The effect of medicated, sugar-free chewing gum on plaque and clinical parameters of gingival inflammation: a systematic review.

OBJECTIVE: This study aimed to systematically review the present literature to establish the clinical effect of medicated, sugar-free chewing gum on plaque indices and parameters of gingival inflammation. MATERIALS AND METHODS: MEDLINE-PubMed, Cochrane CENTRAL and EMBASE databases were searched up to April 2012 to identify appropriate studies. Included studies used an intervention of medicated, sugar-free chewing gum containing antimicrobial agents or herbal extracts compared with a control gum. Plaque and gingivitis scores were selected as outcome variables. RESULTS: Independent screening of 594 unique titles and abstracts identified 10 non-brushing and four brushing studies that met the eligibility criteria. Means and standard deviations were extracted. A sufficient number of studies evaluated chlorhexidine gum to perform a meta-analysis. Although this review provides evidence for the comparative effectiveness of chewing gums containing various ingredients, the results must be weighed carefully against the methods that were used to assess their outcomes. CONCLUSION: Most of the chewing gums with antimicrobial agents or herbal extracts were shown to have a positive effect with respect to plaque and gingivitis scores. The most compelling evidence was provided for chewing gum containing chlorhexidine. Meta-analysis and individual results indicate a beneficial effect of chlorhexidine on plaque inhibition. However, GRADE evidence profile shows that the recommendation to use CHX-gum to reduce plaque scores in the absence of brushing is considered to be 'weak'. Other ingredients with positive outcomes on plaque scores are eucalyptus, acacia, funoran, Pycnogenol and mastic. Limited data with respect to gingivitis scores were available, and the following agents showed a positive effect: magnolia, eucalyptus and CHX.

The effect of sugar-free chewing gum on plaque and clinical parameters of gingival inflammation: a systematic review.

OBJECTIVE: The aim of this study was to systematically review the current literature on the clinical effects of sugar-free chewing gum on plaque indices and parameters of gingival inflammation. MATERIAL AND METHODS: The MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE databases were searched up to 20 April 2012 to identify any appropriate studies. Plaque indices and parameters of gingival inflammation were selected as outcome variables. RESULTS: An independent screening of the 594 unique titles and abstracts identified six non-brushing and four brushing studies that met the eligibility criteria. In the non-brushing studies, the use of chewing gum did not significantly affect the parameters of interest. In the descriptive analysis of the brushing studies, four of five comparisons showed a statistically significant effect in favour of the sugar-free chewing gum with respect to plaque scores. The meta-analysis for the Quigley & Hein (J Am Dent Assoc 1962; 65: 26) plaque index scores in the brushing studies also showed a significant difference (DiffM -0.24, 95% CI [-0.41; -0.08]). For bleeding tendency, the descriptive analysis showed that one of the two comparisons identified a significant difference in favour of chewing gum. The meta-analysis, however, did not substantiate this difference. CONCLUSION: Within the limitations of this systematic review, it may be concluded that the use of sugar-free chewing gum as an adjunct to toothbrushing provides a small but significant reduction in plaque scores. Chewing sugar-free gum showed no significant effect on gingivitis scores. In the absence of brushing, no effect on plaque and gingivitis scores could be established.

Prevention of lingual calculus formation with daily use of 6% H2O2/2% pyrophosphate whitening strips.

