Digital plaque monitoring: An evaluation of different intraoral scanners.

OBJECTIVES: Intraoral scanners (IOS) display disclosed plaque, and the scientific literature has reported that plaque levels can be monitored on intraoral scans using one IOS system (Dexis 3800; control IOS). This study aimed to investigate whether this is also possible with other IOS systems (i700, Primescan, Trios 5; test IOS). MATERIALS AND METHODS: Ten participants (29.6 ± 5.5 years) were enrolled. After plaque accumulation and subsequent toothbrushing, intraoral scans were performed with the control IOS and the three test IOS. All scans were aligned and the vestibular/oral surfaces of the Ramfjord teeth (16, 21, 24, 36, 41, 44) were analysed with automated planimetry using a predefined threshold value. The proportion of pixels assigned to plaque-covered areas was expressed as a percentage of the total number of pixels (P%). We then assessed whether the planimetrically determined plaque-covered areas corresponded to those identified visually. This revealed that a threshold correction (P%corr) was required for approximately 20 % (i700 and Trios 5) to over 65 % (Primescan) of the images. RESULTS: Bland-Altman analysis showed no significant systematic bias and limits of agreement ranging from approximately -20 to +20 P% units, with a tendency towards lower values at higher plaque coverage. Manual correction improved the agreement and halved the limits of agreement. All test IOS could detect a reduction in plaque after brushing, as well as the typical site-dependant plaque distribution patterns. CONCLUSIONS: All test IOS appeared to be suitable for plaque monitoring. Planimetric methods must be adapted to the colour representation of the IOS. CLINICAL SIGNIFICANCE: Plaque monitoring using IOS opens a new field of application in preventive dentistry.

DIGITAL DENTISTRY AND ITS IMPACT ON ORAL HEALTH-RELATED QUALITY OF LIFE.

Over the past 50 years, digitization has gradually taken root in dentistry, starting with computer tomography in the 1970s. The most disruptive events in digital dentistry were the introduction of digital workflow and computer-aided manufacturing, which made new procedures and materials available for dental use. While the conventional lab-based workflow requires light or chemical curing under inconsistent and suboptimal conditions, computer-aided manufacturing allows for industrial-grade material, ensuring consistently high material quality. In addition, many other innovative, less disruptive, but relevant approaches have been developed in digital dentistry. These will have or already impact prevention, diagnosis, and therapy, thus impacting patients' oral health and, consequently, their oral health-related quality of life. Both software and hardware approaches attempt to maintain, restore, or optimize a patient's perceived oral health. This article outlines innovations in dentistry and their potential impact on patients' oral health-related quality of life in prevention and therapy. Furthermore, possible future developments and their potential implications are characterized.

White spot lesions after fixed appliance treatment-Can we expect spontaneous long-term (≥15 years) improvement?

OBJECTIVE: To investigate the extent to which post-orthodontic white spot lesions (WSLs) change in appearance over a period of ≥15 years and whether an association with caries data exists. SUBJECTS AND METHODS: Seventy-two patients treated with a Herbst-Multibracket appliance at age 14.0 ± 2.7 years for 20.1 ± 5.1 months who attended a recall 18.3 ± 2.9 years post-treatment. Post-treatment (T1) intraoral photographs were assessed by a panel of five dentists using a modified version of the WSL-Index by Gorelick. For affected incisors, photographs from before treatment (T0) and recall (T3) were evaluated. In addition, the WSL-Change Index by Pancherz and Muehlich was assessed for all adequately visible incisors considering T1, T2 (if available), and T3. Radiographic (T0, T1, and T2-if available) and clinical (T3) MFT data were used. RESULTS: 37.5% of the patients exhibited WSLs on ≥ 1 incisor at T1; in total, 81 incisors (14.9%) were affected. At T3, 48% of the WSLs had improved. The modified WSL-Index decreased from 1.2 ± 0.4 to 0.8 ± 0.6 (P < .001), with a score 0 in 28% of the previously affected incisors. When comparing T2 vs. T3, additional improvement after T2 occurred in 11% of the teeth. While no difference existed at T0, the MFT values at T1, T2, and T3 were higher (P ≤ .05) in patients with WSLs at T1 than in those without. LIMITATIONS: The homogeneity of the subjects was limited and no patient-reported outcome was assessed. CONCLUSIONS: Long-term, post-orthodontic WSLs showed spontaneous full recovery in 28% and improvement in 48% of the teeth. Patients affected with WSLs exhibited higher post-treatment MFT values.

