Stefan Zimmer

Publications of Stefan Zimmer

• Cleaning efficacy and soft tissue trauma after use of manual toothbrushes with different bristle stiffness.

  Authors: Stefan Zimmer, Metin Öztürk, Claudia R Barthel, Mozhgan Bizhang, Rainer A Jordan

  Journal of periodontology. 02/2011; 82(2):267-71.

  The purpose of this study is to evaluate the efficacy of manual toothbrushes of the same type with different bristle stiffness concerning plaque removal, gingivitis development, and soft tissueThe purpose of this study is to evaluate the efficacy of manual toothbrushes of the same type with different bristle stiffness concerning plaque removal, gingivitis development, and soft tissue trauma. In a randomized controlled trial, three groups with 40 subjects each used manual toothbrushes with either hard-, medium-, or soft-bristle stiffness. The at-home brushing time was set for 2 minutes, twice a day. Four and 8 weeks after the baseline examination, clinical parameters for plaque removal, gingivitis, and soft tissue damage were recorded again. Recruitment and examinations of the subjects were performed at the Department of Operative and Preventive Dentistry and Endodontics, Heinrich Heine University. A total of 120 volunteers (age range: 18 to 62 years) were recruited and stratified according to sex and age. Primary outcome measures were differences in the Quigley and Hein index (QHI) and papillary bleeding index (PBI) compared to baseline; secondary outcome measures were differences in the modified approximal plaque index (MAPI) and Danser gingival abrasion index. The QHI and MAPI showed lower index scores in subjects who used hard-bristled toothbrushes after 8 weeks (P <0.05 and P <0.001, respectively). In contrast, subjects who used toothbrushes with hard bristles demonstrated more gingival lesions (P <0.01) and higher PBI scores after 4 and 8 weeks (P <0.001) compared to subjects who used soft- or medium-bristled toothbrushes. Manual toothbrushes with hard bristles may better remove plaque, but may also cause more soft tissue trauma compared to brushes with softer bristles.

• Total and free fluoride concentrations of African dentifrices marketed in West Africa.

  Authors: Rainer A Jordan, Ljubisa Markovich, Peter Gaengler, Stefan Zimmer

  Oral health & preventive dentistry. 01/2011; 9(1):53-8.

  To determine the fluoride concentrations of commercial dentifrices marketed in West Africa. Design: In vitro measurement of the total fluoride concentration by liquid gas chromatography, and of theTo determine the fluoride concentrations of commercial dentifrices marketed in West Africa. Design: In vitro measurement of the total fluoride concentration by liquid gas chromatography, and of the free fluoride concentration with a fluoride sensitive electrode. Setting: Collection of fluoride dentifrices in public markets and supermarkets in and around the capital of The Republic of The Gambia, Banjul, after a systematic search. All commercially available different brands sold in The Gambia and produced locally or in other African countries (Egypt, Morocco, Nigeria and South Africa). Outcome measures: Total and free fluoride concentrations of dentifrices in parts per million. Seven different dentifrices were detected with NaMFP as the predominant fluoride source. Four dentifrices showed a total fluoride concentration above 1,000 ppm F-. The products showed - in general - a lower free fluoride concentration. Only one product with NaF as fluoride supplement showed both total and free fluoride concentrations above 1,000 ppm F-. Four products contained calcium-based abrasive additives. The measurement of total and free fluoride concentrations of dentifrices available in The Gambia (West Africa) showed inhomogeneities. This was particularly verified where fluoride compounds were combined with calcium-based abrasives. If so, it is recommended that the total fluoride content should be measured by gas chromatography. Periodic quality control of dentifrices should be introduced in areas with an under-developed consumer-counselling infrastructure.

• Class III atraumatic restorative treatment (ART) in adults living in West Africa--outcomes after 48 months.

  Authors: Rainer A Jordan, Philipp Hetzel, Markus Franke, Ljubisa Markovic, Peter Gaengler, Stefan Zimmer

  Community dentistry and oral epidemiology. 10/2010; 39(2):164-70.