OBJECTIVE: This randomized controlled clinical trial was conducted to evaluate whether daily use of a hydrogen peroxide/ pyrophosphate-containing antitartar whitening strip might safely yield clinical reductions in post-prophylaxis calculus accumulation. METHODS: A three-month, randomized controlled trial was conducted to compare calculus accumulation with a daily 6% hydrogen peroxide/pyrophosphate strip versus regular brushing. After an eight-week run-in phase to identify calculus formers, a prophylaxis was administered, and 77 subjects were randomly assigned to daily strip or brushing only groups. All subjects received an anticavity dentifrice (Crest Cavity Protection) and manual brush for use throughout the three-month study; for subjects assigned to the experimental group, strip application was once daily for five minutes on the facial and lingual surfaces of the mandibular teeth. Efficacy was measured as mm calculus (VMI) before prophylaxis and after six and 12 weeks of treatment, while safety was assessed from examination and interview. RESULTS: Subjects ranged in age from 21-87 years, with groups balanced (p > 0.26) on pertinent demographic and behavioral parameters, and pre-prophylaxis calculus baseline mean scores (16.0 mm). At Week 6, calculus accumulation was lower in the strip group, with adjusted mean (SE) lingual VMI of 12.0 (0.87) for the strip group and 17.0 (0.88) for the brushing control. At Week 12, calculus accumulation was lower in the strip group, with adjusted mean (SE) lingual VMI of 14.3 (0.85) for the strip group and 17.2 (0.86) for the brushing control. Treatments differed significantly (p < 0.02) on calculus accumulation at both time points. A total of three subjects (8%) in the strip group and two subjects (5%) in the brushing control had mild oral irritation or tooth sensitivity during treatment; no one discontinued early due to an adverse event. CONCLUSION: Daily use of hydrogen peroxide whitening strips with pyrophosphate reduced calculus formation by up to 29% versus regular brushing, without meaningful adverse events.

An evaluation of sodium bicarbonate chewing gum in reducing dental plaque and gingivitis in conjunction with regular toothbrushing.

The purpose of the present study was to determine the ability of a chewing gum containing 5% sodium bicarbonate to remove dental plaque and reduce gingivitis when used as a supplement to daily toothbrushing. The study group consisted of 88 adults with moderate gingivitis. Participants were divided into 4 groups and instructed to chew the study gum 0 (control), 1, 2, or 3 times daily for 1 month in addition to regular daily toothbrushing. Chewing sodium bicarbonate-containing gum significantly (P < .05) reduced plaque after 1 week, with progressively greater reductions occurring after 2 and 4 weeks of gum chewing. No correlation was observed between plaque reduction and the number of times per day that the gum was chewed. By week 4, plaque reduction of approximately 16% was achieved in all groups using the gum as compared with the control group. Reductions in gingivitis were observed in all participants who chewed the gum, and these reductions achieved statistical significance by week 4. Slightly greater improvements in gingivitis were achieved in participants who chewed the gum 2 or 3 times daily as compared with the control group and those who chewed the gum once daily. No adverse effects on the oral tissues were observed in any of the participants for the duration of the study. In conclusion, regular use of a chewing gum containing 5% sodium bicarbonate appears safe and effective for the removal of dental plaque and reduction of gingivitis when used in conjunction with daily toothbrushing.

A 3-month clinical comparison of the safety and efficacy of two battery-operated toothbrushes: the Braun Oral-B Battery toothbrush and the Colgate Actibrush.

PURPOSE: To compare the safety and efficacy of two battery-operated, non-rechargeable power toothbrushes, the Braun Oral-B Battery toothbrush (D4) and the Colgate Actibrush. MATERIALS AND METHODS: This was a randomized, single-blind, parallel-group study carried out over a 3-month period. A total of 114 subjects from a general population, who met the inclusion criteria of the study and who had whole mouth plaque scores of > or = 1.5 and gingivitis scores of > or = 1.2, participated in the study. Subjects were given either the D4 or the Colgate Actibrush with the manufacturers' instructions, and were asked to brush their teeth at home twice each day. At baseline and after 1 and 3 months, subjects were examined for oral hard and soft tissue health, after which they were assessed for gingivitis (Modified Gingival Index), bleeding (Gingival Bleeding Index), and plaque (Modified Quigley-Hein Plaque Index). Prior to each assessment, subjects refrained from all oral hygiene procedures for a period of 12-18 hours. RESULTS: No evidence was found of significant oral soft or hard tissue trauma, and both brushes were considered to be safe when used according to the manufacturers' instructions. In the D4 group, whole mouth, marginal and approximal plaque scores were significantly reduced from baseline (P < 0.05) after both 1 and 3 months by 7-12%, whereas, in the Actibrush group, plaque scores remained relatively unchanged from baseline throughout the study. Furthermore, comparisons between the toothbrush groups showed that whole mouth, marginal and approximal plaque scores for the D4 were significantly lower than those for the Actibrush at both the 1- and 3-month assessments. Modified Gingival Index scores after 3 months were significantly reduced from baseline in both groups by 7-8%. Similarly, percentages of bleeding sites were significantly lower by 12-15%. There were no significant differences between the groups with respect to gingivitis scores.

