An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities.

OBJECTIVES: To evaluate how an intervention, which combined hand washing promotion aimed at 5-year-olds with provision of free soap, affected illnesses among the children and their families and children's school absenteeism. METHODS: We monitored illnesses, including diarrhoea and acute respiratory infections (ARIs), school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai, India (35 communities per arm). RESULTS: Outcomes from 847 intervention households (containing 847 5-year-olds and 4863 subjects in total) and 833 control households (containing 833 5-year-olds and 4812 subjects) were modelled using negative binomial regression. Intervention group 5-year-olds had fewer episodes of diarrhoea (-25%, 95% confidence intervals [CI] = -37%, -2%), ARIs (-15%, 95% CI = -30%, -8%), school absences due to illnesses (-27%, 95% CI = -41%, -18%) and eye infections (-46%, 95% CI = -58%, -31%). Further, there were fewer episodes of diarrhoea and ARIs in the intervention group for 'whole families' (-31%, 95% CI = -37%, -5%; and -14%, 95% CI = -23%, -6%, respectively), 6- to 15-year-olds (-30%, 95% CI = -39%, -7%; and -15%, 95% CI = -24%, -6%) and under 5 s (-32%, 95% CI = -41%, -4%; and -20%, 95% CI = -29%, -8%). CONCLUSIONS: Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public-private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference.

Mapping biological to clinical phenotypes during the development (21 days) and resolution (21 days) of experimental gingivitis.

AIM: To characterize and map temporal changes in the biological and clinical phenotype during a 21-day experimental gingivitis study. MATERIALS AND METHODS: Experimental gingivitis was induced over 21 days in healthy human volunteers (n = 56), after which normal brushing was resumed (resolution phase). Gingival and plaque indices were assessed. Gingival crevicular fluid was collected from four paired test and contra-lateral control sites in each volunteer during induction (Days 0, 7, 14 and 21) and resolution (Days 28 and 42) of experimental gingivitis. Fluid volumes were measured and a single analyte was quantified from each site-specific, 30s sample. Data were evaluated by analysis of repeated measurements and paired sample tests. RESULTS: Clinical indices and gingival crevicular fluid volumes at test sites increased from Day 0, peaking at Day 21 (test/control differences all p < 0.0001) and decreased back to control levels by Day 28. Levels of four inflammatory markers showed similar patterns, with significant differences between test and control apparent at Day 7 (substance P, cathepsin G, interleukin-1ß, elastase: all p < 0.03) and peaking at Day 21 (all p < 0.002). Levels of α-1-antitrypsin showed no pattern. CONCLUSIONS: Levels of substance P, cathepsin G, interleukin-1ß and neutrophil elastase act as objective biomarkers of gingival inflammation induction and resolution that typically precede phenotypical changes.

Instant tooth whitening from a silica toothpaste containing blue covarine.

OBJECTIVE: To measure the instant whitening effect delivered immediately after brushing with a novel silica whitening toothpaste containing blue covarine. METHODS: A controlled, single blind, cross-over study was performed to compare the tooth colour measured in a group of subjects at baseline and immediately after brushing with a silica whitening toothpaste containing blue covarine versus a clear gel negative control toothpaste. Measurements of tooth colour were made using a mobile non-contact camera-based digital imaging system and expressed as CIELAB and WIO whiteness index. RESULTS: Analysis of covariance (ANCOVA) showed that the silica whitening toothpaste containing blue covarine was significantly more effective than the negative control toothpaste (p < 0.05), and made teeth measurably less yellow, less red and overall whiter immediately after brushing. CONCLUSION: A statistically significant reduction in tooth yellowness and improvement in tooth whiteness was measured immediately after brushing with a novel whitening toothpaste containing blue covarine.

The in vitro and in vivo validation of a mobile non-contact camera-based digital imaging system for tooth colour measurement.

OBJECTIVE: To assess the reproducibility of a mobile non-contact camera-based digital imaging system (DIS) for measuring tooth colour under in vitro and in vivo conditions. METHODS: One in vitro and two in vivo studies were performed using a mobile non-contact camera-based digital imaging system. In vitro study: two operators used the DIS to image 10 dry tooth specimens in a randomised order on three occasions. In vivo study 1:25 subjects with two natural, normally aligned, upper central incisors had their teeth imaged using the DIS on four consecutive days by one operator to measure day-to-day variability. On one of the four test days, duplicate images were collected by three different operators to measure inter- and intra-operator variability. In vivo study 2:11 subjects with two natural, normally aligned, upper central incisors had their teeth imaged using the DIS twice daily over three days within the same week to assess day-to-day variability. Three operators collected images from subjects in a randomised order to measure inter- and intra-operator variability. RESULTS: Subject-to-subject variability was the largest source of variation within the data. Pairwise correlations and concordance coefficients were > 0.7 for each operator, demonstrating good precision and excellent operator agreement in each of the studies. Intraclass correlation coefficients (ICCs) for each operator indicate that day-to-day reliability was good to excellent, where all ICC's where > 0.75 for each operator. CONCLUSION: The mobile non-contact camera-based digital imaging system was shown to be a reproducible means of measuring tooth colour in both in vitro and in vivo experiments.

