Plasma Cell Gingivitis: An Occasional Case Report.

Plasma cell gingivitis, an infrequently observed oral condition, has been clinically characterized by diffuse gingival enlargement, erythema and sometimes desquamation. These lesions are usually asymptomatic, but invariably the patient will complain of a burning sensation in the gingiva and bleeding from the mouth. The diagnosis requires hematological screening in addition to clinical and histopathological examinations. This case report outlines one such case of plasma cell gingivitis in a 15-year-old female caused by use of an herbal, homemade toothpowder. The case presented here highlights the adverse effects and irrational use of herbal agents in dentifrices. At the same time, it emphasizes the need for comprehensive history taking, careful clinical examination and appropriate diagnostic tests in order to arrive at a definitive diagnosis and treatment plan for gingival conditions that are refractory to conventional therapy and to exclude certain malignancies and oral manifestations of systemic diseases.

Granulomatous Rosacea and Periorificial Dermatitis: Controversies and Review of Management and Treatment.

Granulomatous rosacea and periorificial dermatitis are common skin conditions affecting the face. This article examines the historical origin, causes, clinical presentation, and management strategies for these entities.

The role of toothpaste in the aetiology and treatment of dentine hypersensitivity.

Dentine hypersensitivity (DH) is a common, painful dental condition with a multi-factorial aetiology. The hydrodynamic mechanism theory to explain dentine sensitivity also appears to fit DH: lesions exhibiting large numbers of open dentinal tubules at the surface and patent to the pulp. By definition, DH can only occur when dentine becomes exposed (lesion localisation) and tubules opened (lesion initiation), thus permitting increased fluid flow in tubules on stimulation. Erosion, particularly from dietary acids appears to play a dominant role in both processes. Toothbrushing with most toothpaste products alone cause clinically insignificant wear of enamel but are additive, even synergistic, to erosive enamel loss. Additionally, toothbrushing with toothpaste is implicated in 'healthy' gingival recession. Toothbrushing with most toothpastes removes the smear layer to expose tubules and again can exacerbate erosive loss of dentine. These findings thereby implicate toothbrushing with toothpaste in the aetiology of DH. Management of the condition should have secondary prevention at the core of treatment and therefore, must consider first and foremost the aetiology. Fluoride toothpaste at present appears to provide little primary or secondary preventive benefits to DH; additional ingredients can provide therapeutic benefits. Potassium-based products to block pulpal nerve response have caused much debate and are considered by many as unproven, which should not translate to ineffective. Several toothpaste technologies formulated to block tubules are from studies in vitro, in situ and controlled clinical trials considered proven for the treatment of DH.

In vitro reproduction of incisal/occlusal cupping/cratering.

STATEMENT OF PROBLEM: Occlusal cupping/cratering (depressed dentin surrounded by elevated rims of enamel) has been postulated to be the result of abrasion, bruxism, attrition, acid erosion, stress corrosion, or a combination of these. The primary etiology or the multifactorial sequence of occlusal cupping/cratering remains scientifically unsubstantiated. PURPOSE: The purpose of this study was to reproduce occlusal/incisal cupping/cratering in vitro. This study was designed to create cupping/cratering on the occlusal surfaces of extracted human teeth rather than to quantify the amount of lost tooth structure caused by abrasion. MATERIAL AND METHODS: One name-brand toothbrush was tested with 2 different dentifrices (of different abrasive potentials [low and high]) and water only (nonabrasive) on extracted human teeth. Six specimens of 4 teeth each (24 teeth) were subjected to horizontal brushing in a 1:1 toothpaste/water slurry and water only. RESULTS: The control group, brushed with water only, demonstrated no visible loss of tooth structure. Each of the specimens brushed with toothpaste, regardless of the degree of abrasivity, demonstrated visible wear of the dentin, resulting in occlusal/incisal cupping/cratering. CONCLUSIONS: Pronounced cupping/cratering was caused by horizontal brushing with commercial toothpastes. Brushing in water demonstrated no visual loss of occlusal tooth structure. (J Prosthet Dent 2013;109:384-391).

