The impact of bias of underlying literature in guidelines on its recommendations: assessment of the German fluoride guideline.

PURPOSE: The significance of the underlying literature in clinical guidelines can be weakened by the risk of bias, which could negatively affect the recommendations. Especially in controversial matters, such as fluoride use for caries prevention in children, biased results may be not reliable and lead to incorrect conclusions. This study was performed to detect bias in underlying literature of the German guideline for caries prevention using fluoride in children, where no consensus was reached between paediatricians and paediatric dentists. METHODS: Three tools used for risk of bias assessments of different study designs were RoB 2 for RCTs, ROBINS-I for non-randomized studies, and ROBIS for systematic reviews. For each study cited in the guideline two independent risk of bias assessments were performed. Disagreements were resolved by consensus. RESULTS: Out of 58 papers, 48.3% (n = 28) showed high risk of bias, with the majority in sections regarding fluoride tablets, fluoridated toothpaste, and paediatricians' recommendations. 9 out of 20 recommendations and statements were based on studies with high risk of bias, all of which were in these three controversial sections. 13 out of 29 RCTs showed high risk of bias (44.8%), as all 13 non-randomized trials did, while only 2 of 16 (12.5%) systematic reviews had high risk of bias. CONCLUSION: Considering risk of bias of cited studies in clinical guidelines may result in substantial changes in its recommendations and aid in reaching consensus. Efforts should be made to assess risk of bias of underlying literature in future clinical guidelines.

Impact of operators' experience and patients' age on the success of nitrous oxide sedation for dental treatment in children.

AIM: To evaluate the success rates and potential influencing factors of nitrous oxide sedation for dental treatment in a specialised paediatric dental service. MATERIALS: Medical records of all children treated under nitrous oxide sedation in a specialised pedodontics clinic between 2012 and 2017 were analysed retrospectively for parameters such as age of the patient, experience and change of operating dentists, treatment procedure and success or failure regarding the sedation and treatment. CONCLUSION: Given the high overall success rate of over 90%, nitrous oxide sedation can be a highly effective treatment option for performing dental treatment in pre-cooperative and/or anxious children and adolescents. With age of the children and experience of the dentist, success rates increased.

Ten-year trends in DMF-S and DMF-T in a northeast German adult population.

OBJECTIVE: The aim of this study was to assess 10-year trends in coronal caries in adults aged 20-83 years using data from the two-representative population-based Studies of Health in Pomerania (SHIP-0/SHIP-Trend-0). METHODS: Repeated cross-sectional data from 4,286 SHIP-0 and 3,913 SHIP-Trend-0 participants were analysed. Carious, filled and missing teeth/surfaces were recorded in a half-mouth design and the DMF-T/S scores and sound surfaces/teeth were calculated according to WHO criteria. Trends in DMF-T/S scores and its single components were presented stratified by age group and sex. RESULTS: A statistically significant decline in coronal caries experience (DMF-T and DMF-S) in adults aged 20 to 83 years as well as for D-T/S components was observed. The proportion of edentulous participants was almost halved from 8.7% (SHIP-0) to 5.1% (SHIP-Trend-0), while the number of M-T declined from 4.4 to 3.5 revealing an overall clear shift to a higher retention rate of teeth. In younger adults (25-34 years) 3.8 more sound teeth (17.2 sound surfaces) were found in average in the mouth and in elderly (65-74 years) a clear shift from extracted to filled teeth was observed (M-T reduced by 5.4, while F-T increased by 4). Regarding sex differences, females had consistently on average higher MF-T/S values, but lower D-T/S values than males. CONCLUSION: A clinically relevant drop in the severity of coronal caries experience in all adult age groups in Northeast Germany shows that not only reductions in caries experience in adolescence translated into adulthood but also later improvements led to long-term oral health.

Parental acceptance of advanced behaviour management techniques in paediatric dentistry in families with different cultural background.

