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The aim of this study was to investigate the association of different dental prophylactic modalities and osteoradionecrosis (ORN) and determine the risk of ORN under different timing periods of scaling, with the use chlorhexidine mouth rinse after surgery and with different strategies of fluoride gel application in head and neck cancer (HNC) participants. A cohort of 18,231 HNC participants, including 941 ORN patients and 17,290 matched control cases, were enrolled from a Longitudinal Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) in Taiwan. Based on different dental prophylactic modalities before radiotherapy, including chlorhexidine mouth rinse, scaling, and fluoride gel, all HNC subjects were stratified into different groups. The Cox proportional hazard regression was used to compare ORN incidences under different dental prophylactic modalities. The results revealed that scaling and chlorhexidine mouth rinse were significantly related to ORN risk ( P = 0.004 and P < 0.0001). Chlorhexidine mouth rinse was highly correlated to ORN occurrence (hazard ratio [HR], 1.83–2.66), as exposure increased the risk by 2.43-fold among oral cancer patients, regardless of whether they had received major oral surgery or not. Oral cancer patients receiving scaling within 2 wk before radiotherapy increased their incidence of ORN by 1.28-fold compared with patients who had not undergone scaling within 6 mo. There is no significance of fluoride application for dental prophylaxis in increasing ORN occurrence. In conclusion, dental prophylaxis before radiotherapy is strongly correlated to ORN in HNC patients. Chlorhexidine exposure and dental scaling within 2 wk before radiotherapy is significantly related to ORN risk, especially in oral cancer patients. The use of 1.1% NaF topical application did not significantly increase the risk of ORN in HNC patients. An optimal dental prophylaxis protocol to reduce ORN should concern cancer location, cautious prescription of chlorhexidine mouth rinse, and proper timing of scaling.

A prophylaxis followed by three topical applications of an iodine-potassium iodide solution significantly reduced the levels of Streptococcus mutans in fissure and approximal plaques and in saliva. Reductions persisted 20-24 weeks after treatment in salivary and approximal samples. A prophylaxis alone exerted a small and temporary reduction of S. mutans in occlusal fissure plaque, but did not reduce the levels of this organism in approximal plaque or in saliva. A significant relationship existed between the levels of S. mutans in saliva and the proportions of this organism in plaque. The dorsum of the tongue does not appear to constitute a significant reservoir for S. mutans following disinfecting procedures.

The purpose of this study was to evaluate the associations between interdental cleaning behavior and the prevalence of caries and periodontal disease and numbers of missing teeth, with data from the National Health and Nutrition Examination Survey (2011 to 2012 and 2013 to 2014). Analysis included the following parameters: interproximal clinical attachment level (iCAL) ≥3 mm, interproximal probing depth (iPD) ≥4 mm, number of coronal and interproximal caries, number of missing teeth, ≥1 surfaces with coronal caries, and periodontal profile classes (PPCs). Chi-square was used for bivariate associations. Associations of interdental cleaning with outcomes were assessed with multiple linear regression and generalized logit regression, adjusting for age, race, sex, diabetes, smoking, education, dental visits, and sugar consumption. Nonusers had a significantly higher percentage of sites with iCAL ≥3 mm and iPD ≥4 mm as compared with individuals who used interdental cleaning devices ( P < 0.0001). Individuals with a higher frequency of cleaning (4 to 7×/wk) had a significantly lower extent of sites with iCAL ≥3 mm as compared with lower-frequency cleaning (1 to 3×/wk; P ≤ 0.05). Interdental cleaning users showed lower numbers of coronal caries, interproximal coronal caries, and missing teeth as compared with nonusers ( P < 0.0001). Nonusers had 1.73-times (95% confidence interval, 1.53 to 1.94) higher odds for having ≥1 surfaces of coronal caries as compared with interdental cleaning users, regardless of the weekly frequency. Individuals were less likely to be in diseased PPCs if they were interdental cleaning users. Low-frequency cleaners (1 to 3×/wk) had significantly greater odds (1.43; 95% confidence interval, 1.08 to 1.88) to have severe disease (PPC-G) versus health (PPC-A) than were high-frequency cleaners (4 to 7×/wk). Interdental cleaning users showed lower levels of periodontal disease and caries and lower numbers of missing teeth. Higher frequency of interdental cleaning was correlated with increased periodontal health. Individuals with severe periodontal disease could show additional oral health benefits by increasing cleaning frequency. The data support the use of interdental cleaning devices as an oral hygiene behavior for promoting health.

