Airway disease decreases the therapeutic potential of epithelial stem cells.

BACKGORUND: Tissue-engineered tracheal grafts (TETG) can be recellularized by the host or pre-seeded with host-derived cells. However, the impact of airway disease on the recellularization process is unknown. METHODS: In this study, we determined if airway disease alters the regenerative potential of the human tracheobronchial epithelium (hTBE) obtained by brushing the tracheal mucosa during clinically-indicated bronchoscopy from 48 pediatric and six adult patients. RESULTS: Our findings revealed that basal cell recovery and frequency did not vary by age or region. At passage 1, all samples produced enough cells to cellularize a 3.5 by 0.5 cm2 graft scaffold at low cell density (~ 7000 cells/cm2), and 43.75% could cellularize a scaffold at high cell density (~ 100,000 cells/cm2). At passage 2, all samples produced the number of cells required for both recellularization models. Further evaluation revealed that six pediatric samples (11%) and three (50%) adult samples contained basal cells with a squamous basal phenotype. These cells did not form a polarized epithelium or produce differentiated secretory or ciliated cells. In the pediatric population, the squamous basal cell phenotype was associated with degree of prematurity (< 28 weeks, 64% vs. 13%, p = 0.02), significant pulmonary history (83% vs. 34%, p = 0.02), specifically with bronchopulmonary dysplasia (67% vs. 19%, p = 0.01), and patients who underwent previous tracheostomy (67% vs. 23%, p = 0.03). CONCLUSIONS: In summary, screening high-risk pediatric or adult population based on clinical risk factors and laboratory findings could define appropriate candidates for airway reconstruction with tracheal scaffolds. LEVEL OF EVIDENCE: Level III Cohort study.

Interdental cleaning aids are beneficial for oral health at 7-year follow-up: Results from the Study of Health in Pomerania (SHIP-TREND).

AIM: To estimate association between the use of interdental cleaning aids (IDAs) and type on 7-year follow-up levels of interdental plaque, interdental gingival inflammation, interdental periodontitis severity, the number of interdental sound surfaces and the number of missing teeth in a population-based cohort study. MATERIALS AND METHODS: We used 7-year follow-up data of 2224 participants from the Study of Health in Pomerania (SHIP-TREND). We applied generalized linear and ordinal logistic models, adjusting for confounding and selection bias using inverse probability treatment weighting and multiple imputation. RESULTS: Flossers were 32% less likely to have higher interdental plaque (iPlaque) levels than non-users of IDAs (odds ratio [OR] = 0.68; 95% confidence interval [CI]: 0.50-0.94); flossing resulted in 5% lower means of iPlaque. Effects on interdental bleeding on probing (iBOP), mean interdental probing depths and mean interdental clinical attachment levels were direction-consistent but statistically non-significant. Interdental brushing was associated with lower follow-up levels for interdental plaque (OR = 0.73; 95% CI: 0.57-0.93) and iBOP (OR = 0.69; 95% CI: 0.53-0.89). IDAs were more effective in reducing iPlaque in participants with periodontitis, whereas iBOP reduction was more pronounced in participants with no or mild periodontitis. The analyses did not suggest that the use of IDAs affected caries. Finally, applying change score analyses, flossing reduced tooth loss incidence (incidence rate ratio [IRR] = 0.71) compared with non-users of IDAs. CONCLUSIONS: Recommending flossing and interdental brushing in dental practices represents an approach to the prevention of gingivitis and consequently periodontitis.

Association between tea types and number of teeth: a cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey.

