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Introduction: Guidelines regarding postsurgical dental care have been common in adult total joint arthroplasty patients despite limited supporting evidence in the literature. There is anecdotal evidence that similar precautions are implemented frequently in postoperative pediatric orthopaedic patients without any published evidence to guide clinicians. Methods: A survey of the Active Members of the Pediatric Orthopaedic Society of North America (POSNA) was performed to assess the use of postsurgical guidelines regarding dental care (procedures and prophylaxis) in pediatric patients. A 20-question survey regarding this subject was developed with the input of, and approved by, the Evidence-Based Practice Committee of POSNA, and a link to participate was distributed to the Active Membership. Results: One hundred seventy-three POSNA Members opened the link to the survey. One hundred sixty-three respondents self-identified as Active, for a response rate of 19.8%. One hundred fifty-seven (96.3%) reported direct involvement in surgical and postsurgical care of pediatric orthopaedic patients. Sixty-two (39.4%) indicated use of a postoperative protocol regarding dental interventions. Forty percent of those indicating use of guidelines were uncertain of the specifics of the protocol(s) used at their institution. Eighty-five percent of those utilizing protocols felt that the use of guidelines was a valuable topic for investigation. Conclusions: These results demonstrate that many of the active Members of POSNA utilize postsurgical guidelines for dental care, particularly for those patients who have undergone spinal surgery with permanent implants. This is despite the fact that there is limited evidence to support their use in adult total joint patients and no literature regarding use of such guidelines in pediatric orthopaedic patients. Key Concepts: (1) There is limited and contradictory evidence that postsurgical dental guidelines are indicated in adult orthopaedic patients. (2) There is no published evidence supporting postsurgical dental guidelines in pediatric orthopaedic patients. (3) Almost 40% of active Pediatric Orthopaedic Society of North America Members responding to a survey appear to utilize postsurgical dental care guidelines in pediatric patients, particularly after spinal procedures utilizing implants. Level of Evidence: Level V

Background: Prosthetic joint infection (PJI) of total hip (THA) or total knee arthroplasty (TKA) after dental procedures is uncommon, and antibiotic prophylaxis remains controversial. For high-risk patients, the American Academy of Orthopedic Surgeons recommends amoxicillin prophylaxis. However, no systematic review of the literature of PJIs associated with dental procedures explores if amoxicillin is suitable for the reported organisms. Methods: A librarian-assisted search of the major databases (PubMed, Medline, Embase, Scopus) identified 954 articles. Only case reports, case series, and reviews with patient level data were included. After exclusions, 79 articles were fully reviewed. Results: Forty-four PJIs after dental procedures were identified, 22 in primary THA, 20 in primary TKA, one in revision THA, and one in a hip resurfacing procedure. Antibiotic prophylaxis was documented for 5 patients. The dental procedure was invasive in 35 (79.5%). Comorbidities were present in 17 patients (38.7%). The organisms reported were Streptococcus spp. in 44%, other aerobic gram-positives in 27%, anaerobic gram-positives in 18%, and gram-negative organisms in 11%. An estimated 46% of organisms may be resistant to amoxicillin. The outcomes of treatment were reported for 35 patients (79.5%). Twenty-seven patients (61.4%) had no clinical signs of PJI at the final follow-up visit. Conclusions: Lower extremity PJI associated with dental procedures is often caused by organisms unlikely to be prevented with amoxicillin. Additional studies are warranted to determine the choice and efficacy of antibiotic prophylaxis to prevent dental-associated PJI in the highest risk patients. Insufficient data exist to recommend the optimal treatment for patients with PJI in THA and TKA associated with dental procedures.

