Efficacy and acceptance of a high-velocity microdroplet device for interdental cleaning in gingivitis patients-A monitored, randomized controlled trial.

OBJECTIVES: To compare in a randomized clinical trial the efficacy of a high-velocity microdroplet device for interdental cleaning vs dental floss at reducing plaque and gingivitis. METHODS: Sixty participants with an irregular interdental home cleaning regime were randomly assigned to use either a microdroplet device (n=40, test) or dental floss (n=20, control) for 4 weeks. At baseline and reassessment, the papilla bleeding index, the modified proximal plaque index and the amount of gingival crevicular fluid (GCF) were recorded. At the second appointment, participants completed a questionnaire regarding their assigned interdental cleaning option. The process quality of this investigator-initiated trial was ensured by independent scientific observers and media representatives. RESULTS: Improvement in the interdental cleaning routine reduced gingivitis in both groups (P<.05). The microdroplet device was more effective at reducing plaque (P=.003). The GCF amount remained the same in both groups. Comfort of use was greater with the microdroplet device. However, self-reported effectiveness was superior with dental floss. About 85% of participants using the microdroplet device said they would continue daily use. CONCLUSION: Improving the interdental cleaning routine with the microdroplet device or dental floss reduced gingivitis and plaque in both groups. Acceptance regarding comfort of use was higher with the microdroplet device. Dental floss remained the first choice for narrow interdental spaces, yet the microdroplet device offers an effective and well-accepted alternative for patients who fail the proper flossing routine.

Oral Health Survey of 6-14-Year-Old Children with Disabilities Attending Special Schools Yemen.

OBJECTIVES: The purpose of this study was to assess the oral health status and treatment needs of children with disabilities attending special schools in Sana'a, Yemen. STUDY DESIGN: This cross-sectional study involved 401 children with different disabilities aged between 6 and 14 years. Dental caries was evaluated using DMFT/dmft indices in accordance with WHO criteria. The plaque index (PI) and the gingival index (GI) were used to assess oral hygiene and gingival health, respectively. RESULTS: The mean dmft and DMFT scores of the total population were 4.27 and 1.90 respectively, with no significant differences across gender (p>0.05). According to the type of disability, the physically disabled had the highest mean dmft of 4.68 (SD 3.30) and subjects with compound disabilities had the highest mean DMFT of 2.85 (SD 1.98). Among the disability groups, the blind had the highest PI and GI scores, and the deaf had the lowest. Majority of the children were on need for specific type of dental treatment. CONCLUSION: This study suggests that children with disabilities have a high prevalence of dental caries and poor oral hygiene.

Randomized controlled trial on the efficacy of new alcohol-free chlorhexidine mouthrinses after 8 weeks.

OBJECTIVES: To evaluate the efficacy of two alcohol-free antimicrobial mouthrinses in reducing plaque and gingivitis compared to an alcohol-containing rinse and toothbrushing alone. METHODS: One hundred and sixty healthy volunteers were enrolled in the randomized controlled trial. Participants were randomly and equally assigned to four groups: (i) toothbrushing + rinsing (0.06% CHX + 0.025% NaF, alcohol-containing rinse, positive control); (ii) toothbrushing + rinsing (0.06% CHX + 0.025% NaF, alcohol-free experimental rinse); (iii) toothbrushing + rinsing (0.06% CHX + 0.03% CPC + 0.025% NaF, alcohol-free experimental rinse); (iv) toothbrushing alone (negative control). At baseline, Quigley-Hein plaque index (QHI), modified proximal plaque index (MPPI), and papillary bleeding index (PBI) were recorded. All subjects brushed their teeth as usual during the study. Additionally, groups 1-3 rinsed twice daily. Eight weeks after baseline, indices were recorded again. anova with Bonferroni adjustment served for statistical analysis. RESULTS: One hundred and fifty-five participants were included into final analysis (i: n = 39, 2: n = 39, 3: n = 37, 4: n = 40). Experimental rinses (ii, iii) reduced QHI and MPPI to a higher extent than the negative control (iv), whereas no significant difference to the positive control was found. QHI: (i) 36.6%, (ii) 32.3%, (iii) 36.8%, (iv) 21.6%; MPPI: (i) 11.9%, (ii) 12.2%, (iii) 13.6%, (iv) 3.5%. For PBI, no statistically significant difference was found between groups: (i) 80.2%, (ii) 77.8%, (iii) 76.5% and (iv) 78.8%. CONCLUSIONS: With respect to QHI and MPPI, toothbrushing in combination with any rinse was more effective than toothbrushing alone. No statistically significant differences were found between the alcohol-free and the alcohol-containing control rinses.

