Interdental and subgingival microbiota may affect the tongue microbial ecology and oral malodour in health, gingivitis and periodontitis.

BACKGROUND AND OBJECTIVE: Oral malodour is often observed in gingivitis and chronic periodontitis patients, and the tongue microbiota is thought to play a major role in malodorous gas production, including volatile sulphur compounds (VSCs) such as hydrogen sulphide (H2 S) and methanethiol (CH3 SH). This study aimed to examine the link between the presence of VSCs in mouth air (as a marker of oral malodour) and the oral bacterial ecology in the tongue and periodontal niches of healthy, gingivitis and periodontitis patients. METHODS: Participants were clinically assessed using plaque index, bleeding on probing (BOP) and periodontal probing depths, and VSC concentrations in their oral cavity measured using a portable gas chromatograph. Tongue scrapings, subgingival and interdental plaque were collected from healthy individuals (n = 22), and those with gingivitis (n = 14) or chronic periodontitis (n = 15). The bacterial 16S rRNA gene region V3-V4 in these samples was sequenced, and the sequences were analysed using the minimum entropy decomposition pipeline. RESULTS: Elevated VSC concentrations and CH3 SH:H2 S were observed in periodontitis compared with health. Significant ecological differences were observed in the tongue microbiota of healthy subjects with high plaque scores compared to low plaque scores, suggesting a possible connection between the microbiota of the tongue and the periodontium and that key dysbiotic changes may be initiated in the clinically healthy individuals who have higher dental plaque accumulation. Greater subgingival bacterial diversity was positively associated with H2 S in mouth air. Periodontopathic bacteria known to be prolific VSC producers increased in abundance on the tongue associated with increased bleeding on probing (BOP) and total percentage of periodontal pockets >6 mm, supporting the suggestion that the tongue may become a reservoir for periodontopathogens. CONCLUSION: This study highlights the importance of the periodontal microbiota in malodour and has detected dysbiotic changes in the tongue microbiota in periodontitis.

A Potassium Based Fluorine Containing Bioactive Glass for Use as a Desensitizing Toothpaste.

Potassium releasing bioactive glasses (BAGs) may offer improved relief for dentine hypersensitivity compared to conventional sodium containing BAGs by releasing K+ ions for nerve desensitization and occluding dentinal tubules to prevent fluid flow within dentinal tubules. Potassium oxide was substituted for sodium oxide on a molar basis in a fluoride containing BAG used in toothpastes for treating dentine hypersensitivity. The BAG powders were then immersed in an artificial saliva at pH 7 and tris buffer and the pH rise and ion release behavior were characterized by ICP-OES and ISE. The potassium and sodium containing BAGs were characterized by XRD, DSC, FTIR and NMR. Both BAGs presented amorphous diffraction patterns and the glass transition temperature of the potassium glass was higher than that of the sodium glass. The 31P MAS-NMR spectra indicated a peak at 2.7 ppm corresponding to apatite and a small peak at -103 ppm indicated crystallization to fluorapatite. Both BAGs dissolved and formed apatite at similar rates, although the dissolution of the potassium glass was slightly slower and it released less fluoride as a result of partial nanocrystallization to fluorapatite upon quenching. The potassium release from the potassium ions could potentially result in nerve deactivation when used in toothpastes.

A randomised clinical trial on the efficacy of 5% fluorocalcium phosphosilicate-containing novel bioactive glass toothpaste.

Dentine hypersensitivity (DH) is a common and harrowing dental condition. A novel BioMin-F technology that contains 5% fluorocalcium phosphosilicate bioactive glass has been introduced. It forms fluorapatite, which is more stable towards acid erosion. There is a lack of literature with the utility of this toothpaste in treating DH. Therefore, the authors of this randomised clinical trial have aimed to compare and evaluate the efficacy of 5% fluorocalcium phosphosilicate with an 8% arginine and calcium carbonate and placebo toothpaste. A total of 75 patients clinically diagnosed with DH were randomly divided into three groups: Group A, 5% fluorocalcium phosphosilicate; Group B, 8% arginine and calcium carbonate; and Group C, placebo. The DH was evaluated by tactile and evaporative stimuli, and a visual analogue scale (VAS) was used for evaporative stimuli at pre-baseline, baseline (15 days) and post-baseline (1 month). The results showed symptoms of DH were reduced in all three groups. However, Group A showed a better reduction of DH than the other two groups. The toothpaste containing 5% fluorocalcium phosphosilicate was reported to be more efficacious than the other two toothpastes in managing DH. This novel development opens up a unique opportunity in the prevention and management of DH and may also be beneficial in preventing acid erosion of the tooth surface and in the maintenance of oral hygiene by reducing the effects of plaque accumulation and gingival inflammation.

