A randomized clinical trial on the efficacy of a new oxalate-containing sensitivity relief strip following professional vs self-application.

OBJECTIVES: The purpose of this study was to determine the efficacy of 3.14% dipotassium oxalate monohydrate-containing strip on the relief of dentinal hypersensitivity (DH). A second objective was to determine whether there was a difference in DH levels when the strip was self-applied vs applied by a dental professional. METHODS: Sixty subjects were randomized into self-applied, professionally applied or placebo-strip groups. Dentinal hypersensitivity was evaluated by a blinded examiner, using the Schiff Air Scale (SAS). A verbal rating scale (VRS) was also used to measure the subjects' perception of pain. Measures were taken at baseline, 30 minutes, 4 and 8 weeks post-treatment. RESULTS: There was a significant reduction in DH in all three groups (P ≤ .05) at 30 minutes and 8 weeks post-treatment. At the 4-week follow-up, only the self- and professionally applied (active ingredient) groups had a significant reduction in DH compared to baseline. When comparing the reduction in DH levels between groups, the only significant difference occurred between the professionally applied treatment group and the placebo group at the 4-week follow-up. There were no significant differences in DH reduction levels achieved between the self- and professionally applied groups (P > .05). CONCLUSIONS: This study confirmed the short-term (4 weeks) effectiveness of a single application of 3.14% dipotassium oxalate monohydrate-containing strip. Self- and professional application were not shown to be different.

Halitosis management by the general dental practitioner--results of an international consensus workshop.

Clinical investigations on patients suffering from halitosis clearly reveal that in the vast majority of cases the source for an offensive breath odor can be found within the oral cavity (90%). Based on these studies, the main sources for intra-oral halitosis where tongue coating, gingivitis/periodontitis or a combination of the two. Thus, it is perfectly logical that general dental practitioners (GDPs) should be able to manage intra-oral halitosis under the conditions found in a normal dental practice. However, GDPs who are interested in diagnosing and treating halitosis are challenged to incorporate scientifically based strategies for use in their clinics. Therefore, the present paper summarizes the results of a consensus workshop of international authorities held with the aim to reach a consensus on general guidelines on how to assess and diagnose patients' breath odor concerns and general guidelines on regimens for the treatment of halitosis.

Organoleptic assessment of halitosis for dental professionals--general recommendations.

An organoleptic assessment of an odor is defined as a method that can measure the strength of target odors and expresses the value in terms of a point or number with reference to a pre-defined organoleptic scale. Organoleptic assessments are performed using different scales and are used widely in industry (e.g. for measuring the effectiveness of anti-odor agents), in research (to discover relationships between bad breath and microbiology of the tongue, or the generation of particular volatile compounds), but it is also a prerequisite for the diagnosis of halitosis in individual patients required before directing appropriate treatment. An organoleptic assessment of halitosis patients may be carried out in specialized institutions but--based on the fact that in most cases the odor originates from oral structures--also by dental professionals including general dental practitioners (GDPs). Thus, this paper describes the scientific background for recommendations on how a GDP or dental hygienist or general practitioner with cases of bad breath should use organoleptic methods as a valid approach to assess malodor in patients, with a view to diagnosis and treatment, and subsequent treatment monitoring.

Integrating tobacco dependence counseling into electronic dental records: a multi-method approach.

Dentistry has historically seen tobacco dependence as a medical problem. As a consequence, dentistry has not adopted or developed effective interventions to deal with tobacco dependence. With the expanded use of electronic dental records, the authors identified an opportunity to incorporate standardized expert support for tobacco dependence counseling during the dental visit. Using qualitative results from observations and focus groups, a decision support system was designed that suggested discussion topics based on the patient's desire to quit and his or her level of nicotine addiction. Because dental providers are always pressed for time, the goal was a three-minute average intervention interval. To fulfill the provider's need for an easy way to track ongoing interventions, script usage was recorded. This process helped the provider track what he or she had said to the patient about tobacco dependence during previous encounters and to vary the messages. While the individual elements of the design process were not new, the combination of them proved to be very effective in designing a usable and accepted intervention. The heavy involvement of stakeholders in all components of the design gave providers and administrators ownership of the final product, which was ultimately adopted for use in all the clinics of a large dental group practice in Minnesota.

Effects of four treatment strategies for temporomandibular joint closed lock.

