A long-term longitudinal study of gingival recession in dentists: A 15-year follow-up

OBJECTIVES

To assess the prevalence, distribution pattern, and development/progression of gingival recession in a population of dentists, followed up over an additional 15 years, after an initial and previously published follow-up of 10 years.

METHODS

This 25-year longitudinal gingival recession investigation started in 1994 at the Dental School with 60 final-year dental students; among them, 40 were re-examined in 2004, and 27 of those 40 were further examined in 2019 by the same examiner. A questionnaire session provided information on toothbrushing habits at each appointment.

RESULTS

In this study, 27 individuals aged 31-44 years (724 teeth) were followed up. The prevalence of gingival recession was 100% after 15 years. A total of 204 and 317 recessions found in 2004 and 2019, respectively, were valid for the longitudinal evaluation. The highest recession incidence was observed in the molars during both examinations (p < 0.0001). The mean recession heights were 1.66 ± 0.87 mm and 1.85 ± 1.08 mm, respectively (p = 0.024). The difference between the means was 0.19 mm after 15 years. The mean probing depth and bleeding on probing at the point of the maximum recession decreased (p < 0.0001). A multiple regression analysis on the tooth level was performed and indicated that the keratinized gingival width was negatively associated with the severity of the buccal recession height.

CONCLUSIONS

Fifteen years after the initial follow-up, the mean number of gingival recessions per dentist and the mean recession height increased, while toothbrushing habits remained nearly unchanged.

The effect of location/site on polished human enamel after mechanical and chemical wear

OBJECTIVE

To compare profilometry and microhardness of polished occlusal and buccal human enamel following a mechanical and chemical wear regime.

METHODS

Enamel from polished human molars were sectioned into buccal and occlusal surfaces and randomly allocated into two groups (n = 10) and then exposed to 0.3 % citric acid at pH 2.7 for 10, 20, 40 and 60 mins each followed by abrasion with non-fluoridated toothpaste for 240 strokes in a reciprocating brushing machine. A white light profilometer with a spot size of 12 um measured mean step-height following each cycle. Microhardness indentations were conducted following the final cycled 60 mins erosion/abrasion using 0.01, 0.02, 0.1, 0.5 and 2.5 kgf indentation load. Statistical disparity were evaluated using a two-way ANOVA and post-hoc Sidak's multiple comparisons tests at α = 0.05.

RESULTS

After erosion/abrasion, the mean (SD) step-heights on occlusal and buccal surfaces were not significantly different until 60 mins, when occlusal surfaces exhibited greater step-heights, 32.9 µm (2.8) and 31.1 µm (1.8) and p = 0.02, respectively. Buccal and occlusal microhardness was statistically lower following erosion/abrasion at loads of 0.01 kgf (p = 0.0005) and 0.02 kgf (p = 0.0006) but no significant differences were observed in the microhardness between the surfaces at any loads.

CONCLUSION

The occlusal and buccal surfaces were not statistically different for microhardness or step height suggesting the susceptibility to wear is not related to the anatomy and structure of the tooth and is more likely related to other factors such as the environment.

CLINICAL SIGNIFICANCE

The study emphasizes that a notable difference in wear between occlusal and buccal enamel surfaces emerges only after prolonged exposure to simultaneous chemical and mechanical stress. This finding necessitates a preventive dental approach that accounts for both the duration of exposure and environmental factors.

Oral health knowledge, attitude and practice among parents of children with craniofacial syndromes

Parents play an important role in caring for their children's oral health, especially for those with craniofacial deformities. In this study, we analyzed the oral health knowledge, attitude and practice (KAP) among parents of children of 1 to 16 years-of-age with craniofacial syndromes (CS) at Universiti Malaya Medical Center (UMMC), Malaysia. This was a case-controlled study conducted between March and December 2021 involving 30 parents of children with CS and 30 parents of normal children as controls. A modified validated KAP questionnaire was distributed to all parents. Statistical analysis was carried out using SPSS 26.0 and descriptive analysis was performed, with data expressed as mean, standard deviation, frequency and percentage (%). Most respondents from both groups were mothers (73.3%) between 31 to 40 years-of-age. Both groups of parents had similar levels of oral health knowledge; there was no significant difference between the two groups for 10 of the KAP questions (p > 0.05). However, there was a significant different between the two groups with regards to two 2 relating to the definition of plaque and its relationship to dental caries (p = 0.035 and p = 0.032, respectively). Some parents of CS children believed that primary teeth were not important (23.33%) and were not concerned if their children showed changes in tooth color (26.67%). Despite parental acknowledgement of ideal practice, both groups of children showed irregular dental attendance and reduced toothbrushing frequency. Parents of children with CS had a similar depth of oral health knowledge and a slightly reduced positive attitude when compared to parents in the control group. However, both groups of parents had poor knowledge relating to the transmission and causes of dental caries. Healthcare providers should increase their awareness strategies for parents to be more aware of the ways to improve their children's oral health.

Impact of toothbrush head configuration and dentifrice abrasivity on non-carious cervical lesions in-vitro

OBJECTIVE

To investigate the effect of toothbrush head configuration and dentifrice slurry abrasivity on the development of simulated non-carious cervical lesions (NCCLs) in vitro.

METHODS

Extracted premolars were randomly allocated into 15 groups (n = 16) generated by the association between toothbrush head configuration (flat-trimmed, rippled, cross-angled/multilevel/rubbers added, cross-angled/multilevel/flex head, feathered) and dentifrice slurry abrasivity (low/medium/high). Teeth were mounted on acrylic blocks and had their roots partially covered with acrylic resin, leaving 2-mm root surfaces exposed. Toothbrushing was performed for 35,000 and 65,000 double-strokes. Specimens were analyzed using non-contact profilometry for dental volume loss (mm3) and lesion morphology. Data was analyzed using ANOVA with pairwise comparisons and Kruskal-Wallis tests.

RESULTS

The two-way interaction between toothbrush head configuration and slurry abrasivity was significant (p = 0.02). At 35,000 strokes, the flat-trimmed and cross-angled/multilevel/rubbers added toothbrushes caused the highest loss, when associated to the high-abrasive slurry (p<0.05); whereas cross-angled/multilevel/flex head showed the least loss, when associated to the low-abrasive (p<0.05). At 65,000, more dental loss was observed for all toothbrushes when associated to the high-abrasive slurry, with flat-trimmed causing the highest loss (p < 0.05). Lower dental loss rates were observed for cross-angled/multilevel/flex head associated to the low-abrasive slurry when compared to the other toothbrushes (p < 0.05), except to feathered (p = 0.14) and rippled (p = 0.08). Flat lesions (mean internal angle ± standard-deviation: 146.2°± 16.8) were mainly associated with low-abrasive slurry, while wedge-shaped lesions (85.8°± 18.8) were more frequent with medium- and high-abrasive slurries.

CONCLUSION

The development, progression and morphology of simulated NCCLs were modulated by both toothbrush head configuration and dentifrice abrasivity.

CLINICAL SIGNIFICANCE

Dental professionals should consider both the type of toothbrush and dentifrice abrasivity in the management plan of patients at risk of developing NCCLs.

Toothbrushing-induced vestibular ulcerations with severe gingival defects

BACKGROUND

Daily toothbrushing is a routine approach for helping to keep the oral cavity healthy. However, using a toothbrush as an ordinary oral hygiene habit can also lead to adverse events.

CASE PRESENTATION

A 75-year-old man was referred by a periodontist for vestibular ulcerations with gingival defects. The patient reported no significant medical or social history, which might be associated with his symptoms. On examination, wide labio-buccal gingival defects, white attached gingiva and linear vestibular ulcerations were observed. With the help of the periodontist, a diagnosis of inappropriate toothbrushing-induced traumatic ulcerations was reasoned via an approach of aetiological elimination. The patient was put on a trial course of topical dexamethasone powder with lincomycin. The resolution of vestibular ulcerations was apparent after two weeks. He reported no similar oral ulcerations during the following nine years.

