Blinded Clinical Evaluation of a New Toothbrush Design.

OBJECTIVE: The purpose of this single-blind, crossover study was to compare plaque removal associated with a new manual toothbrush, the O'Nano and a best-selling, commercially available manual toothbrush, the Oral-B Indicator 40. The O'Nano toothbrush has a patented "one-piece molded design" made of Thermal Plastic Urethane, a plastic that has been used in medical devices. METHODOLOGY: Over a six-week period, 40 subjects participated. Following random assignment, 22 subjects started with the O'Nano brush and the remaining started with the Oral-B Indicator 40 brush. Crossover occurred after two-weeks' use of each brush (two-week washout in between). Plaque was scored before and after brushing using the Turesky modification of the Quigley-Hein Index (T/Q-H). Plaque accumulation was 12 to 18 hours prior to examination and brushing. RESULTS: Thirty-nine subjects completed the study; one subject was dropped for non-compliance. Groups were virtually identical at the onset in plaque level scores by study design. In comparison to baseline, both brushes achieved significant (p < 0.001) plaque reductions (gains) with a matched-paired comparison t-test. The O'Nano brush gain was 0.445 (18%) per subject and the Oral-B Indicator 40 brush was 0.504 (20%) per subject. The difference in plaque removal capability between brushes averaged 0.60 in favor of the Oral-B Indicator 40 brush, a non-significant (p = 0.20) finding determined by a matched-paired comparison t-test, which is identical to the repeated measures ANOVA when there are two groups and two time periods. Standard deviation (SD) was smaller for the O'Nano brush in plaque reduction scores (0.183 < 0.235). This difference was tested and found to be non-significant with this particular group size. CONCLUSION: Statistical analysis of T/Q-H scores demonstrated that the O'Nano brush is comparable to the Oral-B Indicator 40 brush under the conditions of this study protocol. With this small study group the slight differences in plaque removal efficiency between both brushes was not significant. The unique "one-piece molded" design of the O'Nano brush was not evaluated for durability in comparison to a more conventional brush, the Oral-B 40.

Diagnosis and management of dental wear.

Dental wear is loss of tooth structure resulting from erosion, attrition, abrasion and, possibly, abfraction. Clinical/experimental data suggest no single damaging mechanism, but rather simultaneous interaction of these destructive processes. The most important interaction is abrasion/attrition potentiated by dental erosion. Awareness of this pathosis is not well-appreciated by the public and dental professionals because the signs may be subtle. This article focuses on recognizing, diagnosing and managing dental wear. Dental wear is a challenging problem for clinicians because of the subtlety of early changes; confusion about the etiology of the problem; and the dilemma of when or how to manage the etiology. Unfortunately, failure to recognize and manage the process often results in inaction until the breakdown is severe. At that point, the structural breakdown is so advanced that major rehabilitative treatment often is needed. This introductory article discusses diagnosing and managing dental wear.

The effectiveness of scaling and root planing with adjunctive time-release minocycline using an open and closed approach for the treatment of periodontitis.

The purpose of this study was to determine the effectiveness of scaling and root planing using a closed and open approach (papilla reflection) with and without a locally delivered antibiotic (minocycline hydrochloride microspheres) in the treatment of moderate to advanced chronic periodontitis. Twenty-five periodontal recall patients with four or more probing depths of 5.0 to 9.0 mm and bleeding on probing (BOP) participated in this double-blind trial. Each of four sites per patient was randomly assigned a different treatment: scaling/root planing only; scaling/root planing followed by minocycline placement; gingival papilla reflection followed by scaling/root planing and flap closure; and gingival papilla reflection, scaling/root planing, minocycline placement, and flap closure. At baseline and each subsequent appointment, probing depth, BOP, and clinical crown length were recorded. Patients returned at three months for measurements and supportive periodontal therapy, and at six months for final measurements. Patients followed their usual oral hygiene regimens. Data were analyzed for significant differences using a repeated measure ANOVA and a Student t-test. All treatments resulted in reduction of probing depths (average of 1.76 mm) and a marked reduction in BOP at six months. While the papilla reflection plus minocycline showed the greatest reduction in probing depth (1.91 mm) and the greatest decrease in BOP (20% at three months and 28% at six months), the differences were not significant (p > 0.05). Clinical crown lengths did not change significantly in the treatment sites; therefore, improvements in probing depth can be attributed to improved clinical attachment levels (long junctional epithelium). The combination therapies did not differ significantly from scaling/root planing alone in decreasing probing depths and BOP.