Efficacy of straight versus angled interdental brushes on interproximal tooth cleaning: a randomized controlled trial.

BACKGROUND: To investigate interproximal biofilm reduction with an angled interdental brush as compared to a straight interdental brush (standard control) in a clinical, single-centre, single-blind, controlled, parallel-group trial. METHODS: Recruitment and examinations of the subjects were performed at the Witten/Herdecke University School of Dental Medicine. 128 volunteers, aged 20-65 years, were recruited and stratified according to sex and age. Two groups with 64 subjects each used either straight (standard control) or angled (test group) handgripped interdental toothbrushes of the same bristle stiffness. After a 12-day home-care habituation period, participants received a professional tooth cleaning followed by a 48-h plaque regrowth period. At the intervention appointment, plaque was recorded with a fluorescent revelator and soft tissue damage was noted (T0 ). Interdental brushing was performed by the participant for 2 min, and clinical parameters were recorded again (T1 ). The primary efficacy end point was the difference in modified Proximal Plaque Index (mPPI) after brushing compared to baseline. Secondary efficacy end points were mPPI differences in subgroups (anterior vs. posterior teeth; vestibular vs. oral tooth surfaces). Safety end point was the Danser gingival abrasion index (DI). RESULTS: mPPI showed lower scores after brushing within all (sub)groups (P < 0.01). mPPI brushing efficacy (ΔT0  - T1 ) in subjects using straight interdental brushes was significantly higher as compared to angled interdental brushes (P < 0.0001). Straight interdental brushes were significantly more effective in posterior teeth, when used from vestibular and from oral tooth surfaces (P < 0.0001, P < 0.01 and P < 0.0001, respectively). No significant differences were found between the groups in anterior teeth and concerning soft tissue damage. CONCLUSIONS: Straight interdental brushes may better remove plaque interproximally when compared to angled interdental brushes.

[Improvement of oral health care in geriatric care by training of nurses and nursing assistants for the elderly]. / Verbesserung der zahnmedizinischen Betreuung in der Altenpflege durch Schulungen von Pflegekräften.

Because oral health among residents of German nursing homes is inadequate, this intervention study evaluated the effects of dental training for nurses and nursing assistants (RN and RA) in homes for the elderly on their assessment of oral health in residents and, as a consequence, on the status of residents' oral health. 53 residents and the RNs and RAs from three homes for the elderly participated in this study. The nursing staff received training in dental health care. As primary outcome, the competence in performing the Brief Oral Health Examination (BOHSE) was measured at baseline date and four months after training. Additional outcome measures were dental and denture hygiene in residents, functional status of dentures, and treatment needs. Dental training was shown to improve the nursing staff's competences in oral health assessment in tendency. Residents' oral hygiene improved significantly, whereas no relevant effects on hygiene and functional status of dentures were registered. The need for dental treatment turned out to be considerable at both measurements. Modifications in test tools with identification of dental treatment needs seem to be indicated in order to improve cooperation between nursing staff and dentists in homes for the elderly.

Detection of nine microorganisms from the initial carious root lesions using a TaqMan-based real-time PCR.

OBJECTIVE: The purpose of this study was to quantify nine selected cariogenic bacteria in plaque from sound root surfaces and initial carious root lesions using TaqMan PCR and to analyse a putative dependence on the kind of initial periodontal treatment. MATERIAL AND METHODS: Fifty-four subjects with generalized chronic periodontitis were randomly allocated to one of the following initial periodontal therapies: full-mouth disinfection, full-mouth scaling and root planing or scaling and root planing within 7 days. Plaque samples were taken before and after periodontal treatment and analysed by TaqMan PCR. RESULTS: The quantity of the cariogenic bacteria Actinomyces spp., Streptococcus mutans, Streptococcus sobrinus, Lactobacilllus spp., Rothia dentocariosa, Parvimonas micra, Propionibacterium acnes and Neisseria mucosa were significantly higher, while the quantity of Veillonella parvula was significantly lower on initial carious lesions than on the sound surfaces both before and after periodontal therapy. No significant differences could be found in any of the tested bacteria except P. micra on initial carious lesions and sound surfaces for both examinations between the groups. CONCLUSION: All the nine species analysed were found to be present in initial carious root lesions as well as sound root surfaces but in different quantities, independent of the different periodontal therapies.