A New Perspective on Dentine Hypersensitivity ­ Guidelines for General Dental Practice.

The aim of this review is to update dental professionals on the issues and challenges associated with the clinical management of dentine hypersensitivity (DH) and to provide simple guidelines based on presenting clinical features that may help them successfully manage the condition in their day-to-day clinical practice. Details on the management of DH have been previously published in Dental Update which indicated that there was a need for such guidelines. The authors of these guidelines also suggested that, despite the various published clinical studies, there does not currently appear to be one ideal desensitizing agent that can be recommended for treating DH. A joint working relationship between the dental professional and the patient in changing the patient's behaviour is therefore essential if the condition is to be successfully treated. Clinical relevance: Dentine hypersensitivity is a persistent and a troublesome clinical condition which at times is under diagnosed by dental professionals who may struggle to resolve the problem to their patients' satisfaction successfully. The recent UK Forum guidelines on the management of DH, based on the presenting features of the condition, provide practical recommendations, helping dental professionals to manage this persistent problem correctly.

Di-Calcium Phosphate and Phytosphingosine as an Innovative Acid-Resistant Treatment to Occlude Dentine Tubules.

The present investigation evaluated the ability of an experimental di-calcium phosphate (DCP) desensitising agent used alone or combined with phytosphingosine (PHS) to occlude dentine tubules and resist a citric acid (CA) or artificial saliva (AS) challenge. Three groups of human dentine specimens (DS) were treated with the following: (1) PHS alone, (2) DCP or (3) a combination of PHS and DCP. Dentine hydraulic conductance of DS was evaluated using a digital flow sensor at 6.9 kPa. The average fluid volume for each of the treated DS was used to calculate the total dentine permeability reduction (%P) prior to and following CA immersion for 1 min or AS immersion for 4 weeks. The treated DS were subjected to both scanning electron microscopy (SEM) and Fourier transform infrared (FTIR) spectroscopy analysis. Statistically significant differences (%P) were identified between the groups by ANOVA and Fisher's multiple comparison test (p < 0.05), respectively. Interestingly, both PHS and DCP appeared to work synergistically. DS treated with DCP or PHS/DCP demonstrated a significant reduction (%P) prior to and following CA or AS challenge (p < 0.05). Both the SEM and FTIR analyses showed consistent brushite crystals occluding the dentine tubules. Conversely, the application of PHS alone failed to demonstrate any significant reduction of dentine permeability (p > 0.05) or show any evidence of occlusion of the dentine tubules. DCP can be used alone or combined with PHS to decrease the dentine permeability as well as to resist a CA and AS challenge. These results would, therefore, suggest that DCP may be a suitable treatment option for dentine hypersensitivity.

An overview on the Effects of 10% and 15% Carbamide Peroxide and its Relationship to Dentine Sensitivity.

The purpose of this overview was to review the available literature to determine if there was any evidence that the application of 10% and 15% carbamide peroxide in tooth whitening procedures resulted in tooth (dentine) sensitivity. The conclusions from the review would indicate that tooth whitening with either 10% or 15% carbamide peroxide is an effective and safe treatment when under a dental professionals' supervision. Reported side-effects were considered mild to moderate in nature and were transient in duration. Reported incidences of dentine sensitivity range from 15-65% of patients using 10% carbamide peroxide.

Abrasive wear of enamel by bioactive glass-based toothpastes.

