal effect. SIGNIFICANCE: Clearfil Protect Bond primer has strong antibacterial activity based upon MDPB against S. mutans, L. casei and A. naeslundii, and the capability to disinfect cavities containing residual bacteria.

Chemomechanical caries removal in children: efficacy and efficiency.

BACKGROUND: The authors investigated the effectiveness of chemomechanical caries removal (CMCR) compared with the traditional method (TM) of caries removal using a round bur when treating dentinal-depth occlusal lesions with minimal enamel access in primary molars. The authors also compare CMCR with TM to determine if it had a higher efficacy and could be used more frequently without the subject's having to undergo local anesthesia. METHODS: The authors collected data from 50 children during operative appointments at which caries was removed using one of the two methods. RESULTS: Complete caries removal within 15 minutes was achieved in only 57.7 percent of the CMCR-treated teeth. In 42.3 percent of these teeth, residual caries was removed using TM. CMCR was almost eight times more time-consuming than was TM when used to excavate dentinal-depth occlusal lesions with minimal cavitation. There was no significant difference between CMCR and TM in the number of subjects who needed to undergo local anesthesia. CONCLUSIONS: The authors found no direct clinical advantage in using CMCR over using TM for treating occlusal dentinal lesions with minimal cavitation in pediatric patients.

Adhesive permeability affects composite coupling to dentin treated with a self-etch adhesive.

Dentin bonded with one-step self-etch adhesives does not couple well to chemically-cured composites despite the presence of ternary catalysts in some systems. To determine whether additional factors are responsible for the poor coupling of dentin bonded with these adhesives, the authors used a one-step self-adhesive in which the ternary catalyst is incorporated separately in the brush applicator for activating the adhesive. The activated adhesive was bonded to dentin or prepolymerized composites. For microtensile bond strength evaluation, a dual-cured hybrid composite was used for coupling to the bonded substrates and activated using: (1) the light-cured mode (LC), (2) delayed light-activation (DL) and (3) the chemical-cured mode (CC). In addition, the composite polymerized in the CC mode was coupled to the two substrates bonded with (4) additional experimental adhesive versions without the ternary catalyst and (5) without the ternary catalyst and tertiary amine. Silver tracer penetration into bonded interfaces was examined using TEM by replacing the dual-cured composite with a light-cured or a chemically-cured microfilled composite. In the CC mode, the composites coupled poorly to both substrates bonded with the unactivated adhesive (5). The use of activated adhesives allowed for good coupling of the composites polymerized in all curing modes to bonded composite, but only in the LC mode to bonded dentin. Water-filled channels in the form of water trees and water blisters were present in the adhesive layer under all composite-curing modes in bonded dentin. These features were completely absent in the bonded composites, showing that the source of the water was from dentin. Water blisters were also observed along the adhesive-composite interfaces in bonded dentin when the coupling composites were polymerized using the CC or DL modes.