Rise and fall of oral health products with Canadian bloodroot extract.

The rhizome of Sanguinaria canadensis (SC, bloodroot) contains an active principle with antimicrobial, antiinflammatory, antioxidative and immunomodulatory effects. For this reason SC extract has been added to toothpastes and mouthwashes in various concentrations. When tested separately, neither the toothpastes nor the mouthwashes with SC extract had any demonstrable clinical effectiveness against dental plaque and gingivitis. Although using them together twice a day seemed more effective than using placebo, more recent studies have shown conflicting results. Preclinical safety studies up to 2000, which did not include studies longer than 6 months, were thought not to indicate any appreciable potential for harm - to the oral mucosa in particular. In 2003, the FDA Subcommittee on Oral Health Care Drug Products for Over-the-Counter Human Use concluded from a review that using SC-containing products is safe. However, for reasons unknown, the review failed to consider publications between 1999 and 2001 that suggested a possible link between the use of SC-containing products and the pre-neoplastic lesion, leukoplakia. As it happened, bloodroot had already been removed (in 2001) from the formula of one of the most widely used products in question and the brand has since then disappeared altogether from the worldwide market.

A randomised double-blind placebo-controlled study on the effects of a herbal toothpaste on gingival bleeding, oral hygiene and microbial variables.

INTRODUCTION: Different systems of traditional medicine of the Indian subcontinent, have used Acacia chundra Willd, Adhatoda vasica Nees., Mimusops elengi L., Piper nigrum L., Pongamia pinnata L. Pirerre, Quercus infectoria Olivier., Syzygium aromaticum L., Terminalia chebula Retz., Zingiber officinale Roscoe., individually or in combinations, to cure oral diseases. OBJECTIVE: To investigate the oral hygiene and gingival health benefits of toothpaste formulated with a mixture of the above herbs (15% w/w). METHODS: Sixty participants (test n = 30, control n = 30, mean age 23.6 +/- 2.25 vs 23.9 +/- 3.2 years) who fulfilled the selection criteria and had similar plaque (1.734 +/- 0.29 vs 1.771 +/- 0.33) and percentage of sites with gingival bleeding (19.6 +/- 7 vs 20.7 +/- 8) were studied in a double blind randomised clinical trial. Brushing instructions to all and a scaling for those with calculus were provided two weeks before baseline examination. One ml of resting saliva was collected to ascertain anaerobic (SAnB) and aerobic (SAB) bacterial counts, plaque index (PI), percentage sites with bleeding on probing (BOP) and pocket depth (PD) (at 6 sites/tooth) were recorded at baseline, followed by home use of the allocated toothpaste (test or placebo) twice a day for 12 weeks. Measurements were repeated at 4, 8, and 12 weeks. RESULTS: PI, BOP and SAnB decreased significantly in the test group at 4, 8, and 12 weeks compared to baseline measurements (Wilcoxon-Signed Rank Test, p < 0.01). There was no statistically significant improvement in PI, BOP, and SAnB in the placebo group. CONCLUSIONS: Our study indicates the beneficial effects of this herbal toothpaste (Sudantha) on oral hygiene and gingival health variables when compared with the placebo. Further clinical trials using patients with gingivitis are necessary to confirm the therapeutic benefits of this herbal toothpaste.

Análise dos fatores de risco ou de proteção para fluorose dentária em crianças de 6 a 8 anos em Fortaleza, Brasil / Analysis of protection or risk factors for dental fluorosis in 6 to 8 year-old children in Fortaleza, Brazil

