Relationship between 1-, 3-, and 6-Month Gingival Bleeding Outcomes.

INTRODUCTION: Results from systematic reviews and meta-analyses show generally consistent antigingivitis effects between 3- and 6-mo observation time points with twice-daily use of stannous fluoride (SnF2) dentifrice. However, the relationship between 1-, 3-, and 6-mo gingivitis responses has not been investigated. METHODS: This pooled analysis was conducted to understand the relationship of 1-, 3-, and 6-mo gingival bleeding outcomes. Number of bleeding sites, derived from Löe-Silness Gingival Index (LSGI) or Gingival Bleeding Index, was identified as the primary end point of the analysis for the biological and clinical relevance. Randomized, double-blinded, controlled clinical studies meeting the following predefined selection criteria were identified: 1) published and unpublished gingivitis clinical trials conducted from 1995 to 2022 comparing efficacy of 0.454% SnF2 dentifrices to negative controls (sodium fluoride or sodium monofluorophosphate dentifrice) and 2) studies with a 3-mo assessment and at least a 1- or 6-mo assessment. RESULTS: The search resulted in ten 6-mo and fourteen 3-mo studies meeting selection criteria. A mixed-effects model was performed on the pooled data to assess gingival bleeding outcomes across time. The bleeding efficacy significantly increased between months 1 and 3 (P < 0.0001) and plateaued between months 3 and 6 (P = 0.007), supporting the fact that bleeding reduction relative to control established by 1 mo will increase and be maintained through 3 and 6 mo (R2 = 0.857). In addition, gingival bleeding and gingivitis efficacy, as measured by LSGI, were found to be highly correlated (R2 = 0.874). CONCLUSION: A clear relationship has been demonstrated between 1-, 3-, and 6-mo gingival bleeding outcomes in gingivitis clinical studies comparing SnF2 dentifrice to negative control dentifrice. These findings have important implications to the dental practice and scientific research as antigingivitis efficacy evaluations can be observed as early as 1 mo and are consistent with those seen at 3 or 6 mo. KNOWLEDGE TRANSFER STATEMENT: Outcomes from this investigation indicate that the clinical evaluation of antigingivitis efficacy at 1 mo is predictive of that at 3 and 6 mo, supporting studies of 1-mo duration as a viable method of knowledge acquisition. This more efficient, expedited research design has positive implications for patient care, clinical practice guidelines, protocols, and policies.

Prevention of lingual calculus formation with daily use of 6% H2O2/2% pyrophosphate whitening strips.

OBJECTIVE: This randomized controlled clinical trial was conducted to evaluate whether daily use of a hydrogen peroxide/ pyrophosphate-containing antitartar whitening strip might safely yield clinical reductions in post-prophylaxis calculus accumulation. METHODS: A three-month, randomized controlled trial was conducted to compare calculus accumulation with a daily 6% hydrogen peroxide/pyrophosphate strip versus regular brushing. After an eight-week run-in phase to identify calculus formers, a prophylaxis was administered, and 77 subjects were randomly assigned to daily strip or brushing only groups. All subjects received an anticavity dentifrice (Crest Cavity Protection) and manual brush for use throughout the three-month study; for subjects assigned to the experimental group, strip application was once daily for five minutes on the facial and lingual surfaces of the mandibular teeth. Efficacy was measured as mm calculus (VMI) before prophylaxis and after six and 12 weeks of treatment, while safety was assessed from examination and interview. RESULTS: Subjects ranged in age from 21-87 years, with groups balanced (p > 0.26) on pertinent demographic and behavioral parameters, and pre-prophylaxis calculus baseline mean scores (16.0 mm). At Week 6, calculus accumulation was lower in the strip group, with adjusted mean (SE) lingual VMI of 12.0 (0.87) for the strip group and 17.0 (0.88) for the brushing control. At Week 12, calculus accumulation was lower in the strip group, with adjusted mean (SE) lingual VMI of 14.3 (0.85) for the strip group and 17.2 (0.86) for the brushing control. Treatments differed significantly (p < 0.02) on calculus accumulation at both time points. A total of three subjects (8%) in the strip group and two subjects (5%) in the brushing control had mild oral irritation or tooth sensitivity during treatment; no one discontinued early due to an adverse event. CONCLUSION: Daily use of hydrogen peroxide whitening strips with pyrophosphate reduced calculus formation by up to 29% versus regular brushing, without meaningful adverse events.

Placebo-controlled trial evaluating safety with 12-months continuous use of 6% hydrogen peroxide whitening strips.

