Why don't dental teams routinely discuss dentine hypersensitivity during consultations? A qualitative study informed by the Theoretical Domains Framework.

AIM: Although dentine hypersensitivity is widespread, can cause substantial pain and impact quality of life, it is not routinely discussed during dental consultations. This qualitative study aimed to develop an understanding of the barriers and facilitators to these discussions. MATERIALS AND METHODS: Using the Theoretical Domains Framework to shape the topic guide, N = 7 online focus groups were organized with a total N = 40 participants comprising experienced dentists, dental foundation trainees and dental care professionals. Inductive and deductive thematic analyses of the anonymized, transcribed focus group conversations were undertaken. RESULTS: An attitude-behaviour gap was observed in dental teams' accounts. Although they saw it as part of their professional role to routinely discuss sensitivity, and believed that such conversations were 'an easy win', in practice they experienced several behavioural barriers that hindered these conversations from taking place. These included competing priorities, a perceived lack of seriousness and assessment of dentine hypersensitivity and practical issues such as time. CONCLUSIONS: Systemic (e.g., lack of time and training, professional culture) and behavioural (e.g., dental teams' belief that conversations should take place only with patients likely to be adherent) barriers to dentine hypersensitivity conversations explain why these conversations do not routinely take place.

Patient-reported understanding and dentist-reported management of periodontal diseases - a survey: do you know what gum disease is?

Introduction Mild-to-moderate gingivitis is treatable by effective toothbrushing with appropriate over-the-counter oral health care products; however, rates remain high.Aim To determine patient knowledge of gingivitis and dentists' views on management.Methods Surveys were completed by dentists and dental hospital patients.Results In total, 224 patients and 50 dentists participated. Clinical health, gingivitis, or periodontitis was detected in 2%, 33% and 56% of patients, respectively; 32% reported never suffering gingival bleeding. Moreover, 74% of patients reported gingival health as very important but only 53.7% with gingivitis occasionally/often were moderately-extremely worried about their symptoms. More than 50% of patients knew gingivitis causes poor oral health but <20% knew it elevated risks of other systemic conditions. Patients thought education on risks associated with poor oral health and product recommendations were most likely, and daily reminders least likely, to improve compliance with oral health advice (OHA). Also, 40% of dentists thought their patients were relatively unaware of the importance of gingival health, 76.9% of their patient-base had gingivitis, and 96% give OHA to these patients but only 30% thought this effected improvement. The most useful tools for improving oral health were better patient knowledge of the consequences and one-to-one instruction.Conclusion Patients struggle to attain oral health following OHA. Education about gingivitis-associated risks might improve OHA compliance.

Comparative efficacy of self-administered dentifrices for the management of dentine hypersensitivity - A systematic review and network meta-analysis.

OBJECTIVES: This systematic review with network meta-analysis synthesises available randomised controlled trials evidence concerning efficacy of self-administered dentifrices for management of dentine hypersensitivity (DH) pain. STUDY SELECTION: Following systematic review registration (CRD42019154064), three data bases (MEDLINE, Embase, CENTRAL) were searched to December 2022 for parallel randomised controlled trials conducted in adults diagnosed with DH, using at least two recognised stimuli, assessing the short-term efficacy of home-use dentifrice treatment in reducing pain. Thirty-two studies and 4,638 participants were included. A Network meta-analysis (NMA) approach was used to compare relative effectiveness between interventions. CONCLUSIONS: Twice daily application of self-applied dentifrice containing formulations of stannous, potassium +/- stannous, or arginine can be recommended for the reduction of dentine hypersensitivity pain. There is a need for standardised methodology guideline development to improve the conduct, analysis and reporting of DH clinical studies. CLINICAL RELEVANCE: This is the first comprehensive NMA to be performed, that follows guidelines for conduct of DH trials to determine the efficacy of self-applied dentifrices for the management of dentine hypersensitivity. Indirect comparisons can be made between formulations that have not been compared to one another in randomised controlled trials.