  This observational study assessed the effectiveness of class III restorations using the atraumatic restorative treatment (ART) approach in permanent anterior teeth over a 48-month period. DentalThis observational study assessed the effectiveness of class III restorations using the atraumatic restorative treatment (ART) approach in permanent anterior teeth over a 48-month period. Dental auxiliaries placed a total of 117 class III ART restorations in 2004, using a cosmetically improved glass-ionomer (Ionofil® Plus; VOCO, Cuxhafen, Germany), in 67 patients with a mean age of 27.3 years in the rural Jahali Health Center, The Gambia. Independent examiners evaluated the restorations after 24 and 48 months using the clinical ART evaluation criteria. Seventy-six of the restorations could be observed over 48 months in 51 patients. After 48 months, 53 of 76 restorations were classified as clinically acceptable (without or with minor intervention (repair) needed), and 23 restorations were classified as insufficient. There was no statistical difference in a clustered performance rating between restorations placed in central and lateral incisors (P=1.0). The adoption of the ART approach to class III caries cavities made restorative dental care in anterior teeth available in a West African region. The long-term performance was comparable to other studies. Longitudinal clinical studies with greater populations are required to substantiate these results.

• Clinical significance of sleep bruxism on several occlusal and functional parameters.

  Authors: Michelle A Ommerborn, Maria Giraki, Christine Schneider, Lars Michael Fuck, Stefan Zimmer, Matthias Franz, Wolfgang Hans-michael Raab, Ralf Schaefer

  Cranio : the journal of craniomandibular practice. 10/2010; 28(4):238-48.

  The aim of this study was to evaluate the association between various functional and occlusal parameters and sleep bruxism. Thirty-nine (39) sleep bruxism patients and 30 controls participated inThe aim of this study was to evaluate the association between various functional and occlusal parameters and sleep bruxism. Thirty-nine (39) sleep bruxism patients and 30 controls participated in this investigation. The assessment of sleep bruxism was performed using the Bruxcore Bruxism-Monitoring Device (BBMD) combined with a new computer-based analyzing method. Sixteen functional and/or occlusal parameters were recorded. With a mean slide of 0.95 mm in the sleep bruxism group and a mean slide of 0.42 mm in the control group (Mann Whitney U test; p<0.003), results solely demonstrated a significant group difference regarding the length of a slide from centric occlusion to maximum intercuspation. The results suggest that the slightly pronounced slide could be of clinical importance in the development of increased wear facets in patients with current sleep bruxism activity. Following further evaluation including polysomnographic recordings, the BBMD combined with this new analyzing technique seems to be a clinically feasible instrument that allows the practitioner to quantify abrasion over a short period.

• Performance of atraumatic restorative treatment (ART) depending on operator-experience.

  Authors: Rainer A Jordan, Peter Gaengler, Ljubisa Markovic, Stefan Zimmer

  Journal of public health dentistry. 02/2010; 70(3):176-80.

  Oral health care is not of major interest in developing countries because of lack of infrastructure and professional manpower. Therefore, atraumatic restorative treatment (ART) was introduced by theOral health care is not of major interest in developing countries because of lack of infrastructure and professional manpower. Therefore, atraumatic restorative treatment (ART) was introduced by the World Health Organization to be performed by dental auxiliary personnel. The aim of this study was to evaluate the performance of ART depending on operator-experience in The Republic of The Gambia. One hundred twenty-eight newly inserted restorations were followed up for 12 months using the clinical ART index in a prospective and blinded study design. The patients were randomly assigned to operators. The clinical performance was compared among three groups: trainees, experienced Community Oral Health Workers (COHW), and professional dentists. The difference in success rates was calculated at a 95 percent confidence interval. There was a statistically significant difference between trainees and dentists in performing leakage/gap-free one-surface restorations (P < 0.05). No significant differences were found between the two groups of auxiliaries (trainees versus experienced COHWs, P > 0.05). Finally, both groups--experienced COHWs and dentists--performed restorations not showing statistically significant differences (P > 0.05). For The Republic of The Gambia--especially for areas with underdeveloped medical infrastructure--training and assignment to perform ART can be recommended for auxiliary dental staff of Community Oral Health Workers.

• Association between oral health-related and general health-related quality of life in subjects attending dental offices in Germany.

