Vibrio cholerae O139 genomes provide a clue to why it may have failed to usher in the eighth cholera pandemic.

Cholera is a life-threatening infectious disease that remains an important public health issue in several low and middle-income countries. In 1992, a newly identified O139 Vibrio cholerae temporarily displaced the O1 serogroup. No study has been able to answer why the potential eighth cholera pandemic (8CP) causing V. cholerae O139 emerged so successfully and then died out. We conducted a genomic study, including 330 O139 isolates, covering emergence of the serogroup in 1992 through to 2015. We noted two key genomic evolutionary changes that may have been responsible for the disappearance of genetically distinct but temporally overlapping waves (A-C) of O139. Firstly, as the waves progressed, a switch from a homogenous toxin genotype in wave-A to heterogeneous genotypes. Secondly, a gradual loss of antimicrobial resistance (AMR) with the progression of waves. We hypothesize that these two changes contributed to the eventual epidemiological decline of O139.

Enhanced plaque removal to improve gingival health: 3-month randomized clinical study of the effects of baking soda toothpaste on plaque and gingivitis.

PURPOSE: To compare the effectiveness in reducing plaque and gingivitis of a fluoride toothpaste with 20% baking soda and a fluoride toothpaste control. METHODS: 159 subjects, who met the entry criteria, participated in this single-center, double-blind, randomized, parallel-group clinical study. Gingival Index (MGI), Gingival Bleeding Index (GBI), and Plaque Index (PI) were assessed after 4, 8, and 12 weeks use of the assigned test or control toothpaste. After 12 weeks, participants resumed 4 weeks of their customary oral hygiene after which they were re-evaluated using the same measures. RESULTS: Both toothpastes statistically significantly reduced MGI, GBI, and PI versus baseline at all-time points. Brushing with the 20% baking soda toothpaste statistically significantly reduced MGI, PI, and GBI compared to the control toothpaste at all time points. After 12 weeks, the reductions in MGI, PI, and GBI were 12.6%, 9.6%, and 44.2%, respectively. After the 4-week customary oral hygiene period, the benefits of the study period had begun to diminish, but statistically significant reductions in MGI and GBI for the test versus control were still evident. This 3-month clinical study shows that brushing with fluoride toothpaste containing 20% baking soda reduces dental plaque and concurrently reduces gingival inflammation and bleeding compared to toothpaste with fluoride alone. CLINICAL SIGNIFICANCE: Fluoride toothpaste with 20% baking soda has the potential to offer multiple oral health benefits when used as an adjunct to regular tooth brushing and, therefore, may be confidently recommended to patients.

Genomic plasticity associated with antimicrobial resistance in Vibrio cholerae.

The Bay of Bengal is known as the epicenter for seeding several devastating cholera outbreaks across the globe. Vibrio cholerae, the etiological agent of cholera, has extraordinary competency to acquire exogenous DNA by horizontal gene transfer (HGT) and adapt them into its genome for structuring metabolic processes, developing drug resistance, and colonizing the human intestine. Antimicrobial resistance (AMR) in V. cholerae has become a global concern. However, little is known about the identity of the resistance traits, source of AMR genes, acquisition process, and stability of the genetic elements linked with resistance genes in V. cholerae Here we present details of AMR profiles of 443 V. cholerae strains isolated from the stool samples of diarrheal patients from two regions of India. We sequenced the whole genome of multidrug-resistant (MDR) and extensively drug-resistant (XDR) V. cholerae to identify AMR genes and genomic elements that harbor the resistance traits. Our genomic findings were further confirmed by proteome analysis. We also engineered the genome of V. cholerae to monitor the importance of the autonomously replicating plasmid and core genome in the resistance profile. Our findings provided insights into the genomes of recent cholera isolates and identified several acquired traits including plasmids, transposons, integrative conjugative elements (ICEs), pathogenicity islands (PIs), prophages, and gene cassettes that confer fitness to the pathogen. The knowledge generated from this study would help in better understanding of V. cholerae evolution and management of cholera disease by providing clinical guidance on preferred treatment regimens.