Objectives: Growth in rates of preventive services has been linked to trends in retention of teeth and the emergence of minimal intervention approaches. In this study, we examined associations between patient-level characteristics and rates of the preventive services dental/prophylaxis and application of remineralisation agents., Methods: A random sample of dentists in Australia was posted a self-administered questionnaire in 2009-2010. A service log was used to collect data on preventive services and patient characteristics., Results: Responses were obtained from 1,148 dentists (response rate = 67%). Preventive service rate models, adjusted according to the age and gender of patients, indicated that insured patients had higher rates of prophylaxis [rate ratio (RR) = 1.39; 95% confidence interval (95% CI): 1.21-1.59) and remineralisation services (RR = 1.85; 95% CI: 1.46-2.33), and that emergency visits had lower rates for prophylaxis (RR = 0.26; 95% CI: 0.20-0.35) and remineralisation services (RR = 0.23; 95% CI: 0.14-0.38). Those who had 20 teeth or more demonstrated higher rates of prophylaxis (RR = 1.41; 95% CI: 1.13-1.75) and remineralisation services (RR = 1.45; 95% CI: 1.02-2.08). Those with decayed teeth had lower rates of prophylaxis (RR = 0.54; 95% CI: 0.46-0.63) and remineralisation services (RR = 0.66; 95% CI: 0.53-0.82)., Conclusions: Preventive services were associated with patient age, characteristics of visits and oral health. Patients who were worse off, in terms of attending an emergency visit for the relief of pain and having decayed teeth, had lower rates of preventive care. The findings indicate that patients most in need are missing out on the benefits of preventive dental services., (© 2016 FDI World Dental Federation.)

Objective: This clinical study evaluated the color longevity after one-year of at-home bleaching with 10% carbamide peroxide (CP) in smokers and nonsmokers., Methods: Sixty patients, 30 smokers and 30 non-smokers were subjected to bleaching with 10% CP during three hours daily for three weeks. The color was measured at baseline and one week, one month and one year after the completion of dental bleaching using the spectrophotometer Vita Easyshade (ΔE*), shade guide Vita classical organized by value and Vita Bleachedguide 3D-MASTER (ΔSGU). In the one-year recall, the color was assessed before and after dental prophylaxis with Robinson brush and prophylaxis paste. Data from color evaluation were analyzed by two-way repeated measures ANOVA and Tukey's test for the contrast of means (α=0.05)., Results: Twenty-seven smokers and 28 non-smokers attended the one-year recall. For both study groups, only the main factor assessment time was statistically significant for ΔSGU (Vita classical) and ΔE* (p<0.001). Effective whitening was observed for both groups at baseline, which was stable at one-month and one year after dental prophylaxis. A slight darkening was observed after one year when the color was measured without prophylaxis. For the Vita Bleachedguide 3D-MASTER, color rebound was observed irrespectively of dental prophylaxis., Conclusion: The bleaching with 10% CP remained stable in both groups as long as extrinsic stains from diet and cigarette smoke were removed by professional dental prophylaxis., Clinical Trials Registry: NCT02017873., Clinical Relevance: The results of this study indicate that the bleaching is effective in smokers even after one-year, but dental prophylaxis may be necessary to remove extrinsic stains caused by diet and smoking., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: The 2007 American Heart Association (AHA) guidelines for the prevention of infective endocarditis (IE) called for a major reduction in the number of patients recommended for antibiotic prophylaxis (AP) and redefined the dental procedures considered to put these patients at risk of acquiring the infection. The purpose of the authors' study was to determine the acceptance of these changes among and the impact of the changes on dentists and their patients., Methods: The authors sent a survey to a random sample of 5,500 dentists in the United States., Results: Ninety-five percent of the 878 respondents indicated that they saw patients who receive AP. More than 75 percent were either satisfied or very satisfied with the AHA guidelines, and the respondents indicated that they believed almost three-quarters of their patients also were pleased. Seventy percent of dentists, however, had patients who took antibiotics before a dental procedure even though the guidelines no longer recommend it., Conclusions: Acceptance of the 2007 guidelines appears to be high, but controversy remains. Additional scientific data are needed to resolve these issues., Practical Implications: The 2007 AHA guidelines have greatly simplified the identification of patients who need AP for dental procedures, given that, in general, far fewer people with cardiac abnormalities are considered to be at risk as a result of invasive procedures. Some physicians, however, continue to prescribe antibiotics for some patients whom the AHA no longer considers to need them. Patients also may choose to continue this practice themselves. There is ongoing controversy surrounding this common clinical question in dental practice, and the next guidelines from the AHA may change on the basis of data from future clinical studies.

