Effects of stabilized stannous fluoride dentifrice on dental calculus, dental plaque, gingivitis, halitosis and stain: A systematic review.

OBJECTIVES: The aim of the present systematic review was to examine the scientific evidence for the efficacy of stabilized stannous fluoride (SnF2) dentifrice in relation to dental calculus, dental plaque, gingivitis, halitosis and staining. DATA AND SOURCES: Medline OVID, Embase.com, and the Cochrane Library were searched from database inception until June 2017. Six researchers independently selected studies, extracted data, and assessed methodological quality. A meta-analysis of the 6-month gingivitis studies was done. Risk of bias was estimated using a checklist from the Swedish Agency for Health Technology Assessment (SBU, 2018). STUDY SELECTION: Two studies on dental calculus, 21 on dental plaque and gingivitis, 4 on halitosis, and 5 on stain met the inclusion criteria. Risk of bias was high for the studies on dental calculus, halitosis, and stain, and varied for the dental plaque and gingivitis studies. Significant reductions in dental calculus and in halitosis were reported for the SnF2 dentifrice; no differences in stain reduction were noted. A meta-analysis on gingivitis found better results for the SnF2 dentifrice compared to other dentifrices, though the results of the individual trials in the meta-analyses showed a substantial heterogeneity. CONCLUSIONS: The present review found that stabilized SnF2 toothpaste had a positive effect on the reduction of dental calculus build-up, dental plaque, gingivitis, stain and halitosis. A tendency towards a more pronounced effect than using toothpastes not containing SnF2 was found. However, a new generation of well conducted randomized trials are needed to further support these findings. CLINICAL RELEVANCE: Adding a SnF2 toothpaste to the daily oral care routine is an easy strategy that may have multiple oral health benefits.

Salivary Colony Stimulating Factor-1 and Interleukin-34 in Periodontal Disease.

BACKGROUND: Colony-stimulating factor (CSF)-1 and interleukin (IL)-34 are macrophage growth factors and regulators of osteoclastogenesis. Their potential involvement in periodontal disease is yet unknown. The aim of this study is to explore the presence of CSF-1 and IL-34 in whole saliva in relation to periodontal disease. METHODS: Protocol validation was assessed in saliva of healthy donors (n = 21) by enzyme-linked immunosorbent assay. Salivary CSF-1, IL-34, and matrix metalloproteinase (MMP)-8, a biomarker candidate of periodontitis, were determined in 48 patients (29 patients with periodontitis, 12 with gingivitis, and seven healthy patients) and related to the following clinical periodontal parameters: bleeding on probing, probing depth, clinical attachment loss, and plaque index. An additional separate group of patients with gingivitis (n = 21) and some of the patients with periodontitis (n = 11) were subjected to non-surgical periodontal treatment, whereupon changes in salivary CSF-1, IL-34, and MMP-8 levels were determined and related to periodontal outcome. RESULTS: Patients with periodontitis displayed higher CSF-1 and MMP-8 levels in saliva compared with healthy patients, and IL-34 levels were lower. A higher CSF-1/IL-34 ratio was observed in patients with periodontitis compared with healthy patients. There was a positive correlation between CSF-1 and MMP-8, which both correlated negatively to IL-34, in patients with gingivitis and periodontitis. Clinical periodontal parameters correlated positively with CSF-1, MMP-8, and with the CSF-1/IL-34 ratio, and negatively with IL-34 in patients with periodontitis. After treatment CSF-1 and MMP-8 levels decreased together with observed clinical improvement in patients with gingivitis. CONCLUSION: CSF-1 and IL-34 are present in saliva and seem to have complementary roles in periodontal disease: IL-34 in steady-state and CSF-1 in inflammation.

Enhancing meaningful learning and self-efficacy through collaboration between dental hygienist and physiotherapist students - a scholarship project.

