Oral Health and Preventive Dentistry, 05/2019

Purpose: To compare the clinical efficacy of toothpastes containing Pro-Argin and NovaMin as dentin hypersensitivity (DH) treatment. Materials and Methods: A systematic review and meta-analysis based on PRISMA was conducted (PROSPERO registration CRD42018095367). Electronic searches were performed in Pubmed, Scopus, Cochrane Library, Web of Science, Virtual Health Library and Open Grey until June 2018, with the terms [pro-argin OR arginine] AND [novamin OR calcium sodium phosphosilicate OR calcium sodium phospho silicate]. Randomised and non-randomised clinical trials comparing DH reduction in adults given Pro-argin-containing toothpastes and NovaMin-containing toothpastes were included. Study selection and quality assessment with Cochrane tool were performed. In the meta-analysis, the comparison between desensitising toothpastes was assessed by standardised mean difference (SMD) with 95% confidence intervals (CI). Certainty of evidence was evaluated with GRADE. Results: Five studies fulfilled the inclusion criteria. In four included studies, a reduction in the DH under tactile stimulus between baseline and post-application times for both toothpastes was demonstrated. Three studies were suitable for meta-analysis. No statistically significant difference between the two toothpastes for DH reduction was observed at immediate (SMD = -1.05, CI = -3.52;1.41), 2-week (SMD = -0.55, CI = -2.59;1.48) and 4-week (SMD = -0.49, CI = -2.78;1.81) follow-up. Certainty of the evidence was very low. Included studies presented a high risk of bias. Conclusions: Pro-argin-containing and NovaMin-containing toothpastes showed effectiveness for DH reduction. No statistically significant difference between the two toothpastes was found. Thus, both can be prescribed to treat DH in adults with equivalent effectiveness up to four weeks. Keywords: dentin desensitising agents, dentin hypersensitivity, Novamin, Pro-Argin, toothpastes

Purpose: Patients undergoing hematopoietic stem cell transplantation (HSCT) are at high risk of oral complications with the potential of causing significant morbidity and mortality. Dental professionals should play a fundamental role in the prevention and treatment of oral sequelae of HSCT. However, the dental community is not well informed and experienced in providing oral care of the oral complications for HSCT patients. This narrative review attempts to fill the knowledge gap through reviewing the oral complications and current recommendations for oral and dental care for the patient before, during and after HSCT. Results: Oral care in the HSCT process was divided into five stages with the goal being to provide practical guidance for dental care providers to assist in managing these patients. It is well known that the maintenance of good oral health is important in cancer patients, including patients with hematologic malignancies. In addition to negatively impacting quality of life, oral pain and/or infections can cause delays, modification and discontinuation of life-saving cancer treatment. Oral complications can lead to new or extended hospitalization. By providing a preventive and treatment algorithm based on currently available literature reports and expert opinion, we can hope to achieve better patient outcomes. Conclusion: We present oral and dental management recommendations with a focus on oral health maintenance, infection prevention, pain control and oral complication management to support oral and general health of this medically complex patient population prior to, during and following HSCT. Keywords: hematopoietic stem cell transplantation, infection prevention, oral care, oral complication, pain control

Purpose: Florid cemento-osseous dysplasia (COD) is a well-described condition that occurs predominantly in black women. The lesion is usually asymptomatic, but in severe cases, symptoms can occur in association with focal expansion due to infection. The safety of dental procedures that involve areas with florid COD has been little discussed. Therefore, the present study aims to emphasise the importance of nonsurgical periodontal treatment in patients with periodontal diseases and COD. Materials and Methods: Four thousand five hundred panoramic radiographs from the image bank of the School of Dentistry of Ribeirão Preto were clinically and radiographically evaluated. Results: Eleven patients had images compatible with florid COD. Eight patients were asymptomatic and three symptomatic. All patients were diagnosed with chronic periodontitis (CP) and their panoramic radiographs showed mixed radiopaque and radiolucent images in the alveolar bone. In symptomatic patients, besides the clinical signs of CP, exposed bone with severe suppuration occurred in the posterior region of the mandible. Conclusions: The maintenance of systemic and oral health is mandatory to prevent secondary infections, and knowledge about the interface between different dental specialties and florid COD management may prevent erroneous decisions and ensure patient safety, taking into account the dental treatment that can be performed without further complications. Keywords: bone infections, oral health, osseous dysplasia, osteomyelitis, periodontal diseases

