Anti-caries evaluation of a nano-hydroxyapatite dental lotion for use after toothbrushing: An in situ study.

OBJECTIVES: The aim of this randomized, double-blind, two-arm crossover in situ study was to investigate whether nano-hydroxyapatite (nanoHAP) dental lotion (Apagard Deep Care) applied immediately after tooth-brushing with nanoHAP toothpaste (Apagard M-plus) enhances the remineralization promotion and the demineralization inhibition efficacies of nanoHAP toothpastes. METHODS: 64 sound enamel blocks and 64 blocks bearing artificially-produced initial caries were produced from human permanent molar teeth. During each treatment period, lasting 14 days per arm, two blocks, one sound and one lesion-bearing, were exposed to either 5% nanoHAP-containing or placebo dental lotion after tooth-brushing with 5% nanoHAP toothpaste, via an intra-oral appliance worn by 30 adults in each of the study groups. Baseline and post-test mineral loss were quantified using transverse microradiography (TMR). One-sided t-test of one group mean was used for intragroup comparison, while two-sided t-test of two independent means was used to compare the two dental lotions. RESULTS: Pairwise comparison (baseline vs. post-test) indicated significant (p<.001) remineralization by nanoHAP toothpaste in both groups. However, when compared against each other, there was a significantly (p<.001) greater percentage of remineralization with nanoHAP lotion [58.4(±1.8)%] than with placebo lotion [37.7(±2.2)%]. TMR examination showed absolute demineralization inhibition in sound enamel blocks exposed to either lotions. CONCLUSIONS: Toothpaste containing 5% nanoHAP effectively remineralized initial caries and inhibited demineralization of healthy enamel; however, the application of a dental lotion containing 5% nanoHAP after brushing resulted in superior remineralization compared to a placebo lotion. CLINICAL SIGNIFICANCE: Dental lotion containing 5% nanohydroxyapatite used immediately after toothbrushing with 5% nanohydroxyapatite toothpaste can serve as an adjunct to enhance the clinical benefits of the toothpaste.

The Potential of Hydroxyapatite Toothpaste to Prevent Root Caries: A pH-Cycling Study.

PURPOSE: The effectiveness of a hydroxyapatite (HAP) toothpaste and a fluoride toothpaste in preventing root tissue demineralization (root caries) was compared using an established pH-cycling caries model. MATERIALS AND METHODS: Sixty dentin blocks were produced from the root tissue of extracted human teeth and were assigned to 3 test groups (n=20/group): 10% hydroxyapatite toothpaste (HAP), 1450 ppm fluoride toothpaste (fluoride), and artificial saliva (artsaliva). Early root caries lesions were developed in each sample by 7-day demineralization using a pH-cycling caries model. The daily cyclic treatment regimen consists of two 2-minute toothpaste-slurry treatment periods, one 6-hour acid challenge using acidified gel (pH 4.5), and then storage in remineralizing solution (artsaliva) for the rest of the time. Demineralization was assessed as the amount of mineral loss (∆z) using transverse microradiography (TMR). Pairwise comparisons (between treatments) were performed using analysis of variance (ANOVA), and then Tukey's HSD for multiple comparisons. All p-values are considered significant if p<0.05. RESULTS: Both ANOVA and Tukey's HSD indicated no significant (ANOVA; n=20) difference in mean ∆z among the groups, with least ∆z (±Sd) in the HAP (1117±366) compared to fluoride (1392±334) and artsaliva (1406±223). Relative to control, HAP and fluoride inhibited root demineralization by 21% and 6%, respectively. CONCLUSION: Within the limit of the present study, the tested toothpaste containing 10% HAP is an effective root caries control toothpaste. Toothpaste containing 10% HAP was slightly more effective in preventing tooth demineralization than 1450 ppm fluoride provided as sodium fluoride. Thus, this study shows that HAP toothpastes can serve as an effective alternative to fluoride toothpastes for root caries management.

Prevention of white spot lesions around orthodontic brackets using organoselenium-containing antimicrobial enamel surface sealant.