Molecular Insights into Antimicrobial Resistance Traits of Multidrug Resistant Enteric Pathogens isolated from India.

Emergence of antimicrobial resistant Gram-negative bacteria has created a serious global health crisis and threatens the effectiveness of most, if not all, antibiotics commonly used to prevent and treat bacterial infections. There is a dearth of detailed studies on the prevalence of antimicrobial resistance (AMR) patterns in India. Here, we have isolated and examined AMR patterns of 654 enteric pathogens and investigated complete genome sequences of isolates from six representative genera, which in aggregate encode resistance against 22 antibiotics representing nine distinct drug classes. This study revealed that ~97% isolates are resistant against ≥2 antibiotics, ~24% isolates are resistant against ≥10 antibiotics and ~3% isolates are resistant against ≥15 antibiotics. Analyses of whole genome sequences of six extensive drug resistant enteric pathogens revealed presence of multiple mobile genetic elements, which are physically linked with resistance traits. These elements are therefore appearing to be responsible for disseminating drug resistance among bacteria through horizontal gene transfer. The present study provides insights into the linkages between the resistance patterns to certain antibiotics and their usage in India. The findings would be useful to understand the genetics of resistance traits and severity of and difficulty in tackling AMR enteric pathogens.

Phenotypic and Genetic Heterogeneity in Vibrio cholerae O139 Isolated from Cholera Cases in Delhi, India during 2001-2006.

Incidence of epidemic Vibrio cholerae serogroup O139 has declined in cholera endemic countries. However, sporadic cholera caused by V. cholerae O139 with notable genetic changes is still reported from many regions. In the present study, 42 V. cholerae O139 strains isolated from 2001 to 2006 in Delhi, India, were retrospectively analyzed to understand their phenotype and molecular characteristics. The majority of isolates were resistant to ampicillin, furazolidone and nalidixic acid. Though the integrative conjugative element was detected in all the O139 isolates, the 2004-2006 isolates remained susceptible to co-trimoxazole, chloramphenicol, and streptomycin. Cholera toxin genotype 1 was present in the majority of the O139 isolates while few had type 3 or a novel type 4. In the cholera toxin encoding gene (ctx) restriction fragment length polymorphism, the majority of the isolates harbored three copies of CTX element, of which one was truncated. In this study, the ctx was detected for the first time in the small chromosome of V. cholerae O139 and one isolate harbored 5 copies of CTX element, of which 3 were truncated. The ribotype BII pattern was found in most of the O139 isolates. Three V. cholerae O139 isolated in 2001 had a new ribotype BVIII. Pulsed-field gel electrophoresis analysis revealed clonal variation in 2001 isolates compared to the 2004-2006 isolates. Molecular changes in V. cholerae O139 have to be closely monitored as this information may help in understanding the changing genetic features of this pathogen in relation to the epidemiology of cholera.

Cotton leaf curl Burewala virus with intact or mutant transcriptional activator proteins: complexity of cotton leaf curl disease.