A split-mouth comparison of a three-dimensional-action electric toothbrush and a high-frequency electric toothbrush for reducing plaque and gingivitis.

PURPOSE: To compare the effectiveness in reducing plaque and gingivitis of an electric toothbrush with three-dimensional (oscillating/rotating/pulsating) brush head action, Braun Oral-B 3D Plaque Remover, and an electric toothbrush with high-frequency vibrating action, Sonicare Plus. MATERIALS AND METHODS: This was a randomised, split-mouth study of 33 adult subjects who used both electric toothbrushes for a total of 9 weeks. After a 2-week acclimation period of brushing with each device on alternating days, subjects received a prophylaxis, then refrained from any oral hygiene on the mandibular teeth for 21 days to induce gingivitis. However, they continued to brush the maxillary teeth on alternating days with each electric toothbrush. Then, for a period of 4 weeks they brushed each side of the mouth with different toothbrushes, randomly assigned to right or left. Plaque and gingivitis were assessed initially, after the 21-day no-oral-hygiene period, and after 2, 3 and 4 weeks of brushing twice daily. RESULTS: After 21 days without oral hygiene, mean mandibular plaque and gingivitis scores increased significantly for all subjects. Use of both electric toothbrushes during the treatment phase progressively reduced plaque and gingivitis scores at each successive examination. The Braun toothbrush was significantly more effective than the Sonicare toothbrush in reducing plaque at every examination and gingival bleeding after 4 weeks of brushing. It is concluded that the Braun electric toothbrush with three-dimensional brush head action offers advantages over the Sonicare electric toothbrush with high-frequency vibrating action in terms of plaque control and potential improvement of gingival health following induction of experimental gingivitis.

Development and validation of a short-term clinical model for assessing calculus inhibitory agents.

The purpose of this project was to develop and validate an efficient, short-term clinical model for assessing topically-applied anticalculus agents. In this model, calculus development occurred within 14 days on both labial and lingual surfaces of the mandibular anterior teeth. Because of documented long-term clinical efficacy, pyrophosphate dentifrices were used to investigate the validity of the short-term calculus model for evaluating anticalculus agents. This paper provides the results of the final 3 studies conducted during the development of this model. For each study, the design consisted of two 14-day phases, i.e., a control phase and a treatment phase, separated by a 7-day washout phase. At the start of each phase, a prophylaxis was performed on the mandibular anterior teeth to remove all plaque and calculus. At the end of each phase, supragingival calculus formation on the labial and lingual surfaces of these same teeth was measured using the VMI scoring method. Twice a day during the control phase, subjects applied a control dentifrice undiluted to the test teeth with a custom-fitted toothshield and brushed only the exposed teeth with the same dentifrice. For the treatment phase, subjects were randomly assigned to groups balanced on the basis of control-phase calculus scores and then delivered the dentifrices using the toothshield as in the first phase. After 14 days, calculus formation occurred in all groups. However, the pyrophosphate dentifrice groups had significantly less calculus (16-30%) than the control dentifrice group. These studies demonstrated that this methodology permitted rapid formation of dental calculus, and by substantiating with anticalculus systems documented to have activity in long-term human trials, it is concluded that this short-term clinical model is valid for assessing anticalculus agents.

