Oral Health and Preventive Dentistry, 05/2017

Purpose: To compare the efficacy of an herbal toothpaste with two other chemically active toothpastes regarding plaque and gingivitis control. Materials and Methods: Seventy-six (27 females and 49 males, mean age 47.8 years, range 40-58 years) of 84 initial participants with slight and moderate chronic periodontitis used standardised manual toothbrushes and their usual technique for daily manual mechanical plaque control for 24 weeks of supportive periodontal therapy. The volunteers were randomly assigned to one of 3 groups: group 1 used the herbal toothpaste, group 2 a triclosan/copolymer toothpaste, and group 3 an amine/stannous fluoride toothpaste. OHI, API, SBI, BOP, PD and AL were recorded at baseline and after 6, 12 and 24 weeks (PD and AL only at baseline). The Kruskal-Wallis, Mann-Whitney U-, Friedman, and Wilcoxon tests were used for statistical analysis. Results: Moderate changes occurred in API and OHI in all groups. The herbal toothpaste resulted in significantly lower API and OHI in comparison to the fluoride toothpaste during the study period (p = 0.001 and 0.049, minimum and maximum of cases, respectively). SBI was significantly improved in all groups starting after 12 weeks (p = 0.001 and 0.033). BOP remained largely unchanged in all groups and was always significant lower in the herbal toothpaste group (p = 0.001 and 0.036). Conclusion: During the study period of 24 weeks, the herbal toothpaste was as good as the control toothpastes. No side effects were seen. In terms of improving periodontal conditions, the tested herbal toothpaste could be a suitable alternative to conventional toothpastes with artificial chemical ingredients. Keywords: amine fluoride, herbal toothpaste, inflammation, plaque, saliva, stannous fluoride, triclosan/PVM/MA copolymer

Purpose: Along with calcium and phosphate ions, fluoride ions promote remineralisation of noncavitated carious lesions to form fluorapatite. However, the supply of calcium and phosphate ions from saliva may not be adequate for effective remineralisation in patients with high caries risk. Therefore, an additional supply of calcium and phosphate ions is mandatory to enhance effective remineralisation with fluoride ions. Several calcium- and phosphate-based remineralisation agents are available for clinical use. However, the nature of the incorporated calcium and phosphate ions and the method of their stabilisation are not similar. Therefore, this review summarises research findings on the enamel remineralisation potential of calcium- and phosphate-based remineralisation agents. Materials and Methods: Appropriate key words were used and the Pubmed electronic database was searched to retrieve articles. Screening through titles and abstracts identified relevant articles. Full text review of the identified relevant articles was performed and the significant findings were summarised and presented in this review. Results: Several studies including laboratory-based studies, in situ and randomised controlled clinical trials showed casein phosphopeptide amorphous calcium phosphate (CPP-ACP)-containing remineralisation agents to have superior remineralisation potential compared to other forms of calcium- and phosphate-based remineralisation agents, such as functionalised tri-calcium phosphate (fTCP) and amorphous calcium phosphate (ACP). Conclusions: More long-term clinical studies are necessary to compare the enamel remineralisation potential of calcium- and phosphate-based agents that contain fTCP and ACP with those containing CPP-ACP. Additional well-designed randomised controlled clinical trials are also necessary to justify long-term clinical supplemental use of products containing CPP-ACP. Keywords: calcium, CPP-ACP, phosphate, remineralisation, review

Purpose: To examine whether a difference exists in the relapse rate between the conservative and radical approaches after the treatment of solid/multicystic ameloblastoma (SMA), a systematic review of the literature based on evidence of the last decade was performed. Materials and Methods: The search strategy incorporated examinations of electronic databases, supplemented by hand searches. A search of four electronic databases, including Ovid MEDLINE, PubMed, EMBASE and Web of Science, was carried out for relevant studies published in the English language from January 2005 to September 2015. Cross referencing and hand research was used to identify further articles. Relative Risk (RR) as effect estimates was calculated in both fixed and random effects models. Results: Of 4234 abstracts screened, only 26 articles met the inclusion criteria and were screened in full text. Of these, only 4 were included in the final meta-analysis. Conclusion: The inverse of variance test revealed a statistical difference in the relapse rate for SMA treatment with the conservative vs radical approach. The higher recurrence rate after a conservative approach compared to the surgical approach is significant. However, this review cannot give any recommendation due to the lack of clinical evidence. Keywords: ameloblastoma, ameloblastoma surgical treatment, conservative approach, odontogenic tumour, radical approach, solid multicystic ameloblastoma