[GambiaDentCare - evaluation of a primary oral health-care programme in West Africa]. / GambiaDentCare - Evaluierung eines zahnmedizinischen Grundversorgungsprogramms in Westafrika.

STUDY AIM: Atraumatic restorative treatment, developed in the mid 1980s, was a milestone in primary oral health care in developing countries. In 2001, the basic package of oral care was implemented in Gambia (West Africa) by training nurses to become community oral health workers. It was therefore the aim of this study to evaluate the processes of the operative units of this programme. METHODS: The study was conducted in the form of a visitation, an employee attitude survey, and an analysis of the medical records. RESULTS: The evaluation revealed a continuous oral health care by competent community oral health workers in 5 out of 8 units. The patient catchment area considerably exceeded the village limits. Predominantly, pain therapy as a result of dental caries was administered with a restoration-extraction ratio of 1:10. Within a 12-month period, 5,524 patients of all ages were treated. The dental supply rate was 35%. CONCLUSIONS: Health care delivery in a primary oral health-care programme in the Repubilc of Gambia with community oral health workers was rated successfully. There is room for improvement in the organisational supervision of the operative units. The curriculum of future trainings should be adapted to changing epidemiological trends.

Pilot pathfinder survey of oral hygiene and periodontal conditions in the rural population of The Gambia (West Africa).

OBJECTIVE: To document oral hygiene and periodontal conditions in the rural population of The Gambia. BASIC RESEARCH DESIGN: Cross-sectional study according to the recommendations of the WHO for oral health surveys. CLINICAL SETTING: Examination by two calibrated investigators in the health centres of rural communities after a public radio call. Patients were randomly allocated to the investigators. PARTICIPANTS: 162 patients (20-54 years old; 52.5% female, 47.5% male). INTERVENTIONS: Patients were interviewed for personal information and examined in a full-mouth recording. MAIN OUTCOME MEASURES: Oral Hygiene Index (OHI), Gingival Index (GI), Community Periodontal Index (CPI), and the Gingivitis-Periodontitis-Missing/Teeth Index (GPM/T). Statistical analysis was performed using the Wilcoxon-rank-sum test and Kruskal-Wallis test with statistical significance at P < 0.05. RESULTS: OHI increased by age from 6.9 to 9.2 (P < 0.05) and showed in tendency higher levels in men (P = 0.07), while the GI remained stable at 1.2. Community Periodontal Index codes increased by age (P < 0.05) and showed a fourfold higher prevalence for severe periodontitis in males (P < 0.05). Likewise, an age-related increase in GPM/T was evident (20.5 versus 25.4), significantly in the number of moderate periodontitis and missing teeth (P < 0.05). In GPM/T, males again demonstrated significantly more teeth affected by periodontitis than women. No statistical associations were found between ethnic groups or for different oral hygiene methods concerning CPI or GPM/T. CONCLUSIONS: Prevalence of predominantly mild to moderate periodontal disease indicates treatment needs that should be considered when developing a national oral health care plan in The Gambia (West Africa).

[Caries risk assessment - are saliva tests as well as microbiological and clinical test procedures worthwhile?]. / Kariesrisikoerkennung - Helfen Speicheltests, mikrobiologische und klinische Testverfahren weiter?

The recent representative survey has proven once more that people in Germany are affected by caries to a very different extent. Since caries can be prevented by risk-adjusted preventive programs, it would be helpful to have a possibility to determine the individual caries risk before cavities occur. Determination of a relative risk, risk screening and risk diagnosis are different levels of caries risk assessment. The present article provides information about which caries risk assessment options are available for different populations. A relative risk can be determined by the detection of Mutants Streptococci in caries-free 2-5-year-old children. With Dentoprog, a valid instrument for caries risk screening is available for 6-12-year-old school children. With respect to all other patients, a quantitative risk diagnosis can be roughly performed using the Cariogram which is based on the assessment of multiple risk parameters. The conclusion is that several options for caries risk assessment for different age groups are available. Nevertheless, there is no solution to how often a patient should appear for prevention in a dental office nor which preventive measures have to be taken to keep him/her healthy. Therefore it seems reasonable to roughly determine the recall frequency on the basis of the respective risk assessment and to adjust this frequency over time after the evaluation of disease progression.