OBJETIVO: Investigar os fatores de risco ou de proteção para a fluorose dentária na dentição permanente de crianças de 6 a 8 anos em um bairro no Município de Fortaleza, Brasil. MÉTODOS: Este estudo de caso-controle incluiu 67 crianças com fluorose nos incisivos superiores e inferiores permanentes erupcionados, conforme o índice de Dean, e 57 controles. A presença de fluorose foi determinada como variável dependente. Os dados acerca das variáveis independentes foram obtidos através de entrevistas com os pais das crianças. O teste exato de Fisher foi utilizado para verificar a existência de associação entre fluorose e as variáveis independentes. Foi calculada a razão de chances (odds ratio, OR) para verificar a associação e a probabilidade de fluorose no grupo-caso, ambos com significância de 95 por cento. RESULTADOS: Houve associação significativa da fluorose com tipo de moradia (própria, alugada ou ocupada), mas não com fonte de água para consumo ou uso de dentifrícios fluoretados e suplementos de flúor. Na análise univariada, o risco de fluorose foi maior em crianças que iniciaram o consumo de leite em pó reconstituído com água antes dos 2 anos de idade (OR = 4,53; IC95 por cento: 1,07 a 26,74) e nas que não mamaram (OR = 6,66; IC95 por cento: 1,61 a 38,62). Na análise multivariada, somente a amamentação apresentou associação com a fluorose (4,54; IC95 por cento: 1,21 a 16,66). CONCLUSÕES: A amamentação se configurou como fator de proteção contra a fluorose. É preciso estabelecer critérios de classificação mais específicos para permitir a investigação de relações entre fluorose e classe socioeconômica.

OBJECTIVE: To investigate protection or risk factors for dental fluorosis in permanent teeth of 6 to 8 year-old children in a neighborhood of Fortaleza, Brazil. METHODS: This case-control study included 57 controls and 67 children with fluorosis affecting superior and inferior incisors teeth as determined by the Dean classification criteria. Presence of fluorosis was considered as the dependent variable. Data concerning independent variables were obtained through interviews with the parents. Fisher's exact test was used to determine associations between fluorosis and the independent variables. Odds ratios (OR) were calculated to investigate associations and likelihood of fluorosis in the case group, with 95 percent significance level. RESULTS: Fluorosis was significantly associated with type of housing (owned, rented or squatted), but not with the source of drinking water or use of fluoridated toothpaste and fluoride supplements. Univariate analysis showed that the risk of fluorosis was higher in children who began drinking powdered milk mixed with water before 2 years of age (OR = 4.53; IC95 percent: 1.07-26.74) and in those who did not breastfeed (OR = 6.66; IC95 percent: 1.61-38.62). In the multivariate analysis, only breastfeeding was associated with fluorosis (4.54; IC95 percent: 1.21-16.66). CONCLUSIONS: Breastfeeding was a protection factor against fluorosis. More specific categorization criteria must be established to investigate relationships between fluorosis and socioeconomic class.

[Analysis of protection or risk factors for dental fluorosis in 6 to 8 year-old children in Fortaleza, Brazil]. / Análise dos fatores de risco ou de proteção para fluorose dentária em crianças de 6 a 8 anos em Fortaleza, Brasil.

OBJECTIVE: To investigate protection or risk factors for dental fluorosis in permanent teeth of 6 to 8 year-old children in a neighborhood of Fortaleza, Brazil. METHODS: This case-control study included 57 controls and 67 children with fluorosis affecting superior and inferior incisors teeth as determined by the Dean classification criteria. Presence of fluorosis was considered as the dependent variable. Data concerning independent variables were obtained through interviews with the parents. Fisher's exact test was used to determine associations between fluorosis and the independent variables. Odds ratios (OR) were calculated to investigate associations and likelihood of fluorosis in the case group, with 95% significance level. RESULTS: Fluorosis was significantly associated with type of housing (owned, rented or squatted), but not with the source of drinking water or use of fluoridated toothpaste and fluoride supplements. Univariate analysis showed that the risk of fluorosis was higher in children who began drinking powdered milk mixed with water before 2 years of age (OR = 4.53; IC95%: 1.07-26.74) and in those who did not breastfeed (OR = 6.66; IC95%: 1.61-38.62). In the multivariate analysis, only breastfeeding was associated with fluorosis (4.54; IC95%: 1.21-16.66). CONCLUSIONS: Breastfeeding was a protection factor against fluorosis. More specific categorization criteria must be established to investigate relationships between fluorosis and socioeconomic class.

