Composites made of flame-sprayed bioactive glass 45S5 and polymers: bioactivity and immediate sealing properties.

AIM: To engineer systems using polyisoprene (PI) or polycaprolactone (PCL) and nanometric bioactive glass 45S5 (BG) that could create a hydroxyapatite interface and thus ultimately make the use of an endodontic sealer unnecessary. METHODOLOGY: Different composites using PI or PCL as matrix material were prepared with BG contents of up to 30 wt%. Unfilled PI and PCL, commercially available filled PI (Obtura gutta-percha) and PCL pellets (Resilon) served as control materials. Bioactivity (in vitro precipitate formation in simulated body fluid) was investigated using scanning electron microscopy and X-ray diffraction analysis. To test immediate sealing ability, simulated root canals were filled with heated materials, and dye leakage was assessed. Leakage was statistically compared between groups using Kruskal-Wallis analysis of variance followed by Mann-Whitney U tests and Bonferroni correction. The alpha-type error was set at 0.05. RESULTS: Both composite systems revealed hydroxyapatite formation on their surface. This was not observed on control materials. Incorporating 30 wt% BG into PI and PCL significantly (P < 0.05) improved their immediate sealing ability compared to that of unfilled polymers, so that dye leakage in simulated root canals was prevented completely. CONCLUSION: Polyisoprene and PCL composites with BG showed promising results as single root canal filling materials. Incorporation of BG fillers into the polymers under investigation made the resulting composite materials bioactive and improved their immediate sealing ability.

Radio-opaque nanosized bioactive glass for potential root canal application: evaluation of radiopacity, bioactivity and alkaline capacity.

AIM: To produce novel nanosized bioactive glass particles with radio-opaque properties and high alkaline capacity and to evaluate their performance as a potential bioactive root canal dressing or filling material. METHODOLOGY: Flame spray-derived bioactive glass particles in the nanometre range were produced including bismuth oxide as a radiopacifier. Calcium hydroxide, barium sulphate and bismuth oxide served as controls. Corresponding materials were compressed to obtain dense specimens with increased alkaline capacity. Radiopacity was evaluated, and in vitro bioactivity was monitored using Raman spectroscopy and scanning electron microscopy. Leaching of bismuth was controlled using atomic absorption spectroscopy. RESULTS: Bioactive glass particles with up to 50 wt% bismuth oxide revealed radiopacity with an equivalent of 4.94-mm aluminium. The introduction of bismuth into the bioactive glass altered the alkaline capacity and the in vitro bioactivity only for high bismuth oxide quantities. Bismuth oxide leaching out of the glass matrix was hardly detectable. CONCLUSION: Bioactive glass can be modified with bismuth oxide to become radio-opaque.

Effect of short-time povidone-iodine application on osteoblast proliferation and differentiation.

BACKGROUND AND OBJECTIVE: Povidone-iodine [polyvinylpyrrolidone-iodine complex (PVP-I)] is a broad-spectrum antimicrobial agent, frequently used in dentistry. In this study we investigated the short- and longterm effects on osteoblast number, viability, and function after short exposure to PVP-I with and without additional bone-morphogenetic protein-2 (BMP-2). MATERIAL AND METHODS: Confluent osteoblast-like cell line (MC3T3-E1, subclone 24) cultures were exposed to pure PVP-I solution (7.7 mg/ml) and dilutions of 1:10, 1:100 and 1:1000 for 10 seconds and washed with phosphate buffer solution. Cell proliferation and viability was determined by MTT and differentiation status by alkaline phosphatase (ALP) activity 6 days after initial plating. In a separate experiment, long-term cell proliferation, viability and function were assessed 4 weeks after PVP-I treatment by MTT and deposited calcium using an Alizarin-red staining test. RESULTS: PVP-I decreased ALP activity substantially. Stimulation by BMP-2 recovered ALP activity to near control levels at 1:100 and 1:1000 dilutions of PVP-I. The MTT assay showed reduced proliferation of the preosteoblastic cells for all treatments, irrespective whether BMP-2 was used or not. Only at PVP-I dilutions of 1:1000 proliferation rate was back to normal levels (95.6±2.4 %). No adverse long-term effect of PVP-I on mineralization of the extracellular matrix (Alizarinred) for dilutions higher than 1:100 was observed. Interestingly, undiluted and 1:10 diluted PVP-I even showed a significant increase in mineral deposition, especially in the presence of BMP-2. CONCLUSION: Short-time application of PVP-I in concentrations of 1:10 and higher lead to decreased viability and impaired differentiation. However, surviving cells showed good recovery and mineralization potential.

