Effect of Prevalence and Severity of Molar-Incisor Hypomineralization on Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis.

Objectives: The aim of this systematic review and meta-analysis is to assess the association between the MIH presence as well as the severity and OHRQoL in children. Material and methods: Relevant studies were identified in PubMed, Embase, Cochrane and Google Scholar. Studies involving MIH and OHRQoL in children were included. A methodological quality assessment of included studies was performed using the Newcastle-Ottawa Scale (NOS) and its adapted version for cross-sectional studies. Random effects models were used to estimate summary effect measures for the association between MIH presence (presence vs. absence) as well as severity (moderate/severe MIH vs. no MIH) and OHRQoL using generic inverse variance meta-analyses. Tests for heterogeneity, publication bias and sensitivity of results were also performed. Results: Out of 1696 identified publications 11 studies reporting on 5,017 children were included in the meta-analysis assessing the impact of MIH presence. There was no statistically significant association between the presence of MIH and lower OHRQoL in affected children (OR = 1.72, 95% CI = 0.99-2.98). Concerning MIH severity and its impact on OHRQoL, a sum of 6 studies were included in the meta-analysis involving a total of 2,595 children. There was a significant association between moderate/severe MIH and lower OHRQoL in affected children (OR = 3.43, 95% CI = 1.69-6.98). Conclusion: Moderate/Severe MIH has a significant and clinically relevant negative impact on OHRQoL, and it should therefore be addressed adequately. Future research should also consider the impact of a uniform MIH diagnosis and precise severity criteria.

Caries Decline in Preschool Children from Low Social Classes and with Migration Background in Hamburg, Germany: Outcome from Repeated Cross-Sectional Caries Epidemiological Studies.

Over several decades, the dental caries burden in the deciduous dentition has decreased in Germany. However, a dependency of the caries burden on social parameters, such as socio-economic status (SES) or migration background, is generally described. Therefore, the aim of the evaluation was to analyse to what extent children with a low social class affiliation or a migration background have participated in the caries decline. For the city of Hamburg, Germany, data from a series of five caries epidemiological surveys in day-care centres are available since 1977. Using the same methodology, the dmft values were determined, according to WHO criteria, and in addition including initial caries (IC). For the present evaluation, the data and the changes of caries load (caries prevalence and caries experience; dmft) over time were compared with reference to SES and a migration background. A decrease in the caries prevalence from 58.4% to 22.7% and in the dmft value from 2.6 to 0.8 was determined from 1977 to 2016 (WHO criteria). Including IC, the caries prevalence has decreased from 91.0% to 44.4%, and the caries experience shows a decline from 6.4 to 1.8. The caries reduction can be observed in children of all social classes and regardless of a migration background, although significant differences in caries prevalence and caries experience remain recognisable for each survey through 2016. In conclusion, preschool children from families with low SES or with a migration background have not been left behind in the improvement of dental health, but have also benefited from caries prevention measures in roughly the same order of magnitude as other children.

Regular childhood dental visits, health-related factors and quality of life in later life.

Purpose To examine the relationship between regular childhood dental visits, and health status and quality of life in later life. Methods Cross-sectional data from wave 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used (n = 2,368; mean age was 66.2 (SD: 9.1, ranging from 50 to 95 years). We focused on data from Germany. Health-related outcome measures (i.e. functional status, cognitive functioning, and self-rated health) were quantified using established tools. Quality of life was assessed using the well-recognized CASP-12. Results In sum, 65.8% of the individuals had regular childhood dental visits. Multiple linear regressions showed that regular childhood dental visits were not associated with present functional status, cognitive functioning or with self-rated health. However, regular childhood dental visits were associated with better quality of life. Moreover, being married, tertiary education (reference: primary education) and not being obese were each associated with higher cognitive functioning, better self-rated health and better quality of life. Conclusion: Regular childhood dental visits were associated with better quality of life. Future studies are required to elucidate the underlying causes.

Child physical abuse: knowledge of dental students in Hamburg, Germany.