OBJECTIVES: To investigate the antimicrobial potential of organo-selenium compound when applied as enamel surface sealant or primer (DenteShield™ [DS]) around orthodontic brackets to prevent enamel demineralization. METHODS: Human teeth were randomly assigned to seven treatment groups (15/group): control (No primer or sealant), Leopard light primer (LLP), DS Primer (DS-P), DS Enamel Surface Sealant (DS-S), Pro Seal, Opal Seal and combined DS-P/DS-S (DS-PS). Following etching, the tooth surface was coated with their respective material (except control group) and a bracket was bonded on each treated surface. All samples were subject to cariogenic challenge in a continuous flow microbial caries model at 37 °C in an incubator for 28 days. Demineralization was evaluated with Transerse microradiography to determine mineral loss (Δz) and lesion depth (LD). Data was statistically analyzed using Bonferroni protected Mann-Whitney tests (α = 0.05). RESULTS: Demineralization was obsessrved only in Control and LLP groups. Control group had significantly (p < 0.001) greater mean LD (109.47 ± 34.22 µm) and mean Δz (2251.07 ± 514.26 vol%µm) when compared with the LLP with mean LD (44.98 ± 11.69 µm) and Δz (700.67 ± 310.66 vol%µm). All other groups did not develop any lesions. CONCLUSIONS: Selenium-based primer and sealant used alone or in combination were effective in protecting enamel from demineralization around brackets. The combination of primer and enamel surface sealant has no added benefit. SIGNIFICANCE: DS-S and DS-P containing antimicrobial organo-selenium compound can prevent whitespot lesions development when applied on tooth surface during orthodontic treatment. Light primer applied alone on tooth surface may not provide adequate protection for the enamel around orthodontic appliances.

Comparison of hydroxyapatite and fluoride oral care gels for remineralization of initial caries: a pH-cycling study.

OBJECTIVE: The present in vitro study investigated if simulated daily use of hydroxyapatite-based gel (15% HAP) remineralizes early caries lesions as effective as weekly use of high fluoride (12,500 ppm) concentration gel, comparing them with artificial saliva alone. MATERIALS AND METHODS: Three tooth blocks were produced from each of 20 bovine teeth. Caries-like lesion was created on each block by 4-day demineralization in acidified gel. The blocks were randomized into three remineralization groups (20 blocks/group); Hydroxyapatite-based gel (Karex gelée, 15% HAP, fluoride-free), fluoride-based gel (Elmex gelée, 12,500 ppm F-), and artificial saliva (AS). Remineralization was conducted using pH-cycling model for 28 days with storage in AS. The pH cycling model consisted of 2 h demineralization once daily for all groups, and 3 min HAP gel application once daily, 3 min fluoride gel application once weekly, or remain in AS only respectively. Baseline and post-test mineral loss were quantified using microradiography. RESULTS: Paired t-tests (baseline vs. post-Test) indicated significant (p < 0.0001) remineralization in all groups. When compared against each other using Games-Howell's multiple comparison test, no significant difference in remineralization was observed between the two gels, but both gels exhibited significantly (p < 0.001) higher percentage mineral gain (HAP:39 ± 7%; fluoride:41 ± 11%) than AS alone (6 ± 2%). CONCLUSION: Hydroxyapatite-based gel (15% HAP) was as effective as fluoride-based gel (12,500 ppm F-) in remineralizing initial caries lesion.

Prevalence of dental fluorosis among 12-15-year-old students in Enugu Metropolis, Nigeria.

BACKGROUND: Excessive ingestion of fluoride during tooth development, particularly at the maturation stage, may result in dental fluorosis, with clinical implications. Literature is scarce on dental fluorosis in Enugu, Nigeria. PURPOSE: The aim of this study was to assess the prevalence of dental fluorosis in Enugu, a major city in South East Nigeria. MATERIALS AND METHODS: A multistage sampling technique was used to select a calculated sample of 400 students. A pretested interviewer-administered questionnaire was used to ascertain student's sociodemographic and related variables. The student participants were examined for dental fluorosis using Dean's index criteria according to the World Health Organization guidelines. Data were analyzed using SPSS version 16, and Chi-square test of association was used to compare proportions and ratios with significant level set at P < 0.05 and 95% confidence level. RESULTS: Among the 400 students analyzed, 231 (57.8%) and 169 (42.2%) were male and female, respectively. Mean age was 13.43 ± 1.021 years. The prevalence of dental fluorosis was 11.3%, with the preponderance of very mild score (82.2%), and no observed severe dental fluorosis. The difference in the distribution of the scores of fluorosis among the children was highly statistically significant (χ2 = 72.80, P = 0.000). Dental fluorosis was found present in 39 (10.3%) of 378 users of fluoridated toothpaste and in 6 (27.7%) of the 22 users of nonfluoridated toothpaste. The differences in the presence and absence of dental fluorosis were statistically significant among users of fluoridated toothpaste. CONCLUSION: This study shows the prevalence of dental fluorosis to be low among secondary school students of Enugu metropolis.

Comparative Efficacy in Preventing Plaque Formation around Pit and Fissure Sealants: A Clinical Trial.