  Authors: Stefan Zimmer, Nora Bergmann, Ebtehal Gabrun, Claudia Barthel, Wolfgang Raab, Jens-Ulrich Rüffer

  Journal of public health dentistry. 12/2009;

  Objectives: To evaluate the GHRQoL and OHRQoL of patients attending dental offices in Germany and to determine correlation coefficients between SF (Short Form)-12 and OHIP (Oral Health ImpactObjectives: To evaluate the GHRQoL and OHRQoL of patients attending dental offices in Germany and to determine correlation coefficients between SF (Short Form)-12 and OHIP (Oral Health Impact Profile)-14 scores. Methods: A total of 10,342 dental offices were randomly selected. Each of the 1,113 that consented to participate received 20 questionnaires to be filled in by a convenience sample of the patients. The questionnaire included the OHIP-14-form for OHRQoL as well as the SF-12-form for GHRQoL. Results: A total of 12,392 completed questionnaires were analyzed. The mean age of the participants (64.9 percent female, 35.1 percent male) was 44.25 years. The mean summary score of OHIP-14 was 6.30 (SD 7.46). The mean physical component summary scale (PCS) of the SF-12 was 51.15 (SD 7.23) and the mental component summary scale (MCS) was 50.17 (SD 8.55). The variance of PCS and MCS could be explained to 10 percent each by oral health-related quality of life (r(2) = 0.095 and 0.101, P < 0.001). Conclusion: OHRQoL is considerably related to GHRQoL.

• Effect of a 5000 ppm fluoride toothpaste and a 250 ppm fluoride mouth rinse on the demineralisation of dentin surfaces.

  Authors: Mozhgan Bizhang, Yong-Hee Chun, Mai-Trinh Winterfeld, Markus Altenburger, Wolfgang Raab, Stefan Zimmer

  BMC research notes. 08/2009; 2(1):147.

  ABSTRACT: BACKGROUND: The purpose of this study was to test the null hypothesis that there is no difference between the effect of (1) a 5000 ppm fluoride toothpaste, and (2) a 250 ppm fluoride mouthABSTRACT: BACKGROUND: The purpose of this study was to test the null hypothesis that there is no difference between the effect of (1) a 5000 ppm fluoride toothpaste, and (2) a 250 ppm fluoride mouth rinse on demineralized human dentin surfaces, against the alternative hypothesis of a difference. FINDINGS: Dentin specimens were obtained from the cervical regions of 45 extracted human third molars. Half the surface of each specimen was sealed with a self-etching adhesive system and served as the reference surface. The dentin specimens were randomly assigned to one of the three groups, 5000 ppm fluoride toothpaste (Duraphat), 250 ppm fluoride mouth rinse (Meridol) and distilled water (negative control). An intraoral appliance was made for one volunteer. In each test cycle, 15 specimens were inserted in the appliance and worn for 24 hours a day, over a period of three weeks. Once daily, the appliance was immersed in the agent being tested; either toothpaste slurry, mouth rinse or distilled water for 60 seconds. Demineralization was assessed in terms of lesion depth (um) and mineral loss (vol. %X um) by transversal microradiography. Data analysis was accomplished using Kolmogorov-Smirnov test and ANOVA (SPSS 12.0). Statistically significant differences for mineral loss and lesion depth were found between the toothpaste and the mouth rinse as well as between the toothpaste and the control group, but not between the mouth rinse and the control group. CONCLUSIONS: Within the limitations of this study, the results suggest that treatment of demineralised dentin with a toothpaste containing 5000 ppm fluoride may considerably reduce mineral loss and lesion depth on exposed dentin.

• The constitutive activation of extracellular signal-regulated kinase 1 and 2 in periodontal ligament nerve fibers.

  Authors: Yüksel Korkmaz, Wilhelm Bloch, Franz-Josef Klinz, Alexander C Kübler, Kurt Schneider, Stefan Zimmer, Klaus Addicks, Wolfgang H-M Raab

  Journal of periodontology. 06/2009; 80(5):850-9.