While prevention practices are widely encouraged, the link between the performance of preventive behaviors and oral health status has rarely been examined. This study investigates the association between preventive dental behaviors (recent and long-term) and oral health status and compares the strength of such associations. Longitudinal data over six time points on 649 dentate white men were obtained from the VA Dental Longitudinal Study (DLS). Participants' oral health was measured through dental examinations, and preventive dental behaviors-i.e., toothbrushing, flossing, using interdental devices, seeking dental prophylaxis, and undergoing dental treatment-were assessed by self-report. Oral health status was measured in terms of (1) functioning teeth, (2) sound-equivalent teeth, (3) decayed, missing, and filled teeth, and (4) decayed and filled root surfaces. Pearson correlation and linear regression analysis revealed significant positive associations between most preventive behaviors and measures of oral health status. Dental prophylaxis emerged as the strongest predictor of oral health status. Long-term preventive dental behavior measures explained more variance in oral health status than short-term preventive behaviors measured cross-sectionally.

The primary ecological niche for suspected periodontal pathogens seems to be the subgingival area, even though periodontal pathogens are also frequently recovered from saliva. The interrelationship of different periodontal conditions and the salivary levels of suspected periodontal pathogens is not known. In the present study, salivary levels of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Campylobacter rectus, and Peptostreptococcus micros were determined by bacterial culture and related to clinical periodontal status in 40 subjects with either advanced, moderate, or initial/no periodontitis. Culture-positive subjects harbored the 5 bacterial species in mean numbers ranging from 2 x 105 to 6 x 107 colony-forming units (CFU)/mL saliva. A. actinomycetemcomitans was found in none and P. gingivalis in one of the subjects with initial periodontitis, whereas both species were found in 33% and 44%, respectively, of the subjects with moderate periodontitis and in 60% and 40%, respectively, of the subjects with advanced periodontitis. The mean numbers of CFU/mL of P. intermedia, C. rectus and P. micros were significantly higher in subjects with advanced periodontitis than in subjects with initial/no periodontitis. Ten patients with advanced periodontitis were treated mechanically and with adjunctive systemic metronidazole, and were re-examined 1 and 6 months after treatment. Periodontal treatment eradicated or significantly reduced the levels of salivary periodontal pathogens for half a year, whereas in untreated subjects, the levels and the detection frequencies generally remained fairly stable. In conclusion, the results showed that the salivary levels of periodontal pathogens reflect the periodontal status of the patient.

If it is to be effective, preventive dental treatment must be based on an individual’s risk of caries and periodontal disease. However, hitherto, preventive treatment has been generally conducted without proper caries-risk assessment because of lack of knowledge about an individual’s caries risk. This study sought to identify high-risk adult patients and examine the effectiveness of preventive programs. Data for 442 patients from a single general practice who met the inclusion criteria were analyzed. Multiple logistic-regression analysis showed that high levels of mutans streptococci (SM) correlated with the onset of primary and secondary caries, with odds ratios of 2.34 (95%CI: 1.15-4.76, p = 0.019) and 2.22 (95%CI: 1.06-4.62, p = 0.034), respectively. Lactobacilli (LB) also correlated with secondary caries, with an odds ratio of 3.34 (95%CI: 1.35-6.85, p = 0.007). When the patients were checked after three years of a preventive program, the correlation with SM and LB disappeared. Survival analyses by Cox regression models and Kaplan-Meier methods showed that secondary caries was difficult to control by conventional preventive programs alone in patients with high levels of cariogenic bacteria. In conclusion, cariogenic bacteria play an important role in the incidence of caries, and additional intensive preventive treatment should be considered for high-risk patients.