CONCLUSION

To our knowledge, this is the first case reported in the literature of vestibular ulcerations with severe gingival defects caused by inappropriate toothbrushing. The establishment of a correct diagnosis needs a close collaboration between periodontists and oral medicine specialists. Instruction on correct toothbrushing, especially for older people can be beneficial.

Longterm abrasive and erosive effect of whitening toothpaste on dentin surface

PURPOSE

To evaluate the amount of dentin loss following immersion in or toothbrushing with whitening toothpaste (WT) containing hydrogen peroxide (HP) and citric acid (CA). Additionally, the amount of dentin loss after brushing with a WT alone or in combination with a conventional toothpaste was assessed, and the effects of HP and CA solutions on the dentin surface were investigated.

METHODS

Bovine dentin specimens (n= 350) were randomly assigned to seven solutions of various compositions as toothpaste: The specimens assigned to each solution were then further divided into five treatment groups (n=10 each) : Group A = 1-hour immersion in each solution (ES); Group B = 10,000 brushing in ES; Group C = 1-hour immersion in ES + 10,000 brushing in ES; Group D = 1-hour immersion in ES + 10,000 brushing in reference slurry (RS); Group E = 10,000 brushing in ES + 10,000 brushing in RS. The amount and pattern of dentin loss were determined, and the surfaces were observed using noncontact profilometry.

RESULTS

The WT (pH 5.0) caused lower dentin loss than RS after a single brushing cycle; however, the extent of dentin loss after 1 hour of immersion in the WT was significantly greater than that in the RS. Among the specimens treated with WT, a significant difference in dentin loss was observed between Group C and Groups D and E (P< 0.05) but not between Groups D and E. The surfaces exposed to CAS1, CAPB, and WT exhibited U-shaped patterns of dentin loss after brushing or immersion, whereas a wedge-shaped pattern was observed in those that underwent brushing with the RS.

CLINICAL SIGNIFICANCE

The effects (dentin abrasion) of a whitening toothpaste containing hydrogen peroxide and citric acid when used in combination with a conventional toothpaste were similar to those seen with the continuous use of a conventional toothpaste alone.

Can Frequent Toothbrushing Reduce the Risk of Cirrhosis among Patients with Nonalcoholic Fatty Liver Disease? Hints from a Registry-Based Study

INTRODUCTION

While poor oral hygiene has been previously associated with an increased risk of nonalcoholic fatty liver disease (NAFLD), its association with hepatic fibrosis remains unclear. Here, we sought to analyze if toothbrushing frequency, an easy-to-assess indicator of oral health habits, would be associated with liver stiffness measurement (LSM) by transient elastography (TE) in patients with an established diagnosis of NAFLD.

METHODS

In this registry-based study, LSM was measured in 1,156 patients with NAFLD and analyzed in relation to the self-reported daily frequency of toothbrushing. LSM values ≥12 kPa were considered indicative of cirrhosis.

RESULTS

A trend toward a stepwise decrease (cross-sectional p = 0.13) in LSM was found in patients who reported having their teeth brushed more frequently: less than once a day (10.6 ± 8.6 kPa; 13% of the study sample), once a day (9.95 ± 8.40 kPa; 40%), twice a day (9.21 ± 7.63 kPa; 43%), and after every meal (8.91 ± 5.30 kPa; 4%). Patients who brushed their teeth less than once a day had a significantly higher prevalence of LSM values ≥12 kPa (p < 0.05). In multivariable logistic regression analysis, the association of LSM values ≥12 kPa with toothbrushing habits remained statistically significant for less than once a day (odds ratio = 1.69, 95% confidence interval = 1.07-2.66, p = 0.02) with reference to twice a day or after every meal.

CONCLUSION

Among patients with NAFLD, there is an independent association between brushing teeth less than once a day and TE-established cirrhosis.

Abrasive Enamel and Dentin Wear Resulting from Brushing with Toothpastes with Highly Discrepant Relative Enamel Abrasivity (REA) and Relative Dentin Abrasivity (RDA) Values

PURPOSE

To investigate the absolute wear caused by toothpastes with highly discrepant REA (Relative Enamel Abrasivity) and RDA (Relative Dentin Abrasivity) values on both enamel and dentin: Candida Peppermint (CP; REA: 1; RDA: 42), Colgate Total Original (CTO; REA: 4; RDA: 100), Signal White System (SWS; REA: 8; RDA: 143), and Candida White Diamond (CWD; REA 244; RDA: 12).

MATERIALS AND METHODS

Eighty (80) bovine enamel samples and 80 dentin samples were divided into four groups each (n = 20) and investigated after a 6-h brushing procedure (21,600 cycles, 60 cycles/min, load of 2.5 N) with the four toothpastes. The abrasive enamel and dentin wear were registered using a contact profilometer. The median and interquartile range (IQR) of the abrasive enamel and dentin wear were calculated for each group. Pairwise comparisons were conducted using the Wilcoxon signed-rank exact test, and the p-value was adjusted according to Holm (statistical significance set at 0.05).

RESULTS

CWD led to the highest abrasive enamel wear (9.86 μm [5.77]). CTO caused the highest abrasive dentin wear (166.70 μm [69.90]), being statistically significantly higher than the wear for CP (54.20 μm [24.00]) and CWD (17.00 μm [7.80]) (p = 0.00001). The abrasive dentin wear for CWD was statistically significantly lower in comparison to all other groups (p = 0.00001).

CONCLUSION

Toothpastes with highly discrepant REA and RDA values presented statistically significantly different absolute wear on enamel and dentin. REA and RDA values should both be declared for every toothpaste.

Activated Charcoal Dental Products: Evidence of Effectiveness Is Lacking

With society trending toward the avoidance of artificial components, so-called "natural" products have been gaining space and people's attention in recent years. Activated charcoal-based dental products are a prominent example of this movement because of their promise of removal of extrinsic stains or whitening of teeth by a natural means. Such products have gained popularity among patients, and companies have explored this market, launching charcoal-based and activated charcoal-based dentifrices, mouthrinses, toothbrushes, and whitening products that can be easily found at nearby stores and on the internet.1.

Effect of tapered-end and round-end bristles on the abrasive dentine wear applying increasing brushing forces

OBJECTIVE

To investigate the effect of toothbrush bristles end configuration on the abrasive dentine wear at different brushing forces.

MATERIAL AND METHODS

One hundred and sixty bovine dentine samples were randomized into eight groups (n = 20). Groups (1 to 4) were brushed with tapered-end bristles at 1-, 2-, 3-, and 4-N brushing forces, respectively. Groups (5 to 8) were brushed with round-end bristles with the same brushing forces. The brushing sequence was carried out using an abrasive slurry (RDA = 121) for 25 min. Profiles were recorded using a contact profilometer. Mean and standard deviation were calculated for the abrasive dentine wear in each group. Two-way ANOVA was used to locate any significance. The significance values were corrected after Tukey (α = 0.05).

RESULTS

Brushing with tapered-end bristles resulted in statistically significantly less abrasive dentine wear than round-end bristles regardless of the applied brushing force (1 N: 4.4 ± 1.5 vs. 7.7 ± 2.0 µm; 2 N: 7.7 ± 2.1 vs. 12.2 ± 2.7 µm; 3 N: 11.3 ± 2.6 vs. 19.4 ± 3.7 µm; 4 N: 11.2 ± 2.1 vs. 25.3 ± 4.8 µm). The interaction between bristle configuration and brushing force was statistically significantly (p < 0.001).

CONCLUSION

Tapered-end toothbrushes might be a safer choice for patients, especially when showing signs of non-carious cervical lesion. However, other toothbrush properties should also be considered.