Introduction: The purpose of this research was to demonstrate the potential of the optical coherence tomography technique on the evaluation of changes and damages in the enamel structure caused by debonding and cleanup procedures., Methods: Twin metal and ceramic brackets were bonded to the labial enamel surfaces of 120 incisors; the brackets were debonded 24 hours later. The anterior surfaces of the teeth were scanned, and optical coherence tomography images were captured in 2-dimensional and 3-dimensional modes before and after debonding and cleanup. A commercial spectral domain optical coherence tomography system with a 5-μm axial spatial resolution was used. The system is based on the Michelson interferometer setup. It is connected to a preconfigured personal computer, and the images are captured with a scanner probe that controls the light beam position at the sample. A total of 960 images were evaluated., Results: The analysis of the 2-dimensional and 3-dimensional images obtained with optical coherence tomography allows observation and evaluation of adhesive remnants, enamel damage, and superficial aspects of enamel from different methods of adhesive remnant removal. The 2-dimensional optical coherence tomography analysis allows in-depth observation of the adhesive remnant layer., Conclusions: Optical coherence tomography can be a powerful tool for academic and clinical applications for the evaluation of debonding procedures., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: In this study, we assessed the changes in bisphenol A (BPA) levels in saliva and urine after placing lingual bonded retainers., Methods: Liquid chromatography/mass spectrometry was used to examine the BPA levels in the saliva and urine samples collected from 22 volunteers who received a lingual bonded retainer on their mandibular dentition. Samples were collected immediately before placement and 30 minutes, 1 day, 1 week, and 1 month after placement. The time elapsed after placement, type of resin composite (nanohybrid filled flowable resin or conventional hybrid resin), surface prophylaxis, age, and sex were evaluated for their effects on the BPA levels., Results: The only significant high level of BPA was observed in the saliva collected just after placement of the lingual bonded retainer. Age and sex did not affect the BPA levels. Subjects in the flowable resin group had lower BPA levels than those in the conventional hybrid resin group; pumice prophylaxis decreased the level of BPA released from the conventional hybrid resin at the immediate time point. The salivary BPA level (maximum, 20.889 ng/mL) detected in the samples collected just after placement was far lower than the reference daily intake dose., Conclusions: Accordingly, the potential toxicity of BPA from placing lingual bonded retainer might be negligible. On the other hand, because the health-effective amount of BPA is controversial, BPA release should be minimized., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: The purposes of this in-vivo study were to compare the modes of failure of uncoated and adhesive precoated metal brackets by using the adhesive remnant index, and to assess the quality of the enamel surface after cleanup by using the enamel damage index., Methods: Twelve Victory brackets (group A) and 12 Victory adhesive precoated brackets (group B) (both, 3M Unitek, Monrovia, Calif) were bonded onto the maxillary second premolars of 12 volunteers. The uncoated brackets were bonded with Transbond XT adhesive resin (3M Unitek). Replicas of the teeth were made before bonding (T0), after bracket removal (T1), and after cleanup (T2). Scanning electron microscope images of all labial enamel surfaces were taken at T0, T1, and T2, and these were evaluated according to the adhesive remnant index and the enamel damage index., Results: Evaluation of the adhesive remnant index scores with the chi-square test showed no statistically significant difference between the groups. Evaluation of the enamel damage index grades with the sign test for paired samples showed a statistically significant difference (P <0.01) between T0 and T2., Conclusions: Uncoated and precoated brackets exhibited similar debonding patterns. Additionally, the debonding method tested in this study did not restore the original enamel surface, although there was no clinically relevant enamel damage., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Objectives: The objectives of this study were to define the incidence, pain, and healing in cancer patients treated with intravenous bisphosphonates., Study Design: The study included long-term follow-up of 99 bisphosphonate-using patients (group A) and conservative treatment of 67 patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ, group B) using 3 antibiotic schemes and oral hygiene., Results: The frequency of zoledronic acid single-agent use was 85.9% and 69.8% in group A and B, respectively. Median follow-up was 13 months (group A) and 16 months (group B). Two patients in group A developed BRONJ (2%). Of those with BRONJ in group B who completed follow-up, healing occurred in 14.9% (7/47) and pain subsided in 80.9% (38/47). Healing was significant in patients who received pamidronate followed by zoledronic acid (P = .023) and with BRONJ stages 0 and stage I (P = .003)., Conclusions: This case series suggests that oral hygiene and conservative antibiotic therapy play a role in healing and pain alleviation in BRONJ. Oral hygiene and follow-up may decrease incidence of BRONJ., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Objectives: To assess the ability of 0.1%w/w o-cymen-5-ol/ 0.6%w/w zinc chloride gel to foam dentifrice to maintain gingival health compared to a sodium fluoride control dentifrice., Design: Following a baseline examination, subjects went through a regimen to bring them to a high level of gingival health. This involved a professional dental prophylaxis supported by oral hygiene instruction prior to commencing study treatment. Subjects brushed twice daily for 12 weeks with either the test or control dentifrice. Examinations for gingival inflammation (MGI), bleeding and plaque were performed after 12 weeks., Results: 205 subjects were included in the efficacy analysis. Relative to the sodium fluoride/ silica control dentifrice group the o-cymen-5-ol/ zinc chloride gel to foam dentifrice exhibited statistically significant reductions (p<0.0001) in MGI, bleeding and plaque of 32.2%, 26.3% and 20.7% respectively after 12 weeks., Conclusion: The results of the present clinical study demonstrate that the use of the 0.1%w/w o-cymen-5-ol/ 0.6%w/w zinc chloride gel to foam dentifrice over a 12 week period provides a statistically significant benefit in maintaining gingival health compared to a sodium fluoride control dentifrice., (© 2011 FDI World Dental Federation.)