Purpose: The national supervised toothbrushing programme was implemented in 2015-2016 among 3- to 4-year-old children attending 600 nurseries in Israel. The objectives of this study were to assess factors associated with sustainability of programme implementation, based on nursery teachers' attitudes towards the programme, beliefs in its success and willingness to continue it in in the future. Materials and Methods: A phone survey was conducted among nursery teachers participating in the programme. Study objectives were assessed using a 19-item structured questionnaire. A linear regression model was built to identify factors which contributed to the positive attitude of the teachers towards programme sustainability. Results: Some 300 teachers were interviewed over the telephone. The programme was implemented daily or several times a week in 66% of the nurseries. Around 70% of teachers reported willingness to continue the programme in the future. Teachers' confidence in programme success (r = 0.73), acknowledgment of their role in teaching children to brush their teeth (r = 0.53), tendency to like teaching toothbrushing (r = 0.59) were positively associated with their willingness to continue the programme. Teachers who anticipated more problems were less willing to implement the programme in the future (r = -0.34). Statistically significant differences in frequency of programme implementation were found according to teachers' attitudes towards the programme. A strong relationship (adjusted r2 = 0.71) was found between the teacher's positive perception of programme sustainability and the attribute variables. The degree of interest in continuing a programme and the belief in their ability to operate it attributed most to teachers' positive perception of programme sustainability. Conclusion: A high percentage of teachers expressed a positive attitude towards the programme. Factors contributing to the positive attitude of teachers towards programme sustainability were identified. The survey's results may help in the implementation of similar programmes and contribute to their future success. Keywords: community programme, caries, prevention, children, primary healthcare

Purpose: The rationale of using platelet-rich plasma (PRP) in reconstructive periodontal surgery is to amplify or accelerate the wound healing through the growth factors contained in platelets. On the other hand, bacterial colonisation of membranes may negatively affect the healing process. The aim of this study was to evaluate bacterial contamination of non-bio-resorbable membranes (ePTFE) used for regenerative periodontal therapy of intrabony defects and the clinical attachment level (CAL) gain with or without PRP. Materials and Methods: Seventeen patients were treated with a natural bone mineral (NBM) and guided tissue regeneration (GTR) with an ePTFE membrane (NBM + GTR group; ie, control group), while in another 17 patients PRP was additionally applied (NBM + PRP + GTR group; ie, test group). Furthermore, the retrieved membranes were analysed for the presence of periodontopathogens and data were related to the gain of clinical attachment. In addition, the in vitro sensitivity of selected microbes to PRP was checked by using agar diffusion test. Results: Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were not detected in the PRP group whereas in the controls A. actinomycetemcomitans was detected in five patients (p = 0.022) and P. gingivalis in two cases (difference not statistically significant, p = 0.242). Detection of A. actinomycetemcomitans was not associated with less CAL gain. If the samples were positively tested for Prevotella intermedia/nigrescens and/or P. gingivalis, the CAL gains were lower compared with the negative samples (p = 0.002). PRP did not show any inhibitory effect on bacterial growth in vitro. Conclusion: Within their limits, the present results appear to suggest that the presence of P. intermedia/nigrescens and/or P. gingivalis at the regenerated site may negatively influence the clinical outcomes. However, the potential influence of PRP on bacterial colonisation and the impact on the clinical outcome is still unclear and remains to be elucidated. Keywords: guided tissue regeneration, natural bone mineral, periodontitis, periodontopathogens, platelet-rich plasma

Purpose: The purpose of this study was to analyse the connection between dental arch widths, malocclusion type, nutritive sucking habits and non-nutritive sucking habits, and respiratory factors with the presence of crossbites (CB) in the early mixed dentition. Materials and Methods: Data were collected from 72 children with and without CB. A questionnaire was applied to parents/carers to obtain information about nutritive and non-nutritive sucking habits. The posterior and anterior crossbites were diagnosed in a centric relationship. Dental arch widths were measured directly from the models by two calibrated examiners. The data were analysed statistically using chi-square and Fisher's exact tests. Results: The incidence of Class III malocclusion and the presence of ear, nose and throat problems in the study group were significantly higher than in the control subjects (p = 0.01, p = 0.047). The mean breastfeeding duration for children in the CB group was found significantly shorter than in the control subjects (p = 0.043). The number of children with mouth breathing in sleep was significantly higher in the CB group than the control subjects (p = 0.046). The children with CB demonstrated a statistically significant increase in mandibular intercanine width (ICW) than the control group (p = 0.044). Conclusion: The results demonstrated that an insufficient duration of breastfeeding, mouth breathing, ear-nose-throat problems and Class III malocclusion were associated with the presence of CB in the early mixed dentition. Keywords: arch widths, crossbite, mixed dentition, oral habits

Purpose: To determine the oral hygiene habits, levels of dental caries, and periodontal condition of patients with repaired cleft lip and/or palate (CL/P) in Central Vietnam. Materials and Methods: A total of 78 patients (1-54 years old; median: 6 years) with CL/P were examined for dental caries, gingivitis and periodontitis using the decayed, missing, and filled teeth (dmft/DMFT) index, gingival bleeding on probing and periodontal pocket depth. Data about dental visits, brushing habits and socioeconomic status were collected. Results: A majority of patients brushed their teeth at least once a day with fluoride dentifrice but did not floss. The caries prevalence was 87.2%. The dmft of patients aged ≤ 5 years and 6-12 years were 7.4 and 9.0. The DMFT of patients aged 6-12 years, and ≥ 13 years were 1.6, and 6.7; the difference was statistically significant (p 0.05). The percentages of patients who had bleeding on probing and had periodontal pocket depth 3.5-5.5 mm were 57.7% and 5.3%, respectively. Conclusions: Patients with repaired CL/P in Central Vietnam had a very high level of caries and had signs of gingivitis but not periodontitis. It is recommended to implement dental care in the treatment protocol for patients with CL/P. Keywords: cleft lip, dental caries, gingivitis, periodontitis

