Clinical assessment of extrinsic stain removal efficacy with a new Pulsonic toothbrush.

OBJECTIVE: To assess the extrinsic stain removal benefit of two different power toothbrushes: an experimental Oral-B Pulsonic rechargeable toothbrush and a positive control Sonicare FlexCare toothbrush. METHODS: This was a randomized, positive-controlled, examiner-blind, two-treatment, parallel group, two-week study. A Lobene stain index was performed at baseline on the facial surfaces of the anterior teeth. Subjects were randomized to one of two treatment groups: Pulsonic or FlexCare. Both groups were assigned the same fluoride dentifrice, and were instructed to brush their teeth twice per day for two minutes with the assigned toothbrush and dentifrice in front of a mirror. A further Lobene stain index was performed following two weeks of brushing. RESULTS: A highly significant reduction (p < 0.001) in mean Lobene composite scores after two weeks was found for both the Pulsonic treatment group and the FlexCare treatment group (median reduction of 94.4% and 90.7%, respectively). Both treatment groups also showed a highly significant (p < 0.001) reduction in extent and intensity scores. No significant treatment group differences were seen in the reduction in mean Lobene scores (p > 0.1). CONCLUSION: Both the experimental Pulsonic and the positive control FlexCare power toothbrushes showed highly effective stain removal efficacy relative to baseline following two weeks of brushing. Stain removal efficacy did not differ significantly between brushes.

Antimicrobial efficacy of soap and water hand washing versus an alcohol-based hand cleanser.

The emergence of alcohol-based hand cleansers may represent an alternative to soap and water in the clinical dental setting. In this study, the antimicrobial efficacy of traditional hand washing vs. a unique alcohol-based hand cleanser with persistence was evaluated. Two experienced dentists participated over a 10-day period. On days 1-5, each clinician used an antibacterial liquid soap (Dial, Dial Corporation, Scottsdale, AZ). Days 6-10, an alcohol-based hand cleanser (Triseptin Water Optional, Healthpoint Surgical, Fort Worth, TX) was used. Sampling was by modified glove juice technique. The results indicate that the alcohol-based hand cleanser dramatically outperforms the traditional hand washing agent in the general dental setting.

A clinical evaluation of extrinsic stain removal: a rotation-oscillation power toothbrush versus a dental prophylaxis.

AIM: To assess extrinsic stain removal efficacy of a power toothbrush and a dental prophylaxis followed by the use of a standardized American Dental Association (ADA) reference manual toothbrush. METHODS AND MATERIALS: This was a randomized, positive-controlled, examiner-blind, parallel group, two-week study. A Lobene stain examination was performed at baseline. Subjects were randomized to one of two treatment groups: Group 1: Oral-B Vitality Pro White power toothbrush or Group 2: Subjects receiving a dental prophylaxis then using a standardized ADA reference manual toothbrush. Subjects were instructed to brush their teeth with the assigned toothbrush and a fluoride dentifrice in front of a mirror twice per day for 2 minutes. Stain was reassessed following 2 weeks of brushing. RESULTS: A significant reduction (p <0.001) in mean Lobene composite scores after 2 weeks was found for Group 1 (90.6%) and Group 2 (94.4%). Both groups also showed a significant reduction (p <0.001) in extent and intensity scores. There was no significant group difference in reduction in mean Lobene composite scores (p>0.1). CONCLUSIONS: The Oral-B Vitality Pro White power toothbrush showed effective stain removal at a level similar to receiving an oral prophylaxis followed by the use of an ADA reference manual toothbrush. CLINICAL SIGNIFICANCE: In this small study the Oral-B Vitality Pro White power toothbrush achieved statistically significant stain removal between dental visits.

Risk stratification and dental management of the patient with thyroid dysfunction.