There is growing evidence that chronic periodontitis may be a risk factor for pre-term birth. The goal of this intervention study was to determine the effect of periodontal treatment on the pregnancy outcome in women with threatening pre-term birth and initial localized chronic periodontitis. Forty-one women with a singleton pregnancy were enrolled in the study. For this treatment group, oral hygiene instruction and periodontal therapy were provided in the third trimester, while those in the control group (42 persons) did not receive any periodontal treatment. In the treatment group, the mean weight of newborns was 3079.0 g, compared with the control group mean of 2602.4 g. The incidence of pre-term birth and low birthweight in the treatment group was significantly less than in the control group ( p = 0.015). Periodontal treatment completed before the 35th week appeared to have a beneficial effect on birth weight and time of delivery.

Although silica particles have been used for tooth polishing, polishing with nanosized particles has not been reported. Here we hypothesize that such polishing may protect tooth surfaces against the damage caused by cariogenic bacteria, because the bacteria can be easily removed from such polished surfaces. This was tested on human teeth ex vivo. The roughness of the polished surfaces was measured with atomic force microscopy (AFM). A considerably lower nanometer-scale roughness was obtained when silica nanoparticles were used to polish the tooth surfaces, as compared with conventional polishing pastes. Bacterial attachment to the dental surfaces was studied for Streptococcus mutans, the most abundant cariogenic bacteria. We demonstrated that it is easier to remove bacteria from areas polished with silica nanoparticles. The results demonstrate the advantage of using silica nanoparticles as abrasives for tooth polishing.

This report reviews the current status of various topical fluoride systems commonly used for caries prevention; these systems include professional fluoride applications, prophylaxis pastes, varnishes, rinses, gels, and dentifrices. Although the cariostatic benefits of professional applications are well-established from early studies, the magnitude of benefit relative to other preventive measures needs to be re-assessed under current conditions. Significant cariostatic benefits from fluoride prophylaxis pastes remain to be established, as does the relative efficacy of fluoride varnishes in comparison with other fluoride measures. The established cariostatic activity of fluoride rinses with supervised usage needs confirmation under normal home usage conditions. There is inadequate evidence to justify either increasing or decreasing the concentration of fluoride in conventional dentifrices whose efficacy is well-established. Based on limited clinical data and supportive laboratory data, fluoride appears to be effective for preventing root-surface caries.

The question has been raised whether low-caries children regularly using fluoride toothpaste will benefit from the professional application of additional fluoride gel. To investigate the caries-reducing effect of semi-annually-applied neutral 1% sodium fluoride gel, we carried out a double-blind randomized controlled clinical trial (n = 594) in a child population, initially aged 9.5–11.5 years, with baseline caries experience of D3MFS = 0 (decayed, missing, and filled tooth surfaces of permanent teeth). The mean number of tooth surfaces saved from caries development by fluoride gel application after 4 years was 0.2 D3MFS (SE = 0.17). The preventive fraction (PF) showed a mean relative effect of professionally applied fluoride gel of 18%. The cariostatic effect of the fluoride gel on pits and fissures would have been influenced by the sealant strategy in the study. Professionally applied fluoride gel showed no statistically significant effect on mean D3MFS score in low-caries 9.5- to 11.5-year-olds.

Dental prophylaxis with APF gels (1.23%) may cause gastric distress as a side-effect. This gastric irritation is probably due to a direct toxic effect of fluoride (F), swallowed in conjunction with the treatment, on the gastric mucosa. The aim of the present study was to investigate whether-and to what extent-a dental treatment with 3 g of a 0.42%-F gel could affect the gastric mucosa due to inadvertent swallowing of the gel. Ten subjects underwent a control gastroscopy, and two weeks later, a second gastroscopy was performed two h after a F gel treatment. During the gastroscopy, the mucosa was examined and the injuries graded according to an arbitrary scale. Four biopsies of the antral and corpus regions of the stomach were taken and evaluated histologically. The mean (± SD) amount of F retained after the application was 5.1 ± 2.1 mg, i.e., 40% of the applied amount of F. Petechiae and erosions were found in the mucosa in seven of the ten patients. The histopathological evaluation revealed changes in nine of ten patients, with the surface epithelium as the most affected component of the mucosa. The present study clearly shows that a treatment with a F gel of rather low F concentration may result in injuries to the gastric mucosa. The importance of current recommended guidelines so that the amount of F swallowed during a gel application can be minimized is emphasized. From a toxicological standpoint, the use of a low-F gel instead of a 1.23%-F gel in small children is recommended for avoidance of adverse gastric effects.