PURPOSE: To investigate the differences of parental acceptance of advanced behaviour management techniques (BMT) in different cultural backgrounds (Germany vs. Jordan). METHODS: A convenience sample of 100 parents each of paediatric patients at the University of Greifswald/Germany and Jordan University/Jordan completed a questionnaire to rate their acceptance of four advanced BMT (passive restraint, active restraint, nitrous oxide sedation, and general anaesthesia) using a five-point Likert scale. RESULTS: In both groups, nitrous oxide sedation was the most accepted advanced BMT (mean 3.78 ± 1.34/3.22 ± 1.50, respectively). The least acceptable technique in Germany was passive restraint (2.05 ± 1.18) and in Jordan general anaesthesia (2.11 ± 1.30). The parents in Germany are significantly more accepting of nitrous oxide sedation than are parents in Jordan (p = 0.010), while parents in Jordan are more willing to accept passive restraint (p = 0.001). The acceptance of all advanced BMT increased significantly in both groups when the treatment was urgent. CONCLUSIONS: Parental cultural background and the urgency of the treatment affect the acceptance of different BMT. Moreover, the parental attitude to the pharmacological technique has changed, as nitrous oxide sedation generally appears to be the most preferred advanced technique in both groups.

Dental trauma characteristics in the primary dentition in Greifswald, Germany: a comparison before and after German unification.

BACKGROUND: The data on the distribution and pattern of dental trauma in the primary dentition are very rare. AIM: To investigate primary dental trauma patterns in relation to gender, age, time and cause for a recent paediatric cohort and to compare this with a historic one before German unification. METHODS: This retrospective study compared the patterns of dental trauma injuries at the trauma centre at Greifswald University/Germany for a recent paediatric cohort (2014-16, 103 children) with a historic one (1974-1989, n = 120). The data contained details on etiology, injury types and treatment delivered for 450 injured teeth (247 historic, 203 recent). RESULTS: In both cohorts, the occurrence was more common in males than females (63%/55%, resp.) with an age peak from 2 to 6 years. Maxillary incisors were most affected (89.6%/88.6%, resp.) and periodontal ligament injuries dominated (77.8%/90.3%, resp.). Almost half of the injuries occurred at home (46.6%), mostly due to falling (48.5%) or during playing (37.8%) in the recent paediatric cohort which provided better forensic data due to insurance issues and potential concern about child abuse. Advice and follow up was the most common approach in the recent paediatric cohort (76%). CONCLUSION: Even after 30 years and a change in the health care system due to German unification, the patterns of dental traumatic injuries in the primary dentition were similar.

National oral health survey on refugees in Germany 2016/2017: caries and subsequent complications.

OBJECTIVES: To assess oral health, caries prevalence, and subsequent complications among recently arrived refugees in Germany and to compare these findings with the German resident population. METHODS: This multicenter cross-sectional study recruited 544 refugees aged 3-75+ years; they were examined at ten registration institutions in four federal states in Germany by two calibrated dentists. The refugees were screened for caries (dmft/DMFT) and its complications (pufa/PUFA); this data was compared to the resident population via the representative national oral health surveys). RESULTS: The deciduous dentition of the 3-year-old refugees had a mean dmft value of 2.62 ± 3.6 compared with 0.48 dmft in the German resident population, and caries increased to 5.22 ± 3.4 for 6-7-year-olds (Germany: 1.73 dmft). Few refugee children had naturally healthy teeth (7% in 6-7-year-olds, Germany: 56%). In the permanent dentition, the gap in caries prevalence between refugees and the German population decreased with age (35-44-year-olds: 10.55 ± 7.1 DMFT; Germany: 11.2), but refugees exhibited more caries defects (35-44-year-olds DT = 3.13 ± 3.0; Germany: 0.5). German residents had more restorations (35-44-year-olds FT = 4.21 ± 4.6). Regarding complications, the 6-7-year-olds exhibited the highest pufa index (0.86 ± 1.4) which decreased in adolescence (13-17-year-olds, 0.18 ± 0.6) and increased in adults (45-64-year-olds, 0.45 ± 0.8). CONCLUSION: The refugees had high caries experience, often untreated caries teeth and more complications compared with the German resident population, especially in children. Closing this gap by extending preventive systems to the refugees would decrease future treatment needs. CLINICAL RELEVANCE: European countries should be prepared for the higher dental treatment needs in recent refugees, especially in children.