The thyroid gland produces hormones critical to the maintenance of the cellular metabolic rate. The actions of these hormones are far-reaching, affecting thermoregulation and calorigenesis; the metabolism of carbohydrates, fats, and proteins; and oxygen utilization. Thyroid hormones also appear to act synergistically with epinephrine and enhance tissue sensitivity to catecholamines. Signs and symptoms of hypothyroidism include listlessness, fatigue, cold intolerance, dry skin, hair loss, constipation, weight gain, muscle soreness, and slow heart rate. Signs and symptoms of hyperthyroidism include irritability, heat intolerance, tremors, increased sweating, frequent bowel movements, and quickened heart rate. The effect of inadequately treated or undiagnosed hyperthyroidism on the heart carries perioperative risks. To provide competent dental care to patients with thyroid dysfunction, clinicians must understand the disease, its treatment, and the impact the disease and its treatment may have on the patient's ability to undergo and respond to dental care.

Plaque-removal efficacy of four types of dental floss.

BACKGROUND: Effective plaque removal is essential for gingival health, and dental floss is used to augment plaque removal achieved with a toothbrush. METHODS: This randomized, controlled, examiner-masked, five-period crossover study examined plaque removal in 25 subjects following single use with an American Dental Association reference manual toothbrush alone and in combination with four floss products: three traditional (unwaxed, woven, and shred-resistant) and one powered flosser. Plaque was scored before and after brushing for 1 minute. The Rustogi modified Navy plaque index was used to focus scores on tooth areas contacted during the proper use of dental floss. RESULTS: Mean plaque reductions (baseline minus postbrushing) in floss contact areas were as follows: 0.181 with the toothbrush alone; 0.228, 0.217, and 0.210 for the toothbrush in combination with the three traditional flosses, unwaxed, woven, and shred-resistant, respectively; and 0.252 for the toothbrush plus powered flosser. No statistically significant differences were found between the three traditional floss treatments. All four floss treatments showed greater (P <0.05) mean plaque removal than the toothbrush alone. Mean plaque removal with the powered flosser combination was greater than for the woven combination and shred-resistant combination (both P < or =0.006) and fell just short of significance compared to the unwaxed combination (P = 0.051). CONCLUSIONS: All four floss products in combination with a manual toothbrush removed plaque significantly better than the toothbrush alone. Among floss types, there was evidence of superiority for the powered flosser, but there were no significant treatment differences between the three traditional floss products.

Tuberculosis: infection control/exposure control issues for oral healthcare workers.

AIM: The aim is to present the essential elements of an infection control/exposure control plan for the oral healthcare setting with emphasis on tuberculosis (TB). METHODS AND MATERIALS: A comprehensive review of the literature was conducted with special emphasis on TB infection-control issues in the oral healthcare setting. RESULTS: Currently available knowledge related to TB infection-control issues is supported by data derived from well-conducted trials or extensive controlled observations. In the absence of supportive data the information is supported with the best-informed, most authoritative opinion available. CONCLUSION: Essential elements of an effective TB infection-control plan include a three-level hierarchy of administrative, environmental, and respiratory-protection controls. CLINICAL SIGNIFICANCE: Standard precautions provide the fabric for strategies to prevent or reduce the risk of exposure to bloodborne pathogens and other potentially infectious material. However, standard precautions are inadequate to prevent the spread of organisms through droplet nuclei 1-5 micron in diameter and additional measures are necessary to prevent the spread of Mycobacterium tuberculosis. Oral healthcare settings have been identified as outpatient settings in which patients with suspected or confirmed infectious TB disease are expected to be encountered. Therefore, oral healthcare settings must have a written TB infection-control program.

Tooth whitening through the removal of extrinsic stain with two sodium hexametaphosphate-containing whitening dentifrices.