High resolution 16S rRNA gene Next Generation Sequencing study of brain areas associated with Alzheimer's and Parkinson's disease.

Introduction: Alzheimer's (AD) and Parkinson's disease (PD) are neurodegenerative conditions characterized by incremental deposition of ß-amyloid (Aß) and α-synuclein in AD and PD brain, respectively, in relatively conserved patterns. Both are associated with neuroinflammation, with a proposed microbial component for disease initiation and/or progression. Notably, Aß and α-synuclein have been shown to possess antimicrobial properties. There is evidence for bacterial presence within the brain, including the oral pathobiont Porphyromonas gingivalis, with cognitive impairment and brain pathology being linked to periodontal (gum) disease and gut dysbiosis. Methods: Here, we use high resolution 16S rRNA PCR-based Next Generation Sequencing (16SNGS) to characterize bacterial composition in brain areas associated with the early, intermediate and late-stage of the diseases. Results and discussion: This study reveals the widespread presence of bacteria in areas of the brain associated with AD and PD pathology, with distinctly different bacterial profiles in blood and brain. Brain area profiles were overall somewhat similar, predominantly oral, with some bacteria subgingival and oronasal in origin, and relatively comparable profiles in AD and PD brain. However, brain areas associated with early disease development, such as the locus coeruleus, were substantially different in bacterial DNA content compared to areas affected later in disease etiology.

A pilot study to evaluate the impact of digital imaging on the delivery of oral hygiene instruction.

AIMS: To determine whether personalised Oral Hygiene Advice (OHA) using an intra-oral-camera (IOC) combined with standard OHA as provided in general dental practice reduces plaque levels after 4 weeks more than the provision of standard OHA. MATERIALS AND METHODS: 22 healthy adult participants diagnosed with gingivitis took part in this pilot parallel-designed, randomised, examiner-blind, 2x-treatment, study regarding their home-care oral hygiene habits and attitudes to oral health. An IOC-image was taken and plaque, gingival and bleeding scores were recorded. Test group participants received standard OHA with IOC-images to indicate areas for improvement, control group participants received standard OHA. Questionnaires and plaque, gingival and bleeding scores were repeated after 4 weeks. Plaque was scored from the IOC-images and scores compared to clinical plaque scores. RESULTS: Lifestyle habits, attitudes to oral health, plaque (0.63vs0.61, control vs test) and bleeding scores (1.17vs0.96, control vs test) were similar at baseline. After 4-weeks, plaque scores improved more in test as compared to control group (39.4vs20.6%, p<0.05, while gingival and bleeding scores approached significance. There was no difference in lifestyle habits between groups, but the test group reported significantly greater confidence in adhering to their bespoke oral health plan. Agreement between the clinical and IOC plaque scores was good. CONCLUSIONS: Use of IOC further personalises the prevailing standard of oral hygiene advice and generates great patient engagement with pictorial reports to facilitate a more in-depth patient explanation of their gingival health, resulting in significant plaque reduction and improved gingival health compared to the standard OHA alone.

Randomised controlled trial demonstrating the impact of behaviour change intervention provided by dental professionals to improve gingival health.