Simulation of Non-Carious Cervical Lesions by Computational Toothbrush Model: A Novel Three-Dimensional Discrete Element Method

Non-carious cervical lesions (NCCLs) are saucer-shaped abrasions of a tooth. NCCLs can form due to various etiologies, including toothbrushing wear, acid erosion, and mechanical stress. Owing to this complex interplay, the mechanism of NCCLs in tooth abrasion has not been established. This study aims to develop a numerical method using a computational toothbrush to simulate NCCLs. The forces acting on the teeth and the amount of abrasion generated were evaluated. The discrete element method using in-house code, connected particle model, and Archard wear model were applied for brushing. In the toothbrush model, 42 acrylic tufts were fixed into a toothbrush head. The teeth models with enamel properties comprised four flat plates and two grooves to simulate the anterior teeth and NCCLs. The brushing speed and depth for one cycle were established as simulation parameters. The force applied within the ununiform plane was concentrated on several bristles as the toothbrush passed through the interproximal space. The brushing force (depth) had a greater effect on tooth abrasion than the brushing speed. Toothbrushing abrasion was mainly concentrated in the interproximal space. Therefore, forceful tooth brushing can cause NCCLs from the interproximal space to the cervical area of the tooth.

Toothbrush, an Unusual Foreign Body

Accidental consumption of foreign body is a common presenting complain among patients especially in young age group. Majority of patients can be discharged safely after reassurance while a fraction of patient requires observation and further management. Here we report a case of a 35-year-old gentleman who presented to the out-patient department of our hospital in June 2021 for accidental ingestion of toothbrush. After detailed history and physical examination upper gastrointestinal endoscopy was planned for the patient. Failed endoscopic removal was considered the indication for surgery. A supraumbilical midline incision was used to remove the toothbrush. Following the surgical removal, he was managed conservatively and was discharged without significant complications. We describe this case in detail in addition to reviewing the pertinent literature.

The Effect of Brush Motion and Rinsing When Manually Cleaning Cannulated Medical Devices

Cleaning cannulated medical devices can be challenging for perioperative and sterile processing department personnel. We performed a laboratory experimental study to evaluate differences in cleaning effectiveness using either a back-and-forth or helical spinning brushing motion and the effect of rinsing the bristles at each reintroduction of the brush in the lumen. We also tested the lumen cleanliness after high-pressure water cleansing without brushing. We inspected the devices to determine whether visible soil remained, and we measured the amount of residual organic matter using adenosine triphosphate testing to determine cleaning method effectiveness. The results showed that rinsing the brush during cleaning decreased the amount of organic material that remained in the lumen. A helical spinning motion with brush rinsing at each reintroduction of the brush may be more effective than back-and-forth brushing with rinsing, but additional testing with a larger sample size is required to determine whether this result is replicable.

Prevalence and Its Associated Risk Factors in Tooth Wear

Introduction

Tooth wear is described as loss of hard tooth tissue with no occurrence of dental caries or trauma. Basic Erosive Wear Examination, a new scoring system, is a partial scoring system recording the most severely affected surface in a sextant and the cumulative score guides the management of the condition for the practitioner. The objectives of this study were to determine the prevalence of tooth wear and its association with its risk factors like gender, oral hygiene, diet, general health and life style.

Methods

A cross-sectional study was done in 364 dental patients of Kathmandu Medical College. A questionnaire was filled by interview and Basic Erosive Wear Examination was done. The data so collected were entered in Statistical Package for Social Sciences. Descriptive statistical analysis and Chi-square tests were done at confidence interval of 95% and statistical significance was set at P=0.05.

Results

The prevalence of tooth wear was 218 (60.1%) with no significant gender difference. A significant association was observed between tooth wear and age group (P<0.01), duration of brushing (P=0.05), method of brushing (P<0.01), swishing of soft drinks before swallowing (P<0.01) and tobacco chewing (P=0.02).

Conclusions

The prevalence of tooth wear in the study population was high.

Accidental Ingestion Of Toothbrush: An Unusual Foreign Body

Toothbrush is a rare foreign body to be ingested accidentally. The unusual shape of the toothbrush with no theoretical possibility of spontaneous passage mandates an interventional approach. If left untreated, it can lead to pressure necrosis, bleeding, perforation and ulceration. An endoscopic attempt in an expert clinic if available is the ideal approach. If failed, surgical management by laparoscope or mini laparotomy should be done. The evaluation for underlying psychiatric disorders like bulimia, schizophrenia or generalized eating disorder should be considered to prevent such recurrence. Here, we present a case of 55 years of age, male living a normal life with no known comorbid, who ingested accidentally a toothbrush two weeks prior to presentation and was managed at our surgical department after a failed endoscopic attempt.

Prevention of erosions by a surface sealant and adhesives under abrasive conditions

It was the aim of the current in vitro study to test the erosion-preventive potential of an experimental surface sealant (K-0184) and currently marketed self-etch adhesive systems under abrasive conditions. Ninety-six dentine specimens were randomly allocated to eight groups (n=12): (1) positive control (no treatment), (2) K-0184, (3) Shield Force Plus, (4) Xeno Select, (5) Scotchbond Universal, (6) Adhese Universal, (7) OptiBond All-In-One, and (8) Clearfil SE Bond. Before and after sealing, dentine specimens were measured profilometrically to determine the layer thickness of the protective agents.During 12 days, the specimens were demineralized daily for 5 min using hydrochloric acid (pH=3) and abraded by applying 600 brushing strokes (F=2.5 N). Calcium content in the hydrochloric acid was determined using atomic absorption spectroscopy. Calcium concentration was consistently highest in the positive control group (p < 0.05 compared to all other groups). The lowest cumulated Ca release was measured for K-0184; it differed significantly (p < 0.05) from that determined in groups 4, 6, and 7. K-0184 also had the highest layer thickness (p < 0.05 compared to all other groups). It was concluded that the experimental surface sealant K-0184 and the adhesive systems Xeno Select, Scotchbond Universal, Adhese Universal, and Clearfil SE Bond prevent dentine erosion under the current abrasive conditions with a total of 7,200 brush strokes.

Protocol for measurement of enamel loss from brushing with an anti-erosive toothpaste after an acidic episode

Tooth erosion from an acidic insult may be exacerbated by toothbrushing. The purposes of this study were to develop an in vitro methodology to measure enamel loss after brushing immediately following an acidic episode and to investigate the effect of brushing with an anti-erosive toothpaste. The null hypotheses tested were that tooth erosion after brushing with the toothpaste would not be different from brushing with water and that a 1-hour delay before brushing would not reduce tooth erosion. Forty bovine enamel slabs were embedded, polished, and subjected to baseline profilometry. Specimens were bathed in hydrochloric acid for 10 minutes to simulate stomach acid exposure before post-acid profilometry. Toothbrushing was then simulated with a cross-brushing machine and followed by postbrushing profilometry. Group 1 was brushed with water; group 2 was brushed with a 50:50 toothpaste-water slurry; and groups 3 and 4 were immersed in artificial saliva for 1 hour before brushing with water or the toothpaste slurry, respectively. The depth of enamel loss was analyzed and compared using 1-way analysis of variance and post hoc testing (α = 0.05). Greater enamel loss was measured in groups brushed with toothpaste than in groups brushed with water. One-hour immersion in artificial saliva significantly reduced enamel loss when teeth were brushed with water (group 3; P < 0.05) but not with toothpaste (group 4). This study established a protocol for measuring enamel loss resulting from erosion followed by toothbrush abrasion. The results confirmed the abrasive action of toothpaste on acid-softened enamel.

Toothbrush abrasivity in a long-term simulation on human dentin depends on brushing mode and bristle arrangement

Objective

The aim of this study was to evaluate the susceptibility of dentin to brushing abrasion using four different toothbrushes (rotating-oscillating, sonic and two types of manual toothbrushes) with the same brushing forces.

