The new toothpastes.

Fluoride toothpastes that fight cavities have become common. The current competition among products is for the additional benefits they can offer--with antitartar and whitening leading the way. Toothpastes serving special populations have been increasing and now include desensitizing dentifrices, natural toothpastes, smokers toothpastes, and one designed for people with xerostomia. The newest toothpastes are multibenefit products that include among their properties a clinically demonstrated anti-gingivitis effect--such as Crest Gum Care and Colgate Total, which was recently cleared by the Food and Drug Administration for antiplaque/antigingivitis as well as anticaries effects.

The image of dentistry in contemporary culture.

The multimedia portrayals of dentists and dentistry have expanded in scope. Prevention and esthetics have replaced drilling and extraction in the public perception of dental practice. According to the author, dentists themselves are no longer treated exclusively as buffoons or sadists. Instead, he writes, they are more apt to be seen as solid citizens, occasionally as romantic figures and even as complex, realistic human beings.

Overview of clinical trials of periodontal diagnosis methods and devices.

Changing views of the pathogenesis and progression of the periodontal diseases and new modalities for treatment have stimulated a plethora of physical, biochemical, microbiologic, and immunologic diagnostic procedures, tests, and devices. Clinical trials address needs for: 1) screening tests and risk assessment for disease susceptibility; 2) identification of active and progressive disease sites; 3) making therapeutic decisions; 4) monitoring therapy; 5) establishing a maintenance schedule; and 6) prognosis assessment. Needs and priorities of general, specialty, and public health practitioners differ. Validation of tests proceeds in a hierarchy of study designs from cross sectional and case control studies to retrospective and prospective longitudinal multi-center trials. For broad-scale application, randomized controlled trials (and eventual meta-analysis) will be required. Design issues are those common to all clinical trials in periodontics plus special considerations depending on type of test and its intended use. For diagnostic tests, recommended surrogate endpoints are attachment and alveolar bone levels-the traditional "gold standards." Validation of diagnostic tests is best accomplished by generation of 2 x 2 contingency tables to calculate sensitivity and specificity, positive and negative predictive values, relative and absolute risks, and odds rations. Each has a place-depending on the clinical situation and needs of the clinician.

Caries prevention: current strategies, new directions.

Despite major advances in caries prevention, a large subset of the U.S. population still needs additional control measures. In numerous other countries, needs are escalating as caries rates continue to rise. Building on current strategies and new insights into the specific mechanisms of caries initiation, researchers are creatively using a variety of new technologies, especially in molecular biology, to fashion a new generation of preventive measures.

On being a scientist in a rapidly changing world.

The practice of biological science has changed dramatically since mid-century, reshaped not only by a rapid series of landmark discoveries, but also by governmental directives, institutional policies, and public attitudes. Until 1964, the major influences were the mentor, who provided direction and indoctrination into the culture of science, and in dentistry, the newly established NIDR, which fueled the research engine with an expanding research and training program. The 1965-74 period witnessed the advent of the Institutional Review Board, an increased social involvement of biological scientists, and a recognition of the need for biological and physical safeguards in the conduct of research. The most turbulent years were 1975-89, when there was a confluence of animal rights activism and regulation, growing concerns with scientific fraud and publication malpractice, and the stresses and strains (and opportunities) resulting from the rapid expansion of the academic-industrial complex. The current period is characterized by rapid pace, high volume, and an increased depth and breadth of knowledge-a major change in scale in the conduct of science. It is an exciting time but one in which ethical issues are multiplying. Attention must be paid.

Effect of sucralose in coffee on plaque pH in human subjects.

Our earlier work demonstrated that the sweetener sucralose, C12 H19 CI3 O8, mixed with water had no effect on intraoral plaque pH. The current study compared the effect on resting plaque pH of sucralose to sucrose when these sweeteners were used in hot coffee at equivalent sweetness levels. Twelve subjects with an identified acidogenic plaque were tested at dicrete sessions, using coffee as vehicle with: (1) sucrose; (2) sucralose; (3) sucralose plus maltodextrin (SM); (4) sucralose plus dextrose and maltodextrin (SMD), and (5) no additional sweetener. Each subject rinsed for 1 min with the test rinse, expectorated, and plaque pH was measured at six dental sites for 60 min using an antimony touch electrode method. Data were summarized for baseline pH, delta pH (baseline pH minus lowest pH attained), minimum pH, and area under the pH curve (AUC). Baseline pH was not different throughout all tests. Quantification of AUC in the various groups showed that sucralose with coffee had no statistically significant impact on plaque acidogenesis. AUC, minimum pH and delta pH were least changed by coffee and sucralose, while the SM and SMD combinations generally led to intermediate changes as compared with coffee sweetened with sucrose or sucralose. Because of its acidic nature, unsweetened coffee led to a modest pH depression, the effect of which appears to be blunted by sucralose. This study confirms that sucralose is non-acidogenic and indicates that sucralose may reduce the acidogenic potential of coffee.