Purpose: To evaluate in a systematic review whether the use of dental floss in primary teeth is associated with a reduction in incidence of proximal caries. Materials and Methods: Searches were performed using the following databases: PubMed MEDLINE, Web of Science, Bireme, Scopus and The Cochrane Library. Only 5 studies were eligible for inclusion. The quality assessment and bias control of the studies were carried out based on the Fowkes and Fulton Guideline. The study concept was first registered in the international prospective register of systematic reviews (PROSPERO). Results: Flossing was professionally performed in one study and self-reported (by parents or by the children) through questionnaires in all other 4 studies. In the first study, the authors concluded that daily interdental flossing resulted in a significant reduction in the incidence of proximal caries in deciduous teeth during a 20-month period. Two cross-sectional studies found that the use of interdental floss did not show any relevant association with the prevalence of caries; one study found that a higher the frequency of flossing was associated with higher caries experience, and the other found an association between severe caries and the use of dental floss, independently of the flossing frequency. Conclusion: There is only one study in the current literature showing evidence of an association between the use of dental floss and proximal caries reduction on primary dentition. However, the use of dental floss should never be discouraged. Healthy habits acquired in childhood continue throughout adult life, with numerous oral- and general-health benefits. Keywords: deciduous, dental caries, dental devices, home care, proximal caries, tooth

Purpose: This prospective, blinded clinical trial assessed the performance of amalgam restorations that were refurbished, replaced, or not treated. Materials and Methods: Twenty-three patients were included, ages 18-80 years, with 63 amalgam restorations that had one or more defects in their clinical features, such as defective anatomic form, roughness and/or luster according to United State Public Health Service (USPHS) criteria. Restorations were randomly assigned to either refurbishment (A: n = 21), replacement (B: n = 21) or untreated (C: n = 21) groups. Two calibrated examiners evaluated the restorations at baseline (Kappa = 0.74) and after 10 years (Kappa = 0.84), according to eight parameters: anatomy, roughness, luster, secondary caries, marginal adaptation, occlusal contact, marginal staining and tooth sensitivity. Wilcoxon tests were performed for within-group comparisons, and Friedman tests were used for multiple within-group comparisons. The Mantel-Cox test was used to compare survival curves. Results: After 10 years, 49 restorations (77.8%) were assessed (group A: n = 19; group B: n = 13; group C: n = 17). Over a decade, the three groups showed similar clinical performances for all studied parameters: anatomy (p = 0.410), roughness (p = 0.930), luster (p = 0.984), secondary caries (p = 1.0), marginal adaptation (p = 0.433), occlusal contact (p = 0.33), marginal staining (p = 0.470), and tooth sensitivity (p = 0.784). Conclusions: Amalgam restorations that have defective anatomic form, roughness and/or luster performed similarly for all studied parameters, whether they were refurbished, replaced or left untreated after 10 years in patients with low and intermediate caries risk. Most of the restorations were classified as clinically acceptable after ten years. Restorations in all three groups tended to deteriorate over time. Keywords: amalgam restorations, clinical trial, oral health care, refurbished restorations, restoration replacement

Purpose: To determine the extent of dental disease and associated treatment costs designed to mitigate the risk of medication-related osteonecrosis of the jaws (MRONJ) among older, socially disadvantaged veterans prior to physician's administration of antiresorptive medication for osteoporosis or malignant bone disease. Materials and Methods: This prospective study based on over seven years (2008-2015) of data describes the type and volume of disease, treatment, work-load measures, and costs using Veterans Affairs databases. Results: One hundred fifty-two outpatients (94% male, mean age 69 ± 12 years) were referred by physicians for clinical/radiographic examination and treatment. Sixteen had a healthy dentition and 17 were completely edentulous with satisfactory prostheses. Three edentulous patients required prosthesis adjustment, 116 dentate individuals required restoration of carious teeth (mean 6.3 ± 5.7) and multiple quadrant (mean 3.1 ± 1.0) scaling/subgingival curettage. In the latter group, 75 required extractions (mean 6.0 teeth, range 1-23). Clinician's (dentist and dental assistant) costs for providing care and preventive education over the 7-year timespan came to almost $132,700. Conclusion: Older veterans requiring initiation of antiresorptive bone medication harbor extensive, untreated dental disease requiring immediate treatment. An appropriate physician-to-dentist referral network and provision of oral care and patient education prior to initiation of medication can potentially moderate the risk of jaw osteonecrosis. Keywords: medication-related osteonecrosis of jaw, preventive dentistry, stomatognathic disease