AIM: The purpose of this study is to compare the clinical performance of an organo-selenium-containing pit and fissure sealant with that of a selenium-free sealant for clinical retention and prevention of plaque and caries development around the sealants. MATERIALS AND METHODS: Following an in vitro study confirming the antimicrobial effect of an organo-selenium-containing pit/fissure sealant [DenteShield™ (DS)], 120 adolescents (7-20 years old) at varying caries risk status had DS sealant applied to a single tooth on the left or the right side of the dentition and UltraSeal™ XT Plus (UXT) on a corresponding tooth on the opposite side. Sealants' assessment was performed quarterly for 1 year for clinical retention, plaque, and caries formation around the sealant. Each sealant lost was replaced but considered as a failure in further analysis. McNemar's test was used to statistically analyze the outcome variables at each assessment time point. RESULTS: While 7% and 12% plaque growth was observed around the UXT sealant at 9th and 12th months, respectively, DS exhibited 100% prevention of plaque growth. Both sealants exhibited 100% caries prevention. Clinical retention did not significantly differ between DS and UXT at all assessment time points except at 12 months when DS showed statistically significantly (p < 0.001) better retention (96%) than UXT (81%). CONCLUSION: In this study, while both sealants are equally effective in caries prevention, DS completely prevented plaque growth around it with better clinical retention than UXT that offered only limited protection against plaque growth. CLINICAL SIGNIFICANCE: Being antimicrobial, DS pit and fissure sealant may be the best sealant option for patients whose caries risk status is due to poor oral hygiene.

Effectiveness of S-PRG Filler-Containing Toothpaste in Inhibiting Demineralization of Human Tooth Surface.

OBJECTIVES: Using an established pH-cycling caries model, the authors evaluated the effectiveness of toothpastes containing Surface Pre-reacted Glass-ionomer filler (S-PRG) in preventing tooth surface demineralization. MATERIALS AND METHODS: 210 tooth blocks were randomly assigned to seven experimental groups (30 blocks/group): no treatment (A), and toothpaste containing either NaF (B), 0 wt% S-PRG (C), 1 wt% S-PRG (D), 5 wt% S-PRG (E), 20 wt% S-PRG (F) or 30 wt% S-PRG (G). Groups were subjected to 14-day demineralization for development of early caries lesions using a pH-cycling caries model. Demineralization was assessed using Quantitative Light-induced Fluorescence (QLF) and Transverse Microradiography (TMR). All pairwise contrasts (between treatments) were tested using Analysis of Variance (ANOVA), and then Tukey's HSD for multiple comparisons. All p-values are considered significant if <0.05. RESULTS: With QLF, there was a significant (ANOVA; p<0.001) difference in mean percent fluorescence loss (∆F) observed among the groups. Relative to control, all S-PRG-containing toothpastes significantly (Tukey's; p<0.0001) inhibited demineralization at varying percentages (48.6%, 61.3%, 67.4% and 69.8% reduction with S-PRG 1%, 5%, 20% and 30% respectively). Demineralization reduction was not significant with either NaF (15.6% reduction) or 0% S-PRG (-2.5% reduction i.e. 2.5% more demineralization than the Control) when compared to control group. Mineral loss assessed using TMR followed a similar trend as fluorescence loss. CONCLUSION: Toothpaste containing S-PRG filler can serve as an effective caries control tool. S-PRG filler-containing dentifrice to be more effective in preventing tooth demineralization than 1100 ppm fluoride provided as sodium fluoride.

Evaluation of the caries-preventive effect of toothpaste containing surface prereacted glass-ionomer filler.

AIM: Although fluoride interventions have the most consistent benefit in preventing caries, caries still develop in high-risk individuals. Authors have evaluated the effectiveness of toothpastes containing surface prereacted glass-ionomer (S-PRG) filler in preventing tooth demineralization. METHODS: Human tooth enamel blocks were randomly assigned to six groups (30 blocks/group): no treatment (a), and toothpaste containing either 1500 ppm fluoride as sodium monofluorophosphate (NaMFP) (b), 0 wt% S-PRG (b), 1 wt% S-PRG (d), 5 wt% S-PRG (e), or 20 wt% S-PRG (f). Early caries developed on each block by 7-days demineralization using a microbial caries model. Mineral loss (Δz) and lesion depth (LD) were determined using transverse microradiography. RESULTS: Relative to the control, all toothpastes, except 0% S-PRG, significantly (analysis of variance, Tukey's, P<.0001) reduced Δz and LD at varying percentages. With regard to Δz, all comparisons were significant (P<.0001), except 0% S-PRG vs the control. Otherwise, S-PRG 1%, 5%, and 20% had 0.50, 0.37, and 0.27 times Δz compared to the control, respectively, while NaMFP had 0.61 times Δz compared to the control. LD followed an almost similar trend as Δz. CONCLUSIONS: The findings of the present study demonstrate the effectiveness of toothpaste containing S-PRG filler in inhibiting tooth demineralization in the presence of bacterial plaque, thus highlighting its potential as an effective caries-control tool for individuals at high risk of developing caries.

