Clinical evaluation of brushing time and plaque removal potential of two manual toothbrushes.

AIM: To compare plaque removal efficacy of Oral-B CrossAction (CA) used for 1 min with an American Dental Association (ADA) manual toothbrush used for 2 or 5 min in an examiner-blind, three-treatment, six-period crossover study. MATERIALS AND METHODS: After refraining from all oral hygiene procedures for 23-25 h, subjects were randomly assigned to one of nine possible six-period (visit) treatment sequences. Plaque was assessed at baseline (Rustogi Modified Navy Plaque Index). Post-brushing scores were recorded after brushing with a marketed dentifrice and the assigned toothbrush for the specified duration. The same procedure was followed at each of six subsequent visits. Clinical measurements were carried out by the same examiner. RESULTS: Forty subjects completed the study. All three treatments effectively removed plaque from the whole mouth, along the gingival margin and from approximal surfaces. Whole mouth and gingival margin plaque removal scores with CA for 1 min did not differ significantly from scores with the ADA toothbrush used for 2 min. The ADA brush used for 5 min showed significantly greater whole mouth (P < 0.001) and gingival margin (P < 0.001) plaque reduction than the two other treatments. Approximal plaque removal scores did not differ between the three treatments. CONCLUSIONS: Efficient plaque removal can be achieved after 1 min of brushing with CA. The amount of plaque removed did not differ significantly from that achieved with the ADA brush after 2 min of brushing. Greater whole mouth and gingival margin plaque removal scores were seen with the ADA brush after 5 min.

PDGF BB and bFGF stimulate DNA synthesis and upregulate CSF-1 and MCP-1 gene expression in dental follicle cells.

CSF-1 and MCP-1, released by dental follicle cells, stimulate the influx of monocytes into the follicle sac and enhance the formation of osteoclasts that, in turn, resorb alveolar bone for the eruption pathway. PDGF and bFGF, released by cells adjacent to the follicle or by activated monocytes, are prime candidates that may regulate CSF-1 and MCP-1 gene expression. The present study demonstrates that PDGF and bFGF are mitogens for dental follicle cells and stimulate CSF-1 and MCP-1 mRNA, but with different time course kinetics. Peak induction of CSF-1 mRNA was observed at 6-8h, while maximal MCP-1 induction was observed at 2h. These findings suggest that MCP-1 is an early chemotactic signal for monocytes and that subsequent release of CSF-1 may act synergistically with MCP-1 to enhance monocyte influx. Further understanding of the molecular mechanisms by which cytokines regulate CSF-1 and MCP-1 may lead to more effective treatment regimens for disorders associated with abnormal tooth eruption.

The patient with hypertension.

Elevated blood pressure appears to be an affliction that is more common in developed than in developing countries. However, the blood pressure consistently increases with age in most populations in the world, modified only by genetic and environmental factors. In the United States, it is estimated that there may be as many as 58 million people with hypertension; fewer than 5% of these cases have a curable cause. Oral health care providers can expect to be called on to care for patients with this progressively debilitating disease. To provide competent care to patients with hypertension, clinicians must understand the disease, its treatment, and its impact on the patient's ability to undergo and respond to dental care.

The patient with Alzheimer's disease.

Victims of Alzheimer's disease show a gradual and steady deterioration in memory, orientation, emotional stability, language capacity, abstract thinking, motor skills, and, ultimately, self care. Cognitive and motor deficits are accompanied by a gradual inability to perform adequate oral hygiene. Alzheimer's disease also interferes with the patient's ability to communicate dental symptoms of pain or dysfunction, and progressive deterioration of cognition interferes with the patient's ability to tolerate most therapeutic interventions. When treating patient's with Alzheimer's disease, oral health care providers must develop timely, preventive, and therapeutic strategies compatible with the patient's physical and cognitive ability to undergo and respond to dental care. They should strive to achieve those goals with the same ethical, moral, and professional standards of care as may be appropriate in the management of any other patient.