The tongue microbiome of young patients with chronic kidney disease and their healthy mothers.

OBJECTIVES: Oral microbiome plays a crucial role in the incidence and development of oral diseases. An altered intestinal microbiome has been reported in adults with chronic kidney disease (CKD). This study aimed to characterize the tongue microbiome of young patients with CKD compared to their healthy mothers to identify the influence of CKD-associated factors on resilient tongue ecosystem. MATERIAL AND METHODS: Thirty patients with CKD (mean age, 14.2 years; 16 males and 14 females) and generalized gingivitis were included in the study. Swabs of the posterior tongue were collected from the patients and 21 mothers (mean age 40.8 years). Next-generation sequencing of 16S rDNA genes was employed to quantitatively characterize microbial communities. RESULTS: The bacterial communities were similar in terms of richness and diversity between patients and mothers (p > 0.05). In patients with CKD, 5 core phyla, 20 core genera, and 12 core species were identified. CONCLUSIONS: The tongue microbiome of the study participants showed no relevant CKD-associated differences compared to their mothers and appears to be a highly preserved niche in the oral cavity. Differences observed in the abundance of individual species in this study could be attributed to the age rather than CKD, even after a mean disease duration of 11 years. CLINICAL RELEVANCE: CKD and its associated metabolic changes appear to have no detectable impact on the resilient tongue microbiome observed in young patients.

The impact of a needs-oriented dental prophylaxis program on bacteremia after toothbrushing and systemic inflammation in children, adolescents, and young adults with chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) still leads to high mortality rates, mainly due to cardiovascular disease. One important influencing factor is persisting low-grade chronic inflammation partly maintained by gingivitis that favors transient bacteremia during daily activities such as toothbrushing. METHODS: To examine whether intensive dental prophylaxis can restore oral health, reduce the prevalence of bacteremia and degree of systemic inflammation indicated by CRP levels, we conducted this pilot study examining 30 CKD patients aged 6-26 years, 15 receiving intensive prophylaxis (IP), 15 receiving treatment as usual (TAU) serving as control group. There were three appointments for examination, each 10 ± 1 weeks apart (at baseline, after intervention periods one and two, when TAU also received IP, and the IP group stopped prophylaxis). RESULTS: The gingival index (GI) in the IP group decreased by 90% (GI 0.09; p=0.001), resulting in almost healthy gingiva. There was no significant change in CRP or prevalence of bacteremia. General prevalence of bacteremia after toothbrushing was 9.5% affecting 7 (26%) of the participants. In three participants, bacteremia dissolved after IP, in one after TAU. Two patients developed bacteremia ≥ 10 weeks after ending IP. We identified eight different bacterial species. CONCLUSIONS: We were able to show that IP can effectively treat gingivitis. It might be a promising approach to reduce systemic inflammation and subsequently lower premature cardiovascular disease, despite the lack of statistical significance. Future research requires a larger patient cohort to enable matched treatment groups with long-term follow-up and molecular detection methods for bacteremia. A higher resolution version of the Graphical abstract is available as Supplementary information.

Third-party toothbrushing is associated with a positive patient experience: randomized, single-blind, patient-centered analysis.

BACKGROUND: As the need for care increases with higher age, so does the need for assistance with oral hygiene. A recent study analyzed the clinical effectiveness of oral hygiene assistance provided by caregivers. The current secondary analysis of this study aimed to assess pleasant and unpleasant perceptions of patients while being brushed and to investigate whether these perceptions depend on the qualification of the person brushing and the type of toothbrush used (manual vs. powered). METHODS: First, a qualitative study was conducted. This aimed at developing the questionnaire. Items were extracted on the basis of qualitative interviews with a sample of 6. A delphi process ensured the content validity of the final instrument. The main study comprised 39 periodontitis patients with reduced oral hygiene capability randomized to one of four groups: brushing carried out by trained laypeople or dental professionals, each using a manual or powered toothbrush at three different time points during anti-infective periodontal therapy. Patient perceptions of the third-party toothbrushing were assessed immediately after brushing. RESULTS: Patients reported mainly positive feelings regarding being brushed by a third person and the interaction with this person during brushing. Neither the professional background of the brushing person nor the type of brush had a significant influence on pleasant and unpleasant perceptions (all F < 3.30, all p > 0.07, all η2 < 0.10). CONCLUSIONS: Patient perceptions of third-party toothbrushing are mainly positive regarding wellbeing and interactions with the toothbrushing person, and do not depend on the qualification of the brushing person or the toothbrush used (manual versus powered). Trial registration https://www.germanctr.de , No. DRKS00018779 (04/11/2019).