INTRODUCTION: Within the field of Dental Hygiene (DH) and Physiotherapy (PT), students are taught to use an evidence-based approach. Educators need to consider the nature of evidence-based practice from the perspective of content knowledge and learning strategies. Such effort to seek best available evidence and to apply a systematic and scholarly approach to teaching and learning is called scholarship of teaching and learning. OBJECTIVES: To evaluate the application of the scholarship model including an evidence-based approach to enhance meaningful learning and self-efficacy among DH and PT students. METHODS: Based on the research on student learning, three central theories were identified (constructivism, meaningful learning and self-efficacy). These were applied in our context to support learner engagement and the application of prior knowledge in a new situation. The DH students performed an oral health examination on the PT students, and the PT students performed an individual health test on the DH students; both groups used motivational interviewing. Documentation of student's learning experience was carried out through seminars and questionnaires. RESULTS: The students were overall satisfied with the learning experience. Most appreciated are that it reflected a 'real' professional situation and that it also reinforced important learning from their seminars. CONCLUSION: The scholarship model made the teachers aware of the importance of evidence-based teaching. Furthermore, the indicators for meaningful learning and increased self-efficacy were high, and the students became more engaged by practising in a real situation, more aware of other health professions and reflected about tacit knowledge.

The invisible work with tobacco cessation - strategies among dental hygienists.

OBJECTIVE: This study elucidates dental hygienists' experiences of work with tobacco cessation among patients who smoke or use snuff. METHODS: Data were obtained and categorized by interviewing 12 dental hygienists, who worked actively with tobacco cessation interventions. Qualitative content analysis was used for analysis. RESULTS: The latent content was formulated into the core category 'the invisible oral health promotion work'. The informants thought that they had a responsibility to work with tobacco cessation. They perceived the financial system in which they perform the activity as frustrating, because tobacco cessation has no treatment code in the dental care insurance. This was one of several reasons why they had to integrate it in other treatment procedures. The results identified three categories: 'balance in the meeting', 'possibilities and hindrance' and 'procedures'. In the narratives, both positive and negative aspects were displayed. CONCLUSIONS: The financial conditions for tobacco cessation interventions need to be reformed and the activity has to be given a higher priority in the organization of dental care. Practical training in performing tobacco cessation interventions is important during the dental hygiene education; otherwise, tobacco cessation interventions will remain invisible in oral health promotion in the future.

The role of the toothbrush in the abrasion process.

AIM: To evaluate the relative abrasivity of different toothbrushes both qualitatively and quantitatively. MATERIALS AND METHODS: Acrylic plates were exposed to brushing in a brushing machine with ten different toothbrushes with water alone and with a toothpaste. The results were evaluated using a profilometer after one and 6 h of brushing (corresponding to 2000 and 12,000 double strokes, respectively). A surface roughness value (Ra-value) and also a volume loss value were calculated from the profilometer measurements. These values were then compared to each other. RESULTS: The results showed that brushing with water alone caused less abrasion than when a toothpaste was added. Six-hour brushing with water caused less abrasion than 1 h with a toothpaste. The number of filaments or filament diameter influenced the results in various ways. When brushing with water, the harder toothbrush (Jordan Medium) caused more abrasion (higher Ra-value), but when adding the toothpaste, the softer toothbrush (Jordan soft) caused more abrasion after 12,000 double strokes. CONCLUSION: Besides supporting the fact that a toothpaste is needed to create a significant abrasion, this study also showed that a softer toothbrush can cause as much and in some cases more abrasion than harder ones. When conducting abrasivity studies, it is important to look at both the quantitative and qualitative aspect of abrasivity.

The influence of academic stress on gingival inflammation.

OBJECTIVE: The aim of the present study was to investigate the effects of academic stress on periodontal health, in relation to inflammatory markers in gingival crevicular fluid (GCF) and cortisol in saliva. MATERIALS AND METHODS: The study included 20 healthy dental hygienists (females: mean age 29.3 +/- 8.5 SD) and was conducted during a major exam period and 4 weeks later after the exams. A clinical examination was performed and GCF was collected from four sites in each subject on these two occasions. Interleukin (IL)-1beta, IL-4, IL-6, IL-10 levels were determined using Luminex 100 and cortisol amounts by radioimmunoassay (RIA (125)I). Students registered their perceived stress on a visual analogue scale (VAS). Significance of the findings was determined using paired t-test, Wilcoxon-matched pair and Spearman's rank correlations. RESULTS: Students had higher amounts of dental plaque (P < 0.007) and gingival inflammation (P < 0.001) during the exam period compared with after the exams. The amounts of IL-6 and IL-10 in GCF were significantly increased during the time of examinations. The median level of cortisol in saliva was also significantly raised during the exam period compared with after the exams, 20.52 nmol/l (range: 11.91-27.34) and 16.41 nmol/l (range: 10.91-24.17) respectively, P < 001. The results from the VAS registration revealed a significant difference (P < 001) between the two occasions. CONCLUSION: Academic stress appears to affect periodontal health, shown by more plaque accumulation, gingival inflammation and increased amounts of IL-6, IL-10 in GCF and cortisol in saliva.