How to intervene in the caries process: proximal caries in adolescents and adults-a systematic review and meta-analysis.

OBJECTIVES: For an ORCA/EFCD consensus, this systematic review assessed the question "How to intervene in the caries process in proximal caries in adolescents and adults". MATERIAL AND METHODS: Separating between the management of initial and cavitated proximal caries lesions, Medline via PubMed was searched regarding non-operative/non-invasive, minimally/micro-invasive and restorative treatment. First priority was systematic reviews or randomized controlled trials (RCTs), otherwise cohort studies. After extraction of data, the potential risk of bias was estimated depending on the study type, and the emerging evidence for conclusions was graded. RESULTS: Regarding non-invasive/non-operative care (NOC), no systematic reviews or RCTs were found. In cohort studies (n = 12) with a low level of evidence, NOC like biofilm management and fluoride was associated with a low proportion and slow speed of progression of initial proximal lesions. Minimally/micro-invasive (MI) treatments such as proximal sealants or resin infiltration (four systematic reviews/meta-analyses) were effective compared with a non-invasive/placebo control at a moderate level of evidence. Data on restorative treatment came with low evidence (5 systematic reviews, 13 RCTs); with the limitation of no direct comparative studies, sample size-weighted mean annual failure rates of class II restorations varied between 1.2 (bulk-fill composite) and 3.8% (ceramic). Based on one RCT, class II composite restorations may show a higher risk of failure compared with amalgam. CONCLUSIONS: Proximal caries lesions can be managed successfully with non-operative, micro-invasive and restorative treatment according to lesion stage and caries activity. CLINICAL RELEVANCE: Proximal caries treatment options like non-operative, micro-invasive and restorative care should be considered individually.

Choosing a paediatric dentist: Factors influencing parents' decision.

AIM: Choosing a paediatric dentist is an important decision for parents. The mechanisms of this selection have hardly been studied. This study assesses the factors influencing parents' decision choosing a specialised paediatric dentist for their child. MATERIALS AND METHODS: A questionnaire consisting of 30 items that could potentially be relevant to decision-making was sent nationwide in Germany to paediatric dentists to be given to the parents of new patients (n=450). Eighty-nine out of 102 returned questionnaires (response rate=22.7%) were evaluated. RESULTS: Parent's and children's experience in previous dental visits played an "important" or "very important" role in choosing a paediatric dentist (78.8% and 62.2%, respectively). The most frequently mentioned recommendation for the paediatric dentist was by friends and acquaintances (86.5%). Recommendations from other dentists were often included in the decision making (60.7%), while specialist journals or Internet portals were less important for the respondents (15% and 19%, respectively). Most of the parents used Internet search engines and the practice website to obtain information. CONCLUSION: Previous negative experience with general dentists was the main reason for visiting a specialised paediatric dentist. Recommendations came mostly from the close social environment and the qualifications were the most important feature for choosing a paediatric dentist.

Parental acceptance of advanced behaviour management techniques in normal treatment and in emergency situations used in paediatric dentistry.

BACKGROUND: Behaviour management techniques (BMT) in children are essential to achieve a successful dental treatment, but parents are not equally accepting BMT. AIM: To investigate the parental acceptance of advanced behaviour management techniques used in paediatric dentistry in normal and in emergency situations in Germany. METHODS: Parents bringing their children for dental care answered a questionnaire on the acceptance of four advanced BMT: passive restraint, active restraint, nitrous oxide sedation and general analgesia. The study was conducted in five university dental clinics in Germany. Parents rated overall acceptance of each technique using a five points Likert scale. RESULTS: 136 parents answered the questionnaire. The acceptance of all advanced BMT was significantly higher when the treatment was urgent (p < 0.001, paired sample t test). Nitrous oxide sedation was rated as the most acceptable technique in normal treatment (52.6%) and in emergency situation (68.2%), while passive restraint was the least acceptable technique in both normal (19.9%) and emergency situation (37.8%). CONCLUSIONS: Parents in Germany are more willing to accept advanced BMT in emergency situations, with nitrous oxide being generally the most preferred technique.