Understanding the Influence of Patient Factors on Accuracy and Decision-Making in a Diagnostic Accuracy Study with Multiple Raters-A Case Study from Dentistry.

In diagnostic accuracy studies, the test of interest is typically applied only once in each patient. This paper illustrates some possibilities that arise when diagnoses are carried out by a sufficiently large number of multiple raters. In a dental study, sixty-one examiners were asked to diagnose 49 tooth areas with different grades of tissue loss (minor, moderate, and advanced) to decide whether dentine was exposed (positive status) or not (negative status). The true status was determined by histology (reference). For each tooth, the rate of correct decisions reflecting the difficulty to diagnose this tooth and the positive rate reflecting the perception of the tooth by the raters was computed. Meta-analytical techniques were used to assess the inter-tooth variation and the influence of tooth-specific factors on difficulty or perception, respectively. A huge variation in diagnostic difficulty and perception could be observed. Advanced tissue loss made diagnoses more difficult. The background colour and tissue loss were associated with perception and may hint to cues used by the raters. The use of multiple raters in a diagnostic accuracy study allows detailed investigations which make it possible to obtain further insights into the decision-making process of the raters.

Intraoral scanner-based monitoring of tooth wear in young adults: 24-month results.

OBJECTIVES: Tooth wear causes irreversible cumulated surface loss and already occurs at a young age. Therefore, the objective of this clinical prospective observational study was to monitor the occlusal surface of a mandibular first molar in young adults for a period of 24 months. Furthermore, potential aetiological factors obtained by a questionnaire were considered. MATERIALS AND METHODS: The study teeth (FDI #36 or #46) of 81 participants (mean age 22.8 ± 2.2 years) were scanned with the intraoral scanner (IOS, Trios 3, 3Shape) at the second follow-up (T2) after an observation period of 24 months. Standard-tessellation-language datasets were superimposed with baseline (T0) and T2 scans in 3D analysis software (GOM Inspect). The maximum vertical substance loss was measured between T0 and T2 at 6/7 areas (4/5 cusps and 2 ridges) of each study tooth and data compared to the already published data of the first follow-up (T1) after 12-month observation period. The morphology of tooth wear was classified into three groups: cupping (C), facet (F) and combined cupping-facet (CF). The analysis of aetiological factors, such as acid impacts, was based on a questionnaire filled out by participants at time points T0, T1 and T2. Non-parametric tests were used for statistical analysis (p < 0.05). RESULTS: The buccal load-bearing cusps (mesiobuccal: median 15 µm, 95%CI 11/18 µm; mesiolingual 8 µm, 0/11 µm) were most affected by tooth wear. Loss values increased significantly at T2 compared to T1 for all areas, although significantly less than in the first 12 months (T0-T1). Areas that already exhibited F at T0 mostly displayed them also at T2 and only rarely developed further into C or CF. The only association between aetiological factors and loss values could be detected for sex as males had significantly higher loss values than females. CONCLUSIONS: Progression of tooth wear could be clearly shown with high interindividual variations in loss values among participants. This indicates the need for individual monitoring with IOS. CLINICAL RELEVANCE: IOSs show the potential for patient-specific monitoring to detect the progression of tooth wear. Thus, data of 24 months fills the gap of tooth wear data for young adults in literature. Further studies over a longer observation period are highly recommended to gain more information about the dynamic of tooth wear and aetiological factors.

Visualization of dental plaque with a 3D-intraoral-scanner-A tool for whole mouth planimetry.