The measurement of enamel wear by four toothpastes.

OBJECTIVES: To determine the enamel abrasivity of three whitening toothpastes and a silica toothpaste and to measure the brushing forces used. METHODS: Polished human enamel blocks were indented with a Knoop diamond and attached to dentures of adult volunteers. The blocks were brushed ex vivo, twice per day with either a whitening toothpaste containing Perlite (White System), a commercial whitening toothpaste (A and B) or a silica toothpaste. After four and twelve-weeks, one block per subject was removed and the Knoop indent remeasured. From the changes in the indent length, the amount of enamel wear was calculated. RESULTS: The mean enamel wear (sd) for White System, silica toothpaste, whitening toothpaste A and B after four-weeks was 0.14 (0.15), 0.09 (0.16), 0.14 (0.12) and 0.89 (0.93) and after twelve-weeks was 0.24 (0.21), 0.37 (0.73), 0.36 (0.52) and 1.04 (0.98) microm respectively. After four-weeks, the differences in enamel wear between whitening toothpaste B and all other toothpastes were of statistical significance (p < 0.003), but not after twelve-weeks. The mean ex vivo normal brushing force (sd) was 2.67 (1.33) N. CONCLUSIONS: All three whitening toothpastes did not give significantly more enamel wear than a silica toothpaste after twelve-weeks in situ with ex vivo brushing.

In vitro evaluation of the abrasiveness of a commercial low-abrasive dentifrice and an experimental dentifrice containing vegetable oil

Toothpastes usually contain detergents, humectants, water, colorant, fluoride and thickeners (e.g.: silica). Tooth wear has a multi-factorial etiology and the use of abrasive dentifrices is related to abrasion of dental tissues during toothbrushing. This study evaluated in vitro the abrasiveness of a commercial silica gel low-abrasive dentifrice compared to an experimental dentifrice containing vegetable (almond) oil. Distilled water served as a control group. Acrylic specimens (8 per group) were submitted to simulated toothbrushing with slurries of the commercial dentifrice, experimental dentifrice, almond oil and water in an automatic brushing machine programmed to 30,000 brush strokes for each specimen, which is equivalent to 2 years of manual toothbrushing. Thereafter, surface roughness (Ra) of the specimens was analyzed with a Surfcorder SE 1700 profilometer. Data were analyzed statistically by ANOVA and Tukey’s test at 5% significance level. There was no statistically significant difference (p>0.05) in the surface roughness after brushing with water, almond oil or experimental dentifrice. The commercial dentifrice produced rougher surfaces compared to the control and abrasive-free products (p<0.05). Further studies are necessary to confirm the potential benefits of using vegetable oil in toothpastes as an alternative to abrasives in an attempt to minimize the tooth wear caused by toothbrushing.

Plasma cell gingivitis among herbal toothpaste users: a report of three cases.

AIM: The aim of this article is to present a brief review of plasma cell gingivitis (PCG) along with reports of three cases with varying clinical presentations of the condition associated with the use of herbal toothpaste. BACKGROUND: PCG is a rare benign condition of the gingiva characterized by sharply demarcated erythematous and edematous gingivitis often extending to the mucogingival junction. This is considered a hypersensitive reaction. The histological appearance consists of a dense infiltration of normal plasma cells separated by collagenous stroma, usually confined to the free and attached gingiva. The lesion can be eliminated by identifying and avoiding the source of the allergen. REPORT: Three patients ages 26, 27, and 36, respectively, presented with acutely inflamed gingival and a history of recently switching to herbal toothpaste. The gingiva bled readily on probing. Blood tests and gingival biopsy were not contributory. Patients were advised to refrain from the use of herbal toothpaste, and, along with periodontal treatment, the condition underwent remission within a week to two weeks in all three cases. SUMMARY: As more and more herbal products are gaining popularity, clinicians should be aware of some of the untoward effects of these products. Since PCG mimics lesions associated with leukemia and myeloma an early diagnosis of the condition is vital.

