Clinical Preventive Dentistry

Publications
A number of commercially prepared chlorhexidine mouthrinses which are now available are formulated at concentrations lower than the more usual 0.2%. This study compared 0.12% and 0.1% chlorhexidine mouthrinses for effects on plaque regrowth and gingivitis, using a two 19-day period single-operator blind-crossover study design on 14 healthy human volunteers. The 0.12% rinse was a commercial product previously shown as effective as a 0.2% rinse. The 0.1% rinse was a reformulated version of a 0.1% preparation commercially available at the time of this study. Plaque reformation was recorded on days 12 and 19 by score and area. Gingivitis was recorded at day 1, 12 and 19 by measuring gingival crevicular fluid, gingival index and bleeding on probing. The mouthrinses were used twice a day and as recommended by the manufacturer. Mean scores for plaque and gingivitis were mostly lower with the 0.12% rinse but only reached significance for plaque score on days 12 and 19 and for plaque area on day 19. Reformulation of the 0.1% would appear to have markedly improved the antiplaque properties to levels similar to a known effective commercially available 0.12% rinse.
 
The inhibitory effect of a chlorhexidine rinse on gingival inflammation and plaque accumulation has been well documented. The purpose of this study was to determine whether a twice daily oral rinse with 0.12% chlorhexidine will resolve denture-associated inflammation in a geriatric population. Thirty-six subjects, average age 83 years, were randomly divided into two groups, active and control, and further stratified into three subgroups, removable partial dentures, complete overdentures and lacking a removable prosthesis. Gingival (Löe and Silness '63) and plaque (Silness and Löe '64) indexes were performed on teeth Nos 3, 9, 12, 19, 25 and 28 at baseline and at 60 days. The subjects, following baseline measurements, were required to rinse twice daily for 30 seconds with either a 15 ml solution of 0.12% chlorhexidine or a placebo and instructed to continue their normal oral hygiene routine. The data were statistically analyzed. When active and control groups were compared, either in total or within their stratified subdivisions, significant differences were observed (P less than 0.001). The active group had a 10.27% and 16.68% reduction in the gingival and plaque indexes, respectively, compared to insignificant changes in the control groups. It was concluded that although chlorhexidine proved effective in reducing inflammation and plaque scores, this reduction was not influenced by the type of prosthesis worn.
 
Chlorhexidine and phenolic mouthrinses have attracted considerable interest as adjuncts to oral hygiene. The aim of this study was to compare two well known proprietary mouthrinse products for their effects on plaque regrowth, the development of gingivitis and the formation of toothstaining. The study was a single-blind, randomized, placebo-controlled, triple cross-over experimental, gingivitis design. A group of 15 volunteers with a very high standard of oral hygiene and gingival health used each rinse for 19 days in the absence of normal toothcleaning. Each period was separated by a 21 day washout. Plaque scores were significantly different between the rinses, being lowest with chlorhexidine and highest with saline. The plaque area increased 3-fold with the phenolic rinse and 6-fold with the saline rinse compared to the chlorhexidine rinse. Similarly, gingivitis increments were lowest with chlorhexidine and highest with saline but differences between rinses did not reach significance. Staining was significantly different between rinses, primarily due to minimal staining associated with the saline rinse. Staining occurred with both the chlorhexidine and phenolic mouthrinses. It is concluded that the 0.2% chlorhexidine rinse offers greater oral hygiene benefits than the phenolic rinse. The question of indications and durations of use of mouthwash products should be addressed.
 
A two-phase study was conducted to compare the plaque-removal effectiveness of a .007 toothbrush and a .008 toothbrush when used in an unsupervised home-care program. In the first phase of the study, two children's toothbrushes, a .007 toothbrush (POH Junior #8) and a .008 toothbrush (Allie-Croc), were compared in a population of third through sixth grade children. The .007 group had a greater reduction of plaque from pretest to post-test than the .008 group in all grades, with statistically significant differences favoring the .007 toothbrush for fourth and sixth grades. In phase two a .007 adult toothbrush (POH #4) was compared to a .008 adult toothbrush (Oral B 40) in a population of nursing and dental hygiene students. Both toothbrushes performed equally well with a significant decrease in plaque and gingival inflammation observed from pretest to post-test regardless of toothbrush used. Any changes in soft-tissue abrasion were negligible and not statistically significant. Based on the results of this study, both brushes appear to be safe and effective and can be recommended with confidence.
 
Two identical dental examinations were conducted in Lincoln, Nebraska to evaluate the dental health of public elementary and high school subjects before and after the community water supply had been fluoridated to an ideal level. All the subjects were examined clinically and radiologically. In 1984, 398 dental records from a similar 1964 survey were reanalyzed to develop standard epidemiological tables and demographic information. Two hundred forty-nine student subjects were examined in 1984. The results of this study were tabulated for the primary teeth, permanent teeth, and the total dentition. When considering permanent teeth, the 1964 pre-fluoridation student subjects had an average of 5.51 decayed, missing, and filled teeth (DMFT); and an average of 10.27 decayed, missing, and filled surfaces (DMFS). In contrast, the 1984 post-fluoridation student subjects, had an average DMFT of 2.51 and an average DMFS of 3.76.
 