BACKGROUND: Previous studies have suggested that tea consumption may have a positive impact on oral health. However, the effects of different tea types on oral health remain unclear. Therefore, this study aimed to determine the association between residual teeth and consumption habits of different types of tea (green tea, black tea, oolong tea, and scented tea) in older adults. METHODS: We conducted a secondary analysis using data from the Chinese Longitudinal Healthy Longevity Survey in 2018. In a sample of 6,387 older adults, we performed logistic regression analysis to examine the relationship between persistent tea consumption and oral health according to sex and brushing frequency. The indices for particularly healthy oral health and relative health were set at more than 20 teeth and more than 10 teeth, respectively. RESULTS: The study included 2,725 males and 3,662 females, both aged 65 and older. Among individuals with more than 20 teeth, drinking green tea significantly improved oral health in men (adjusted odds ratio [ORs]: 1.377; 95% confidence interval [CI]: 1.082-1.752) and drinking black tea significantly improved the oral health of women (ORs: 2.349, 95%CI: 1.028-5.366). In the daily brushing group, green tea had a significant beneficial effect on increasing the number of teeth in men and black tea had a significant beneficial effect in women. Among individuals with more than 10 teeth, drinking green tea significantly improved oral health in men (ORs: 1.539; 95% CI: 1.209-1.959) and drinking green tea and scented tea significantly improved the oral health of women (ORs: 1.447, 95%CI: 1.052-1.991; ORs: 1.948, 95%CI: 1.137-3.340). In the daily brushing group, consumption of green tea and black tea had significant beneficial effects on increasing the number of teeth in men, whereas that of green tea, black tea, and scented tea had significant beneficial effects in women. CONCLUSION: Long-term green tea consumption in males and black tea consumption in females were significantly associated with maintaining functional dentition (≥20 teeth). Similarly, long-term green tea consumption in males and green tea and scented tea consumption in females were associated with avoiding severe tooth loss (≥10 teeth). Furthermore, in the daily tooth brushing group, long-term consumption of black tea was associated with avoiding severe tooth loss in both sexes. However, tea consumption alone had no effect on oral health without good brushing habits.

Should We Wait to Brush Our Teeth? A Scoping Review Regarding Dental Caries and Erosive Tooth Wear.

BACKGROUND: Tooth brushing is a universal recommendation. However, the recommendations related to the time of its execution are conflicting, especially when dealing with patients at risk of erosive tooth wear (ETW) or dental caries. SUMMARY: Our objective was to summarize the evidence on the timing of brushing with fluoridated toothpaste in relation to ETW and cariogenic dietary challenges. We conducted a scoping review following the PRISMA-ScR checklist, using three databases searching for in vivo, in situ, or in vitro studies involving human teeth exposed to either a cariogenic or an erosive challenge. Only models including human saliva and fluoride were assessed. Data selection, extraction, and risk of bias analysis were done in duplicate and independently. From 1,545 identified studies, 17 (16 related to ETW and 1 to dental caries) were included. Most evidence (n = 10) supported that brushing with a fluoride-containing product does not increase ETW, independent of the moment of brushing. Delaying tooth brushing up to 1 h (n = 4) or individualized recommendations based on the patient's problem (n = 2) were less frequent. Only one study reported that brushing pre- or post-meal does not affect Streptococcus mutans counts. Most data were in situ (n = 13), and the overall study quality was judged as sufficient/low risk of bias. KEY MESSAGES: Although the available evidence lacked robust clinical studies, tooth brushing using fluoridated products immediately after an erosive challenge does not increase the risk of ETW and can be recommended, which is in line with recommendations for dental caries prevention. Furthermore, we suggest updating the international guidelines to promote individualized recommendations based on risk factors to prevent either ETW or dental caries.

Comparison and review of abrasive bronchial brushing versus non-abrasive aspiration, lavage and washing - Higher sensitivity but with risk of over-diagnosis for bronchial brushing.

Bronchial exfoliative cytology is classified as non-abrasive (washing, aspiration and bronchoalveolar lavage) and abrasive (brushing). Brush abrasion dislodges epithelial cells but can induce bleeding and cytomorphologic artifacts. In this study, the largest cohort to date of bronchial cytology specimens were referenced against bronchial biopsy as the reference standard. Findings in the study will be useful for selecting biopsy modality and reducing necessary procedural risks. All consecutive bronchial cytology and bronchial biopsy from 1995 to 2022 were retrieved. The diagnoses were reviewed and categorized into five-tiered diagnostic categories to compare diagnostic agreement and concordance. Review of 14,148 specimens yielded 3963 non-abrasive, 2378 abrasive cytology specimens matched to biopsy, with 4355 matches between non-abrasive and abrasive cytology specimens. Agreement between non-abrasive and abrasive cytology was moderate (κ = 0.580), and similar when referenced against biopsy (κ = 0.456 (non-abrasive), κ = 0.498 (abrasive)). Abrasive bronchial cytology showed a higher percentage of malignant diagnosis (20.95 % vs. 12.63 %, p < 0.001) and over-diagnosis rate (36.40 % vs. 29.79 %, p < 0.001), but higher sensitivity (0.747 vs. 0.572, p = 0.002). For subgroup analysis of transbronchial biopsies, matched abrasive cytology showed higher discordant rates (p < 0.05) and lower accuracy (0.907 vs. 0.873, p = 0.020). With the added bleeding risk associated with brushing, abrasive techniques may only be preferable in cases with clinical or bronchoscopic suspicion of malignancy, in particular endobronchial mucosal lesions. For routine bronchoscopy, non-abrasive bronchial cytology appears to be adequate.