Treatment of Carious Lesions Using Self-Assembling Peptides.

Modern approaches in caries treatment involve lesion management without tissue removal. Regenerative medicine focuses on replacing damaged tissues with biologically similar tissues. This article discusses the scientific evidence and clinical results for self-assembling peptides in modern caries management. The biomimetic remineralization promoted by self-assembling peptide P11-4 has been proven in vitro as an effective therapy for initial caries. P11-4 was rationally designed to promote formation of hydroxyapatite on its surface. The formulation was optimized to ensure the ability of monomeric P11-4 to penetrate past the subsurface lesions and assembly into a biomatrix within. Furthermore, P11-4 has shown that it assembles into fibers within carious lesions, and promotes the remineralization thereof. In a recent clinical study, the safety and efficacy of P11-4 in treatment of initial caries were evaluated. The additional effect of the application of P11-4 (Curodont Repair) was compared to the application of fluoride varnish (Duraphat) alone in active occlusal initial caries lesions on erupting permanent molars. In the 3- and 6-month recalls, the test group showed, both in the laser fluorescence readings and in the clinical assessment of the caries stage and activity, significantly superior lesion regression compared to the control group. No adverse events, medical complications, or allergic reactions related to the treatments were reported. Clinical applicability of treatment was regarded as satisfactory. Patients were happy to receive noninvasive caries treatments. In conclusion, biomimetic mineralization facilitated by P11-4 in combination with fluoride may present a simple, safe, and effective noninvasive treatment for early carious lesions.

Self-assembling Peptide P11-4 and Fluoride for Regenerating Enamel.

Regenerative medicine-based approaches for caries treatment focus on biomimetic remineralization of initial carious lesions as a minimal invasive therapy. In vitro, self-assembling peptide P11-4 enhances remineralization of early carious lesions. To investigate the safety and clinical efficacy of P11-4 for treatment of initial caries, a randomized controlled single-blind study was conducted on children aged >5 y with visible active early caries on erupting permanent molars. Subjects were randomized to either the test group (P11-4 + fluoride varnish) or control group (fluoride varnish alone). Caries were assessed at baseline and at 3 and 6 mo posttreatment per laser fluorescence, a visual analog scale, the International Caries Detection and Assessment System, and Nyvad caries activity criteria. Intention-to-treat analyses were performed, and safety and clinical feasibility of the treatment approaches were assessed. Compared with the control group, the test group showed clinically and statistically significant improvement in all outcomes at 3 and 6 mo. The laser fluorescence readings (odds ratio = 3.5, P = 0.015) and visual analog scale scores (odds ratio = 7.9, P < .0001) were significantly lower for the test group, and they showed regression in the International Caries Detection and Assessment System caries index (odds ratio = 5.1, P = 0.018) and conversion from active to inactive lesions according to Nyvad criteria (odds ratio = 12.2, P < 0.0001). No adverse events occurred. The biomimetic mineralization facilitated by P11-4 in combination with fluoride application is a simple, safe, and effective noninvasive treatment for early carious lesions that is superior to the presently used gold standard of fluoride alone. By regenerating enamel tissue and preventing lesion progression, this novel approach could change clinical dental practice from a restorative to a therapeutic approach. This could avoid additional loss of healthy hard tissue during invasive restorative treatments, potentially enabling longer tooth life and thereby lowering long-term health costs ( ClinicalTrials.gov NCT02724592).

Severity of MIH findings at tooth surface level among German school children.