Impact of care level, setting and accommodation costs on a newly developed oral care nursing plan format for elderly patients with care needs - Results from a cross-sectional study.

OBJECTIVES: A new oral care nursing plan format for improved communication among dentists, nursing staff and caregivers has been developed in Germany. We aimed to (1) describe this plan, (2) investigate the prevalence of oral health problems among elderly patients with care needs documented by the plan, outline the recommendations in the plans and (3) investigate whether the accommodation costs or care needs of patients influenced oral care quality or the need for oral hygiene support documented within the plan. METHODS: In this cross-sectional trial, oral care nursing plans were collected from outpatient and inpatient care clinics. Items on the oral care nursing plan were divided into three areas (oral health, oral hygiene needs, and coordination needs and dental therapy) and were correlated with the care level and accommodation costs. RESULTS: Oral care nursing plans were collected from seven dentists (N = 747; 94.5% from inpatient and 5.5% from outpatient care). The plans enabled documentation of well-known oral health and hygiene problems among elderly patients. In their current form, the plans provided recommendations for obvious oral hygiene tasks such as toothbrushing or fluoridating, rather than specialized tasks such as nutritional advice or dry mouth asymptomatic therapeutic approaches. Although accommodation costs were associated with the need for oral hygiene support (not with oral care condition), the care level influenced both measures. CONCLUSIONS: The oral care nursing plan can facilitate documentation of oral health and hygiene among elderly individuals with care needs. Further clarification of the plan would help promote careful documentation by dentists.

Does a pretreatment with a dentine hypersensitivity mouth-rinse compensate the pain caused by professional mechanical plaque removal? A single-blind randomized controlled clinical trial.

OBJECTIVES: Pain is affecting acceptance of supportive periodontal therapy and primary periodontitis prevention. Our objective was to evaluate the efficacy of a 1-week pre-treatment use of dentinal-hypersensitivity-reducing mouth-rinses (DHM) in periodontal maintenance (SPT) or dental prophylaxis patients. MATERIAL AND METHODS: One hundred fifty-five participants attending for professional mechanical plaque removal (PMPR) were randomly assigned to use a mouth-rinse twice daily for 1 week prior to their next PMPR. Rinses were containing either potassium oxalate (n = 52), arginine (n = 52), or herbal extracts (n = 51). At baseline and reassessment, procedural pain was assessed by visual analogue scale (VAS) and verbal rating scale (VRS). Self-reported efficacy was documented. RESULTS: No inter-group differences were estimated between both test groups and the control for baseline and reassessment means (VAS, VRS). In the SPT group, VAS reduction and self-reported efficacy were found (p < 0.05). CONCLUSION: The 1-week use of DHM failed to show a predictable effect on discomfort during PMPR overall. Around 20% of the patients showed a quantifiable benefit from both test mouth-rinses, whereas more than 50% reported a subjective pain reduction. Focusing patients undergoing supportive periodontal therapy, quantifiable effects were found for both test groups. From a patient's point of view, DHM might be a suitable adjunct to enhance procedural comfort, especially in patients with a history of periodontitis. CLINICAL RELEVANCE: The 1-week use of the dentinal-hypersensitivity-reducing mouth-rinses prior to professional-mechanical-plaque-removal showed to be a suitable adjunct to enhance procedural comfort during instrumentation, especially in patients undergoing supportive periodontal therapy. Registration number: DRKS00010811.

Effectiveness of brushing teeth in patients with reduced oral hygiene by laypeople: a randomized, controlled study.

