An in vitro comparison of the effects of various air polishing powders on enamel and selected esthetic restorative materials.

OBJECTIVE: The purpose of this study was to investigate the effects of each of the commercially available air polishing powders on the surface characterization of human enamel, hybrid composite, and glass ionomer using a highly standardized protocol. The air polishing powders utilized in the study included aluminum trihydroxide, calcium carbonate, calcium sodium phosphosilicate, glycine, and sodium bicarbonate. METHODS: The hybrid composite and glass ionomer cement were mixed and photo light-cured for 40 seconds according to manufacturer's directions, and formed in a specially prepared mold that was coated using a Teflon aerosolized spray. The enamel samples were prepared by removing sections of human enamel from extracted unerupted third molars using a water-cooled, slow-speed diamond rotary saw. The enamel sections were approximately one centimeter in diameter and 3 mm thick. The enamel sections were flattened using a series of silicon carbide grit papers (600, 800, and 1200 grit) mounted on a rotating polishing wheel. A flat polished enamel surface, at least 5 mm in size, was produced and embedded in the hybrid composite material used for testing purposes, resulting in a sample approximately 10 mm in diameter and 2 mm thick. The restorative material samples were wet-polished to produce a uniform smooth surface and to remove the resin-rich surface layer, using the same series of silicon carbide grit papers used on the enamel (600, 800, and 1200 grit). The 1200 grit abrasive paper used is equivalent to a dental polishing disc commonly used to finish dental restorations. All samples were stored in distilled water at 37 degrees C prior to testing. Each of the three types of samples was treated with each air polishing powder for one, two, and five seconds. A test group of five samples each of hybrid composite, glass ionomer cement, and enamel was fabricated for each of the six types of abrasive powder and three-time exposures for the air polishing treatment, resulting in a total of 270 samples. The treatment samples were exposed to the air polishing powders for the three periods of time using a custom mounting jig and shutter device that was fabricated to standardize the air polishing treatments. The air polishing handpiece was placed in a mounting jig that positioned the tip of the handpiece at an 80 angle from the sample surface. The exposure to the air polishing air, water, and polishing powder was regulated by an articulated metal plate positioned between the tip and the test sample. The holder for the test sample kept the sample in a constant circular motion to simulate clinical use of the air polishing handpiece. A custom computer program was developed to activate a stepper motor that rotated the metal plate away from the sample for the controlled exposure times of one, two, and five seconds before the plate moved back to intercept the polishing spray mixture. RESULTS: The effect of the air polishing application on the surfaces of the tooth enamel and restorative materials was evaluated for changes in surface roughness and surface topography. The average surface roughness value was evaluated with a contact profilometer prior to and after the air polishing treatment. Changes in the surface characterization of each sample due to air polishing treatment were recorded using scanning electron microscopy. Epoxy resin replicas of representative test samples were made for evaluating under the scanning electron microscope. Samples were sputter-coated with gold palladium and the scanning electron photomicrographs were taken at a magnification of 25X and at a 45 degrees angle. Based on evaluation with the contact profilometer, there were statistically significant interactions between the type of powder and material, type of power and time, and type of material and time. The SEM photomicrographs were used to evaluate the clinical significance of the effects of the air polishing on each type of material. The SEM photomicrographs provided a visual quantitative analysis of the effects of air polishing powders on the restorative materials and the enamel. Any disruption of the surface characterization was considered to be clinically significant and represented volumetric loss and violation of the integrity of the restorative materials and/or enamel. CONCLUSIONS: Based on the results of this study, the air polishing powders that are compatible with use on hybrid composite and glass ionomer cements are EMS glycine and EMS sodium bicarbonate. The air polishing powders that are compatible for use on enamel include EMS glycine, Dentsply sodium bicarbonate, and EMS sodium bicarbonate.

Dental hygiene intervention to prevent nosocomial pneumonias.