AIM: This study was to investigate the distribution and clinical characteristics of teeth diagnosed with MIH at surface and defect type level in a cohort of German children. METHODS: The study cohort included 242 children diagnosed with MIH which had been recorded during the compulsory dental school examinations of 20 German primary schools. The subjects had been enrolled by cluster sampling. All children attended the second to fourth grade (age 7-10 years, mean 8.1 ± 0.8). The children were examined by five calibrated examiners (kappa = 0.9) after tooth brushing. The recording comprised teeth, surfaces, type and severity of MIH defects and was conducted using a portable light, mirrors and cotton rolls. MIH was registered according to the EAPD criteria. Defects <1 mm were not recorded. Statistical analysis included descriptive statistics and Spearman's correlation. RESULTS: Most affected teeth were first permanent molars (71.4 %) followed by the maxillary central incisors (15.6 %). The most common defects were demarcated opacities (82.2 %), while the remaining 17.8 % of the affected teeth exhibited severe enamel defects. The most frequently affected surface in molars was the occlusal surface (72.4 %); in incisors, it was the buccal surface (73.5 %). There were no atypical restorations in the affected incisors. Different types of MIH defects at various surfaces of the same tooth were common. The number of affected tooth surfaces was positively correlated with the severity of MIH at child (p < 0.001). CONCLUSIONS: The study demonstrates severe enamel defects involving in almost one-fifth of all MIH teeth. The knowledge of the intra-oral distribution and severity of MIH findings at the enamel surface level is important for assessing the treatment needs.

[GeKo KidS--Health Literacy in School Children]. / GeKo KidS--Gesundheitskompetenz bei Kindern in der Schule.

The main goal of this study was the evaluation of an intervention programme for the promotion of health literacy in school-aged children (grade 5-6). The project and the programme were highly accepted, the extension of the annual dental health examination was suitable to collect data within evaluation projects in schools. In spite of positive outcomes, a longer supervision phase would be necessary in order to optimise and to implement other programme components fully.

Caries management strategies for primary molars: 1-yr randomized control trial results.

Minimal invasive approaches to managing caries, such as partial caries removal techniques, are showing increasing evidence of improved outcomes over the conventional complete caries removal. There is also increasing interest in techniques where no caries is removed. We present the 1-yr results of clinical efficacy for 3 caries management options for occlusoproximal cavitated lesions in primary molars: conventional restorations (CR; complete caries removal and compomer restoration), Hall technique (HT; no caries removal, sealing in with stainless steel crowns), and nonrestorative caries treatment (NRCT; no caries removal, opening up the cavity, teaching brushing and fluoride application). In sum, 169 children (3-8 yr old; mean, 5.56 ± 1.45 yr) were enrolled in this secondary care-based, 3-arm, parallel-group, randomized clinical trial. Treatments were carried out by specialist pediatric dentists or postgraduate trainees. One lesion per child received CR, HT, or NRCT. Outcome measures were clinical failure rates, grouped as minor failure (restoration loss/need for replacement, reversible pulpitis, caries progression, etc.) and major failure (irreversible pulpitis, abscess, etc.). There were 148 children (87.6%) with a minimum follow-up of 11 mo (mean, 12.23 ± 0.98 mo). Twenty teeth were recorded as having at least 1 minor failure: NRCT, n = 8 (5%); CR, n = 11 (7%); HT, n = 1 (1%) (p = .002, 95% CI = 0.001 to 0.003). Only the comparison between NRCT and CR showed no significant difference (p = .79, 95% CI = 0.78 to 0.80). Nine (6%) experienced at least 1 major failure: NRCT, n = 4 (2%); CR, n = 5 (3%); HT, n = 0 (0%) (p = .002, 95% CI = 0.001 to 0.003). Individual comparison of NRCT and CR showed no statistically significant difference in major failures (p = .75, 95% CI = 0.73 to 0.76). Success and failure rates were not significantly affected by pediatric dentists' level of experience (p = .13, 95% CI = 0.12 to 0.14). The HT was significantly more successful clinically than NRCT and CR after 1 yr, while pairwise analyses showed comparable results for treatment success between NRCT and CR (ClinicalTrials.gov NCT01797458).

Sealants in dentistry: outcomes of the ORCA Saturday Afternoon Symposium 2007.

