Does dentifrice use help to remove plaque? A systematic review

Analysis of the Informational Content of Turkish Videos on YouTube About Tooth Brushing

INTRODUCTION

To examine the content of Turkish videos on YouTube about tooth brushing and to evaluate their usefulness in providing information to the public.

METHODS

Two keywords were determined using the website Google Trends. For each keyword, the top 100 most watched videos were determined according to the searches made on YouTube and a total of 200 videos were examined. According to the inclusion and exclusion criteria, 99 videos were included in the study. The URL address of each video included, the number of views, the number of likes, the number of dislikes, the duration of the video, the time elapsed since the upload date (days) and whether the videos was narrated by a dentist, commercial institution or individual user was recorded. In addition, the interaction index and viewing rates of the videos were calculated. The contents of the videos included were evaluated by a specialist dentist.

RESULTS

Based on the evaluation of the information content of the videos, 54.5% of them contained minimal information, 38.4% poor information, 5.1% good information and 2% excellent information. The two videos containing excellent information include 10 of the 12 topics evaluated and both videos are narrated by a dentist.

CONCLUSION

Turkish videos about tooth brushing on YouTube are insufficient in terms of content and accurate information. For this reason, individuals should be directed to professional sources in order to receive accurate and up-to-date information, and dentists should share videos containing sufficient content and quality information on this platform.

Plaque scores after 1 or 2 minutes of toothbrushing A systematic review and meta-analysis

AIM

To evaluate the difference in plaque score reduction achieved by 1 and 2 min of toothbrushing, based on data from single brushing exercises.

METHODS

MEDLINE-PubMed, Cochrane-CENTRAL databases and the first five pages of Google Scholar were searched for randomised controlled trials. Extracted data were summarised in a descriptive and, if possible, a meta-analysis using standardised mean difference (SMD). Separate analyses were performed for manual (MTB) and powered (PTB) toothbrushes.

RESULTS

Based on the selection criteria, the search identified five unique eligible publications providing 16 comparisons. For both toothbrush types, 2 min of brushing resulted in a significantly higher plaque score reduction. The SMD of 1 versus 2 min of brushing using MTB was 0.69 [95% CI: 0.06, 1.33] (p = 0.03) can be interpreted as a medium size effect and the SMD of using a PTB was 0.47 [95% CI: 0.28, 0.66], (p < 0.00001) interpreted as a small size effect.

CONCLUSION

With respect to plaque scores, based on single brushing exercises, there is moderate certainty for the recommendation to brush for 2 min over 1 min.

Evaluation of morin and carvacrol loaded-nanoparticles on oral polymicrobial biofilm control

This study aimed to develop and characterize sodium alginate (SA)/chitosan (CS) based nanoparticles (NPs), with or without morin or carvacrol, and to evaluate the antimicrobial and antibiofilm activity against polymicrobial oral biofilms. Three different NPs (0.15:1; 0.3:1; 0.5:1 CS:SA) whether or not containing morin or carvacrol were developed and characterized by particle size, zeta potential, scanning electron microscope (SEM), encapsulation efficiency, and in vitro drug release. NPs antibiofilm and antimicrobial activity were evaluated using polymicrobial oral biofilms by means of quantifying the biomass, assessment of viable microorganisms (CFU/mL), and acidogenicity of the biofilm by pH readings. The NPs presented nanometric size (<500 nm), with spherical shape and smooth surface. Encapsulation efficiency of the samples containing morin ranged from 46.17 to 55.15% and for carvacrol from 55.30 to 90.15%. Total release of carvacrol and morin occurred within 15 min. The NPs significantly reduced biofilm biomass and microbial viability compared to the control. However, did not significantly increase the biofilm pH. The NPs were effectively synthesized and showed antimicrobial and antibiofilm effect against oral biofilm and the addition of natural substances morin or carvacrol increased this effect. Combination of chitosan and sodium alginate and addition of morin or carvacrol in NPs can be a promising strategy for oral use, fighting biofilm and consequently biofilm dependent diseases.

Self-Reported Oral Hygiene Performance of Patients in Albania: A Questionnaire-Based Survey

Background/Objectives: Oral hygiene is a key factor for dental and periodontal diseases and the prognosis of any treatment to restore their consequences. The present survey aimed to evaluate how well informed patients in Albania are on oral hygiene, given the scarce evidence on this topic. Methods: This survey was performed using a Google Forms questionnaire on oral hygiene habits, type and technique of instruments used, and frequency of dental recall visits. Results: A total of 1006 questionnaires were filled in a one-month time period (January 2020) from a population of 75.2% females and 24.8% males, 32.7 ± 11.3 years of age, from whom 94.6% reported a lack of systemic diseases and 80% were non-smokers. All of the population brushed their teeth at least once daily. The most used type of toothbrush was a manual one (91.1%) with medium-bristle hardness in 71% of cases. The most prevalent way of using the toothbrush was through circular movements (36.7%) with a duration of 2-3 min in 72% of the population. Only 77.1% of the population used interdental instruments, mainly interdental floss. Conclusions: Within the limits of this study, it could be concluded that the present population seemed to be mostly appropriately informed, but the information needs further revision and promotion by dentists.

The Effect of a Nature-Based Gel on Gingival Inflammation and the Proteomic Profile of Crevicular Fluid: A Randomized Clinical Trial

Evidence has shown the clear positive effects of nature-based products on biofilm control and improved gingival health. However, most studies have used in vitro models, have tested single natural components, or have not evaluated proteomic changes after treatment. This double-blind, parallel, randomized, and controlled clinical trial evaluated the benefits of a nature-based gel in controlling gingival inflammation and its effects on the proteomic gingival crevicular fluid (GCF) profile. Gingivitis patients were distributed into the following groups: (1) nature-based gel containing propolis, aloe vera, green tea, cranberry, and calendula (n = 10); (2) control-conventional toothpaste (n = 10). GCF was collected and evaluated by means of liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). At 3 months, the groups showed similar clinical benefits (p < 0.05). A total of 480 proteins were identified across all groups. In a pooled comparison of both groups at both time points, exclusive proteins were identified in the nature-based gel (78) and the control (21) groups. The exclusive proteins identified for the toothpaste mainly acted in wound healing, and those for the nature-based gel mainly acted on immune system processes. The nature-based gel achieved similar clinical outcomes to conventional toothpaste. However, the nature-based gel markedly changed the proteomic profile of GCF after treatment, showing a profile associated with a host response.

Impact of the uninstructed use of a herbal, ayurvedic toothpaste on parameters of gingival health in periodontal aftercare patients: A randomized, double-blinded, two-arm parallel-group study

AIM

The aim of this study was to evaluate the impact of the uninstructed use of a toothpaste containing herbal ayurvedic ingredients on parameters of gingival health in a cohort of periodontal aftercare patients affected by gingival inflammation compared to the use of a standard, non-herbal toothpaste.