The in vitro and in vivo reproducibility of a video-based digital imaging system for tooth colour measurement.

OBJECTIVES: To assess the robustness of a new custom built video-based digital imaging system (VDIS) for measuring tooth colour and whiteness under in vitro and in vivo conditions. METHODS: The VDIS imaging system was developed for tooth colour measurement and evaluated in vitro and in vivo. The in vitro validation used extracted human teeth (HT, n=14) stored in water and VITA Classical shade guide tabs (SG, n=16). These were measured by the VDIS at baseline, 5min, 2h, 1 week and 2 weeks to evaluate the system repeatability. For in vivo validation, adult volunteers (male/female, n=34) with two natural, unrestored central incisors had their teeth imaged using the VDIS at baseline, 5min and 2h (3 images each) by two different operators to evaluate time and operator effects. Between taking individual images, subjects moved from the imaging-frame to assess the effect of re-positioning on reproducibility. From the in vitro and in vivo images, the average tooth RGB values were obtained, and the CIELAB values and a tooth whiteness index WIO value were calculated. Repeatability and reproducibility of VDIS imaging system was assessed using appropriate repeated measurement analysis techniques and ANOVA. RESULTS: The measurement variations in vitro were between 1 and 2 units of ΔWIO and the average colour differences were less than 1 ΔE*ab unit. For the in vivo study, analysis of the CIELAB parameters and WIO showed that subject variability accounted for between 82 and 99% of the observed variability in the measurement process. The operator variability was less than 0.5% and the overall measurement error was found to be only 0.3% for WIO. Across assessment times the variability was less than 0.5%. CONCLUSIONS: The dental imaging system V-DIS was shown to be a highly reproducible means for tooth colour and whiteness measurement. CLINICAL SIGNIFICANCE: Digital imaging based techniques gives a highly reproducible approach to measuring tooth colour.

In vitro and clinical evaluation of optical tooth whitening toothpastes.

OBJECTIVES: To measure tooth whitening effects delivered immediately after brushing with silica-based toothpastes containing either blue covarine or a combination of blue covarine and FD&C Blue No. 1 in vitro and in vivo. METHODS: Salivary pellicle coated human extracted teeth were brushed with either a slurry of a toothpaste containing blue covarine (BC) or a formulation containing a matched level of blue covarine and FD&C Blue No.1 (BC+D). The colour of the specimens were measured in vitro using a colorimeter, before and after brushing and changes in CIELAB and tooth Whiteness Index (WIO) values calculated. In a double-blind cross-over clinical study, subjects brushed with BC toothpaste, a toothpaste containing increased levels of blue covarine (BC+) or BC+D toothpaste and tooth colour changes were measured with a digital image analysis system. RESULTS: The in vitro study demonstrated that BC+D gave a significantly (p=0.002) greater change in WIO value than BC. Clinical results showed that BC, BC+ and BC+D gave a significant increase in WIO (p<0.0001) from baseline. The WIO change was significantly greater when brushing with BC+D toothpaste than with either toothpaste BC (p<0.0001) or BC+ (p<0.05). CONCLUSIONS: Toothpastes containing blue covarine or a combination of blue covarine and FD&C Blue No. 1 gave a statistically significant improvement in tooth whiteness immediately after brushing in both in vitro and clinical studies. In addition, the toothpaste containing both blue covarine and FD&C Blue No. 1 gave statistically significant greater tooth whitening from baseline than the blue covarine containing toothpastes. CLINICAL SIGNIFICANCE: The silica-based toothpastes containing blue covarine or a combination of blue covarine and FD&C Blue No. 1 evaluated in the current study gave significant tooth whitening benefits immediately after one brush.

Tooth whitening evaluation of blue covarine containing toothpastes.