Planimetry is a reliable method for detecting and monitoring plaque. Until now, this method has mainly been applied to conventional-camera images, which is difficult and time-consuming in relation to the entire dentition. Today, 3D-intraoral-scans are well suited for imaging the entire dentition and are therefore an efficient and feasible alternative. 3D-intraoral-scans have already proven successful for the quantification of plaque based on a plaque index. Therefore, aim of this study was to investigate whether images from 3D-intraoral-scans are also suitable for valid planimetric plaque measurements and monitoring; intraoral-camera images served as a reference. Twenty subjects (27.5±1.2 years) were included. Plaque was disclosed at three different time points: habitual plaque (T1), after 72 h without oral hygiene (T2) and after subsequent tooth brushing (T3) and quantified using 3D-intraoral-scans and intraoral-camera images (intraoral-camera CS 1500, intraoral-scanner CS 3600; Carestream Dental, Germany). The percentage of the plaque-covered surface of the total surface area (P%) was determined with a software specially programmed for this purpose using images from 3D-intraoral-scans of the oral and vestibular surfaces of the Ramfjord teeth (16, 21, 24, 36, 41, and 44); the intraoral-camera images of the vestibular surfaces of 16 and 36 served as reference. P% from images of the 3D-intraoral-scan and the intraoral-camera revealed a very good correlation (r = 0.876; p ≤ 0.001); the Bland-Altmann analysis showed a good agreement with no proportional and a very minor systematic bias with slightly higher values from images of the 3D-intraoral-scan. Further, P% measurements of the images of the 3D-intraoral-scan were able to detect changes in plaque levels, showing a 47% (p ≤ 0.001) increase in P% from T1 to T2 and a 43% (p ≤ 0.001) decrease after toothbrushing (T3). Planimetry using images of the 3D-intraoral-scan seems to be a suitable tool for whole mouth planimetry to record and monitor dental plaque.

In vitro evaluation of the effects of different particle types in toothpastes on the efficacy against enamel erosion and wear.

The effects of the particle fraction in toothpastes in the context of erosion and erosive tooth wear has not been fully elucidated. Thus, aim of this study was to investigate experimental toothpastes, each with one specific particle type. Toothpastes with seven different types of silica or alumina were prepared as slurry either with or without active ingredients (NaF or F/Sn). Human enamel samples were exposed to a cyclic erosion/abrasion model, and were either treated with the respective slurries only or additionally brushed in a brushing machine. Tissue loss was profilometrically monitored. After treatment with slurries without active ingredients or with NaF, tissue loss increased significantly within groups over time (p < 0.001 each). At the end of the trial, there were minor differences between groups (not exceeding 10-20%; p > 0.05 for most comparisons). After treatment with the F/Sn slurries, tissue loss stagnated completely over time, with the exception of one silica type and alumina, but both still reduced tissue loss by 40-50% (compared to control p < 0.001 each). Relative to the type of the active ingredient, the particle type seems to be a secondary factor for the efficacy of toothpastes on erosion and erosive tooth wear in enamel.

The Suitability of Questionnaires for Exploring Relations of Dietary Behavior and Tooth Wear.

Tooth wear is a relevant oral health problem, especially at a young age. Although ongoing acid exposures may contribute to tooth wear, the role of acidic dietary components in this context remains unclear. To date, in tooth wear studies, dietary behavior has been assessed using traditional questionnaires, but the suitability of this approach has not been investigated so far. In our longitudinal study, we followed 91 participants (21.0 ± 2.2 years) over a period of 1 year (373 ± 19 days) and monitored tooth wear with an intraoral scanner. At baseline (T0) and at the end (T1), we assessed dietary behavior with questionnaires asking about the consumption frequencies of acidic dietary components and the acid taste preferences. Complete data were available from 80 subjects. The consumption frequencies of T0 and T1 correlated weakly to moderately. Taste preferences seem to be a more consistent measure, but there was predominantly no significant correlation with the corresponding consumption frequencies. None of the dietary parameters showed a significant relation with tooth wear. The suitability of dietary questionnaires to assess tooth-relevant dietary behavior seems to be limited.

Detecting and monitoring dental plaque levels with digital 2D and 3D imaging techniques.