MATERIALS AND METHODS

The monocentric, randomized, double-blinded, two-arm parallel-group intervention was performed in a cohort of 88 periodontal aftercare patients with clinical signs of gingival inflammation. At baseline, bleeding on probing (BoP), gingival index (GI) and Quigley-Hein plaque index (QHI) were recorded. Subsequently, the study patients were randomly provided with a herbal ayurvedic toothpaste (n = 44) or a conventional, non-ayurvedic control toothpaste (n = 44) and without additional oral hygiene training instructed to use it 2× daily for the next 28 days. On day 28, BoP, GI and QHI were recorded again.

RESULTS

At baseline, there were no significant differences between both groups. On day 28, mean GI and BoP scores were significantly lower (p < 0.001) compared to baseline in both groups. Differences between the groups could not be verified. Mean QHI scores did not change significantly between day 0 and day 28 in both groups.

CONCLUSIONS

The impact of uninstructed toothbrushing with an ayurvedic toothpaste on the manifestation of gingival inflammation in periodontal aftercare patients is not significantly different to the use of a conventional, non-herbal toothpaste.

Efficiency of the photodynamic therapy on viability of Streptococcus mutans in the oral cavity using chitosan nanoparticles: an in vitro study

PURPOSE

This study aimed to investigate the efficiency of antimicrobial photodynamic therapy (aPDT) on Streptococcus mutans biofilm in the oral cavity using the photosensitizer chloroaluminum phthalocyanine encapsulated in chitosan nanoparticles (ClAlPc/Ch) at three preirradiation times.

METHODS

Biofilms of Streptococcus mutans strains (ATCC 25,175) were cultivated on bovine tooth blocks and exposed to a 10% sucrose solution three times a day for 1 min over three consecutive days. The samples were randomly distributed into five treatment groups (n = 5): (I) aPDT with ClAlPc/Ch with a preirradiation time of 5 min (F5), (II) aPDT with ClAlPc/Ch with a preirradiation time of 15 min (F15), (III) aPDT with ClAlPc/Ch with a preirradiation time of 30 min (F30), (IV) 0.12% chlorhexidine digluconate (CHX), and (V) 0.9% saline solution (NaCl). After treatment, the S. mutans biofilms formed on each specimen were collected to determine the number of viable bacteria (colony-forming units (CFU)/mL). Data were analyzed for normality using the Shapiro-Wilk test and the analysis of variance (ANOVA) and Tukey HSD tests to analyze the number of viable bacteria (α = 0.05).

RESULTS

The one-way ANOVA showed a difference between the groups (p = 0.0003), and the Tukey HSD posttest showed that CHX had the highest microbial reduction of S. mutans, not statistically different from the F5 and F15 groups, whereas the NaCl group had the lowest microbial reduction statistically similar to the F30 group.

CONCLUSION

The results demonstrate that aPDT mediated by ClAlPc/Ch when used at preirradiation times of 5-15 min can be an effective approach in controlling cariogenic biofilm of S. mutans, being an alternative to 0.12% CHX.

Caries Etiology and Preventive Measures

Caries is a widespread disease in both children and adults. Caries is caused by the conversion of fermentable carbohydrates by plaque bacteria into acids on the tooth surface. Thus, it is important to focus on sugar reduction and plaque control. For efficient plaque removal/control, state-of-the-art toothpastes contain various active ingredients such as antimicrobial agents (e.g., chlorhexidine, stannous salts, and zinc salts), abrasives (e.g., calcium carbonate, calcium phosphates, and hydrated silica), surfactants (e.g., sodium lauryl sulfate and sodium methyl cocoyl taurate), and natural compounds (e.g., polyphenols and xylitol). Agents with pH-buffering and calcium-releasing properties (e.g., calcium carbonate and calcium phosphates) and biomimetic actives (e.g., hydroxyapatite) reverse the effects of the acids. Additionally, modern toothbrushes (i.e., electric toothbrushes) as well as dental floss and interdental brushes significantly help remove plaque from dental surfaces including interproximal surfaces. In conclusion, modern concepts in caries prevention should focus not only on tooth remineralization alone but also on the control of all the key factors involved in caries development.

Effect of Dentifrice Ingredients on Volume and Vitality of a Simulated Periodontal Multispecies Biofilm

The aim of this in vitro study was to investigate the effect of different toothpaste ingredients on biofilm volume and vitality in an established non-contact biofilm removal model. A multi-species biofilm comprising Porphyromonas gingivalis, Streptococcus sanguinis, and Fusobacterium nucleatum was grown on protein-coated titanium disks. Six disks per group were exposed to 4 seconds non-contact brushing using a sonic toothbrush. Four groups assessed slurries containing different ingredients, i.e., dexpanthenol (DP), peppermint oil (PO), cocamidopropyl betaine (CB), and sodium hydroxide (NaOH), one positive control group with the slurry of a toothpaste (POS), and a negative control group with physiological saline (NEG). Biofilm volume and vitality were measured using live-dead staining and confocal laser scanning microscopy. Statistical analysis comprised descriptive statistics and inter-group differences. In the test groups, lowest vitality and volume were found for CB (50.2 ± 11.9%) and PO (3.6 × 105 ± 1.8 × 105 µm3), respectively. Significant differences regarding biofilm vitality were found comparing CB and PO (p = 0.033), CB and NEG (p = 0.014), NaOH and NEG (p = 0.033), and POS and NEG (p = 0.037). However, no significant inter-group differences for biofilm volume were observed. These findings suggest that CB as a toothpaste ingredient had a considerable impact on biofilm vitality even in a non-contact brushing setting, while no considerable impact on biofilm volume was found.

Clinical Assessment of Plaque Removal Using a Novel Dentifrice Containing Cellulose Microfibrils

Dentifrice performance in the removal of dental plaque is influenced by the interactions of dentifrice components with tooth surfaces. This randomized controlled clinical study assessed the effectiveness and safety of a novel fluoride dentifrice formulation that included a micro-fibrillated cellulose network with entangled microcrystalline cellulose and silica particles (ProtegeraTM), and compared this to a positive control fluoride dentifrice (Crest Cavity Protection™). Whole mouth dental plaque levels in 82 healthy adults were measured after the first supervised use, and following a week of twice daily use at home. Overall, the test dentifrice was at least three times and up to four times more effective in whole-mouth plaque reductions, with a 38.6% reduction on first use, a 30.9% reduction at day 7, and a 41.6% reduction from day 1 to day 7, compared to reductions of 12.0%, 9.6% and 11.6%, respectively for the positive control, and up to seven times more effective in lingual plaque reductions, than the reference dentifrice (p < 0.001), with a 27.7% reduction on first use, a 22.3% reduction at day 7, and a 31.0% reduction from day 1 to day 7, compared to reductions of 4.4%, 2.2%, and 4.5%, respectively, for the positive control. No safety issues arose from the use of the test dentifrice. These results indicate that including micro-fibrillated cellulose enhances plaque removal effectiveness, without causing adverse changes to oral soft tissues.