The purpose of this three-month clinical trial was to evaluate the effects of a 0.1 % octenidine mouthrinse on plaque, gingivitis, extrinsic dental stain, and the oral soft tissues. A total of 451 adult volunteer subjects was initiated into the study and given baseline dental examinations. The subjects were stratified into two balanced groups according to gender, plaque, and gingivitis scores. The subjects then received a dental prophylaxis and were provided with dentifrice, toothbrushes, and either a mouth rinse containing 0.1 % octenidine dihydrochloride as the active ingredient or a similar placebo mouthrinse. Subjects were instructed to rinse with their assigned product for 30 s twice each day. Examinations were repeated at six weeks (soft-tissue assessment, gingivitis) and three months (soft tissues, plaque, gingivitis, dental stain). The results showed that the group rinsing with 0.1% octenidine had significantly less plaque (39%), gingivitis (50%), and bleeding sites (60%) than the group using the control product, but had significantly higher stain formation and experienced longer prophylaxis times to remove the stain. The oral soft-tissue examinations revealed no differences in the groups in either the numbers or types of lesions noted.

Most periodontal trials are based on the assumption that the superior treatment, as judged by short-term intangible changes in probing attachment levels (the surrogate), is also the treatment most likely to affect tooth mortality. This assumption is valid if: (1) the surrogate is informative about tooth mortality, and (2) the surrogate captures a substantial proportion of the treatment effect on tooth mortality (e.g., > 50% or 75%). The goal of this study was to evaluate whether both conditions were satisfied in a randomized controlled trial (RCT) of elders at high risk for dental diseases. The results suggested that the first condition for a valid surrogate was satisfied: Both one- and two-year changes in probing attachment level were informative about tooth mortality risk. A 1-mm loss measured over a one-year period was associated with a 56% increased tooth mortality risk (relative risk= 1.56; 95% confidence interval, 1.08 to 2.26; p = 0.017); a 1-mm loss measured over a two-year period was associated with a 102% increased risk for tooth mortality (relative risk = 2.02; 95% confidence interval, 1.26 to 3.25; p = 0.004). The second condition necessary for a valid surrogate could not be confirmed in the present trial. With 95% confidence, it was concluded that one-year changes in probing attachment level measurements did not capture a significant proportion of the treatment effect (point estimate, 6%; 95% confidence interval ;- 38% to 53%). No useful statements could be made regarding the proportion of treatment effect captured by two-year changes, due to the width of the confidence interval (point estimate, 18%; 95% confidence interval; -151% to 140%). It is concluded that (1) the evidence surrounding the one-year change in probing attachment level indicates that it can be ruled out as being anything more than a weak surrogate marker for tooth mortality, and (2) further research is required to study the validity of two-year change in probing attachment level as a surrogate marker. Due to characteristics of the population and the treatments investigated, the generalizability of these findings to other RCTs is questionable.

The hypotheses to be tested were: (i) that chewing sugar-free gum frequently and for long periods would be associated with higher amounts of supragingival calculus, and (ii) that there would be no site-specificity of calculus deposition on the lingual surfaces of the 6 lower anterior teeth. Subjects, 436 in Glasgow and 191 in Winnipeg, were scored for calculus at mesial, lingual, and distal sites on the lingual surface of each of the 6 lower anterior teeth, by the Volpe-Manhold method. They also answered questions on the time since the last prophylaxis, the frequency of gum chewing, the type of gum chewed, and the length of a typical gum-chewing episode. A subset (233) of the Glasgow subjects were scaled and re-scored for calculus 3 months later. When the data for the logarithmic transformations of the initial calculus scores were subjected to stepwise multiple-regression analysis, the only factor which correlated significantly with initial calculus scores in both cities was the time since the last prophylaxis. In the Glasgow subjects scored 3 months after a prophylaxis, there was a negative correlation between chewing sugar-free gum and calculus scores, whereas in the Winnipeg subjects, age and the chewing of sucrose-containing and sugar-free gum were positively correlated with calculus scores. Thus, the results were contradictory with respect to the first-tested hypothesis. The calculus distribution patterns were very similar in the subset of Glasgow subjects and the Winnipeg subjects, with the amounts on the lateral incisors and canines averaging 70.2% and 44.5%, respectively, of those on the central incisors. Thus, the second hypothesis was disproved.