OBJECTIVE: To assess the safety and tolerability of 6% hydrogen peroxide whitening strips over 12 months. METHODS: 80 adults were randomly assigned equally to one of two treatments: 6% hydrogen peroxide strips or placebo strips. Strips were worn 5 min daily for 12 months. Safety and tolerability were assessed via oral status interviews and oral examinations at baseline and after 1, 2, 3, 6, 9, and 12 months of use. RESULTS: Tooth sensitivity and oral irritation were the two most common adverse events. After 12 months use, tooth sensitivity was reported by 10% of subjects in the 6% strip group with a 95% confidence interval (CI) of (2.8%, 23.7%) and 5% of subjects in the placebo group with a 95% CI of (0.6%, 16.9%). The occurrence of reported oral irritation was 0% in the 6% strip group with a 95% CI of (0%, 8.8%) and 2.5% in the placebo strip group with a 95% CI of (0.1%, 13.2%). The occurrence of observed oral irritation was also similar between groups. The groups did not differ significantly (p>0.67) for the percent of subjects with each type of adverse event. In the 6% strip group, two subjects discontinued product use due to an adverse event (tooth sensitivity) compared to no subjects in the placebo group. Groups did not differ significantly (p>0.49) with respect to this outcome. CONCLUSION: Use of 6% hydrogen peroxide whitening strips over 12 months resulted in a safety profile similar to that seen with placebo strips.

Infantile lethal variant of Simpson-Golabi-Behmel syndrome associated with hydrops fetalis.

Simpson-Golabi Behmel syndrome (SGBS) is an X-linked disorder characterized by pre- and postnatal macrosomia, minor facial anomalies, and variable visceral, skeletal, and neurological abnormalities. Since its first description by Simpson et al. [1975: BD:OA XI(2):18-24], a wide clinical range of cases has been reported. There is great variability in severity, ranging from a mild form associated with long-term survival to an early lethal form with multiple congenital anomalies and severe mental retardation. In 8 reported families, affected individuals died in infancy. Here we present 4 maternally related, male cousins with a severe variant of SGBS. One of these males was aborted therapeutically at 19 weeks of gestation following the detection of multicystic kidneys on ultrasound. The 3 liveborn males were hydropic at birth with a combination of craniofacial anomalies including macrocephaly; apparently low-set, posteriorly angulated ears; hypertelorism; short, broad nose with anteverted nares; large mouth with thin upper vermilion border; prominent philtrum; high-arched or cleft palate; short neck; redundant skin; hypoplastic nails; skeletal defects involving upper and lower limbs; gastrointestinal and genitourinary anomalies. All 3 patients were hypotonic and neurologically impaired from birth. With the exception of a trilobate left lung in one patient, the cardiorespiratory system was structurally normal. All patients died within the first 8 weeks of life of multiple complications including pneumonia and sepsis. Two SGBS kindreds, with moderate expression of the condition, have been mapped to Xq27. It is not known whether severe, familial cases, such as ours, are genetically distinct from and map to another locus. Final resolution of the genetic basis of the phenotypic variability in SGBS must await cloning and mutation analysis of the SGBS gene(s).

Electrochemical studies on the stability and corrosion resistance of titanium-based implant materials.

The corrosion susceptibility of Ti, Ti-6A1-4V and Ti-45Ni was studied in a buffered saline solution using anodic polarisation and electrochemical impedance measurements. Pitting potentials as low as + 250 mV(SCE) were recorded for Ti-45Ni and once initiated pits continued to propagate at potentials as low as -150 mV(SCE). It was possible to increase the pitting potential of Ti-45Ni to values greater than +800 mV(SCE) using a H2O2 surface treatment procedure; however, this surface modification process had no beneficial effect on the rate of pit repassivation. Impedance spectra, recorded under open-circuit conditions, were modelled using a dual oxide film model; a porous outer layer and an inner barrier oxide layer. The nature of this porous outer layer was found to depend on the nature of the electrode material and the presence of phosphate anions in the saline-buffered solution. The porous layers formed on Ti-45Ni and Ti-6Al-4V in the presence of phosphate anions had low resistances typically between 10 and 70 ohm cm2. Much higher porous layer resistances were recorded for Ti and also for Ti-45Ni and Ti-6Al-4V in the absence of the phosphate anions.

Drug release characteristics of unimolecular polymeric micelles.

Biodegradable, unimolecular polymeric micelles possess several features that are attractive for drug delivery applications: Thermodynamic stability, ability to encapsulate and solubilize a hydrophobic guest molecule, biodegradability, as well as size and surface characteristics that prevent rapid clearance by the RES. Here we investigate the potential of these unimolecular polymeric micelles to release a drug for an extended time. Lidocaine was used as a model drug for in vitro studies using a horizontal diffusion cell and cellulose membrane that prevented polymer transport from the source to the receiver compartment. The transport of free lidocaine from source to receiver under sink conditions was zero-order and complete within 8 h. The transport of lidocaine initially encapsulated in polymer was zero-order for the first 14 h, and 96% of the lidocaine was detected within 24 h.