Effect of Commercial Children's Mouthrinses and Toothpastes on the Viability of Neonatal Human Melanocytes: An In Vitro Study

In this study, we examined the cytotoxic effects of six commercial children's mouthrinses (designated as #1, #2, #3, #4, #5, and #6) and four commercial children's toothpastes (designated as #1, #2, #3, and #4) on primary human neonatal melanocytes that were used as a representative model for oral melanocytes. Mouthrinses diluted directly with culture medium (1:2, 1:5, 1:10, 1:100, and 1:1000) were added to monolayers of melanocytes for 2 min, followed by 24 h recovery, after which MTS cytotoxicity assay was conducted. The extracts of each toothpaste were prepared (50% w/v), diluted in culture medium (1:2, 1:5, 1:10, 1:50, 1:100, and 1:1000), and added to cell monolayers for 2 min (standard brushing time), followed by an analysis of cell viability after 24 h. Results showed that all mouthrinses except mouthrinse #4 showed significantly greater loss of cell viability, ascribed to cetylpyridinium chloride (CPC) that induced significant cytotoxicity to melanocytes (IC50 = 54.33 µM). In the case of toothpastes, the examination of cellular morphology showed that a 2 min exposure to all toothpaste extracts induced a concentration-dependent decline in cell viability, pronounced in toothpaste containing sodium lauryl sulfate (SLS) detergent. Further results suggested SLS to be the critical driver of cytotoxicity (IC50 = 317.73 µM). It is noteworthy that toothpaste #1 exhibited much lower levels of cytotoxicity compared to the other three toothpastes containing SLS. Taken together, these findings suggest that the melanocytotoxicity of children's mouthrinse (#4) and toothpaste (#1) is comparatively low. To the best of our knowledge, this is the first study to examine the impact of children's toothpastes and mouthrinses on neonatal primary human melanocytes. Future studies to investigate these findings in a realistic scenario replicating oral cavity conditions of the presence of microbiota, pellicle layer and saliva, and other cell types are warranted.

Screening of heat-killed lactic acid bacteria based on inhibitory activity against oral bacteria and effects of oral administration of heat-killed Ligilactobacillus salivarius CP3365 on periodontal health in healthy participants: a double-blinded, randomized, placebo-controlled trial

Objectives

The aims of this study were to select heat-killed lactic acid bacteria (HKL) with antibiotic activity and investigate the efficacy of this bacteria in maintaining periodontal parameters in healthy participants.

Materials and methods

An in vitro evaluation was conducted to assess the inhibitory efficacy of lactic acid bacteria against Porphyromonas gingivalis and Fusobacterium nucleatum subsp. nucleatum. The effects of HKL administration on various parameters (plaque control record, bleeding on probing, and probing pocket depth) were assessed in a randomized, placebo-controlled trial. Participants in the test and placebo groups (n = 32) consumed oral tablets containing placebo or HKL daily for 8 weeks. Oral bacteria in supra-plaque and saliva were identified using 16S rRNA gene community profiling analysis.

Results

Heat-killed Ligilactobacillus salivarius CP3365 significantly (p < 0.05) decreased the viability of oral bacteria and was selected for clinical trials. Administration of HKL CP3365 significantly (p < 0.05) inhibited increases in each parameter. No changes in the relative abundance of P. gingivalis or F. nucleatum subsp. nucleatum were detected by HKL CP3365, but the relative abundance of oral bacteria (genera Porphyromonas, Fusobacterium, and Haemophilus) was significantly (p < 0.05) decreased.

Conclusion

HKL CP3365 effectively inhibited oral bacteria growth and was useful for maintaining periodontal health.

Clinical Trial Registration

[https://www.umin.ac.jp/ctr/index.htm], identifier [UMIN000045656].

Potential Use of Brazilian Green Propolis Extracts as New Photosensitizers for Antimicrobial Photodynamic Therapy against Cariogenic Microorganisms

The synergic effect of Streptococcus mutans and Candida albicans increases dental caries severity. Antimicrobial photodynamic therapy (aPDT) is a non-invasive treatment for antimicrobial aspects. However, the current photosensitizers (PS) have many downsides for dental applications. This study aimed to evaluate the efficiency of two different Brazilian green propolis (BGP-AF and BGP-AG) as PS for aPDT against these microorganisms. A single-species biofilm was irradiated with crude extracts and their fractions and controls. Such extracts showed the best results and were evaluated in dual-species biofilms. Photodegradation, reactive oxygen species (ROS), cytotoxicity, and color stability assays were also investigated. Reductions higher than 3 log₁₀ CFU/mL (p < 0.0001) occurred for crude BGP in single- and dual-species biofilms. Singlet oxygen was produced in BGP (p < 0.0001). BGP-mediated aPDT delayed S. mutans and C. albicans regrowth after 24 h of treatment (p < 0.0001). Both BGP did not change the color of dental materials (p > 0.05). BGP-AF-mediated aPDT showed 72.41% of oral keratinocyte viability (p < 0.0001). BGP extracts may be used in aPDT against S. mutans and C. albicans. Specifically, BGP-AF may represent a promising PS for dental applications.

Prevalence of Periodontal Disease among Patients at the Outpatient Clinic of Internal Medicine in an Academic Hospital in The Netherlands: A Cross-Sectional Pilot Study

There is a worldwide increase in individuals suffering ≥2 chronic diseases (multimorbidity), and the cause of combinations of conditions remains largely unclear. This pilot study analysed the prevalence of periodontal disease (PD) among (multi)-morbid patients at the outpatient clinic of internal medicine. PD is an inflammatory disease of the tooth supporting tissues and has a negative impact on the overall health. Data were obtained from 345 patients, on demographics, systemic conditions and presence of PD. The possible differences in the distribution of PD status among patients with/without multimorbidity and Medical Subject Headings (MeSH) disease chapters were explored. In total, 180 (52.2%) patients suffered from multimorbidity. The prevalence of severe PD was 16.2%, while the prevalence of mild and severe PD combined (Total PD) was 53.6%. Patients with disease chapter cardiovascular diseases (CVD) had a significantly higher prevalence of severe PD (odds ratio (OR) 2.33; 95% confidence interval (CI) 1.25, 4.33) and Total PD (OR 1.61; 95% CI 1.04, 2.50) than patients without CVD. After subsequent analyses, myocardial infarction was significantly associated with severe PD (OR: 4.68 (95% CI; 1.27 to 17.25)). Those suffering from multimorbidity showed to have a non-significant increased risk for severe (OR 1.27; 95% CI 0.69, 2.34) or Total PD (OR 1.23; 95% CI 0.81, 1.88). In conclusion, PD is highly prevalent in multimorbidity patients. Furthermore, PD was significantly prevalent in patients with CVD. However, larger epidemiological studies are necessary to confirm that the prevalence of PD is significantly increased among multimorbid patients.

Influence of the Amount of Toothpaste on Cleaning Efficacy: An In Vitro Study

OBJECTIVES

 The aim of this in vitro study was to test the influence of the amount of toothpaste on enamel cleaning efficacy.