AIMS: To determine impact of oral hygiene behaviour change intervention compared to the prevailing standard of oral hygiene advice provided in general dental practice, on bleeding on probing (BOP) in gingivitis patients, over 3-months. The effect of providing power-brushes was also evaluated. MATERIALS AND METHODS: NHS dental practices were cluster-randomised to intervention or control (2:1). Dentists at intervention sites received behaviour modification training. Participants were stratified to high (≥20% BOP) or low (<20% BOP) presence of gingivitis and a subset assigned a power-brush. BOP and plaque scores were assessed at baseline and 3-months. RESULTS: A total of 538 participants (369:169; intervention: control) completed the study. BOP reduced in both gingivitis groups with significantly greater reduction in intervention compared to control group (BOP:38% vs 19%, p = 0.0236); Borderline significance favouring the intervention was demonstrated for the low gingivitis group (BOP:37% vs 15%, p = 0.0523). A highly significant reduction in BOP (intervention vs control) was demonstrated for volunteers who swapped from manual to power-brush (44% vs 37%, p = 0.0039). Plaque score improved more in control than intervention group (Plaque:37% vs 44%, p = 0.00215). CONCLUSIONS: Behaviour change techniques were readily mastered by the dental professional researchers. The introduction of an oral hygiene behaviour change intervention significantly reduced gingivitis in volunteer patients compared to control at 3 months. Swapping to a power-brush significantly favoured BOP reduction compared to manual brush continuation although plaque reduction did not follow expectation in comparison to BOP scores. Behaviour change techniques should routinely be considered in patient care. CLINICAL SIGNIFICANCE: Plaque-induced gingivitis is highly prevalent in the UK despite being preventable with good oral hygiene. Its continuum, periodontitis, negative impacts quality of life. This study suggests oral hygiene behavioural interventions (GPS) significantly reduce gingivitis and that GPS introduction will improve oral health and may improve quality of life.

A randomised controlled trial to compare the efficacy of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste with a control toothpaste for the prevention of dentine hypersensitivity.

OBJECTIVES: To determine the efficacy of a cosmetic aluminium lactate/potassium nitrate/hydroxylapatite toothpaste for the reduction of dentine hypersensitivity (DH) pain as compared to a control toothpaste containing potassium nitrate. METHODS: The study was a randomised, examiner-blind, two treatment arm, parallel controlled trial in healthy adults with at least 2 sensitive teeth (Schiff >2). At baseline, immediately after treatment and at 7 and 14 days of twice-daily brushing of the test or control toothpaste the sensitivity of 2 test teeth was measured following iced-water (Schiff and VAS) and tactile (Yeaple probe) stimuli, and a whole mouth plaque score was obtained. Participants also completed a whole-mouth VAS and DHEQ15 quality of life questionnaire at baseline, 7 and 14 days. RESULTS: Both toothpastes reduced DH in test teeth, but pain reduction in the test group was significantly better at all timepoints and by all measures (p = 0.005, tooth-level VAS immediately after brushing; p < 0.001 all other comparisons). There was a relative risk reduction of Schiff sensitivity of 55 % immediately after brushing which rose to 81 % after 7 and 88.6 % after 14 days (all p < 0.001). There were no differences in plaque, whole mouth VAS or DHEQ15 scores at any time point. CONCLUSION: This study demonstrated the efficacy of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste compared to a potassium nitrate control toothpaste for the prevention of dentine hypersensitivity both immediately and over a 2 week period. This agent appears to have potential for pain alleviation from the common oral pain condition of DH and further research is warranted. CLINICAL SIGNIFICANCE: DH pain, whilst transient in nature, is arresting in magnitude, affecting quality of life. Daily application of efficacious toothpastes can relieve DH pain however, as yet, there is no gold standard treatment. The results of this study support further investigation of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste for DH management.

Development of a Chewing Robot With Built-in Humanoid Jaws to Simulate Mastication to Quantify Robotic Agents Release From Chewing Gums Compared to Human Participants.

Medicated chewing gum has been recognised as a new advanced drug delivery method, with a promising future. Its potential has not yet been fully exploited because currently there is no gold standard for testing the release of agents from chewing gum in vitro. This study presents a novel humanoid chewing robot capable of closely replicating the human chewing motion in a closed environment, incorporating artificial saliva and allowing measurement of xylitol release from the gum. The release of xylitol from commercially available chewing gum was quantified following both in vitro and in vivo mastication. The chewing robot demonstrated a similar release rate of xylitol as human participants. The greatest release of xylitol occurred during the first 5 minutes of chewing and after 20 minutes of chewing only a low amount of xylitol remained in the gum bolus, irrespective of the chewing method used. Saliva and artificial saliva solutions respectively were collected after 5, 10, 15 and 20 minutes of continuous chewing and the amount of xylitol released from the chewing gum determined. Bioengineering has been implemented as the key engineering strategy to create an artificial oral environment that closely mimics that found in vivo. These results demonstrate the chewing robot with built-in humanoid jaws could provide opportunities for pharmaceutical companies to investigate and refine drug release from gum, with reduced patient exposure and reduced costs using this novel methodology.