Purpose: The purpose of this study is to evaluate the results of patients, with a chief complaint of recurrent aphthous stomatitis (RAS), who were found to have zinc deficiency as the predisposing factor and received appropriate replacement therapy. Materials and Methods: A retrospective study was conducted using data from the medical records of patients with a chief complaint of RAS. Patients with potential ulcer-causing conditions were excluded. All patients were intraorally examined to rule out trauma-associated aetiologies. Blood tests were ordered to measure total blood count, serum transferrin, ferritin, zinc, folic acid and vitamin B12 levels. Results: A total of 48 patients, 34 with zinc deficiency and 14 with both zinc and iron deficiencies, were included in this study. Patients received an initial three-monthly replacement treatment and blood tests for the certain deficiencies were repeated at the end of this time interval. Two patients with zinc deficiency reported no relief due to incorrect intake of tablets with milk. Following correct instructions, all patients reached normal serum mineral levels and reported no recurrences. All patients remained asymptomatic and their mineral levels were monitored in every 3 months to detect any abnormalities. Overall mean follow-up for this study was 12.06 months (range: 8-28 months, SD: ± 5.7). Conclusion: Zinc deficiency should be considered and investigated as part of the diagnostic process of RAS. A simple blood test may aid in correct diagnosis and complete resolution of this recurring condition rather than constant prescription of certain medicines to suppress the symptoms. Keywords: diet, phytate, oral ulcers, recurrent aphthous stomatitis, zinc deficiency

Purpose: To evaluate the remineralisation effect of an experimental nano silver fluoride (NSF) formulation using an in vitro remineralisation model, compared with silver diamine fluoride (SDF) and sodium fluoride varnish (NaF) in current clinical use. Materials and Methods: 45 sound human third molars were sectioned in buccolingual and mesiodistal direction and 180 enamel specimens were divided into four groups (NSF; SDF; NaF; Control). Early caries-like lesions were artificially created. Remineralisation agents were applied with a microbrush for 2 min in NSF and SDF group; NaF varnish were applied in a thin layer and then all specimens were stored in a moist environment at 37°C for 24 h. Each group was subjected to a pH cycling model for 7 days. The Vickers microhardness values (VHN) of specimens were compared before treatment, after demineralisation and after remineralisation. In addition, scanning electron microscope (SEM) images were investigated to compare morphological changes on the surfaces. Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis to compare the groups at p 0.05. Results: All remineralisation agents were found to be statistically significant for the rehardening of the demineralised enamel specimens (p 0.001). There was a statistically significant difference between the all groups after remineralisation (p 0.001). The VHN values for postdemineralisation were determined as, respectively, NaF (229.96) > SDF (222.96) > NSF (191.36) > Control (175.80). SEM images have also supported the microhardness values. Conclusions: NSF was not found to be effective as sodium fluoride varnish and SDF on artificial enamel caries lesions. Additional investigation is needed to recommend it as an alternative agent to routine fluoride treatments. Keywords: nano silver fluoride, silver diamine fluoride, fluoride varnish, artificial caries, remineralisation

Purpose: This paper discusses the cariostatic mechanisms of some of the most promising natural products and explores the research directions that are needed to translate the potential of natural products into commercial oral care products for dental caries control. Materials and Methods: The search strategy for this narrative review involved performing a comprehensive literature search to capture all published studies (up to December 2017) specifically related to natural products with anticaries effects. The databases searched were Medline (via PubMed), Embase and Web of Science, using a combination of controlled vocabulary and text words. The reference list of all selected studies was also manually searched for additional relevant studies. Results: In recent years there has been renewed interest in the anticariogenic properties of several natural products, especially those that have the ability to inhibit cariogenic virulence properties or bacterial adhesion without disrupting the key health benefits of the resident oral microbiome. Other cariostatic mechanisms identified for natural products include phytochemicals that can inhibit demineralisation and enhance remineralisation thereby beneficially rebalancing the caries equilibrium, and natural non-fermentable dietary sweeteners that can reduce the acidogenic challenge posed by sugar-laden foods or beverages. Conclusion: Natural phytochemicals hold enormous potential as adjunctive therapeutic agents against cariogenic bacteria in the prevention and control of dental caries. However, there are several significant challenges to which future research needs to be directed in order to translate the potential of cariostatic natural products into clinically relevant oral care products for dental caries control. Keywords: dental caries, natural products, prevention