PURPOSE: To determine the abrasivity of a 45S5 bioactive glass based toothpaste on enamel as a function of the particle size and shape of the glass. METHODS: 45S5 glass was synthesized ground and sieved to give various particle sized fractions < 38, 38-63 and 63-110 microns. Two different grinding routes were used: percussion milling and ball milling. The glass powders were formulated into toothpastes and their tooth brush abrasivity measured according to BS EN ISO11609 methodology. RESULTS: Enamel loss increased with increasing particle size. The percussion milled powder exhibited particles that had sharp edges and the pastes were significantly more abrasive than the pastes made with round ball milled powders. One interesting observation made during the present study was that there was preferential wear of the enamel at the dentin-enamel junction (DEJ), particularly with the coarse particle sized pastes.

Current diagnosis of dentin hypersensitivity in the dental office: an overview.

OBJECTIVES: The aim of this overview is to consider the problems that may be associated with making a diagnosis of dentin hypersensitivity (DHS) and to provide a basis for clinicians to effectively diagnose and manage this troublesome clinical condition. MATERIALS AND METHODS: A PUBMED literature research was conducted by the author using the following MESH terms: ('diagnosis'[Subheading] OR 'diagnosis'[All Fields] OR 'diagnosis'[MeSH Terms]) AND ('therapy'[Subheading] OR 'therapy'[All Fields] OR 'treatment'[All Fields] OR 'therapeutics'[MeSH Terms] OR 'therapeutics'[All Fields]) AND ('dentin Sensitivity'[MeSH Terms] OR ('dentin'[All Fields] AND 'sensitivity'[All Fields]) OR 'dentin sensitivity'[All Fields]). Variations to the above MeSH terms using terms such as 'cervical', 'dentine' and 'hypersensitivity' as substitutes were also explored, but these searches failed to add any further information. RESULTS: The literature search provided only limited data on specific papers relating to the clinical diagnosis of DHS by dental professionals. Evidence from these published studies would therefore indicate that clinicians are not routinely examining their patients for DHS or eliminating other possible causes of dental pain (differential diagnosis) prior to subsequent management and may rely on their patients' self-reporting of the problem. Furthermore, the findings of the Canadian Consensus Document (2003) would also suggest that clinicians are not confident of successfully treating DHS. CONCLUSIONS: It is apparent from reviewing the published literature on the diagnosis of DHS that there are a number of outstanding issues that need to be resolved, for example, (1) is the condition under- or overestimated by dentists, (2) is the condition adequately diagnosed and successfully managed by dentists in daily practice, (3) is the impact of DHS on the quality of life of sufferers adequately diagnosed and treated and (4) is the condition adequately monitored by clinicians in daily practice. These and other questions arising from the workshop forum should be addressed in well-conducted epidemiological and clinical studies in order for clinicians to be confident in both identifying and diagnosing DHS and subsequent management that will either reduce or eliminate the impact of DHS on their patients' quality of life. CLINICAL RELEVANCE: Clinicians should be made aware not only of the importance of identifying patients with DHS but also of the relevance of a correct diagnosis that may exclude any confounding factors from other oro-facial pain conditions prior to the successful management of the condition.

Dentine hypersensitivity--guidelines for the management of a common oral health problem.

UNLABELLED: Dentine hypersensitivity (DHS) remains a worldwide under-reported and under-managed problem, despite making some dental treatments more stressful than necessary and having a negative impact on the patient's quality of life. This article is designed to build dental professionals' confidence and remove any confusion regarding the diagnosis, prevention and treatment of sensitive teeth caused by dentine hypersensitivity in those patients known to be at risk. There is a need for simple guidelines, which can be readily applied in general practice. However, it is also obvious that one strategy cannot suit all patients. This review describes a DHS management scheme for dental professionals that is linked to management strategies targeted at three different groups of patient. These patient groups are: 1) patients with gingival recession; 2) treatment patients with toothwear lesions; and 3) patients with periodontal disease and those receiving periodontal treatment. The authors also acknowledge the role of industry as well as dental professionals in a continuing role in educating the public on the topic of sensitive teeth. It is therefore important that educational activities and materials for both dental professionals and consumers use common terminology in order to reduce the possibility for confusion. CLINICAL RELEVANCE: This review article provides practical, evidence-based guidance on the management of dentine hypersensitivity for dental professionals covering diagnosis, prevention and treatment. Sensitivity associated with gingival recession, toothwear and periodontal disease and periodontal treatment are specifically addressed in the article.