Bioavailable gluconate chelated stannous fluoride toothpaste meta-analyses: Effects on dentine hypersensitivity and enamel erosion.

OBJECTIVES: To compare the effect of bioavailable gluconate-chelated stannous fluoride (SnF2) toothpaste with control toothpastes for treatment of dentine hypersensitivity (DH) and enamel erosion. DATA AND SOURCES: A Procter & Gamble Oral Care archive of clinical studies was reviewed from 2000 to 2020. Eligible studies were Randomised Controlled Trials (RCTs) investigating bioavailable gluconate-chelated SnF2 toothpaste efficacy compared to controls in adult participants measured following tactile (Yeaple force) and/or evaporative stimuli (Schiff score) in-vivo, duration <2 months (DH); or by erosive toothwear (profilometry) from in-situ samples, duration 10-15 days. Two authors independently assessed eligibility and resolved disagreements by discussion. A meta-analysis was undertaken and Risk of Bias (RoB) assessed using the Cochrane collaboration RoB tool for randomized parallel-group and cross-over trials. RESULTS: Fourteen RCTs (1287 participants) assessed DH relief and Six RCTs (184 participants) enamel erosion protection. For DH SnF2 toothpastes provided a 57 % (evaporative air) and 142 % (tactile) benefit versus negative controls (sodium fluoride/monofluorophosphate, 8 studies; p < 0.001). Compared to positive controls (potassium nitrate or arginine, 6 studies), a 22 % advantage (p = 0.036) was seen for evaporative air. In erosion studies, SnF2 toothpastes provided an 83 % benefit versus control toothpastes (arginine or sodium fluoride; p < 0.001) with a change (95 %CI) in average surface profilometry level (µm) of -2.02(-2.85, -1.20). CONCLUSIONS: The use of these bioavailable SnF2 toothpastes, as part of a daily oral hygiene regimen, will provide patients with enamel erosion protection, combined with alleviation of DH pain when present, improving quality of life.

A novel cervical tooth wear and recession index, the cervical localisation code, and its application in the prevention and management of dentine hypersensitivity.

OBJECTIVES: To design and validate a new index to assess tooth wear (TW) in the cervical region and its association with gingival recession (GR), for use both in research studies and as resource in General Dental Practice, with focused prevention and management strategiesparticularly related to aetiology of dentine hypersensitivity provided for each Code score. METHODS: Codes to reflect clinical presentations of the cervical region in health and disease recording both TW and GR were defined. Validation of the Code was undertaken by 3 trained examiners who scored buccal and lingual surfaces of eligible teeth in 42 adult healthy volunteers. Each volunteer underwent 4 identical clinical examinations, being assessed twice by the examiner who performed the first and last exam. RESULTS: Cervical Localisation Code definitions were A: no GR, no coronal TW, B: no GR, distinct coronal TW, C: GR but no coronal TW, D: GR with distinct coronal and root TW. For validation 2073 eligible tooth surfaces were scored. There were only 57 within and 201 between examiner disagreements, the most common being between scores C and D. CONCLUSIONS: The Cervical Localisation Code was used reproducibly by three independent examiners. It will provide focussed data on the cervical region in research studies allowing the association of patient reported dietary and lifestyle factors with specific lesion types, and a tool to aid the management of clinical scenarios, specifically those that lead to dentine hypersensitivity in general dental practice. CLINICAL SIGNIFICANCE: Exposure of dentine at the cervical margin by TW and/or GR often results in dentine hypersensitivity, however current TW indices do not record TW location or GR presence. The Cervical Localisation Code captures both parameters and suggests likely aetiology for dentine hypersensitivity and guide clinical management of the cervical region.