  Background: The extracellular signal-regulated kinases 1 and 2 (ERK1/2) have been implicated in the inflammation-dependent sensitization of nociceptors. Because the periodontal ligament (PDL)Background: The extracellular signal-regulated kinases 1 and 2 (ERK1/2) have been implicated in the inflammation-dependent sensitization of nociceptors. Because the periodontal ligament (PDL) contains numerous nociceptors and mechanoceptors, phosphorylation of ERK1/2 was investigated in nerve fibers of the PDL to elucidate the role of constitutive local activation of ERK1/2 in peripheral sensitization. Methods: Decalcified free-floating sections of rat molars with PDL were incubated using total (t)-ERK1/2 and phosphorylated (p)-ERK1/2 antibodies. For identification of nerve fibers in the PDL, double staining was performed using protein gene product 9.5 (PGP 9.5) with p-ERK1/2. To test whether p-ERK1/2 activated in sensory and mechanoreceptive terminals, double incubations were performed using p-ERK1/2 with calcitonin gene-related peptide (CGRP) and with calretinin. Labeled nerve fibers were quantified by the point-counting method. Results: In cervical, midroot, and apical zones of the PDL, t-ERK1/2- and p-ERK1/2-labeled nerve fibers were found in close association with blood vessels. The p-ERK1/2-labeled free nerve fibers were often detected in cervical and apical areas of the PDL. In nerve fibers of the PDL, p-ERK1/2 was colocalized with PGP 9.5, CGRP, and calretinin. Conclusions: The perivascular distribution of t-ERK1/2 and p-ERK1/2 in nerve fibers in the PDL is compatible with a role for the constitutive activation of ERK1/2 in the neural regulation of blood vessels in the PDL. The colocalizations of p-ERK1/2 with CGRP and calretinin indicate that ERK1/2 is constitutively activated in a subpopulation of sensory and mechanoreceptive nerve terminals in the PDL.

• The extent of the psychological impairment of prosthodontic outpatients at a German University Hospital.

  Authors: Michelle Ommerborn, Alfons Hugger, Johannes Kruse, Joerg Handschel, Rita Depprich, Ulrich Stuettgen, Stefan Zimmer, Wolfgang Raab

  Head & face medicine. 11/2008; 4(1):23.

  ABSTRACT: BACKGROUND: Psychological factors are not only important in patients with temporomandibular disorders (TMDs), but also in patients suffering from tooth loss and/or in those awaitingABSTRACT: BACKGROUND: Psychological factors are not only important in patients with temporomandibular disorders (TMDs), but also in patients suffering from tooth loss and/or in those awaiting prosthodontic care with fixed or removable dentures as several authors emphasize. The purpose of the present prospective observational study was to compare prosthodontic outpatients of the Department of Prosthodontics at the University of Duesseldorf and patients seeking care at the TMD/Orofacial Pain Outpatient Clinic (TMD/OFPOC) at the same university with respect to sociodemographic data, self-reported somatic complaints, and psychological impairment. METHODS: A total of 234 patients received two self-administered questionnaires including the Symptom-Check-List. Complete data have been obtained from 65 prosthodontic outpatients and 60 patients of the TMD/OFPOC. RESULTS: Results indicated statistically significant group differences regarding sociodemographic data and somatic complaints. Concerning the latter, in 11 of the 21 items, groups differed significantly and confirmed the absence of any mixing between the two outpatient clinics. Although the evaluation of psychological impairment revealed no significant group differences, in 21.9% of the prosthodontic outpatients and in 22.0% of the patients from the TMD/OFPOC, the extent of the determined psychological impairment was similar to that of psychotherapeutic outpatients; in 9.4% and 8.5% it was similar to that of psychotherapeutic inpatients, respectively. CONCLUSIONS: Within the limitations of this study, in approximately one third of the evaluated patients of both the prosthodontic outpatient clinic and the TMD/OFPOC the psychological impairment reached values comparable to those of psychotherapeutic outpatients and psychotherapeutic inpatients. Therefore, the present findings emphasize the need to intensify the integration of psychosomatic aspects into dentistry and, in particular, to add psychological considerations to future German education plans.

• Microbiota of exposed root surfaces after fluoride, chlorhexidine, and periodontal maintenance therapy: a 3-year evaluation.

  Authors: Mozhgan Bizhang, Yong-Hee P Chun, Doreen Heisrath, Peter Purucker, Preeti Singh, Thomas Kersten, Stefan Zimmer

  Journal of periodontology. 09/2007; 78(8):1580-9.