Treatment of orthodontic white spot lesions with a remineralizing dentifrice applied by toothbrushing or mouth trays.

This pilot study investigated the effect of a remineralizing fluoride dentifrice (Enamelon) on newly formed incipient carious lesions using two methods of application. Teenage orthodontic patients with obvious white spot lesions on their teeth were selected to begin treatment within 30 days after debanding. At baseline, the surface enamel of the test teeth was cleaned by air etching with 50 microns alumina at 150 psi. Lesion size (mm2) was measured using a calibrated periodontal probe and surface appearance was quantified as shiny (0), dull (1), or chalky (2). Twice daily for 3 months, one group with a total of 27 lesions brushed with the remineralizing dentifrice, while a second group with 41 total lesions brushed and used a mouth tray to apply the paste directly to the lesions for 5 min. In order to promote treatment compliance, test group assignment was based on subject and parental preference. After 1, 2, and 3 months, lesion size was reduced by 5% (ns), 10% (p < 0.05) and 22% (p < 0.01), respectively, for the brushing group, and 16% (p < 0.05), 37% (p < 0.01) and 30% (p < 0.01) for the combined brushing and tray group, respectively. The dull appearance of the lesions treated by brushing improved slightly over 3 months. However, the lesions receiving combined brushing and tray applications became significantly (p < 0.01) less dull by 28%, 44% and 61% after 1, 2, and 3 months, respectively, indicating the formation of a shiny, intact surface layer. In conclusion, brushing with a remineralizing dentifrice significantly reduced the size of new orthodontic white spots within 2 months, while brushing combined with topical tray applications reduced lesion size within 1 month with concomitant formation of a shiny enamel surface layer. Thus, the combined brushing and mouth tray treatment significantly accelerated the remineralization process.

In vitro tooth whitening by a sodium bicarbonate/peroxide dentifrice.

The main purpose of this laboratory study was to determine the tooth whitening effect of a baking soda dentifrice containing stabilized 1% hydrogen peroxide following repeated applications to intrinsically stained teeth. Additional objectives were to investigate (1) the influence of tooth surface curvature and moisture on color measurements, (2) preliminary treatment parameters using 1% hydrogen peroxide solution, and (3) the relationship between Vita shade guide standards and instrumental color readings. Human tooth specimens with intrinsic stain were specially prepared and measured for color (L*a*b*) by means of diffuse reflectance spectrophotometry. Specimens were measured under wet and dry conditions with natural and flattened enamel surfaces. A preliminary test was conducted with 1% H2O2 solution to establish tooth whitening versus treatment time. Then, new tooth specimens were treated repeatedly with slurries of silica, baking soda, or baking soda/peroxide dentifrices at 30-minute intervals, and color measurements were taken under both wet and dry conditions after 4, 8, 16 and 24 hours. L*a*b* color measurements of the Vita shade guide teeth were also made in order to relate laboratory color changes to clinical effects. The parameter testing results showed that flattening the enamel surface had no effect on tooth color, but the teeth rapidly became lighter and less yellow upon air-drying. The 1% H2O2 solution caused both a significant decrease in yellow (b*) and an increase in lightness (L*). Since the reduction for b* occurred more rapidly and to a greater extent than the L* factor, the b* component may be the more important indicator of tooth whitening by bleaching. Compared to the silica and baking soda dentifrices, the baking soda/peroxide dentifrice significantly decreased the yellow color (b*) of the teeth after 8 or more hours of topical treatment. The instrumental color readings of the Vita Shade guide teeth showed that the color differences between the standards were not linear or consistent, and their accuracy for assessing clinical changes in tooth whiteness is questionable.

Evaluation of a dental floss containing soluble pyrophosphate on calculus formation using a short-term clinical model.