Cotton leaf curl disease (CLCuD) is a serious disease of cotton on the Indian subcontinent. In the present study, three cotton leaf curl viruses, cotton leaf curl Burewala virus (CLCuBuV), cotton leaf curl Kokhran virus (CLCuKoV) and cotton leaf curl Multan virus (CLCuMV), and their associated satellites, cotton leaf curl Multan betasatellite (CLCuMB) and cotton leaf curl Multan alphasatellite (CLCuMA), were detected. CLCuBuV with either intact (CLCuBuV-1) or mutant (CLCuBuV-2) transcriptional activator protein (TrAP) were detected in different plants. Agroinoculation with CLCuBuV-1 or CLCuBuV-2 together with CLCuMB and CLCuMA, resulted in typical leaf curling and stunting of tobacco plants. Inoculation with CLCuKoV or an isolate of CLCuMV (CLCuMV-2), together with CLCuMB and CLCuMA, induced severe leaf curling, while the other isolate of CLCuMV (CLCuMV-1), which was recombinant in origin, showed mild leaf curling in tobacco. To investigate the effect of intact or mutant TrAP and also the recombination events, CLCuBuV-1, CLCuBuV-2, CLCuMV-1 or CLCuMV-2 together with the satellites (CLCuMA and CLCuMB) were transferred to cotton via whitefly-mediated transmission. Cotton plants containing CLCuBuV-1, CLCuBuV-2 or CLCuMV-2 together with satellites showed curling and stunting, whereas the plants having CLCuMV-1 and the satellites showed only mild and indistinguishable symptoms. CLCuBuV-1 (intact TrAP) showed severe symptoms in comparison to CLCuBuV-2 (mutant TrAP). The present study reveals that two types of CLCuBuV, one with an intact TrAP and the other with a mutant TrAP, exist in natural infection of cotton in India. Additionally, CLCuMuV-1, which has a recombinant origin, induces mild symptoms in comparison to the other CLCuMV isolates.

Cholera outbreaks in India.

Cholera is a global health problem as several thousands of cases and deaths occur each year. The unique epidemiologic attribute of the disease is its propensity to occur as outbreaks that may flare-up into epidemics, if not controlled. The causative bacterial pathogen Vibrio cholerae prevails in the environment and infects humans whenever there is a breakdown in the public health component. The Indian subcontinent is vulnerable to this disease due its vast coastlines with areas of poor sanitation, unsafe drinking water, and overcrowding. Recently, it was shown that climatic conditions also play a major role in the persistence and spread of cholera. Constant change in the biotypes and serotypes of V. cholerae are also important aspects that changes virulence and survival of the pathogen. Such continuous changes increase the infection ability of the pathogen affecting the susceptible population including the children. The short-term carrier status of V. cholerae has been studied well at community level and this facet significantly contributes to the recurrence of cholera. Several molecular tools recognized altering clonality of V. cholerae in relation with the advent of a serogroup or serotype. Rapid identification systems were formulated for the timely detection of the pathogen so as to identify and control the outbreak and institute proper treatment of the patients. The antimicrobials used in the past are no longer useful in the treatment of cholera as V. cholerae has acquired several mechanisms for multiple antimicrobial resistance. This upsurge in antimicrobial resistance directly influences the management of the disease. This chapter provides an overview of cholera prevalence in India, possible sources of infection, and molecular epidemiology along with antimicrobial resistance of V. cholerae.

A new betasatellite associated with cotton leaf curl Burewala virus infecting tomato in India: influence on symptoms and viral accumulation.

A begomovirus and its associated alpha- and betasatellite were detected in tomato plants affected with leaf curl disease. Based on a nucleotide sequence identity of 99 %, this begomovirus was designated an isolate of cotton leaf curl Burewala virus (CLCuBuV). The alphasatellite exhibited 93 % sequence identity to cotton leaf curl Burewala alphasatellite (CLCuBuA) and is hence referred to here as a variant of CLCuBuA. The detected betasatellite was recombinant in nature and showed 70 % sequence identity to the known betasatellites. Inoculation of healthy tomato with CLCuBuV plus betasatellite, either in the presence or the absence of alphasatellite, led to typical leaf curling, while inoculation with CLCuBuV in the absence of betasatellite resulted in mild symptoms. This confirmed the role of the betasatellite in expression of disease symptoms. We propose to name the newly detected betasatellite tomato leaf curl Hajipur betasatellite (ToLCHJB).

Molecular characterization and pathogenicity of a carrot (Daucus carota) infecting begomovirus and associated betasatellite from India.