Gingival inflammation, increased periodontal pocket depth and elevated interleukin-6 in gingival crevicular fluid of depressed women on long-term sick leave.

BACKGROUND AND OBJECTIVE: The aim of this work was to investigate periodontal status, in relation to inflammatory markers and cortisol, in the gingival crevicular fluid and saliva of a homogenous group of women on long-term sick leave for job-stress related depression in comparison to nondepressed women. MATERIAL AND METHODS: The participants comprised 20 women with depression (DSM-IV) (mean age 48.5 +/- 6.9 years) and 29 healthy controls (mean age 54.5 +/- 2.9 years). Clinical examination was performed. Gingival crevicular fluid was collected by an intracrevicular washing technique. Interleukin-1 beta, interleukin-6, matrix metalloproteinase (MMP)-8 and MMP-9 were determined with enzyme-linked immunosorbent assay and cortisol was determined by using a radioimmunoassay. One-way analysis of covariance was used as the statistical method. RESULTS: The depressed patients had significantly higher gingival inflammation (p < 0.001), and deeper pockets (p < 0.003), than the healthy controls, after adjusting for age and smoking. The levels of interleukin-6 in the gingival crevicular fluid were significantly higher in the patients than in the controls: 3.84 +/- 1.58 pg per site and 0.79 +/- 1.83 pg per site, respectively, p < 0.003. There were no significant differences in the levels of interleukin-1 beta, MMP-8 and MMP-9. The patients had lower cortisol values in gingival crevicular fluid than the controls, whereas the levels of cortisol in saliva were similar in both groups. CONCLUSION: Women on long-term sick-leave for depression had more severe periodontitis and higher concentrations of interleukin-6 in gingival crevicular fluid than healthy controls. An alteration of the immune system in these patients might be interpreted as reflecting the consequences of long-term stress exposure and might contribute to worse periodontal conditions in these particular patients.

Quantitative secretion and maximal secretion capacity of retinol, beta-carotene and alpha-tocopherol into cows' milk.

Changes in the contents of retinol, alpha-tocopherol and beta-carotene in plasma, milk and milk fat from 38 Holstein-Friesian cows were followed during their first lactation, and the quantitative and kinetic relationships for secretion of alpha-tocopherol and beta-carotene from blood into milk were determined. The cows were assigned to three groups such that all cows in the same group had the same sire. Milk yield and milk fat content differed with stage of lactation, but not according to sire. The plasma concentrations of retinol, alpha-tocopherol and beta-carotene differed with stage of lactation; in addition, retinol and beta-carotene concentration also differed according to sire. The concentrations of all three vitamins in milk and milk fat differed according to sire and stage of lactation. Furthermore, the total secretion of retinol, alpha-tocopherol and beta-carotene into milk (expressed as mg/d) differed with sire and stage of lactation. The quantitative secretion of alpha-tocopherol and beta-carotene from blood into milk followed Michaelis-Menten kinetics for active transport across membranes. Values of maximum secretory capacity Vmax and the half-rate constant K(m) for both alpha-tocopherol and beta-carotene varied according to sire. Overall means for Vmax for alpha-tocopherol and beta-carotene were 32.4 and 2.5 mg/d. Thus, the daily secretion of alpha-tocopherol and beta-carotene is limited in quantity, and is independent of the yields of milk and milk fat. It follows that continuing breeding and management systems that focus solely on increasing milk and milk fat yield will result in a steady dilution in the milk fat of these vitamins and antioxidants important for the immune defence of the cows and oxidative stability of milk products. The genetic variation found offers the possibility of utilizing these variations in breeding systems.