A randomised controlled trial to determine patient experience of a magnetostrictive stack scaler as compared to a piezoelectric scaler, in supportive periodontal therapy.

OBJECTIVES: To compare the pain/discomfort experienced by patients in supportive periodontal therapy, following treatment with a piezoelectric ultrasonic scaler, designed for use with warmed water irrigation, and a magnetostrictive ultrasonic scaler. METHODS: This was a single-centre, randomised, split mouth study with regard to side, and crossover with regard to treatment order. Patients attending general dental practice for supportive periodontal therapy were randomised to receive treatment from one scaler on the left and the other scaler on the right-hand side of the mouth, the left side of the mouth always being treated first. The piezo scaler (Tigon+®) was used with room temperature irrigation for half of the participants (approx 20 °C) and warmed water irrigation (approx 36 °C) for the other half. The magnetostrictive scaler (Cavitron Select SPS 30K®) was used with room temperature irrigation (approx 20 °C) only. Participants rated their pain/discomfort, noise and vibration by VAS scale. RESULTS: 140 participants completed the study. Mean VAS scores for all measures were significantly better for the piezo scaler used with warm irrigation as compared to the magnetostrictive scaler p < 0.001. When both scalers were used with room temperature irrigant, there were no significant differences in the VAS scores between scalers (pain/discomfort, p = 0.68; noise p = 0.2; vibration p = 0.85). CONCLUSIONS: Participants indicated to statistical significance, less pain/discomfort, noise and vibration when the piezo scaler (Tigon+®) device was used with warmed irrigant, compared to the magnetostrictive scaler (Cavitron Select SPS 30K®). There were no significant differences between the instruments when room temperature irrigant was used. CLINICAL SIGNIFICANCE: Regular scaling in supportive periodontal therapy, is essential for maintenance of susceptible patients, however it can be painful due to dentine hypersensitivity deterring patients from attending. Using a piezo scaler with warm water improves patient quality of life and subsequent oral health. This may have positive effects on patient attendance. ISRCTN REGISTERED: ISRCTN15573995.

Comparison of Blood Bacterial Communities in Periodontal Health and Periodontal Disease.

The use of Next Generation Sequencing (NGS) techniques has generated a wide variety of blood microbiome data. Due to the large variation in bacterial DNA profiles between studies and the likely high concentrations of cell-free bacterial DNA in the blood, it is still not clear how such microbiome data relates to viable microbiota. For these reasons much remains to be understood about the true nature of any possible healthy blood microbiota and of bacteraemic events associated with disease. The gut, reproductive tracts, skin, and oral cavity are all likely sources of blood-borne bacteria. Oral bacteria, especially those associated with periodontal diseases, are also commonly associated with cardiovascular diseases such as infective endocarditis, and also have been linked to rheumatoid arthritis and Alzheimer's disease. Periodontal treatment, dental probing, and toothbrushing have been shown to cause transient bacteraemia and oral bacteria from the phyla Firmicutes (e.g. Streptococci) and Bacteroidetes (e.g. Porphyromonas) are found in cardiovascular lesions (CVD). Many studies of blood bacterial DNA content however, find Proteobacteria DNA to be the dominant microbiome component, suggesting a gut origin. Most studies of this type use total DNA extracted from either whole blood or blood fractions, such as buffy coat. Here, using a method that purifies DNA from intact bacterial cells only, we examined blood donated by those with active, severe periodontitis and periodontally healthy controls and show that 43-52% of bacterial species in blood are classified as oral. Firmicutes, consisting largely of members of the Streptococcus mitis group and Staphylococcus epidermidis, were predominant at 63.5% of all bacterial sequences detected in periodontal health and, little changed at 66.7% in periodontitis. Compared to studies using total DNA Proteobacteria were found here at relatively low levels in blood at 13.3% in periodontitis and 17.6% in health. This study reveals significant phylogenetic differences in blood bacterial population profiles when comparing periodontal health to periodontal disease cohorts.

