The anticariogenic effect of sugar-free gum containing CPP-ACP nanocomplexes on approximal caries determined using digital bitewing radiography.

This study investigated, using digital bitewing radiography, the progression and regression of approximal caries in adolescent subjects chewing a sugar-free gum containing 54 mg CPP-ACP relative to the identical gum without CPP-ACP. 2,720 subjects from 29 schools were randomly assigned to one of the two gums and were instructed to chew their assigned gum for 3 x 10 min/day, with one session supervised on school days, over the 24-month study period. Standardized digital bitewing radiographs were taken at the baseline and 24-month clinical examinations for each subject. The radiographs, scored by a single examiner, were assessed for approximal surface dental caries at both the enamel and dentine level. Surface level transitions were scored using a transition matrix. Caries progression or regression was analysed using proportional-odds ordered logistic regression modelling of the transition scores at the tooth surface level. There was a statistically significant difference in the frequency distributions of the transition scores between the two gum groups (OR = 0.82, p = 0.03). For subjects chewing the CPP-ACP gum the odds of a surface experiencing caries progression were 18% less than those of a surface experiencing caries progression for subjects chewing the control gum. In conclusion, the 54 mg CPP-ACP sugar-free gum significantly slowed progression and enhanced regression of approximal caries relative to a control sugar-free gum in a 24-month clinical trial.

Over-the-counter mouthrinses.

Mouthrinses have traditionally been used for cosmetic purposes. Therapeutic products are now available, many of which are sold over the counter. Consumers rely on dental professionals for guidance in the selection of a mouthrinse. The various product categories are reviewed and criteria for patient and/or consumer selection are suggested.

The nature and extent of jaw involvement in Gaucher disease: observations in a series of 28 patients.

A wide variety of osteoarticular pathoses plague the clinical course of many patients with Gaucher disease. Osseous lesions involving the jaws have been described, usually as isolated case reports. The purpose of this study was to ascertain the nature and extent of mandibulo-maxillofacial pathosis in 28 patients with documented Gaucher disease by means of panoramic radiography. Twenty-five of the 28 patients displayed radiographic evidence of jaw involvement. The most prevalent finding was gross widening of marrow spaces; frank radiolucencies, endosteal scalloping, cortical thinning, root resorption, and inferior displacement of the mandibular canal or effacement of its cortices were also seen. A previously unreported finding was delayed eruption of permanent teeth, which was seen in more than one half of the patients who were under 20 years of age. Osseous changes throughout the jaws may be more common than previously suspected and may alert the dentist to the presence of the disease.

The history of oral hygiene products: how far have we come in 6000 years?

How far have we come in the past six millennia? Numerous dental epidemiological studies indicate that people are keeping their teeth longer than over before in this century. Agents and devices have evolved, by custom and by research, to enable people, with professional assistance, to maintain good oral health. Our diets, our lifestyles and our professional colleagues have "conspired" as pathogenic influences on oral health. The profession has met the challenge by developing and perfecting a myriad of devices and agents to thwart these pathogenic factors. Patient motivation and professional acceptance of preventive dentistry procedures still remain challenges. We certainly eat well, speak well, look fine and "smell fresh"--but we also have plaque, gingivitis and dental caries. The reader can determine how much progress has been made by reflecting on his or her personal oral health status!

Hydrogen peroxide: a review of its use in dentistry.

Several dentifrices that contain hydrogen peroxide are currently being marketed. The increased use of bleaching agents containing (or generating) H2O2 prompted this review of the safety of H2O2 when used in oral hygiene. Daily exposure to the low levels of H2O2 present in dentifrices is much lower than that of bleaching agents that contain or produce high levels of H2O2 for an extended period of time. Hydrogen peroxide has been used in dentistry alone or in combination with salts for over 70 years. Studies in which 3% H2O2 or less were used daily for up to 6 years showed occasional transitory irritant effects only in a small number of subjects with preexisting ulceration, or when high levels of salt solutions were concurrently administered. In contrast, bleaching agents that employ or generate high levels of H2O2 or organic peroxides can produce localized oral toxicity following sustained exposure if mishandled. Potential health concerns related to prolonged hydrogen peroxide use have been raised, based on animal studies. From a single study using the hamster cheek pouch model, 30% H2O2 was referred to as a cocarcinogen in the oral mucosa. This (and later) studies have shown that at 3% or less, no cocarcinogenic activity or adverse effects were observed in the hamster cheek pouch following lengthy exposure to H2O2. In patients, prolonged use of hydrogen peroxide decreased plaque and gingivitis indices. However, therapeutic delivery of H2O2 to prevent periodontal disease required mechanical access to subgingival pockets. Furthermore, wound healing following gingival surgery was enhanced due to the antimicrobial effects of topically administered hydrogen peroxide. For most subjects, beneficial effects were seen with H2O2 levels above 1%.

Prevalence of dental caries among Ethiopian emmigrants.

Studies have documented the prevalence of caries in developing countries. The current study adds to this body of knowledge. Of the total Ethiopian Jewish population who emmigrated to Israel in 1991, a sample of over 800 individuals was randomly selected representing all age groups. DMF-T and DMF-S scores were recorded, as well as percentages of caries free individuals. Results indicated that almost no fillings or crowns had been provided to the study population. The Missing 'M' component was low as was the Decay 'D' component, although this increased with increasing age, ranging from 0.33 D-T at the 0-12 age group to 2.46 at the 51+ age group. In the permanent dentition 88.4 per cent of those 0-12 years of age were caries free and 74.5 per cent were caries free in both the primary and permanent dentition. Almost 59 per cent of the 13-20 years olds were caries free and 32.8 per cent of those 21-50 years old. Only 16.7 per cent were caries free at age 51+ years old. The data indicate a relatively low prevalence of both coronal and root caries, and an effort has to be made to keep these figures low for years to come mainly by diet and dental health education.