Effect of aqueous solutions of sucralose on plaque pH.

PURPOSE: To compare the effect on in vivo plaque pH of rinsing with an aqueous solution of sucralose (alone or in combination with maltodextrin or maltodextrin and dextrose) to the effect of rinsing with an aqueous solution of sucrose. MATERIALS AND METHODS: Each solution (four in total) had a sweetness equivalent to two teaspoons of sucrose in 6 oz. of water. The four test solutions were administered randomly over four test visits (one solution per visit) to 10 subjects presenting 2-day resting plaque. Before, and at specified time intervals over 60 minutes following the rinse, in vivo plaque pH was monitored at six designated sites using a Beckman 3500 digital pH meter. Data were analyzed by ANOVA. RESULTS: The mean pH minimum for the sucralose rinse (6.56) was significantly higher than the sucralose/maltodextrin (SM), sucralose/maltodextrin/dextrose (SMD), and sucrose rinses (6.15, 5.84, and 5.29, respectively). The mean delta pH (difference between resting and minimum pH) for the sucralose rinse (0.45) was significantly lower when compared to the SM (0.79), SMD (1.14), and sucrose (1.69) rinses. The differences seen in mean pH minimum and mean delta pH for the SM and SMD groups vs. the sucrose group were also statistically significant. Mean areas under the pH vs. time curve for the sucralose, SM and SMD rinses were all significantly less compared to the sucrose rinse. Rinsing with aqueous solutions of sucralose, or of sucralose in combination with maltodextrin and/or dextrose (commercially available formulations, of sucralose) was less acidogenic than rinsing with a sucrose solution of equivalent sweetness.

Calculus update: prevalence, pathogenicity and prevention.

Does reduction of supragingival calculus provide only a cosmetic effect, or does it benefit oral health as well? The author discusses the causes and effects of calculus development and reviews methods of calculus control.

Nature vs. nurture in dental caries.

Why are some people more resistant to dental caries than others? Certainly diet plays a part, but are there hereditary factors that affect caries development? This report explores genetic components that appear related to caries resistance and susceptibility.

Antimicrobial mouthrinses: overview and update.

The Seal of Acceptance of the American Dental Association's Council on Dental Therapeutics has been awarded to Listerine and chlorhexidine gluconate (Peridex). The mechanism of action of Listerine involves bacterial cell wall destruction, bacterial enzymatic inhibition, and extraction of bacterial lipopolysaccharides. Chlorhexidine has the property of substantivity, i.e. the ability to bind to hard and soft tissue with slow release. Antibacterial mouthrinses/dentifrices containing triclosan hold promise for the reduction of plaque and gingivitis but are not yet available in the United States. The quaternary ammonium compounds and sanguinarine compounds (Viadent) have some merit, but studies of their efficacy in plaque and gingivitis reduction are mixed. New products containing various fluorides and oxygenating agents may have potential for the future as antiplaque and antigingivitis agents.

Dental quackery: a retrospective view.

Instances of dental quackery are easy to spot in history, but what qualifies as quackery in contemporary dentistry? A historical perspective leads to an evaluation of questionable practices in the field today.

Communicating science to our patients and the public.

Communicating dental science, especially on issues of health and safety, is assuming increased importance in dental practice and in the relation of the profession to the public. Effective risk communication requires knowledge, balance and sensitivity to the concerns of our patients and the public. It is a skill that takes preparation, training and practice, and schools and professional organizations should be encouraged to include it in their educational programs. Presenting dental science to the public is a more difficult challenge than for the individual patient since there is no readily available site for exchange, such as the office, and no personally established relationship, credibility or trust. A larger cadre of trained spokespersons from the practice, public health, academic and research communities is needed, and more extensive multi-lingual and multi-cultural educational material should be made available for community outreach. Oral presentations to the public require different skills of both a verbal and nonverbal nature than for office communication or professional group presentation-and guidelines are offered.

Occupational risks in dentistry: comforts and concerns.

Dentistry has been portrayed as a high-risk profession in recent reports. A look at several areas of concern, however, shows that the field is no more hazardous than any other profession--and less than most.