PURPOSE: This study was aimed at evaluating the levels of knowledge of child abuse among students attending the School of Dental and Oral Medicine at the University of Hamburg- Eppendorf, Germany. METHODS: This cross-sectional study utilized a self-administered and structured questionnaire, consisting of 23 multiple-choice questions; the questionnaire focused on rating the students' knowledge of and ability to diagnose child abuse. Each question was analysed with simple descriptive statistics. RESULTS: The students (181) were aware of their legal and ethical responsibilities towards the children and their parents. More than two-thirds (69.6%) responded positively when asked whether a dentist should be legally responsible to report cases of child abuse brought to their attention. The majority of the students (96.1%) agreed that dentists had an ethical duty to report such cases. However, the students were unable to define or describe the signs, symptoms, and social indicators of child abuse. Approximately 93.4% of the students lacked basic training related to child abuse, while 95.7% of them indicated that there was insufficient training in issues related to child abuse. CONCLUSIONS: There is a general lack of information regarding child abuse among dentistry students. The majority of the students showed interest in the topic of child abuse and neglect, but were unable to clearly identify the signs and symptoms. More lectures and workshops relating to child abuse should be available to all dentists to reinforce their knowledge as well as to strengthen their confidence when confronted with suspected cases of child abuse.

[Use of fluorides for caries prevention]. / Verwendung von Fluoriden zur Kariesprävention.

For a few decades, a decrease in the caries burden in all age groups has been observed in Germany. The regular use of fluoride preparations is described as the main reason for the caries decline. It is well established that topical fluoride application directly to the tooth surfaces in the oral cavity, in particular fluoride-containing toothpastes and fluoride varnishes, is responsible for the decline. Several mechanisms of action, such as the formation of a calcium fluoride layer, remineralization, and the effects on bacterial plaque, were determined to be responsible for the overall clinical effect. All these mechanisms can be effective on enamel and root dentin in patients of all ages. There is a dose-response relationship between the fluoride concentration in the applied preparations and the average caries reduction achieved.There are no general toxicological concerns about topical fluoride application. Fluoride toothpastes should be used from the eruption of the first deciduous tooth. The amount of toothpaste used should be limited to the recommended volumes to avoid the development of enamel fluorosis. The professionally performed application of highly concentrated fluoride varnishes, in addition to having a high caries-inhibiting effectiveness, also exhibits advantages in cases of increased caries risk and existing demineralization. This is also the case for the application on root dentin, where significant primary and secondary preventive effects have been demonstrated by application of highly concentrated fluoride preparations.

New method of measuring subjective well-being: prospective validation study of the 'Daily Experience Sampling Questionnaire' (DESQ) in patients with psoriasis and healthy subjects in Germany.

OBJECTIVES: To validate the newly developed Daily Experience Sampling Questionnaire (DESQ) that measures affective subjective well-being (SWB). The DESQ is an end-of-day diary in which respondents retrospectively rate their SWB at six different, randomly determined moments; it is completed over 1 week. The DESQ shall provide an alternative or complementary approach to existing methods of near-time SWB measurement (experience sampling, Day Reconstruction Method). The primary research objective was to determine criterion validity of the DESQ. DESIGN: Prospective, non-interventional study. SETTING: Participants were recruited in Hamburg, Germany, at a specialised outpatient clinic (patients) and via different channels (healthy participants). PARTICIPANTS: 101 adults with diagnosed and stable psoriasis (46 women, 55 men); 105 adults without psoriasis (49 women, 56 men). PRIMARY AND SECONDARY OUTCOME MEASURES: Participants completed the DESQ for 3 weeks. In weeks 2 and 3, they also performed experience sampling. Criterion validity was determined by weekwise intraclass correlations (ICC) between both methods. Sensitivity to change was determined by the correlation between changes in both methods from weeks 2 to 3. For convergent validity, related concepts such as life satisfaction were measured. Retest reliability was determined using DESQ values of weeks 2 and 3. RESULTS: Criterion validity was excellent (ICC: patients=0.86, 95% CI 0.81 to 0.91; healthy participants=0.86, 95% CI 0.79 to 0.91). Sensitivity to change was r=0.57 and r=0.56, respectively. Correlations with convergent criteria were mostly significant and higher in constructs more proximal to SWB. The ICC indicating retest reliability was 0.77 in patients (95% CI 0.68 to 0.84) and 0.81 in healthy participants (95% CI 0.73 to 0.86). CONCLUSIONS: The DESQ is a valid, reliable and feasible instrument for SWB measurement in people with psoriasis and healthy people. Its approach of end-of-day evaluations of single moments may also lend itself to the measurement of other highly time-variant constructs such as pain, fatigue or depression.

Trends in caries experience in the permanent dentition in Germany 1997-2014, and projection to 2030: Morbidity shifts in an aging society.