MATERIALS AND METHODS

 The hydrated silica-based test toothpaste (radioactive dentin abrasion: 60.19 ± 1.35) contained all ingredients of a regular fluoride toothpaste. The cleaning efficacy of four different toothpaste amounts (1.00 g, 0.50 g [both "full length of brush"], 0.25 g ["pea-size"], and 0.125 g ["grain of rice-size"]) diluted in 1.00 mL water were each tested for different brushing times (10, 30, 60, 120, 180, and 300 seconds) using a standardized staining model on human molars with a brushing machine. Photographic documentation and colorimetric measurements were conducted, respectively, initially, after staining and after each brushing step. Colorimetric measurements were used to calculate the stain removal (in %).

STATISTICAL ANALYSIS

 Results were analyzed by one-way analysis of variance with post hoc Tukey test and Levene's test for analysis of homogeneity of variance. The level of significance α was set at ≤ 0.05.

RESULTS

 The cleaning efficacy decreased significantly when using smaller toothpaste amounts. Stain removal after 120 seconds brushing time was: 77.4 ± 5.0% (1.00 g toothpaste), 75.7 ± 3.4% (0.50 g toothpaste), 54.1 ± 6.7% (0.25 g toothpaste), and 48.2 ± 7.1% (0.125 g toothpaste), respectively.

CONCLUSION

 In this in vitro study the cleaning efficacy of a medium-abrasive, hydrated silica-based toothpaste was analyzed. Note that 1.00 g toothpaste showed for all brushing times a significantly higher cleaning efficacy than 0.25 g toothpaste and 0.125 g toothpaste.

Czech and Slovak Dental Students' Oral Health-Related Knowledge, Attitudes, and Behaviours (KAB): Multi-Country Cross-Sectional Study

Dentists play a key role in the primary prevention of oral diseases and related systemic complications; therefore, their views on behavioural interventions need to be aligned with the current agendas for oral health. Likewise, dental students' oral health-related knowledge, attitudes, and behaviours (KAB) are of practical importance, as they are the future opinion leaders for oral health in their respective communities. A cross-sectional survey-based study was designed to evaluate the oral health KAB of dental students in both the Czech Republic and Slovakia. The study utilized translated versions of the Hiroshima University Dental Behavioural Inventory (HU-DBI), and it aimed to recruit students from all Czech and Slovak dental schools. A total of 487 students were included in this study, out of which 372 (76.4%) were females, 271 (55.6%) were enrolled in preclinical years, 68 (14%) reported smoking tobacco at least once a week, and 430 (88.3%) reported problematic internet use. The mean HU-DBI score of Czech and Slovak dental students (8.18 ± 1.80) was comparable with the previously reported scores of dental students in Nordic and Western European countries. Czech students (9.34 ± 1.29) had a significantly higher score than their Slovak counterparts (7.56 ± 1.73). In both countries, preclinical students (8.04 vs. 8.35), the students who reported tobacco smoking (7.63 vs. 8.27), and those who reported problematic internet use (8.11 vs. 8.70) had significantly lower HU-DBI scores than their counterparts, respectively. In the Czech Republic, the significant increases in HU-DBI scores occurred after the first academic year when the students received preventive dentistry courses; therefore, one can put forward that early implementation of preventive elements in undergraduate dental curricula may yield better and more sustainable oral health gains for the students. Future research on Czech and Slovak dental curricula need to re-evaluate the oral hygiene and anti-smoking components and their impact on students' views and attitudes.

Estonian Dental Students' Oral Health-Related Knowledge, Attitudes and Behaviours (KAB): National Survey-Based Study

The strategic plan for dentistry and oral health in Estonia of 2030 focuses on oral health promotion and disease prevention through undergraduate dental curricula and fostering public health-oriented research among students. The present study was designed as a descriptive cross-sectional study to evaluate oral health-related knowledge, attitudes, and behaviours (KAB) of dental students in Estonia. The study was carried out in the spring semester of 2020, and it used a modified version of the Hiroshima University Dental Behavioural Inventory (HU-DBI). A total of 129 students responded to the survey, constituting a response rate of 93.5% due to the total population sampling (census) technique used in this study and the small target population size. Out of the 124 students included in the final analysis, 79% were females, 62.1% were clinical students, 11.3% reported smoking tobacco at least once a week, and 86.3% reported problematic internet use. The present study found that mean HU-DBI score of Estonian dental students was 8.09 ± 1.22 which is so far the highest recorded HU-DBI score in Europe. There was no significant difference between female vs. male or preclinical vs. clinical students in terms of HU-DBI score. While clinical students reported less faulty oral hygiene practices, such as hard toothbrush use and aggressive toothbrushing, preclinical students reported a slightly higher mean HU-DBI score. Smoking behaviour was more common among male and clinical students, and it was also associated with alcohol drinking and worry about teeth colour and halitosis.

Cariogenic Biofilms: Development, Properties, and Biomimetic Preventive Agents

Oral biofilms will build up within minutes after cleaning of the dental hard tissues. While the application of remineralizing agents is a well-known approach to prevent dental caries, modern oral care products offer also additional active agents to maintain oral health. Human saliva contains many different organic and inorganic compounds that help to buffer organic acids produced by cariogenic microorganisms. However, most oral care products only contain remineralizing agents. To improve the benefit of those products, further active ingredients are needed. Books, review articles, and original research papers were included in this narrative review. Putting all these data together, we give an overview of oral biofilms and active compounds used in modern oral care products to interact with them. The special focus is on inorganic compounds and their interaction with oral biofilms. While organic compounds have several limitations (e.g., cell toxicity), inorganic compounds based on calcium and/or phosphate (e.g., sodium bicarbonate, hydroxyapatite, calcium carbonate) offer several advantages when used in oral care products. Calcium release can inhibit demineralization, and the release of hydroxide and phosphate ions might help in the buffering of acids. Therefore, the focus of this review is to summarize the scientific background of further active ingredients that can be used for oral care formulations.

Toothbrushing Wear Resistance of Stained CAD/CAM Ceramics

Aim: To investigate the effect of toothbrushing on different stained Computerd Aided Design/Computer Aided Manufacturing CAD/CAM ceramics. Materials and Methods: Fifty specimens (high translucency zirconia, YZHT; zirconia-reinforced lithium silicate, ZLS; feldspathic, FDL; hybrid ceramic, HC; all from Vita Zahnfabrik) were divided into five groups according to their staining technique. ZLS allowed the composition of two groups: ZLS1 with crystallization and staining together; ZLS2, with the stain firing after the crystallization. YZHT received a stain firing after the sintering process, and FDL received stain firing directly. The HC was stained with acrylic staining, and was light-cured on its surface. The specimens were brushed in total for 150,000 cycles at 2.45 N with 180 strokes/min. Surface measurements to obtain Rz were performed after 50,000, 100,000 and 150,000 cycles, with five evaluation lines (5 mm) per specimen orthogonal to the brushing direction, covering brushed and unbrushed areas. The wear was analyzed using two-way ANOVA and Tukey tests (α = 5%). Scanning electron microscopy (SEM) was performed to access the surface profile. The wear was affected by material (p < 0.001) and time (p = 0.139). Superior wear (µm) was observed for HC (6.6 ± 4.4; 6.8 ± 4.0; 9.2 ± 3.5) compared to ZLS2 (1.0 ± 0.3; 1.2 ± 2.2; 1.3 ± 0.3), YZHT (1.0 ± 0.1; 1.2 ± 0.3; 1.2 ± 0.3), ZLS1 (0.9 ± 0.1; 1.1 ± 0.5; 1.2 ± 0.3) and FDL (0.9 ± 0.1; 0.9 ± 0.1; 1.0 ± 0.2) after 5, 10 and 15 years of simulation, respectively. SEM showed different wear patters for HC with the removal of the glaze layer. HC showed a higher staining wear rate compared to the glass-based and polycrystalline ceramics after 15 years. The extrinsic characterization of feldspathic ceramic showed its superior longevity compared to the evaluated high-translucency zirconia, zirconia-reinforced lithium silicate, and hybrid ceramic.