Detecting and monitoring dental plaque is an important issue in research and clinical practice. In this context, new digital imaging methods that permit permanent documentation of the clinical findings could be promising tools. The aim of the study was therefore to investigate whether disclosed plaque can be reliably visualised on 2D and 3D images captured with digital intraoral imaging devices. Clinical examination was the reference method. Twenty subjects (27.5±1.2 years) were included and plaque was measured at three different stages: habitual plaque (T1), after 72 h without oral hygiene (T2) and after a subsequent habitual brushing exercise (T3). At each time point, plaque was disclosed followed by the clinical examination and capturing the 2D and 3D images (intraoral-camera CS 1500 and intraoral-scanner CS 3600; Carestream Dental, Germany). Plaque amounts were recorded on oral and vestibular surfaces of the Ramfjord-teeth (16, 21, 24, 36, 41, 44) using the Rustogi-modified-Navy-Plaque-Index (RMNPI) and expressed as percentage of plaque-containing RMNPI areas of all RMNPI areas. At T1, percentages (mean±SD) obtained from the clinical examination, 2D and 3D images were 62.2±10.6, 65.1±10.0 and 64.4±10.6 resp. increasing to 76.9±8.0, 77.9±8.6 and 77.5±9.4 resp. at T2. After toothbrushing (T3), values decreased to 56.3±11.1, 58.2±12.1 and 61.2±10.8 resp. All methods were able to show statistically significant changes in plaque amounts at the different time points with in part statistically significant but minor differences between them. The Bland-Altmann analysis revealed a good agreement between values from both 2D and 3D images with the clinical examination. The agreement of the scores obtained with the both image-based methods for the single RMNPI areas with the clinical examination was mainly classified as substantial to almost perfect. Amounts of plaque can be reliably detected and monitored on 2D images from an intraoral camera and on 3D images from an intraoral scanner.

Interdental biofilm reduction and composition after use of an activated and inactivated side-to-side toothbrush - a proof-of-principle clinical study.

OBJECTIVES: To evaluate interdental biofilm reduction and composition after powered toothbrushing with a side-to-side (sonic) toothbrush compared to manual toothbrushing following single brushing exercises in periodontally healthy young adults. MATERIALS AND METHODS: All participants brushed with a side-to-side toothbrush without toothpaste in four different modes: toothbrush (a) inactivated without instruction (OFF-NI), (b) activated without instruction (ON-NI), (c) inactivated with instruction (OFF-I), and (d) activated with instruction (ON-I) at consecutive visits (single brushing exercises). Before and after brushing, the Approximal Plaque Index (API) was assessed at three interdental spaces and plaque samples were taken from two interdental sites. Biofilm reduction and composition were analyzed microbiologically by total bacterial load and 16S rRNA sequencing. RESULTS: Thirty participants (age: 22.9 ± 2.5 years) completed the study. Most participants showed no or incomplete plaque removal assessed by API following single brushing exercises, while the frequency of API reduction was higher after ON-NI compared to OFF-I (p = 0.023). Irrespective of the brushing mode, a significant reduction of total bacterial load was detected with lower bacterial counts after OFF-NI compared to ON-NI (p = 0.008) and ON-I (p = 0.007). Biofilm composition showed slight changes in the relative abundances of bacterial taxa, regardless of the brushing mode. CONCLUSIONS: Manual and powered toothbrushing with a side-to-side toothbrush, with and without instruction, showed incomplete interdental biofilm removal in periodontally healthy young adults following single brushing exercises. CLINICAL RELEVANCE: Data has to be validated in further studies on other groups, however, in periodontally healthy young adults, additional devices seem to be necessary for sufficient interdental cleaning.

Intraoral scanner-based monitoring of tooth wear in young adults: 12-month results.