Purpose: The aim of this study was to determine the changes of salivary flow rate, pH, buffering capacity, total antioxidant capacity and changes in streptococci and lactobacilli counts at baseline, 1 month and 6 months of fixed orthodontic treatment. Materials and Methods: An unstimulated salivary sample was collected from 30 out of 43 patients who were in need of fixed orthodontic treatment (mean age 17.8 ± 5.01 years). Salivary samples were collected from the patients before the placement of fixed orthodontic appliance (Gemini MBT 0223M) at 1 month and 6 months following start of the treatment. Samples were tested for significant changes in flow rate, pH, buffering capacity, total antioxidant capacity and streptococci and lactobacilli counts. Results were compared using ANOVA. Results: The study results showed that orthodontic appliances significantly changed the unstimulated salivary flow rate (p 0.05) (baseline: 0.40 ± 0.11, 1 month: 0.45 ± 0.09, 6 months: 0.44 ± 0.07) and buffering capacity (p 0.05) (baseline: 5.01 ± 0.50,1 month: 3 .98 ± 0.78, 6 months: 4.02 ± 0.78) at the end of 1 month and 6 months whereas lactobacilli count showed significant changes at the end of 6 months (p 0.05) (baseline: 6.20 ± 2.07, 1 month: 7.09 ± 3.78, 6 months: 7.85 ± 1.88). The pH, total antioxidant capacity and streptococci counts did not show any significant changes during the study period. Conclusion: It appears that 6 months of treatment with fixed orthodontic appliance resulted in a significant increase in unstimulated salivary flow rate and lactobacilli counts, whereas buffering capacity decreased significantly during the study period. Keywords: lactobacilli, orthodontic appliance, saliva

Purpose: To evaluate the preventive effect of titanium fluoride (TiF4) gel and solution, in different concentrations, on dentin erosion. Materials and Methods: Of 140 root dentin slabs (3 x 3 x 1 mm) cut from 70 freshly extracted human third molars, 70 with intermediate Knoop microhardness and lowest surface curvature were selected and randomly divided into 7 groups (n = 10): G1: negative control (no treatment); G2: positive control (AmF/NaF/SnCl2 solution); G3: placebo gel (no fluoride); G4: 1% TiF4 solution; G5: 1% TiF4 gel; G6: 4% TiF4 solution; G7: 4% TiF4 gel. Samples were subjected to 10 days of erosive cycling, consisting of alternating exposures to citric acid (0.05 M, pH 2.3, 2 min, 6x/day) and remineralizing solution (pH 7.0, 90 min, between acid exposures). Each cycle consisted of a total of 6 immersions in acid per day. After 5 and 10 days of pH cycling, surface loss was assessed by optical profilometry (µm). Results: One-way ANOVA and Tukey's test (p 0.05) showed that after 5 days, G7 revealed a significant reduction in surface loss compared to the other groups, while G4, G5 and G6 did not differ significantly from G1. After 10 days of erosive challenges, G7 did not differ significantly from G2 and there was no difference between G4, G5, G6 and G1. G3 showed the highest surface loss compared to all groups, except G1 and G5. Conclusion: The treatments tested were not able to prevent dentinal erosion, but the application of 4% TiF4 gel did reduce surface loss of dentin. Keywords: dentin, erosion, fluoride, profilometry, TiF4

Ankylotic root resorption is a serious complication following traumatic dental injuries. The aetiology of root resorption includes acute injury to the cementum and periodontal ligament, and subsequent biological processes that propagate the harm. The aim of the present paper is to present a structured treatment protocol for teeth that have experienced trauma and are at risk of developing ankylotic root resorption, followed by a decoronation protocol for situations in which ankylotic root resorption developed. This protocol provides a structured road map from the primary dental trauma, through the initial development of ankylosis detected radiographically, to the clinical manifestation that results in significant infra-occlusion. The current protocol integrates the best available evidence from the literature and from published guidelines. Ample contradictory data, which mainly consists of case reports related to the treatment of ankylotic root resorption, is available in the current literature. No accepted protocol or uniform guidelines for treatment in these cases exist, and many clinicians prefer avoiding replantation of an avulsed tooth that seems to have an uncertain longterm prognosis, or performing decoronation when infra-occlusion developed. As a result, young patients lose the benefits associated with replantation and decoronation procedures. The option of re-implantation of the avulsed teeth should be considered irrespective of the negative long-term prognosis. Following ankylosis development, the goal of submerging the tooth root (decoronation) is to maintain the horizontal dimension of the alveolar ridge and also to gain vertical dimension, allowing implant placement in the future. Keywords: ankylotic resorption, avulsion, decoronation, luxation, protocol