Association of temperament with oral health behaviour and caries status in Thai preschool children.

BACKGROUND: Temperament associated with oral health behaviour and early childhood caries (ECC) in preschoolers remains inconclusive. AIM: This cross-sectional study investigated the association of temperament with oral health behaviour and ECC status. DESIGN: A total of 421 Thai preschoolers were recruited from elementary schools in Chonburi Province, Thailand. Their caregivers assessed three temperament dimensions (surgency, negative affectivity and effortful control) using the Thai version of the Children's Behaviour Questionnaire Very Short Form and reported oral health behaviours (brushing cooperation and cariogenic snack frequency). Three calibrated dentists assessed ECC status using the modified WHO dmft/dmfs (decayed, missing and filled teeth/surface) index that included noncavitated and cavitated carious lesions. RESULTS: Multiple regression analysis, after adjusting for child's and caregiver's characteristics, revealed that children with high negative affectivity or low effortful control were more likely to have uncooperative brushing behaviour. The temperament scores of children who consumed cariogenic snacks daily and those who did not were comparable. Children with low surgency, high negative affectivity or low effortful control were more likely to have high dmfs scores. CONCLUSION: Negative affectivity and effortful control were associated with brushing behaviour. Temperament was not associated with the frequency of cariogenic snack consumption. All temperamental dimensions, however, were associated with ECC.

A proof of principle investigation of a novel enzyme formulation on dental calculus deposition: a 4-week randomized human clinical trial.

BACKGROUND: The dissolution of dental calculus, safely and at home, is among the more challenging issues facing the over-the-counter healthcare industry. Pontis Biologics, Inc. has developed novel model of calculus development and structure and has formulated a dentifrice (Tartarase™) using digestive enzymes as active ingredients that is shown to dissolve dental calculus in this Proof of Principle clinical trial. METHODS: This investigation was designed to evaluate the safety and efficacy of a novel enzyme formulation to remove existing calculus deposits in 4 weeks, measured using the Volpe-Manhold Index (V-MI) on lingual surfaces of 6 lower anterior teeth. The test formulation was compared to Crest Cavity Protection, as a control dentifrice. A total of 40 randomized test subjects began the study with 20 assigned to the control dentifrice and 20 assigned to the Tartarase groups (ten each, one brushing with Tartarase twice daily and one brushed with Tartarase and wore a dental tray filled with Tartarase for 30 min then brushed again with Tartarase, once daily). RESULTS: The Crest group experienced a 12% increase in calculus, in contrast to the results of both Tartarase groups that experienced a 40% reduction in calculus in 4 weeks of unsupervised at home use of the Tartarase toothpaste formulation. CONCLUSIONS: This proof of principle study demonstrates that a dentifrice, formulated along the lines of the Tartarase material, is capable of combating calculus accumulation using the same oral hygiene habits that are common worldwide. TRIAL REGISTRATION: This trial was registered retrospectively at clinicaltrials.gov and has the Unique Identification Number: NCT06139835, 14/11/2023.

Efficacy of flossing and mouth rinsing regimens on plaque and gingivitis: a randomized clinical trial.