OBJECTIVES: To investigate tooth wear in young adults, intraoral scanning was used for digital monitoring of the mandibular first molar over 12 months. A possible influence of aetiological factors obtained by a questionnaire on tooth wear was investigated. MATERIALS AND METHODS: A total of 109 participants (mean age at the start of the study: 21.0 ± 2.2 years) were included in this clinical study. At baseline (T0), an intraoral scan (Trios 3, 3Shape) of the study tooth (FDI # 36 or #46) was conducted. After a mean observation period of 373 ± 19 days, a second intraoral scan (T1, n = 94) of the same tooth as at T0 was performed and standard tessellation language datasets were superimposed with 3D analysis software (GOM Inspect). The occlusal surface of the study tooth was divided into 7 areas (5 cusps, 2 ridges) and maximum vertical substance loss was measured between T0 and T1 (n = 91). Three types of tooth wear were defined: cupping (C), facet (F) and combined cupping-facet (CF). Furthermore, a questionnaire on aetiological factors, such as dietary behaviour, was filled out at T0. Data were analysed with non-parametric tests (p < 0.05). RESULTS: Only one study tooth exhibited no tooth wear at T0, whereas 3 teeth showed C, 47 teeth F and 40 teeth CF. A progression of vertical substance loss for all three types was shown. Most affected were the mesiobuccal cusps (43, 38/47 µm; median, 95%CI) followed by distobuccal (36, 33/39 µm), mesiolingual (35, 26/40 µm), distolingual (34, 27/36 µm) and distal (31, 25/34 µm). On mesial and distal ridges, only F was detected with the lowest vertical substance loss of all areas (mesial ridge: 0, 0/0 µm; distal ridge: 0, 0/0 µm). An association between aetiological factors and loss values could not be shown. CONCLUSIONS: All study teeth showed clear signs of wear, and after only 1 year, further substance loss was detectable. This result is of significance for young adults. CLINICAL RELEVANCE: Since data of young adults regarding tooth wear are scarce, the results give a first idea of the amount of vertical loss per year and its relation to aetiological factors such as dietary behaviour. Therefore, further studies over a longer observation period are highly recommended.

Efficacy of a sonic toothbrush on plaque removal-A video-controlled explorative clinical trial.

Clinical studies on the efficacy of sonic toothbrushes show inconsistent results, most studies have been conducted without sufficient supervision of appropriate toothbrush usage. Aims of the explorative clinical trial were therefore to investigate whether the usage of an activated sonic toothbrush reduces plaque more effectively than an inactivated one used as a manual toothbrush, and to which extent the correct use of such toothbrush plays a role in its efficacy. The clinical trial was designed as a video-controlled interventional study. Thirty participants (mean (±SD) age 22.9 (±2.5) years) were included, areas of interest were the buccal surfaces of the upper premolars and the first molar (partial mouth recording). Toothbrushing was performed without toothpaste in a single brushing exercise under four different conditions: switched off, habitually used as manual toothbrush, no instruction; switched on, habitually used as powered toothbrush, no instruction; switched off, used as manual toothbrush, instruction in the Modified Bass Technique; switched on, used as powered toothbrush, instruction in a specific technique for sonic toothbrushes. Brushing performance was controlled by videotaping, plaque was assessed at baseline (after 4 days without toothbrushing) using the Rustogi modified Navy-Plaque-Index and planimetry. Main study results were that plaque decreased distinctly after habitual brushing regardless of using the sonic brush in ON or OFF mode (p for all comparisons < 0.001). After instruction, participants were able to use the sonic brush in ON mode as intended, with only minor impact on efficacy. Using the toothbrush in OFF mode with the Modified Bass Technique was significantly less effective than all other conditions (p for all comparisons < 0.001). Under the conditions used, the sonic toothbrush was not more effective when switched on than when switched off, and there was no evidence that the correct use of the toothbrush was more effective than the habitual use.

Monitoring of Erosive Tooth Wear with Intraoral Scanners In vitro.