Fine-tuning of bioactive glass for root canal disinfection.

An ideal preparation of 45S5 bioactive glass suspensions/slurries for root canal disinfection should combine high pH induction with capacity for continuing release of alkaline species. The hypothesis of this study was that more material per volume of bioactive glass slurry is obtained with a micrometric material (< 5 microm particle size) or a micrometric/ nanometric hybrid, rather than a solely nanometric counterpart. This should correlate with alkaline capacity and antimicrobial effectiveness. Slurries at the plastic limit were prepared with test and reference materials in physiological saline. Total mass and specific surface area of glass material per volume were determined. Continuous titration with hydrochloric acid was performed, and antimicrobial effectiveness was tested in extracted human premolars mono-infected with E. faecalis ATTC 29212 (N = 12 per material). While the nanometric slurry had a 12-fold higher specific surface area than the micrometric counterpart, the latter had a considerably higher alkaline capacity and disinfected significantly better (Fisher's exact test, P < 0.05). The hybrid slurry behaved similarly to the micrometric preparation.

Caries prevalence in 2-year-old children in the city of Zurich.

OBJECTIVES: To establish caries prevalence in 2-year-olds in the city of Zurich; and to investigate the relationship between caries prevalence and dietary habits, and oral hygiene practices in native children and children with immigrant background. METHOD: 1,000 randomly selected 2-year-olds were invited to participate in a clinical examination, at which parents were interviewed about the child's oral hygiene and dietary habits. Caries diagnosis was based on visual inspection of all tooth surfaces and included both initial (d1) and cavitated (d2) lesions. Univariate and multivariate logistic regressions for two subgroups of children (children of Swiss and foreign-born mothers) were performed in order to assess the association between predictor variables and caries. RESULTS: 771 children were examined (participation rate 78%; mean age 2.4 years (age range 2.06-2.90 years)). Although the majority (94%) was born in Switzerland, 61% of children had immigrant backgrounds (mother not born in Switzerland). Cavitated teeth (d2mft) were observed in 12.6% of children (95% CI: 10.4-15.1%). Caries including initial lesions (dl2mft) affected 25.3% of children (95% CI: 22.4-28.5%). There were 34 (4.4%) children with severe caries (all maxillary incisors cavitated). For children with caries, the mean d2mft was 4.3 (+/- 2.8). Children with foreign-born mothers (mothers not born in Switzerland) exhibited a significantly higher caries prevalence than those with Swiss-born mothers (17.4% versus 5.0% with d2mft > 0). CONCLUSIONS: Children with foreign-born mothers exhibited significantly higher caries prevalence rates than those with Swiss-born mothers. Poor oral hygiene and night-time bottle use were identified as risk indicators for caries in all children. Further risk indicators identified in children of foreign-born mothers were a preference for sugar-containing non-milk drinks, no pacifier use, child's age and male gender.

Relationship between nanohardness and mineral content of artificial carious enamel lesions.

The aim of this study was to compare cross-sectional nanohardness, measured using an ultra-microindentation system, with mineral content, from transversal microradiography, of artificial enamel caries lesions. Sections (85 +/- 10 microm) from 16 bovine enamel samples with artificial caries were prepared. The mineral content and cross-sectional nanohardness at known depths from the surface were compared. Both methods showed lesion profiles with a surface layer. The determination of nanohardness seems limited to lesions with a mineral content >45 vol%. There was a moderate linear relationship between mineral content and the square root of nanohardness (R2 = 0.81). It was concluded that the conversion of cross-sectional hardness into mineral content remains questionable and cannot be recommended.

Recovery of Enterococcus faecalis from cheese in the oral cavity of healthy subjects.

INTRODUCTION: Enterococci are rarely found in the healthy human oral cavity, yet they are strongly associated with filled root canals. The origin of these enterococci remains unknown. Our hypothesis is that they are transient food-born colonizers under healthy conditions. This pilot study reinvestigated the prevalence of enterococci in the oral cavity of healthy volunteers, screened cheese samples for enterococci and investigated colonization of the oral cavity after ingestion of an enterocci-positive cheese. METHOD: Concentrated oral rinse samples were collected from a cohort of 50 dental students and proved negative for viable enterococci. Twenty cheese samples were obtained from local supermarkets. Enterococci were cultured and identified using standard methods. RESULTS: Viable enterococci were detected in one of five specimens of Swiss Tilsiter, three of five samples of French soft cheese, one of five Mozzarella samples and one of five Feta samples. Eight volunteers from the cohort consumed 10 g of a cheese with high Enterococcus faecalis load. Oral rinse samples were collected before and 1, 10 and 100 min after cheese ingestion. One minute after ingestion, a median of 5,480 E. faecalis colony-forming units was recovered from the oral rinse samples. Bacterial counts were reduced after 10 min, had dropped after 100 min to levels that were significantly (P < 0.005) different from the 1-min and 10-min scores and were below the detection limit after 1 week. CONCLUSIONS: These findings suggest that colonization of the healthy oral cavity by enterococci is transitional, but at the same time add weight to our hypothesis that enterococcal root canal infections could be food-borne.

