Oral Health and Preventive Dentistry, 04/2019

Objectives: The aim of the present study is to assess the means and methods being suggested by Greek orthodontists to their patients for cleaning their removable devices. Materials and Methods: A questionnaire survey was conducted among a total of 418 Greek orthodontists found from the registry of orthodontists in Greece. The clinicians were asked about the means and methods of daily cleaning they usually advise their patients for removable appliances. Furthermore, the questionnaire included questions related to possible complications of these devices and data about the use and type of applied devices. Results: From 418 Greek orthodontists, 279 filled the questionnaire and participated in this study. All but one reported that they use removable appliances in their practice for patients of almost any age. All orthodontists recommend routine manual toothbrushing, but the majority of them also suggest at the same time other oral hygiene aids complementary to brushing, such as immersion in denture cleaners (70.06%), in disinfecting solutions (12.73%) and in vinegar (36.94%). Some 15% of all the practitioners advise the use of ultrasonic instruments for cleaning removable orthodontic appliances. At last, clinicians have faced complications from the use of removable devices in the oral cavity at a statistically significant percentage. The most usual is trauma of the mucosa, mycosis and hyperplasia. Conclusion: Greek orthodontists use removable orthodontic appliances, active or passive, in their practice. Brushing with a toothbrush and the use of cleaning products for removable prostheses are the preferred methods for cleaning removable orthodontic appliances regardless of the orthodontic specialty programme they had graduated from. Keywords: disinfection, denture cleaner, oral hygiene, removable orthodontic appliance

Purpose: Historically, the healthcare needs of 'Looked After Children' (LAC) within the UK have been relatively neglected and there is no universally adopted designated dental care pathway (DDCP) in place to ensure their care. This paper aims to discover the contribution of the community dental service (CDS) to the dental health of LAC throughout England and Wales. Materials and Methods: An electronic questionnaire was sent to CDS Clinical Directors in England and local health boards in Wales between November 2011 and January 2012. Ten questions were included with 5-point Likert scale responses and the option for free text comments. Results: In Wales, 41 questionnaires were returned (35% response rate) of which 37 services provided care for LAC. In England, 67 questionnaires were returned (44% response rate), of which 59 services provided care for LAC. Conclusion: The study found that the majority of CDSs in the UK provide care for LAC, However, we cannot ascertain if the CDS is the most appropriate service to provide dental care for this group of patients. The use of DDCPs, non-attendance and other care policies varied markedly amongst respondents, which may suggest that provision of dental care for LAC within the CDS in England and Wales is inconsistent. The authors believe that the utilisation of an LAC-specific and universally accepted DDCP that has been developed could help to reduce these inconsistencies. Further surveys are planned in order to monitor the care of this vulnerable group of patients and assess the impact of these recommendations. Keywords: community dental service, dedicated dental care pathway, looked after children

Purpose: The purpose of our study was to evaluate the impact of different irrigation fluid temperatures on intraosseous temperature increment during guided and freehand implant site preparation. Materials and Methods: Bovine rib segments were used. Temperature was detected using K-type thermocouples. The studied groups were defined as combinations of the following: drilling speed (1500, 2000 RPM), drill diameter (2.0, 2.5, 3.0, 3.5 mm), surgical method (guided, freehand), and irrigation fluid temperature (10°C, 15°C, 20°C). The data were analysed with Kruskal-Wallis analysis of variance (ANOVA) and ANOVA, as appropriate. Results: At 1500 RPM, guided drilling with 20°C irrigation fluid yielded temperature values exceeding the necrotic threshold (47°C) when performed with bits of 3.0 and 3.5 mm diameters. Meanwhile, 15°C irrigation managed to keep the mean increment below 8.0°C at the diameter of 3.5 mm for both guided and freehand surgery. However, 10°C irrigation cancelled every statistically significant difference between guided and freehand groups. At 2000 RPM and with 20°C irrigation, mean peak temperatures exceeded the necrotic threshold at the diameters 3.0 and 3.5 mm (guided) and 3.5 mm (freehand). When applying 10°C irrigation, though, all measurements indicated peak temperatures in the safe zone. Conclusion: Drillings at 1500 and 2000 RPM, in a guided setting, cause temperature elevations that exceed the necrotic threshold. A speed of 2000 RPM drilling may produce potentially harmful temperatures also in a freehand setting. 10°C and 15°C irrigation kept temperature increments in the safe zone at 2000 RPM and 1500 RPM, respectively. Keywords: dental implants, heat production, osteonecrosis, osteotomy