UNLABELLED: Nosocomial and ventilator associated pneumonias that plague critically ill, elderly and long-term care residents could be reduced with effective oral hygiene practices facilitated collaboratively between nurses and dental hygienists. BACKGROUND: Nosocomial pneumonias, specifically aspiration pneumonias and ventilator-associated pneumonias in the elderly and infirm have become a major health care issue, The provision of oral care in hospital and hospital-like facilities presents challenges that can prevent patients from receiving optimal oral care One sequela can be aspiration pneumonia which ranks first in mortality and second in morbidity among all nosocomial infections. Since aspiration pneumonia is linked to the colonization of oral bacteria in dental plaque and biofilm, it is time to look for creative solutions to integrating the expertise of dental hygienists into health care teams in these institutional settings. METHODS: A comprehensive review of the literature was conducted regarding the etiology and prevalence of health care related pneumonias. Evidence describing the challenges and barriers that the nurses, nursing staff, and dental hygienists face in the provision of oral care in hospitals and long-term care facilities is provided. Intercollaborative solutions to providing optimal oral care in hospitals and long-term care facilities are suggested. CONCLUSION: Dental hygienists have the expertise and practice experience to provide oral care in hospitals, long-term care and residential facilities. They can contribute to solving oral care challenges through intercollaboration with other health care team members. Yet, there are long-standing systemic barriers that must be addressed in order to provide this optimal care. Dental hygienists becoming better assimilated within the total health care team in hospital and residential facilities can positively impact the suffering, morbidity and mortality associated with aspiration pneumonias.

Laboratory evaluation of plaque removal at interproximal sites by a specially engineered powered toothbrush with unique sensing and control technologies.

OBJECTIVE: This laboratory study compared a specially engineered sonic powered toothbrush with unique sensing and control technologies and having two different brush heads to a manual flat-trim toothbrush for their ability to remove plaque at interproximal sites. METHODS: Interproximal access efficacy (IAE) was measured as the maximum width of plaque removed from the artificial plaque substrate around the teeth. Six brushes of each product were tested four times for a total of 24 tests. Results from these tests were statistically analyzed using an analysis of variance (ANOVA). A post hoc Tukey test for pair-wise comparisons, with a minimum significance level of 0.05, was used to identify significant mean differences between the test products. RESULTS: Relative to the manual flat-trim toothbrush, the sonic powered toothbrush, equipped with either the Triple Clean or Sensitive refill brush head, had statistically significantly higher IAE means (p < 0.001). In addition, when equipped with the Sensitive refill brush head, the new sonic powered toothbrush showed increased efficiencies compared to when it was equipped with the Triple Clean brush head with respect to IAE means. CONCLUSION: The specially engineered sonic powered toothbrush with unique sensing and control technologies had higher interproximal access efficacy compared to a manual flat-trim toothbrush, particularly with the Sensitive brush head.

Laboratory efficacy of three compact toothbrushes to reduce artificial plaque in hard to reach areas.

PURPOSE: To evaluate the effect of three toothbrushes [GUM Summit+Compact Head, GUM Technique Deep Clean Compact Head, and Oral-B Indicator 35 (compact head)] on plaque reduction in difficult to reach areas: interproximal sites (Interproximal Access Efficacy, IAE), the gingival margin (Gingival Margin Cleaning, GMC) and under the gumline (Subgingival Access Efficacy, SAE). METHODS: Six toothbrushes from each product group were randomly tested four times for a total of 24 tests on each toothbrush design. In the IAE studies, toothbrushing was conducted for 15 seconds using horizontal and vertical brushing motions, simulated anterior and posterior teeth and a brushing pressure of 250 g. IAE was recorded as the maximum width of artificial plaque removed. In the GMC and SAE assays, the toothbrush to be tested was aligned with the papillae of artificial gingiva placed over simulated posterior teeth and brushing was conducted for 15 seconds using horizontal brushing and a brushing pressure of 500 g. The GMC efficacy was recorded as the maximum length of artificial plaque removed at the gingival margin. The maximum depth of the plaque substrate removed under the gingiva was recorded as the SAE. Significant mean differences between the toothbrushes were determined using ANOVA and Tukey's test for pairwise comparisons with a significance level of P<0.05. RESULTS: In all three assays conducted, the GUM Summit+Compact Head and GUM Technique Deep Clean Compact Head toothbrushes had significantly higher efficacy means compared to the Oral-B Indicator 35 (compact head) toothbrush. There was no significant difference in efficacy between the GUM Summit+Compact Head and GUM Technique Deep Clean Compact Head toothbrushes in the testing performed.