OBJECTIVES: To measure the tooth whitening effects delivered immediately after brushing with silica-based toothpastes containing blue covarine in vitro and in vivo. METHODS: Salivary pellicle coated human extracted teeth were brushed with either a slurry of a toothpaste containing blue covarine (BC), a formulation containing an increased level of blue covarine (BC+) or a negative control toothpaste containing no blue covarine. The colour of the specimens were measured in vitro using either a Minolta chromameter or a VITA Easyshade spectrophotometer, before and after brushing and changes in CIELAB values and tooth Whiteness Index (WIO) values calculated. In a double-blind cross-over clinical study, subjects brushed with either BC or BC+ toothpaste and tooth colour changes were measured with a digital image analysis system. RESULTS: The in vitro studies demonstrated that toothpastes containing blue covarine gave a significantly (p<0.05) greater change in b* and WIO values than the negative control toothpaste; the BC+ toothpaste gave a significantly greater increase in b* and WIO values than the BC toothpaste, and BC+ gave a significant increase in shade change versus the negative control. Clinical results showed that BC and BC+ gave a significant reduction in b* (p<0.0001) and increase in WIO (p<0.0001) from baseline indicating significant tooth whitening had occurred. The parameter changes were significantly greater when brushing with the BC+ toothpaste than with the BC toothpaste (WIO p=0.006; b* p=0.013). CONCLUSIONS: Toothpastes containing blue covarine gave a statistically significant reduction in tooth yellowness and improvement in tooth whiteness immediately after brushing in both in vitro and clinical studies. In addition, the higher concentration blue covarine toothpaste gave statistically significant greater tooth whitening benefits than the lower concentration blue covarine toothpaste. CLINICAL SIGNIFICANCE: The silica-based toothpastes containing blue covarine evaluated in the current study gave tooth whitening benefits immediately after one brush.

Clinical evaluation of a novel whitening gel, containing 6% hydrogen peroxide and a standard fluoride toothpaste.

OBJECTIVES: The aim of this study was to determine the effect on tooth colour (after 1 and 2 weeks use) of a self-applied tooth-whitening gel containing 6% hydrogen peroxide using a novel applicator, compared to a standard fluoride toothpaste. METHODS: A 2-week, examiner-blind, stratified, parallel design clinical trial was conducted. Efficacy was measured by comparing the Vita shade scores recorded at baseline and after 1 and 2 weeks of product application. To qualify for the study, subjects were required to have at least one upper incisor/canine tooth measuring Vita shade A3 or darker. All upper incisors/canines of qualifying subjects were evaluated for change in Vita shade irrespective of their level of whiteness at baseline, allowing for the whitening gel to be tested on the full range of Vita tooth shades. One hundred and seventeen subjects were divided into two groups, balanced according to their darkest tooth shade. One group followed a 2-week, twice-daily regimen of brushing with toothpaste followed by the application of the hydrogen peroxide whitening gel. The other group brushed twice daily with toothpaste for 2 weeks. RESULTS: Subjects using the whitening gel showed a statistically significant improvement, (p<0.05) in mean tooth shade score of 0.75 and 1.02 units after 1 and 2 weeks, compared to baseline. These improvements from baseline were significantly greater than those observed for the toothpaste only group (0.14 and 0.35 units change after 1 and 2 weeks). CONCLUSIONS: The self-applied tooth-whitening gel containing 6% hydrogen peroxide has been shown to significantly improve the whiteness of teeth after 1 and 2 weeks of product use, compared to the baseline and the toothpaste only group.

Remineralisation effect of a dual-phase calcium silicate/phosphate gel combined with calcium silicate/phosphate toothpaste on acid-challenged enamel in situ.

OBJECTIVES: To test if a novel dual-phase gel system (calcium silicate and phosphate with 1450 ppmF, as NaF/MFP; TG) combined with a toothpaste (calcium silicate and sodium phosphate with 1450 ppmF, as MFP; TG) was able to re-harden previously acid-challenged enamel to a greater extent than other toothpastes. METHODS: The study consisted of a double-blind, randomised, cross-over design with four 7-day treatment legs. In each leg, subjects wearing a partial denture holding four demineralised enamel specimens (25 min in 0.3% citric acid, pH3.8) used either the test regimen (TG+TP) or one of the three controls. (placebo TG+TP; Positive Control - placebo TG+marketed 1450 ppmF toothpaste; Negative Control - placebo TG+placebo TP). Enamel specimens were removed after 1, 2, 3 and 7 days. The gel systems were applied once per day for the first three days during which subjects also brushed with the corresponding toothpaste; this was followed by four days use of the toothpastes only. Toothpastes were used in the conventional way brushing twice per day throughout the seven days. The outcome variable was %Surface Microhardness Recovery calculated after three and seven days of in situ treatment. RESULTS: The results showed a statistically significant (p<0.001) re-hardening effect for all treatments compared to pre-treatment hardness. After three days and after seven days of in situ treatment significantly greater hardening (p<0.05) was found in the samples treated with calcium silicate/phosphate gel system plus calcium silicate/phosphate toothpaste than in the control groups. CONCLUSIONS: It is concluded that the test regimen based on the novel dual-phase gel system combined with toothpaste was able to re-harden acid-challenged tooth enamel to a greater extent than a normal fluoride toothpaste. CLINICAL SIGNIFICANCE: The novel oral care products containing calcium silicate, sodium phosphate salts and fluoride is a new approach to the repair of demineralised enamel.