Are mutans streptococci detected in preschool children a reliable predictive factor for dental caries risk? A systematic review.

Research suggests that mutans streptococci play an important role in cariogenesis in children but the usefulness of bacterial testing in risk assessment is unknown. Our objective was to summarize the literature assessing the association of mutans streptococci and dental caries in preschool children, (Pre)Medline (1966-2003), Embase (1980-2003), the Cochrane Register of Controlled Trials (2003, issue 3), and reference lists of included studies were searched. All abstracts found by the electronic searches (n = 981) were independently scrutinized by 2 reviewers. Minimal requirements for inclusion were assessment of preschool children without caries at baseline, reporting of mutans streptococci present in saliva or plaque at baseline and assessment of caries presence after a minimum of 6 months of follow-up. Participants' details, test methods, methodological characteristics and findings were extracted by one reviewer and cross-checked by another. Homogeneity was tested using chi2 tests. Results of plaque and saliva testing were pooled separately using a fixed effects model. Methodological quality of reports was low. Out of 9 studies included, data from 3 reports on plaque test assessment alone (n = 300) and from 4 reports on saliva test assessment alone (n = 451) were available for pooled analysis. The pooled risk ratio (95% CI) was 3.85 (2.48-5.96) in studies using plaque tests and 2.11 (1.47-3.02) in those using saliva testing. Presence of mutans streptococci, both in plaque or saliva of young caries-free children, appears to be associated with a considerable increase in caries risk. Lack of adjustment for potential confounders in the original studies, however, limits the extent to which interpretations for practice can be made.

A new fluoride-releasing rubber cup for professional oral hygiene.

Rubber cups in combination with prophylaxis pastes are commonly used for supragingival professional tooth cleaning. This procedure requires frequent interruption in order to collect fresh paste. Moreover, the paste-saliva slurry blurs the visibility, which implies intermittent rinsing to look for residual discolorations. Hawe Neos Dental (Bioggio, Switzerland) has developed a new prophylaxis cup aimed at cleaning and smoothing the tooth surfaces, while simultaneously fluoridating the enamel without a prophylaxis paste. This new prophylaxis cup was tested with respect to cleaning efficiency, resulting surface roughness, abrasivity, and the promotion of fluoride uptake into enamel. After 15 seconds of use, the new cup showed a cleaning efficiency which was 20 to 30% higher than that of a conventional rubber cup (p < 0.01) used with the prophylaxis pastes Nupro coarse or Hawe cleanic (78% vs. 57 and 49%). The fluoride cup had a smoothing effect on the enamel surface comparable to that effected by the two prophylaxis pastes. The abrasivity on enamel was lowest with the new cup. On dentin, abrasivity was comparable to Nupro coarse, but higher than with Hawe cleanic. The fluoride cup also produced a higher amount of KOH-soluble fluoride on the enamel surface when compared to Hawe cleanic. With respect to the structurally bound fluoride, no difference was found. The newly developed fluoride releasing Hawe Neos cup represents an effective alternative to conventional procedures for supragingival professional tooth cleaning on enamel.

Comparison of the mechanical effects of a toothbrush and standard abrasive on human and bovine dentine in vitro.

Dentine abrasion is an important possible side effect of individually used mechanical oral hygiene products. Since human teeth are sometimes not available in sufficient numbers for research purposes, bovine teeth are often used as a substitute for in vitro tests of dentine abrasion. The aim of the present comparative study was to determine the mechanical effects of a manual toothbrush and a standard abrasive on human and bovine dentine under standardized conditions. Roots of human and bovine teeth were radioactivated and subjected to standardized machine brushing using a manual toothbrush and a standard abrasive slurry. Dentine abrasion was assessed by measuring radioactive phosphorus contained in the slurry after brushing. Non-radioactive human and bovine roots were brushed in the same machine, and the generated surface roughness was assessed using profilometry. Artificially stained human and bovine roots were brushed as described, and the cleaning effect was expressed as the extent of stain-free surfaces after different brushing times. The results for abrasion and surface roughening found with bovine and human dentine suggest that if standardized methods are used, roots of bovine mandibular front teeth can be used in place of human roots for in vitro studies of the mechanical effects of toothbrushes and toothpastes on dentine. The use of bovine dentine for measuring the cleaning effects of these products is, however, not recommended.