A mathematical model of an aqueous-organic partition-based controlled release system using microporous membranes.

A mathematical model with an exact solution is presented for the membrane-controlled release of small molecules such as nicotine, caffeine, and benzoic acid initially present in solution in the reservoir of the device. Both hollow fiber and flat membrane device geometries are considered. The reservoir is bounded by a microporous membrane, the pores of which are filled with a pore liquid immiscible with the reservoir phase liquid. At the interface between the reservoir and the pore, the solute partitions between the reservoir and the pore liquid phases, before diffusing outward through the membrane pore. The model results compare well with experimental data. Parametric studies reveal the interaction between system parameters and the controlled release behavior. A high partition coefficient of the solute between the reservoir and pore phases is found to effect pseudo-zero order release for an extended time. Similarly, when the ratio of time constants for transport of the solute through the reservoir and membrane regions is small, a constant release rate is achieved for an extended time.

Contribution of women dentists to general practice.

The number of women general dental practitioners has increased in the last few years as the number of women graduating from UK dental schools has also increased. The increase in women practitioners from 1975 to 1985 is of the order of 10 per cent, although only 23 per cent of the total owned their own practices either alone or in partnership. The paper describes the author's own experiences in setting up a thriving practice and the problems she encountered as a woman. Also described are the author's observations in striving for greater goals for general dental practitioners in terms of continuing education and vocational training.

A clinical evaluation and comparison of bioactive glass and sodium bicarbonate air-polishing powders.

OBJECTIVE: Compare clinical effectiveness of sodium bicarbonate and bioactive glass powders used for dental prophylaxis. METHODS: 25 patients were allocated to either good or poor oral hygiene subgroups (n=50). Using a double-blind, split-mouth model, all patients underwent prophylaxis treatment on mandibular teeth; maxillary teeth were untreated controls. Bioactive glass (Sylc, OSspray Ltd., UK) and sodium bicarbonate (Prophy Jet, Dentsply, UK) were applied randomly to opposite sides of each mouth. Sensitivity to cold air/ethyl chloride, dental shade change and procedural comfort were measured. All parameters were recorded immediately pre- and post-treatment and at 10-day recall. RESULTS: Bioactive glass air-polishing, in both subgroups, reported a 44% (0.80+/-0.10, p<0.05) decrease in dental sensitivity, against controls, immediately after application, and a 42% (0.85+/-0.05, p<0.05) decrease at 10-day recall when stimulated with cold air. Ethyl chloride stimulation showed a 10% (3.05+/-0.17, p<0.05) and 22% (2.64+/-0.33, p<0.05) reduction in sensitivity immediately post-op and at 10-day recall. Application of sodium bicarbonate powders increased sensitivity, 17% (1.76+/-0.3, p<0.05), at 10 days when stimulated with cold air. Both powders showed variation between subgroups in colour change, bioactive glass powder 1 and 4 shades whiter, sodium bicarbonate 1 and 2 shades whiter in good and poor oral hygiene groups, respectively. Patients in both subgroups reported a 46% (7.9+/-1.4, p<0.05) increase in comfort of procedure with the bioactive glass over that when using sodium bicarbonate. CONCLUSIONS: Bioactive glass air-polishing was more clinically and statistically effective at desensitising both good and poor oral hygiene groups, and removing stain in the poor oral hygiene patient subgroup. Bioactive glass also provided better overall patient comfort during the procedure.

Association between interleukin-6 -174 polymorphism and Aggregatibacter actinomycetemcomitans in chronic periodontitis.

BACKGROUND: We previously demonstrated an association between interleukin-6 (IL-6) polymorphisms and the detection of periodontopathogenic bacteria in aggressive and chronic periodontitis on a patient basis (pooled samples). The aim of this study is to comprehensively analyze the relative contribution of IL-6 genetic factors and local (tooth and site) factors on the detection of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) and Porphyromonas gingivalis in patients with chronic periodontitis. METHODS: Forty patients diagnosed with severe chronic periodontitis had subgingival samples harvested from four sites (the deepest probing depths in each quadrant). All subjects had a blood sample taken to genotype the single nucleotide polymorphism at position -174 in the IL-6 gene promoter. Nested polymerase chain reaction analysis was performed on subgingival plaque samples for the detection of A. actinomycetemcomitans and P. gingivalis in each of the 160 sampled sites. The association between IL-6 -174 genotypes and bacterial detection was investigated with multilevel analysis accounting for the clustering of multiple sites analyzed within patients. RESULTS: Respectively 60%, 62%, and 40% of subjects had A. actinomycetemcomitans, P. gingivalis, and both bacteria concomitantly detected in ≥1 site. The multilevel analysis confirmed that, among all site and subject factors, IL-6 -174 G homozygosity showed the strongest association with the presence of A. actinomycetemcomitans in all subjects and in the subgroup of whites only. No associations were detected for P. gingivalis. CONCLUSION: This study provides further confirmatory evidence that the detection of A. actinomycetemcomitans is associated with IL-6 genetic factors in chronic periodontitis cases.