Can Desensitizing Toothpastes Also Have an Effect on Gingival Inflammation? A Double-Blind, Three-Treatment Crossover Clinical Trial

Background: Many desensitizing toothpastes exist commercially; however, few clinical trials have investigated their anti-inflammatory effects. This study aimed to evaluate the anti-inflammatory effect and patient appreciation of two toothpastes containing desensitizing agents: (1) a zinc-carbonate-hydroxyapatite nanoparticle (CHA) and (2) a calcium sodium phosphosilicate bioactive glass (CSPS). Methods: CHA and CSPS were compared with an anti-inflammatory and antibacterial herbal based toothpaste (HB). The aims were accomplished by comparing the following outcomes: (1) the reduction in plaque and bleeding score (Full Mouth Plaque Score (FMPS) and Full Mouth Bleeding Score (FMBS), respectively); (2) the antibacterial activity (AbA) of the toothpaste by saliva samples; (3) the patient appreciation score (Visual Analogue Scale; VAS). Clinical parameters were assessed at baseline and 14 days post-treatment. Results: The final sample consisted of 25 subjects, aged between 20 and 58 years. Although no differences in FMPS were reported (p > 0.05), both desensitizing toothpastes showed an improvement in FMBS. CSPS and HB recorded more AbA compared to CHA (p < 0.05). Moreover, HB resulted in a higher VAS score than both desensitizing toothpastes (p < 0.05). Conclusion: In conclusion, only CSPS displayed a similar anti-inflammatory effect compared to HB. Despite the low VAS score, CSPS could be considered as a valid and effective toothpaste in subjects with both dentin hypersensitivity and inflamed gums, highlighting its utility in clinical practice.

Parental social-cognitive correlates of preschoolers' oral hygiene behavior: A systematic review and meta-analysis

BACKGROUND

Regular and consistent parental involvement in children's oral hygiene practices is crucial to prevent oral diseases in young children. This emphasizes the need for interventions targeting parental-supervised oral hygiene behavior. To inform the design of future interventions, this meta-analysis aimed to identify the parental social-cognitive factors associated with oral hygiene behavior of preschoolers.

METHOD

Five bibliographic databases were searched. A study was eligible for inclusion when it reported an association between a parental social-cognitive factor and an oral hygiene behavior in the targeted age cohort. Meta-analyses were performed when there were at least four independent effect sizes (k > 3).

RESULTS

Of the 5945 records identified, 25 studies contained eligible data to be included in four meta-analyses: attitude (k = 12); self-efficacy (k = 12); intention (k = 6), and sense of coherence (k = 5). The results showed that greater frequency of preschoolers' oral hygiene behavior is significantly associated with parental attitudes (r⁺ = 0.18), self-efficacy (r⁺ = 0.34), and intention (r⁺ = 0.29), and not significantly associated with parental sense of coherence (r⁺ = 0.08).

CONCLUSION

Self-efficacy, attitudes, and intention were identified as significant correlates of parental-supervised oral hygiene behavior. However, this is a limited evidence base and many social-cognitive factors, such as self-regulatory processes including planning and action control, have yet to be explored in this context. The significant social-cognitive correlates identified in this study, as well as potential other self-regulatory factors, should be targeted in future intervention studies aimed at improving this important preventive behavior.

Contemporary practices for mechanical oral hygiene to prevent periodontal disease

It is well established that dental plaque on teeth leads to gingivitis and periodontitis, and that several mechanical and chemical methods of plaque control can prevent gingivitis. The aim of the current review is to summarize and synthesize the available scientific evidence supporting practices for mechanical oral hygiene to prevent periodontal diseases. Evidence for contemporary practices of mechanical oral hygiene to prevent periodontal disease relies on studies of gingivitis patients. General recommendations concerning the ideal oral hygiene devices and procedures are still inconclusive. However, toothbrushing and interdental cleaning remain the mainstays of prevention of periodontal diseases. The primary approach requires individually tailored instruction for implementation of a systematic oral hygiene regimen.

Measurement of bristle splaying of toothbrushes using digital imaging and evaluation of plaque removal efficacy over 3 months: A randomized controlled trial (RCT)

OBJECTIVE

The aim of this study was to develop an objective method to assess the degree of bristle splaying of used manual toothbrushes and to investigate their plaque removal efficacy.

METHODS

A randomized controlled trial targeting Hiroshima University students was performed to assess the plaque removal efficacy of polybutylene terephthalate (PBT) manual toothbrushes. Participants were randomly assigned to the soft toothbrush group (n = 40) or the medium toothbrush group (n = 40). A small number of participants discontinued the intervention for personal reasons in both the medium (n = 6) and soft (n = 2) toothbrush groups. Toothbrushes were collected immediately after first use (T0: baseline), after 1 month of use (T1: month 1), after 2 months of use (T2: month 3) and after 3 months of use (T3: month 6), following the allocation of a new toothbrush. The bristle surface area was measured using digital software.

RESULTS

The surface area of the bristles was significantly greater at T1, T2 and T3 than at T0 in the medium toothbrush group (n = 34) and soft toothbrush group (n = 38) (P < .001). Importantly, plaque removal efficacy, calculated from a modified plaque control record score and modified patient hygiene performance score, was significantly lower at T2 than at T0 in both groups.

CONCLUSIONS

Our method for evaluation of bristle splaying is considered to be reliable and reproducible. PBT toothbrushes may become less effective after two months of use.

What is the effect of active ingredients in dentifrice on inhibiting the regrowth of overnight plaque? A systematic review

Objectives

The aim of this systematic review was to establish the adjuvant clinical effect of brushing with a dentifrice containing purported active ingredients as compared to a regular sodium fluoride dentifrice with respect to the inhibition of overnight dental plaque regrowth from studies with human participants.

Methods

MEDLINE‐PubMed, EMBASE and Cochrane CENTRAL were searched, up to June 2019. The inclusion criteria were controlled clinical trials with participants aged ≥ 18 years in good general health. Studies were included that evaluated the effect of toothbrushing with a dentifrice on the inhibition of overnight dental plaque regrowth when an active ingredient was added to the dentifrice as compared to a common sodium fluoride product. Data were extracted from the eligible studies, the risk of bias was assessed, and a meta‐analysis was performed where feasible.