Pen-type laser fluorescence device versus bitewing radiographs for caries detection on approximal surfaces.

BACKGROUND: The accurate detection of approximal caries is generally difficult. The aim of this study was to assess the ability of the pen-type laser fluorescence device (LF pen) to detect approximal carious lesions in comparison to bitewing radiographs (BW). METHODS: Three hundred forty-one tooth surfaces were diagnosed in 20 patients with an average age of 26.70 (±2.82) years. Each test tooth was sequentially assessed by a single calibrated examiner using visual inspection, BW, and the LF pen. Radiographs were used as the gold standard to calculate an appropriate cut-off. RESULTS: Sensitivity, specificity and accuracy values for cut-off limits of 15, measured by the LF pen were compared using the chi2 test (McNemar test). For approximal caries at D3 level, the highest values of specificity and sensitivity were observed for the LF pen at a cut-off value of 15 (96.8 and 83.0 %) and for visual inspection (99.3 and 4.3 %). CONCLUSION: Within the limitations of this study, dentin caries on approximal surfaces could be detected equally well by the LF pen as by the bitewing radiographs. Therefore, the LF pen can be recommended as an alternative to radiographs for the detection of approximal caries in a regular dental practice setting. TRIAL REGISTRATION: DRKS00004817 on DRKS on 12th March 2013.

Dye penetration in root canals filled with AH26 in different consistencies.

It is recommended that the powder to liquid ratio of AH26 be very high and that the mixture be warmed to decrease viscosity before insertion into the root canal. In this study, the effectiveness of the powder to liquid ratio and temperature were assessed using 60 root canals of maxillary central incisors randomly divided into four groups after their cleaning and shaping. The teeth were obturated by either lateral condensation or the single-cone technique using AH26 warmed or at room temperature. After exposure to basic fuchsin, the teeth were embedded and cross-sectioned using a diamond saw. The dye penetration was measured microscopically and reported as a percentage of the total circumference of the filling of each slice using a goniometric eye-piece. After statistical analysis, it was concluded that AH26 in combination with lateral condensation leads to less leakage when used at room temperature.

Long-Term bacterial leakage along obturated roots restored with temporary and adhesive fillings.

The aim of this study was to examine whether obturated roots combined with several adhesive and temporary filling materials can be bypassed by bacteria. Standardized cavities were coronally prepared into 130 straight roots mimicking clinical access cavities. After obturation the roots were assigned to six test and three control groups and coronally sealed with either Clearfil, CoreRestore, IRM, Ketac Fil, or a combination of IRM/wax or Ketac Fil/wax. The roots were then fixed between a top and a bottom chamber each. The top chamber contained soy broth with 108 Staphylococcus epidermidis colony-forming units/ml, and the bottom chamber contained sterile soy broth. For 1 yr the mounts were checked on a regular basis for turbidity in their bottom chambers indicating bacterial growth. After 1 yr only three samples from the CoreRestore group and two samples from the Clearfil group resisted leakage. At termination there was no significant difference in number of leaking samples among the groups. At the beginning of the experiment IRM performed worst. Between months 5 and 10 Clearfil showed the least leaking samples; for some months this was statistically significant compared with IRM or Ketac Fil.

Caries prevention with fluoride varnish in a socially deprived community.

UNLABELLED: It has been suggested that specific preventive programs be developed for children with high caries risk. One possibility is to consider whole classes in socially deprived schools as caries-risk groups and perform an intensified preventive program for the entire class. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of such a program which includes the application of a fluoride varnish (Duraphat). METHODS: The application of the varnish was offered three to four times a year in a community with low socio-economic status and a generally high caries level. Two hundred and sixty-nine children in six primary schools of Linden/Limmer, a district in Hannover, Germany, were allocated to a test or a control group. The test group received the fluoride varnish for 4 years whereas the control group received no professional fluoride application. DMFT was recorded at the beginning of the study and after 4 years. RESULTS: At the end of the study, children who had received a minimum of two fluoride applications per year showed a significantly lower caries increment in comparison with the control group (0.88 DMFT vs 1.39 DMFT, P < 0.05). CONCLUSIONS: It can be concluded that a minimum of two applications of the fluoride varnish Duraphat per year may be an effective measure in preventing caries in socially deprived children with high caries activity.