A clinician's perspective on antimicrobial mouthrinses.

Today's dental professional must advise patients as to the antimicrobial mouthrinse appropriate for their periodontal condition. Considerations such as chemical nature, mechanism of action, efficacy, and safety of mouthrinses are important to the clinician. Taste and cost are equally important considerations to the patient. No ideal antimicrobial mouthrinse exists; yet, chlorhexidine gluconate (Peridex), Listerine, and two of its generic equivalents have the American Dental Association's Seal of Acceptance. An expanded role of antimicrobial mouthrinses that holds promise is that of preprocedural rinsing. This protocol can decrease the number of microorganisms aerosolized during numerous dental procedures.

Oral ulcerations.

Oral ulcers represent a comprehensive group of lesions. Because they are both common and painful, the dentist and physician are frequently consulted for diagnosis and treatment. The pathogenesis, clinical appearance, and suggested treatment modalities for the most common ulcerations are presented. Knowledge of the classification of oral ulcers will aid in proper diagnosis and direct the clinician toward appropriate therapy. In many cases, only palliative care can be offered, but symptoms can often be ameliorated.

The motivational benefits of a dentifrice containing baking soda and hydrogen peroxide.

Twenty-two family practice dentists, in a large metropolitan area, were recruited to act as independent examiners in a study to evaluate the compliance of their patients to accept a good oral hygiene regimen with the use of a fluoride dentifrice, containing hydrogen peroxide and baking soda, dispensed from a dual dispensing package. To evaluate compliance, the dentists attended an orientation seminar and were trained to assess gingival health using the CPITN periodontal probe. Each dentist evaluated the gingival health status of five to seven of his own patients, initially and after one and three months of product use following hygiene instruction and product assignment. One-hundred and thirty-one patients successfully completed the study. After one month of using the hydrogen peroxide/baking soda toothpaste, the mean reduction in bleeding sites was 53%; at three months the reduction was 62%. The hydrogen peroxide/baking soda dentifrice was well accepted by dentist and patient, and a discernible improvement in oral health of the patients was achieved when the product was used in a conscientious oral hygiene program.

The laboratory and clinical safety evaluation of a dentifrice containing hydrogen peroxide and baking soda.

This study reports the laboratory, clinical, and microbiological finding of the safety testing and daily use of a dentifrice delivering 0.75% hydrogen peroxide and 5% baking soda. Laboratory studies using Ca45 labeled teeth and biologically stained teeth confirmed that the dentifrice did not decalcify enamel or bleach teeth. Over the course of a six-month period, 62 subjects using a hydrogen peroxide-baking soda dentifrice and 21 subjects using a control dentifrice were examined for oral soft tissue change and hard tissue alterations. No soft tissue changes attributable to the use of either dentifrice were noted. Experienced clinicians using Trubyte shade guide teeth observed no significant changes to the subjects' anterior teeth following 6 months use of the test dentifrice. Paired discrimination tests revealed that the examiners could distinguish color differences in the shade guide teeth at 0.7%. Microbiological monitoring of the subjects for six months use of their assigned dentifrice and for the following months on the control dentifrice, revealed neither an increased incidence of candida nor increased candida counts.

Dental specialty education.

Dental education has been the topic of considerable discussion in the dental literature during the period between February 1990 and January 1991. Emphasis has been given to the current financial and pedagogic problems facing the profession. It is a time of change, perhaps even great change, and this review focuses on those articles most significant for specialty education at the predoctoral and postdoctoral levels.

Controversies in oral medicine.

This article reviews two conditions commonly seen in oral medical practice. Aphthous ulceration and lichen planus are two very perplexing problems with controversies about etiology, pathogenesis, diagnosis, management, and, in the case of lichen planus, malignant potential.

Clinical index systems used to assess the efficacy of mouthrinses on plaque and gingivitis.

The American Dental Association's Council on Dental Therapeutics has adopted Guidelines for acceptance of chemotherapeutic products for the control of supragingival dental plaque and gingivitis. The most widely used plaque indices are the plaque index (PI) and the Turesky index. Gingivitis has usually been assessed by the Löe and Silness method, although the modified gingival index of Lobene and a bleeding index reported by Caton and Polson have also been used. To date, 2 products have been accepted by the Council as being effective in helping control supragingival plaque and gingivitis. These products were evaluated using clinical indices described in this review. The indices were selected from the many in the literature as being valid, reliable, and easily learned. Suggestions are made for criteria to be used in comparability studies.

Role of the general practitioner in data collection and cross matching.

Dental records used in identification procedures are most often obtained from the offices of general practitioners. The family dentist is required to provide accurate and well documented data to assist in the identification process. The forensic team participating in a mass disaster identification may also utilize the services of general practitioners. They play an active role in the oral autopsy, the oral radiographic procedure, and the identification process itself.

Current status of indices of plaque.

Microbial plaque has been described by the Council on Dental Therapeutics of the American Dental Association in their recently drafted Guidelines for acceptance of products for the management of dental plaque and gingivitis. The choice of an index system to be used in plaque trials should be made in terms of the objective of the trial, the size of the population, the period of the study, and the type and extent of change anticipated. The indices currently in use estimate the quantity of plaque in terms of tooth area covered or the thickness of material in the area measured. The Silness and Loe and the modified Turesky methods have been suggested as acceptable indices for the estimation of cleansing ability.