Intraoral scanners (IOS) have been used to quantify tooth wear, but so far they have not been systematically validated for monitoring of tissue loss. The aim of this in vitro study was to investigate whether progression of tissue loss can be detected with an IOS and whether IOS values agree with those obtained with noncontacting profilometry (PRO) serving as a standard method. Model jaws were mounted in a phantom head positioned in a dental chair. Flattened areas were prepared on the non-load-bearing cusps of the first molars (model teeth; n = 16) in order to fix flat enamel samples with an experimental area and a reference area. After baseline PRO and IOS, the experimental enamel area was stepwise etched with 35% H3PO4 gel (4 × 30 s and 4 × 15 s). After each etching, PRO and IOS was performed and the vertical tissue loss between the reference and experimental areas was measured, each at the same 3 measurement points. Furthermore, cupped cusps were simulated by stepwise preparation of the load-bearing cusps of the model teeth with a spherical diamond bur, and the maximum vertical depth after each preparation step was measured only by IOS. Trios3 (3Shape, Denmark), Carestream CS3600 (Carestream, USA) and an optical profilometer (MicroProf, Fries, Germany) were used to measure the flat areas of the enamel samples, whereas only IOS were used to measure curved surfaces on the load-bearing cupped cusps of the model teeth. The IOS data were analyzed with an external software (GOM Inspect, Germany) and with the respective internal IOS software. PRO revealed a mean (±SD) tissue loss of 17.1 ± 4.7 µm after 30-s etching steps and 10.1 ± 5.1 µm after the 15-s etching steps. IOS and software types were able to detect the progression of tissue loss after each etching step (p ≤ 0.001 each); Bland-Altmann plots revealed good agreement with PRO regardless of the order of tissue loss, and no systematic difference was found. Increasing cupped lesion depths were detected by all IOS, with no significant differences between IOS and analysis methods. IOS were able to detect small amounts of tissue loss under simulated clinical conditions and seem to be a promising tool for monitoring even initial erosive tooth wear.

Validation of motion tracking as tool for observational toothbrushing studies.

Video observation (VO) is an established tool for observing toothbrushing behaviour, however, it is a subjective method requiring thorough calibration and training, and the toothbrush position is not always clearly visible. As automated tracking of motions may overcome these disadvantages, the study aimed to compare observational data of habitual toothbrushing as well as of post-instruction toothbrushing obtained from motion tracking (MT) to observational data obtained from VO. One-hundred-three subjects (37.4±14.7 years) were included and brushed their teeth with a manual (MB; n = 51) or a powered toothbrush (PB; n = 52) while being simultaneously video-filmed and tracked. Forty-six subjects were then instructed how to brush their teeth systematically and were filmed/tracked for a second time. Videos were analysed with INTERACT (Mangold, Germany); parameters of interest were toothbrush position, brushing time, changes between areas (events) and the Toothbrushing Systematic Index (TSI). Overall, the median proportion (min; max) of identically classified toothbrush positions (both sextant/surface correct) in a brushing session was 87.8% (50.0; 96.9), which was slightly higher for MB compared to PB (90.3 (50.0; 96.9) vs 86.5 (63.7; 96.5) resp.; p = 0.005). The number of events obtained from MT was higher than from VO (p < 0.001) with a moderate to high correlation between them (MB: ρ = 0.52, p < 0.001; PB: ρ = 0.87; p < 0.001). After instruction, both methods revealed a significant increase of the TSI regardless of the toothbrush type (p < 0.001 each). Motion tracking is a suitable tool for observing toothbrushing behaviour, is able to measure improvements after instruction, and can be used with both manual and powered toothbrushes.

Comparison of Quantitative light-induced fluorescence-digital (QLF-D) images and images of disclosed plaque for planimetric quantification of dental plaque in multibracket appliance patients.

The purpose of the present cross-sectional clinical study was to check the ability of plaque detection and quantification by QLF-D against conventional digital photographs of disclosed plaque in multibracket appliance (MB) patients. 20 patients were included according to the following criteria: (1) upper and lower jaw treated by MB appliance, (2) patients being 16 years of age or older, (3) all central and lateral incisors as well as canines in situ, (4) absence of developmental defects, carious lesions, surface fillings, prosthetic restorations or recessions greater than 1/3 of root length in central/lateral incisors and canines as well as (5) declaration of consent. QLF-D and conventional photographs were analyzed planimetrically regarding plaque coverage on buccal and oral surfaces of central/lateral incisors and canines. The conventional photographs of stained plaque served as gold standard. On average, in QLF-D pictures 20.7% ± 17.4 of the tooth surfaces were covered with plaque, while the conventional photographs of disclosed plaque presented a mean plaque-covered area of 36.2% ± 23.5. The Bland-Altman plot for both imaging modalities showed a very large inconsistent scattering with both negative and positive deviations. The method discrepancy increased with increasing plaque coverage, thus indicating a systematic method error. On average, the deviation of the methods from the optimal line of accordance was -15.5%. In patients wearing MB appliances, there was no clinical significant agreement regarding the plaque-covered tooth surface depicted by QLF-D respectively conventional images of disclosed plaque. Due to the large method discrepancy, QLF-D is currently not reliable for precise plaque quantification in MB patients.