Knowledge and Attitudes on Preventing and Treating Dentin Hypersensitivity and Its Predicting Factors: A Cross-sectional Study with Brazilian Citizens.

OBJECTIVES: Most dental schools have included dentin hypersensitivity (DH) as part of their taught curriculum to educate undergraduates; however, it is possible that the public still does not recognize its symptoms and the factors that predispose to the onset of this condition. Thus, the aim of this study was to assess the knowledge of a Brazilian population regarding the prevention and treatment of DH and to identify what self-reported factors can serve as predictors of the frequency of DH. MATERIALS AND METHODS: An online questionnaire investigated the demographic characteristics, oral health self-perception and attitudes, and DH prevention and treatment measures of 226 participants. STATISTICAL ANALYSIS: Data were analyzed descriptively and by a multiple linear regression with DH frequency score as the dependent variable (α < 0.05). RESULTS: Total 61.1% of females (n = 138) and 38.9% of males (n = 88) (mean age: 35.1 ± 12.2 years) completed the questionnaire. The sample's mean DH frequency score (minimum 0; maximum 20) was 4.2 and classified as low, with 19.1% using desensitizing products and 22.1% reporting having noncarious cervical lesions (NCCLs). When experiencing DH episodes, 21.2% never and 30.1% rarely scheduled dental appointments. Regression analysis retrieved a significant final model (F [5,220] = 12.047; p < 0.001; R 2 = 0.215). CONCLUSION: This study identified that 36.7% and 18.6% of the sample were unaware that DH can be both prevented and treated, respectively. Moreover, the presence of NCCLs, frequency of daily toothbrushing, use of desensitizing products, presence of DH modulating factors, and the presence of parafunctional habits symptoms served as predictors of DH frequency.

Prevalence of Moderate to Severe Periodontitis in an 18-19th Century Sample-St. Bride's Lower Churchyard (London, UK).

The aim of the study was to determine the prevalence of moderate to severe periodontitis in 18-19th century skulls in the St Bride's Lower Churchyard in London, UK. MATERIALS AND METHODS: A total of 105 adult skulls (66 M: F 39) from the Museum of London collection were examined for evidence of dental disease. The primary method was to measure the presence of moderate to severe periodontitis. Other dental pathologies were recorded such as tooth wear, calculus, and caries. RESULTS: Overall, the prevalence of moderate to severe periodontitis in the sample was 21-24%. Males were observed to be more susceptible to periodontal disease than females. The severity of bone loss in the skull collection also increased with age. There was no significant difference in the amount of calculus deposition when comparing either age or sex. A total of 14% of the individuals in the sample showed signs of smoking. CONCLUSION: The results of the study indicated that the prevalence of moderate to severe periodontitis in an 18-19th century skull sample was 21-24%, which was higher than in previous studies. This may be due to the lack of basic personal mouth care and professional dental treatment as well as known risk factors such as smoking, stress, low socioeconomic status, and malnutrition.

The effect of layered double hydroxide on fluoride release and recharge from a commercial and an experimental resin varnish.

OBJECTIVES: Layered Double Hydroxide (LDH) is capable of fluoride anion exchange and release. This study investigated the effects of incorporating ZnAl-LDH in commercial and experimental dental varnishes, on fluoride release and re-release after charging in NaF. METHODS: Five discs of each material (commercial ClinproXT varnish and experimental light cured resin varnish), with and without 9%ZnAl-LDH were immersed and agitated in deionised water (DW) at 37 °C. A fluoride ion selective electrode measured fluoride release in DW daily over two-weeks. At 3, 6, 9 and 12 days the discs were recharged in 15 ml 0.05 M NaF solution (37 °C) for five minutes followed by immersion in DW. Energy dispersive X-ray spectra (EDS), weight changes and SEMs were performed on discs, before and after each cycle. RESULTS: Evidence of ZnAl-LDH was confirmed by the presence of peaks for zinc and aluminium in EDS spectra. Cumulative fluoride and mean fluoride released between Clinpro, Clinpro + LDH and resin were significantly different (ANOVA, Tukey's HSD post-hoc test, p < 0.001) except between the resin and resin + LDH. Mean fluoride concentrations differed significantly after every recharge between Clinpro, Clinpro + LDH and resin, but not between the resin and resin + LDH (p < 0.01). The weights and SEMs of the experimental resins +/-LDH, appeared to be stable whilst the weights of Clinpro samples +/-LDH, fluctuated and fragmented. SIGNIFICANCE: ClinproXT and experimental resin containing ZnAl-LDH recharged with fluoride did not significantly increase fluoride release compared to the unmodified materials. However, all LDH-F incorporated materials demonstrated fluoride recharging properties which appear beneficial to dentistry and thus further work is required to improve these properties.