Sealants are a successful tool in caries prevention, but their role in preventive strategies after the caries decline has to be discussed. A survey of paediatric departments across Europe revealed that indications for pit and fissure sealants vary considerably, both nationally and internationally. Evidence for effectiveness of sealants in controlling caries in posterior teeth implies that sealants should be an integrated part of management of pit and fissure caries. Still, the indication for occlusal sealants seems to be shifting from primary prevention to a therapeutic decision for caries management of lesions in enamel and the outer part of the dentine. Sealants are also an interesting concept for caries management in approximal surfaces. Clinical trials suggest that novel techniques of sealing or infiltrating approximal lesions show promise. However, approximal sealing techniques are as complex to apply and time-consuming as approximal fillings. The article proposes guidelines for teaching on the use of sealants.

Evaluation of disparities in physical development and dental age of two specific groups of boys.

AIM: The aim of the study was to investigate potential differences between the physical development and the dental age in two groups of male pupils from two schools with different socio-economic profiles in the city of Torun (Poland). MATERIALS AND METHODS: A total number of 286 school boys (age: 9-12 years) was examined: Group A consisted of 104 pupils of a private school (mean age: 10.36-/+0.1 years), group B were 182 normally intellectually developed, non-handicapped pupils (10.59-/+0.1 years) of a therapeutic school for children with specific learning difficulties like dyslexia, dysgraphy, ADHD or severe speech disorders. The parameters of the physical development (body height, body weight) and the dental age assessed by eruption were evaluated based on a biological frame of reference and percentile charts. RESULTS: The two groups showed distinct disparities in physical and dental development: the mean values of body height were significantly higher in group A than group B (p<0.02). In addition, differences in percentile distributions of body height, body mass and dental age showed statistical significance (p<0.001, 0.01 and 0.01, respectively). The relationship between body height/body mass and dental age was not statistically significant (p>0.3). CONCLUSION: The pronounced disparities concerning physical and dental development within boys of different socio-demographic background should be taken into account by health professionals. No correlation was found between physical and dental development.

Effectiveness of sealants in adolescents with high and low caries experience.

The aim of this 3-year longitudinal study was to analyze caries increment and the caries-preventive effect of sealants in adolescents in the setting of the German national health system. 434 pupils (193 male, 241 female) took part in compulsory school examinations at age 12 (mean 12.3 +/- 0.4 years) and 15 (mean 15.6 +/- 0.3 years) according to WHO criteria, including the examination of sealants. Mean DMFT increased from 1.78 (+/- 2.15) to 3.97 (+/- 3.68), mean DMFS from 2.79 (+/-4.07) to 6.94 DMFS (+/- 8.34), respectively. Logistic regression analysis showed that high caries incidence at the individual level was mostly associated with the type of school ('Gymnasium', RR = 0.3), gender (female, RR = 2.08) and high baseline DMFS (RR = 1.2 per surface), but not with the number of sealants. In an interaction model, adolescents with high baseline DMFS values had an even higher risk of caries increment with an increasing number of sealants compared to adolescents with fewer sealants (p = 0.047). At the tooth level, this effect was detected for first permanent molars, while sealants in premolars and second permanent molars did not result in a statistically significant caries-preventive effect due to the low caries incidence on these surfaces. Thus, sealants on occlusal surfaces of first permanent molars were only protective in individuals with low or moderate caries activity (p = 0.006), which indicates the need for other measures to reduce caries activity in high risk adolescents. In addition, rates of 19% lost sealants and 18% carious or filled surfaces in 3 years suggest a discrepancy between sealant retention under real-life conditions and the results of controlled clinical trials.

Chemo-mechanical dentine caries removal with Carisolv using a rotating brush.

AIM: The aim of this study was to assess the efficacy of removing dentine caries using carbide burs, Carisolv with hand instruments and Carisolv in combination with a new mechanical excavation method using a rotating brush. METHODS: 36 extracted permanent teeth, with dentine caries, were assigned into 3 groups according to caries removal technique. Caries removal was monitored by checking the properties of the dentine with a dental explorer. After embedding and sectioning (400 microm), remaining caries was assessed by using a caries detector. In microscope images (7x) of the samples, the mean stain depth of the remaining carious tissue per tooth was calculated by AnalySIS computer software. RESULTS: Four to 8 applications (mean time = 10.9 min) of Carisolv were necessary for caries removal with the new method using rotating brushes. The mean thickness of residual dentine caries by this procedure (226 microm, +/- 136) was higher than the one using Carisolv with hand instruments (57 microm, +/- 39) or carbide burs (32 microm, +/- 20). Even in areas with good access to the lesion, an unacceptable amount of residual caries was observed. CONCLUSION: Thus, it seems that Carisolv using rotating brushes does not reach the degree of caries removal reached by additional mechanical abrasion of Carisolv using hand instruments or conventional rotating carbide burs.