Result

Independent screening of 213 unique papers resulted in 10 eligible publications that provided 14 comparisons. Stannous fluoride and triclosan dentifrices were found as the active ingredients. The descriptive analysis indicated that all, but two comparisons demonstrated an additional effect on the active‐ingredient dentifrice. The meta‐analysis supported and strengthened these findings. It showed that when plaque was scored digitally, a DiffM was −3.15(95% CI [−4.61:‐1.69], P < .001, prediction interval [−5.07;‐1.24]). When plaque was scored clinically, the difference of means (DiffM) was −0.33(95% CI [−0.49:‐0.16], P < .001, prediction interval [−0.87; 0.21]).

Conclusion

The results of this review demonstrate moderate‐quality evidence that brushing with an active‐ingredient dentifrice with stannous fluoride or triclosan does provide an added clinically relevant effect concerning plaque inhibition capabilities that surpass the effect of a regular sodium fluoride dentifrice.

Antimicrobial Effect of Newly Formulated Toothpastes and a Mouthrinse on Specific Microorganisms: An In Vitro Study

Objective The aim of this in vitro study was to assess the antimicrobial properties of newly formulated toothpastes (four toothpastes for adults and two toothpastes for kids/babies) and a mouthrinse.

Materials and Methods Newly formulated six different toothpastes and one mouthrinse of a single brand and commercially available five toothpastes and three mouthrinse were investigated for their antimicrobial activity against two oral pathogens, Streptococcus mutans and Candida albicans , by agar well diffusion assay. After incubation, the inhibition zone diameters were measured in millimeters and statistical analyses were performed.

Results All experimental adult toothpastes exhibited good antimicrobial activity against S. mutans and C. albicans except the experimental toothpaste D. Experimental toothpaste B exhibited the highest antibacterial activity against C. albicans and S. mutans . Experimental toothpaste for kids showed the best antimicrobial activity against S. mutans when kids’ toothpastes were compared. None of the tested toothpastes for kids/babies showed antibacterial effects for C. albicans . Among the mouthrinse tested, Sensodyne mouthrinse showed the best results. Experimental mouthrinse showed significantly lower antibacterial activity against S. mutans then Sensodyne, Eludril, and chlorhexidine mouthrinse.

Conclusion Although experimental toothpaste and mouthrinse formulations revealed good results in terms of antimicrobial activity to some specific microorganisms, further studies involving more bacterial species or analyzing the quality and efficacy of these products by other in vitro or in vivo tests are needed.

Stain removal and whitening by baking soda dentifrice: A review of literature

BACKGROUND

Tooth discoloration may be caused by intrinsic or extrinsic stains or a combination of both. There are 2 major approaches to removing the stains, including the chemical mechanism using peroxides for tooth bleaching and the mechanical mechanism using abrasives in prophylactic pastes and dentifrices to remove stains, resulting in a whitening effect. Attempts have also been made to add a low concentration of peroxides to dentifrices to enhance their abrasive cleaning to remove tooth stains.

TYPES OF STUDIES REVIEWED

This article provides a review of both in vitro and clinical studies on stain removal and whitening effect of dentifrices containing sodium bicarbonate (baking soda). In recent years, whitening dentifrices have become popular because of little additional effort for use, ease of availability, low cost, and accumulated evidence of clinical efficacy and safety in the literature. Advances in research and technology have led to innovative formulations of dentifrices using baking soda as the sole abrasive or a component of an abrasive system. Baking soda is biologically compatible with acid-buffering capacities, antibacterial at high concentrations, and has a relatively lower abrasivity.

CONCLUSIONS

The evidence available in the literature indicates that baking soda-based dentifrices are effective and safe for tooth stain removal and consequently whitening. A number of clinical studies have also shown that baking soda-based dentifrices are more effective in stain removal and whitening than some non-baking soda-containing dentifrices with a higher abrasivity. So far, research efforts have mainly focused on stain removal and tooth-whitening efficacy and clinical safety of baking soda dentifrices used with manual toothbrushes, with only a few studies investigating their effects using powered toothbrushes, for which further research is encouraged.

PRACTICAL IMPLICATIONS

As part of a daily oral hygiene practice, baking soda-based dentifrice is a desirable, alternative or additional measure for tooth stain removal and whitening.

Effect of Photodynamic Therapy on Microorganisms Responsible for Dental Caries: A Systematic Review and Meta-Analysis

The aim of this study was to perform a systematic review of the literature followed by a meta-analysis about the efficacy of photodynamic therapy (PDT) on the microorganisms responsible for dental caries. The research question and the keywords were constructed according to the PICO strategy. The article search was done in Embase, Lilacs, Scielo, Medline, Scopus, Cochrane Library, Web of Science, Science Direct, and Pubmed databases. Randomized clinical trials and in vitro studies were selected in the review. The study was conducted according the PRISMA guideline for systematic review. A total of 34 articles were included in the qualitative analysis and four articles were divided into two subgroups to perform the meta-analysis. Few studies have achieved an effective microbial reduction in microorganisms associated with the pathogenesis of dental caries. The results highlight that there is no consensus about the study protocols for PDT against cariogenic microorganisms, although the results showed the PDT could be a good alternative for the treatment of dental caries.

Visualization and Quantification of the Oral Hygiene Effects of Brushing, Dentifrice Use, and Brush Wear Using a Tooth Brushing Simulator

Approaches that reproduce dental hygiene regimens under controlled conditions have applications in preclinical research. We have applied standardized, reproducible brushing regimes to typodonts coated in simulated or biological plaques to assess the effects on tooth cleaning of toothbrush/dentifrice regimens. Replicated typodonts were coated with Occlude^TM or Glogerm^TM indicators to simulate plaque, and brushed reproducibly using a mechanical brushing simulator to compare the cleaning of occlusal surfaces before and after brushing with water or a dentifrice. An in vitro model using salivary inocula to cultivate oral biofilms on typodont surfaces was then developed to evaluate removal of disclosed plaque by new toothbrushes in comparison to toothbrushes with wear equivalent to 3 months of use. Analyses of typodonts brushed under controlled conditions significantly (p < 0.01) distinguished between brushed and unbrushed surfaces and between the use of water vs. dentifrice for the removal of simulated interproximal plaque (p < 0.05). New toothbrushes removed significantly (p < 0.05) more biological plaque from typodont surfaces than brushes that had been worn by repeated brushing. Through controlled and defined brushing of typodonts with simulated and biological plaques, the effectiveness of dental hygiene regimens was compared under reproducible conditions. Data indicate that the cleaning effectiveness of brushing was augmented by the addition of dentifrice and that new brushes were significantly more effective than brushes with substantial wear from previous use. Whilst we have focussed on the occlusal surfaces of molars and worn brushes, the method could be applied to a range of other tooth surfaces and oral hygiene regimens.