BACKGROUND: To evaluate the success of plaque reduction after external toothbrushing by instructed laypeople versus dental professionals using either a manual or powered toothbrush. Longitudinal, randomized, parallel-group intervention study in periodontitis patients with reduced oral hygiene quality undergoing anti-infective therapy. Patients were randomly and equally assigned to one of four groups: laypeople using a manual or powered toothbrush or dental professionals using a manual or powered toothbrush. Plaque reduction (Quigley-Hein-Index (QHI), Marginal Plaque Index (MPI)), gingivitis (papilla bleeding index), and cleaning time (seconds) were investigated. RESULTS: Thirty-nine patients participated in the study. Neither the choice of toothbrush (p = 0.399) nor the use of a dental professional (p = 0.790) had a significant influence on plaque levels achieved. However, multivariate modeling indicated statistically significant differences in the external cleaning time between brushing groups, with longer time required by laypeople (p = 0.002) and longer use of the powered toothbrush (p = 0.024). CONCLUSION: When the ability to carry out personal oral hygiene is reduced, external brushing by dental professionals or instructed laypeople who meet previously defined criteria such as sufficient personal oral hygiene at home could help to fill the emerging dental care gap. A combination of oral hygiene approaches adapted to the individual needs of the patients in need of external help is necessary for optimum oral hygiene. TRIAL REGISTRATION: German Clinical Trials register ( https://www.germanctr.de ; number DRKS00018779; date of registration 04/11/2019).

[Oral health assessment of seniors under outpatient care by family doctors : Development and validation of the geriatric outpatient oral health screening]. / Erfassung der Mundgesundheit von ambulant betreuten Senioren durch Hausärzte : Entwicklung und Validierung des geriatrischen ambulanten Mundgesundheits-Screenings.

BACKGROUND: Despite a high prevalence in the general practitioner (GP) and geriatric field, limitations of oral health of seniors under outpatient care in Germany are not routinely recorded. Since seniors with a high age visit GPs more often than dentists, the question arises whether an interdisciplinary screening instrument can be used to identify reduced oral health in routine practice. OBJECTIVE: The aim of the work was to develop a screening tool for reduced oral health for GPs and to validate this by dental examinations. MATERIAL AND METHODS: The geriatric outpatient oral health screening (GAMS) was developed as a subjective screening instrument to depict dental aspects relevant for geriatric patients, such as chewing problems, pain, periodontitis, bad breath or dry mouth in dichotomous questions. The urgency of a visit to the dentist is also assessed by the family doctor. A total of 75 patients were included and the GAMS and a dental examination were performed for validation. RESULTS: The subjective assessment of patients and dental findings showed reduced oral health especially with recognized risk factors for the development of systemic comorbidities, such as dysphagia and malnutrition, whereas oral health problems were underestimated by patients. Bites, chewing problems and dry mouth showed sufficient correspondence between dental findings and subjective assessment. CONCLUSION: The GAMS could help facilitate the consideration of oral health problems in geriatric patients in a GP setting and promote cooperation with dentists in the sense of European recommendations for action.

[Subjective oral health problems of geriatric outpatients and general medical geriatric findings-a pilot study]. / Subjektive Mundgesundheitsprobleme ambulant betreuter geriatrischer Patienten und allgemeinmedizinisch-geriatrische Befunde ­ eine Pilotstudie.

BACKGROUND: Oral health problems of the aged in Germany are not recorded in general practitioner's practices despite a high prevalence. For this purpose, a subjective geriatric outpatient oral health screening (GAMS) is available. AIM: The aim was to clarify whether subjective oral health problems reported by the GAMS can serve as risk indicators for medical findings in geriatric patients. MATERIAL AND METHODS: A total of 75 geriatric patients >75 years old in a family doctor's practice, GAMS, laboratory parameters, e.g. blood count with hemoglobin (g/dl), leukocytes (cells/nl), platelets (cells/nl), sodium (mmol/l), potassium (mmol/l), glucose in serum (mg/dl), HbA1c (HPLC)%, cholesterol (mg/dl) and glomerular filtration rate (GFR, ml/min), Barthel index and timed up and go test (TUG) were carried out. RESULTS: The most common oral health problems were chewing difficulties (19%) and xerostomia (40%). In the case of oral health problems, there were reduced everyday skills (p = 0.066), slower walking speed (0.049), higher serum glucose (p = 0.001) and long-term glucose values (p = 0.002). Bleeding gums are risk indicators for higher leukocyte concentration (p = 0.036). With xerostomia, the hemoglobin value drops by 1.13 g/dl (p = 0.001). DISCUSSION: The GAMS helps to identify oral problems as risk indicators of reduced geriatric health. Also, GAMS can be initiated in cases of the described geriatric pathologies in order to identify possible oral problems.

Efficacy of regular professional brushing by a dental nurse for 3 months in nursing home residents-A randomized, controlled clinical trial.