A previous randomized controlled trial (RCT) by Schiffman et al. (2007)(15) compared four treatments strategies for temporomandibular joint (TMJ) disc displacement without reduction with limited mouth opening (closed lock). In this parallel group RCT, 106 patients with magnetic resonance imaging (MRI)-confirmed TMJ closed lock were randomized between medical management, non-surgical rehabilitation, arthroscopic surgery, and arthroplasty. Surgical groups also received rehabilitation post-surgically. The current paper reassesses the effectiveness of these four treatment strategies using outcome measures recommended by the International Association of Oral and Maxillofacial Surgeons (IAOMS). Clinical assessments at baseline and at follow-up (3, 6, 12, 18, 24, and 60 months) included intensity and frequency of TMJ pain, mandibular range of motion, TMJ sounds, and impairment of chewing. TMJ MRIs were performed at baseline and 24 months, and TMJ tomograms at baseline, 24 and 60 months. Most IAOMS recommended outcome measures improved significantly over time (P≤0.0003). There was no difference between treatment strategies relative to any treatment outcome at any follow-up (P≥0.16). Patient self-assessment of treatment success correlated with their ability to eat, with pain-free opening ≥35mm, and with reduced pain intensity. Given no difference between treatment strategies, non-surgical treatment should be employed for TMJ closed lock before considering surgery.

Degradation in the dentin-composite interface subjected to multi-species biofilm challenges.

Oral biofilms can degrade the components in dental resin-based composite restorations, thus compromising marginal integrity and leading to secondary caries. This study investigates the mechanical integrity of the dentin-composite interface challenged with multi-species oral biofilms. While most studies used single-species biofilms, the present study used a more realistic, diverse biofilm model produced directly from plaques collected from donors with a history of early childhood caries. Dentin-composite disks were made using bovine incisor roots filled with Z100(TM) or Filtek(TM) LS (3M ESPE). The disks were incubated for 72 h in paired CDC biofilm reactors, using a previously published protocol. One reactor was pulsed with sucrose, and the other was not. A sterile saliva-only control group was run with sucrose pulsing. The disks were fractured under diametral compression to evaluate their interfacial bond strength. The surface deformation of the disks was mapped using digital image correlation to ascertain the fracture origin. Fracture surfaces were examined using scanning electron microscopy/energy-dispersive X-ray spectroscopy to assess demineralization and interfacial degradation. Dentin demineralization was greater under sucrose-pulsed biofilms, as the pH dropped <5.5 during pulsing, with LS and Z100 specimens suffering similar degrees of surface mineral loss. Biofilm growth with sucrose pulsing also caused preferential degradation of the composite-dentin interface, depending on the composite/adhesive system used. Specifically, Z100 specimens showed greater bond strength reduction and more frequent cohesive failure in the adhesive layer. This was attributed to the inferior dentin coverage by Z100 adhesive, which possibly led to a higher level of chemical and enzymatic degradation. The results suggested that factors other than dentin demineralization were also responsible for interfacial degradation. A clinically relevant in vitro biofilm model was therefore developed, which would effectively allow assessment of the degradation of the dentin-composite interface subjected to multi-species biofilm challenge.

A reproducible oral microcosm biofilm model for testing dental materials.

AIMS: Most studies of biofilm effects on dental materials use single-species biofilms, or consortia. Microcosm biofilms grown directly from saliva or plaque are much more diverse, but difficult to characterize. We used the Human Oral Microbial Identification Microarray (HOMIM) to validate a reproducible oral microcosm model. METHODS AND RESULTS: Saliva and dental plaque were collected from adults and children. Hydroxyapatite and dental composite discs were inoculated with either saliva or plaque, and microcosm biofilms were grown in a CDC biofilm reactor. In later experiments, the reactor was pulsed with sucrose. DNA from inoculums and microcosms was analysed by HOMIM for 272 species. Microcosms included about 60% of species from the original inoculum. Biofilms grown on hydroxyapatite and composites were extremely similar. Sucrose pulsing decreased diversity and pH, but increased the abundance of Streptococcus and Veillonella. Biofilms from the same donor, grown at different times, clustered together. CONCLUSIONS: This model produced reproducible microcosm biofilms that were representative of the oral microbiota. Sucrose induced changes associated with dental caries. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first use of HOMIM to validate an oral microcosm model that can be used to study the effects of complex biofilms on dental materials.

Human temporomandibular joint and myofascial pain biochemical profiles: a case-control study.