Laboratory evaluations of a bi-level, extremely tapered bristled toothbrush and a conventional uniform bristled toothbrush.

PURPOSE: To compare a uniquely shaped tapered-bristle manual toothbrush to a toothbrush with bristles uniform in height and diameter for the ability to remove artificial plaque deposits in areas of the mouth that are difficult to access; interproximal areas, the gingival margin and subgingival. METHODS: This study compared a GUM Summit+ Compact toothbrush featuring extremely tapered bristles and conventional bristle ends in a bi-level design. The upper, longest tapered bristles have the final 6 mm tapered to 0.01 diameter mm at the end. The conventional rounded end bristles have less than 0.5 mm tapered down to 0.02 mm diameter. The comparison manual toothbrush (Oral-B 40 Indicator) has bristles that are uniform in height and diameter. Interproximal access efficacy was evaluated using a pressure-sensitive artificial plaque substrate placed around simulated anterior and posterior teeth. Subgingival access and gingival margin cleaning were determined by using simulated gingiva prepared with a 0.2 mm space between the gingiva and the artificial plaque substrate on tooth surfaces and results were recorded as the artificial plaque removed below the gingiva or around the gingival margin. RESULTS: Interproximal access values were significantly (P < 0.001) higher for the GUM Summit+ Compact than for the Oral-B 40 Indicator. The mean value for gingival margin cleaning efficacy of the GUM Summit+ Compact was significantly (P < 0.001) superior compared to the Oral-B 40 Indicator. The Gum Summit + Compact had a significantly superior subgingival access (P < 0.001) mean value when compared to the Oral-B 40 Indicator. In this laboratory study, the GUM Summit+ Compact toothbrush was statistically significantly more effective for removing plaque from the interproximal areas, at the gingival margin and subgingivally than the Oral-B 40 Indicator toothbrush.

Dental hygiene participation in managing incipient and hidden caries.

With the advent of new caries detection devices that allow early detection, dental hygienists can intervene in the demineralization process and work with the patient toward remineralization through patient self-care procedures and the professional application of topical fluorides. The focus of this article is on caries detection devices, caries risk assessment, agents used to prevent dental caries, and the development of self-care plans for patients that include prevention, intervention, and therapeutic components.

Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque.

OBJECTIVE: The purpose of this twenty-eight day, randomized, single-blind clinical trial was to assess the efficacy of the addition of daily oral irrigation to both power and manual tooth brushing, compared to a traditional regimen of manual tooth brushing and flossing, to determine which regimen had the greatest effect on the reduction of gingival bleeding, gingivitis, and supragingival plaque. METHODOLOGY: The study was designed for a total of 105 subjects to participate in a twenty-eight day trial, with 35 subjects randomly assigned to one of three groups: Group 1-manual toothbrush and floss; Group 2-manual toothbrush and dental water jet; and Group 3-sonic toothbrush and dental water jet. All subjects received written and verbal instructions for using their regimens. Subjects were asked to brush for a timed two minutes, twice per day, with the brush and the dentifrice provided, and to refrain from using any additional oral hygiene aids. Subjects using the dental water jet were instructed to use the water jet on a medium setting, irrigating once per day with 500 ml of luke warm water. Subjects using the dental floss were instructed to use the floss once daily. Subjects were examined by two calibrated examiners, and data were collected at baseline (BSL), 14 days (D14), and 28 days (D28). Subjects were asked to abstain from any oral hygiene for 12 hours prior to each study visit. Subjects were scored using the Carter and Barnes Bleeding Index, Löe and Silness Gingival Index, and the Proximal/Marginal Plaque Index. Mean scores on the three indices for the three groups were used for statistical analysis at each time point. Additionally, the means were used for comparisons as change from baseline and percent change from baseline at D14 and D28. The significance of percentage change in each index from baseline to D14 and D28 was evaluated using a one-tailed t-test. Significant differences are reported at alpha < or = 0.05 for these planned group comparisons. RESULTS: Thirty-one subjects in Group 1, 32 subjects in Group 2, and 32 subjects in Group 3 completed the study. Bleeding Index: Groups 2 and 3, the irrigation groups, were statistically significantly more effective than Group 1 in reducing the bleeding index at D14 and D28, whether measured by mean reduction or percentage reduction. Gingival Index: At D14, both irrigation groups demonstrated a statistically significantly greater reduction in the gingival index compared to brushing and flossing for the facial surfaces. There was no significant difference between groups for the lingual surface at D14. At D28 there was a significant difference between Groups 1 and 2 for both the facial and lingual surfaces. Plaque Index: There was one significant difference between groups for the plaque index measured on the lingual surfaces. The manual toothbrush and floss were less effective than the sonic toothbrush and irrigation. Group 3 was also significantly better than Group 1 in reducing the plaque index on the facial surfaces at both D14 and D28. On plaque percentage reduction on the facial surface, Group 2 was significantly better than Group 1 at D14. There was no statistical difference between Group 1 and Group 2 at D28. CONCLUSION: The results of this clinical trial indicate that when combined with manual or sonic tooth brushing, oral irrigation is an effective alternative to manual tooth brushing and dental floss for reducing bleeding, gingival inflammation, and plaque removal.