The purpose of this double-blind, longitudinal clinical study was to assess the efficacy of a dentifrice containing 3.3% soluble pyrophosphate in inhibiting calculus formation and its effect upon the oral soft tissues. A total of 265 adult volunteers was given a dental prophylaxis. Each was examined for dental calculus and oral soft tissue pathology. The volunteers were then randomly assigned to use either a dentifrice containing soluble pyrophosphate and sodium fluoride or a placebo sodium fluoride formulation for ad libitum home usage. At the two-month completion of the study, 217 subjects were available for examination. The results showed that the group using the dentifrice containing soluble pyrophosphate experienced a significant 26% decrease in calculus formation as compared with the placebo group, with both dentifrices being equally well-tolerated by the oral soft tissues.

The effects of some oral hygiene measures on Streptococcus mutans and approximal dental caries were evaluated. One hundred and eighty-seven 13-year-old individuals with high levels of salivary S. mutans (>106/mL) were selected. They were randomly distributed into three groups. Group I initially received professional mechanical toothcleaning, tongue-scraping, chlorhexidine treatment, and oral hygiene instructions concentrated on the approximal surfaces most colonized by S. mutans. The treatment was given four times with intervals of two days, followed by one single treatment every six months throughout the experimental period. The initial treatment period for group II, also consisting of four visits, included the same oral hygiene instructions as for group 1. The instructions were repeated every six months. Group III was maintained in the preventive program provided by the local Dental Health Office, based on mechanical plaque control and topical use of fluorides and chlorhexidine at individualized intervals. Group I showed a significant immediate reduction of S. mutans in saliva as well as on approximal tooth surfaces. After six months, there were no differences among the three groups regarding these variables. Compared with baseline, there was a significant reduction of S. mutans in all groups. There was no significant difference in caries progression among the three groups. However, the selected "high-risk" individuals in group I developed 0.25 new manifest caries lesions approximallylyear, compared with 0.27 for all children of the same age group in the area. Seventeen individuals had approximal surfaces with consistently high or consistently low S. mutans levels. Forty-six percent of the surfaces with high values developed new or progressive caries, compared with 2% of the surfaces with low values.

A method for assessing the relative abrasion of prophylaxis materials is described. The method utilizes irradiated human enamel and dentin specimens, and treatments are performed using a simulated prophylaxis procedure. Results obtained with this method indicate that variations in treatment time, load, and cup speed may influence the relative abrasion.

Cost-effectiveness analysis was used to evaluate alternative methods of periodontal disease control. The alternatives considered included non-surgical and surgical procedures as well as the use of antimicrobial agents. Data on costs were obtained from American Dental Association publications of average charges for periodontal services. The concept of quality-adjusted tooth-years (QATYs) was developed to provide an outcome measure which could be compared across treatments. The conclusions of this analysis are as follows: (1) Conservative non-surgical treatments for periodontal disease control not only have costs lower than surgical alternatives, as would be expected, but also maximize expected quality-adjusted tooth-years over a wide range of estimates; (2) antimicrobial therapy used as an adjunct to non-surgical treatment is likely to be both effective and cost-effective; and (3) quality of tooth-years is a critical consideration in the determination of outcome of periodontal treatment. For example, when tooth-years are not adjusted for quality, differences between treatments are diminished, and surgical treatment becomes as good as or better than more conservative treatments for some levels of disease severity

A controlled environment operatory and specially designed human aerosol test chamber were used to study characteristics of bacterial aerosols generated from a patient's mouth during dental procedures and by common naso-oral activities. Some dental procedures generated aerosols with bacterial concentrations that exceeded those produced during coughing or sneezing and that were considered potential health hazards.