Neurobiological mechanisms of human musculoskeletal pain are poorly understood. This case-control study tested the hypothesis that biomarkers within temporomandibular muscle and joint disorders (TMJD) subjects' masseter muscles or temporomandibular joint (TMJ) synovial fluid correlate with plasma biomarker concentrations. Fifty subjects were recruited and categorized into TMJD cases (n=23) and pain-free controls (n=27) at the University of Minnesota School of Dentistry. Prior to specimen collection, pain intensity and pressure pain threshold masseter muscles and the TMJs were assessed. We collected venous blood; biopsied masseter muscle; and sampled TMJ synovial fluid on the subjects' side of maximum pain intensity. We assayed these tissues for the presence of nerve growth factor (NGF), bradykinin (BK), leukotreine B(4) (LTB(4) ) and prostaglandin E(2) (PGE(2) ), F(2) -isoprostane (F(2) I) and substance P (SP). The data was analyzed using Spearman Correlation Coefficients. We found that only plasma concentrations of bradykinin statistically correlated with synovial fluid concentrations (ρ=-0·48, P=0·005), but no association was found between pain intensities. The data suggests that biomarkers used to assess TMJD need to be acquired in a site-specific manner. We also discovered that F(2) I concentrations were associated with muscle pain intensity and muscle pressure pain threshold (PTT) (ß=0·4, 95%CI: 0·03-0·8) and joint PPT (ß=0·4, 95%CI: 0·07-0·8) suggesting that muscle oxidative stress is involved in myofascial pain and that F(2) -I may be a biomarker for myofascial pain.

Comparison of breath and in-mouth collection for the measurement of oral malodorous compounds by gas chromatography using sulfur chemiluminescence detection.

Volatile sulfur compounds (VSCs), specifically hydrogen sulfide, methyl mercaptan and dimethyl sulfide, are generally considered to be the primary volatiles responsible for 'morning' malodors in breath. To date, the 'gold standard' for detecting VSC concentrations in breath is the use of gas chromatography coupled with sulfur chemiluminescence detection. Breath gas is often collected in a polypropylene syringe and then aliquots are injected into a gas chromatograph for analysis. The objective of this work was to compare the Twister™ bar in-mouth extraction methodology for measurement of VSCs with the gas syringe breath-sampling collection technique. The Twister bar technology captures malodorous compounds in the mouth as opposed to breath gas. Using these techniques, comparable results were obtained in studies demonstrating the efficacy of a proprietary oral malodor counteraction system.

Effects of training on odor judges scoring intensity.

OBJECTIVE: This pilot study was intended to test whether a training protocol improved validity of odor judges (OJs), with or without experience, and whether odorant types differed in error proneness. METHODS: The OJs (four experienced, two inexperienced) completed a 4-phase training protocol based on the American Society of Testing and Materials standards (ASTM): (i) introduction to sensory scales, n-butanol reference, sniffing techniques; (ii) pretraining measurements; 20 samples of varying intensities of four unpleasant and three pleasant odorants; (iii) exercises assessing quality, intensity, ranking, and matching; and (iv) post-training measurements. MAIN OUTCOME MEASURES: Subjects' intensity scores were analyzed as the absolute difference from the 'true' intensity (ASTM n-butanol standard) using repeated measures ANOVA. RESULTS: Training significantly (P = 0.02) reduced OJ errors. Experienced and novice judges did not differ in average errors (P = 0.99), or in improvement in error from pre- to post-training (P = 0.94). Improvement was consistent from pre- to post-training for all odorants except dimethylsulfide for which errors worsened (P = 0.01). Unpleasant and pleasant odorants differed (P = 0.006) in error. After removing water the effects of water control scores from the pleasant odorants, the difference was not significant (P = 0.26). CONCLUSIONS: The OJs improved in their ability to assess odor intensity irrespective of previous experience. Training is recommended for all OJs prior to research trials.

Study on the organoleptic intensity scale for measuring oral malodor.

The 0-5 organoleptic scale is used widely in breath research and in trials to measure the efficacy of anti-odor agents. However, the precise relationship between odor scores and gas concentrations of target odorants is unknown. The purpose of this study was to relate mean organoleptic scores from odor judges (n = 7) for pure odorants (n = 8) representative of those found in oral malodor. Judges used a common 0-5 scale to report the odor intensity of sample sets in random order of concentration. Regression analysis of data showed that odor score was proportional to the log concentration of odorant, and comparison of slopes showed H(2)S to be the most significant in terms of odor power. Detection thresholds (mol.dm(-3)) were: Skatole (7.2 x 10(-13)) < methylmercaptan (1.0 x 10(-11)) < trimethylamine (1.8 x 10(-11)) < isovalerate (1.8 x 10(-11)) < butyrate (2.3 x 10(-10)) < hydrogen sulphide (6.4 x 10(-10)) < putrescine (9.1 x 10(-10)) < dimethyl disulphide (5.9 x 10(-8)). The study demonstrates the exponential nature of the olfactory response and shows that any single compound's contribution to malodor depends on odor power and threshold in addition to concentration.