OBJECTIVES: The oral health of nursing home residents is poor for various reasons. Many require help for oral hygiene. Regular professional brushing by a dental nurse should improve oral hygiene. This study aimed to determine the efficacy of regular tooth brushing by a dental nurse on the oral health of nursing home residents. METHODS: This controlled trial randomized participants (n = 50; mean age 83 ± 8 years) to brushing by a dental nurse every 2 weeks for 3 months (n = 25; test group) or oral hygiene procedures performed/controlled by nursing home staff (n = 25; control group). Personal, general and oral health, as well as various oral hygiene parameters-plaque index (PI), gingivitis index (GI), papilla bleeding index (PBI), oral hygiene index (OHI) and Volpe-Manhold Index (VMI)-were evaluated at baseline, after initial professional dental cleaning and before last brushing. RESULTS: At baseline, oral health was impaired according to investigated indices in both groups. After professional brushing for 3 months, there were improvements in PI, GI and PBI, with significant increases compared with the control group in OHI and VMI (P = 0.017 and P < 0.001, respectively). Among the control group, the number of teeth decreased while the root caries index increased (P = 0.002 between groups). CONCLUSIONS: Regular professional brushing every 2 weeks by a dental nurse can be recommended for nursing homes residents to improve oral health parameters and to help reduce root caries incidence as a basis to preserve the number of teeth. Such oral hygiene procedures will maintain and improve the oral health of nursing home residents.

Protective Buffering Capacity of Restorative Dental Materials In Vitro.

PURPOSE: To investigate the buffering capacity of restorative materials during a simulated carious and intrinsic erosive attack. MATERIALS AND METHODS: Cavities with a volume of 130 µl were milled (Cerec MC XL) out of blocks of Ceram X Mono (CM), Quixfil (QX), Filtek Supreme (FS), Apa Fill 3 (AF), an experimental dual-curing composite containing a bioactive glass (EX), Dyract eXtra (DY), Beautifil (BE), Equia Fil (EQ), Telio CAD (TL) (negative control), TheraCal (TC; positive control), and extracted teeth (ED). 80 µl of lactic acid (pH 4.5) and hydrochloric acid (pH 2.6) were each pipetted into the cavities of two samples of each material. Change of pH in the solutions was measured continuously for 12 min using a calibrated pH electrode. RESULTS: CM, AF, and FS (final pH 3.0-3.2) neutralized hydrochloric acid to a significantly lesser extent than did BE, EQ, DY and QX (final pH 5.0-5.6) (p < 0.05, ANOVA Scheffé). The lactic-acid buffering capacity of CM, BE, and AF was equivalent (final pH 6.3-7.4) to that of ED (7.5), but was surpassed by FS (pH 8.0). pH values for EX and TC (final pH 9.2-11.3) increased significantly (p < 0.05) in response to both acids. CONCLUSIONS: Conventional restorative materials do not buffer better than human teeth. However, the experimental composite demonstrates that buffering against carious and intrinsic erosive acid attacks is technically feasible.

Subjective and objective halitosis among patients with Parkinson's disease.

OBJECTIVES: Parkinson's disease (PD) affects oral health, but prevalence of subjective and objective halitosis and the influence of hyposalivation remain unclear. We aimed to explore whether patients with PD suffer from halitosis and to define correlations between halitosis and hyposalivation. We hypothesised that patients with PD suffer more often from halitosis compared to healthy controls, influenced by dry mouth. MATERIALS AND METHODS: Subjective (halitosis, xerostomia visual analogue scale [VAS], short German Oral Health Impact Profile [OHIPG]-14) and objective scales (e.g., organoleptic score, volatile sulphur compounds [VSCs], stimulated whole saliva [SWS]) were assessed from 26 patients with PD and 26 healthy controls. RESULTS: The mean organoleptic score was 0.7 (SD: 0.7) in all patients, and VSCs were either comparable or significantly lower (dimethyl sulphide, P = .010) in PD patients compared with controls, yet more patients with PD perceived halitosis to be stronger (77% vs 54%, respectively; P = .059). Dry mouth was significantly more likely in patients with PD than controls: mean xerostomia VAS 4 (SD: 2) vs 1 (SD: 2), P = .010; SWS 0.4 (SD: 0.4) vs 0.7 (SD: 0.6) mL/min, P < .05); SWS did not correlate with subjective or objective halitosis. Oral health-related quality of life (OHRQoL) was lower in patients with PD than controls (mean OHIPG-14 score 12 (SD: 0.2) vs 5 (SD: 7.0), respectively; P < .05). CONCLUSIONS: Patients with PD suffer from subjective and objective halitosis, dry mouth and impaired OHRQoL. Dry mouth problems do not correlate with prevalence or intensity of halitosis.