Purpose: To measure the demineralisation changes on human deciduous enamel produced by pH cycling after preventive treatment with Er:YAG laser irradiation, fluoride varnish application and a combination of the two. Materials and Methods: Sixty extracted human anterior primary teeth were assigned to six groups (n = 10). Group C: untreated; group L: Er:YAG laser; group TCP-NaF: Clinpro White (5% sodium fluoride and modified tricalcium phosphate); group CPP-ACP-NaF: MI varnish (5% sodium fluoride with casein phosphopeptide-amorphous and calcium phosphate); group L+TCP-NaF: Er:YAG + 5% sodium fluoride + modified tricalcium phosphate; group L+ CPP-ACP-NaF: Er:YAG + 5% sodium fluoride with casein phosphopeptide-amorphous and calcium phosphate. The samples were subjected to a 10-day pH-cycling regimen to create caries-like lesions, with 8 h in demineralising solution and 16 h in remineralising solution at 37°C. Enamel demineralisation was evaluated by laser fluorescence (DIAGNOdent) before and after pH cycling. The Mann-Whitney U-test and Wilcoxon tests were performed with statistical significance set at p ≤ 0.05. Results: The Wilcoxon test revealed statistically significant differences at baseline and after pH cycling in groups C (p = 0.02), L (p = 0.034) and L+TCP-NaF (p = 0.025) and the lowest percentage of healthy tooth substance compared to the other groups. Conclusions: The results suggest that the treatment protocols employed in groups TCP-NaF, CPP-ACP-NaF, and L+ CPP-ACP-NaF had similar effects in terms of preventing demineralisation, as reflected in a higher percentage of healthy dental structure maintained. Hence, these treatments are recommended for clinical use as an effective preventive measure. Keywords: YAG, laser fluorescence, primary teeth, remineralisation

Purpose: To determine the prevalence of molar-incisor hypomineralisation (MIH) in 7- to 9-year-old (±1 year) schoolchildren living in Dubai, United Arab Emirates, and to find a possible association with caries, fluorosis and socioeconomic status. Materials and Methods: In this cross-sectional study, a representative sample of 779 children with an age of 7 to 9 years ±1 year in primary schools in Dubai were randomly selected and examined by one investigator who had previously been trained and calibrated with the diagnostic criteria of European Academy of Paediatric Dentistry (EAPD) for MIH, caries diagnostic criteria of the World Health Organization (WHO) and Dean's criteria for fluorosis. Results: The prevalence of MIH in Dubai was 7.57% and was almost identical for both genders (female 7.57% and male 7.58%). The caries index was high (2.41±1.7). Children with MIH in Dubai exhibited statistically significantly higher DMFT values than did children without MIH (mean 3.5 ± 1.7 vs 2.3 ± 1.7; p 0.001). The prevalence of fluorosis was 10.9% with no statistically significant age or gender differences. Conclusion: The prevalence of MIH in Dubai is low. However, the caries and fluorosis values are much higher, which calls for strengthening caries-preventive efforts. Keywords: caries, fluorosis, molar-incisor hypomineralisation, socioeconomic status

Purpose: To evaluate if periodontists are coherent in their judgement and treatment decisions of patients with different periodontal conditions, and to compare them with general dental practitioners' (GDPs) findings. Materials and Methods: Eighty-six periodontists participated in a questionnaire study based on four patient cases: (a) generalised bone loss but minimal signs of inflammation (well-maintained); (b) generalised bone loss and signs of inflammation (periodontitis); (c) negligible bone loss and minimal signs of inflammation (healthy); and (d) negligible bone loss but with signs of inflammation (gingivitis). Periodontists had the option to judge each patient as healthy or diseased, propose a diagnosis, evaluate treatment needs, propose a treatment plan and assess the prognosis. Comparison between periodontists considered: (a) level of experience and (b) judgement of each patient case as healthy or diseased. Periodontists were additionally compared to a previous sample of GDPs (n = 74). Results: Periodontists' response rate was 77%. The diagnostic judgement of the four patient cases showed rather large variation both among periodontists and GDPs. Periodontists' intention to treat and prognostic assessment depended on their judgement of each patient, as healthy or diseased (p 0.05). GDPs intended to treat three out of four patient cases (except periodontitis case) more often and were more pessimistic in their prognostic assessment of patients with negligible bone loss (p 0.05), comparing to periodontists. Conclusions: Both periodontists and GDPs are defining periodontal health and disease differently, which affects treatment decisions and prognostic assessment. There is a need to define periodontal health and disease more precisely, in order to improve coherence in judgement. Keywords: clinical decision-making, gingivitis, periodontal diseases, periodontitis, specialists