Comparison of volatile sulfur compound concentrations measured with a sulfide detector vs. gas chromatography.

The accuracy of the Halimeter, an inexpensive, simple instrument that measures total breath volatile sulfur compounds (VSCs), has not been adequately tested. We compared Halimeter measurements with those obtained with a specific and sensitive gas chromatographic (GC) technique. The Halimeter gave different, biexponential responses to a constant concentration of different VSCs: The relative response rate and sensitivity were hydrogen sulfide > methyl mercaptan > dimethylsulfide. The transient peak VSC concentration of oral samples was reached long before the sulfide detector fully responded. The GC measurement of initial total VSCs in breath samples was 2.7+/-0.48 times greater than the peak concentration of the Halimeter. However, the plateau phase measurement of the Halimeter was 25% greater than that of GC. While GC and Halimeter measurements positively correlated, appreciable differences were observed. In studies where relatively precise VSC measurements are required, GC is the preferable technique.

Spontaneous fluctuations in the concentrations of oral sulfur-containing gases.

Breath hydrogen sulfide (H2S) and methyl-mercaptan (CH3SH) concentrations are used as quantitative indicators of halitosis. However, measurements of these gases in duplicate oral samplings often show poor reproducibility. To determine if this poor reproducibility is an artifact of the collection/analytical procedure or a true biological phenomenon, we used a standardized technique to collect from 20 to 30 oral gas samples at two-minute intervals from 11 healthy subjects. The samples were analyzed for sulfur gases and CO2. Sizable variations in H2S and CH3SH concentrations were not associated with alterations in CO2, indicating that the variations did not reflect variable contamination with atmospheric or pulmonary gas. In addition, fluctuations in H2S and CH3SH were not identical and often were not random. We conclude that minute-to-minute variability in oral sulfur gas concentrations is a true biological phenomenon. This fluctuation complicates experimental studies designed to show that interventions alter halitosis.

Counseling and treating bad breath patients: a step-by-step approach.

Bad breath (oral malodor, halitosis) can be detrimental to one's self-image and confidence causing social, emotional, and psychological anxiety. With the majority of breath problems having an oral origin, the dental office is the most logical place for patients to seek treatment. When patients look to dental professionals for expert advice, it is critical they have the knowledge base and communication techniques to provide quality clinical assessment and implement effective intervention programs. Moreover, dental professionals should feel comfortable proactively counseling patients about oral malodor without fear of offending the patient. Numerous continuing education programs and journal articles related to the diagnosis and treatment of oral malodor are available. In addition, electronic sources are accessible for dental professionals to expand their knowledge base regarding oral malodor information. Fewer resources are available, however, regarding techniques to facilitate an effective dialogue with patients on this sensitive issue. This article seeks to provide such information and to help professionals tailor the target communication message to meet the specific needs of individual patients.

Continuous quality improvement for introduction of automated blood culture instrument.

Despite the critical nature and high cost of blood cultures, hospitals rely on manufacturers' test site data. As a result, in-hospital testing and compliance evaluation of newly acquired instruments are seldom done. The goal of this study was to apply a continuous quality improvement approach and to develop assessment criteria for all stages from the purchase order, through the on-site instrument evaluation, to the compliance evaluation. Despite the introduction of an automated high-blood-volume instrument (BacT/Alert) in our hospital, 56% of adult patients had only one venipuncture and 89.5% had < or = 20 ml of total blood volume sampled. False positives were associated with overfilling of bottles. These problems occurred because the phlebotomists did not like to perform multiple venipunctures on ill patients; therefore, they were drawing 20 ml of blood from one venipuncture and splitting it between two bottles. Unknown to the staff, the vacuum in the bottles draws significantly more than 10 ml of blood; therefore, the first bottle in the set was frequently overfilled and the second bottle was frequently underfilled. A diagrammatic guideline for a new blood culture protocol based on two venipunctures, taken one immediately after the other, to inoculate three bottles was developed. Compliance evaluation demonstrated that within 1 month of starting the new protocol, 74% of patients had at least two or more venipunctures and 60% had > or = 30 ml of blood drawn per patient episode. This study demonstrates the need for continuous quality improvement, including compliance evaluation, to ensure that the potential benefits of newer blood culture technology are actually realized.