The aims of this study were to assess the trends in dental caries experience in the permanent dentition (i.e., the number of decayed, missing, or filled teeth, DMFT) in Germany from 1997-2014 and to project caries experience to 2030. Components of caries experience (decayed teeth, DT, missing teeth, MT, filled teeth, FT) from repeated waves (1997, 2005, 2014) of the nationally representative German Oral Health Studies were analyzed in 12-, 35-44-, and 65-74-year-olds. Weighted means were interpolated cross-sectionally by fitting piecewise-cubic spline-curves and were then subjected to longitudinal regression and combined with population estimates. In 1997, children (12-year-olds) had a mean caries experience (decayed, missing, filled teeth, DMFT) of 1.7 teeth; this experience decreased to 0.5 teeth in 2014. For 2030, an experience of 0.2 teeth is projected. In adults (35-44-year-olds), a decrease was recorded (1997: 16.1 teeth; 2014: 11.2 teeth). This decrease is expected to continue until 2030 (to 7.7 teeth). Similarly, in seniors (65-74-year-olds), a decrease was recorded (1997: 23.6 teeth; 2014: 17.7 teeth); this decrease is expected to continue until 2030 (to 14.9 teeth). While the number of missing teeth has decreased consistently across age groups, the number of filled and decayed teeth has increased in seniors and is expected to continue to increase. The cumulative caries experience has decreased from 1.1 billion DMFT in 2000 to 867 million in 2015 and is expected to decrease to 740 million in 2030. Caries experience in the permanent dentition has been decreasing substantially, mainly due to a decrease in missing teeth. Younger age groups also show fewer decayed and filled teeth, while in older groups, restorative needs have not decreased, as more teeth are retained. Concepts for addressing the emanating morbidity shifts are required.

Dental Caries in European Adults and Senior Citizens 1996-2016: ORCA Saturday Afternoon Symposium in Greifswald, Germany - Part II.

This review assesses the development of oral health habits and status in European adults (35-44 years old) and senior citizens (65-74 years old) over the period of 1996-2016. There seem to be good opportunities for improving oral health habits by brushing twice daily with fluoride toothpaste among adults, as only 33-85% reported doing so. Caries experience was extensive among adults (≥92%). In adults of 23 countries, the mean DMFT score ranged from 6.6 to 17.6 (median 12.1). In senior citizens of 21 countries, the mean DMFT score varied from 14.7 to 25.5 (median 22.0). Repeated cross-sectional studies on caries trends in adults revealed a reduction of the DMFT value by 20%, referring to country-wide data. Among senior citizens, the corresponding reduction was 13%, with a shift in the DMFT components, i.e., with lower MT and higher FT scores. Edentulousness in the age group of 35- to 44-year-olds started disappearing in Europe from the year 2000, and had been markedly reduced in some countries during the last decade. However, the eradication of edentulousness among 65- to 74-year-olds has not yet been reported. Further epidemiological surveys should apply caries diagnostic criteria that, besides representing our contemporary understanding of oral health care, allow comparisons with previous surveys using the WHO criteria. In conclusion, in the last two decades, a decline in caries was observed among European adults, and to a lesser extent among senior citizens. It is expected that the decline in caries will contribute to better oral health of individuals.

Root caries experience in Germany 1997 to 2014: Analysis of trends and identification of risk factors.