PURPOSE: To evaluate the tooth whitening benefit through stain removal delivered by a marketed whitening dentifrice (Crest Vivid White) used twice a day or a combination regimen of two marketed dentifrices (Crest Vivid White Night used at night and Crest Cavity Protection used in the morning) relative to a positive control over a 2-week period. METHODS: Both studies were randomized, two treatment, parallel group, examiner-blind, 2-week clinical trials involving 22 and 30 healthy adults with longstanding visible extrinsic stain on the facial surfaces of at least six anterior teeth. In each study, subjects were randomized to one of two treatments: a sodium fluoride/sodium hexametaphosphate whitening dentifrice used alone (Study 1) or in combination with a cavity protection dentifrice (Study 2) with an ADA reference manual toothbrush versus a control power toothbrush with a cavity protection dentifrice (both studies). RESULTS: In both studies, all treatment groups statistically significantly (P < 0.001) reduced baseline stain scores following 1 and 2 weeks of brushing. After 2 weeks, the whitening dentifrice used twice daily had a median percent stain removal of 90% and the night-time whitening dentifrice (used once a day) in combination with the cavity protection dentifrice had a median percent stain removal of 85% while powered toothbrush groups showed median percent stain removal of 88-89% in both studies. Stain removal scores after 1 and 2 weeks of brushing did not differ significantly between the two treatment groups in either study.

Risk stratification and dental management of patients with adrenal dysfunction.

Intrinsic and extrinsic physiological stressors (physical, metabolic, or psychological) are constantly challenging the body's homeostatic mechanisms. Regardless of their nature, the body will initiate a series of autonomic responses in an effort to maintain homeostasis. For example, to cope with a perceived threat, cardiac output and respiration are increased, the availability of glucose is increased, and blood flow to the heart, brain, and muscles is increased. Conversely, once the threat subsides, conter-regulatory mechanisms act to down-regulate these responses. The adaptive stress response is essential for a patient's well-being. An altered adaptive stress response may lead to illness, and, at times, even to death. Oral healthcare providers must develop preventive and therapeutic strategies compatible with the functional capacity of a patient's adaptive stress response.

HIV: infection control issues for oral healthcare personnel.

AIM: To present the essential elements of an infection control/exposure control plan in the oral healthcare setting with emphasis on HIV infection. METHODS AND MATERIALS: A comprehensive review of the literature was conducted with special emphasis on HIV-related infection control issues in the oral healthcare setting. RESULTS: Currently available knowledge related to HIV-related infection control issues is supported by data derived from well-conducted trials or extensive, controlled observations, or, in the absence of such data, by best-informed, most authoritative opinion available. CONCLUSION: Essential elements of an effective HIV-related infection control plan include: (1) education and training related to the etiology and epidemiology of HIV infection and exposure prevention; (2) plans for the management of oral healthcare personnel potentially exposed to HIV and for the follow-up of oral healthcare personnel exposed to HIV; and (3) a policy for work restriction of HIV-positive oral healthcare personnel. CLINICAL SIGNIFICANCE: While exposure prevention remains the primary strategy for reducing occupational exposure to HIV, knowledge about potential risks and concise written procedures that promote a seamless response following occupational exposure can greatly reduce the emotional impact of an accidental needlestick injury.

Oral hygiene regimens, plaque control, and gingival health: a two-month clinical trial with antimicrobial agents.