Modified amelogenin is a new and versatile nanomaterial for biomedical applications.

Amelogenin self-assembly is crucial for tooth biomineralization and crystallite enamel orientation. Amelogenin forms stable nanoparticles under physiological conditions. Here, we tested whether the surface properties and binding characteristics of these particles could be modified to enhance amelogenin function as a biomaterial. We evaluated different amelogenin fusion proteins for their ability to form hybrid nanoparticles. As a proof-of-concept, the integrin-binding tripeptide Arg-Gly-Asp (RGD) sequence from fibronectin was integrated into mouse amelogenin (rM179) at three different positions. Dynamic light scattering (DLS) measurements revealed that these amelogenin fusion proteins still form nanospheres. Additional DLS and isothermal titration calorimetry measurements showed that the mixtures of RGD-modified amelogenin and wild-type amelogenin form stable particles. We determined that insertion of the RGD-loop at the amelogenin C-terminus converts the nanoparticle into a cell-binding substrate. Calvarial osteoblasts efficiently attached and spread on modified amelogenin, whereas almost no binding was observed on wild-type amelogenin. These results establish amelogenin as a new versatile biomaterial that can be easily modified to add additional functions.

Influence of intra-pocket anesthesia gel on treatment outcome in periodontal patients: a randomized controlled trial.

AIM: Compare the treatment outcome after scaling and root-planing using local anesthesia gel or injected local anesthesia. MATERIAL AND METHOD: Thirty-eight patients with periodontitis and good general health were included in a randomized, single-blind, split-mouth clinical trial. Probing depths and clinical attachment levels were recorded at baseline and 6 weeks after treatment. Performed treatment procedures were scaling and root planing using two types of local anesthesia for separate treatment appointments. Anesthetics used were intra-pocket lidocaine and prilocaine gel (2.5% each) and injected articaine (1:100,000 adrenaline). Type of anesthesia for first appointment was randomized and switched for second appointment. Patients' pain perception and anesthesia acceptance were recorded on questionnaires. RESULTS: No influence of applied type of anesthesia could be detected for change of probing pocket depths and clinical attachment level (p > 0.05). These findings are valid even for deeper pockets. Gel-group had significant higher intra-operative pain perception. In retrospect 69% of patients favored gel. CONCLUSION: Treatment outcome is not compromised by use of anesthesia gel in comparison to injected anesthesia. The same beneficial results for probing pocket depths and clinical attachment gain could be detected. The majority of patients prefer local anesthesia gel despite a slightly greater procedural discomfort.

Halitosis in young patients with chronic kidney disease: findings from a randomized controlled trial.

BACKGROUND: Chronic kidney disease (CKD) directly affects oral health. Yet data about halitosis in young CKD patients and the impact of dental prophylaxis is limited. Therefore, as part of this randomized clinical trial, halitosis in young CKD patients undergoing intensive or standard oral preventive procedures was to be explored. METHODS: Three volatile sulfur compounds (hydrogen sulfide, methyl mercaptan and dimethyl sulfide) were measured in 30 young patients with CKD (mean age 14.2 years; 16 males, 14 females). Breath samples were taken after 3 and 6 months and analyzed with selective gas chromatography (OralChroma). Tongue coating (Winkel Index) and clinical indices to determine local inflammation or oral hygiene (Papillary Bleeding Index and Quigley-Hein Index) were assessed. Within an extended anamnesis, patients and their mothers and nurses were questioned about the perceived halitosis. Corresponding quotes were noted verbatim. Patients were randomized to either intensive need-related oral health care measures (oral preventative program, OPP) or a one-stage standard prevention (treatment as usual, TAU). RESULTS: While there were no differences in volatile sulfur compound levels between TAU and OPP at the three time points of measurements (p > 0.05), there was a tendency towards a reduction in dimethyl sulfide and hydrogen sulfide of affected patients within the OPP group over time. Looking at potential differences between both groups with regard to tongue coating, significant differences were observed between baseline and 3 months after study start in the OPP group, and between baseline and 6 months after study start in the TAU group (p < 0.05). The burden of halitosis was frequently reported by patients' mothers and nurses. CONCLUSIONS: Young CKD patients regularly suffered from halitosis and dimethyl sulfide was its main source. Preventive measures mainly resulted in a reduction of tongue coating. TRIAL REGISTRATION: The German Clinical Trial Register (# DRKS00010580).