Patients' perception of their oral and periodontal health and its impact: a cross-sectional study in the NHS.

Aims To determine patient awareness of periodontal health, dentine hypersensitivity and tooth wear, and their impact on oral health quality of life in patients attending NHS practices in South West England.Method In this cross-sectional, multi-centre epidemiological study 814 adult NHS patients completed an oral health questionnaire and then underwent a clinical examination. Pocket probing depths (mm), gingival recession (mm), gingival bleeding (yes/no), dentine hypersensitivity (Schiff score, and yes/no) and tooth wear (basic erosive wear examination score) were measured.Results Participants were regular dental attenders, with good oral hygiene practices and a low prevalence of periodontal disease (probing depth of 4 mm or more) (25%). For all conditions assessed, self-reported data and clinical indices were significantly positively associated, with the strongest associations being seen for dentine hypersensitivity and the weakest for tooth wear. Periodontal disease and dentine hypersensitivity were significantly associated with all four patient-reported measures of oral health quality of life studied.Conclusion This NHS patient population is well cared for and educated with respect to their oral health. The findings confirm the negative impact of periodontal disease and dentine hypersensitivity, and identifies the need to increase awareness of the signs and symptoms of tooth wear.

A randomised controlled trial to investigate the efficacy of an oxalate strip for the management of dentine hypersensitivity pain.

OBJECTIVES: To compare a 3.14% potassium oxalate strip and 8% arginine calcium carbonate toothpaste for the reduction of dentine hypersensitivity after 2 and 4 weeks. METHODS: This was an examiner-blind, parallel study in 80 healthy adults with dentine hypersensitivity (Schiff score >2) in >1 tooth. After acclimatisation, participants were randomised to the oxalate desensitising strip with fluoride toothpaste or the arginine desensitising toothpaste control which also contained fluoride. Products were applied under supervision of study staff after measuring baseline sensitivity, thereafter the strip or control toothpaste (fingertip application) was applied after 1 and 2 weeks, and teeth brushed twice-daily with the fluoride (test group) or the fluoridated arginine control toothpaste. Sensitivity was assessed following airblast (Schiff and VAS) and tactile stimuli (Yeaple probe) at baseline, 2 and 4 weeks. RESULTS: Both groups showed significant reductions from baseline in VAS, Schiff and Yeaple sensitivity scores after 2 and 4 weeks (p < 0.0005). The oxalate group had significantly lower Schiff and higher Yeaple probe scores compared to control after both time points (p < 0.0002 and p < 0.05), but while scores favoured the oxalate group, there were no significant differences in VAS. CONCLUSIONS: This study demonstrated application of a 3.14% potassium oxalate strip combined with toothbrushing with paste was more effective in pain management of dentine hypersensitivity than brushing with arginine toothpaste. CLINICAL SIGNIFICANCE: Treatment of sensitive teeth with the oxalate strip reduced dentine hypersensitivity after 2 and 4 weeks to a significantly greater degree than a positive control sensitivity toothpaste demonstrating that oxalate strips are an effective targeted treatment for dentine hypersensitivity sufferers.

A randomised clinical trial to determine the effect of a toothpaste containing enzymes and proteins on gum health over 3 months.