OBJECTIVE: The purpose of this study was to examine the effects of various product combinations involving brush, paste, rinse, and floss on the prevention of plaque regrowth and gingivitis. METHODOLOGY: In this randomized, parallel-group, examiner-blind, eight-week study, 179 subjects with gingivitis had a dental prophylaxis and were randomly assigned to one of six product combinations: 1) Colgate Wave manual toothbrush + Colgate Total dentifrice (0.3% triclosan/copolymer dentifrice); 2) Wave + Total + Listerine (essential oils rinse); 3) Oral-B CrossAction manual toothbrush + Crest Pro-Health dentifrice (0.454% stannous fluoride/sodium hexametaphosphate); 4) CrossAction + Pro-Health dentifrice + Crest Pro-Health Rinse (0.07% cetylpyridinium chloride rinse); 5) Oral-B ProfessionalCare Series 8000 power toothbrush + Pro-Health dentifrice; or 6) ProfessionalCare power brush + Pro-Health dentifrice + Oral-B Hummingbird power flosser. Subjects used their test products for the duration of the study. Whole mouth plaque, gingivitis, and product-related adverse events were assessed. Treatments were compared at a 0.05 level of significance. RESULTS: One-hundred and seventy-four subjects completed the study and were included in the data analysis. At Week 8, the overnight adjusted whole mouth plaque scores were statistically significantly lower in all other groups relative to the Wave + Total group (p < or = 0.030). Plaque scores were also statistically significantly lower (approximately 20%) in both groups where a therapeutic rinse was added to a manual brush and therapeutic paste relative to scores for the brush plus paste without a rinse (p < or = 0.034). All groups showed a reduction in gingivitis at Week 4, and mean scores remained stable or increased slightly at Week 8. The power toothbrush groups were directionally better at preventing gingivitis than the manual groups at Weeks 4 and 8. CONCLUSION: Reductions in overnight plaque were seen when therapeutic rinses were added to manual brush plus therapeutic dentifrice regimens above that observed with a manual brush and therapeutic dentifrice alone.

The patient with actinic cheilosis.

Recent research has greatly enhanced the understanding of the etiopathogenic pathways underlying squamous cell carcinoma (SCC) of the skin. The predominant etiologic agent is ultraviolet radiation. Excessive exposure to sunlight may lead to the development of sunburn, premature aging of the skin, cataracts, immune suppression, and skin cancer. Actinic keratoses represent an early clinical stage of a continuum that ultimately may progress to become SCC of the skin. Actinic cheiloses represent actinic keratoses that occur on the lip vermilion. While numerous therapeutic measures are available for managing actinic cheilosis, close follow-up, combined with strict measures to reduce future sun exposure, is mandatory. Oral health care providers are in a prime position to identify patients at risk for actinic cheiloses, educate patients on preventive measures to reduce and negate the damaging effects of sunlight, and (if necessary) manage early actinic cheiloses.

Comparative plaque removal efficacy of a dual-action power toothbrush and a manual tooth: effects by tooth type.

PURPOSE: To evaluate the plaque removal efficacy of a dual action power toothbrush (Crest SpinBrush Pro Clean) relative to an ADA reference manual toothbrush. In addition to overall plaque removal, emphasis was put on plaque reduction around the gingival margin, interproximal areas of the tooth and in the posterior segment of the dentition. METHODS: The study was a randomized, examiner-blind, two-treatment, four-period, crossover design. After an informed consent, 50 healthy volunteers were randomized to four treatment sequences and used each toothbrush twice according to their assigned treatment sequence. At every visit, plaque removal was assessed at baseline and after a single brushing using the Rustogi-modified Navy Plaque Index that allows estimation of interproximal plaque and plaque at the gingival margin. Self-reported and examiner-observed adverse events were collected at every visit. Mean Plaque Index (MPI) scores were calculated for the whole mouth, gingival region, interproximal region and different areas of the dentition using an analysis of covariance for crossover design with baseline plaque score as the covariate. RESULTS: 49 subjects provided complete data and were included in the analysis. Baseline MPI scores were not significantly different between the groups for any investigated tooth region or dentition area. Following a single brushing, the power toothbrush provided a reduction of 43% (P< 0.001) for the whole mouth MPI, 43% (P< 0.001) for the gingival margin MPI and 65% (P< 0.001) for the interproximal MPI relative to a manual brush. Use of the power toothbrush resulted in a significant reduction of whole-mouth and gingival margin MPI across all areas of the dentition compared to a manual toothbrush (P< 0.001). The power toothbrush also had superior interproximal plaque removal efficacy compared to the manual toothbrush for molars (P< 0.001, with 118% greater removal score). Both brushes were well tolerated.

The pregnant and breast-feeding patient.

