Preventing Dental Caries: Part 1 the scientific rationale for preventive advice.

UNLABELLED: This article highlights the fundamental issues which the primary care team should consider when developing preventive dental advice for their patients. Although it is important to have a clear understanding of the carious process, this knowledge must take account of social influences on health when assessing the preventive strategy for individuals. A key factor is that caries is a lifelong process involving fluctuations in demineralization and remineralization. The dental team should ensure that the oral environment favours remineralization and avoids irreversible loss of enamel and dentine. An understanding of this'see-saw' process will influence not only our preventive philosophy but how we, as health professionals, diagnose and treat dental caries. CLINICAL RELEVANCE: Preventing dental caries is an essential skill for all dental professionals. This article brings together the scientific basis of the appropriate advice.

Preventing dental caries: part 2. Case studies in prevention.

UNLABELLED: This article seeks to bring together the preventive messages given in Paper 1 and apply them to specific individual patients. The key elements are the appropriate advice on fluorides, fissure sealants, diet and formulating advice in terms of an individual's educational background. CLINICAL RELEVANCE: This article offers practical advice on the prevention of dental caries using individual patient-based scenarios.

How effective are interdental cleaning aids in improving dental health?

UNLABELLED: This paper reviews recent systematic reviews of the evidence on the effectiveness of interdental cleaning aids in delivering oral health benefits. CLINICAL RELEVANCE: Dental professionals need to consider the evidence for the effectiveness of different interdental cleaning aids carefully when making recommendations to patients.

The application of fluoride varnish in the prevention and control of dental caries.

UNLABELLED: The method of applying fluoride varnish is described and the evidence of its effectiveness in the prevention and control of caries is summarized.The application of fluoride varnish should be an integral part of caries preventive programmes. CLINICAL RELEVANCE: This paper describes how to apply fluoride varnish and reviews its effectiveness in preventing caries.

Delivering better oral health--an evidence-based toolkit for prevention: a review.

UNLABELLED: This article aims to give background to the UK's Department of Health evidence-based prevention toolkit for clinical teams. Initially, it describes the purpose, principles and format of the toolkit and then lists some of the key preventive messages contained within it. Finally, the factors which may affect its impact on dental health are discussed. CLINICAL RELEVANCE: Clinical teams will find the evidence-based prevention toolkit helpful when implementing a preventive approach.

High fluoride toothpastes: their potential role in a caries prevention programme.

UNLABELLED: This paper reviews the clinical evidence for the effectiveness of two, prescription only, toothpastes which contain 2800 and 5000 ppm F. The potential benefit of these toothpastes for high caries risk adolescents, adults and the elderly are discussed. CLINICAL RELEVANCE: Dentists are now able to prescribe two high fluoride toothpastes for high caries risk individuals.

Vital tooth bleaching in dental practice: 3. Biological, dental and legal issues.

UNLABELLED: The final section of this series examines both the evidence for the safety of external bleaching with hydrogen peroxide and related products and the legal position in the UK with regard to their sale and use in general dental practice. Potential side-effects are examined, including biological effects and dental effects, with a review of the current evidence. The EU Cosmetics and Medical Device Directive are both described and their impact on the provision of tooth bleaching in the UK is explained. The legal position in the UK renders the sale and supply of solutions containing >0.1% peroxide illegal, and practitioners must be aware of the underlying legislation and the basis upon which a prosecution may be pursued. CLINICAL RELEVANCE: Clinicians considering using hydrogen peroxide products must be aware of the safety issues surrounding their use and be able to explain to patients the nature of the risk and also the likelihood of any given patient experiencing them.

Manual versus powered toothbrushes: what is the evidence?

UNLABELLED: Powered toothbrushes are a significant segment of the oral care market. Numerous clinical trials have compared the effectiveness of manual and powered toothbrushes for their effectiveness in improving oral health and the results are often conflicting. Recent Systematic Reviews by the Cochrane Oral Health Group have distilled this information and provided unbiased conclusions, namely that: powered toothbrushes with an oscillating rotating action are more effective than manual toothbrushes in reducing plaque and gingivitis; other types of powered toothbrushes produced less consistent reductions in plaque and gingivitis than manual brushes. Further studies are required to determine the relative effectiveness of manual and powered toothbrushes in improving the status of patients with periodontitis. CLINICAL RELEVANCE: This review provides the dental professional with an unbiased summary of current evidence regarding the relative effectiveness of manual and powered toothbrushes.

Periodontal disease and general health.

There is considerable interest in the possible relationship between periodontal disease and pregnancy complications, cardiovascular disease, diabetes and respiratory diseases. This interest has been stimulated by data obtained from epidemiological studies and a better understanding of the pathogenesis of periodontal disease. Whilst much of the data support an association between oral and general health, further studies are needed to accept or reject a causal relationship.

Advanced oral antibacterial/anti-inflammatory technology: A comprehensive review of the clinical benefits of a triclosan/copolymer/fluoride dentifrice.