A strategy for encouraging young adults' adoption of a preferred oral hygiene technique.

PURPOSE: Adherence to dental preventive programmes in young adults is low. The aim of the present longitudinal study was to evaluate whether tutoring peers can be a compliance-enhancing tool or not. METHODS: In Part 1, two randomly selected classes (49 female students, mean age 19.8 + or - 2.3 years) were taught adult toothbrushing technique (the modified Bass technique) in a project-like manner. After the course, knowledge was tested using a class test, and compliance was evaluated using anonymous quantitative questionnaires. Compliance was defined as a reported degree of change from the easy-to-learn childhood toothbrushing techniques to the more efficient and challenging Bass technique. In Part 2 of the present longitudinal study, the compliance of these students was re-evaluated after having developed and applied themselves a programme of how to tutor peers in oral health. Re-evaluation of compliance was performed after 3 and 9 months. RESULTS: In Part 1, 28.5% of the students were compliant after 1 week. Compared with Part 1, the compliance in Part 2 was significantly higher (P u 0.001), both after 3 months (90%) and after 9 months (82%). CONCLUSIONS: Tutoring peers can significantly enhance the compliance over a period of 9 months. Tutoring can function as a form of empowerment and can establish a strong sustained health engagement. Tutoring peers in health-related subjects can readily be implemented in schools and might be an additional means of oral health promotion with fewer additional costs.

The Underestimated Problem of Intra-Oral Halitosis in Dental Practice: An Expert Consensus Review.

Approximately 90% of halitosis cases originate within the oral cavity (intra-oral halitosis). With a focus on intra-oral halitosis, this narrative review article provides a current summary of the epidemiology, diagnosis and management of halitosis and discusses practical considerations for healthcare professionals (HCPs), including dentists, dental hygienists, general practitioners, community pharmacists, nurses and medical specialists. MEDLINE and PubMed were searched up to 31 December 2019. Additional information was sourced from reference lists of relevant published literature. Full-text articles which reported on the epidemiology, diagnosis and management of halitosis were considered for inclusion. Halitosis affects substantial numbers of individuals globally and is an underestimated problem in dental practice. Current estimates of the prevalence of halitosis, in addition to diagnostic methods and management considerations for halitosis, are discussed. Although not a life-threatening condition, halitosis has a significant impact on patients' quality of life and can result in psychological consequences including social, professional and affective limitations. Using a simple step-wise approach for diagnosis and treatment, dentists and dental hygienists are ideally placed to respond to an initial consultation for halitosis.

Peer teaching pilot programme for caries prevention in underprivileged and migrant populations.

BACKGROUND: Focused caries prevention programmes for migrant children often fail because there is an important barrier of linguistic and cultural diversity. AIM: The aim of this study was to evaluate whether a tailored peer teaching approach can improve oral health behaviours of underprivileged and/or multinational migrant first graders. DESIGN: Two fourth grade classes (30 children, mean age 9.6) and two first grade classes (38 children, mean age 6.6) with high migrant background participated. The fourth graders took part in a preparatory course of oral health and developed a concept for tutoring first graders in oral health concepts as well as the Fones toothbrushing method. Later then, the fourth graders instructed the first graders during two lessons. Toothbrushing of each first grader was filmed before and 7 days after instruction. Toothbrushing time, method, and systematic were evaluated. RESULTS: After instruction, circular toothbrushing movements and systematic toothbrushing were observed significantly more often (P = 0.0001); toothbrushing time did not change. CONCLUSIONS: This pilot study shows that tutoring by older peers of similar origin resulted in significant changes towards better oral health in underprivileged and/or multinational migrant first graders. Authentic role models could be provided, and communication and cultural barriers circumvented.

Peer tutoring pilot program for the improvement of oral health behavior in underprivileged and immigrant children.