The pregnant or breast-feeding patient presents a number of unique management problems for oral health care providers. Clinicians are responsible for providing safe and effective care for the mother, while also considering the safety of the fetus or newborn. They must consider the effects of medications, which may be distributed from the maternal plasma through the placenta to the fetus, or to breast milk, exposing the nursing infant to potentially dangerous concentrations. In addition, a number of maternal oral changes, requiring the attention of oral health care providers, may be observed as a consequence of the multiple physiologic changes associated with pregnancy. In view of the dual responsibility that oral health care providers face in treating the pregnant or breast-feeding patient, understanding the physiology of pregnancy, fetal development, potential oral complications of pregnancy, and the effects that dental intervention may have on the woman, her fetus, or her neonate are imperative.

Cost analysis of hand hygiene using antimicrobial soap and water versus an alcohol-based hand rub.

Proper hand hygiene is acknowledged as the most critical element of an adequate infection control program in the oral healthcare setting. However, adherence to proper hand hygiene protocols is often lacking. Poor compliance with hand hygiene protocols has been attributed to such factors as lack of time, hand irritation, hand dryness, forgetfulness, skepticism over importance, understaffing, perceived low risk of cross-infection, inconvenience, and the belief gloves alone offer protection. In the medical environment the use of alcohol-based hand rubs now represent the preferred method of performing hand hygiene when delivering non-surgical care. In this study we compared the costs associated with traditional hand washing against an alcohol-based hand rub protocol in the dental setting. The results indicate an alcohol-based hand rub protocol is less costly and less time consuming when compared to traditional handwashing in the dental setting, creating a new paradigm for hand hygiene in the dental office.

The use of COX-2 inhibitors for acute dental pain: A second look.

BACKGROUND: On the basis of their perceived better safety profile compared with other analgesic agents, cyclo-oxygenase-2 (COX-2) inhibitors have been prescribed frequently as first-line agents to treat acute dental pain. However, recently identified cardiovascular adverse reactions associated with these drugs mandate a reappraisal of their use in dental practice. TYPES OF STUDIES REVIEWED. The authors reviewed 18 clinical studies that evaluated the efficacy of a COX-2 inhibitor for the treatment of acute dental pain. All of the studies used the widely established third-molar surgical extraction model to induce postsurgical inflammatory based pain, and all were randomized, double-blinded and placebo-controlled. However, numerous vagaries in overall study design made direct comparisons difficult. RESULTS: None of the studies established any of the COX-2 inhibitors as clearly better than ibuprofen, the current gold standard for the treatment of surgically induced dental pain. However, in single-dosing scenarios, the COX-2 inhibitor often demonstrated a longer duration of action compared with ibuprofen. CLINCAL IMPLICATIONS: The evidence to date fails to demonstrate any therapeutic advantage to using a COX-2 inhibitor to treat acute dental pain compared with ibuprofen. In the rare event that a COX-2 inhibitor may be appropriate, the clinician must inform the patient of the potential risks, and the drug should be used for the shortest possible time.

Adverse reactions to latex products: preventive and therapeutic strategies.

Evidence-based infection control/exposure control practices are evolutionary in nature. Elements of historical note were first recorded with the suggestions of Lister for guidelines on aseptic procedures. Others, like Semmelweis, promoted the practice of hand washing by medical students and physicians prior to leaving autopsy suites and before entering the labor and delivery areas of hospitals. Halstead is credited with being the first to use surgical gloves in a clinical setting. While the use of latex surgical gloves became routine by the end of World War I, it wasn't until the adoption of universal precautions by the Centers for Disease Control in 1987 that the use of gloves was officially expanded to cover virtually all aspects of patient care. The ubiquitous use of latex gloves and other latex products in healthcare has resulted in a parallel increase in latex-associated adverse reactions. To provide for a safe environment for both oral healthcare providers and patients alike, clinicians must understand the basis for latex-related adverse reactions, recognize associated signs and symptoms, and initiate appropriate preventive and therapeutic strategies. The recommendations for preventing/minimizing latex allergy in the oral healthcare setting are based on current knowledge and a common sense approach to the problem. Evolving manufacturing technology and improvements in measurement methods (for latex proteins) may lead to changes in these recommendations in the future.