The yellow mosaic pattern and shortening of leaf petiole are common disease symptoms associated with begomovirus infection in carrot. DNA from field infected carrot leaves was analyzed by rolling circle amplification and sequencing. The results established the presence of ageratum enation virus (AEV), which is referred to here as ageratum enation virus-carrot (AEV-Car). Symptomatic ageratum (Ageratum conyzoides) plants, growing adjacent to the carrot fields, also showed the presence of AEV (AEV-Age). Ageratum yellow leaf curl betasatellite (AYLCB) was also detected in the AEV infected carrot and ageratum samples. AEV-Car and AEV-Age are 95-97% identical in their DNA sequences, represent groups of isolates from the respective plant hosts (carrot and ageratum). Agroinoculation using infectious clones of AEV-Car plus AYLCB or AEV-Age plus AYLCB in carrot, ageratum, tobacco (Nicotiana tabacum) and tomato (Solanum lycopersicum) produced yellow mosaic and curling symptoms in leaves of inoculated plants. Agroinoculation of the two isolates together, along with the betasatellite (AEV-Car plus AEV-Age plus AYLCB) resulted in the enhancement of symptoms in comparison to the plants inoculated with single isolate. Plants with more severe symptoms showed a higher level of viral DNA accumulation, suggesting synergistic interactions between the two isolates of AEV.

A 4-week clinical comparison of a novel multi-directional power brush to a manual toothbrush in the reduction of gingivitis and plaque.

PURPOSE: To evaluate the efficacy of a novel multi-directional power toothbrush in reducing plaque and gingivitis relative to a standard manual toothbrush control. METHODS: This 4-week, randomized and controlled, single-center, parallel group, examiner-blinded clinical study enrolled adults with mild-to-moderate gingivitis. At baseline, pre-treatment gingivitis and plaque levels were assessed via the Lobene Modified Gingival Index (MGI), the Gingival Bleeding Index (GBI), and the Rustogi Modified Navy Plaque Index (RMNPI). Subjects qualifying were assigned randomly to one of two toothbrush groups: a novel multi-directional power toothbrush (Oral-B Professional Deep Sweep TRICLEAN 1000, also marketed as Oral-B TriZone) or a standard soft manual control toothbrush. Aside from a supervised brushing at baseline on-site, subjects brushed at home twice daily with their assigned test brush. After 1 week, subjects returned for RMNPI plaque evaluations. At Week 4, subjects were again recalled to evaluate toothbrush efficacy, and received MGI and GBI gingivitis and RMNPI plaque evaluations. RESULTS: 119 evaluable subjects completed the study. Both the novel power and manual control toothbrushes yielded statistically significant (P < 0.001) mean plaque reductions compared to baseline at Weeks 1 and 4 (except Week 1 manual brush gingival margin) and significant mean MGI and GBI gingivitis reductions (P < 0.001). Comparing the relative effectiveness of the test brushes, the novel multi-directional power brush produced significantly superior anti-gingivitis and anti-plaque reductions compared to pre-treatment relative to the manual control brush in every analysis at both time points. The Week 4 adjusted mean relative reductions favoring the multi-directional power brush were 3 and 1.49 times greater for whole mouth MGI and GBI, respectively (P < 0.001); and were 2.1, 4.7 and 2 times greater for the RMNPI whole mouth, gingival margin and interproximal regions, respectively (P < 0.001). Both toothbrushes were well-tolerated.

Comparison of two power interdental cleaning devices on plaque removal.