Effectiveness of mechanical tongue cleaning on oral levels of volatile sulfur compounds.

BACKGROUND: Mechanical tongue cleaning may be an effective method for decreasing oral levels of volatile sulfur compounds, or VSC, and oral malodor. The authors conducted a study to compare the effectiveness of a specially designed tongue cleaner (One Drop Only Tongue Cleaner, One Drop Only, Berlin), a tongue scraper and a toothbrush in reducing oral VSC levels. METHODS: In this balanced, crossover study, 30 subjects had four morning appointments each with a waiting period of one week between appointments. At each appointment, a dental professional performed a single standardized tongue cleaning procedure using one of the cleaning tools. The authors monitored the subjects' oral VSC values using a portable sulfide monitor until their baseline VSC values were reached. RESULTS: The baseline values showed no significant difference between the three groups. The tongue cleaner and the tongue scraper (42 percent and 40 percent, respectively) reduced oral VSC levels more than the toothbrush (33 percent) did. Reduced VSC values could be detected significantly longer after using the tongue cleaner than after using the tongue scraper or the toothbrush. The authors, however, could not detect a significant VSC reduction for more than 30 minutes in any of the subjects. CONCLUSIONS AND CLINICAL IMPLICATIONS: The tongue cleaner, a combination brush and scraper, was slightly more effective in reducing oral VSC levels than were the tongue scraper and a regular toothbrush. Because of the limited duration of the effect, however, the clinical efficacy on the reduction of oral malodor remains questionable.

Predicting clinical performance: a two-step approach.

This paper presents the results of a two-year study on the predictive value of the Spatial Relations Test of the Differential Aptitude Test (SRTDAT) for grades in dental hygiene laboratory and clinical courses. The data indicate the SRTDAT was a statistically significant predictor of early laboratory product performance, and this performance was predictive of final clinical performance.

Clinical study of the effectiveness of two sonic toothbrushes.

The aim of this study was to determine the oral hygiene effects of two sonic toothbrushes, the Water Pik Sonic Speed (W) and Sonicare (S), compared to a manual toothbrush (Elmex Super 39, E). Thirty-six healthy volunteers between 13 and 69 years of age participated in this single-blind, crossover study. They were randomly assigned to three groups, with 12 participants each. Two weeks after a screening examination, a baseline examination was performed for each participant followed by professional tooth cleaning. Three indices were recorded to assess the oral hygiene status: a papillary bleeding index (PBI), a plaque index for smooth surfaces (PI) and a plaque index for approximal surfaces (API). After instructions on how to use the toothbrushes, each group started the experiment with a different type of toothbrush. After two weeks of application, the indices were recorded a second time. This was followed by two weeks of recess, where each participant used the same brand of manual toothbrush, and then before each group switched to the next toothbrush, participants had another baseline examination and professional tooth cleaning. The three types of brushes were used in the following order: S, E, W; recess; E, W, S; recess; W, S, E. The duration of the study was 12 weeks. A single investigator performed all examinations. The Friedman test and Wilcoxon signed rank test were used for statistical analysis. Compared to the manual toothbrush the Sonic Speed and the Sonicare were more effective in removing plaque and preventing gingivitis. The study indicated that the two sonic toothbrushes may be effective alternatives to a commonly used manual toothbrush.

The effect of an oral hygiene program on oral levels of volatile sulfur compounds (VSC).

Volatile sulfur compounds (VSCs) produced by bacteria in niches of the oral cavity play a major role in the etiology of bad breath, and can be easily detected by a portable sulfide monitor (Halimeter). To investigate the effect of an oral hygiene program on VSC levels, Halimeter readings were taken from 55 healthy dental students during a course in oral hygiene training, including instruction on brushing, flossing and professional tooth cleaning. Ten students who received no oral hygiene training served as a negative control. The oral hygiene status was measured using the papillary bleeding index (PBI). PBI and VSC values did not show significant changes during the study period of 10 weeks in the control group. In the test group, PBI values significantly decreased compared to baseline and the control, indicating that the oral hygiene program had a benefit on the oral hygiene status. The VSC values also decreased significantly during the study period compared to baseline and the control. It was concluded that in a group of dental students, a thorough oral hygiene training program was capable of reducing the oral level of VSC Halimeter readings.