[Animal nutrition for veterinarians--recent cases of clinical disorders in horses after intake of ionophore-containing feed]. / Tierernährung für Tierärzte--aktuelle Fälle Klinische Störungen bei Pferden nach Aufnahme Ionophore-haltigen Mischfutters.

Anamnesis and clinical signs of horses form five different stables after ingestion of ionophores are reported and techniques of feed examination are described. Within a few hours or days after feeding of new types or batches of concentrates horses fell ill. They showed colic-like symptoms with intense sweating and ataxia. Most of the sick animals died within a short time span. Samples of the concentrates were analysed and different types and amounts of ionophores were detected. In four cases contamination by monensin in concentrations of less than 5 mg to 679 mg/kg feed were found. One feed sample contained monensin (8.8 mg/kg feed) as well as salinomycin (67.3 mg/kg feed). In one case lasalocid (7.9 mg/kg feed) was present. One horse from the stable where animals had obtained concentrates containing monensin (679 mg/kg feed) was necropsied. Typical signs of monensin intoxication with severe myocardial degeneration were found. Veterinarians should be alert to this rare but severe intoxication of horses.

Renal osteodystrophy. Effect of hemodialysis and 1 alpha-hydroxy vitamin D3 on bone lesions and metacarpal bone mass.

Radiologic bone lesions in 20 long-term hemodialyzed patients with chronic renal failure are described. During chronic dialysis the bone lesions increased. Treatment of 8 patients with 1 alpha-OH-D3 for 6 months prevented progression of the bone lesions or improved them.

Recurrent instability of the ankle joint. Surgical repair by the Watson-Jones method.

Twenty-one ankle joints with recurrent lateral instability, treated with surgical repair by the Watson-Jones method, were included in a follow-up study 1--5 years after operation. Good results were achieved in 80 per cent. However, the results were not better than those after free dissection and direct suture of the ligamentous ruptures. It is therefore recommended that the more extensive Watson-Jones procedure be reserved for selected cases.

Bone maturation in children with chronic renal failure. Effect of 1 alpha-hydroxy vitamin D3 and renal transplantation.

In 8 of 11 children with terminal chronic renal failure, bone age was retarded 6 months to 3 years. During hemodialysis the bone maturation rate decreased. 1 alpha-OH vitamin D3 treatment and renal transplantation normalized the bone maturation rate.

Radiological diagnosis of lateral ligament lesion of the ankle. A comparison between talar tilt and anterior drawer sign.

In a prospective study of 244 patients with ankle lesions a comparison between the talar tilt and the anterior drawer sign was made, leading to the following conclusions: Ligament lesions which are not disclosed by the talar tilt examination may be diagnosed by the anterior drawer sign. The anterior drawer sign cannot replace the talar tilt examination, or vice versa. The two methods are complementary. It is not possible to differentiate between an isolated lesion of the anterior talofibular ligament and a combined lesion of the anterior talofibular and the calcaneofibular ligaments by the two methods.

Increased serum calcitonin in patients with mammary carcinoma.

Serum calcitonin war within normal range in 11 patients with benign breast tumour. In cases with local malignant breast tumour increased calcitonin was found in 25 per cent (4/16), in cases with regional metastases in 40 per cent (2/5), and in cases with osteolytic bone metastases in 77 per cent (10/13). Two patients with osteosclerotic bone metastases had low calcitonin concentration. It is suggested that increased calcitonin in mammary carcinoma is a physiologic response to osteolytic bone metastases.

Chronic sclerosing osteomyelitis of the mandible. Radiographic differential diagnosis from fibrous dysplasia.

Among 13 patients with chronic osteomyelitis of the lower jaw, clinical, radiologic and histologic difficulties were encountered in 5 cases, in the differential diagnosis from fibrous dysplasia. The radiologic, and in some measure the clinical and histologic features typical of the two diseases are described. Variations in the bone structure during the course of the disease, as well as periosteal new-bone formation, are characteristics of chronic osteomyelitis. When problems are encountered in differentiating between fibrous dysplasia with periodical pain and swelling, and osteomyelitis, repeated radiologic examinations are to be recommended.