OBJECTIVE: The objective of this randomized, single-use, single-blind, two-group, parallel clinical trial was to evaluate the supragingival plaque removal efficacy of two power interdental devices combined with a manual toothbrush. METHODS: Eighty-two (82) subjects completed the study. Subjects were randomly assigned to one of two groups: Waterpik Water Flosser (WF) plus manual tooth brushing or Sonicare Air Floss (AF) plus manual tooth brushing. Pre-brushing and interdental cleaning scores were obtained using the Rustogi Modified Navy Plaque Index (RMNPI). Subjects were instructed on the use of the manual toothbrush and assigned an interdental product. Post-brushing and interdental cleaning scores were obtained after a supervised two-minute brushing and use of the interdental device. Scores were recorded for whole mouth, marginal, approximal, facial, and lingual regions for each subject. RESULTS: There were no differences in the pre-cleaning plaque scores for whole mouth, marginal, approximal, facial, or lingual regions. Both groups showed significant reductions in plaque from baseline for all regions. The WF group demonstrated significantly higher reductions as measured by the RMNPI compared to the AF for whole mouth (74.9% vs. 57.5%), marginal (58.6% vs. 36.7%), approximal (92.1% vs. 77.4%), facial (83.6% vs. 69.1%), and lingual (65.7% vs. 45.4%). CONCLUSION: The use of the Waterpik Water Flosser removes significantly more plaque from tooth surfaces (whole mouth, marginal, approximal, facial, and lingual) than the Sonicare Air Floss when used with a manual toothbrush.

Comparison of two power interdental cleaning devices on the reduction of gingivitis.

OBJECTIVE: The objective of this study was to compare the reduction of gingivitis by two power interdental devices combined with a manual toothbrush. METHODS: Eighty-two subjects completed this randomized, four-week, single-blind, two-group parallel clinical study. Subjects were randomly assigned to one of two groups: Waterpik Water Flosser (WF) plus manual tooth brushing or Sonicare Air Floss (AF) plus manual tooth brushing. Subjects were provided written and verbal instructions for all products at the baseline visit and instructions were reviewed at the two-week (W2) visit. Data were evaluated for whole mouth, lingual, and facial areas for gingivitis and bleeding on probing. Plaque data were evaluated for whole mouth, lingual, facial, approximal, and marginal areas of the tooth. Gingivitis, bleeding on probing, and plaque were scored at baseline (BSL), two weeks, and four weeks (W4). RESULTS: Both groups showed significant reductions in gingivitis, bleeding on probing, and plaque from baseline for all regions and time points measured (p < 0.001). The WF group was significantly more effective than the AF group at reducing plaque and gingivitis at W2 and W4 for all areas measured (p <0.001). At W4, the WF group was 80% more effective than AF for whole mouth gingivitis reduction, and twice as effective for the lingual region. In terms of plaque removal at W4, the WF group was 70% more effective for whole mouth (50.9% vs. 30%), 60% for approximal area (76.7% vs. 48%), and 47% for facial (52.8% vs. 35.9%) surfaces. The WF was twice as effective for lingual areas and more than three times as effective for marginal areas vs. the AF group (p <0.001). Results for bleeding on probing showed the WF group was numerically better than the AF group for all areas and time points, with these improvements being statistically significance for whole mouth (p = 0.02) and facial area (p = 0.004) at W2, and for the facial area (p = 0.02) at W4. CONCLUSION: The Waterpik Water Flosser is significantly more effective than Sonicare Air Floss for reducing gingivitis and plaque.

Amplified fragment length polymorphism of clinical and environmental Vibrio cholerae from a freshwater environment in a cholera-endemic area, India.