PURPOSE: Caries prevalence in underprivileged children is particularly high and, even though many efforts have been made, adherence to dental preventive programs is low. The purpose of this study was to evaluate whether a tutoring program can improve oral health behavior in underprivileged and/or immigrant children. METHODS: Thirty fourth-grade children (mean age = 9.6), over 50 percent of immigrant background, participated in this longitudinal pilot study. The fourth graders were invited to develop on oral health program for their first-grade peers. For this purpose, the fourth graders learned oral health practices and developed the peer tutoring program. Prior to the intervention and after having instructed their first-grade peers, all fourth graders were interviewed about their oral health habits and their tooth-brushing was recorded on video. Toothbrushing time, performance of circular tooth-brushing movements, and systematic cleaning of all dental surfaces were analyzed before and after the intervention. RESULTS: After peer teaching, there was a significant increase concerning tooth-brushing time (P = .004), performance of circular tooth-brushing movements (P < .001), and systematic cleaning of all dental surfaces (P < .001). CONCLUSIONS: The tutoring program yielded a significant improvement in relevant oral care behavior. This approach provided an environment which, in contrast to traditional approaches, facilitates empowerment.

Power bleaching enhances resin infiltration masking effect of dental fluorosis. A randomized clinical trial.

OBJECTIVES: Patients with moderate dental fluorosis often feel esthetically compromised. Aim of this RCT was to evaluate the objectively and self-assessed masking effect of resin infiltration alone or in combination with in-office bleaching on dental fluorosis in adults. METHODS: Twenty-seven patients (9 male, 18 female, 24.81 ± 3.7 yrs) with 410 fluorotic teeth (TF 1-4) were randomly assigned to a treatment (BLI) or control group (NBLI). Patients underwent in-office bleaching (25% H2O2) in the BLI or a placebo bleaching (ACP gel) in the NBLI group followed by resin infiltration after two weeks. Standardized digital photographs were obtained at baseline; after bleaching; before and after resin infiltration and after 1, 3, and 6 months. Color differences (ΔE) between sound and fluorotic areas were calculated and patient satisfaction was evaluated using a VAS (1-10). RESULTS: Statistical analysis revealed significant differences in the mean ΔE values 6 months after resin infiltration between the BLI (ΔE = 1.41) and the NBLI group (ΔE = 4.33) (p = 0.024). VAS values increased after resin infiltration (p < 0.05) in both groups. After 3 months patients in the BLI group had higher VAS values than in the NBLI group (p = 0.029). CONCLUSIONS: Findings of this study suggest that resin infiltration alone can effectively mask mild to moderate dental fluorosis in young adults. In-office bleaching with 25% H2O2 before resin infiltration provides significantly better masking effects. CLINICAL SIGNIFICANCE: Resin infiltration is a safe and efficient treatment option for masking fluorotic opacities. A priori in-office bleaching with 25% H2O2 enhances the masking effect. This controlled clinical trial is registered in the German Clinical Trials Register #DRKS00010465.

Patients' preferences in periodontal disease treatment elicited alongside an IQWiG benefit assessment: a feasibility study.

BACKGROUND AND PURPOSE: The German Institute for Quality and Efficiency in Health Care (IQWiG) previously tested two preference elicitation methods in pilot projects and regarded them as generally feasible for prioritizing outcome-specific results of benefit assessment. The present study aimed to investigate the feasibility of completing a discrete choice experiment (DCE) within 3 months and to determine the relative importance of attributes of periodontal disease and its treatment. PATIENTS AND METHODS: This preference elicitation was conducted alongside the IQWiG benefit assessment of systematic treatments of periodontal diseases. Attributes were defined based on the benefit assessment, literature review, and patients' and periodontologists' interviews. The DCE survey was completed by patients with a history of periodontal disease. Preferences were elicited for the attributes "tooth loss within next 10 years", "own costs for treatment, follow-up visits, re-treatment", "complaints and symptoms", and "frequency of follow-up visits". Patients completed a self-administered questionnaire including 12 choice tasks. Data were analyzed using a random parameters logit model. The relative attribute importance was calculated based on level ranges. RESULTS: Within 3 months, survey development, data collection among 267 patients, data analysis, and provision of a study report could be completed. The analysis showed that tooth loss (score 0.73) was the most important attribute in patients' decisions, followed by complaints and symptoms (0.22), frequency of follow-up visits (0.02), and costs (0.03) (relative importance scores summing up to 1). CONCLUSION: A preference analysis performing a DCE can be generally feasible within 3 months; however, a good research infrastructure and access to patients is required. Outcomes used in benefit assessments might need to be adapted to be used in preference analyses.