Terminology of Erosive Tooth Wear: Consensus Report of a Workshop Organized by the ORCA and the Cariology Research Group of the IADR.

Our understanding of erosive tooth wear and its contributing factors has evolved considerably over the last decades. New terms have been continuously introduced, which frequently describe the same aspects of this condition, whereas other terms are being used inappropriately. This has led to unnecessary confusion and miscommunication between patients, professionals, and researchers. A group of 15 experts, selected by the European Organization for Caries Research (ORCA) and the Cariology Research Group of the International Association for Dental Research (IADR), participated in a 2-day workshop to define the most commonly used terms in erosive tooth wear. A modified Delphi method was utilized to reach consensus. At least 80% agreement was achieved for all terms discussed and their definitions related to clinical conditions and processes, basic concepts, diagnosis, risk, and prevention and management of erosive tooth wear. Use of the terms agreed on will provide a better understanding of erosive tooth wear and intends to enable improved communication on this topic.

Viscosity of chitosan impacts the efficacy of F/Sn containing toothpastes against erosive/abrasive wear in enamel.

OBJECTIVES: Chitosan (Ch) in F/Sn-toothpastes can increase toothpastes' anti-erosive efficacy. Whether efficacy can be further increased by changing chitosan's viscosity was study aim. METHODS: 192 human enamel specimens were assigned to 2 × 6 groups (n = 16 each): Four F/Sn (500 ppm F-, 800 ppm Sn2+) toothpastes with chitosan (0.5 %, viscosity 50, 500, 1000 or 2000 mPas), negative-control (no F/Sn/chitosan), positive-control (F/Sn, no chitosan). The study was conducted in two experiments (E1/E2). Specimens were cyclically demineralised (10 d, 6 × 2 min/d; 0.5 % citric acid); half of groups (E1) was exposed to toothpaste slurries (2 × 2 min/d), the other half was additionally brushed (2 × 15 s/d, E2). Tissue loss (mean ±â€¯SD, µm) was quantified profilometrically. Element analysis (EDX, wt%) on specimen surfaces and on toothpastes' particulate fraction and SEM analysis of specimen surfaces were performed. RESULTS: Tissue loss in negative-controls (E1/E2) was 4.96 ±â€¯1.55/12.76 ±â€¯2.45. Toothpastes with active agents (AA) reduced tissue loss compared to negative-control (p < 0.0001). E1: All AA caused precipitates, being the thickest after Ch500. Chitosan increased carbon retention, not tin retention. E2: Only Ch1000 increased efficacy (-0.97 ±â€¯4.48) compared to positive-control (2.98 ±â€¯1.32; p = 0.05). EDX showed comparable carbon values in all AA; tin content was higher in Ch1000 (6.5 ±â€¯3.4) compared to other AA (range: 3.8 ±â€¯0.3-4.3 ±â€¯1.3). On abrasives, tin adsorption was decreased by all chitosans. SEM revealed minor structural differences. CONCLUSIONS: Chitosan viscosity has impact on efficacy of F/Sn toothpastes. Under erosive/abrasive conditions Ch1000 showed the best protective effect with higher tin retention on surfaces and lower tin absorption by abrasives. CLINICAL SIGNIFICANCE: The biopolymer chitosan shows protective effect against enamel erosion and erosion/abrasion when used in an F/Sn toothpaste with specific viscosity.

An oral care programme for adults- Evaluation after 15 years.