The use of bioactive glass (BAG) in dental composites: A critical review.

OBJECTIVE: In recent years, numerous studies have analyzed the role of bioactive glass (BAG) as remineralizing additives in dental restorative composites. This current review provides a critical analysis of the existing literature, particularly focusing on BAGs prepared via the melt-quench route that form an "apatite-like" phase when immersed in physiological-like solutions. METHODS: Online databases (Science Direct, PubMed and Google Scholar) were used to collect data published from 1962 to 2020. The research papers were analyzed and the relevant papers were selected for this review. Sol-gel BAGs were not included in this review since it is not a cost-effective manufacturing technique that can be upscaled and is difficult to incorporate fluoride. RESULTS: BAGs release Ca2+, PO43- and F- ions, raise the pH and form apatite. There are numerous published papers on the bioactivity of BAGs, but the different glass compositions, volume fractions, particle sizes, immersion media, time points, and the characterization techniques used, make comparison difficult. Several papers only use certain characterization techniques that do not provide a full picture of the behavior of the glass. It was noted that in most studies, mechanical properties were measured on dry samples, which does not replicate the conditions in the oral environment. Therefore, it is recommended that samples should be immersed for longer time periods in physiological solutions to mimic clinical environments. SIGNIFICANCE: BAGs present major benefits in dentistry, especially their capacity to form apatite, which could potentially fill any marginal gaps produced due to polymerization shrinkage.

Novel fluoride rechargeable dental composites containing MgAl and CaAl layered double hydroxide (LDH).

OBJECTIVE: This study aims to incorporate 2:1 MgAl and 2:1 CaAl layered double hydroxides (LDHs) in experimental dental-composites to render them fluoride rechargeable. The effect of LDH on fluoride absorption and release, and their physico-mechanical properties are investigated. METHODS: 2:1 CaAl and 2:1 MgAl LDH-composite discs prepared with 0, 10 and 30wt% LDH were charged with fluoride (48h) and transferred to deionized water (DW)/artificial saliva (AS). Fluoride release/re-release was measured every 24h (ion-selective electrodes) with DW/AS replaced daily, and samples re-charged (5min) with fluoride every 2 days. Five absorption-release cycles were conducted over 10 days. CaAl and MgAl LDH rod-shaped specimens (dry and hydrated; 0, 10 and 30wt%) were studied for flexural strength and modulus. CaAl and MgAl LDH-composite discs (0, 10, 30 and 45wt% LDH) were prepared to study water uptake (over 7 weeks), water desorption (3 weeks), diffusion coefficients, solubility and cation release (ICP-OES). RESULTS: CaAl LDH and MgAl LDH-composites significantly increased the amount of fluoride released in both media (P<0.05). In AS, the mean release after every recharge was greater for MgAl LDH-composites compared to CaAl LDH-composites (P<0.05). After every recharge, the fluoride release was greater than the previous release cycle (P<0.05) for all LDH-composites. Physico-mechanical properties of the LDH-composites demonstrated similar values to those reported in literature. The solubility and cation release showed a linear increase with LDH loading. SIGNIFICANCE: LDH-composites repeatedly absorbed/released fluoride and maintained desired physico-mechanical properties. A sustained low-level fluoride release with LDH-composites could lead to a potential breakthrough in preventing early stage carious-lesions.