This clinical study compared the effect of a dental floss containing 0.25 mg tetrasodium pyrophosphate per cm and a placebo floss on supragingival calculus formation using a 6-week, partial-mouth toothshield model. The six lower anterior teeth were scaled and polished before each 2-week period (i.e., pre-trial, washout, trial). During both the pre-trial and trial periods, subjects brushed twice daily with a non-tartar control dentifrice, while a toothshield protected the six test teeth from brushing. After rinsing with water and removing the shield, they flossed the test teeth. All subjects used placebo floss during the pre-trial period in order to determine the baseline Volpe-Manhold Index (VMI) calculus formation scores, which were used to balance groups for the trial period. During the trial period, one group used the placebo floss, while the second group used the pyrophosphate floss. The final results demonstrated that the pyrophosphate floss significantly inhibited calculus formation between teeth (mesial-distal scores) by 21%, and on labial surfaces by 37% relative to the placebo floss.

Effect of supervised use of an alum mouthrinse on dental caries incidence in caries-susceptible children: a pilot study.

Aluminum salts have demonstrated anticaries activity in a number of laboratory and animal studies. The aim of this double-blind, pilot, clinical trial was to evaluate the effect of an alum (Al) mouthrinse on dental caries formation both by itself and in combination with an ADA-approved sodium fluoride (F) dentifrice. A total of 260 caries-prone children residing in a low-F area were preselected for the study and scored independently for caries by two experienced examiners. After using gender, age, and initial DMFT(S) scores for baseline stratification, the subjects were assigned to one of three treatment regimens: (1) placebo mouthrinse and F dentifrice, (2) Al mouthrinse and placebo dentifrice, and (3) Al mouthrinse and F dentifrice. The alum mouthrinse contained 500 ppm Al and the sodium fluoride dentifrice contained 1100 ppm F. Rinsing was supervised at school on weekdays for 30 sec/day, while the dentifrices were used ad libitum at home. Subjects were reexamined for caries and oral health after six and twelve months. Both examiners found that children who used Al mouthrinse, in conjunction with either placebo or F dentifrices, had lower caries incidence than those who used placebo mouthrinse/F dentifrice combination; but the differences were statistically significant for only one of the examiners. No evidence of deleterious effects to the oral tissues was observed. The results of this pilot clinical trial demonstrated that daily supervised use of an alum mouthrinse inhibited caries development in decay-prone children at least as effectively as a F dentifrice.

Evaluation of an alum-containing mouthrinse in children for plaque and gingivitis inhibition during 4 weeks of supervised use.

Aluminum salts have demonstrated activity against oral bacteria and also have shown indications of inhibiting plaque and gingivitis. The aims of this clinical trial were to determine the effects of daily supervised rinsing with a specially formulated, alum-containing mouthrinse on existing plaque and gingivitis in children and to monitor its effect on the oral tissues and its acceptability to subjects. Using a double-blind, parallel design, 48 sixth-graders rinsed once daily for 30 sec under supervision with either a placebo or a mouthrinse containing 0.02 M alum while continuing their normal oral hygiene habits. Plaque and gingivitis were assessed and intraoral examinations were performed at 0, 2 and 4 weeks. The alum mouthrinse significantly (P < 0.05) reduced the amount of plaque relative to the placebo after both 2 and 4 weeks. Gingivitis and plaque thickness also were decreased, but the differences did not attain significance. No evidence of deleterious effects to the oral tissues was observed and the alum mouthrinse was well accepted by the children. This trial demonstrated that daily use of an alum-containing mouthrinse was safe and produced a significant effect on plaque that supplemented the benefits of daily toothbrushing. Thus, topically applied aluminum may have potential applications in preventive dentistry for controlling plaque.

Effect of aluminum concentration on dental caries formation in the rat.