BACKGROUND: To investigate the effects of combinations of mechanical (brushing and flossing) and chemotherapeutic regimens which included essential oils (EO) non-alcohol and alcohol-containing mouthrinses compared to brushing only in the prevention and reduction of plaque, gingivitis, and gingival bleeding. METHODS: This was a randomized, virtually supervised, examiner blind, controlled clinical trial. Following informed consent and screening, subjects (N = 270) with gingivitis were randomly assigned to one of the following regimens: (1) Brush Only (B, n = 54); (2) Brush/Rinse (EO alcohol-containing mouthrinse) (BA, n = 54); (3) Brush/Rinse (EO non-alcohol containing mouthrinse) (BZ, n = 54); (4) Brush/Floss (BF, n = 54); (5) Brush/Floss/Rinse (EO non-alcohol containing mouthrinse) (BFZ, n = 54). Unflavored waxed dental floss (REACH unflavored waxed dental floss), and fluoridated toothpaste (Colgate Cavity Protection) were used. Examinations included oral hard and soft tissue, plaque, gingivitis, gingival bleeding, probing depth and bleeding on probing. RESULTS: After 12 weeks, both BA and BZ and the BFZ group were superior in reducing interproximal plaque (30.8%, 18.2%, 16.0%, respectively), gingivitis (39.0%, 36.9%, 36.1%, respectively), and bleeding (67.8%, 73.6%, 79.8%, respectively) compared to B. The BF group did not provide significant reductions in interproximal plaque but did reduce interproximal gingivitis (5.1%, p = 0.041) at Week 4 and bleeding at Weeks 4 and 12 (34.6%, 31.4%, p < 0.001 respectively) compared to B. The BFZ group did not significantly reduce interproximal plaque, gingivitis or bleeding compared to BZ. CONCLUSIONS: This study demonstrated that the addition of EO non-alcohol containing mouthrinse to the manual toothbrushing and flossing regimen further reduces plaque, gingivitis and bleeding showing that addition of EO mouthrinses (alcohol or non-alcohol containing) to the oral hygiene regimen provides sustained reductions in plaque to help maintain gingival health after a dental prophylaxis. Dental professional recommendation of the addition of an EO non-alcohol containing mouthrinse to daily oral hygiene routines of brushing or brushing and flossing should be considered to aid supragingival plaque control and improve gingivitis prevention. STUDY REGISTRY NUMBER: NCT05600231.

Enhancement plaque control in preschool children by an intelligent brushing guide device.

This study aims to investigate the impact of a tooth-brushing guidance system on the enchancement of the dental plaque removal in preschool children. In this study, we selected a group of 124 healthy children in which their aged were between 3 and 5 years old following by treatment at the Pediatric Dentistry Center at Jinzhou Stomatological Hospital (JinZhou, Liaoning Province, China). We then followed up to check and identify the Turesky modification of the Quigley-Hein plaque index (TMQHPI). Study group was randomly assigned to an experimental group in which they received constantly guidance on intelligent tooth-brushing and a control group which was used by manual brushing techniques. The total numbers in each group were 62 participants that were gone under the clinical investigation for seven days. The plaque index of both groups were assessed by using a plaque display instrument and a periodontal probe for up day 28. It was shown that the experimental group had a lower average TMQHPI value (0.98 ± 0.15) in comparison with control group (1.41 ± 0.17), and this difference was statistically significant (p < 0.05). The experimental group had a significantly lower TMQHPI value (0.89 ± 0.13) on the tongue/palatal side of the anterior teeth area in comparison with control group (1.41 ± 0.17) (p < 0.05). We observed that experimental group showed significantly lower TMQHPI value (1.16 ± 0.12) on the tongue/palatal side of the posterior dental region in comparison with control group (1.70 ± 0.13) (p < 0.05). It was confirmed a significant difference in the average plaque clearance rate between the experimental and control groups (p < 0.05). Our study clearly indicates that a developed method of toothbrush guide effectively improved the removal rate of plaque compared with manual tooth-brush, specifically in hard-to-reach areas like the tongue and palate.

Caries indicators in relation to healthcare access and hygienic-dietary habits in Spanish preschoolers.