Comparison of conventional periodontal maintenance versus scaling and root planing with subgingival minocycline.

BACKGROUND: Alternative regimens using subgingival antimicrobials compared to conventional periodontal maintenance (PM) may lead to more efficient protocols. The purpose of this study was to evaluate treatment time and clinical and radiographic outcomes in 2 periodontitis cohorts, one receiving conventional PM and the other receiving scaling and root planing (SRP) and multiple doses of subgingival minocycline. METHODS: Moderate to advanced chronic periodontitis patients were concurrently treated with either: 1) scaling and root planing and 4 subgingival doses of minocycline microspheres in all > or = 5 mm pockets over a 6-month period (RP/M; n = 24 patients); or 2) conventional 3-month periodontal maintenance (PM; n = 24 patients). Clinical and radiographic measurements, including probing depth (PD), clinical attachment level (CAL), and interproximal bone height (BH), were analyzed in 2 premolar/molar interproximal > or = 5 mm pockets at baseline and 1 year using paired t tests, analysis of variance, chi-square analysis, and correlation coefficients. RESULTS: Baseline clinical and radiographic data were similar between RP/M and PM patients. Probing depths showed greater mean improvement in RP/M (0.9 +/- 0.1 versus 0.4 +/- 0.1 mm, P = 0.02), with 25% of subjects in RP/M gaining > or = 2 mm compared to 4.2% in PM (differences were statistically significant). The mean loss in bone height and percent subjects losing bone height were less in RP/M (0.05 +/- 0.05 mm; 12.5%) than PM (0.09 +/- 0.08 mm; 16.7%), but bone height differences were not statistically significant. A subset of RP/M molar furcation sites responded with similar PD reduction and no BH loss over 1 year. While cross-sectional RP/M data between CAL and BH, or PD and CAL were highly correlated, changes over 1 year were not correlated among any of these parameters. CONCLUSIONS: Scaling and root planing and subgingival minocycline in experimental sites took little time (<5 minutes/appointment), but resulted in more probing depth reduction and less frequent bone height loss than conventional periodontal maintenance.

A comparison of a waterpik dual-motor powered toothbrush and a manual toothbrush in affecting interproximal bleeding reduction and dental biofilm accumulation.

OBJECTIVE: This single-blind, 21-day clinical study was designed to compare the effectiveness of a dual-motor powered toothbrush (SynchroSonic) and a manual toothbrush in affecting interproximal bleeding reduction and dental biofilm accumulation in a cohort of 70 subjects. METHODOLOGY: After baseline evaluations of soft tissue trauma, dental biofilm and interproximal bleeding, subjects were randomly assigned to one of the two experimental groups, given toothbrushing instructions and had their teeth cleaned. At 21 days, the clinical parameters were again evaluated. RESULTS: In the powered toothbrush group, there were 37 subjects at baseline and 36 subjects at follow-up. In the manual toothbrush group, there were 34 subjects at baseline and 33 subjects at follow-up. In the powered toothbrush group, the mean biofilm index fell from 3.46 to 3.12; a 9.7% reduction. In the manual toothbrush group, the mean biofilm index fell from 3.51 to 3.30; a 5.4% reduction. The powered toothbrush group showed significantly greater biofilm reduction (9.7% vs. 5.4%, p = 0.043). In the powered toothbrush group, the mean gingival bleeding index fell from 0.66 to 0.44; a 32% reduction. In the manual toothbrush group, the mean gingival bleeding index fell from 0.66 to 0.53; a 20% reduction. The powered toothbrush group showed significantly greater gingival bleeding reduction (32% vs. 20%, p = 0.02). CONCLUSION: The results demonstrated that both the manual toothbrush and the SynchroSonic powered toothbrush were safe, with no evidence of clinically significant hard or soft tissue abrasion observed. Additionally, the powered toothbrush was more effective in reducing biofilm and gingival bleeding than the manual toothbrush.