OBJECTIVE: Topically applied aluminum (AI) reduced fissure caries in rats with indigenous microflora, but neither therapeutic activity nor concentration effects have been studied in animals infected with caries-inducing bacteria. This study investigated the effects of solutions containing various AI concentrations on formation of smooth surface and sulcal caries in cariogenically challenged rats infected with Streptococcus sobrinus. METHODS: Weanling rats, inoculated with S. sobrinus, were randomly assigned to six groups which were topically treated twice daily with water (treatment control), a NaF solution of 100 parts/10(6) F (positive control), or AIK(SO4)2 solutions containing 100, 1000, 2000, or 4000 parts/10(6) AI. Rats were fed a high-sucrose diet and distilled water ad libitum for 10 weeks, then the molars were scored for enamel and dentin caries. RESULTS: Relative to the water control, NaF and all AI solutions significantly reduced prevalence of both smooth-surface and fissure caries. Protection by AI solutions was greater on smooth surfaces than sulcal areas. AI treatments reduced smooth surface scores by 49-71% and sulcal scores by 27-53%. For all comparisons the protective effect of the 100 parts/10(6) AI solution was less than solutions containing 1000 parts/10(6) AI or more. NaF and all AI solutions also significantly reduced the extent of lesions penetration into dentin. CONCLUSIONS: Topically applied AI reduced the formation and progression of both smooth surface and sulcal caries and showed evidence of a dose response in a rat model infected with S. sobrinus.

Investigation of the effects of aluminum mouthrinses on rat dental caries and plaque.

The effects of topically applied mouthrinses containing AlCl3, or AlK(SO4)2 on dental caries and plaque were investigated in a rat model. For comparison, NaF and a two-step treatment of AlCl3 and NaF were also tested. Six groups of 20 weanling rats were inoculated with Streptococcus sobrinus 6715 and provided a caries-inducing diet and distilled water ad libitum. Test agents were topically applied twice daily 5 days per week at a concentration of 0.037 mol/l in a mouthrinse vehicle and were compared with a vehicle control rinse and a distilled water control. After 10 weeks none of the treatments reduced plaque amounts relative to the controls. The AlCl3 and AlK(SO4)2 rinses significantly reduced both smooth-surface and sulcal caries by approximately 40%. The cariostatic activity of the aluminum rinses was equivalent to an equimolar NaF mouthrinse on smooth surface lesions, but was statistically less than NaF on sulcal caries. The two-step treatment with AlCl3 and NaF indicated numerically additive effects, but the results were not statistically better than with NaF alone. Dentine caries progression paralleled the enamel caries prevalence results. No deaths, toxicologic effects, or inhibition of growth rates were observed in any treatment group. This study confirmed that topically applied solutions of aluminum salts inhibited caries formation in the rat caries model and showed that the cariostatic activity of aluminum was maintained in a compatible mouthrinse vehicle.

Effect of various surfactants and aluminum solutions on in vitro acid dissolution of dental enamel.

Various surfactants were investigated for compatibility and stability in aqueous dispersions with aluminum (Al) and for their ability to inhibit enamel acid dissolution both with and without Al present. A total of 39 samples, representing anionic, cationic and nonionic surfactant classes, were dispersed at a concentration of 1% in water or a 0.005 mol/l AlK(SO4)2 solution. After 24 h the dispersions were evaluated for visual appearance, pH and ability to reduce enamel acid dissolution (EDR). Because reactions involving Al are sometimes very slow to equilibrate, the surfactants that were compatible with Al and did not suppress the 80% EDR of the Al solution were tested again after storage for 12 months. Most surfactant samples formed limpid aqueous dispersions that had little or no EDR activity. However, there were substantial differences in the effect of surfactants on Al EDR activity. Under the conditions of this study, nonionic samples from every subclass were compatible with Al. Anionics usually resulted in the formation of insoluble products that inactivated Al, although a polyethoxy carboxylate and a sulfated ester were exceptions which formed clear, stable dispersions that yielded high EDR values. The cationics varied in their response to Al; the amines reacted with and deactivated Al, but quaternary ammonium compounds were more compatible. No surfactants from any class enhanced the capacity of Al to reduce enamel acid dissolution. The long-term stability data revealed that 21 of 22 Al-surfactant combinations tested retained a significant EDR activity. However, some dispersions exhibited visual signs of instability, and the pH of many nonionic samples decreased. This study showed that, in the presence of Al, nonionic surfactants were relatively stable for long periods and did not block the ability of Al to inhibit enamel acid dissolution. However, certain anionic and cationic surfactants also displayed comparable properties.