Methods

Dentin samples (n = 72) were selected from 72 impacted third molars. Half of the surface of dentin samples was covered with an adhesive tape, creating a protected and a freely exposed area in the same specimen. Brushing was performed with either a: sonic (Sonicare PowerUp, Philips GmbH, Hamburg, Germany), b: oscillating-rotating (Oral B Vitality Precisions Clean, Procter & Gamble, Schwalbach am Taunus, Germany) or two different manual toothbrushes c: flat trim brush head toothbrush (Dr. Best: Original, Glaxo-Smith-Kline, Bühl, Germany) and d: rippled-shaped brush head toothbrush (Blend-a-Dent, Complete V-Interdental, Blend-a-med, Schwalbach, Germany) in a custom made automatic brushing machine. The brushing force was set to 2 N and a whitening toothpaste (RDA = 150) was used. The simulation period was performed over a calculated period to mimic a brushing behavior of two times a day brushing for eight years and six months. Dentin loss was quantitatively determined by profilometry and statistically analyzed by Wilcoxon and Mann-Whitney-U Test (p < 0.05).

Results

The mean (standard deviation) surface loss was 21.03 (±1.26) μm for the sonic toothbrush, 15.71 (±0.85) μm for the oscillating-rotating toothbrush, 6.13 (±1.24) μm for the manual toothbrush with flat trim brush head and 2.50 (±0.43) μm for the manual toothbrush with rippled-shaped brush head. Differences between all groups were statistically significant at p<0.05.

Conclusion

Using the same brushing force and a highly abrasive toothpaste, manual toothbrushes are significantly less abrasive compared to power toothbrushes for an 8.5—year simulation.

Influence of polishing on surface roughness following toothbrushing wear of composite resins

This study aimed to evaluate the influence of different polishing systems on the surface roughness of composite resins following procedures to simulate the effects of toothbrushing over time. Four currently available commercial composites were used to make 128 cylindrical specimens. The specimens were randomly allocated to polishing with a 1-step polisher or 1 of 3 multistep polishers (n = 8 per group). The baseline surface roughness was measured, and the specimens were submitted to 5000, 10,000, and 20,000 brushing cycles to represent toothbrushing throughout 6, 12, and 24 months, respectively. Results showed that surface roughness was influenced by the type of composite and polishing system and was not influenced by the simulated toothbrushing time. However, the surface roughness, as challenged by toothbrushing wear, was affected by the interaction among the composite, the polisher, and the toothbrushing time. The 1-step polisher produced the highest surface roughness and influenced toothbrushing wear resistance of some composites.

Prevalence and risk factors of periodontal disease among pre-conception Chinese women

BACKGROUND

Periodontal disease is one of the most common chronic infectious diseases. It has been reported that periodontal disease is associated with various adverse pregnancy outcomes including preterm birth, low birth weight, and gestational diabetes mellitus. Given the fact that the treatment for periodontal disease during pregnancy was ineffective in improving pregnancy outcomes by most of studies, the pre-conception period has been put forward as a more optimal time. However, very few studies have reported the prevalence of periodontal disease among pre-conception women. This study aimed to examine the prevalence and risk factors of periodontal disease among Chinese pre-conception women.

METHODS

A survey was conducted among pre-conception women at the Maternal and Child Health Hospital, Changzhou, China between January 2012 and December 2014. A total of 987 pre-conception women were recruited for a full-mouth dental examination after providing informed consent. A dental examination was carried out by probing six sites per tooth using a manual UNC-15 probe and a recording form.

RESULTS

The overall rate of periodontal disease among participants was 73.9% (729/987) (95% confidence interval (CI): 71.0-76.6%). Among women with periodontal disease, 48.0% of cases were mild, 50.9% were moderate and 1.1% were severe. Self-reported bleeding during tooth brushing was the only significant predictive factor for overall periodontal disease (adjusted odds ratio (aOR): 3.71, 95% CI: 2.24, 6.15, P < 0.001) and moderate/severe periodontal disease (aOR: 5.17, 95% CI: 3.05, 8.79, P < 0.001).

CONCLUSION

A high prevalence of periodontal disease was found in pre-conception Chinese women. Women who have bleeding during tooth brushing could be at increased risk of periodontal disease, and might require further oral health care.

[Durability of protective effect of resin-based coating material on root surface]

OBJECTIVE

To compare the durability of resin-based root-surface coating material and all-in-one self-etching adhesive on root surface in vitro.

METHODS

Human extracted premolars or molars with intact roots were selected. The cementum was removed using a periodontal scaler to expose root dentin. The root surface was coated with an acid-resistant nail varnish, leaving a window of 3 mm×3 mm on the exposed dentin.The window was covered with either PRG Barrier Coat (PRG) or Clearfil S3 Bond (CS3). After water aging for 14 d, specimens were immersed in acid buffer at pH 4.5 for 4 d and the demineralization buffer was changed every 24 h. Then the specimen was split longitudinally through the center of the 'window' and the cross-sectional surface was observed with scanning electron microscope (SEM). After fixed and dehydrated, the prepared samples were coated with platinum. The coating material, root dentin and the interface was observed by scanning electron microscope (SEM). The thickness of the coating material was measured on the SEM images. Regarding toothbrush wear test, coronal dentindisks were prepared and covered with PRG and CS3, respectively. After storage in water for 24 h, the specimen was subjected to the toothbrush wear tester for 100, 200, 300, 500, 700, 1 500 brushing cycles. A slurry of fluoride toothpaste (1:2 ratio of toothpaste and deionized water by weight) was used and the brushing load was 300 N. The surface microstructure of remaining coating material was analyzed using SEM. The wear depths were determined by a profilometer. Statistical analysis was performed with SPSS 20.0 by one-way ANOVA. The level of significance was at 0.05.

RESULTS

Application of PRG Barrier Coat produced a coating layer of (47.1±27.3) μm, while CS3 presented a thin film of (5.7±2.1) μm in thickness. The exposed dentin was hermetically sealed and no obvious gap was observed at the interface in both PRG and CS3 groups. There was no dentin demineralization observed in both groups after water aging. The wear depths of PRG and CS3 increased along with the numbers of brushing cycles. PRG wore at a significant lower pace than CS3 did (P<0.05).

CONCLUSION

PRG coating resin had similar performances as CS3 on protecting root dentin from demineralization after water aging. What's more, PRG demonstrated a higher toothbrush wear resistance than CS3. We concluded that PRG Barrier Coat contained S-PRG filler may be an effective coating material for protecting exposed root from both chemical and mechanical challenges. Further studies should be carried out to evaluate the long-term reliability of the rootsurface coating materials under the clinical setting.

Influence of Bristle Stiffness of Manual Toothbrushes on Eroded and Sound Human Dentin--An In Vitro Study

Aim

The aim of this study was to determine the influence of manual toothbrushes with different bristle stiffness on the abrasivity on eroded and sound human dentin.

Materials and Methods

Dentin specimens were made from impacted third molars and attributed to three groups: erosion-abrasion (EA), abrasion (A) and erosion (E). The specimens from EA and E were treated with 1% citric acid (pH 2.3) for 1 min rinsed, and neutralized with artificial saliva for 15 min. This cycle was repeated five times. Thereafter, specimens from EA and A were treated with three toothbrushes types with different bristle stiffness (soft, medium, and hard) in a custom-made toothbrushing machine. The brushing was performed at a load of 3 N with a toothpaste slurry for 630 s. This procedure was repeated five times, in group EA after each erosion cycle. EA and A groups passed through five cycles with a total of 6300 strokes. The abrasivity was analyzed by contact-free profilometry. Kruskal-Wallis and Mann-Whitney U tests were performed for statistical analysis.