  BACKGROUND: Fluoride and chlorhexidine (CHX) are state-of-the-art preventive measures for remineralizing teeth and for preventing plaque accumulation. The aim of this study was to examine the effectsBACKGROUND: Fluoride and chlorhexidine (CHX) are state-of-the-art preventive measures for remineralizing teeth and for preventing plaque accumulation. The aim of this study was to examine the effects of fluoride and CHX varnishes on root caries and microbiota located on root surfaces. METHODS: Thirty-three patients from a periodontal maintenance program, having at least one tooth with gingival recession in each quadrant, participated in this study. One tooth per quadrant was assigned randomly to the control group or to one of the test groups that were treated with fluoride varnish, 1% CHX, or 40% CHX. The varnish treatment and the tooth cleaning were repeated every 3 months. Clinical examinations were performed at baseline and once a year for 3 years. Caries status and oral hygiene indices were evaluated clinically. The total cultivable microbiota and percentage of Mutans streptococci (MS), Actinomyces (ACC), and lactobacilli (LB) were analyzed. RESULTS: Oral hygiene was improved greatly during the course of the study. The percentage of MS, ACC, and LB of the total cultivable microbiota revealed a statistically significant reduction between baseline and final examination for each of the four groups. CONCLUSION: Professional tooth cleaning alone at 3-month intervals might be as effective in reducing MS, ACC, and LB as adjunctive treatment with fluoride or chlorhexidine.

• Effect of a 40% chlorhexidine varnish on demineralization of dentin surfaces in situ.

  Authors: Mozhgan Bizhang, Rainer Seemann, Gregor Römhild, Yong-Hee P Chun, Niklas Umland, Hermann Lang, Stefan Zimmer

  American journal of dentistry. 06/2007; 20(3):193-7.

  PURPOSE: To evaluate the effect of varnish with different chlorhexidine concentrations on the demineralization of dentin surfaces in situ. METHODS: An intraoral model was used to study the ability ofPURPOSE: To evaluate the effect of varnish with different chlorhexidine concentrations on the demineralization of dentin surfaces in situ. METHODS: An intraoral model was used to study the ability of chlorhexidine to prevent demineralization. Dentin specimens from extracted human teeth were treated with chlorhexidine varnish and exposed to the oral environment of 47 subjects. The dentin specimens were prepared from the cervical regions of 47 third molars, sterilized by irradiation with 60 GY and mounted in intraoral appliances worn by the subjects. Before the delivery of the appliance, the specimens and participants were treated once with one of the three different varnishes (according to the manufacturer's instructions). All participants were randomly assigned to one of the three groups: (1) EC 40 (n=16), (2) Cervitec (n=15), or (3) ChemFil Varnish (control group, n=16). The appliances were worn day and night for 3 weeks. At mealtimes, the appliance was stored in 10% sucrose solution. After exposure to demineralization, the dentin surface was evaluated by microradiography to assess the depth of the lesion (microm) and the loss of mineral (Vol% microm). Data analysis was accomplished using one-way ANOVA plus LSD testing (P< 0.05). RESULTS: Both chlorhexidine varnishes EC 40 and Cervitec resulted in significantly decreased mineral loss and lesion depth in dentin than the control. In addition, EC 40 treated specimens demonstrated significantly reduced lesion depth compared to Cervitec and the control (109.22 microm vs. 139.23 microm and 178.21 microm).

• Clinical efficacy of flossing versus use of antimicrobial rinses.

  Authors: Stefan Zimmer, Claudia Kolbe, Gerrit Kaiser, Tracy Krage, Michelle Ommerborn, Claudia Barthel

  Journal of periodontology. 08/2006; 77(8):1380-5.