Oral hygiene habits are strongly associated with general health behaviours; good oral self care should result in good dental health. Clinical dental hygiene services have limited long range probability of success if the patient is not diligent in the daily procedures of personal care to remove and control dental plaque. Therefore, it is important to help make the individual aware of their own ability to control and maintain good oral health after a dental prophylaxis through oral care instruction and the use of select antimicrobials to maintain the gingival health. This paper reviews the evidence outlining the relative roles of prophylaxis and correct oral self-care in maintaining gingival health., (© 2011 FDI World Dental Federation.)

Objective: To evaluate the novel assessment of gingival contour volume measurement from digital impressions compared with traditional clinical indices (Modified Gingival Index and Bleeding Index) and oral microflora following a dental prophylaxis., Methods: Following baseline examinations and full mouth digital impression using the LAVA™ Oral Chairside Scanner (COS), subjects had one maxillary quadrant and the contra-lateral mandibular quadrant randomly allocated to receive a complete dental prophylaxis. Subjects then brushed twice daily at home using a standard toothpaste. After 1, 2, 4, 6 and 12 weeks gingivitis examinations and digital impressions of the maxillary and mandibular arches were taken., Results: Significant improvements in gingivitis for the prophylaxis versus no prophylaxis quadrants were observed up to six weeks using both the traditional gingivitis indices and the assessment of change in gingival contour volume from the digital impressions., Conclusion: The assessment of changes in gingival contour volume may be a promising technique for the objective and quantitative clinical evaluation of products or procedures used to treat gingivitis. The effects of a dental prophylaxis were demonstrated by both this novel measure and traditional clinical indices., (© 2011 FDI World Dental Federation.)