Results

With respect to bristle stiffness there was no statistically significant difference in dentin loss within the EA group. In group A, a statistically significantly higher dentin loss was found for the soft in comparison to the hard bristles. No statistically significant differences were measured between soft/medium and medium/hard toothbrushes. The amount of dentin loss from specimens in the EA group was significantly higher than in the A group.

Conclusions

Within the limitations of this study, the dentin loss in the Abrasion group was higher with soft bristles than with hard ones. This result might have an influence on the toothbrush recommendations for patients with non-carious cervical lesions.

Effect of toothbrushes and denture brushes on heat-polymerized acrylic resins

It is important to choose an appropriate brush for denture cleaning to prevent damage to the surface properties of prosthetic devices. The purpose of this study was to evaluate the abrasiveness of toothbrushes and denture brushes on boiled and microwave-processed acrylic resins. Specimens of 4 resin brands were prepared (n = 30). Five brands of brushes (n = 6) were used in a toothbrushing machine, first for 17,800 strokes and then for an additional 35,600 strokes (total of 53,400), at a load of 200 g. An analytical balance and a profilometer were used to assess the weight and surface roughness, respectively, before and after 17,800 and 53,400 strokes. Analysis of variance and Tukey tests were used for data analysis (α = 0.05). Weight loss increased with time, while surface roughness remained the same. There were no statistically significant differences among toothbrushes and denture brushes in the resulting weight loss (17,800 strokes, 1.83 mg; 53,400 strokes, 3.78 mg) or surface roughness (17,800 or 53,400 strokes, 0.14 µm). The weight loss values after 53,400 brush strokes indicated that Clássico (2.28 mg) and VIPI Wave (2.75 mg) presented significantly greater abrasion resistance than Lucitone 550 (3.36 mg) and Onda-Cryl (2.85 mg) (P < 0.05). The type of brush and the polymerization method did not influence resin wear after brushing.

Influence of an arginine-containing toothpaste on bond strength of different adhesive systems to eroded dentin

The aim of this study was to evaluate the bond strength of different adhesive systems to eroded dentin following toothbrushing with an arginine-containing toothpaste. Sixty standardized 3 × 3 × 2-mm fragments of root dentin (n = 10) were prepared. After all surfaces except the buccal surfaces were impermeabilized, specimens were subjected to an erosive wear protocol and stored for 24 hours at 37°C. The specimens underwent 1000 toothbrushing cycles with an arginine-containing toothpaste, an arginine-free toothpaste (positive control group), or artificial saliva (negative control group). Following application of a self-etching or an etch-and-rinse adhesive to the buccal surfaces of the specimens, 6-mm-high composite resin blocks were built up in 2-mm increments. After 24 hours' storage in 100% relative humidity, microtensile test specimens with an approximate area of 1 mm² were prepared. The test was performed at a speed of 0.5 mm/min until specimen fracture, and the failure patterns were evaluated using a stereoscopic loupe. Two-way analysis of variance revealed no significant difference between the toothpastes, the adhesive systems, or the interactions between toothpaste and adhesive system in terms of the bond strength to eroded dentin (P > 0.05). The predominant failure pattern was adhesive in all groups. It was concluded that a toothpaste containing arginine did not interfere with the bond between either the self-etching or the etch-and-rinse adhesive system and eroded dentin.

Impact of toothpaste on abrasion of sound and eroded enamel: An in vitro white light interferometer study

PURPOSE

To evaluate the influence of brushing using toothpastes marketed under different categories on abrasion of sound and eroded enamel in vitro at nanometer scale using a white light interferometer (WLI).

METHODS

Enamel surface of resin-embedded bovine incisors were fine polished with diamond slurry and divided into testing area (approximately 2 mm x 4 mm) and reference area using a nail varnish. The enamel specimens were randomly assigned to 10 groups (n = 10 each); six of which were subjected to erosive challenge. The testing area in these eroded groups was exposed to 10 ml of Coca-Cola for 90 seconds and then rinsed for 10 seconds in deionized water (DW). Enamel specimens, except for those in one eroded group, were brushed by an automatic brushing machine with 120 linear motion strokes in 60 seconds under load of 250 g with/without toothpaste slurry. After the toothbrushing abrasion, each specimen was rinsed for 10 seconds with DW followed by immersion in artificial saliva for 2 hours. Toothpaste slurries were prepared containing one of the four toothpastes used and DW in a ratio of 1:2. The erosion-abrasion cycle was repeated three times. Then, the nail varnish was removed and enamel surface loss (SL) was measured by the WLI. Data were statistically analyzed by one-way ANOVA followed by Bonferroni's correction at significance level of 0.05.

RESULTS

For eroded specimens, the mean SL values of groups not brushed and brushed with no toothpaste were not significantly different, but were significantly lower than those of whitening, anti-erosion and anti-caries toothpaste groups (P < 0.001). The whitening toothpaste group showed significantly higher SL than all other groups (P < 0.001). For sound enamel specimens, SL was not measured except for the whitening toothpaste group.

[A child who developed internal carotid artery obstruction 2 weeks after incurring an intraoral blunt injury: A case report]

This report describes a 9-year-old boy with an internal carotid artery (ICA) injury caused by a fall with the blunt edge of a toothbrush held in the mouth. The initial injury appeared trivial, but 2 weeks later, generalized convulsion and left hemiparesis occurred. Magnetic resonance imaging and magnetic resonance angiography revealed an infarction of the right striatum, right ICA occlusion, and stenosis of the right middle cerebral artery, which were caused by the dissection or intimal damage of the ICA due to the blunt trauma. For children, intraoral blunt trauma sometimes causes ICA occlusion and consecutive strokes after the latent interval of days to weeks. Therefore, a careful clinical observation is essential to prevent overlooking strokes. This patient was an unique case with a long latent interval among the past literatures.

Effects of cyclic loading and toothbrush abrasion on cervical lesion formation

This study sought to determine the effect of cyclic loading and toothbrush abrasion (with and without abrasive slurries) on cervical lesion formation. The roots of extracted human third molars were embedded in acrylic resin, leaving 2 mm of root structure and crowns exposed. Teeth were divided into 6 groups (n = 10) with the following treatments: no treatment (control), cyclic load in distilled water, brushing with distilled water, cyclic load followed by brushing with distilled water, brushing with toothpaste slurry, and cyclic load followed by brushing with toothpaste slurry. Cyclic loading and toothbrushing machines subjected the teeth to 1.6 million cyclic loads and 30,000 brushing strokes, the equivalent of 4 years of function and brushing for an average patient. The teeth were scanned with a 3-dimensional optical profilometer to determine the volumetric loss of tooth structure. Load cycling had no significant effect on cervical tooth loss. Brushing with toothpaste resulted in significantly greater cervical tooth loss than brushing with water, which in turn was significantly greater than no treatment at all.

Correlation between gingival thickness and gingival recession in humans

Gingival recession is characterized by the apical migration of the gingival margin, exposing the root surface. Studies have demonstrated several etiological factors for gingival recession such as periodontitis, traumatic toothbrushing, use of oral piercing, and past orthodontic therapy, among others. It might not be possible to identify and quantify the influence of each factor, and gingival recession at some sites may be the result of the combination of these factors. Gingival recession affects individuals at all ages, with prevalence increasing as time passes. The aim of this study was to observe whether there is correlation between gingival thickness and gingival recession. Fifty-five subjects of both genders aged 18-35 years participated in the study. The volunteers were under treatment at the School of Dentistry of the Federal University of Rio Grande do Sul. Buccal gingival thickness was measured on incisors, canines and bicuspids, under anesthesia, following inclusion and exclusion criteria. Statistical analysis was performed with STATA version 10.1. The results had a Pearson Correlation Coefficient of -0.216. Linear regression had a statistically significant pvalue of 0.025. It may be concluded that there is weak negative correlation between gingival thickness and gingival recession.

