A 6-month clinical investigation of custom tray application of peroxide gel with or without doxycycline as adjuncts to scaling and root planing for treatment of periodontitis.

PURPOSE: To evaluate the 6-month clinical effects of one scaling and root planing (SRP) procedure alone or combined with local administration of hydrogen peroxide gel (with or without inclusion of doxycycline for 2 weeks) using periodontal medicament carriers in the form of customized prescription trays for treatment of subjects with chronic periodontitis. METHODS: Using a randomized controlled design, 61 subjects with moderate to advanced periodontitis were assigned to three parallel treatment groups: 1) SRP combined with prescription-tray (Perio Tray) application of 1.7% hydrogen peroxide gel (Perio Gel) and, for the first 2 weeks, doxycycline, 2) SRP combined with prescription-tray application of peroxide gel, and 3) SRP alone. All subjects brushed twice daily with standard dentifrice and toothbrush for a 4-week acclimation phase, and continued this regimen throughout the 6-month treatment phase. Pocket probing depth (PPD) and bleeding index (BI) were assessed on natural and restored sites at baseline and after 2, 5, 13, and 26 weeks. SRP was performed 3 weeks after baseline. Clinical variables were compared by ANCOVA and paired t-tests after each treatment interval, analyzing natural and restored sites separately. RESULTS: 57 subjects completed the trial. Analysis of pockets > 5 mm at baseline showed that mean PPD for both test groups significantly decreased from baseline approximately 0.50 mm prior to SRP. Two weeks following SRP, mean PPD significantly decreased from baseline by > 0.90 mm for both test groups and 0.29 mm for the control. By 26 weeks, mean PPD decreased > 1.10 mm for both test groups compared to 0.38 mm for the SRP-only control (P < 0.001 for test versus control at all post-SRP comparisons). Analysis of pockets ≤ 5 mm at baseline showed the same relationship between groups (P < 0.001 for test versus control). Mean BI dropped significantly only for test groups before SRP, and the tray/peroxide-doxycycline group was significantly different from the control (P = 0.033). Two weeks post-SRP, mean BI reductions for test groups were significantly greater than the control, and remained so for most comparisons. For restored sites, mean PPDs of both test groups were significantly better (P < 0.05) than the control for all post-baseline comparisons.

Preventing dental caries through school-based sealant programs: updated recommendations and reviews of evidence.

BACKGROUND: School-based sealant programs (SBSPs) increase sealant use and reduce caries. Programs target schools that serve children from low-income families and focus on sealing newly erupted permanent molars. In 2004 and 2005, the Centers for Disease Control and Prevention (CDC), Atlanta, sponsored meetings of an expert work group to update recommendations for sealant use in SBSPs on the basis of available evidence regarding the effectiveness of sealants on sound and carious pit and fissure surfaces, caries assessment and selected sealant placement techniques, and the risk of caries' developing in sealed teeth among children who might be lost to follow-up. The work group also identified topics for which additional evidence review was needed. TYPES OF STUDIES REVIEWED: The work group used systematic reviews when available. Since 2005, staff members at CDC and subject-matter experts conducted several independent analyses of topics for which no reviews existed. These reviews include a systematic review of the effectiveness of sealants in managing caries. RESULTS: The evidence supports recommendations to seal sound surfaces and noncavitated lesions, to use visual assessment to detect surface cavitation, to use a toothbrush or handpiece prophylaxis to clean tooth surfaces, and to provide sealants to children even if follow-up cannot be ensured. CLINICAL IMPLICATIONS: These recommendations are consistent with the current state of the science and provide appropriate guidance for sealant use in SBSPs. This report also may increase practitioners' awareness of the SBSP as an important and effective public health approach that complements clinical care.

A controlled 6-month clinical trial to study the effects of a stannous fluoride dentifrice on gingivitis.

OBJECTIVES: This study was conducted to assess anti-plaque and anti-gingivitis benefits of a stabilized stannous fluoride (SnF(2))/sodium hexametaphosphate (SHMP) dentifrice versus a negative control. MATERIAL AND METHODS: This was a randomized, 6-month, stratified, single-centre, double-blind, parallel group, clinical study conducted in harmony with the guidelines for evaluating chemotherapeutic products for the control of gingivitis outlined by the American Dental Association. A stabilized 0.454% SnF(2)/SHMP dentifrice was tested against a commercially available negative control dentifrice. Following baseline measurements, subjects received a dental prophylaxis. Subjects were instructed to brush twice daily for 60 s using their assigned product. Efficacy measurements were obtained at baseline, 3 and 6 months post treatment using the Modified Gingival Index, Gingival Bleeding Index and the Turesky Modified Quigley-Hein Plaque Index. Oral tissue examinations were performed at all visits. RESULTS: A total of 140 subjects were enroled and 128 completed the study. RESULTS after 6 months showed the SnF(2) dentifrice delivered a 16.9% reduction in gingivitis (p<0.001), a 40.8% reduction (p<0.001) in gingival bleeding, and an 8.5% reduction in plaque (p=0.001) versus the negative control. Both treatments were well tolerated. CONCLUSIONS: Twice daily use of the SnF(2)/SHMP dentifrice over 6 months provided statistically significant anti-plaque and anti-gingivitis benefits relative to a negative control.

Interproximal gingivitis and plaque reduction by four interdental products.

OBJECTIVE: The study was conducted to compare the performance of three interdental products to dental floss in the control and removal of plaque, and in the reduction of gingivitis. METHODOLOGY: One-hundred and twenty subjects were screened for the presence of interproximal sites of a size suitable for a GUMO Go-Betweens cleaner, and for being in compliance with inclusion and exclusion criteria. They were then assessed with the Plaque, Gingivitis, and Eastman Interdental Bleeding Indices (EIBI) at baseline, given a prophylaxis, randomly assigned to one of four products (Glide dental floss, Butler flossers, GUM Go-Betweens cleaners, and GUM Soft-Picks cleaners), and given product use instructions. Subjects returned at three weeks for a compliance review and at six weeks for a final visit. Plaque was assessed at the final visit before and after using the assigned products. Plaque, gingivitis, and bleeding scores were evaluated by analysis of covariance using the baseline measurements as the covariate. RESULTS: All four interdental products significantly reduced interdental plaque from baseline to before-use at the final visit (after six weeks) employing baseline plaque as a covariate. Reductions were 16% to 24%. Similarly, use of the products at the final visit resulted in 26% to 31% reductions in plaque with the before-use plaque as a covariate. Interdental gingivitis scores showed a reduction both lingually and buccally, with reductions ranging from 27% to 36% for the former and 34% to 53% for the latter (baseline was the covariate). No statistical differences were found between the products on the lingual interdental sites. The Go-Betweens cleaners showed a statistically greater reduction in the Gingival Index score buccally than the other three products. No differences were noted among the products for the EIBI. CONCLUSION: In this study, dental floss, the recognized "gold standard" for gingivitis reduction, was matched in performance by flossers and an interdental cleaner with small elastomeric fingers, and surpassed by an interdental brush. All products performed comparably for plaque reduction and removal.