Purpose: To describe dental caries experience by age and gender among preschool children in a health district in northeast Italy and to plot a trend of primary-dentition dental caries prevalence and severity over a 27-year time span (1984-2011). Materials and Methods: In a cross-sectional survey, 27 out of 88 kindergartens were randomly selected with a sample of 2603 preschoolers drawn from a population of 8328 3-, 4- and 5-year-old children. Dental caries (d3 t) experience according to the criteria of the British Association for the Study of Community Dentistry was evaluated by two calibrated examiners at schools in 1960 (75.3%) 3- to 5-year-old children from October 2010 to May 2011. Three previous surveys performed in the same area, applying the criteria of the World Health Organization, were used to plot a trend over a 27-year period. Comparisons between groups were made using Pearson's chi-squared test, and caries occurrence was established by logistic regression analysis to assess the influence of sex and age (independent variables) on caries experience (dependent variable). Results: Prevalence (%) and severity (mean dmft ± SD) increased with age (17% and 0.5 ± 1.7 at age 3; 24% and 0.8 ± 2.2 at age 4; 35% and 1.3 ± 2.6 at age 5). The level of untreated caries was 85.8%. No statistically significant difference was found for gender. From 1984 to 2004, the prevalence and severity of caries declined at all examined ages, but were unchanged from 2004 to 2011. Conclusion: The current caries scores in preschoolers are low and similar to those reported in other western European countries. Nevertheless, as very early childhood is a key opportunity to intervene, an effort must be made to provide clear oral health guidance and increase the cooperation among all health professionals. Keywords: caries, epidemiology, preschoolers, trend of caries experience

Purpose: To confirm that the quantitative light-induced fluorescence-digital (QLF-D) system is an adequate tool for monitoring changes in the mineral contents of white spot lesions. Materials and Methods: Twenty-three anterior teeth from five orthodontic patients were selected for the samples. Initial fluorescent images were taken with the QLF-D system immediately after removing the fixed orthodontic appliances, and the white spot lesions were visualised in the fluorescent images that were selected. Subsequently, a fluoride varnish containing 0.1% fluoride was applied to all white spot lesions, and the final QLF-D images were taken two weeks after fluoride treatment. Finally, the following four parameters were compared between the images taken at baseline and two weeks after the treatment with paired t-tests: the mean fluorescence loss (∆F), maximum fluorescence loss (∆Fmax), lesion area (area), and lesion volume (∆Q). Results: All the parameters obtained by QLF-D after two weeks had improved significantly when compared with baseline (p 0.01). The recovery rates of the ∆F, ∆Fmax, area, and ∆Q were 11.4%, 17.1%, -37.5%, and 42.1%, respectively. Shallow lesions (∆Fi ≥ -15%) were better remineralized than deep lesions (∆Fi -15%). The ratios of the ∆F, ∆Fmax, area, and ∆Q parameters between the shallow and deep lesions were 2.86, 3.30, 2.20, and 1.88, respectively. Conclusion: The QLF-D system is a sensitive tool for the assessment of small levels of mineral changes in carious lesions after the removal of orthodontic appliances. Keywords: dental caries, diagnosis, quantitative light-induced fluorescence-digital system, white spot

Purpose: To determine the caries prevalence and experience in Thuringian infants and to assess their caries risk. Material and Methods: The subjects were participants in a regional preventive programme, a birth cohort study with the aim of preventing caries. In the first year of life, children were invited to a dental examination at the Jena University Hospital. Dental caries was scored using WHO diagnostic criteria at the d1-level without radiography. Children were categorised as being of low, moderate or high risk for caries according to the caries-risk assessment tool of the American Academy of Pediatric Dentistry (AAPD). Results: 512 children (mean age 6.7 ± 2.2 months) were examined. 58.2% (n = 298) of all children had teeth (2.21 ± 2.76). Caries prevalence of cavitated carious lesions was 1.7%, and prevalence of non-cavitated carious lesions was 7.7% in children who had teeth. Caries experience was 0.3 ± 1.0 d1-4mfs/0.2 ± 1.5 d3-4mfs (range of 0 to 16). Children with caries were on average 10.8 ± 3.2 months old, while children without caries were 6.6 ± 2.1 months. One hundred sixty-nine children (33.1%) were categorised at high risk for caries, and 98 already had teeth. Conclusion: Although caries prevalence and experience was relatively low in infants, one third of all children were categorised as being at high caries risk. Early dental visits are necessary to detect the first signs of caries, to assess the caries risk and to establish a dental home with a risk-related recall system. The caries-risk assessment tool (CAT) of the AAPD can assist the clinician in the decision-making process. Keywords: caries experience, caries prevalence, dental caries, infants, risk factors, susceptibility