The study involved 53 patients aged 18 to 67 (mean age 38.8, SD 13.6), 26 male and 27 female, who were monitored by means of a 27-hour non-invasive ambulant blood pressure registration, using the Oxford Monitoring System. All patients had been under dental supervision by the same dentist for more than one year, and were familiar with the procedure during checkups. This study showed a significant rise in systolic blood pressure (8.6 mmHg) and a tendency towards increased diastolic pressure (2.9 mmHg) during dental checkups in comparison with the values recorded 24 hours earlier during normal daily activity. These results were independent of the blood pressure classification (normotensive, borderline or hypertensive) of the patients and are comparable to the increases measured during a visit to the GP. Neither the sex nor the manner of the dentist had any significant influence on either the systolic or diastolic pressure values during the checkup. Nor did the phobic level of the patients significantly influence blood pressure values during the dental checkup. On the basis of the results of this study, it may be concluded that regardless of whether the patient is phobic or non-phobic, and regardless of the sex and manner of the dentist, blood pressure measurements taken during dental checkups are reliable and can be used for referral decisions.
 
The characteristics of the air-powder abrasive device (APAD) was reviewed from the current dental literature and found to be an excellent alternative to traditional methods for stain and plaque removal. Access to crowded teeth, grooves and involved furcation areas are easily obtainable with less operator fatigue. The APAD slurry produces different root surface abrasiveness, depending on the method of use. Extended maintenance periods of exposed root surface using the APAD can result in an enormous loss of root structure. To avoid permanent damage of the root, the device should be used with overlapping strokes and root exposure to the APAD slurry should be minimized. The device can be used for total cementum removal with less operator fatigue and more reproducibility than with hand instruments, leaving smooth and clean surfaces. In addition, the device may be a valuable tool in the detoxification of root surfaces during periodontal surgery.
 
The Rota-dent brush has been compared to conventional manual toothbrushes as to the abrasive effect on the dentin. Thirty-two teeth were embedded in epoxyresin. The test blocks were ground and polished, thereafter brushed with Jordan Soft, Jordan Blå Kjerne, Wisdom Plaque Master (hard) and three different Rota-dent brushes, Standardpoint, Hollow-cup and Longpoint. The brushing experiment was made in a test chamber filled with distilled water. After the brushing, the profiles of the brushtracks on the blocks were measured. On all the blocks, small tracks appeared which were not measurable. Conventional toothbrushes and Rota-Dent brushes used without dentifrice gave minimal abrasion on the dentin.
 
Thermoluminescence dosimetry (TLD) has been widely used in the monitoring of radiation exposure in healthcare workers operating radiation devices. This study compared the reliability of TLD to an electronic dosimeter. The absorbed dose registered by the TLD chips was found to be higher than that by the electronic dosimeter. Variability was found to be significantly higher and the variance component attributed to the variability of the method of measurement was more than twice as much in TLD when compared to the electronic dosimeter. It is concluded that TLD is a more variable method of measuring absorbed dose than the electronic dosimeter.
 
Slow-release varnish containing chlorhexidine was applied prior to the application of a periodontal dressing. The ability of the slow-release varnish to inhibit accumulation of dental plaque under the dressing was compared to a placebo varnish. Seven volunteers were fitted with periodontal dressing on the lower and upper jaws. One jaw was pre-coated with slow-release varnish containing chlorhexidine, while the other was coated with a placebo. A week later the dressings were removed and the plaque under the dressing was scored. Significantly less plaque was found on teeth pre-coated with the slow-release varnish containing chlorhexidine as compared to the control. An increase in the amount of gingival fluid was observed in both the control and experimental groups after removing the periodontal dressing.
 
The purpose of this study was to compare the effectiveness of plaque removal of the Water Pik Automatic Toothbrush and Interplak brush versus the Oral B-40 manual brush. Thirty healthy patients having plaque on all tooth surfaces were admitted for this two-week, double-blind study. Patients served as their own control by brushing manually for one week, and then for a second week with a randomly-assigned electric brush. Three plaque indexes were scored at baseline, one week and two weeks. For all these indexes, results showed that the Water Pik Automatic Toothbrush removed significantly more plaque than manual brushing. The Interplak brush removed statistically more plaque than manual brushing only with the Turesky Index. The data for all indexes have a trend toward better plaque scores for patients who used the Water Pik Automatic Toothbrush. However, statistical analysis of these scores showed that both electric toothbrushes performed equally well.
 
Although the Volpe-Manhold Calculus Index (VMI) is used frequently in clinical trials, it is not clear how representative this index is of the actual tooth surface area covered with calculus. This study correlated the mean VMI and mean calculus area, as measured objectively by using computer-assisted planimetry, in 40 subjects with a wide range of calculus deposition. The resulting statistically significant (p less than 0.05) correlation coefficient of .93 indicates a strong correlation between the VMI and mm2 calculus area, confirming the suitability of this index for use in calculus clinical trials.
 