Objectives: Being able to predict an individual's risks of dental caries would offer a potentially huge natural step forward toward better oral heath. As things stand, preventive treatment against caries is mostly carried out without risk assessment because there is no proven way to analyse an individual's risk factors. The purpose of this study was to try to identify those patients with high and low risk of caries by using Classification and Regression Trees (CART)., Methods: In this historical cohort study, data from 442 patients in a general practice who met the inclusion criteria were analysed. CART was applied to the data to seek a model for predicting caries by using the following parameters according to each patient: age, number of carious teeth, numbers of cariogenic bacteria, the secretion rate and buffer capacity of saliva, and compliance with a prevention programme. The risks of caries were presented by odds ratios. Multiple logistic regression analysis was performed to confirm the results obtained by CART., Results: CART identified high and low risk patients for primary caries with relative odds ratios of 0.41 (95%CI: 0.22-0.77, p = 0.0055) and 2.88 (95%CI: 1.49-5.59, p = 0.0018) according the numbers of cariogenic bacteria. High and low risk patients for secondary caries were also identified with the odds ratios of 0.07 (95%CI: 0.01-0.55, p = 0.00109) and 7.00 (95%CI: 3.50-13.98, p < 0.0001) according the numbers of bacteria and existing caries., Conclusions: Cariogenic bacteria play a leading role in the incidence of caries. CART proved effective in identifying an individual patient's risk of caries., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

An interdisciplinary approach is often the best option for achieving a predictable outcome for an adult patient with complex clinical problems. This case report demonstrates the combined periodontal/orthodontic treatment for a 49-year-old woman presenting with a Class II Division 1 malocclusion with moderate maxillary anterior crowding, a 9-mm overjet, and moderate to severe bone loss as the main characteristics of the periodontal disease. The orthodontic treatment included 2 maxillary first premolar extractions through forced extrusion. Active orthodontic treatment was completed in 30 months. The treatment outcomes, including the periodontal condition, were stable 17 months after active orthodontic treatment. The advantages of this interdisciplinary approach are discussed. Periodontally compromised orthodontic patients can be satisfactorily treated, achieving most of the conventional orthodontic goals, if a combined orthodontic/periodontic approach is used., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Background: The aim of this split-mouth, randomized controlled trial was to compare the whitening results of at-home and in-office tooth bleaching techniques and the longevity of their effects at nine months after teeth had been bleached., Methods: The authors conducted a study involving a 14-day bleaching period, during which the first maxillary premolars of 17 participants, who were 20 to 25 years of age, were bleached by means of either an at-home technique involving 10 percent carbamide peroxide or an in-office technique involving 38 percent hydrogen peroxide. The authors recorded color variables as proposed by the Commission Internationale de l'Eclairage-lightness (L*), redness (a*) and yellowness (b*)-by using a spectrophotometer at baseline and at one week, one month and nine months after bleaching. They also calculated a whiteness (W) index that was based on the distance of the color value in the color space from a nominal white point., Results: At the nine-month recall visit, comparison between the at-home and the in-office techniques did not show significantly different values for L* (P = .448), a* (P = .350), b* (P = .144) and W (P = .151) color variables. None of the participants experienced any adverse events related to the bleaching during the treatment period., Conclusions: The study results showed no clinically significant difference in bleaching efficacy. Both techniques produced satisfactory and long-lasting bleaching results., Clinical Implications: In young adults, either the at-home or the in-office technique can be used effectively.