Is it safe to use a toothbrush?

AIM

To systemically collect and summarize the literature on case reports concerning adverse events associated with the oral use of a toothbrush.

MATERIALS AND METHODS

Two electronic databases were searched for articles published up to October 2013 to identify appropriate studies using focused search terms and 'case reports' as a filter. Results. A comprehensive search identified 419 unique titles and abstracts. Ninety-four studies met the eligibility criteria. In total, 118 subjects (age range = 1-60 years) presented adverse events related to the oral use of a toothbrush. Events could be summarized in five categories, of which ingestion was the most reported problem among the individuals (50 cases). This was followed by impaction of a toothbrush (27 cases). Reports more frequently involved females and children were more likely to have injuries compared to males and adults. Most of the cases that presented with adverse events of the oral use of a toothbrush were referred for treatment to a physician.

CONCLUSIONS

The combined evidence related to serious adverse events as presented in case reports showed that the oral use of a toothbrush can be associated with ingestion, impaction, instant trauma, gingival traumatic injury and seizures. Given the incidence of reporting, important recommendations are that a toothbrush should not be used to induce vomiting, nor should people walk or run with this device in their mouths, especially children.

[Conservative treatment of oesophageal perforation in a child caused by a toothbrush]

Traumatic perforation of the oesophagus is a condition with high morbidity and mortality. We report a case of a one-year-old girl with traumatic oesophageal perforation caused by a fall with a toothbrush. She underwent a conservative regimen consisting of drainage of the mediastinum by a naso-cavitary drain, antibiotics and a feeding tube. No sign of mediastinitis was found on a follow-up computed tomography 19 days later, and she was discharged in good condition.

Effect of simulated intraoral erosion and/or abrasion effects on etch-and-rinse bonding to enamel

PURPOSE

To assess the influence of simulated oral erosive/abrasive challenges on the bond strength of an etch-and-rinse two-step bonding system to enamel using an in situ/ex vivo protocol.

METHODS

Bovine enamel blocks were prepared and randomly assigned to four groups: CONT - control (no challenge), ABR - 3x/day-1 minute toothbrushing; ERO - 3x/day - 5 minutes extraoral immersion into regular Coca Cola; and ERO+ABR - erosive protocol followed by a 1-minute toothbrushing. Eight blocks were placed into an acrylic palatal appliance for each volunteer (n = 13), who wore the appliance for 5 days. Two blocks were subjected to each of the four challenges. Subsequently, all the blocks were washed with tap water and Adper Single Bond 2/Filtek Z350 were placed. After 24 hours, 1 mm2 beams were obtained from each block to be tested with the microtensile bond strength test (50 N load at 0.5 mm/minute). The data were statistically analyzed by one-way RM-ANOVA and Tukey's tests (alpha = 0.05).

RESULTS

No difference was detected among the ABR, ERO, and CONT groups (P > 0.05). ERO+ABR group yielded lower bond strengths than either the ABR and ERO groups (P < 0.0113).

Interdental cleaning and gingival injury potential of interdental toothbrushes

The effective cleaning of interdental spaces using toothbrushes is a challenge. The aim of the present in vitro study was to evaluate on the one hand the interdental cleaning efficiency and on the other hand the gingival injury potential of an electric single-headed sonic toothbrush (Water-pik) and two single-tufted manual toothbrushes (Curaprox 1009; Lactona Interdental Brush). Brushes were evaluated using a brushing device. Test dental casts (maxillary sextants) consisting of black teeth coated with white paint were brushed using standardized horizontal movements. Thereafter, black (i.e. cleaned) areas were measured planimetrically. The soft tissue injury potential was evaluated using front segments of porcine mandibles. In the same brushing device, test brushes were moved over the gingiva. Before and after each treatment, the porcine mucosa was stained with a plaque disclosing agent to visualize injured areas, which could then be measured planimetrically as well. These evaluations were each made after 15, 30, 60, and 120 seconds of brushing. The statistical analysis was performed using non-parametric Mann-Whitney tests, and the level of significance was set at 5%. The best cleaning performance of 46% across all interdental spaces assessed was found with the electric sonic toothbrush (Waterpik), while the performances of the manual brushes from Lactona and Curaprox were 14.8% and 5%, respectively. At each point of evaluation, the gingiva was injured most markedly by the powered sonic toothbrush (Waterpik), followed by the manual Curaprox brush. The smallest damage of the porcine gingiva was produced by the manual Lactona brush. When comparing the manual toothbrushes, the Lactona product revealed a better cleaning performance combined with a smaller injury potential than the Curaprox brush. Thus, the prophylactic goal to achieve high degrees of cleaning while producing minimal damage is important and should have priority when evaluating and selecting toothbrushes.

Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults

BACKGROUND

Effective oral hygiene is a crucial factor in maintaining good oral health, which is associated with overall health and health-related quality of life. Dental floss has been used for many years in conjunction with toothbrushing for removing dental plaque in between teeth, however, interdental brushes have been developed which many people find easier to use than floss, providing there is sufficient space between the teeth.

OBJECTIVES

To evaluate the effects of interdental brushing in addition to toothbrushing, as compared with toothbrushing alone or toothbrushing and flossing for the prevention and control of periodontal diseases, dental plaque and dental caries.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 7 March 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 2), MEDLINE via OVID (1946 to 7 March 2013), EMBASE via OVID (1980 to 7 March 2013), CINAHL via EBSCO (1980 to 7 March 2013), LILACS via BIREME (1982 to 7 March 2013), ZETOC Conference Proceedings (1980 to 7 March 2013) and Web of Science Conference Proceedings (1990 to 7 March 2013). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the metaRegister of Controlled Trials (http://www.controlled-trials.com/mrct/) for ongoing trials to 7 March 2013. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (including split-mouth design, cross-over and cluster-randomised trials) of dentate adult patients. The interventions were a combination of toothbrushing and any interdental brushing procedure compared with toothbrushing only or toothbrushing and flossing.

DATA COLLECTION AND ANALYSIS

At least two review authors assessed each of the included studies to confirm eligibility, assessed risk of bias and extracted data using a piloted data extraction form. We calculated standardised mean difference (SMD) and 95% confidence interval (CI) for continuous outcomes where different scales were used to assess an outcome. We attempted to extract data on adverse effects of interventions. Where data were missing or unclear we attempted to contact study authors to obtain further information.

MAIN RESULTS

There were seven studies (total 354 participants analysed) included in this review. We assessed one study as being low, three studies as being high and three studies as being at unclear risk of bias. Studies only reported the clinical outcome gingivitis and plaque data, with no studies providing data on many of the outcomes: periodontitis, caries, halitosis and quality of life. Three studies reported that no adverse events were observed or reported during the study. Two other studies provided some data on adverse events but we were unable to pool the data due to lack of detail. Two studies did not report whether adverse events occurred. Interdental brushing in addition to toothbrushing, as compared with toothbrushing alone Only one high risk of bias study (62 participants in analysis) looked at this comparison and there was very low-quality evidence for a reduction in gingivitis (0 to 4 scale, mean in control): mean difference (MD) 0.53 (95% CI 0.23 to 0.83) and plaque (0 to 5 scale): MD 0.95 (95% CI 0.56 to 1.34) at one month, favouring of use of interdental brushes. This represents a 34% reduction in gingivitis and a 32% reduction in plaque. Interdental brushing in addition to toothbrushing, as compared with toothbrushing and flossing Seven studies provided data showing a reduction in gingivitis in favour of interdental brushing at one month: SMD -0.53 (95% CI -0.81 to -0.24, seven studies, 326 participants, low-quality evidence). This translates to a 52% reduction in gingivitis (Eastman Bleeding Index). Although a high effect size in the same direction was observed at three months (SMD -1.98, 95% CI -5.42 to 1.47, two studies, 107 participants, very low quality), the confidence interval was wide and did not exclude the possibility of no difference. There was insufficient evidence to claim a benefit for either interdental brushing or flossing for reducing plaque (SMD at one month 0.10, 95% CI -0.13 to 0.33, seven studies, 326 participants, low-quality evidence) and insufficient evidence at three months (SMD -2.14, 95% CI -5.25 to 0.97, two studies, 107 participants very low-quality evidence).