A case report of oral and periodontal manifestation of agranulocytosis in a 12-year-old girl is presented. The agranulocytic state may have been caused by chronic brucellosis since childhood. On admission to the hospital, the acute oral symptoms were treated in order to enable the child to eat and perform standard oral hygiene measures. Chlorhexidine gluconate 0.2% was irrigated daily under pressure for supra- and subgingival plaque control. Resolution of inflammation was achieved without increase in white blood count and thus can be attributed to the control of the local etiologic factor, i.e., plaque.
 
The urgent or after hours phone call to the dentist's office usually indicates a dental, traumatic, infectious, or pain emergency relating to the teeth or adjacent supporting structures. One subject not discussed at length in the professional literature is the emergency patient with acute pain or dysfunction of the orofacial musculoskeletal system, primarily the muscles of mastication and the temporomandibular joint (TMJ). The practitioner should be able to rapidly and efficiently diagnose and manage these emergency patients, or make adequate referral as necessary. Essential features in the diagnosis involve distinguishing muscle problems from intracapsular disorders. Knowledge of general medical-dental differential diagnosis is essential to rule out those problems masquerading as muscle or TMJ disorders. Proper emergency management is directed at controlling the pain or hypomobility disorder and stabilizing the patient. Contrary to most other aspects of dental practice, rapid and complete elimination of symptomatology may not be possible at this visit. Subsequent management should further define the pathologic process and direct the patient to additional phases of care. This report suggests a series of diagnostic and therapeutic guidelines.
 
This study examined the adequacy of sterilization of air-water syringe (AWS) tips following contamination during routine dental care treatment procedures. Although the internal chambers of most AWS tips were determined to be contaminated following use, no residual microbes were detected following autoclave sterilization of the AWS tips used during patient treatment procedures. Therefore, AWS tips apparently are readily heat sterilizable by conventional methods following clinical usage.
 
A Study of a number of oral inhabitant bacteria for adherence to composite resins showed that the most adherent was Bacteroides gingivalis, and that their complicated affinity for the prostheses plays an important role in the development of periodontal diseases.
 
The cariogenic properties of simple sugars are less well appreciated than those of sucrose. The clinical features of an adult patient who presented with extensive caries of unknown etiology are described. The predominant etiologic factor was prolonged usage of self-administered mineral supplements containing lactose. The preventive management strategies are described, and an approach to dietary counselling for patients using unusual self-administered medications is outlined.
 
The purpose of this study was to assay the concentration of metronidazole in gingival fluid, to correlate clinical and microbiologic parameters of periodontal disease to each other and to the gingival fluid concentration of the drug. Ten subjects with a minimum of two contralateral pairs of periodontal pockets of greater than or equal to 5 mm were utilized. One side of the mouth was selected to serve as the root-planed site while the other was left untreated. On day 0, plaque and bleeding-time indexes and probing depths were recorded. Subgingival plaque was analyzed using phase contrast microscopy. When root planing was completed, the subjects were prescribed either metronidazole or placebo three times daily for seven days. Within 24 hours of the last dose, and thereafter at intervals of 1, 2 and 3 weeks, fluid samples were assayed for metronidazole. Clinical and bacterial data were likewise recorded. The results indicate that root planing with metronidazole appears to be more effective in promoting periodontal health than root planing alone. Concentrations of metronidazole ranging from 5 to 20 micrograms/ml were detectable in fluid samples obtained within 24 hours of administration of the last dose. No discernible levels could be found in samples taken at the longer intervals.
 
To determine the influence of cetylpyridinium chloride (CPC) adsorption on the wettability and elemental surface composition of human enamel, with and without adsorbed salivary constituents, surface-free energies and elemental compositions were determined. The surface-free energies were estimated from contact angle measurements; whereas the elemental compositions were determined by X-ray photoelectron spectroscopy. Surface-free energies of ground and polished enamel (88 +/- 8 mJ.m-2 and saliva-coated enamel (103 +/- 4) became similar (109-112) upon adsorption of CPC. Also, the N/C concentration ratios of the ground and polished enamel surface (0.06) and saliva-coated enamel (0.21) become equal upon CPC adsorption. The N/C concentration ratio after CPC adsorption (N/C = 0.04) corresponds with the value expected on basis of the molecular structure of CPC. The strongest evidence for adsorption of CPC to both ground and polished enamel and saliva-coated enamel is presented by the double nitrogen N1s peak. This double nitrogen1s peak is not observed for ground and polished enamel nor for enamel with a salivary coating on top of adsorbed CPC, which indicates that adsorbed CPC can be completely screened by salivary proteins. This study demonstrates that CPC has a definite capacity to adsorb both on ground and polished enamel as well as on pellicle-coated enamel.
 
Top-cited authors
Megan Addy
  • University of Chester
Sias Renier Grobler
  • University of the Western Cape
Robert G Newcombe
  • Cardiff University
Pramod Soparkar
  • The Forsyth Institute
John Moran
  • University of Bristol