BACKGROUND: The region around Chandigarh in India has witnessed a resurgence of cholera. However, isolation of V. cholerae O1 from the environment is infrequent. Therefore, to study whether environmental nonO1-nonO139 isolates, which are native to the aquatic ecosystem, act as precursors for pathogenic O1 strains, their virulence potential and evolutionary relatedness was checked. METHODS: V. cholerae was isolated from clinical cases of cholera and from water and plankton samples collected from freshwater bodies and cholera-affected areas. PCR analysis for the ctxA, ctxB, tcpA, toxT and toxR genes and AFLP with six primer combinations was performed on 52 isolates (13 clinical, 34 environmental and 5 reference strains). RESULTS: All clinical and 3 environmental isolates belonged to serogroup O1 and remaining 31 environmental V. cholerae were nonO1-nonO139. Serogroup O1 isolates were ctxA, tcpA (ElTor), ctxB (Classical), toxR and toxT positive. NonO1-nonO139 isolates possessed toxR, but lacked ctxA and ctxB; only one isolate was positive for toxT and tcpA. Using AFLP, 2.08% of the V. cholerae genome was interrogated. Dendrogram analysis showed one large heterogeneous clade (n = 41), with two compact and distinct subclades (1a and 1b), and six small mono-phyletic groups. Although V. cholerae O1 isolates formed a distinct compact subclade, they were not clonal. A clinical O1 strain clustered with the nonO1-nonO139 isolates; one strain exhibited 70% similarity to the Classical control strain, and all O1 strains possessed an ElTor variant-specific fragment identified with primer ECMT. Few nonO1-nonO139 isolates from widely separated geographical locations intermingled together. Three environmental O1 isolates exhibited similar profiles to clinical O1 isolates. CONCLUSION: In a unique study from freshwater environs of a cholera-endemic area in India over a narrow time frame, environmental V. cholerae population was found to be highly heterogeneous, diverse and devoid of major virulence genes. O1 and nonO1-nonO139 isolates showed distinct lineages. Clinical isolates were not clonal but were closely related, indicating accumulation of genetic differences over a short time span. Though, environment plays an important role in the spread of cholera, the possibility of an origin of pathogenic O1 strains from environmental nonO1-nonO139 strains seems to be remote in our region.

Superiority of an essential oil mouthrinse when compared with a 0.05% cetylpyridinium chloride containing mouthrinse: a six-month study.

OBJECTIVE: To evaluate the antiplaque/antigingivitis effectiveness of an essential oils containing mouthrinse as compared to a 0.05% cetylpyridinium chloride mouthrinse. METHOD: Generally healthy subjects with mild to moderate levels of plaque and gingivitis participated in a 6-month, examiner-blind, single centre, randomised, parallel-group controlled clinical trial. They were randomised into three mouthrinse groups--control (C), 0.05% cetylpyridinium chloride (CPC), or a fixed combination of essential oils (EO). Subjects received a dental prophylaxis at baseline and rinsed twice daily in addition to their usual oral hygiene for six months. Plaque Index and Modified Gingival Index were determined at 3 and 6 months. RESULTS: At 6 months, the EO group exhibited statistically significantly lower mean scores for MGI and PI than CPC (32.4% and 56.2% reductions, respectively). Compared to control, EO provided statistically significantly lower mean MGI and PI scores (36.3% and 69.7 %, respectively). The CPC group showed statistically significantly lower mean MGI and PI scores than the C group (5.8% and 30.7%, respectively). CONCLUSION: This study demonstrated the superiority of an EO rinse compared to a 0.05% CPC rinse in reducing plaque and gingivitis and confirmed that the daily use of an EO containing mouthrinse can provide a clinically significant benefit in reducing plaque and gingivitis.

Plaque and gingivitis reduction efficacy of an advanced pulsonic toothbrush: a 4-week randomized and controlled clinical trial.

PURPOSE: To compare the safety and efficacy of a novel sonic power toothbrush and a manual toothbrush in the reduction of gingivitis and plaque over a 4-week period. METHODS: This study employed a randomized two treatment, examiner-blinded, parallel group design. Subjects with evidence of gingivitis were randomly assigned to 4 weeks' twice daily home use of either the Oral-B Pulsonic sonic toothbrush or an ADA reference manual toothbrush. At baseline (Visit 1) and again after product use at Week 4, subjects received gingivitis evaluations with the Modified Gingival Index (MGI) and Gingival Bleeding Index (GBI) examinations, followed by plaque assessment using the Rustogi Modified Navy Plaque Index (RMNPI). For 12 hours before both visits, subjects abstained from all oral hygiene, and ceased eating, drinking and smoking 4 hours prior. RESULTS: Both brushes significantly reduced gingivitis, gingival bleeding and plaque compared with baseline, and were well-tolerated by the 129 subjects completing the study. The sonic toothbrush was statistically significantly (P < 0.0001) more effective than the manual brush, with greater relative mean reductions in MGI, GBI and RMNPI of 11.9%, 62.3% and 46.5%, respectively.