Brief Motivational Interviewing in Dental Practice.

Motivational Interviewing has been demonstrated to be effective for a wide range of health behaviors. It is an effective behavior change method, which can be utilized in the dental practice setting. It can be used as a brief intervention to increase motivation to improve patients' oral hygiene behaviors as well as providing a framework for delivering diet, smoking cessation, oral health changes, and alcohol advice. It involves four processes: engaging, focusing, evoking, and planning, guiding, which supports the patient towards a positive behavior change. Motivational Interviewing is a collaborative, patient-centered approach evoking the patient's own motivation to change, thereby enhancing the relationship between the clinician and patient and improving patient outcomes. This review will provide an overview on the topic for dental professionals as well as helpful suggestions for supporting a positive behavior change in their dental practices.

A Survey of Dentists in the Management of Dentine Hypersensitivity: A Questionnaire-based Study.

OBJECTIVE: Previous studies have indicated that dentists may be uncertain about the etiology, diagnosis, and effective management of dentine sensitivity/dentine hypersensitivity (DH).: The purpose of the present study was to evaluate the knowledge and understanding of Greece-based dental professionals in treating DH.: MATERIALS AND METHODS: A 26-item questionnaire was sent to a representative sample of Greek dentists. RESULTS: Two hundred thirty questionnaires were originally provided to the participants and of the 210 questionnaires that were returned, 191 questionnaires (90 M; 86 F; mean age 36.26 years [standard deviation: 11.34]) were included for analysis, a response rate of 83% was observed. 39.8% of dentists indicated that 1 in 10 of their patients experienced discomfort from DH with 76.4% of dentists indicating that their patients initiated the conversation on DH. In contrast, 44% of the dentists indicated that they initiated the relevant conversation. 34.9% of dentists indicated that the duration of discomfort lasted up to 3 weeks and 76.4% indicated that DH had an impact on their patients' quality of life. Incorrect tooth brushing was considered to be a major etiological factor (68.6%) with "air blast" (37.3%) and "probing" (15%) as the main methods for identification. 83.6% of dentists indicated that they were confident in recommending over-the-counter products for home use. CONCLUSION: The results of this study suggest that in terms of knowledge and understanding of DH, there is still confusion concerning some aspects of the diagnosis and management of the condition.

Layered Double Hydroxide Fluoride Release in Dental Applications: A Systematic Review.

This systematic review appraises studies conducted with layered double hydroxides (LDHs) for fluoride release in dentistry. LDH has been used as antacids, water purification in removing excess fluoride in drinking water and drug delivery. It has great potential for controlled fluoride release in dentistry, e.g., varnishes, fissure sealants and muco-adhesive strips, etc. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was followed with two reviewers performing a literature search using four databases: PubMed, Web of Science, Science Direct and Ovid Medline with no date restrictions. Studies including any LDH for ion/drug release in dentistry were included, while assessing the application of LDH and the value of the methodology, e.g., ion release protocol and the LDH production process. Results: A total of 258 articles were identified and four met the inclusion criteria. Based on two in vitro studies and one clinical study, LDH was previously studied in dental materials, such as dental composites and buccal muco-adhesive strips for fluoride release, with the latter studied in a clinical environment. The fourth study analysed LDH powder alone (without being incorporated into dental materials). It demonstrated fluoride release and the uptake of volatile sulphur compounds (VSC), which may reduce halitosis (malodour). Conclusion: LDHs incorporated in dental materials have been previously evaluated for fluoride release and proven to be clinically safe. LDHs have the potential to sustain a controlled release of fluoride (or other cariostatic ions) in the oral environment to prevent caries. However, further analyses of LDH compositions, and clinical research investigating any other cariostatic effects, are required.

Dentine Tubule Occlusion by Novel Bioactive Glass-Based Toothpastes.