OBJECTIVES: This study tested the efficacy of a toothpaste containing enzymes and proteins reflecting those naturally occurring in saliva which play an important role in maintaining bacterial balance to improve gingival health condition and reduce supra-gingival plaque formation over a period of 13 weeks as compared to a commercial control toothpaste. METHODS: This study was a double-blind, randomised, parallel group, 3 month home use study in healthy volunteers. Non-smokers with a mean modified gingival index (MGI) score of between 2.00-2.75 and at least 20 natural teeth, a minimum of 5 teeth in each quadrant were enrolled in the study. At screening, participants underwent a dental prophylaxis and were issued with a standard fluoride toothpaste and toothbrush to use for 4 weeks. After 4 weeks, participants demonstrating ongoing eligibility were assessed for gingival health and plaque score and randomised to either test or control toothpaste, which they used at home twice daily. After 13 weeks, gingival health and plaque were re-scored. RESULTS: 229 participants completed the study. There were no treatment associated adverse events. Plaque and gingival scores were significantly better in the test group as compared to the control group. Furthermore, in the test group plaque and gingival scores fell, while those in the control group rose over the 13 week period. CONCLUSIONS: The test toothpaste containing enzymes and proteins demonstrated significant plaque and gingival benefit compared to the control toothpaste, and was well tolerated. CLINICAL SIGNIFICANCE: Toothbrushing with the test product derived from naturally occurring enzymes and proteins had a clinical adjunctive improvement on gingival health compared to brushing alone with a commercially available fluoride toothpaste.

Randomized clinical trial to determine if changes in dentin tubule occlusion visualized by SEM of replica impressions correlate with pain scores.

PURPOSE: To quantify dentin tubule occlusion and correlate this with pain reduction in vivo. METHODS: This was a single-center, randomized two treatment, examiner-blind, parallel study. 20 participants with confirmed dentin hypersensitivity (DH) were evaluated by Schiff Air Blast, VAS Air Blast and replica impression of the tooth surface to visualize tubule occlusion at baseline and following 4-week twice daily use of either an occluding toothpaste (8% strontium acetate, 1,040 ppm fluoride) or a non-occluding toothpaste (1,450 ppm fluoride). RESULTS: Both treatments increased tubule occlusion significantly from baseline to 4 weeks (P= 0.01) with significant decreases in pain score only seen with the occluding toothpaste (Schiff, P= 0.01; VAS, P= 0.01). Schiff pain score after 4 weeks was markedly reduced following treatment with the occluding toothpaste as compared to the non-occluding toothpaste, (P= 0.05) with no significant differences between the pastes for occlusion score or patient reported VAS, although the scores favored the occluding toothpaste. CLINICAL SIGNIFICANCE: Occlusion scores as obtained by replica impression techniques with SEM imaging correlate significantly with DH pain scores confirming proof of concept. With further refinement, this technique could be used to accurately quantify tubule occlusion in vivo and the associated pain reduction achieved by occluding toothpastes.

The Efficacy of Plasma Rich in Growth Factors for the Treatment of Alveolar Osteitis: A Randomized Controlled Trial.

PURPOSE: To investigate the efficacy of plasma rich in growth factors (PRGF; BTI Biotechnology Institute, San Antonio, Spain) for the treatment of alveolar osteitis compared with a positive control (Alvogyl; Septodont, Maidstone, Kent, UK). MATERIALS AND METHODS: This single-center, single-blinded, randomized, 2-treatment, parallel study was conducted in a UK dental hospital. All healthy adults who presented with alveolar osteitis after tooth extraction over a 3-month period were invited to participate. Each socket was randomized and treated with 1 of 2 treatment modalities, a test treatment (PRGF) or a positive control (Alvogyl). After treatment, patients were reviewed at 3 and 7 days by a second clinician blinded to the treatment given. Outcome measures included pain, exposed bone, inflammation, halitosis, dysgeusia, and quality-of-life assessment. RESULTS: Thirty-eight patients with data from 44 sockets (22 in the PRGF group and 22 in the Alvogyl group) were analyzed. The PRGF group showed significantly faster bone coverage and significantly decreased inflammation and halitosis (P < .05) compared with the control group receiving Alvogyl. There was no significant difference for pain, quality-of-life measures, or dysgeusia between groups. CONCLUSION: PRGF predictably treated alveolar osteitis after tooth extraction compared with the conventional standard treatment of Alvogyl, which has been used for many years. PRGF could be considered an alternative treatment for alveolar osteitis and indeed appears to have considerable advantages over Alvogyl.

Randomised clinical trial to evaluate changes in dentine tubule occlusion following 4 weeks use of an occluding toothpaste.