Seatbelt use among drivers in an urban city in Nigeria: an observational study.

Studies from parts of Nigeria reported low compliance with seatbelt. This study sought to establish driver seatbelt use in Enugu, Nigeria by gender, vehicle type/use and time of day. Observations were done day and night at randomly selected locations. Data were analysed with SPSS version 15. Differences in response were checked with chi-square for trend. Confidence interval was 95% and P value < 0.05 was regarded as significant. Average compliance was 37.6% for the 510 males (85%) and 90 females (15%) observed. It was 74.8% in the day and 0.3% at night. Among males, 218 (42.7%) wore seatbelt while 9 (10%) females did. For commercial drivers 159 (65.2%) complied while 68 (19.1%) private drivers did. Truck drivers had 100% compliance while sports utility vehicle drivers had the lowest (18.8%). There is poor seatbelt compliance in Enugu, Nigeria and need for educational campaigns and stricter enforcement.

Proximal caries lesion detection using the Canary Caries Detection System: an in vitro study.

OBJECTIVE: This study investigated the accuracy of the Canary System (CS) to detect proximal caries lesions in vitro, and compared it with conventional methods: International Caries Detection and Assessment System (ICDAS) II and bitewing radiography (BW). METHODS: Visible proximal surfaces of extracted human teeth were assessed by ICDAS-II before setting them in five manikin mouth models. Then contacting proximal surfaces in mouth models were assessed by BW and CS. Histological validation with polarized-light microscopy served as a gold standard. Pairwise comparisons were performed on area under the curve (AUC), sensitivity, and specificity of the three methods, and corrected using Bonferroni's method. Sensitivities and specificities were compared using a test of proportions and AUC values were compared using DeLong's method. RESULTS: The CS presented significantly higher sensitivity (0.933) than ICDAS-II (0.733, P = 0.01) and BW (0.267, P < 0.001), and ICDAS-II higher sensitivity than BW (P < 0.001). There were no significant differences between their specificity values: 0.825 (CS), 0.65 (ICDAS-II), and 0.875 (BW). The AUC of CS (0.862) was significantly higher than of ICDAS-II (0.681, P < 0.001) and BW (0.577, P < 0.001). CONCLUSION: The CS demonstrated greater accuracy in detecting proximal lesions than ICDAS-II and BW, although without significantly higher specificity.

Concurrent Presentation of Burning Mouth Syndrome and Globus Pharyngis in Enugu, Nigeria: A Ten-year Clinical Evaluation.

PURPOSE: To review 22 patients with globus pharyngis among a group of 39 patients who presented with burning mouth syndrome and to highlight the clinical presentation and treatment outcome of these oropharyngeal symptoms, often ignored by practicing oral surgeons. PATIENTS AND METHODS: We carried out a retrospective review of 39 patients with burning mouth syndrome seen at oral surgery units of three specialist hospitals in Enugu, Nigeria between 2001 and 2010. The focus was on the 22 of these patients with burning mouth syndrome and globus pharyngis (the persistent sensation of having phlegm, a pill or some other sort of obstruction in the throat when there is none). Relevant information included patients' oral habits and dental status, past medical history, sociodemographic data, onset of symptoms and treatment outcome. RESULTS: Amongst the 22 patients, 8 (36.4%) were males while 14 (63.6%) were females, giving a male to female ratio of 1:1.8. Of the 8 male patients, 3 (37.5%) were retrenched workers, 2 (25%) were drug addicts, 2 (25%) had a history of psychiatric problems and 1 (12.5%) had post-radiation therapy due to diagnosis of adenocystic carcinoma. Amongst the 14 female patients, 6 (42.8%) were divorcees, 3 (21.4%) were unemployed and unmarried, 2 (14.3%) had menopausal problems, 2 (14.3%) had dental prostheses and 1 (7.2%) had a history of mental disorder. CONCLUSION: Globus pharyngis can present at the same time in some individuals with burning mouth syndrome. The emotional aetiological factor in this unusual ailment calls for proper examinations and a multidisciplinary approach in the management of patients who presented with burning mouth syndrome, especially with a history of depression.