Effectiveness of root planing with diode laser curettage for the treatment of periodontitis.

This study investigated the effectiveness of scaling/root planing using closed approach, closed approach with laser-curettage, closed approach with laser-curettage/laser-sealing, and an open approach (papilla reflection/flap closure) in treating moderate-advanced chronic periodontitis. All treatments resulted in a reduction in probing depth and bleeding upon probing. The closed approach therapies: SRP, laser-curettage/SRP, and laser-curettage/SRP/laser-sealing resulted in less gingival recession than the open approach (papilla reflection/flap closure). If esthetics are a concern, laser-curettage is a viable option.

Effects of nutritional supplementation on periodontal parameters, carotenoid antioxidant levels, and serum C-reactive protein.

Few studies have focused on the role of nutrition in periodontal disease. The purpose of this trial was to determine the effect of a nutritional supplement on gingival inflammation, bleeding, probing depth, clinical attachment level, carotenoid antioxidant level, and C-reactive protein. The test supplement, consisting of a standard multivitamin formula, as well as several phytonutrients associated with antiinflammatory/antioxidant effects, provided modest benefits in reducing inflammation; however, further studies with larger populations and longer intervention are warranted.

Diagnosis and management of dental wear.

Dental wear is loss of tooth structure resulting from erosion, attrition, abrasion, and, possibly, abfraction. Clinical/experimental data suggest no single damaging mechanism but rather simultaneous interaction of these destructive processes. The most important interaction is abrasion/attrition potentiated by dental erosion. Awareness of this pathosis is not well-appreciated by the public and dental professionals because the signs may be subtle. This article focuses on the recognition, diagnosis, and management of dental wear.

Clinical challenges in diagnosing and monitoring periodontal inflammation.

An understanding of the new paradigm that periodontal disease may have a relationship to various systemic inflammatory conditions of aging reinforces the importance of monitoring oral inflammation. As oral health care providers, it is important to accurately assess, monitor, and manage our patients' inflammatory load. This review examines some of the clinical challenges associated with diagnosing and monitoring periodontal inflammation. Given these difficulties, patient management may be more effective when these patients are co-managed with a periodontist.

Blinded clinical evaluation of a new manual toothbrush.

OBJECTIVE: A new manual toothbrush with an innovative design has recently been introduced into the marketplace. The purpose of this single-blind, crossover study was to compare plaque removal associated with this new manual toothbrush (Curvex) and a best-selling commercially available manual tootbrush (Oral-B Indicator 40). METHODOLOGY: Over a five-week period, twenty-one subjects participated in this investigation. Following random assignment, ten of the subjects started with the Curvex toothbrush, and the remaining subjects began with the Oral-B Indicator 40 toothbrush. Subjects brushed twice daily for two minutes over a two-week period. After a one-week washout period, the subjects brushed with the alternate toothbrush for two weeks. At the beginning and end of each two-week trial period, subjects were scored before and after brushing using the Turesky modification of the Quigley-Hein Plaque Index (T/Q-H). Findings of reductions in plaque scores were limited to "before vs. after" assessments. Plaque scores were measured in each subject (up to 168 sites) on each of four occasions. RESULTS: The average baseline and test plaque scores for the Oral-B Indicator 40 brush were 2.41 and 1.72; for the Curvex brush these values were 2.34 and 1.69. Repeated measures ANOVA revealed no difference between brushes. Paired-comparison t-tests were conducted on each of the 168 evaluated sites, and no patterns of superiority for either brush were identified. Although both toothbrushes effectively reduced mean plaque scores, ANOVA demonstrated no significant difference between toothbrushes. CONCLUSION: The Curvex toothbrush is as effective as the Oral-B Indicator 40 toothbrush in removing plaque. Additionally, there was no evidence of any soft tissue abrasion from either brush.

Long-term follow-up of successful orthodontic-periodontal treatment of localized aggressive periodontitis: a case report.

This report describes a case of localized aggressive periodontitis (localized juvenile periodontitis) that was jointly treated with conventional periodontal therapy, selective extractions to eliminate localized areas of vertical bone loss, and orthodontic therapy. A 20-year follow-up is described in this report. The success of periodontal treatment in a case such as this depends on making an accurate diagnosis, providing periodontal treatment to control the disease, and providing regular periodontal maintenance during and after orthodontic treatment.