INTRODUCTION: Dental caries continues to be a public healthcare problem due to its high prevalence and morbidity. It was proposed to evaluate caries indicators in relation to healthcare access and hygienic-dietary habits in Spanish preschoolers. MATERIALS AND METHODS: A cross-sectional study was carried out on a random sample consisting of 343 patients ranging from 3 to 5 years of age in the primary care setting, the main measurements were: dental care access, hygienic-dietary habits, and caries registration according to WHO criteria. RESULTS: The prevalence of caries was 35.3% and mean ± standard deviation (SD) dft was 1.51 ± 2.93. Preschoolers who had ever visited the dentist had a higher dft occurrence than those who had never attended the dentist. The lower prevalence of caries was significantly associated with the frequency of two daily brushings versus non-daily brushing (p = 0.007; 25.3% vs. 47.1%) and was 10.7% lower in patients who had the habit of night brushing (p = 0.041). The consumption of sugary liquids between meals implied a higher dft index. CONCLUSIONS: The high prevalence of early childhood caries and the dental care access associated with poor oral health suggest the need to implement a multidisciplinary oral healthcare program that involves both healthcare and dental healthcare professionals in Primary Health Care Units without forgetting the participation of the community and local administrations.

Comparison of the effectiveness of two manual toothbrushes: Conventional design versus double-sided toothbrush design. A pilot study.

OBJECTIVES: Dental hygiene is the most effective method in the prevention of oral diseases. However, most patients do not use the recommended teeth brushing techniques and/or time brushing is insufficient. With this objective, modifications in conventional toothbrushes have been developed to deal with these findings. The aim of this study was to compare plaque removal effectiveness of a manual toothbrush with a modified head (MTMH) with a wrap-around design versus a conventional manual toothbrush. METHODS: This pilot prospective clinical study was designed according to STROBE guidelines. The patients suspended oral hygiene habits for 24 h (baseline). Subsequently, the teeth were brushed for 60 s. Both toothbrushes followed the same study procedure, separated by 1 month. Plaque-removing effectiveness was measured before and after tooth brushing using the modified O'Leary Plaque Index (PI). RESULTS: Seven patients were included in this pilot study. The mean age was 37.66 ± 10.68 years. PI mean differences between baseline and after brushing were 51.99% ± 16.43 for MTMH and 27.93 ± 6.85, for conventional toothbrush (p = 0.0013). After brushing, mean PI values were 18.36% ± 6.95%, and 37.61% ± 10.57% respectively (p < 0.001). CONCLUSION: Within the limitations of the present study, it can be concluded that the effectiveness of plaque removal by using MTMH is significantly higher than the conventional manual toothbrush.

Quantitative detection of Epstein-Barr virus DNA methylation in the diagnosis of nasopharyngeal carcinoma by blind brush sampling.

Detecting EBV DNA load in nasopharyngeal (NP) brushing samples for the diagnosis of nasopharyngeal carcinoma (NPC) has attracted widespread attentions. Currently, NP brush sampling mostly relies on endoscopic guidance, and there are few reports on diagnostic markers suitable for nonguided conditions (blind brush sampling), which is of great significance for extending its application. One hundred seventy nasopharyngeal brushing samples were taken from 98 NPC patients and 72 non-NPC controls under the guidance of endoscope, and 305 blind brushing samples were taken without endoscopic guidance from 164 NPC patients and 141 non-NPC controls (divided into discovery and validation sets). Among these, 38 cases of NPC underwent both endoscopy-guided NP brushing and blind brushing. EBV DNA load targeting BamHI-W region and EBV DNA methylation targeting 11029 bp CpG site located at Cp-promoter region were detected by quantitative polymerase chain reaction (q-PCR). EBV DNA load showed good classification accuracy for NPC in endoscopy-guided brushing samples (AUC = 0.984). However, in blind bushing samples, the diagnostic performance was greatly reduced (AUC = 0.865). Unlike EBV DNA load, the accuracy of EBV DNA methylation was less affected by brush sampling methods, whether in endoscopy-guided brushing (AUC = 0.923) or blind brushing (AUC = 0.928 in discovery set and AUC = 0.902 in validation set). Importantly, EBV DNA methylation achieved a better diagnostic accuracy than EBV DNA load in blind brushing samples. Overall, detection of EBV DNA methylation with blind brush sampling shows great potential in the diagnosis of NPC and may facilitate its use in nonclinical screening of NPC.

Mechanical plaque removal in step-1 of care.