INTRODUCTION: We assessed time trends in root caries experience, i.e. the sum of filled and carious root surfaces (FRS, CRS), and evaluated risk indicators of FRS/CRS in Germany. METHODS: FRS and CRS from repeated waves (1997, 2005, 2014) of the nationally-representative German Oral Health Studies were analyzed in 35-44- and 65-74-year-olds (adults/younger seniors; n = 4388). Weighted means were interpolated cross-sectionally across age groups by fitting piecewise-cubic spline-curves, and population-level FRS and CRS calculated. We also projected population-level FRS and CRS to 2030. To evaluate risk indicators of FRS and CRS, zero-inflated negative-binomial regression was applied. RESULTS: In adults FRS increased from 1997 to 2005 at individual and population level (from a mean of 0.49 to 0.63 surfaces; from a total of 6.2 to 8.7 million surfaces) and then decreased to 2014 (to 0.16 surfaces/1.6 million surfaces). CRS constantly increased (1997: 0.37 surfaces/4.7 million surfaces; 2014: 0.94 surfaces/9.3 million). In younger seniors, FRS increased from 1997 to 2005 (from 0.67 to 1.92 surfaces; 5.0 to 17.5 million surfaces) and then decreased to 2014 (0.89 surfaces/7.5 million surfaces). CRS constantly increased (1997: 0.39 surfaces/2.9 million surfaces; 2014: 1.43 surfaces/12.1 million surfaces). Driven by demographic changes until 2030, population-level FRS and CRS is likely to increase in younger seniors, but not adults. Sex, toothbrushing behavior, age, coronal caries experience and the number of teeth with probing-pocket-depths≥4 mm were associated with FRS and CRS. CONCLUSIONS: While FRS does not show a clear trend, CRS has constantly increased since 1997. Concepts for preventing and managing CRS in Germany are needed. CLINICAL SIGNIFICANCE: Evaluating time trends and assessing risk indicators of root caries experience is helpful to understand morbidity dynamics, plan resource allocation and identify individuals/groups at risk. While FRS shows no clear trend, CRS has increased since 1997 in Germany. Concepts for addressing the emanating treatment needs are needed.

Diet and Lifestyle Before and During Pregnancy - Practical Recommendations of the Germany-wide Healthy Start - Young Family Network.

Diet and exercise before and during pregnancy affect the course of the pregnancy, the child's development and the short- and long-term health of mother and child. The Healthy Start - Young Family Network has updated the recommendations on nutrition in pregnancy that first appeared in 2012 and supplemented them with recommendations on a preconception lifestyle. The recommendations address body weight before conception, weight gain in pregnancy, energy and nutritional requirements and diet (including a vegetarian/vegan diet), the supplements folic acid/folate, iodine, iron and docosahexaenoic acid (DHA), protection against food-borne illnesses, physical activity before and during pregnancy, alcohol, smoking, caffeinated drinks, oral and dental hygiene and the use of medicinal products. Preparation for breast-feeding is recommended already during pregnancy. Vaccination recommendations for women planning a pregnancy are also included. These practical recommendations of the Germany-wide Healthy Start - Young Family Network are intended to assist all professional groups that counsel women and couples wishing to have children and during pregnancy with uniform, scientifically-based and practical information.

The Fifth German Oral Health Study (Fünfte Deutsche Mundgesundheitsstudie, DMS V) - rationale, design, and methods.

BACKGROUND: Oral diseases rank among the most prevalent non-communicable diseases in modern societies. In Germany, oral epidemiological data show that both dental caries and periodontal diseases are highly prevalent, though significant improvements in oral health has been taking in the population within the last decades, particularly in children. It is, therefore, the aim of the Fifth German Oral Health Study (DMS V) to actualize the data on current oral health status and to gather information on oral health behavior and risk factors. In addition to current oral health monitoring, the study will also permit conclusions about trends in the development of oral health in Germany between 1989 and 2014. METHODS/DESIGN: DMS V is a cross-sectional, multi-center, nationwide representative, socio-epidemiological study to investigate the oral health status und behavior of the German resident population in four age cohorts. Study participants are children (12-year-olds), adults (35- to 44-year-olds), young olds (65- to 74-year-olds), and old olds (75- to 100-year-olds) who are drawn from local residents' registration offices. Social-science investigation parameters concern subjective perceptions and attitudes regarding oral health and nutrition, sense of coherence, and socio-demographic data. Clinical oral parameters are tooth loss, caries and periodontitis, prosthodontic status, further developmental and acquired dental hard tissue and mucosal lesions. To ensure reproducibility, the dental investigators are trained and calibrated by experts and multiple reliability checks are performed throughout the field phase. Statistical analyses are calculated according to a detailed statistical analysis plan. DISCUSSION: The DMS studies first performed in 1989, 1992 and repeated in 1997 and 2005 are the only cross-sectional oral health studies conducted in Germany on a population-based national representative level. Updated prevalence and trend analyses of key oral diseases are, therefore, of major epidemiological and health services research interest. TRIAL REGISTRATION: German Health Services Research Data Bank VfD_DMSV_13_002152.

In vitro activity of photoactivated disinfection using a diode laser in infected root canals.