Objective: To evaluate the antiplaque/antigingivitis effectiveness of an essential oils containing mouthrinse as compared to a 0.05% cetylpyridinium chloride mouthrinse., Method: Generally healthy subjects with mild to moderate levels of plaque and gingivitis participated in a 6-month, examiner-blind, single centre, randomised, parallel-group controlled clinical trial. They were randomised into three mouthrinse groups--control (C), 0.05% cetylpyridinium chloride (CPC), or a fixed combination of essential oils (EO). Subjects received a dental prophylaxis at baseline and rinsed twice daily in addition to their usual oral hygiene for six months. Plaque Index and Modified Gingival Index were determined at 3 and 6 months., Results: At 6 months, the EO group exhibited statistically significantly lower mean scores for MGI and PI than CPC (32.4% and 56.2% reductions, respectively). Compared to control, EO provided statistically significantly lower mean MGI and PI scores (36.3% and 69.7 %, respectively). The CPC group showed statistically significantly lower mean MGI and PI scores than the C group (5.8% and 30.7%, respectively)., Conclusion: This study demonstrated the superiority of an EO rinse compared to a 0.05% CPC rinse in reducing plaque and gingivitis and confirmed that the daily use of an EO containing mouthrinse can provide a clinically significant benefit in reducing plaque and gingivitis.

Objective: To evaluate and compare the responses of human incisor and premolar pulps after bleaching., Study Design: A bleaching agent with 38% hydrogen peroxide (H(2)O(2)) was applied on the buccal surface of 10 sound lower teeth (G1: 6 premolars; G2: 4 incisors) for 45 minutes. Three premolars and 3 incisors that received only rubber/pumice prophylaxis were used as control groups G3 and G4, respectively. Two days after the bleaching procedure, the teeth were extracted and processed for histologic evaluation., Results: Only in G2 (4 incisors) were any changes in the pulp detected. In the coronal pulp there was a large zone of coagulation necrosis. The radicular pulp showed mild inflammatory changes manifested as an accumulation of mononuclear cells around congested and dilated blood vessels. No pulpal damage was seen in either of the control groups (G3 and G4) or in group G1., Conclusion: Bleaching with 38% H(2)O(2) for 45 minutes causes irreversible pulp damage in lower incisors but not in premolars., (Copyright 2010 Mosby, Inc. All rights reserved.)

Background: The authors describe and evaluate the short-term effectiveness of a community-based program for dental caries prevention in children., Methods: The authors enrolled pupils in the ForsythKids program after receiving informed consent. They targeted children at six Massachusetts elementary schools, grades 1 through 3, with pupil populations at high risk of developing caries. The children underwent examination by dentists using calibrated technique and received comprehensive preventive care from dental hygienists. The authors determined effectiveness by means of comparing results of the initial examination with those of a second examination performed six months later., Results: At baseline, 70 percent of the 1,196 participating children had decayed or filled teeth. More troublingly, 42.1 percent of the primary teeth and 31.1 percent of the permanent teeth had untreated decay. Six months after preventive intervention, the proportion of teeth with new decay was reduced 52 percent in primary teeth and 39 percent in permanent teeth. Furthermore, the percentage of children with newly decayed or restored primary and permanent teeth was reduced by 25.4 percent and 53.2 percent, respectively., Conclusions: These results indicate that this care model relatively quickly can overcome multiple barriers to care and improve children's oral health., Clinical Implications: If widely implemented, comprehensive caries prevention programs such as ForsythKids could accomplish national health goals and reduce the need for new care providers and clinics.

Objectives: The authors aimed to evaluate the utility of an in-office international normalized ratio (INR) testing device in identifying patients with INR test values considered out of the normal range for dental procedures., Methods: This prospective cohort study involved use of an INR testing device to obtain INR test values in the dental office for patients thought to be at risk of experiencing bleeding complications after undergoing invasive dental procedures. The authors recorded demographic, social and medical history data, as well as clinical signs and symptoms of liver disease. The authors considered an INR out of range if it was greater than or equal to 1.4 for patients with potential liver disease and greater than 3.5 for patients receiving warfarin., Results: The authors completed an in-office INR test for 66 patients receiving warfarin whose INR had not been tested within the preceding 48 hours and 34 patients suspected of having liver disease. Eleven (17 percent) patients receiving warfarin and seven (21 percent) patients suspected of having liver disease had INR values considered out of range. Dental treatment was deferred for eight of 11 patients in the warfarin group who had INR values in the range of 3.6 to 7.4, while three others had dental procedures without bleeding complications. Six of seven patients who had documented or suspected liver disease and an out-of-range INR (range 1.5-2.5) underwent their dental procedures without experiencing bleeding complications., Conclusions: Use of an in-office INR test indicated a high incidence of elevated INR values. The results of this study point to the importance of obtaining current INR values before performing invasive dental procedures for patients receiving warfarin therapy whose INR values have not been tested recently, and for patients thought to be at risk of developing or having liver disease.