The distribution and bacterial content of splatter particles emanating from a patient's mouth during dental procedures was studied in a controlled environment operatory. Levels of contamination far exceeding those produced by common oral activities were observed. Suction and preoperative oral hygiene procedures are not effective in reducing contamination from bacterial splatters, and the modification of certain procedures and the use of protective shields or glasses is advised.

Microradiographic and electron microscopic studies showed that cementum exposed to the oral environment can calcify beyond the normal level. Evidence of exchange of mineral and organic components across the tooth-saliva interface became morphologically detectable within a few weeks after thorough planing of cementum and root dentin.

A procedure involving the use of a tritiumlabeled acrylic strip was developed for the rapid, accurate, and reproducible evaluation of the abrasiveness of dentifrices. Comparisons were made of dentifrices widely sold in the United Kingdom (including some marketed specifically for denture cleaning) and a standard paste.

A series of preventive methods in combination have been used to reduce dental caries in children including dental health education, prophylaxes, pit and fissure sealants, topical application of fluoride and restorative care. Prophylaxes, sealant, and fluoride procedures are repeated every six months. Two-year results show reductions of occlusal caries increments of 74.3% for first graders and 77.1% for sixth graders. Sealant loss, as defined in this study, varied from 33% to 90% with the highest loss occurring in the newly erupted permanent molars during the first six months of the project. These high sealant loss rates are thought to be related to the age of the population which was designed to include children at the ages of peak eruption of permanent molar teeth (ages six and twelve). These teeth were often only minimally erupted and maintaining the dry field required for sealant retention was extremely difficult. However, in spite of these high rates of sealant loss, caries reduction on occlusal surfaces was highly significant in comparison to that of children who did not receive sealants.

Schoolchildren residing in a fluoride-deficient area were provided either a sodium fluoride (0.1% F) or a non fluoride dentifrice for home use. About half the children provided each type of dentifrice were also given an initial prophylaxis. Combining the data with regard to the type of dentifrice indicated that the sodium fluoride dentifrice resulted in dental caries reductions of 24 and 26% as noted by the two examiners, respectively.

The cariostatic potentiality of an acidulated phosphate fluoride-pumice prophylactic paste was tested on children in grades 5 through 7 in a fluoridated community and in a nonfluoridated community. Measurements of effectiveness were made by one examiner without the use of radiographs; a second examiner made the measurements with and without the use of radiographs. The only significant differences (

enzyme superoxide dismutase, converts 02 (superoxide radicals) to H202 and 02 (I. Goda etal., Biochem Biophy Res Comm 48:660-666, 1974). Palosein or Orgotein is a zinc-and copper-containing protein which occurs in bovine liver and has very high superoxide dismutase activity (Diagnostic Data, Inc., Mountainview CA). It shows anti-inflammatory effects in standard models of induced inflammation such as an adjuvant-induced polyarthritis and inflamed paw procedures using carrageenin, yeast, silver nitrate and cotton pellet-induced granuloma. Purified Palosein is a poor antigen and appears to be safe for repeated parenteral application (S. Carson et al., Toxicology Appl Pharmacol 26:184, 1973). It has been tested in animals as an antiinflammatory agent and has also been found to relieve osteoarthritis in humans (K. Lund Oleson et al., Curr Therap Res 16:706, 1974). In addition, Palosein has a shelf life of more than one year at room temperature. Because of the above interesting properties of the agent, we tested its effects on plaque-induced gingivitis in beagle dogs. Eight registered beagle dogs 14 to 16 months of age were given a complete dental prophylaxis with pumice and rubber cups. Disclosing solution was used to insure a complete removal of soft and hard dental deposits. The animals were then kept on soft diets for six weeks in order to permit plaque accumulation and development of gingivitis. At the end of the six-week period, gingivitis was assessed by the gingival index of Loe and Silness (Acta Odont Scand 21:551553, 1963) on these teeth: 1M, 4p, 3p, 2p, 1C and M1, P4, P3, and P2 and C1. Number of bleeding units was also assessed (Miihlemann and Son, Helv Odont Acta 15:107-113, 1971). Crevicular fluid flow was measured with the Periotron (Harco Electronics, Winnipeg, Canada) on 4P, 'C, P4 and C1. The groups were balanced on the basis of crevicular fluid flow. After having baseline