Acción antimicrobiana in vitro de dentífricos conteniendo fitoterápicos / Antimicrobial action in vitro of dentifricies with phytoterapeutics agents

Éste estudio analizó el potencial antimicrobiano in vitro de 7 dentífricos conteniendo sicoterápicos sobre bacterias orales recuperadas de la saliva y cepas patrón de S. mutans ATCC25175, S. sanguis ATCC 10556 y L. casei ATCC4646. Fueron obtenidas soluciones concentradas de los dentífricos evaluados y de controles mezclándose 3 gramos de cada uno con 10 mL de agua deionozada estéril, seguido de centrifugación; los sobrenadantes resultantes fueron diluidos en proporciones de 1:2 hasta 1:32. Fue realizado un test de difusión en ágar, colocando cepas patrón y la saliva total estimulada de 10 pacientes saludables. Discos empapados con las suspensiones de los dentífricos fueron dispuestos en las placas, las cuales fueron incubadas en anaerobiosis por 48 horas, siendo losaros de inhibición medidos en milímetros. Los resultados obtenidos fueron analizados mediante ANOVA y llevando en consideración el control positivo se constató que, solamente las soluciones puras de los dentífricos presentaron capacidad antimicrobiana contra cepas patrón, equivalente a la del dentífrico con triclosan, excepto el Gessy Cristal®. Además, los dentífricos diluidos a 1:2 presentaron acción antimicrobiana contra las bacterias orales recuperadas de la saliva, excepto el Parodontax® (AU)

The aim of this study was to evaluate and compare in vitro antimicrobial potential of 7 dentifrices containing phytotherapics agents oral bacteria obtained from saliva and standard strains of S. mutans ATCC 25175, S. sanguis ATCC 10556, and L. casei ATCC 4646. For this purpose, concentrated test and control solutions were obtained by mixing 3 grams of each in 10 ml of sterile deionized water which was submitted to centrifugation, the sublimate obtained was further dissolved in a ratio of 1:2 to 1:32. A diffusion test in agar was carried out by sowing the standard strain and stimulated total saliva. Disks soaked in a dentifrices solution and then placed on culture disks were then incubated in anarobiosis for 48 hours. Inhibition halos were then measured. Results obtained from ANOVA statistical analysis. However, comparison in the presence of a positive control, revealed that against standard strains, the pure solution of the dentifrices had antimicrobial activity, with the exception of Gessy Cristal®. Against oral bacteria recovered from saliva, diluted dentifrices to 1:2 showed the same activity, excepting Parodontax® (AU)

The measurement of enamel and dentine abrasion by tooth whitening products using an in situ model.

OBJECTIVES: To determine the enamel and dentine wear of two whitening toothpastes using an in situ model with ex vivo brushing. METHODS: Human enamel/dentine (approximately 50:50) blocks (approximately 4 x 4mm) were placed in the upper buccal aspects of full or partial dentures of a group of 25 subjects. Subjects brushed the specimens ex vivo with either a calcium carbonate/perlite or silica containing whitening toothpaste under exaggerated conditions as compared to normal for 30 s, twice per day. Specimens were removed after 4, 8 and 12 weeks and the wear to the enamel and dentine was determined. Enamel wear was determined by change in Knoop indent length and dentine wear was determined from the enamel-dentine step height, measured using optical profilometry. RESULTS: The mean wear after 12 weeks was for enamel 0.27 and 0.19 microns, and for dentine 34.3 and 61.1 microns, for the calcium carbonate/perlite and silica toothpastes respectively. There were no significant differences between products after 12 weeks. The rate of wear was found to decrease throughout the duration of the study. CONCLUSION: There were no significant differences between the two whitening toothpastes in terms of enamel and dentine wear after 12 weeks brushing.

Fluoride metabolism and fluorosis.