  BACKGROUND: Dental floss is only used by a small part of the population on a daily basis. Therefore, an easy, applicable alternative is needed. This alternative could be a mouthrinse withBACKGROUND: Dental floss is only used by a small part of the population on a daily basis. Therefore, an easy, applicable alternative is needed. This alternative could be a mouthrinse with antimicrobial activity for daily use. The aim of the present study was to evaluate the efficacy of two mouthrinses in reducing interdental plaque and gingivitis compared to dental floss. METHODS: A total of 156 healthy volunteers were randomly assigned to the following groups: 1) toothbrushing and rinsing (0.06% chlorhexidine and 0.025% fluoride); 2) toothbrushing and rinsing (0.1% cetylpyridiniumchloride and 0.025% fluoride); 3) toothbrushing and flossing; and 4) toothbrushing only (N = 39 subjects in each group). At baseline, the modified proximal plaque index (MPPI) and papillary bleeding index (PBI) were recorded. Thereafter, subjects had to brush in the usual manner during 8 weeks. Additionally, test groups had to rinse once a day (groups 1 and 2: 30 seconds) or to floss (group 3). Eight weeks after baseline, indices were recorded again and improvements were calculated. Analysis of variance (ANOVA) and the Bonferroni test served for statistical analysis. RESULTS: After 8 weeks, reductions for all indices were found in all groups (P <0.05). With respect to the MPPI, mouthrinse groups performed better than the control and floss groups: 1) 0.73; 2) 0.82; 3) 0.40; and 4) 0.32 (P <0.05). The PBI showed no statistically significant difference between groups: 1) 0.46; 2); 0.50; 3); 0.42; and 4) 0.37. CONCLUSION: The results suggest that, in combination with toothbrushing, daily use of the tested mouthrinses may result in a higher interproximal plaque reduction than daily flossing.

• Bacterial leakage in roots filled with different medicaments and sealed with Cavit.

  Authors: Claudia R Barthel, Felix F Zaritzki, Wolfgang H-M Raab, Stefan Zimmer

  Journal of endodontics. 03/2006; 32(2):127-9.

  The aim of this study was to evaluate the time required by four different root canal medications coupled with the temporary filling material Cavit (ESPE, Seefeld, Germany) to prevent penetration ofThe aim of this study was to evaluate the time required by four different root canal medications coupled with the temporary filling material Cavit (ESPE, Seefeld, Germany) to prevent penetration of bacteria into the root canal. There were 145 roots prepared in a standardized manner. Four groups with 15 samples each were dressed with calcium hydroxide (Ca(OH)(2)), a 5% chlorhexidine gel (CHX), a chloromono-campherphenolic compound (ChKM), and Ledermix (LM), respectively, and sealed with Cavit. Four control groups contained identical medications but the roots were left unsealed. The 25 remaining roots served as additional controls. A standard setup for bacterial leakage studies was chosen with Staphylococcus epidermidis as test strain. Cavit application resulted in a significantly better seal compared with the unsealed groups. In the Cavit-sealed groups, all groups differed significantly from one another except for the CHX and the ChKM groups. The Ca(OH)(2) medicated roots provided the longest protection (median of 36 days), followed by the Ledermix-group (27 days) and the CHX (18 days) or ChKM groups (19 days). It may be concluded that Cavit-sealed and medicated root canals do not provide adequate protection against bacterial leakage for more than 1 month.

• Efficacy of the Cybersonic in comparison with the Braun 3D Excel and a manual toothbrush.

  Authors: Stefan Zimmer, Juliane Strauss, Mozhgan Bizhang, Tracy Krage, W H-M Raab, Claudia Barthel

  Journal of clinical periodontology. 04/2005; 32(4):360-3.

  OBJECTIVES: To evaluate the efficacy of two power toothbrushes (Cybersonic and Braun 3D Excel) and one manual brush (Elmex super 29). MATERIAL AND METHODS: After professional toothcleaning 120OBJECTIVES: To evaluate the efficacy of two power toothbrushes (Cybersonic and Braun 3D Excel) and one manual brush (Elmex super 29). MATERIAL AND METHODS: After professional toothcleaning 120 subjects were randomly assigned to three groups. Four weeks later, at baseline, the Quigley-Hein plaque index (QHI), the modified approximal plaque index (API), and the papillary bleeding index (PBI) were recorded. Thereafter the subjects used the assigned toothbrushes for 8 weeks. Improvements of the indices after 4 and 8 weeks were calculated as medians. Kruskal-Wallis- and Mann-Whitney U-test served for statistical analysis. RESULTS: All indices showed statistically significant reductions for both power toothbrushes which were superior to the manual brush (4 weeks: Cybersonic: API, 0.21; PBI, 0.25; QHI, 0.23; Braun: API, 0.20; PBI, 0.39; QHI, 0.22; Elmex: API, 0.04; PBI, 0.02; QHI, 0.07; 8 weeks: Cybersonic: API, 0.28; PBI, 0.36; QHI, 0.41; Braun: API, 0.36; PBI, 0.61; QHI, 0.35; Elmex: API, 0.03; PBI, 0.10; QHI, 0.08; p<0.001). The Braun was superior to the Cybersonic with respect to API after 8 weeks (p<0.05) and PBI after 4 and 8 weeks (p<0.01). CONCLUSION: Cybersonic and Braun 3D Excel may be more efficacious than a manual toothbrush in removing plaque and reducing gingivitis.