Relative plaque removal of three toothbrushes in a nine-period crossover study.

BACKGROUND: This study measured the ability of three toothbrushes to remove plaque following three single brushing episodes with each toothbrush. METHODS: This was a randomized, controlled, examiner-blind, nine-period crossover study conducted in 72 adult subjects over a 3-month period that examined plaque removal with a rechargeable power toothbrush and two manual toothbrushes. During the course of this study, subjects brushed three times with each of the toothbrushes. Plaque was scored before and after brushing using the Rustogi Modification of the Navy Plaque Index. RESULTS: Average baseline plaque scores were between 0.373 and 0.376 for the three treatment groups. The power toothbrush delivered an adjusted (via analysis of covariance) mean difference between baseline and post-brushing plaque scores of 0.270, whereas the manual toothbrushes delivered adjusted mean differences of 0.211 (control ADA manual toothbrush) and 0.190 (experimental manual toothbrush). The power toothbrush demonstrated a statistically significantly greater reduction in plaque than the ADA reference manual toothbrush (P < 0.001), which in turn had a statistically significantly greater reduction in plaque than the experimental manual toothbrush (P < 0.001). The powered toothbrush group had, on average, 42.4% and 28.2% greater plaque removal scores than the experimental manual toothbrush and ADA reference manual toothbrush groups, respectively. Results for the interproximal and gingival regions also demonstrated statistically significantly (P < 0.001) greater plaque removal for the powered toothbrush relative to the control manual toothbrushes. CONCLUSION: The powered toothbrush was found to deliver greater plaque removal by 42.4% and 28.2% compared to the control manual toothbrushes.

Squamous cell carcinoma of the oral tissues: a comprehensive review for oral healthcare providers.

North Americans in 2004 were projected to die from oral and pharyngeal cancer at a rate of 1.2 per hour. Oral healthcare providers can be instrumental in reducing the incidence of oral and pharyngeal premalignant and malignant lesions by identifying patients with high-risk behavior, educating their patients about the consequences of their high-risk behavior, and by early detection of premalignant and malignant conditions. The fact only 34% of the cancers of the oral cavity and larynx are localized at the time of diagnosis and evidence that at least one third of the patients diagnosed with an oral or pharyngeal malignancy have undergone oral cancer screening within the past three years suggests the current protocol for the early detection of pre-malignant or malignant changes appears to be deficient. To facilitate early diagnosis, oral healthcare providers must take into consideration the capriciousness of oral cancer and must be familiar with the availability and application of diagnostic modalities beyond conventional visual inspection and palpation of oral soft tissues. This article provides a comprehensive review of the disease for healthcare professionals.

The patient with diabetes mellitus: etiology, epidemiology, principles of medical management, oral disease burden, and principles of dental management.

Diabetes mellitus is an etiologically and clinically heterogeneous group of metabolic disorders that share the commonality of hyperglycemia. Long-term hyperglycemia produces tissue damage, which ultimately manifests as microvascular and macrovascular disease, and neuropathy. The presence of macrovascular disease should alert clinicians to the possibility that the patient may have coronary artery disease, particularly because coronary artery disease and myocardial ischemia are likely to be silent. Elderly patients with diabetes mellitus are also more likely to develop congestive heart failure. Patients with unstable coronary syndromes, decompensated heart failure, and symptomatic cardiac arrhythmias are at increased risk of perioperative cardiovascular complications (myocardial infarction, heart failure, and sudden death) while undergoing noncardiac procedures. In addition, clinicians must avoid the risk of hypoglycemic episodes. Oral health care providers can expect to be called upon to care for patients with this progressively debilitating disease. To provide competent care to patients with diabetes mellitus, dental clinicians must understand the disease, its treatment, and the impact the disease and its treatment may have on the patient's ability to undergo and respond to dental care.