OBJECTIVES: This paper is primarily concerned with the only proven risk associated with water fluoridation: enamel fluorosis. Its purpose is to review current methods of measuring enamel fluorosis, its aetiology and metabolism. A further objective is to identify risk factors to reduce the prevalence of enamel fluorosis and employ methods to manage such risk factors. DATA: The prevalence of enamel fluorosis is increasing in Ireland and internationally. A critical period has been identified at which teeth are most at risk of developing enamel fluorosis: 15-24 months of age for males and 21-30 months of age for females. The data included took these two factors into account. SOURCE: A thorough narrative review of published literature was conducted to identify studies concerning the aetiology and metabolism of enamel fluorosis. Risk factors for fluorosis were identified from these studies. STUDY SELECTION: As it is the pre-eruptive phase of enamel development which represents the greatest risk to developing enamel fluorosis, studies examining sources of fluoride ingestion for young children were selected. These included studies on ingestion of fluoride toothpaste by young children, fluoride supplementation and infant formula reconstituted with fluoridated water. CONCLUSIONS: There is evidence that the age at which tooth brushing with fluoride toothpastes is commenced and the amount of fluoride placed on the brush are important risk factors in the incidence of dental fluorosis. It is recommended that brushing should not commence until the age of 2 and that a pea-sized amount (0.25 g) of toothpaste should be placed on the brush.

The measurement of enamel wear of two toothpastes.

PURPOSE: The aim of this study was to compare the enamel abrasivity of a whitening toothpaste with a standard silica toothpaste. MATERIALS AND METHODS: Polished human enamel blocks (4 x 4 mm) were indented with a Knoop diamond. The enamel blocks were attached to the posterior buccal surfaces of full dentures and worn by adult volunteers for 24 hours per day. The blocks were brushed ex vivo for 30 seconds, twice per day with the randomly assigned toothpaste (n = 10 per treatment). The products used were either a whitening toothpaste containing Perlite or a standard silica toothpaste. After four, eight and twelve weeks, one block per subject was removed and the geometry of each Knoop indent was re-measured. From the baseline and post-treatment values of indent length, the amount of enamel wear was calculated from the change in the indent depth. RESULTS: The mean enamel wear (sd) for the whitening toothpaste and the standard silica toothpaste after four weeks was 0.20 (0.11) and 0.14 (0.10); after 8 weeks was 0.44 (0.33) and 0.18 (0.17), and after 12 weeks was 0.60 (0.72) and 0.67 (0.77) microns respectively. After four, eight and twelve weeks, the difference in enamel wear between the two toothpastes was not of statistical significance (p > 0.05, 2 sample t-test) at any time point. CONCLUSIONS: The whitening toothpaste did not give a statistically significantly greater level of enamel wear as compared to a standard silica toothpaste over a 4-, 8- and 12-weeks period.

The association between Viadent use and oral leukoplakia--results of a matched case-control study.

OBJECTIVES: Several oral pathologists have described oral leukoplakia of the maxillary vestibule in patients with no traditional risk factors for the condition. On questioning these patients, it was determined that Viadent mouthrinse or Viadent toothpaste was commonly used by them. A hypothesis was developed that Viadent or a component of Viadent caused the lesions. This paper evaluates the association between oral leukoplakia and use of Viadent products. METHODS: A matched case-control study was designed to test the hypothesis that use of Viadent products increases an individual's risk of oral leukoplakia. Cases included 58 patients diagnosed with oral leukoplakia identified through the biopsy service at the Ohio State University, College of Dentistry, Oral Pathology Section. The matched control was a friend or relative of the patient. Cases and controls were administered a questionnaire about their use of Viadent, and other known risk factors for leukoplakia such as tobacco and excessive alcohol use. RESULTS: An age difference was seen between cases and controls, the cases being older (P < .001). After controlling for confounding factors, results of exact conditional logistic regression analyses showed that use of Viadent products was a risk indicator for oral leukoplakia (odds ratio = 10.0; 95% confidence interval = 2.0, 89.2). CONCLUSIONS: Viadent use is a risk indicator for oral leukoplakia, confirming our previous findings.