Fluoride release from a toothbrush.

The purpose of the present study was to evaluate the fluoride concentration in unstimulated saliva after using a toothbrush with 9,048 ppm fluoride as sodium fluoride incorporated in the bristles. A toothpaste with 1,500 ppm fluoride served as the positive control. Twelve volunteers took part in the single-blind crossover study. In a pre-test phase of 14 days, the subjects refrained from eating fluoride-rich foods and did not use any fluoride-containing products for oral hygiene measures. This was followed by a test period of four weeks. At day one and after 14 and 28 days, unstimulated saliva was collected and analyzed for its fluoride content. Saliva was collected immediately after toothbrushing and after 15, 30, 60, 90, 120 150, and 180 minutes. On day one, the fluoride toothbrush released significant amounts of fluoride immediately after the brushing, and after 15 and 30 minutes (p < 0.01). After 14 days of use, this could be found immediately after brushing and after 15 minutes (p < 0.01 or p < 0.05, respectively). After 28 days, a significant fluoride release was only found immediately after brushing (p < 0.05). On all days, compared to the positive control, the fluoride release from the fluoride toothbrush was generally lower immediately after brushing and after 15 minutes (p < 0.001, p < 0.01 or p < 0.05, respectively). It may be concluded that a toothbrush with incorporated sodium fluoride could act as a fluoride-releasing. device.

Use of interdisciplinary education to foster familiarization among health professionals.

This paper describes a pilot interdisciplinary experience between the dental hygiene and medical technology programs at Marquette University. It was designed, in part, to familiarize dental hygiene students with the medical technology profession. Comments solicited from students on the final evaluation form indicated that this pilot project was highly successful and met the objectives. Affective, multiple-choice questions on pretests and posttests showed a positive change in attitude, but this change was not statistically significant. Possible reasons for this are discussed. Benefits of this pilot project were an improved understanding of medical technology on the part of the dental hygiene students, enhanced interdepartmental communication, and plans to develop a reciprocal interdisciplinary experience for the medical technology students. It is hoped that this pilot project will serve as a stimulus for similar experiences among other health science programs.

Kinetics of fluoride bioavailability in supernatant saliva and salivary sediment.

UNLABELLED: The assessment of the fluoride kinetics in whole saliva as well as in the different salivary phases (supernatant saliva and sediment) is essential for the understanding of fluoride bioavailability. OBJECTIVES: To assess the fluoride content, provided by sodium fluoride and amine fluoride, in the supernatant saliva and in salivary sediment. METHODS: Seven trained volunteers were randomly attributed to 2 groups in a cross-over design and brushed their teeth in the morning for 3 min with a product containing either sodium fluoride or amine fluoride. Saliva was collected before, immediately after tooth brushing and 30, 120, and 360 min later and measured. The samples were centrifuged 10 min at 3024 × g. Fluoride content of the supernatant saliva and of the sediment was analysed using a fluoride sensitive electrode. All subjects repeated the study cycles 2 times, and statistical analyses were made using the nonparametric sign test for related samples, the Wilcoxon-Mann-Whitney-test for independent samples. RESULTS: There was a significant increase in fluoride immediately after tooth brushing in both groups in saliva and sediment. The distribution of fluoride between salivary sediment and supernatant saliva (ratio) varied considerably at the different collection times: decreased from 17.87 in baseline samples of saliva to 0.07 immediately and to 0.86 half an hour after tooth brushing in the sodium fluoride group and from 14.33 to 2.85 and to 3.09 in the amine fluoride group. Furthermore after 120 min and after 360 min after tooth brushing the ratio increased from 17.6 to 31.6 in the sodium fluoride group and from 20.5 to 25.76 in the amine fluoride group. No difference was found in the sediment-supernatant saliva ratio between the sodium fluoride and the amine fluoride groups 360 min after tooth brushing. CONCLUSION: For the assessment of fluoride kinetics in whole saliva it is necessary to pay attention to at least four factors: fluoride formulation, time after fluoride application, fluoride concentration in supernatant saliva and fluoride concentration in salivary sediment. This study was approved by the Ethical Committee of the University of Witten/Herdecke permission 21/2008.