Comparative anticaries efficacy of sodium fluoride and sodium monofluorophosphate dentifrices. A two-year caries clinical trial on children in New Jersey and Puerto Rico.

PURPOSE: To provide a head-to-head comparison of the anticaries efficacy associated with two commercially-available and American Dental Association-accepted dentifrices: Crest Cavity Fighting Toothpaste with Fluoristat, containing 0.243% sodium fluoride in a silica base, and Colgate Great Regular Flavor Fluoride Toothpaste, containing 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base. The study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward this purpose. MATERIALS AND METHODS: The study employed a double-blind, parallel-groups, multi-center two-treatment design, and involved third, fourth, and fifth grade schoolchildren from Newark, New Jersey, and from the Cidra and Lares areas of Puerto Rico. Qualifying subjects were stratified according to age and sex, and were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by the presentation of educational films and lectures at school, by semi-annual mailings to parents, and through the periodic distribution of small novelty gifts along with the dentifrice deliveries, in order to enhance the interest and enthusiasm of study participants. Post-baseline examinations were performed after 1 and after 2 yrs of product use. Two thousand four hundred seventy-nine (2,479) subjects completed this 2-yr study. For these subjects, the mean (S.D.) DFS scores at baseline were 2.77 (3.35) for the Crest group, and 2.66 (3.18) for the Colgate group. For caries increment after 1 yr, the respective means were 1.68 (2.53) and 1.70 (2.57). After 2 yrs, the mean caries increments were 3.56 (4.11) for the Crest group, and 3.56 (4.05) for the Colgate group. RESULTS: The analysis of the 2-yr caries increment scores support the conclusion that the anticaries efficacy associated with Colgate Great Regular Flavor Fluoride Toothpaste is equivalent to that associated with Crest Cavity Fighting Toothpaste with Fluoristat, in accordance with the procedures and standards provided by the published guidelines of the American Dental Association. Further, consistent with those same standards, the results of this study serve to lend additional support to the conclusion that dentifrices formulated with sodium monofluorophosphate provide an equivalent level of anticaries efficacy as to those formulated with sodium fluoride.

Community-based dental programs: University of Medicine and Dentistry of New Jersey-New Jersey Dental School.

The dental school plans to incorporate CODE into the curriculum so that more students have community-based dental educational experiences. Future plans also include increasing standardization of reports, clinical and administrative procedures, resources, and processes across the sites in order to lower managerial overhead. This process will be aided by further enhancement of computerized information systems and electronic links. The major lesson learned is that new extramural programs can be created and sustained by pooling school resources with those from the private and public sectors. Funding sources and opportunities available to one party alone are insufficient. While one-time funding was used to build and furnish the NJDS extramural sites, the clinics were established only after business plans demonstrated the availability of funds to sustain their operations. The Statewide Network of Community Oral Health Care and CODE models are still evolving, but they are replicable not only in dental education but in other types of health services. The details of the partnerships and funding streams will vary from site to site, but through outreach and careful negotiation with potential partners and detailed contracts, the community service and educational missions of a health professions school can have a successful outcome.

Linking postdoctoral general dentistry programs with community-based clinical care settings.

This article presents the results of a small workgroup convened by the American Association of Dental Schools to examine experiences related to establishing and conducting dental education programs that have significant affiliations with community-based clinical care settings. The workgroup meeting is a component of the association's effort to identify and promote innovative and non-traditional methods by which the number of postdoctoral general dentistry (PGD) positions can be increased to meet current demand for PGD education. The participants identified factors and conditions believed to be critical to successful program linkages. The information should be helpful to others as they consider opportunities to establish PGD programs or increase their number of PGD training positions.

Hearing-damage risk and communication interference in dental practice.

The use of high-speed air-turbine handpieces, operated at 300,000 to 400,000 revolutions per minute, has led to concern over the possibility of noise-induced hearing loss. Sound levels were measured in clinical settings and in a pre-clinical laboratory for estimation of hearing-damage risk among dentists, and the extent of communication interference. Octave-band sound pressure levels were obtained with use of a Fast-Fourier-Transform analyzer and associated instrumentation. The results of this study indicate that the sound energy contribution of a typical dental practice is about 8% to 12% of the dentist's average 24-hour noise exposure. However, noise levels during dental procedures result in an articulation index of 0.21 to 0.37, corresponding to understanding of about 18% to 48% of nonsense syllables and 52% to 90% of sentences. It appears that hearing-damage risk is slight among dentists using modern equipment. However, further noise control in handpieces is necessary so that error-free communication during dental procedures can be ensured.