Background: The authors examine the role of dental disease and nonsurgical dental procedures in the incidence and duration of bacteremia in children., Methods: The authors randomized a group of children to receive amoxicillin or a placebo before dental rehabilitation in an operating room setting. They collected eight blood draws at the following times: two minutes after intubation (draw 1); after dental restorations, pulp therapy and cleaning (draw 2); 10 minutes later (draw 3); and five draws during and after dental extractions (draws 4-8). The authors compared dental disease parameters and the type of dental procedures performed with the incidence and duration of bacteremia., Results: The authors enrolled 100 children (aged 1-8 years) in the study. The incidence of bacteremia from draw 2 was 20 percent in the placebo group and 6 percent in the amoxicillin group (P = .07), and the incidence from draw 3 was 16 percent in the placebo group and zero percent in the amoxicillin group (P = .03). Subjects with higher gingival scores were more likely to have a bacteremia for draw 2 (P = .01). The authors found that subjects in the group with bacteremia for draw 3 had undergone more pulpotomies than did subjects in the group without bacteremia for draw 3 (3 +/- 2.5 standard deviation [SD] versus 1.5 +/- 1.6 SD, P = .04), while they found almost no differences for draw 2., Conclusions: This study suggests that gingival disease has an impact on bacteremia after dental restorations and prophylaxis. Although antibiotics have an impact, they do not eliminate bacteremia altogether.

Background: Although factors affecting perceived dental treatment needs have been investigated, the effect of smoking status on perceptions of dental needs has not been examined., Methods: The authors examined data on 13,227 dentate people aged 20 to 79 years from the Third National Health and Nutrition Examination Survey (NHANES III). Information was collected information on sociodemographic characteristics, cigarette smoking, perceived dental treatment needs and other factors during a home interview, and clinical oral health information was collected at a mobile examination center., Results: In univariate analyses, current smokers were more likely than nonsmokers to perceive dental needs in all categories, except for the need for a dental cleaning. Multivariate regression results indicate that current smokers were more likely to report a need for periodontal treatment and dental extractions compared with nonsmokers (odds ratio [OR] = 1.40; 95 percent confidence interval [CI] = 1.05-1.87 and OR = 1.61; 95 percent CI = 1.22-2.14, respectively). The authors found an interaction between smoking and race/ethnicity in models describing the need for teeth to be filled/replaced and for orthodontic/cosmetic work., Conclusions: Current smokers were more likely to have more perceived dental needs compared with nonsmokers. Practice Implications. These results may be important for the advancement of efforts directed toward tobacco-use cessation programs and to understand factors that could affect dental care utilization.

Purpose: The purpose of this study was to assess the effect of fluoride application at 3 different steps of the bonding process on the shear bond strength and bond failure site of a resin-modified glass ionomer cement., Material: Sixty stainless steel brackets were bonded to bovine incisors with Fuji Ortho LC (GC Europe, Leuven, Belgium) under 4 different enamel conditions: (1) uncontaminated enamel, (2) enamel precleaned with fluoride-containing prophylaxis paste, (3) 1.1% acidulated phosphate fluoride (APF) gel applied immediately before conditioning, and (4) 1.1% APF gel applied immediately before bonding. After bonding, all samples were stored in distilled water for 24 hours and subsequently tested in shear mode on a universal testing machine., Results: No significant differences were found between groups 1 (uncontaminated enamel) and 2 (fluoride application during prophylaxis). Both groups showed significantly greater shear bond strength values than groups 3 (fluoride application before conditioning) and 4 (fluoride application before bonding). Groups 3 and 4 did not differ significantly. Moreover, no significant differences in debond locations were found among the 4 groups., Conclusions: Fluoride application during initial prophylaxis does not affect the bond strength values of Fuji Ortho LC, whereas it significantly lowers bond strength values when applied before both conditioning and bonding.