OBJECTIVES: The objective of this study is to determine whether a silicone impression material could precisely replicate dentine tubule changes following 4 weeks toothbrushing with occluding or non-occluding toothpaste and whether changes reflected hypersensitivity clinical assessment. MATERIALS AND METHODS: This was a single site, examiner blind, parallel, two treatment arm, randomised clinical trial. Participants were healthy, ≥18, with ≥1 sensitive tooth with exposed dentine, Schiff sensitivity score ≥2, and patent tubules with dentine occlusion score 4-5 as determined by scanning electron microscopy of replica impressions. Nine participants received Sensodyne® Rapid Relief (occluding toothpaste) and 10 Crest® Decay Prevention (non-occluding toothpaste), and were re-evaluated for sensitivity and occlusion score after two timed minutes and 4 weeks twice-daily home brushing. RESULTS: Occlusion scores did not correlate significantly with pain scores, but correlations were positive and impressions showed characteristic dentine tubule patency and occlusion. After 4 weeks, thermal VAS was significantly lower than baseline for the non-occluding toothpaste; all other pain scores were significantly lower for both treatments. Dentine occlusion scores also decreased after 4 weeks of either treatment, but did not achieve significance (p = 0.0625). CONCLUSIONS: Both toothpastes reduced clinical sensitivity and increased tubule occlusion. It is hypothesised that during impression, taking some material may have sheared off and occluded tubules resulting in false positives. CLINICAL RELEVANCE: This study has demonstrated that a silicone impression material can accurately replicate the dentine surface to demonstrate dentine tubular occlusion and patency; however, although the association between occlusion and pain score was positive, this technique needs to be refined before use in future studies.

16S rRNA Next Generation Sequencing Analysis Shows Bacteria in Alzheimer's Post-Mortem Brain.

The neurological deterioration associated with Alzheimer's disease (AD), involving accumulation of amyloid-beta peptides and neurofibrillary tangles, is associated with evident neuroinflammation. This is now seen to be a significant contributor to pathology. Recently the tenet of the privileged status of the brain, regarding microbial compromise, has been questioned, particularly in terms of neurodegenerative diseases. It is now being considered that microbiological incursion into the central nervous system could be either an initiator or significant contributor to these. This is a novel study using 16S ribosomal gene-specific Next generation sequencing (NGS) of extracted brain tissue. A comparison was made of the bacterial species content of both frozen and formaldehyde fixed sections of a small cohort of Alzheimer-affected cases with those of cognitively unimpaired (normal). Our findings suggest an increase in bacterial populations in Alzheimer brain tissue compared with normal.

TBK1: a new player in ALS linking autophagy and neuroinflammation.

Amyotrophic lateral sclerosis (ALS) is an adult-onset neurodegenerative disorder affecting motor neurons, resulting in progressive muscle weakness and death by respiratory failure. Protein and RNA aggregates are a hallmark of ALS pathology and are thought to contribute to ALS by impairing axonal transport. Mutations in several genes known to contribute to ALS result in deposition of their protein products as aggregates; these include TARDBP, C9ORF72, and SOD1. In motor neurons, this can disrupt transport of mitochondria to areas of metabolic need, resulting in damage to cells and can elicit a neuroinflammatory response leading to further neuronal damage. Recently, eight independent human genetics studies have uncovered a link between TANK-binding kinase 1 (TBK1) mutations and ALS. TBK1 belongs to the IKK-kinase family of kinases that are involved in innate immunity signaling pathways; specifically, TBK1 is an inducer of type-1 interferons. TBK1 also has a major role in autophagy and mitophagy, chiefly the phosphorylation of autophagy adaptors. Several other ALS genes are also involved in autophagy, including p62 and OPTN. TBK1 is required for efficient cargo recruitment in autophagy; mutations in TBK1 may result in impaired autophagy and contribute to the accumulation of protein aggregates and ALS pathology. In this review, we focus on the role of TBK1 in autophagy and the contributions of this process to the pathophysiology of ALS.