Responder and nonresponder analysis for a caries prevention program.

To be able to generalize studies, it is important to know whether responders and nonresponders differ significantly. These data are usually not available. To assess whether responders and nonresponders differed significantly, 319 first and second graders in Greifswald, Germany took part in a compulsory dental school examination. Their parents completed a questionnaire on oral health topics and were asked to decide about their children's participation in a school-based caries prevention program plus anonymous scientific evaluation. The 91 children who were not allowed to participate (nonresponders) were older (mean 8.5 years) than the 228 responders (mean 8.1 years; p < 0.001), mostly because of a few older children having repeated a grade. In an age-adjusted analysis, nonresponders exhibited in 21 of 30 indices of higher caries and plaque values, less preventive measures and a lower rate of participation. The difference in caries in the permanent dentition and fluorosis reached statistical significance. This study suggests that nonresponders to caries prevention programs might comply less with preventive measures and exhibit poorer oral health than responders: a result which has to be taken into account in research and prevention programs in the community.

The effect of a polyhexamethylene biguanide mouthrinse compared with a triclosan rinse and a chlorhexidine rinse on bacterial counts and 4-day plaque re-growth.

OBJECTIVES: For various clinical applications, polyhexamethylene biguanide hydrochloride (PHMB) has been used for many years as an antiseptic in medicine. Recently, a 0.04% and a 0.12% PHMB mouthwash were shown to inhibit plaque re-growth and to reduce oral bacterial counts. In this study, a 0.2% PHMB mouthrinse (A) was compared with a positive control 0.12% aqueous chlorhexidine solution (B), a commercially available 0.3% triclosan/2.0% polyvinyl methyl ether maleic acid copolymer mouthrinse (Colgate Total Plax) (C), and a negative control placebo rinse (10% ethanol, flavour) (D). MATERIALS AND METHODS: The controlled clinical study was a double blind, randomized, four replicate cross - over design. Plaque re-growth was assessed with the Turesky et al. (1970) modification of the Quigley & Hein (1962) plaque index. The antibacterial effect was assessed by taking bacterial counts on the tooth surface (smears from the buccal surface of 16/26) and mucosa (smears from the buccal mucosa in opposite of area 16/26) after the professional prophylaxis and after the first rinse with the preparations on day 1 and prior to the clinical examination on day 5. Sixteen volunteers participated and, on day 1 of each study period were rendered plaque-free, ceased toothcleaning, and rinsed twice daily with the allocated mouthrinse. On day 5, plaque was scored and smears were collected according to the protocol. A 10-day wash-out period was carried out between each rinse evaluation. Data were analysed using ancova with Bonferroni HSD adjustment for multiple comparisons (colony forming units per sample) with a significance level alpha=0.05. RESULTS: The 0.2% PHMB mouthrinse (A) was significantly better at inhibiting plaque than the placebo (D), but significant less effective than the 0.12% aqueous chlorhexidine solution (B). There is no significant difference between A and the 0.3% triclosan/2.0% copolymer mouthrinse (C). Bacterial count reductions (tooth surface and mucosa) with PHMB (A) were significantly greater compared with the placebo (D) and triclosan (C), but significantly lower compared with chlorhexidine (B) (tooth surface) and equally effective compared with chlorhexidine (B) (mucosa). CONCLUSION: Consistent with previous studies, a PHMB mouthrinse was shown to inhibit plaque re-growth and to reduce oral bacterial counts, indicating that PHMB could be an alternative to established mouthrinses in preventive applications.