Chewing gum--facts and fiction: a review of gum-chewing and oral health.

The world market for chewing gum is estimated to be 560,000 tons per year, representing approximately US $5 billion. Some 374 billion pieces of chewing gum are sold worldwide every year, representing 187 billion hours of gum-chewing if each piece of gum is chewed for 30 minutes. Chewing gum can thus be expected to have an influence on oral health. The labeling of sugar-substituted chewing gum as "safe for teeth" or "tooth-friendly" has been proven beneficial to the informed consumer. Such claims are allowed for products having been shown in vivo not to depress plaque pH below 5.7, neither during nor for 30 minutes after the consumption. However, various chewing gum manufacturers have recently begun to make distinct health promotion claims, suggesting, e.g., reparative action or substitution for mechanical hygiene. The aim of this critical review--covering the effects of the physical properties of chewing gum and those of different ingredients both of conventional and of functional chewing gum--is to provide a set of guidelines for the interpretation of such claims and to assist oral health care professionals in counseling patients.

Dental erosion. Definition, classification and links.

An overview of tooth wear, i.e. of non-carious destructive processes affecting the teeth including abrasion, demastication, attrition, abfraction, resorption and erosion is presented. The nomenclature and classification of dental erosion commonly used in the dental literature are summarized. They are based on etiology (extrinsic, intrinsic, idiopathic), on clinical severity (Classes I to III), on pathogenetic activity (manifest, latent) or on localization (perimolysis). Interactions between erosion and abrasion, demastication, attrition, and abfraction as well as caries and low salivary flow rate are highlighted.

Prevention of progression of dental erosion by professional and individual prophylactic measures.

The key elements for the establishment of a preventive program for patients suffering from erosion are described on pathophysiologic grounds. These elements aim 1) to diminish frequency and severity of acid challenge, 2) enhance salivary flow, 3) to enhance acid resistance, remineralization and rehardening by fluoride application, 4) to offer chemical protection by buffering substances, 5) to minimize abrasion, 6) to offer mechanical protection. Recommendations for prophylactic measures are made as a conclusion and summarized in the form of check-lists.

Dental erosion, summary.

Although reports on dental erosion have always appeared in the dental literature, there is currently a growing interest among researchers and clinicians. Potential risk factors for dental erosion are changed lifestyle and eating patterns, with increased consumption of acidic foods and beverages. Various gastrointestinal and eating disorders expose the dentition to frequent contacts with very acidic gastric content, which may lead to erosion. Whether these factors indeed lead, on a population scale, to a higher prevalence and incidence of erosion is yet to be established. This article summarizes the different aspects of the prevalence, pathology, etiology, assessment, prevention and treatment of dental erosion, and concludes with recommendations for future research.

Acidogenic potential and total salivary carbohydrate content of expectorants following the consumption of some cereal-based foods and fruits.

The acidogenic potential of a group of popular cereal-based foods and fruits and total carbohydrate content of salivary expectorants following their consumption were assessed using an indwelling electrode with telemetry and the anthrone method. Paired t tests indicated that sorbitol did not cause the plaque pH to fall as low as any of the test foods (p <0.05) but there was no significant difference between sucrose and the test foods. Only the fruits produced less acid than sucrose. The breakfast cereals tended to yield the highest levels of total carbohydrate in the salivary expectorants although a greater percentage of original carbohydrate was retained after rice and bread. These results suggest the important effect of carbohydrate retention on plaque pH response.

[Prophylaxis pastes--the new abrasive Perlit compared to conventional polishing substances]. / Prophylaxepasten--das neue Abrasiv Perlit im Vergleich zu konventionellen Putzkörpern.

Perlit is a new dental abrasive, based on volcanic silica. It has a flat, irregular disc-shaped structure which fractures readily in use. Individual discs tend to become oriented parallel to the tooth surface during use while the rough edges also become rounded. A Perlit-based prophylactic paste thus produces polished surfaces although it also has excellent cleaning properties on both enamel and dentin when used with either rubber polishing cups or bristle brushes. The Perlit-based prophy paste, Cleanic, yielded the best results when compared to other prophy pastes during laboratory test scored with the Prophylaxis Paste Index (PPI: Cleaning efficacy: [Abrasivity x Surface roughness]). Consequently, Perlit-based prophy pastes can be used initially as cleaning pastes and the same portion will subsequently polish the dental surfaces as well. Thus Perlit nullifies the rule that an efficient cleaning paste will be abrasive and must produce a roughened dental surface.