• [Recommendations for evidence based oral hygiene of clients in health and care institutions]

  Authors: Thomas Gottschalck, Theo Dassen, Stefan Zimmer

  Pflege. 05/2004; 17(2):78-91.

  An extensive study of literature, from which recommendations for oral hygiene could be deduced, forms the base of this essay. The group of geriatric clients is also taken into consideration. At theAn extensive study of literature, from which recommendations for oral hygiene could be deduced, forms the base of this essay. The group of geriatric clients is also taken into consideration. At the beginning it lists frequent risks in medical and nursing situations that may lead to changes of the oral cavity. It then gives recommendations as to how and with which assessment instruments the oral cavity can be assessed. The main part of the essay contains an overview of means of nursing as well as instruments and methods for the treatment of oral problems. Evidence based intervention possibilities are compiled for essential problems relevant to nursing (unclean mouth, dryness of the mouth, inflammations, infections) and are completed by practical advice on actions. The concluding part consists of further general aspects to be considered by all nursing staff dealing with patients suffering from changes of the oral cavity.

• Relationship of radiologic and histologic signs of inflammation in human root-filled teeth.

  Authors: Claudia R Barthel, Stefan Zimmer, Martin Trope

  Journal of endodontics. 03/2004; 30(2):75-9.

  The aim of this study was to determine the relationship between histologic and radiologic signs of inflammation in human root-filled teeth. In addition, other factors with possible importance forThe aim of this study was to determine the relationship between histologic and radiologic signs of inflammation in human root-filled teeth. In addition, other factors with possible importance for apical inflammation were assessed. Fifty-three block sections of root-filled teeth were gathered from human cadavers. The blocks were radiographically exposed, sectioned, and stained with hematoxylin and eosin. Histologic sections were categorized as inflamed or uninflamed. Radiographically, the roots were assigned as apical lucency, widened periodontal ligament (PDL), or no lucency. Presence and contents of accessory canals were recorded (empty, tissue, or filling material). Statistical analysis was performed with the Chi-square test. All roots had accessory canals; 12 showed tissue remnants, and the others were empty. Of the cases, 49% were histologically uninflamed at the apex, and 52% appeared radiographically intact. The odds ratio of finding a histologically inflamed apex with radiologic lucency versus a radiographically intact apex was 9.2 (p = 0.002). The odds ratio of finding a histologically uninflamed apex with a radiologically tight coronal seal versus an unacceptable seal was 3.7 (p = 0.053). It may be concluded that there are relationships between radiologic and histologic signs of inflammation in human root canal-treated teeth. There appears to be a tendency that the radiologically determined quality of the coronal seal has an impact on the histologic state of the root-filled tooth. No relationship was detected between unfilled lateral or accessory canals and the status of inflammation at the periapex (51% inflamed, 49% uninflamed).

• Reduction of oral levels of volatile sulfur compounds (VSC) by professional toothcleaning and oral hygiene instruction in non-halitosis patients.

  Authors: Rainer Seemann, Gregor Passek, Mozhgan Bizhang, Stefan Zimmer

  Oral health & preventive dentistry. 02/2004; 2(4):397-401.