INTRODUCTION: Triclosan is a broad-spectrum antibacterial agent, marketed for use in oral products. It is effective against both gram-positive and gram-negative bacteria. PVM/MA is the non-proprietary designation for a polyvinylmethyl ether maleic acid copolymer. It has been demonstrated that there is a greater uptake of triclosan to enamel and buccal epithelial cells from the use of a fluoride dentifrice containing triclosan and the PVM/MA copolymer than from a dentifrice containing triclosan alone. This Supplement details the results of antibacterial, anti-inflammatory, and short- and long-term plaque and gingivitis studies with a triclosan/copolymer/ fluoride dentifrice. Additionally, the Supplement reviews studies on the effect of a triclosan/copolymer/fluoride dentifrice on periodontitis, calculus, caries, whitening and stain removal, oral malodor, and on the microflora. CONCLUSION: Clinical studies indicate that the use of a triclosan/copolymer/fluoride dentifrice (Colgate Total Toothpaste) may provide oral health benefits beyond those associated with "traditional" toothpaste use, in a manner that is safe and effective. Studies presented in this Supplement demonstrate that Colgate Total Toothpaste provides superior protection against plaque and gingivitis, caries, oral malodor, exhibits superior stain removal, and provides protection against the progression of periodontal disease.

What's in toothpaste and why?

This article reviews the ingredients of toothpastes and their role in providing medicinal and cosmetic benefits to the consumer.

The prevention of dental caries and periodontal disease from the cradle to the grave: what is the best available evidence?

Increasing weight is being given to applying an evidence-based approach to clinical practice. There is evidence to support a range of preventive measures which the profession and patients can apply to maximize the control of caries and periodontal disease. This paper examines the strength of evidence to support the advice and procedures that may be used by dental professionals to provide an effective preventive programme of advice and procedures for patients of all ages. A hierarchy of evidence is used ranging from Cochrane Reviews at the top, observational studies in the middle, and opinion at the bottom. Whilst the evidence to support preventive advice and procedures in children and adolescents is relatively strong, few studies have been conducted in adults and the elderly.

Orofacial pain: just another chronic pain? Results from a population-based survey.

Features of somatisation have been shown to predict the onset of widespread body pain. This study aims to determine to what extent persons with orofacial pain syndromes share these features and to what extent they are uniquely related to oral mechanical factors. We have conducted a population-based cross-sectional survey in the South-East Cheshire area of the United Kingdom involving 2504 individuals aged 18-65 years. All participants completed a postal questionnaire which enquired about the occurrence of both orofacial pain and widespread body pain. It also enquired about potential risk factors for one or both conditions. In total, 473 subjects (23%) reported orofacial pain only, 123 (6%) widespread pain only, while 85 (4%) reported both. The number reporting both was significantly higher than would be expected if the symptoms were independent (P<0.001). Several oral mechanical factors were significantly associated with both orofacial pain and widespread body pain (grinding teeth, clicking jaw, missing teeth), while two (facial trauma, locking jaw) were specifically related to orofacial pain. Both pain syndromes were associated equally with high levels of psychological distress, indicators of somatisation and maladaptive response to illness. These results suggest that orofacial pain syndromes may commonly be a manifestation of the process of somatisation and the excess reporting of some local mechanical factors amongst persons with these symptoms, may not be uniquely associated with pain in the orofacial region.

Mutation of the signal peptide region of the bicistronic gene DSPP affects translocation to the endoplasmic reticulum and results in defective dentine biomineralization.

Dentine dysplasia type II is an autosomal dominant disorder in which mineralization of the dentine of the primary teeth is abnormal. On the basis of the phenotypic overlap between, and shared chromosomal location with, dentinogenesis imperfecta type II, a second disorder of dentine mineralization, it has been proposed that the two conditions are allelic. As recent studies have shown that dentinogenesis imperfecta type II results from mutation of the bicistronic dentine sialophosphoprotein gene (DSPP ), we have tested this hypothesis by sequencing DSPP in a family with a history of dentine dysplasia type II. Our results have shown that a missense change, which causes the substitution of a tyrosine for an aspartic acid in the hydrophobic signal peptide domain of the protein, underlies the phenotype in this family. Biochemical analysis has further demonstrated that this mutation causes a failure of translocation of the encoded proteins into the endoplasmic reticulum, and is therefore likely to lead to a loss of function of both dentine sialoprotein and dentine phosphoprotein.

Oro-facial pain in the community: prevalence and associated impact.

STUDY OBJECTIVE: To determine the prevalence of oro-facial pain (OFP) in the population and within-population subgroups and to describe the associated disability. DESIGN: Cross-sectional population study. SETTING: General medical practice in South East Cheshire, United Kingdom. PARTICIPANTS: A random sample of 4000 adults aged 18-65 years of whom 2504 responded (adjusted participation rate 74%). MAIN RESULTS: The overall prevalence of OFP was 26% (95% Confidence Interval (CI) 24%, 28%). The prevalence of symptoms was higher in women (30%) than in men (21%) and in both sexes the highest (30%) prevalence was found in the 18-25 year age group and the lowest (22%) in the 56-65 age group. Of all the participants, 12% had pain in or around the eyes, 10% reported pain in and around the temples, 6% pain in front of the ears and 6% pain in the jaw joints. Only 46% of the participants with OFP had sought professional advice from a dentist or general medical practitioner and 17% had to take time off work or were unable to carry out normal activities because of pain. CONCLUSIONS: OFP is a common symptom experienced by a quarter of the adult population, of whom only 46% seek treatment. The prevalence is higher in women and younger age groups.