Maintaining a regular oral hygiene routine is essential for taking care of our mouths, ensuring healthy teeth, and achieving fresh breath. Patient education on oral hygiene is an important component of their overall treatment. Firstly, patients should be informed about the direct connection between bacteria in dental plaque and oral diseases. It is important for patients to understand that these conditions can be treated, but the success of treatment greatly depends on their level of oral hygiene. This journey begins by selecting the appropriate toothbrush and mastering the correct brushing technique to effectively remove dental plaque while avoiding any potential damage to the gums. In addition to toothbrushes, there are other devices available for comprehensive dental cleaning, such as floss, interdental sticks, interdental brushes, and oral irrigators. These aids are particularly beneficial for eliminating dental plaque from hard-to-reach areas. Moreover, tongue brushing or tongue scraping can effectively reduce breath odor and tongue coating. Currently, self-care recommendations for dental implants are primarily based on existing knowledge regarding natural teeth cleaning. Evidence-based recommendations are derived from comprehensive systematic evaluation of various oral hygiene aids.

A cytodiagnosis of adenoid cystic carcinoma of the tracheobronchial tree through a systematic clinical case comparison and analysis.

BACKGROUND: Primary adenoid cystic carcinoma (AdCC) of the tracheobronchial tree is very rare with a high risk for recurrence and metastasis. The diagnosis of AdCC by histologic and immunohistochemical means has been well studied clinically. However, the identification of AdCC by cytologic features remains elusive due to the atypical features the cancer presents. This study aimed to describe the cytologic features of AdCC by using bronchial brushing, which could aid in distinguishing AdCC from other pulmonary carcinomas. METHODS: The cytopathological features of bronchial brushing smears collected from seven cases were histologically diagnosed as AdCC. The defined cytologic features, which could potentially be diagnostic, were systemically analyzed. RESULTS: Four out of the seven cytologic cases were inconcordance with the histologic diagnosis and cytologically classified as positive for malignant cells, small cell carcinoma, or atypical cells. Three cases showed a characteristic adenoid structure and magenta stroma forming globule, which was distinguished from the four cases. Cytologically, the above mentioned three cases were uniform with relatively small bland nuclei and little cytoplasm. In this study, only one case showed atypical polygonal medium-sized cells with conspicuous nucleoli. CONCLUSIONS: Unlike fine-needle aspiration cytology, magenta stroma globules might offer an alternate clue for cytodiagnosis of AdCC clinically. Bronchial brushings cytology was more present in bland uniform cells with high nuclear to cytoplasmic ratios and background mucoid substance. More cases should be collected and confirmed using histopathology with careful film reading to reduce the rate of misdiagnosis.

Bronchial cytology of pulmonary adenoid cystic carcinoma - A multi-institute series with emphasis on immunocytochemistry.

BACKGROUND: Pulmonary adenoid cystic carcinoma (AdCC) is a central and superficial primary lung neoplasm, well-suited for sampling by bronchial cytology. This study aims to review the cytologic features of pulmonary AdCC on bronchial cytology, and to report an experience of applying immunocytochemistry on this rare entity. METHODS: A multi-institute review of bronchial cytology specimens from histologically proven pulmonary AdCCs was performed. Published cases of bronchial cytology of pulmonary AdCC were reviewed. The cytologic features and immunocytochemical profile for pulmonary AdCC was summarized and compared with pertinent differentials. RESULTS: A total of 16 specimens from eight patients were retrieved. The initial cytologic diagnoses were negative (n = 7), atypia (n = 6), suspicious (n = 2) and AdCC (n = 1). Retrospective review showed eight bronchial cytology specimens (including five cases of atypia) with tumor cells present. The tumor cells displayed small basaloid nuclei with occasional small nucleoli, mild nuclear atypia, and scanty cytoplasm. Architectural patterns observed included clusters, tubules, solid sheets, three-dimensional balls, papillary-like fronds, and complex cribriform structures. Basement-membrane-like material, free or associated with tumor cells, were seen in all cases. Immunocytochemistry was performed in one specimen. MYB was positive. TTF-1, synaptophysin and chromogranin were negative. Epithelial and basal markers demonstrated a dual cell population. Literature review yielded 28 cases. Cytologic features described were similar except for cytoplasmic vacuolation in one case. CONCLUSION: Basement membrane-like material is specific for AdCC. MYB positivity, TTF-1 and neuroendocrine marker negativity, support a diagnosis of AdCC. Other immunocytochemistry and cytologic features overlap significantly with adenocarcinoma and small cell carcinoma of lung.