  PURPOSE: The aim of the study was to determine the longitudinal effect of an oral hygiene program on oral levels of volatile sulfur compounds (VSC). MATERIALS AND METHODS: The study subjects werePURPOSE: The aim of the study was to determine the longitudinal effect of an oral hygiene program on oral levels of volatile sulfur compounds (VSC). MATERIALS AND METHODS: The study subjects were randomly selected from patients attending a student course in operative dentistry and from staff members of our dental clinic. The test group (n = 30) received an oral hygiene training including professional toothcleaning (PTC), oral hygiene instruction, and motivation. The control group (n = 10) received no particular treatment. None of the subjects suffered from bad breath nor performed regular tongue cleaning. At baseline, immediately after PTC, one week, and four weeks thereafter we measured the oral hygiene status by means of the papillary bleeding index (PBI) and the oral concentrations of VSC by using a portable sulfide monitor (Halimeter). RESULTS: Immediately after PTC, as well as one week, and four weeks after entering the program the PBI and the VSC-levels were significantly decreased as compared to the baseline values and the control group. VSCs were decreased by 34.9% (+/- 6.3) after PTC, 33.2% (+/- 7.1) one week, and 27.9% (+/- 5.8) four weeks thereafter. CONCLUSION: The present study shows that in a group of patients without bad breath, an oral hygiene training program including professional toothcleaning, motivation and instruction of self-applied oral hygiene procedures is capable of reducing both papillary bleeding and oral levels of VSC Halimeter readings over the observation period of four weeks.

• Clinically controlled study on the quality of class III, IV and V composite restorations after two years.

  Authors: Birgit Geitel, Ralf Kwiatkowski, Stefan Zimmer, Claudia R Barthel, Jean-François Roulet, Klaus-Roland Jahn

  The journal of adhesive dentistry. 01/2004; 6(3):247-53.

  The quality of fillings consisting of a hybrid composite was compared with fillings consisting of two different microfilled composites in a clinical examination. Within the design of a clinicallyThe quality of fillings consisting of a hybrid composite was compared with fillings consisting of two different microfilled composites in a clinical examination. Within the design of a clinically controlled two-year study conducted under practice-relevant conditions, the composites C-Fill MH (Megadenta), Helio Progress (Vivadent), and Visio-Dispers (ESPE) were examined in anterior-tooth cavities in 134 patients by means of the split-mouth technique. The clinical examinations were performed based on modified Ryge criteria (marginal integrity, anatomical form, secondary caries, color, marginal discoloration, surface roughness) after 12 and 24 months. Immediately following filling application, all evaluation criteria except color were assessed as level A. After 12 and 24 months, C-Fill MH was found to be significantly superior to the other materials with regard to marginal integrity, color, and marginal discoloration. The hybrid composite C-Fill MH seems to be superior to the microfilled composites and should therefore be preferred as a restorative filling material.

• [Assessment scales for nursing assessment of the mouth. A literature review]

  Authors: Thomas Gottschalck, Theo Dassen, Stefan Zimmer

  Pflege. 11/2003; 16(5):273-82.

  Especially in patients which are at risk for transformations of the oral soft tissue the importance of an oral assessment is stressed by many authors. The application of an assessment instrumentEspecially in patients which are at risk for transformations of the oral soft tissue the importance of an oral assessment is stressed by many authors. The application of an assessment instrument enables a diagnosis related decision of the care measures which have to be taken. Furthermore, the effectiveness of the measures can be assessed and it is an important research instrument. An assessment instrument gives support and safety to the practitioner in his decisions and simplifies a precise documentation. In the literature, more than 40 assessment methods and instruments to assess the oral health status could be found. Only a few of them are validated. Concerning the assessment criteria, there was no consensus between the authors. There is no agreement if subjective perceptions of the patient should be included in the assessment. Based on available validity characteristics, recommendations for assessment methods which are suitable for patients in geriatrics, intensive care and specific tumor therapy are given.

• [Some frequently used substances, instruments and methods in mouth care with regard to evidence-based applications]

  Authors: Thomas Gottschalck, Theo Dassen, Stefan Zimmer

  Pflege. 05/2003; 16(2):91-102.

  The purpose of this study was to evaluate current practice in mouth care as few data exist in this area. By means of a questionnaire nurses were asked which mouth care substances, methods andThe purpose of this study was to evaluate current practice in mouth care as few data exist in this area. By means of a questionnaire nurses were asked which mouth care substances, methods and instruments they used in their clinical practice. They were also asked about their clinical experience. The most frequently used substances and instruments were then examined with regard to their evidence base using an evaluation system bases on a compilation of scientific literature. The results show that nurses' selections of mouth care substances and instruments are mainly based on their clinical experience and on traditions. There is little scientific evidence for their mouth care practice. Using assessment instruments in order to assess oral conditions and evaluate nursing interventions as well as using more substances with proven effect has the best potential to improve practice. There is an obvious need for evidence-based guidelines and standards.