Aluminum uptake and inhibition of enamel dissolution by sequential treatments with aluminum solutions.

The effects of sequentially applied solutions containing aluminum (Al) on enamel uptake and inhibition of acid dissolution were investigated. Following 10 consecutive 5-min treatments with seven Al solutions varying in concentration from 0.15 to 2.0 mmol/l, the subsequent acid dissolution of enamel was progressively reduced from 0 to over 70%. Teeth treated with 1.5 mmol/l Al from 1 to 30 consecutive 5-min periods demonstrated a stepwise increase in the reduction of enamel acid dissolution ranging from about 10 to 90%. Following the same treatment regimen, the amount of Al deposited in the enamel varied from 2,500 ppm after a single 5-min application to approximately 9,000 ppm after 20 or 30 consecutive treatments. These experiments showed that teeth repeatedly exposed to low concentrations of Al solutions (i.e. < 2 mmol/l) progressively accumulated significant amounts of Al in the surface enamel, which was associated with a concomitant decrease in the acid dissolution rate of enamel.

Validation of a 21-day, partial-mouth gingivitis model for evaluating chemotherapeutic dentifrices.

The experimental gingivitis model has long been used to evaluate chemotherapeutic agents in mouthrinses. Only recently however has the model been modified to test undiluted dentifrices by using a toothshield both to apply dentifrice and to protect selected teeth from toothbrushing. This also enables participants to brush the rest of the mouth and avoid the unpleasantness of 3 weeks without oral hygiene. Because of its well-documented efficacy, chlorhexidine was used in a toothpaste formulation to investigate the validity of the partial-mouth, experimental gingivitis model for evaluating therapeutic dentifrices. Optimal gingival health was established in 88 adults, who then were randomly assigned to two equal groups. A toothshield was constructed for each subject to fit the teeth of one mandibular quadrant. During the trial chlorhexidine or placebo dentifrice was applied undiluted to the test teeth via the toothshield, which also prevented plaque removal during brushing of the remaining dentition. After 21 days, plaque and gingivitis had developed in both groups. However, the chlorhexidine group had significantly less plaque and gingivitis than the placebo group. No adverse soft tissue effects were observed. This study demonstrated that the partial-mouth, experimental gingivitis model allowed unhindered development of plaque and gingivitis that was comparable to whole-mouth studies in which oral hygiene was suspended for 3 weeks. By corroborating with chlorhexidine, it is concluded that this short-term clinical model is valid for evaluating the chemotherapeutic effects of dentifrices.

Formation of flossing habit using a floss-holding device.

The population for this survey consisted of participants from a previous flossing study that employed crossover design in which subjects alternately used a floss-holding device or hand-held floss during consecutive two-month periods. Although both flossing techniques were equally successful in removing interproximal plaque and reducing gingivitis, at the end of the study 70% of the subjects preferred the floss holder over finger flossing. The purpose of this follow-up survey was to determine, six months after completion of the flossing study, the number of former participants who were still flossing regularly and the flossing method they were using. The results from 32 respondents demonstrated that 50% of the previous nonflossers were still flossing regularly (i.e., two or more times per week) and of these new regular flossers, 85% were using the floss-holding device while the remaining 15% preferred flossing by hand. The regular floss-holder users reported flossing slightly more often than the hand-flossers. Overall, the survey demonstrated that the floss-holding device was significantly more effective in helping patients establish a long-term, regular flossing habit.