AUTHORS' CONCLUSIONS

Only one study looked at whether toothbrushing with interdental brushing was better than toothbrushing alone, and there was very low-quality evidence for a reduction in gingivitis and plaque at one month. There is also low-quality evidence from seven studies that interdental brushing reduces gingivitis when compared with flossing, but these results were only found at one month. There was insufficient evidence to determine whether interdental brushing reduced or increased levels of plaque when compared to flossing.

Brushing force of manual and sonic toothbrushes affects dental hard tissue abrasion

OBJECTIVES

This study aimed to determine the brushing forces applied during in vivo toothbrushing with manual and sonic toothbrushes and to analyse the effect of these brushing forces on abrasion of sound and eroded enamel and dentin in vitro.

MATERIALS AND METHODS

Brushing forces of a manual and two sonic toothbrushes (low and high frequency mode) were measured in 27 adults before and after instruction of the respective brushing technique and statistically analysed by repeated measures analysis of variance (ANOVA). In the in vitro experiment, sound and eroded enamel and dentin specimens (each subgroup n = 12) were brushed in an automatic brushing machine with the respective brushing forces using a fluoridated toothpaste slurry. Abrasion was determined by profilometry and statistically analysed by one-way ANOVA.

RESULTS

Average brushing force of the manual toothbrush (1.6 ± 0.3 N) was significantly higher than for the sonic toothbrushes (0.9 ± 0.2 N), which were not significantly different from each other. Brushing force prior and after instruction of the brushing technique was not significantly different. The manual toothbrush caused highest abrasion of sound and eroded dentin, but lowest on sound enamel. No significant differences were detected on eroded enamel.

CONCLUSION

Brushing forces of manual and sonic toothbrushes are different and affect their abrasive capacity.

CLINICAL SIGNIFICANCE

Patients with severe tooth wear and exposed and/or eroded dentin surfaces should use sonic toothbrushes to reduce abrasion, while patients without tooth wear or with erosive lesions confining only to enamel do not benefit from sonic toothbrushes with regard to abrasion.

Effect of sweetening agents in acidic beverages on associated erosion lesions

Accurate diagnosis of erosion defects caused by acidic beverages is essential when designing a comprehensive management strategy that includes combating possible recurrence. The manifestations of erosion lesions associated with acidic beverages are diverse, as seen in the differences and similarities of lesions associated with various regular and diet varieties of beverages. Erosion lesions caused by regular sugar-sweetened beverages display signs similar to dental caries, while lesions resulting from diet, non-sugar-sweetened soft drinks have defects similar to mechanical wear of the dentition. Aggravating factors such as toothbrushing or compromised oral home care could influence the features of erosion lesions. These diverse characteristics of erosion lesions could make identification difficult. This article describes pertinent signs of erosion defects associated with the regular and diet varieties of acidic beverages and discusses their causative factors. This information is designed to avert an improper diagnosis that would derail any restorative intervention and alter a proper preventive management course.

Scanning electron microscopy study of the effect of the brushing time on the human tooth dentin after exposure to acidic softdrinks

Scanning electron microscopy (SEM) was used to examine the abrasive and erosive potential of the brushing time on the dentin surface eroded by acidic soft drinks to suggest an optimized toothbrushing start time after the consumption of cola (pH 2.52) in children. Thirty-six non-carious primary central incisors were assigned to 12 experimental groups (n = 3) based on the erosive and abrasive treatment protocols. Cola exposure was used as the erosive treatment. Three brushing durations (5, 15, and 30 sec) and four brushing start times (immediately, 30 min, 60 min, and 120 min) after an erosive pre-treatment were used for the abrasive treatment. Toothbrushing after exposure to acidic soft drinks led to an increase in the open-tubule fraction and microstructural changes. Toothbrushing immediately after the erosive pre-treatment showed the largest abrasive and erosive potential on the dentin whereas that 60 and 120 min after the pre-treatment showed the least abrasive and erosive potential on the dentin. Toothbrushing for both 60 and 120 min after the pre-treatment showed similar erosive and abrasive potentials on the dentin. The brushing duration showed no effect on the erosive and abrasive potential on the dentin. Therefore, to achieve the desired tooth surface cleaning and less surface lesion on the dentin surface, toothbrushing should be performed at least 1 hour after cola consumption. Three-minute brushing after cola consumption is sufficient to prevent dental lesions, and prolonged brushing can irritate the gingival tissues.

Impact of everyday oral activities on the risk of bacteraemia is unclear

DATA SOURCES

The Cochrane Library, Medline and Embase databases were searched as well as the references of identified articles and reviews.

STUDY SELECTION

Studies were selected independently by two authors with disagreements being resolved by discussion. Only English language papers were included.

DATA EXTRACTION AND SYNTHESIS

Data abstraction was conducted independently and meta-analysis conducted where appropriate.

RESULTS

Twelve studies were included; seven on toothbrushing, one on dental flossing and four on chewing were included. Plaque and gingival indices were found to have a significant effect on the prevalence of bacteraemia following toothbrushing, with pooled odds ratios of 2.61 [95% confidence interval (CI) = 1.45-4.69] and 2.77 (95% CI = 1.50-5.11) respectively. None of five studies on bacteraemia following dental flossing and chewing revealed a statistically significant association between oral hygiene, gingival or periodontal status and the development of bacteraemia.

CONCLUSIONS

Meta-analysis showed that plaque accumulation and gingival inflammation scores significantly increased the prevalence of bacteraemia following toothbrushing. However, systematic review showed no relationship between oral hygiene, gingival and periodontal status and the development of B-chewing, and there is no evidence that gingival and periodontal health status affects B-flossing.

In situ randomised trial investigating abrasive effects of two desensitising toothpastes on dentine with acidic challenge prior to brushing

OBJECTIVES

To determine if brushing dentine with 2 moderate RDA desensitising toothpastes, results in a significant dentine wear difference and whether this difference continues to be relevant when preceded with an erosive challenge.

METHODS

An in situ, single centre, single blind, randomised, split mouth study, evaluated the difference in abrasion of 2 toothpastes (SFM - Sensodyne Fresh Mint(®) RDA 70; CPHM - Crest Pro-Health Clean Mint(®) RDA 120) in 28 healthy volunteers. Two toothpaste treatments were administered 3×/day, for each of the two 15 day periods, subjects wearing bi-lateral, lower buccal appliances each with 4 dentine sections. A 2 min extra-oral acidic challenge preceded toothbrushing for 2 study arms. Contact profilometry measured samples at baseline, days 5, 10 and 15.

RESULTS

Brushing with SFM was significantly less abrasive than brushing with CPHM at all time points, with or without a preceding acidic challenge (p<0.0001). The additional dentine loss arising from the erosive challenge prior to brushing with each paste was linear with time and independent of abrasive effect.

CONCLUSIONS

The desensiting toothpastes' RDA, directly related to dentine loss with toothbrushing. An acidic challenge prior to brushing did not negate the benefits of reduced wear from the lower RDA paste compared to the higher RDA paste. When brushing eroded dentine, the additional wear appeared independent of abrasive effect. Dentine hypersensitivity sufferers should be recommended to use a low-moderate RDA toothpaste, not to brush more than 2×/day and not immediately following an acidic challenge.