The present retrospective analysis sought to investigate the impact of the oral care programme (OCP) for adults provided at the Department of Conservative and Preventive Dentistry, Justus-Liebig-University of Giessen, Germany, on oral health parameters. The OCP was modular and included oral hygiene instruction/professional toothcleaning, nutrition counselling, fluoridation and re-motivation. From 1999-2014, data from 1665 patients (55.1% female, 44.9% male; median age 33 years, range 15;80) were available. Type/date of modules, % of proximal sites with plaque (PP) and with bleeding after probing (PB) and D3/4MFT/D3/4MFS were recorded. PP and PB values are given as median (min;max). Overall, 60.2% of the patients attended the OCP once, 19.1% twice, and 20.7% ≥ three times. Initially, PP/PB were 0.68(0;1)/0.08(0;1) resp. decreasing at visit two (0.62(0;1)/0.07(0;1) resp.; p≤0.001 each) with no further improvement over next visits. Patients with poor oral hygiene improved, but those with good oral hygiene worsened (p≤0.001 each). Shorter intervals between visits were more effective than longer intervals. Attendance patterns changed significantly over the years: earlier, patients attended more visits with different modules; later, patients preferred the oral hygiene module and the intervals between visits lengthened. Prevalence and incidence of caries was associated with higher PP levels. Attendance patterns changed over time and had a significant impact on the outcome of the OCP. The improvement of oral hygiene was limited and occurred within the first two visits; repeated sessions maintained this improvement. The results indicate the need for new strategies improving patients' skills for efficient hygiene techniques.

European Organization for Caries Research Workshop: Methodology for Determination of Potentially Available Fluoride in Toothpastes.

Toothpastes are the most universally accepted form of fluoride delivery for caries prevention. To provide anti-caries benefits, they must be able to release fluoride during the time of tooth brushing or post brushing into the oral cavity. However, there is no standard accepted procedure to measure how much fluoride in a toothpaste may be (bio) available for release. The European Organization for Caries Research proposed and supported a workshop with experts in fluoride analysis in toothpastes and representatives from industry. The objective of the workshop was to discuss issues surrounding fluoride analysis in toothpaste and reach consensus on terminology and best practices, wherever the available evidence allowed it. Participants received a background paper and heard presentations followed by structured discussion to define the problem. The group also reviewed evidence on the validity, reliability and feasibility of each technique (namely chromatography and fluoride electroanalysis) and discussed their strengths and limitations. Participants were able to reach a consensus on terminology and were also able to identify and summarize the advantages and disadvantages of each technique. However, they agreed that most currently available methods were developed for regulatory agencies several decades ago, utilizing the best available data from clinical trials then, but require to be updated. They also agreed that although significant advances to our understanding of the mechanism of action of fluoride in toothpaste have been achieved over the past 4 decades, this clearly is an extraordinarily complex subject and more work remains to be done.

Toothbrushing Systematics Index (TSI) - A new tool for quantifying systematics in toothbrushing behaviour.

Systematics is considered important for effective toothbrushing. A theoretical concept of systematics in toothbrushing and a validated index to quantify it using observational data is suggested. The index consists of three components: completeness (all areas of the dentition reached), isochronicity (all areas brushed equally long) and consistency (avoiding frequent alternations between areas). Toothbrushing should take a sufficient length of time; therefore, this parameter is part of the index value calculation. Quantitative data from video observations were used including the number of changes between areas, number of areas reached, absolute brushing time and brushing time per area. These data were fed into two algorithms that converted the behaviour into two index values (each with values between 0 and 1) and were summed as the Toothbrushing Systematics Index (TSI) value; 0 indicates completely unsystematic and 2 indicates perfectly systematic brushing. The index was developed using theoretical data. The data matrices revealed the highest values when all areas are reached and brushed equally long. Few changes occurred between the areas when the brushing duration was ≥90 s; the lowest values occurred under opposite conditions. Clinical applicability was tested with data from re-analysed videos from an earlier intervention study aiming to establish a pre-defined toothbrushing sequence. Subjects who fully adopted this sequence had a baseline TSI of 1.30±0.26, which increased to 1.74±0.09 after the intervention (p≤0.001). When the participants who only partially adopted the sequence were included, the respective values were 1.25±0.27 and 1.69±0.14 (p≤0.001). The suggested new TS-index can cover a variety of clinically meaningful variations of systematic brushing, validly quantifies the changes in toothbrushing systematics and has discriminative power.