There are numerous over-the-counter (OTC) and professionally applied (in-office) products and techniques currently available for the treatment of dentine hypersensitivity (DH), but more recently, the use of bioactive glasses in toothpaste formulations have been advocated as a possible solution to managing DH. Aim. The aim of the present study, therefore, was to compare several bioactive glass formulations to investigate their effectiveness in an established in vitro model. Materials and Methods. A 45S5 glass was synthesized in the laboratory together with several other glass formulations: (1) a mixed glass (fluoride and chloride), (2) BioMinF, (3) a chloride glass, and (4) an amorphous chloride glass. The glass powders were formulated into five different toothpaste formulations. Dentine discs were sectioned from extracted human teeth and prepared for the investigation by removing the cutting debris (smear layer) following sectioning using a 6% citric acid solution for 2 minutes. Each disc was halved to provide test and control halves for comparison following the brushing of the five toothpaste formulations onto the test halves for each toothpaste group. Following the toothpaste application, the test discs were immersed in either artificial saliva or exposed to an acid challenge. Results. The dentine samples were analyzed using scanning electron microscopy (SEM), and observation of the SEM images indicated that there was good surface coverage following artificial saliva immersion. Furthermore, although the acid challenge removed the hydroxyapatite layer on the dentine surface for most of the samples, except for the amorphous chloride glass, there was evidence of tubular occlusion in the dentine tubules. Conclusions. The conclusions from the study would suggest that the inclusion of bioactive glass into a toothpaste formulation may be an effective approach to treat DH.

Periodontitis is associated with significant hepatic fibrosis in patients with non-alcoholic fatty liver disease.

BACKGROUND AND AIMS: Non-alcoholic fatty liver disease (NAFLD) has a bidirectional association with metabolic syndrome. It affects up to 30% of the general population, 70% of individuals with diabetes and 90% with obesity. The main histological hallmark of progressive NAFLD is fibrosis. There is a bidirectional epidemiological link between periodontitis and metabolic syndrome. NAFLD, periodontitis and diabetes share common risk factors, are characterised by inflammation and associated with changes in commensal bacteria. Therefore we tested the hypothesis that periodontitis is associated with NAFLD and with significant fibrosis in two study groups. METHODS: We analyzed data from a population-based survey and a patient-based study. NHANES III participants with abdominal ultrasound and sociodemographic, clinical, and oral examination data were extracted and appropriate weighting applied. In a separate patient-based study, consenting patients with biopsy-proved NAFLD (or with liver indices too mild to justify biopsy) underwent dental examination. Basic Periodontal Examination score was recorded. RESULTS: In NHANES, periodontitis was significantly associated with steatosis in 8172 adults even after adjusting for sociodemographic factors. However, associations were fully explained after accounting for features of metabolic syndrome. In the patient-based study, periodontitis was significantly more common in patients with biopsy-proven NASH and any fibrosis (F0-F4) than without NASH (p = 0.009). Periodontitis was more common in patients with NASH and significant fibrosis (F2-4) than mild or no fibrosis (F0-1, p = 0.04). CONCLUSIONS: Complementary evidence from an epidemiological survey and a clinical study show that NAFLD is associated with periodontitis and that the association is stronger with significant liver fibrosis.

Managing dentin hypersensitivity.

BACKGROUND: The objective of this review is to inform practitioners about dentin hypersensitivity (DH) and its management. This clinical information is described in the context of the underlying biology. TYPES OF STUDIES REVIEWED: The authors used MEDLINE to find relevant English-language literature published in the period 1999 to 2005. They used combinations of the search terms "dentin*," "tooth," "teeth," "hypersensit*," "desensiti*" and "desensitiz*." They read abstracts and then full articles to identify studies describing etiology, prevalence, clinical features, controlled clinical trials of treatments and relevant laboratory research on mechanisms of action. RESULTS: The prevalence of DH varies widely, depending on the mode of investigation. Potassium-containing toothpastes are the most widely used at-home treatments. Most in-office treatments employ some form of "barrier," either a topical solution or gel or an adhesive restorative material. The reported efficacy of these treatments varies, with some having no better efficacy than the control treatments. Possible reasons for this variability are discussed. A flowchart summarizes the various treatment strategies. CLINICAL IMPLICATIONS: DH is diagnosed after elimination of other possible causes of the pain. Desensitizing treatment should be delivered systematically, beginning with prevention and at-home treatments. The latter may be supplemented with in-office modalities.