Epidemiological study of Vibrio cholerae using variable number of tandem repeats.

By conventional genetic methods, including pulse-field gel electrophoresis and multilocus sequence typing, most pathogenic, cholera toxin-positive O1 and O139 isolates of Vibrio cholerae cannot be distinguished. We evaluated relationships among 173 V. cholerae isolates collected between 1992 and 2007 from different geographic areas in India by analyzing five variable number of tandem repeat (VNTR) loci. Each VNTR locus was highly variable, with between 5 and 19 alleles. eburst analysis revealed four large groups of genetically related isolates. Two groups contained genotypes of isolates with the O139 serogroup (which emerged for the first time in epidemic form in 1992), with the other two groups containing O1 strains. In subsequent analysis, it was possible to track the spread of specific genotypes across time and space. Our data highlight the utility of the methodology as an epidemiologic tool for assessing spread of isolates in both epidemic and endemic settings.

Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances.

INTRODUCTION: Effective self-care is difficult for people with orthodontic appliances because of the inherent design of brackets and archwires. It is not uncommon to have increases in plaque and gingivitis after placement of fixed appliances. The purpose of this study was to evaluate the effect of using a dental water jet (DWJ) with a specialized tip (orthodontic) on plaque and bleeding in adolescent orthodontic patients with fixed appliances. METHODS: One hundred six subjects were enrolled in this single blind, parallel clinical study. They were randomly assigned to 1 of 3 treatment groups: group 1, once daily irrigation with a DWJ and orthodontic jet tip plus a manual toothbrush; group 2, once daily flossing (FL) plus a manual toothbrush; group 3, manual toothbrush (MT) only. Plaque index (PI) and bleeding index (BI) scores were recorded at baseline, and at 2 and 4 weeks. RESULTS: All groups showed statistically significant reductions in PI (whole mouth and interproximal) at 2 and 4 weeks (P <.001). In group 1, the DWJ was statistically more effective at reducing whole-mouth and interproximal plaque than the methods in the other groups (P >.001) at both 2 and 4 weeks, whereas the FL protocol in group 2 was significantly more effective than the MT protocol in group 3 at 4 weeks (P =.025) for whole-mouth plaque and at 2 and 4 weeks (P = .011 and P = .028, respectively) for interproximal plaque. All groups showed statistically significant reductions in BI (whole mouth and interproximal) at 2 and 4 weeks (P <.001). The DWJ in group 1 was statistically more effective at reducing whole-mouth bleeding than the protocols of the other groups at 2 and 4 weeks (P <.001), and the FL was statistically more effective than the MT at both times (P <.001). Both the DWJ and the FL were significantly more effective than the MT at 2 weeks (P <.001 and P <.016, respectively) for interproximal bleeding, but there were no differences between the groups at 4 weeks. CONCLUSIONS: A DWJ with a specialized orthodontic jet tip is effective for adolescents in fixed orthodontic appliances; it demonstrated beneficial results for the reduction of plaque and bleeding.

Clinical effectiveness of a dentifrice containing triclosan and a copolymer for controlling breath odor.