Screening for periodontal diseases by non-dental health professionals: a protocol for a systematic review and overview of reviews

BACKGROUND

Periodontal diseases are responsible for a vast burden of disease globally and are associated with other severe illnesses such as cardiovascular diseases or diabetes. Tests for early diagnosis of periodontal diseases and effective treatments are available. The effectiveness of screening for periodontal diseases to detect periodontal diseases at an early stage during periodic health examinations at primary care facilities, however, is unclear. The objective of this systematic review is to assess the benefits and risks of screening for periodontal diseases in adults during the periodic health examinations.

METHODS

We will use two methodological approaches: (1) a systematic review to assess the effectiveness and risk of harms of screening for periodontal diseases during periodic health examinations and (2) an overview of systematic reviews to determine the effectiveness of treatment approaches for early periodontal disease. We will search electronic databases (Ovid MEDLINE, Embase.com , the Cochrane Library, Epistemonikos, Centre for Reviews and Dissemination databases, PubMed (non-MEDLINE content)) for published studies as well as sources for grey literature to detect unpublished studies. Two authors will independently screen abstracts and full texts using pre-defined eligibility criteria, select studies, extract data, and assess the risk of bias of included studies or reviews. In general, we will conduct a systematic narrative synthesis. Criteria for conducting meta-analyses were defined a priori. Our primary outcomes of interest are tooth loss, loosening of teeth, and depletion of bone tissue. Secondary outcomes are gingivitis/gum inflammation, pocket depths, dental hygiene, lifestyle modifications (e.g., smoking, alcohol, nutrition), and toothache. We consulted a panel of experts and patient representatives to prioritize these outcomes. Two investigators will assess independently the certainty of the evidence for each outcome using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.

DISCUSSION

We anticipate that our review will highlight the gaps in the available evidence about the effectiveness of screening for periodontal diseases during periodic health examinations. Implications for screening programs may be based on linked evidence about the validity of available screening tools and the effectiveness of early treatment.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017081150.

Plaque control and reduction of gingivitis: The evidence for dentifrices

This paper focuses on plaque control and the management of gingivitis in adults and summarizes the evidence of commercially available dentifrices as gathered from existing systematic reviews. Three internet sources were used to search for appropriate papers (up to and including February 2017). The search strategy was designed to include any systematic review published on dentifrices that also included an evaluation of plaque and gingivitis scores. Characteristics of the individual reviews, such as methodological aspects, quantitative data and conclusions, were extracted. The potential risk of bias was estimated and the acquired evidence was graded. Independent screening of 205 unique reviews resulted in 10 published and eligible systematic reviews. One publication evaluated the mechanical contribution of dentifrice to plaque removal. Eight papers were identified that evaluated the efficacy of a proposed single active ingredients, of which two reviewed more than one potentially active ingredient. One study compared two active ingredients. This meta-review appraised the current state of evidence and found that toothbrushing with a standard fluoride dentifrice does not provide an added effect for the mechanical removal of dental plaque. Evidence suggests that compared with a standard dentifrice, those containing triclosan or stannous fluoride have benefits with respect to gingival health and control of dental plaque.

Is plaque regrowth inhibited by dentifrice?: A systematic review and meta-analysis with trial sequential analysis

Objectives

The aim of this systematic review was to establish in studies with human participants the effect of a regular fluoride dentifrice compared to water or saline on dental plaque inhibition.

Methods

MEDLINE‐PubMed, Cochrane‐CENTRAL, EMBASE and other electronic databases were searched, up to April 2018. The inclusion criteria were controlled clinical trials among participants aged ≥18 years with good general health. Papers that evaluated the effect of dentifrice slurry compared with water or saline on plaque regrowth during a 4‐day nonbrushing period were included. Data were extracted from the eligible studies, the risk of bias was assessed, and a meta‐analysis was performed where feasible.

Result

The search retrieved eight eligible publications including 25 comparisons. The estimated potential risk of bias was low for all studies. Based on three different indices, overall plaque regrowth was significantly (P < 0.01) inhibited for 0.25 or more by the use of a dentifrice slurry as compared to water. All subanalysis on specific dentifrice ingredients and the overall descriptive analysis supported these findings.

Conclusion

The results of this review demonstrate moderate‐quality evidence for a weak inhibitory effect on plaque regrowth in favour of the use of a dentifrice intended for daily use.

Dry brushing: Does it improve plaque removal? A secondary analysis

OBJECTIVE

This article is a secondary analysis comparing the effects on plaque removal of brushing with a dry toothbrush and brushing with a prewetted toothbrush.

METHODS

The participants had been included in two previous experiments involving single-brushing exercises. The 46 non-dental participants were systemically healthy and ≥18 years of age. In the first experiment, the control intervention was brushing with a prewetted toothbrush, while during the second experiment it was brushing with a dry toothbrush. Both experiments scored plaque before and after the brushing exercises and assessed participants' perception. The data of these two previous experiments were compared in this secondary analysis.

RESULTS

Plaque score reduction following brushing with a dry toothbrush was 58%, while with a prewetted toothbrush, it was 57%. The mean plaque index score reduction of 0.08 between a dry and a prewetted toothbrush was not significant (P = .096). Prewetting the participants' toothbrush had no influence on the perception of toothbrush filament stiffness (P = .410) nor on the perception of cleaning capability (P = .449). In both experiments, brushing without dentifrice was judged to be unpleasant.

CONCLUSION

On average, following a 2-minute brushing exercise, plaque scored were reduced by 57% or more. Dry brushing did not contribute significantly to toothbrush efficacy. The participants did not find that prewetting a toothbrush influenced the cleaning capability and filament stiffness.

Rapidly-Dissolving Silver-Containing Bioactive Glasses for Cariostatic Applications

A novel bioactive glass series containing incremental amounts of silver oxide was synthesized, ground down, and subsequently incorporated into a dentifrice for the purpose of reducing the incidence of dental caries and lesion formation. Three glasses were synthesized using the melt quench route: Si-Control (70SiO₂–12CaO–3P₂O₅–15Na₂O, mol %), Si-02 and Si-05, where 0.2 and 0.5 mol % Ag₂O were substituted, respectively, for SiO₂ in Si-Control. The glasses were then ground, sieved, characterized, and dissolved in Tris buffer solution (pH = 7.30) for 6, 12, and 24 h, with the pH of the resultant solution being recorded and the ions that were released into solution quantified. Samples of each glass were subsequently embedded into a non-fluoridated, commercially available toothpaste which was then used to brush resin-mounted lamb molars which, up to the point of testing, had been stored in a 1.0 M HCl solution. Knoop microhardness measurements of the molars were recorded before and after brushing to determine the presence of remineralization on the surface of the teeth (surface hardness loss of 37%, 35%, and 34% for Si-Control, Si-02 and Si-05, respectively, after 24 h). Four oral cavity bacterial strains were isolated through swabs of the inner cheek, gums, and teeth surfaces of three volunteers, and placed on agar discs. Of each glass, 0.5 g was placed onto the discs, and the resultant inhibition zones were measured after 6, 12, and 24 h. Si-05 performed better than Si-02 on two strains after 24 h, while exhibiting similar behavior for the remaining two strains after 24 h; the largest inhibition zone measured was 2.8 mm, for Si-05 after 12 h. Si-Control exhibited no antibacterial effect at any time point, providing evidence for the role of silver oxide as the antibacterial component of these glasses.