Toothbrushing practices as risk factors for dental fluorosis in an area with varying fluoride levels in drinking water.

BACKGROUND: Despite contributing to a reduction in dental caries, improper use of fluoridated toothpaste could add to the burden of dental fluorosis in children. AIM: To assess the association between tooth-brushing practices such as the type and amount of toothpaste used, frequency of tooth brushing, parental assistance in tooth brushing, timing of tooth brushing and dental fluorosis in school children in Kurunegala district, an endemic area for dental fluorosis in Sri Lanka. METHODS: For this case-control study, a sex-matched sample of 15-year-old school children attending government schools in Kurunegala district and who were lifetime residents of the district was selected. Dental fluorosis was measured using the Thylstrup and Ferjeskov (TF) Index. Those children with a TF⟩1 were considered as cases and those with a TF score of 0 or 1 served as controls. An interview of parents/caregivers of the participants was used to assess risk factors for dental fluorosis. The fluoride concentration in drinking water was measured using spectrophotometry. Data analysis used chi-square tests and conditional logistic regression. RESULTS: Tooth brushing ≥ twice/day, brushing after breakfast and parent/care giver brushing the child's teeth reduced the likelihood of developing fluorosis. CONCLUSION: Use of fluoridated toothpaste adhering to the recommended guidelines could prevent dental fluorosis in children in this endemic area.

The effect of phytosphingosine associated with tooth brushing on color change, surface roughness, and microhardness of dental enamel - an in vitro and in situ study.

OBJECTIVE: This study evaluated the in vitro and in situ effects of phytosphingosine (PHS) associated with tooth brushing on color stability, surface roughness, and microhardness of dental enamel. METHODS: Sixty-four specimens of bovine teeth (6 × 6 × 2 mm) were separated into 8 groups (n = 8): S + TB: PHS (spray) + tooth brushing; TB + S: tooth brushing + PHS (spray); I + TB: PHS (immersion) + tooth brushing; TB + I: tooth brushing + PHS (immersion); TB: tooth brushing; S: PHS spray; I: immersion in PHS solution, and Saliva: immersion in saliva. Tooth brushing simulation (Mavtec, Brazil) was performed (356 rpm on 3.8 cm area by the toothbrush - Soft Tek) for 1, 7, 15, and 30 days. PHS remained in contact with specimens for 15 min. The specimens were evaluated before and after tooth brushing for color alteration (Easy Shade, VITA), and surface roughness (Model SJ-201P Mitutoyo), and Knoop microhardness (HMV-2, Shimadzu Corporation). For the in situ analyses, 8 participants were recruited and received an intraoral device with 6 fragments of bovine enamel (6 × 6 × 2 mm). The properties evaluated were the same as those of the in vitro study. Participants were randomized following best results of in vitro tested protocols, for 15 days: TB, TB + S, I + TB. Data obtained by in vitro (two-way ANOVA, Tukey, p < .05) and in situ (one-way ANOVA, Tukey, p < .05) studies were analyzed. RESULTS: The in vitro study showed that greater color change was found after 30 days. The greatest differences in surface roughness occurred between the initial value and after 1 day. Regarding microhardness, the highest values occurred after 15 and 30 days, which showed similar results. The in situ study showed greater color changes for the TB and I + TB, and greater surface roughness changes for TB as well as a similar increase in microhardness for the PHS protocols, which were higher than TB. CONCLUSIONS: Phytosphingosine leads to an increase in performance regarding color stability, surface roughness, and microhardness when applied. In general, the application of PHS after brushing showed a positive impact on its performance. CLINICAL RELEVANCE: Phytosphingosine proved to be interesting for compound prevention formulations in the dentistry field.

Influence of brushing motions on the shaping of oval canals by rotary and reciprocating instruments.