The relationship between maternal periodontitis, adverse pregnancy outcome and miscarriage in never smokers.

BACKGROUND: It has been postulated that associations between periodontal disease and systemic conditions may be because of the confounding effects of smoking. In addition, studies of this type rarely investigate the adverse pregnancy outcome of miscarriage. AIM: The aim of this prospective study was to investigate a relationship between periodontal disease in pregnancy and subsequent adverse pregnancy outcomes in a population of never smokers. MATERIALS AND METHODS: Pregnant women were recruited at 12 weeks gestation. Demographic, behavioural and medical data were collected. A periodontal examination was performed and data on each subjects' pregnancy outcome were collected. RESULTS: A total of 1793 women reported never previously smoking. Of these, 7.3% had a pre-term birth and 0.9% a late miscarriage. As expected in this population, we found no associations between poorer periodontal health and either pre-term birth or low birth weight (LBW). In contrast, the subjects who experienced a late miscarriage had a higher mean probing depth at mesial sites compared with the subjects that gave birth at term (2.69 mm versus 2.41 mm, p=0.006). CONCLUSIONS: There was an association between some measures of periodontal disease and late miscarriage; however, there was no association between periodontitis and pre-term birth or LBW in this population.

Treatment of myofascial pain-dysfunction syndrome with occlusal equilibration.

Fifty-three patients with a diagnosis of chronic myofascial pain-dysfunction syndrome were treated with occlusal equilibration to establish complete anterior guidance. In approximately 5 to 7 days after treatment, most myofascial pain dysfunction symptoms disappeared and complete symptom resolution was usually attained within 3 weeks. The common symptoms all patients had were (1) pain and fatigue in the masseter and temporal muscles, (2) nocturnal bruxism, (3) jaw tension on waking up, and (4) difficulty chewing some foods. All patients had an absence of true anterior guidance with molar interferences in all excursive movements. Many patients had previously undergone orthodontic therapy and had "ideal" vertical tooth relationships. Treatment consisted of occlusal equilibration to remove all posterior interferences and establish anterior guidance. Three appointments, 1 week apart, were alloted for treatment. Major symptom reduction occurred after the first appointment. Four-year follow-ups reveal no recurrence of chronic symptoms after treatment completion.

Poisoning from "Spanish fly" (cantharidin).

Cantharidin, known popularly as Spanish fly, has been used for millennia as a sexual stimulant. The chemical is derived from blister beetles and is notable for its vesicant properties. While most commonly available preparations of Spanish fly contain cantharidin in negligible amounts, if at all, the chemical is available illicitly in concentrations capable of causing severe toxicity. Symptoms of cantharidin poisoning include burning of the mouth, dysphagia, nausea, hematemesis, gross hematuria, and dysuria. Mucosal erosion and hemorrhage is seen in the upper gastrointestinal (GI) tract. Renal dysfunction is common and related to acute tubular necrosis and glomerular destruction. Priapism, seizures, and cardiac abnormalities are less commonly seen. We report four cases of cantharidin poisoning presenting to our emergency department with complaints of dysuria and dark urine. Three patients had abdominal pain, one had flank pain, and the one woman had vaginal bleeding. Three had hematuria and two had occult rectal bleeding. Low-grade disseminated intravascular coagulation, not previously associated with cantharidin poisoning, was noted in two patients. Management of cantharidin poisoning is supportive. Given the widespread availability of Spanish fly, its reputation as an aphrodisiac, and the fact that ingestion is frequently unwitting, cantharidin poisoning may be a more common cause of morbidity than is generally recognized. Cantharidin poisoning should be suspected in any patient presenting with unexplained hematuria or with GI hemorrhage associated with diffuse injury of the upper GI tract.

Colonization of caesarean section babies by Excherichia coli.

Eight babies all delivered by Caesarean section were observed for evidence of colonization by E. coli from birth until discharge from hospital 10 to 14 days later. Faecal specimens were cultured daily for E. coli as were swabs from the rectum, groin, umbilicus, head, hands und mouth. Different serotypes of E. coli were isolated from four babies on day 1, one baby on day 2, one baby on day 7 and two babies on day 9. Three babies excreted more than one serotype of E. coli. Serotypes of E. coli isolated from the faeces and rectum were usually isolated from the groin but less often from the umbilicus. Other sides were rarely colonized. In all instances except one the primary site of colonization appeared to be the gastrointestinal tract. Colonization by E. coli was influenced by antibiotic therapy and possibly by the method of feeding.