Phase II rehabilitation of the temporomandibular joint dysfunction patient.

Treatment of pain and dysfunction of the craniomandibular apparatus commonly follows one of two courses, not necessarily independent of each other. In many patients, treatment involves both appliance and non-appliance modalities. A thorough and careful diagnostic evaluation of the patient will help the dentist to select the proper modality of treatment. Following successful Phase I therapy, the patient is now prepared for Phase II therapy, a more definitive treatment stage. The purpose of this article is to provide the reader with the rationale and principles underlying the stabilization and rehabilitation direction of Phase II therapy, emphasizing the prosthodontic and orthodontic perspectives.

Occlusal splint therapy in MPD and internal derangements of the TMJ.

Although occlusal splints are useful in the treatment of MPD and internal derangements, they must be used in a rational manner. Two basic appliances are employed in Phase I palliative therapy: a maxillary full coverage (MAR) and a mandibular orthopedic repositioning appliance (MORA). The MAR is used in MPD patients primarily to disengage the occlusion and reduce parafunctional activity. In many cases of internal derangement, protrusive mandibular repositioning is indicated. By using the MORA during the day and the MAR at night, the disadvantages of each appliance are minimized.

Geriatric dentistry and the Alzheimer's patient: management techniques and service delivery.

A low-cost portable dental operatory system has been developed for the provision of removable prosthodontic services to the Alzheimer's patient. A light-cured denture base material is utilized for complete and partial denture fabrication, relines and repairs. The system is efficient, cost-effective and does not compromise the quality of care.

The geriatric patient: evaluation, treatment planning, affordable concepts.

The predicted growth of the geriatric population mandates the health professional to turn their attention to treatment modalities which are indicated for this particular cohort. The dentist must examine, evaluate and treatment plan these patients with a systematic approach. Guidelines are offered to expedite the care of the elderly both efficiently and cost effectively.

Cervical strain and mandibular whiplash: effects upon the craniomandibular apparatus.

One of the most common injuries that can lead to a multitude of problems is cervical strain and mandibular whiplash resulting from a motor vehicle accident. Many individuals do not fully recover from such injuries, develop additional areas of pain and dysfunction weeks or months after the accident, and/or sustain major trauma that may require surgical intervention. Other than fractures or dislocations of cervical vertebrae, which are usually easily discerned from radiological analysis, two prime factors frequently lead to a prolongation of pain, a long rehabilitation course, and the development of problems at adjacent structures such as the craniomandibular region. These two factors are: 1) the lack of early comprehensive evaluation and referral for definitive therapeutic intervention, and 2) a minimal awareness of the relationship of upper quarter structures to one another. The purpose of this paper is to foster within the reader an appreciation of the interrelationship of the cervical and craniomandibular architectures as well as the significance of proper evaluation and treatment of cervical strain and mandibular whiplash injuries.

The geriatric patient: removable partial denture design, protecting the dentition.

The population of the United States is aging rapidly. By the year 2000, approximately 36 million Americans will be 65 years of age or older. With respect to dentistry, the oral health status of older adults is improving. In addition to retaining more of their teeth, the demand for dental care is increasing amongst the geriatric population. Because total edentulousness is expected to decline in the future, a greater demand for removable and fixed partial dentures is anticipated. This paper serves as an outline for quick reference when treatment planning the replacement of teeth in the partially edentulous arch.

The geriatric patient: controlling tooth contours, protecting the periodontium.

A significant number of geriatric patients are restored with the removable partial denture (RPD). Because the periodontal condition, as well as overall health, of this population is usually less than ideal, the recontouring of teeth prior to RPD construction must be executed precisely with special attention given to the biomechanics of RPD design. The philosophy and technique for the reshaping of abutment teeth is presented to clarify these procedures.

The geriatric patient: one- or two-visit complete denture construction technique. Part 1.

The next two articles will discuss the construction of quality complete dentures in one- or two-patient appointments. Material and techniques are presented for controlling costs by reducing laboratory expenses and dentist chair time. A block unit of 12 to 14 attached flat plane acrylic teeth, light cured denture base materials and modified techniques which incorporate multiple procedures are introduced. The procedure will be divided into two segments and described in two articles. The initial article will carry the technique through the completion of the maxillo-mandibular relations and articulation for the casts. The second section, described in the second article, will encompass the set-up of the teeth, try-in of the set-up, processing of the dentures and insertion of the case.