A Comparison of the Efficacy of 2 Powered Accumulation, Gingivitis, and Gingival Bleeding Toothbrushes in Affecting Plaque.

BACKGROUND: The purpose of this 30-day blinded, parallel-design study was to compare the effect of 2 powered toothbrushes, the Rowenta MH700 and the Braun Plak Control Ultra, on reducing plaque accumulation, gingivitis, and gingival bleeding in a cohort of 60 healthy adults. METHODS: After baseline evaluation of plaque, gingivitis, and gingival bleeding, subjects were randomly assigned to one of the experimental groups, provided written and verbal toothbrushing instructions, and had their teeth polished. At 2 weeks (follow-up 1) and 4 weeks (follow-up 2) all clinical parameters were again evaluated. RESULTS: The Braun group demonstrated a nearly significant reduction in gingival index (Gl) and a significant reduction in GI at follow-up 2. The Rowenta group demonstrated significant reductions in GI, plaque index (PI), and bleeding index (GBI) at both follow-up 1 and 2 examinations. At follow-up 1, the Braun group demonstrated a nearly significant reduction in GI, a significant reduction in PI, and a non-significant reduction in GBI. At follow-up 2, the Braun group demonstrated a significant reduction in GBI, but not a significant reduction in PI. The reduction in GI for the Rowenta group was significantly greater (P values of 0.0001 and 0.0001, respectively) than that demonstrated in the Braun group. However, the Rowenta group did not demonstrate a significantly greater reduction in PI (P values of 0.7135 and 0.3184 for follow-up 1 and follow-up 2, respectively) or GBI than the Braun group at either examination (P values of 0.0663 and 0.3397 for followup 1 and 2, respectively). CONCLUSIONS: The results of this study support the findings of numerous other studies that powered toothbrushes have great potential to remove plaque and improve gingival health and that the improvement can be demonstrated in a relatively short period of time. J Periodontol 1999;70:840-847.

The effects of a commercial aluminum airpolishing powder on dental restorative materials.

INTRODUCTION: JET-Fresh (Dentsply International, York, PA), a new airpolishing powder that contains aluminum trihydroxide as the abrasive agent, has been introduced for use with Prophy-Jet trade mark (Dentsply International). PURPOSE: The aim of this study was to investigate the surface effects of aluminum trihydroxide airpolishing powder on a series of restorative materials. MATERIALS AND METHODS: A total of 6 Class V preparations with enamel margins were created on the buccal surface of extracted human molars. The preparations were restored with Type III gold, a high copper spherical alloy amalgam, porcelain, a light-activated hybrid composite material, a light-activated microfilled composite material, and a light-activated, resin-modified glass ionomer material. The distal half of each restoration was covered with fiberglass tape and the mesial half subjected to treatment with the aluminum trihydroxide powder via the Prophy-Jet for 5 seconds. After removal of the protective tape, the buccal surface of each treated tooth was replicated with impression material. Replicas were generated using epoxy resin and prepared for evaluation with scanning electron microscopy. RESULTS: The aluminum trihydroxide produced surface alterations that were apparent visually and when viewed by a scanning microscope of the hybrid and microfilled composites and the glass ionomer restorations. The surfaces of the amalgam and gold restorations were altered, but not to the extent that the resin-based materials were. No disruption of the surface characterization of the porcelain was detected; however, with gold and porcelain materials, the aluminum trihydroxide removed notable amounts of the luting cements (the results are consistent with the data gathered with sodium bicarbonate powder). CONCLUSION: Aluminum trihydroxide as the abrasive agent in an airpolishing system should be avoided on resin composites, resin-modified composites, and around the margins of cemented restorations.