OBJECTIVE: To investigate the lethal activity of photoactivated disinfection (PAD) on Enterococcus faecalis (ATCC 29212) and mixed populations of aerobic or anaerobic bacteria in infected root canals using a diode laser after the application of a photosensitizer (PS). MATERIALS AND METHODS: First, the bactericidal activity of a low power diode laser (200 mW) against E. faecalis ATCC 29212 pre-treated with a PS (toluidine blue) for 2 min were examined after different irradiation times (30 s, 60 s and 90 s). The bactericidal activity in the presence of human serum or human serum albumin (HSA) was also examined. Second, root canals were infected with E. faecalis or with mixed aerobic or anaerobic microbial populations for 3 days and then irrigated with 1.5% sodium hypochlorite and exposed to PAD for 60 s. RESULTS: Photosensitization followed by laser irradiation for 60 s was sufficient to kill E. faecalis. Bacteria suspended in human serum (25% v/v) were totally eradicated after 30 s of irradiation. The addition of HSA (25 mg/ml or 50 mg/ml) to bacterial suspensions increased the antimicrobial efficacy of PAD after an irradiation time of 30 s, but no longer. The bactericidal effect of sodium hypochlorite was only enhanced by PAD during the early stages of treatment. PAD did not enhance the activity of sodium hypochlorite against a mixture of anaerobic bacteria. CONCLUSIONS: The bactericidal activity of PAD appears to be enhanced by serum proteins in vitro, but is limited to bacteria present within the root canal.

Clinical factors and self-perceived oral health.

Self-perceived oral health is affected not only by awareness of the clinical status but also by comparisons with people of a similar age. This study explored the relative contributions of clinical variables assessing caries, periodontal status, and prosthetic status to self-perceived oral health within two age groups. Data of 891 adults (35-44 yr of age) and 760 older people (65-74 yr of age) from the Fourth German Oral Health Study (DMS IV, 2005) were evaluated. Self-perceived oral health was obtained from questionnaires. Numbers of decayed, filled, and unreplaced teeth, mean attachment loss, bleeding on probing (BOP), the presence of a fixed denture, and the presence of a removable denture were assessed. Multinomial logistic regression models were developed for both age groups, separately, using stepwise methods. For adults, unreplaced teeth, filled teeth, decayed teeth, the presence of a removable denture, and mean attachment loss were added to the final model. For older people, the presence of a removable denture, unreplaced teeth, decayed teeth, mean attachment loss, filled teeth, and BOP were included in the final model. Awareness of the relative contributions of clinical variables to self-perceived oral health is important for obtaining a clearer understanding of patients' subjective and objective self-perceptions of oral health.

Prevalence of Molar-Incisor-Hypomineralisation among school children in four German cities.

BACKGROUND: A wide range for the prevalence of Molar-Incisor-Hypomineralisation (MIH) has been found in regional studies. AIM: The aim of this study was to determine the prevalence of MIH in Germany and to compare the findings with other studies. DESIGN: In the compulsory dental school examination, the first permanent molars, permanent incisors, and second primary molars were examined according to EAPD criteria in 2395 children (8.1 ± 0.8 years) in four regions in Germany for the presence of MIH. Examinations were performed by five calibrated examiners (κ = 0.9) on clean teeth after toothbrushing. RESULTS: The prevalence of MIH at the four regions differed considerably (4.3-14.6%) with a mean prevalence of 10.1%. The DMFT/dmft was generally low, but children with MIH exhibited statistically significant higher caries values. A total of 12.0% of the children with MIH also had at least one affected primary molar, which resulted in a statistically significant correlation between primary and permanent teeth. Most of the affected teeth had demarcated opacities, but more than half of the affected children showed at least one tooth with severe MIH. CONCLUSIONS: Molar-Incisor-Hypomineralisation is a prevalent finding in German school children. The prevalence varies highly in different regions, and the high rate of severe forms has clinically relevant implications.

Comparative antibacterial efficacies of hydrodynamic and ultrasonic irrigation systems in vitro.