[Pregnant women's oral hygiene knowledge and habits after the second millennium in South-East Hungary]

Among the predisposing agents for inflammatory periodontal lesion dental plaque is the most important, but different local and systemic factors may influence the seriousness or progression of periodontitis. Hormonal changes during pregnancy belong to the systemic aggravating factors. The aim of the present study was to assess pregnant women's oral hygiene knowledge and habits, and if these have a relationship with age, residence, educational level and profession/occupation. Questionnaires were used for the data collection. 275 pregnant women, who underwent prenatal care at the Department of Obstetrics and Gynecology in Szeged, volunteered to answer the questions. The results showed that almost all the women brushed their teeth daily, but only about one third of them used special oral hygiene tools, like dental floss. Many of the women claimed to have gingival bleeding when brushing their teeth. More then 70% visited a dentist during pregnancy. There was a significant relationship between educational level and the use of dental floss (p=0.004) and gingival bleeding (p=0.023) Oral hygiene education, dental and periodontal treatment of pregnant women need more emphasis during prenatal care.

Diagnosis and management of dental wear

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

An in situ/ex vivo comparison of the ability of regular and light colas to induce enamel wear when erosion is combined with abrasion

OBJECTIVE

To evaluate whether the type of cola drink (regular or diet) could influence the wear of enamel subjected to erosion followed by brushing abrasion.

METHOD AND MATERIALS

Ten volunteers wore intraoral devices that each had eight bovine enamel blocks divided into four groups: ER, erosion with regular cola; EAR, erosion with regular cola plus abrasion; EL, erosion with light cola; and EAL, erosion with light cola plus abrasion. Each day for 1 week, half of each device was immersed in regular cola for 5 minutes. Then, two blocks were brushed using a fluoridated toothpaste and electric toothbrush for 30 seconds four times daily. Immediately after, the other half of the device was subjected to the same procedure using a light cola. The pH, calcium, phosphorus, and fluoride concentrations of the colas were analyzed using standard procedures. Enamel alterations were measured by profilometry. Data were tested using two-way ANOVA and Bonferroni test (P<.05).

RESULTS

Regarding chemical characteristics, light cola presented pH 3.0, 13.7 mg Ca/L, 15.5 mg P/L, and 0.31 mg F/L, while regular cola had pH 2.6, 32.1 mg Ca/L, 18.1 mg P/L, and 0.26 mg F/L. The light cola promoted less enamel loss (EL, 0.36 Μm; EAL, 0.39 Μm) than its regular counterpart (ER, 0.72 Μm; EAR, 0.95 Μm) for both conditions. There was not a significant difference (P>.05) between erosion and erosion plus abrasion for light cola. However, for regular cola, erosion plus abrasion resulted in higher enamel loss than erosion alone.

CONCLUSION

The data suggest that light cola promoted less enamel wear even when erosion was followed by brushing abrasion.

Different powered toothbrushes for plaque control and gingival health

BACKGROUND

Powered brushes were first introduced commercially in the 1960s. A recent systematic review suggested the superiority of certain modes of powered over manual toothbrushing for plaque and gingivitis reduction. That review did not allow for direct comparison between different modes of powered toothbrush.

OBJECTIVES

To compare different modes of powered toothbrushing against each other for plaque reduction and the health of the gingivae. Other factors to be assessed were calculus and stain removal, cost, dependability and adverse effects.

SEARCH STRATEGY

The following databases were searched: Cochrane Oral Health Group's Trials Register (to 26 July 2010); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3); MEDLINE via OVID (1950 to 26 July 2010); EMBASE via OVID (1980 to 26 July 2010); CINAHL via EBSCO (1982 to 26 July 2010). There were no language restrictions.

SELECTION CRITERIA

Trials were considered for inclusion with the following criteria: random allocation of participants; no compromised manual dexterity; unsupervised powered toothbrushing for at least 4 weeks. The primary outcomes were the plaque and gingivitis scores after powered toothbrush use during trial period.

DATA COLLECTION AND ANALYSIS

Data extraction was performed independently and in duplicate. The authors of trials were contacted to provide missing data where possible. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using the random-effects model. Potential sources of heterogeneity were assessed.

MAIN RESULTS

The review included data from 15 trials with 1015 participants. Due to the dearth of trials assessing the same mode of action, no definitive conclusions can be stated regarding the superiority of one mode of powered toothbrush over any other. Only minor and transient side effects were reported. Cost, dependability were not reported.

AUTHORS' CONCLUSIONS

Further trials of good quality are required to establish if any mode of action has superiority over the other modes of action for powered toothbrushes.

Brushing abrasion of dentin: effect of diluent and dilution rate of toothpaste

PURPOSE

To determine whether toothpaste diluent type and dilution rate influence abrasion of dentin.

METHODS

Slabs of human root dentin (4 x 3 x 2 mm) were embedded in epoxy resin, ground and polished. Adhesive tape was placed on the specimen's surface leaving an exposed central area of 1 x 4 mm. Specimens (n = 15) were then brushed for 1,000 strokes in a reciprocal action brushing simulator using toothpaste that had been diluted in a carboxymethylcellulose-based artificial saliva (CMC) or deionized water (DW) from 1:1 to 1:4 (toothpaste:diluents, in weight). Control groups were brushed with undiluted toothpaste, CMC-based saliva or DW only. Brushing simulation was run at 300 g load at 37 degrees C. After brushing, adhesive tape was removed and wear analyzed by optical profilometry.

RESULTS

One-way ANOVA (P < 0.0001) and Tukey's test revealed that, in general, wear depth (microm) declined with increasing dilution, regardless of the diluent. Brushing with CMC- or DW-only caused the least abrasion.

Enamel hardness after exposure to acidic drinks and brushing

This study tested the hypothesis that short-term exposure to acidic drinks can reduce enamel surface hardness, and that subsequent brushing with toothpaste can cause detectable loss of enamel. Enamel specimens (three groups per storage medium) were immersed in one of four acidic drinks for five seconds, one minute, or 10 minutes. The pH values of all four drinks were measured. Six microhardness indentations were made on each specimen before immersion (baseline), after immersion, and after brushing with toothpaste. Changes in surface microhardness were expressed as the ratio of hardness values after each treatment to the baseline value of each specimen. Two-way ANOVA showed that both storage medium and duration of immersion influenced the ratio significantly. One-way ANOVA showed that the ratio was reduced significantly with increased time of immersion in drinks with a pH =2.8, but the ratio reduction was not significant in drinks with a pH =3.3. Subsequent brushing removed the softened layer and exposed intact surface underneath. Although short-term exposure (~5 seconds) did not significantly affect the surface hardness values, it left a lightly etched enamel surface among specimens immersed in acidic drinks with a low pH. Subsequent brushing could still cause detectable loss of enamel surface after multiple exposures.

Resistance of surface coating resins against toothbrushing abrasion

PURPOSE

To evaluate the durability of a resin coating system after toothbrushing abrasion resistance and surface hardness of the coating resin.

METHODS

Rectangular blocks of Top Coat (TC) or the bonding resin of the two-step self-etching adhesive Clearfil SE Bond (SEB) were prepared by irradiation with halogen light units. After immersion in distilled water at 37 degrees C until stabilized water absorption, the specimens were subjected to toothbrushing abrasion tests in which a toothbrush was moved on the specimen at 60 strokes/minute with a 400 gf vertical load with toothpaste slurry. The specimens were weighed after every 10,000 strokes until 200,000 strokes. Hardness of the specimen was measured with a Knoop hardness tester, and the degree of cure was determined using ATR-FTIR spectroscopy. Statistical differences between materials were analyzed using a Student's t-test.

RESULTS

TC demonstrated significantly less weight loss than SEB after 40,000 strokes (P<0.05), showing 0.87 +/- 0.64 mg loss after 200,000 strokes. The Knoop hardness number of TC was significantly greater than that of SEB (P<0.05), and TC presented a greater degree of cure.