Purpose: To evaluate the efficacy of SmartMouth Clinical DDS compared with 0.12% chlorhexidine and placebo mouthrinses. Materials and Methods: Seventy-six subjects with gingivitis or chronic periodontitis were enrolled in a double-blind, placebo-controlled, clinical study. Examinations included Gingival Index (GI), Bleeding Score (BS), Plaque Index (PI), Tooth Stain Index (TSI), and Calculus Index (CI). Subjects were given a prophylaxis and oral hygiene instructions at the time of enrolment. Subjects were assigned to one of three groups: SmartMouth Clinical DDS (SM), 0.12% chlorhexidine (CHX), or placebo (PL). Subjects were examined at 3 and 6 weeks. Data were evaluated as differences from baseline for each group. Analysis of variance (ANOVA), t tests or non-parametric alternatives were used to analyse data. Results: The GI, BS and PI decreases from baseline were statistically significant at both 3 and 6 weeks for all three groups (p ≤ 0.025). Differences between groups were not statistically significant, except that the PI decrease for CHX was significantly greater than PL at 6 weeks (p = 0.048). At 6 weeks there was a statistically significant increase in TSI for CHX (p ≤ 0.001). CI decreased significantly for all groups at 3 weeks (p ≤ 0.004) and for PL at 6 weeks (p ˂ 0.001). At 3 weeks and 6 weeks, the percentages for compliance were significantly higher for SM and PL than for CHX (p ˂ 0.001). SM had less taste alteration reported than CHX (p = 0.003). Conclusion: While all three groups were shown to improve GI, BS and PI scores; non-prescription SM resulted in less taste alteration, less tooth stain and better compliance than CHX. Keywords: cetylpyridinium chloride, chlorhexidine, mouthrinse, volatile sulphur compounds, zinc-ion

Purpose: The objective was to assess the effect of fissure depth and enamel surface preparation protocols on penetration of resin-based, giomer and glass-ionomer fissure sealants. Materials and Methods: Ninety extracted third molars were assigned into three groups according to the material used. All three groups were subsequently divided depending on tooth preparation: no pretreatment or surface preparation with 10% polyacrylic acid, 37% phosphoric acid, or self-etching adhesive. In addition, Er,Cr:YSGG laser or air abrasion were employed in all subgroups. The penetration was evaluated using scanning electron microscopy. Results: The groups that were pretreated with an appropriate acid resulted in superior penetration of glass-ionomer and resin-based sealants when compared with other surface preparation protocols (p 0.05). The exception was teeth treated with both air abrasion and acid etching. Both preparation protocol and fissure depth significantly affected the sealant penetration (p 0.05), but fissure depth had a greater impact on fissure penetration than did enamel surface pretreatment. Conclusion: All investigated materials exhibit similar properties regarding sealant penetration. Penetration of a fissure sealant is significantly influenced by the fissure depth. In regard to enamel surface preparation protocol, a pretreatment with phosphoric acid in resin-based and polyacrylic acid in glass-ionomers appears to be essential in obtaining the adequate penetration of a sealing material. Keywords: fissure sealant, fissure morphology, glass-ionomer, resin composites, giomers

Purpose: The purpose of this in vitro study was to evaluate the effect of two preventive clinical treatments on bovine enamel susceptibility after erosive challenge induced by a soft drink. Materials and Methods: Eighteen sound bovine incisors were used for this study. Three experimental groups were assigned as follows: Group 1 was the control group; Group 2 specimens received a CPP-ACPF paste treatment; and Group 3 specimens received a treatment with a product containing 1% nano-hydroxyapatite and 455 ppmF-. The specimens were submitted to erosive challenge using a common soft drink (Coca Cola). The erosive activity on the enamel was evaluated by measuring surface microhardness change (Vickers method), surface roughness alterations and surface loss (vertical scanning interferometry (VSI) method). The data were statistically analysed using one-way analysis of variance (ANOVA) and Tukey's post-hoc test at a level of statistical significance a = 0.05. Results: The tested treatments exhibited significantly lower decreases in surface microhardness compared to the control group after the erosive challenge (p 0.05). The tested treatment groups did not show statistically significant lower increases in surface roughness compared to the control group (p > 0.05). In addition, the treatment groups exhibited statistically significant lower surface loss than the control group (p 0.05). Conclusion: Although the tested treatments reduced erosive activity, none of them provided complete protection against the development of enamel erosion, which means that they should be only used as a part of an individually tailored preventive programme. Keywords: enamel erosion, nano-hydroxyapatite, CPP-ACPF, soft drink