PURPOSE: To investigate in a double-blind clinical study the effectiveness of a dentifrice containing triclosan and a copolymer (Colgate Total Toothpaste) for controlling breath odor 12 hours after brushing the teeth. METHODS: A panel of four expert judges using a nine-point hedonic scale evaluated breath odor. Following a baseline evaluation of breath odor, prospective study subjects who presented breath odor scores above the threshold value for unpleasant breath odor were stratified by score, and randomized into two treatment groups. Subjects were provided with a soft-bristled toothbrush, and brushed their teeth thoroughly in their regular and customary manner with their assigned dentifrice. Subjects refrained from dental hygiene, breath mints, or mouthrinses for the next 12 hours, after which they were once again evaluated for breath odor. 76 adult male and female subjects from the Mississauga, Ontario, Canada area participated in the study. RESULTS: At 12 hours after brushing their teeth, subjects in both dentifrice treatment groups presented mean breath odor scores which were statistically significantly lower than the mean scores observed at baseline. However, the difference between the mean 12-hour breath odor score for the Colgate Total group was 4.65, which is within the range of values corresponding to pleasant breath odor; whereas the mean 12-hour breath odor score for the placebo group was 6.11, which is above the threshold value corresponding to unpleasant breath odor. Thus, the results of this double-blind study, conducted according to Guidelines by the Council on Scientific Affairs of the American Dental Association, support the conclusion that Colgate Total dentifrice provides effective control of breath odor at 12 hours after brushing the teeth.

Evaluation of the plaque removal efficacy of three power toothbrushes.

INTRODUCTION: The objective of this randomized, single use, single blind, single center, 4-group parallel clinical study was to evaluate the plaque removal efficacy of three power toothbrushes and a manual toothbrush. METHODS: One hundred forty-four (144) subjects completed the study. Subjects were randomly assigned to one of four toothbrush groups: Sonicare Elite, Oral-B Sonic Complete, Waterpik Sensonic or Oral-B Indicator (manual). Subjects abstained from brushing 23-25 hours prior to the pre-brushing data collection. Pre-brushing scores were obtained using the Rustogi modified navy plaque index (RMNPI). Post-brushing RMNPI scores were obtained after a supervised uninstructed two-minute brushing with the assigned toothbrush. Scores were recorded for whole mouth, marginal region, and approximal region for each subject. RESULTS: Pre-brush comparability of whole mouth, marginal and approximal regions indicated no statistical differences among the four groups for any of the three measurement regions. All four toothbrushes showed statistically significant change from pre-brush to post-brush scores for whole mouth, marginal region, and approximal region. The Waterpik Sensonic provided significantly greater reduction in plaque as measured by the RMNPI compared to the other three brushes for whole mouth (89%), marginal area (81%) and approximal area (97%). The only exception was for adjusted p-values for the approximal area compared to the Oral-B Sonic Complete (p = 0.12). CONCLUSION: All groups demonstrated a significant reduction in plaque. The single use plaque removal efficacy of the Waterpik Sensonic toothbrush compared favorably to the other two power toothbrushes, the Sonicare Elite and the Oral-B Sonic Complete, and compared favorably to the manual toothbrush, the Oral-B Indicator.

Plaque removal efficacy of a novel tooth wipe.

OBJECTIVE: This study was designed to evaluate the safety and plaque removal efficacy of a tooth wipe (Oral-B Brush-Ups) using a manual toothbrush as a control. METHODOLOGY: Twenty-five healthy subjects from a general population were enrolled in this randomized, single-use, crossover study. After 23-25 hours of no oral hygiene, oral hard and soft tissues were examined, and disclosed plaque was scored using the Turesky, et al. modification of the Quigley Hein Plaque Index. Subjects used their randomly assigned product for a timed period of one minute without instruction, after which hard and soft tissues and plaque scores were reassessed. Subjects returned to the clinic after a one-week washout period, and the clinical procedures were repeated before and after use of the alternate product. All clinical measurements were made by one examiner who was masked to treatment sequence. RESULTS: Both the tooth wipe and toothbrush were found to be safe, and significantly reduced plaque levels from whole mouth, facial, and lingual surfaces (p < 0.0001). The toothbrush removed significantly greater plaque than the tooth wipe (p < 0.0001) on whole mouth surfaces (49% vs. 29%), facial surfaces (71% vs. 44%), and lingual surfaces (25% vs. 13%). CONCLUSION: The tooth wipe provides an effective method of plaque removal when tooth brushing is not practical.