OBJECTIVE: The effects of brushing on shaping with three different instruments were assessed in oval canals. DESIGN: Mandibular incisors were assigned to 6 groups (n = 12/group) according to the system, each one with or without brushing: Reciproc Blue, VDW.Rotate, and Race EVO. Micro-computed tomography was performed before and after preparation. RESULTS: Brushing strokes caused no increase in canal volume, surface area, and structure model index independently of the system (p > 0.05), except for RaCe EVO in the full canal surface area (p < 0.05). Brushing did not increase the prepared areas (p > 0.05), except for Reciproc in the apical canal (p < 0.05). Reciproc with no brushing exhibited less pericervical dentin than with brushing (p < 0.05), while RaCe EVO with brushing resulted in less remaining dentin (p < 0.05). CONCLUSIONS: The brushing motion had no effects on the overall shaping performance of the 3 instruments tested. An exception was the increase in prepared surface area in the apical canal segment when the Reciproc instrument was used with brushing strokes.

Prolonged breastfeeding and dental caries in preschool children.

PURPOSE: To explore breastfeeding from 6 to 18 months of age and to study the association between breastfeeding and caries prevalence at 5 years of age. METHODS: The study included 1088 children from one Norwegian county and was based on the Norwegian Mother, Father and Child Cohort Study (MoBa). The children had clinical dental examination at 5 years of age, and parents answered a questionnaire, which included information on breastfeeding, oral health behaviour and child characteristic. Multivariate logistic regressions were performed. The study was ethically approved. RESULTS: Of the studied children, 77% were breastfed at 6 months of age and 16% were still breastfed at 18 months of age. Few children (6%) were breastfed during night at 18 months of age, while 11% received sugary drink during night. No association was found between breastfeeding up to 18 months of age and caries prevalence at 5 years of age (p > .05). Children who at 18 months of age had their teeth brushed less than twice daily (OR 2.4, CI 1.5-3.9), consumed sugary drink once a week or more often (OR 1.7, CI 1.1-2.7) and had non-Western parents (OR 3.4, CI 1.5-8.1) were more likely to have caries experience at 5 years of age than other children. CONCLUSION: Breastfeeding up to 18 months of age was not associated with caries development during preschool age.

Effect of tooth brushing simulation on the surface properties of various resin-matrix computer-aided design/computer-aided manufacturing ceramics.

PURPOSE: The purpose was to investigate the alterations in surface properties of different resin-matrix CAD/CAM ceramics following tooth brushing simulation (TBS) and compare them with a direct resin composite and a glass ceramic CAD/CAM material. MATERIALS AND METHODS: Four resin-based CAD/CAM restoratives (Brilliant Crios-BR, Lava™ Ultimate-LV, Grandio Blocs-GR and Shofu Block HC-SH), a leucite-reinforced glass ceramic (IPS Empress® CAD-EC) and a resin composite (Filtek™ Z250-FZ) for direct restorations were tested. In particular, surface loss, hardness, roughness and morphology were investigated utilizing confocal microscopy, scanning electron microscopy and nanoindentation tester. TBS was conducted for 4 × 15 min on the surface of the samples and then the changes in their surface properties were evaluated. RESULTS: After TBS, all the experimental groups exhibited surface loss to different extent. FZ and BR presented the highest surface loss, while EC and GR the lowest (p < 0.05). Regarding surface roughness, all the tested materials exhibited increase after TBS (p < 0.05), except LV (p = 0.099). EC presented the lowest Sa values, while FZ and BR the highest (p < 0.05). Changes in surface morphology were in compliance with the results of surface roughness and also surface hardness was correlated with surface loss. CONCLUSIONS: The tested resin-matrix CAD/CAM ceramic restorative materials showed a competent behavior against abrasive forces applied during TBS. Surface loss and roughness changes were material dependent and superior compared to a resin composite for direct restorations, while in comparison with a leucite-reinforced glass ceramic exhibited inferior properties. CLINICAL SIGNIFICANCE: Tooth brushing affected differently the surface of the tested restorative materials. However, the abrasive wear that was induced was negligible. Clinical studies are necessary to ascertain if there is clinical significance of these surface alterations that may demand repair of such restorations.