Purpose: To assess the impact of extent and severity of chronic periodontitis (CP) on oral health-related quality of life (OHRQoL). Materials and Methods: A cross-sectional comparative study was performed on subjects from multiple dental centres in Malaysia using a questionnaire covering sociodemographics, OHRQoL using the Malaysian Oral Health Impact Profile questionnaire, OHIP-14(M) and self-reported symptoms. Participants with severe CP were age-and gender-matched with periodontally healthy/mild periodontitis (HMP) participants based on inclusion and exclusion criteria. Full mouth periodontal examination was performed on participants. Outcome measures were OHIP-14(M) prevalence of impact and severity of impact scores. Results: One hundred and thirty (130) participants comprising 65 severe CP and 65 HMP participants were included in the study. Prevalence of impact on OHRQoL was significantly higher in the severe CP than HMP group, with an odds ratio of 3. Mean OHIP-14(M) score was significantly higher in the severe CP (18.26 ± 10.22) compared to HMP (11.28± 8.09) group. The dimensions of psychological discomfort and functional limitation, and factors such as 'discomfort due to food stuck' and 'felt shy' were impacted more in severe CP compared to HMP group (p 0.05). When compared with the HMP group, generalised severe CP participants showed higher prevalence of impact on OHRQoL [OR=5] (p 0.05) compared to localised severe CP [OR=2] (p = 0.05). Participants who had experienced self-reported symptoms had statistically significant impacts on OHRQoL. Conclusions: Severe CP had a greater impact on OHRQoL compared to HMP. Impacts were mainly for functional limitation and psychological discomfort dimensions. When considering extent of disease, the impact on OHRQoL was mostly in generalised severe CP subgroup. Keywords: chronic periodontitis, oral health-related quality of life, OHIP, self-reported symptoms

Purpose: The effects of arginine as a toothpaste additive were assessed on oral streptococci with and without a known arginine deiminase system (ADS) and cariogenic biofilms. Materials and Methods: Suspensions of Streptococcus mutans, S. sobrinus and the ADS-positive (ADS+) S. sanguinis and S. gordonii were cultured with or without 1.5% L-arginine for 24 h. Thereafter, biofilms consisting of the four species were formed on polystyrene surfaces with or without 1.5% L-arginine for up to 10 d. Finally, biofilms that formed on enamel surfaces were exposed to a daily mechanical cleaning with an arginine and sodium monofluorophosphate (SMF+Arg)-containing toothpaste, a sodium monofluorophosphate fluoride (SMF)-containing toothpaste or a negative control for up to 10 weeks. At different incubation times, the pH in the culture media, the citrulline production and the percent of ADS+ bacteria within the biofilms were determined. Microsurface hardness loss was quantified in the experiments using enamel specimens. Results: In the presence of 1.5% arginine, S. sanguinis and S. gordonii showed a high level of production of citrulline after 6 h of incubation, together with an increase in the pH when compared to S. mutans and S. sobrinus. With arginine supplementation, the percentage of ADS+ species was higher at 1, 2 and 4 days and citrulline production was higher at all days of biofilm formation on polystyrene surfaces. After 4 and 10 weeks of treating biofilms on enamel surfaces, the SMF+Arg group had a higher proportion of ADS+ strains than the SMF group; at 4 weeks, the pH was higher in the SMF+Arg group. Loss of enamel hardness was the lowest in the SMF+Arg group and was significantly less in the SMF+Arg group than in the control group after 2, 4 and 10 weeks of treatment. Conclusion: Toothbrushing using an arginine-containing toothpaste may protect against dental caries. Keywords: arginine, citrulline, multispecies biofilm, microsurface hardness, oral streptococci

Purpose: To assess the remineralising efficacy of fluoride varnish containing additives and conventional sodium fluoride varnish. Materials and Methods: 72 extracted upper central incisors specimens were randomly allocated to four groups after demineralisation: control; 5% sodium fluoride varnish (FV) (Fluoritop-SR); resin modified glass ionomer-based calcium phosphate containing fluoride varnish (CV) (Clinpro XT); fluoride varnish with xylitol coated calcium phosphate (cXp) (Embrace). Change in surface morphology, calcium phosphorous ratio and fluoride content of enamel were evaluated using scanning electron microscope and energy dispersive X-ray analysis (SEM-EDAX). Change in surface roughness was evaluated using profilometer analysis. All readings were taken at baseline, after demineralisation, at 2 weeks and 4 weeks of remineralisation. Results: At 4 weeks of remineralisation surface roughness values were ranked as follows: control > FV = cXp > CV. Calcium phosphorus ratios were in the order: CV > FV = cXp > control and fluoride content (for treatment groups): CV = cXp > FV. Scanning electron microscopy images showed mineral deposition on the surfaces of the treatment groups with different deposition pattern of minerals. Conclusion: Fluoride varnishes with or without additives are effective in remineralisation of early enamel lesions. Glass ionomer-based fluoride varnish results in better remineralisation than xylitol coated calcium phosphate containing fluoride varnish and 5% sodium fluoride varnish. Keywords: fluoride varnish, glass ionomer, tooth remineralisation, xylitol