INTRODUCTION: To ensure root canal treatment success, endodontic microbiota should be efficiently reduced. The in vitro bactericidal effects of a hydrodynamic system and a passive ultrasonic irrigation system were compared. METHODS: Single-rooted extracted teeth (n = 250) were contaminated with suspensions of Enterococcus faecalis ATCC 29212, mixed aerobic cultures, or mixed anaerobic cultures. First, the antibacterial effects of the hydrodynamic system (RinsEndo), a passive ultrasonic irrigation system (Piezo smart), and manual rinsing with 0.9% NaCl (the control) were compared. Colony-forming units were counted. Second, the 2 systems were used with 1.5% sodium hypochlorite (NaOCl) alone or NaOCl + 0.2% chlorhexidine (CHX). The colony-forming units in the treated and untreated roots were determined during a period of 5 days. RESULTS: Both irrigation systems reduced bacterial numbers more effectively than manual rinsing (P < .001). With NaCl, ultrasonic activated irrigation reduced bacterial counts significantly better than hydrodynamic irrigation (P = .042). The NaOCl + CHX combination was more effective than NaOCl alone for both systems (P < .001), but hydrodynamic irrigation was more effective with NaOCl + CHX than the passive ultrasonic irrigation system. CONCLUSIONS: Both irrigation systems, when combined with NaOCl + CHX, removed bacteria from root canals.

Change in FS-T index in adults in the German national oral health surveys between 1989 and 2005.

OBJECTIVES: To assess changes in the number of functioning teeth (filled and sound teeth, FS-T index) from 1989/1992 to 2005 in West and East Germany and to evaluate survey- and region-specific associations between sociodemographic and behavioral risk factors and the FS-T index. METHODS: Within the German Oral Health Studies, random samples from 35-44-year-olds were drawn in 1989, 1992, 1997 and 2005. The FS-T index and a questionnaire with socioeconomic and behavioral items were assessed. Negative binomial regression models were evaluated, including all sociodemographic and behavioral factors simultaneously as independent variables. RESULTS: For West Germany, median FS-T index increased by 3 teeth between 1989 and 2005 (Ptrend < 0.001). In East Germans, FS-T index was similar in 1992 and 1997 (median, 24), but increased by one tooth until 2005 (Ptrend < 0.001). For West and East Germany, middle and high school education were significantly associated with higher FS-T indices in all surveys, although effects were most pronounced in 2005. Being married, reporting regular dental visits and good oral hygiene were significantly related to a higher number of functioning teeth in at least one survey year. CONCLUSIONS: Dental health assessed as the number of functioning teeth improved between 1989/92 and 2005 in both German parts and across all educational levels. However, considering the educational level, dental health was less equally distributed in 2005 compared with previous surveys.

Current erosion indices--flawed or valid? Summary.

The problem of erosive tooth wear appears increasingly to be encountered by clinicians and researchers. An adequate way of defining and recording erosive tooth wear is essential in order to assess the extent of this clinical phenomenon, both on an individual level and in the population, and for the adequate provision of preventive and therapeutic measures. Well-established erosion indices have been used in most of these studies, although in many cases modifications have been made to suit the different research aims. This use of different indices is one reason why it still cannot be claimed that there is enough current knowledge on this clinical phenomenon. This article summarises the proceedings of a workshop to discuss the topic of dental erosion indices. The result of the workshop is the proposal for a new scoring system (Basic Erosive Wear Examination, BEWE) designed for use both within the research field and for dental clinicians, with the aims of standardising assessment of erosion for international comparisons, raising awareness and providing guidelines for treatment of erosive tooth wear in dental practice.

Plaque and gingivitis in the elderly: a randomized, single-blind clinical trial on the outcome of intensified mechanical or antibacterial oral hygiene measures.

OBJECTIVES: To study the outcome of intensified mechanical oral hygiene compared with the effect of an adjunctive antibacterial mouth rinse on plaque and gingivitis in elderly people. MATERIAL AND METHODS: In a randomized, single-blind, 6-month controlled clinical study, 106 subjects, 55 years or older, were divided into four groups: (I) Participants were instructed on improved mechanical oral hygiene, including interdental hygiene; (II) subjects used an antibacterial mouth rinse containing amine and stannous fluoride in addition to their usual oral hygiene practices; (III) both intensive mechanical and antibacterial measures were combined; and (IV) a control group with no specific regimen. Gingivitis and plaque were examined. RESULTS: After 6 months, both plaque and gingivitis scores were significantly lower than at baseline in all groups. Reductions in gingivitis differed significantly between the control group and all other groups but not between the three intervention groups. Only groups with improved mechanical oral hygiene showed significant improvements in plaque scores compared with control. CONCLUSIONS: Intensive mechanical oral hygiene resulted in greater plaque reduction than the combination of an antibacterial rinse and usual oral hygiene procedures. Gingivitis was reduced by both intensive oral hygiene and use of the amine/stannous fluoride rinse. Combining intensive mechanical oral hygiene with the antibacterial rinse did not result in further gingivitis reduction.