Association of caries experience and dental plaque with sociodemographic characteristics in elementary school-aged children: a cross-sectional study

Background

Dental caries among Iranian elementary school children aged 6–12 years continue to rise. To estimate treatment needs and guide health initiatives, current epidemiologic data are required. Such data are currently unavailable for dental health. The purpose of this study was to assess caries experience, dental plaque, and associated factors in elementary school-aged children from Iran.

Methods

In this cross-sectional study, 988 elementary school children aged 7–12 years were selected by multistage cluster sampling. Dental caries was studied using the WHO criteria, dental plaque was examined according to O’Leary index. Data on parental education and occupation, living district, dental pain within the past year, and tooth brushing habits under parental supervision were collected through interviews based on questionnaire. The data were analyzed with descriptive statistics and logistic and linear regression.

Results

The mean (SD) age of the elementary school children was 9.64 (1.73) years. The highest dmft was seen in elementary school children aged 7–8 years 6.53 (4.37) and the highest DMFT and dental plaque was in 12 year olds recorded as 1.17 (1.77) and 51.97 (25.86), respectively. The proportion of decayed teeth in 7 years old elementary school based on dmft index was 80.36%, moreover, the proportion in 12 years old elementary school was 40.17% based on the DMFT index. Age, gender, and dental pain within the past year were significantly associated with DMFT and dmft. The odds of developing dental caries (DMFT) was 1.70 times higher in girls than in boys (p < 0.001) and 1.72 times higher in the students that reported dental pain frequently than in those who did not (p = 0.005). The chance of developing dental caries (dmft) was 0.47 times lower in girls than boys (p < 0.001). Age was significantly correlated with dental plaque such that Plaque Index increased by 2.44 times per one year increase in age (p < 0.001).

Conclusion

Results indicated that dental caries experience and plaque formation among elementary school children in Hamadan were high and they were influenced by their sociodemographic factors. The associations found can be used as a helpful guide for planning accurate preventive programs for elementary school children in this region.

Toothbrushing behaviour and periodontal pocketing: An 11-year longitudinal study

AIM

To explore the association between toothbrushing behaviour and change in periodontal pocketing among adults.

METHODS

We pooled data from 1,025 adults, aged 30-89 years, who participated in two national surveys in Finland (Health 2000 and Health 2011, BRIF8901) and reported their toothbrushing frequency. A cumulative measure of regular toothbrushing was created by counting the number of times participants reported brushing twice or more daily across the two surveys (ranging from 0 to 2). The association between toothbrushing behaviour and the number of teeth with periodontal pocket depth (PPD) ≥4 mm over 11 years was assessed in linear regression models adjusting for confounders.

RESULTS

There was a clear dose-response relationship between toothbrushing frequency (either at baseline or follow-up) and change in number of teeth with PPD ≥ 4 mm. There was also evidence of a cumulative effect of regular toothbrushing on change in number of teeth with PPD ≥ 4 mm. Participants who reported brushing twice or more a day in both surveys developed 1.99 (95% CI: 1.02-2.95) fewer teeth with PPD ≥ 4 mm than those who did not report this behaviour in any survey.

CONCLUSION

This 11-year prospective study showed that toothbrushing behaviour was associated with smaller increments in the number of teeth with periodontal pocketing.

Whitening dentifrice and tooth surface discoloration-a systematic review and meta-analysis

OBJECTIVE

The aim of this systematic review was to assess the effect of a whitening dentifrice (WDF) relative to a regular dentifrice (RDF) on the reduction of natural extrinsic tooth surface discoloration (ETD).

MATERIALS AND METHODS

The MEDLINE-PubMed, Cochrane-CENTRAL and EBSCO-Dentistry and Oral Sciences databases were searched, up to April 2017. The inclusion criteria were as follows:(randomized)controlled clinical trials, healthy subjects ≥18 years of age, studies comparing WDF with RDF, a follow-up period of at least 6 weeks and studies scoring ETD as the stain area/extent, stain intensity or a composite score. Studies using an induced staining model were excluded.

RESULTS

Independent screening of 851 unique papers resulted in 21 eligible publications, which included 32 comparisons. The descriptive analysis illustrated that the majority of comparisons showed a significant effect on ETD, in favour of WDF over RDF. The meta-analysis substantiated this observation and revealed that the difference of means (diffM) comparing WDF and RDF was a reduction for stain area of -0.44 [(95% CI: -0.55; -0.339) (P<.00001)] according to the original Lobene Stain Index; this result is in favour of the WDF. For the modified Lobene Stain Index, the diffM was -0.41 [(95% CI: -0.71; -0.10) (P=.009)]. For overall stain intensity, the diffM was -0.35 [(95% CI: -0.44; -0.25) (P<.00001)], and the composite score was -0.39 [(95% CI: -0.57; -0.21) (P<.0001)] and -0.54 [(95% CI: -0.66; -0.43) (P<.00001)]. Subgroup analysis differentiating between products that contained added chemical antidiscoloration agents showed a similar pattern.

CONCLUSION

In this review, nearly all dentifrices that are specifically formulated for tooth whitening were shown to have a beneficial effect in reducing ETD, irrespective of whether or not a chemical discoloration agent was added.

A specific brushing sequence and plaque removal efficacy: a randomized split-mouth design

AIM

It has been propagated by the dental care professionals to start toothbrushing the lingual aspect of teeth first. In general, it is assumed that these surfaces of teeth are more difficult to clean. The evidence to support this recommendation is sparse.

METHOD

In this randomized controlled clinical trial using a split-mouth design, 46 students were included. Before the visit, the participants were requested to refrain from any oral hygiene procedure for 48 h. First, the plaque index (PI) score was assessed full mouth. Two randomly chosen contra-lateral quadrants were used to start brushing from the lingual aspect first. The opposing two quadrants were used to start brushing from the buccal aspect. After the brushing exercise was completed, full-mouth PI was scored again. Subanalyses were performed for the buccal, lingual and approximal surfaces.

RESULTS

At baseline, there was no statistically significant difference between the two sets of contra-lateral quadrants (P = 0.770). Starting at the lingual aspect of the lower jaw resulted in a 55% reduction of plaque scores in comparison with 58% when the brushing exercise was started buccally. [Correction added on 16 January 2017, after first online publication: In the preceding sentence, the percentage reduction of plaque scores when the brushing exercise was started buccally, was previously wrong and has been corrected to 58% throughout this article.] The difference in mean plaque scores between brushing orders was 0.04, which was not significant (P = 0.219). None of the subanalyses revealed any significant differences for the isolated surfaces.

CONCLUSION

Using a manual toothbrush reduced the plaque scores between 55 and 58% with no difference between brushing from either the lingual or buccal aspect first. Within the limitations of this study, a recommendation to start toothbrushing the lingual aspect is not supported by the outcome in this young student population.