Background: Despite the common application of dental prophylaxis as part of patient therapy, there is little reported that describes the microbiological impact of this treatment., Methods: The authors gave 20 healthy college-aged subjects three dental prophylaxes with a fluoride-containing prophylaxis paste during a two-week period and instructed them in oral hygiene. They evaluated the microbiological composition of dental plaque samples collected before and after treatment using DNA probe analysis. They analyzed 40 representative bacterial species in seven bacterial complexes by checkerboard DNA-DNA hybridization assay techniques., Results: After three dental prophylaxes, the patients' mean Gingival Index score decreased from 0.82 to 0.77, the mean Plaque Index score decreased from 0.72 to zero, and the total number of bacteria per tooth decreased to approximately one-third of the original number. The authors computed two different measures of bacterial presence. The reduction in bacterial numbers was statistically significant and occurred in many species. Bacterial proportion (DNA percentage or percentage of the bacteria per tooth) did not change significantly. Greater reductions in bacterial count occurred in species that showed high numbers before treatment. The total bacterial count decreased by approximately 72 percent of its original level before prophylaxis was initiated., Conclusions: Professional dental prophylaxis did not target any particular bacteria or bacterial groups but removed bacteria nonspecifically and in proportion to their initial numbers., Clinical Implications: Repeated dental prophylaxes effect a reduction in bacterial amount that is commensurate with the initial amount, but they do does not alter composition. This suggests that mild gingivitis may be a bacterially nonspecific effect of plaque accumulation and emphasizes the need for regular plaque removal to maintain optimal gingival health.

Aim: To examine the effect of supragingival plaque removal in conjunction with different periodontal therapies on subgingival plaque composition in different subject populations., Method: Four different studies are presented which examined the effect of repeated removal of supragingival plaque performed by professionals or by tooth brushing on subgingival plaque composition. The studies were performed in different populations including chronic periodontitis, periodontal maintenance and refractory subjects. For all studies, each subject was examined for clinical parameters at up to 168 sites and subgingival plaque samples were taken from the mesial aspect of each tooth and examined for their content of specific bacterial species using checkerboard DNA-DNA hybridisation techniques., Results: Repeated supragingival plaque removal used in conjunction with scaling and root planing only or combined with other periodontal therapies resulted in improvements in clinical parameters as well as significant decreases in the counts of subgingival species, including those associated with periodontal disease aetiology. Meticulous tooth brushing provided similar clinical and microbial improvements., Conclusions: Meticulous removal of supragingival plaque has beneficial effects on clinical parameters of periodontal disease and on the nature of the microbiota that colonises both above and below the gingival margin and appropriately has been a major focus in the prevention and control of dental diseases, particularly periodontal disease.

Enamel decalcification is a significant problem in orthodontic patients. The argon laser has been shown to reduce decalcification during an acidic challenge in vitro. The purpose of this study was to investigate the in vivo effects of argon laser irradiation on enamel decalcification during orthodontic treatment. Nine volunteers whose treatment plans included 4 first premolar extractions were enrolled in the study. The 36 extracted premolars were assigned to 1 of the following 4 groups: group 1, control group with no treatment; group 2 (pumice-laser), teeth were pumiced for 3 seconds and treated with a 325 mW, 5-mm diameter laser beam for 60 seconds; group 3 (pumice-etch-laser), teeth were pumiced for 3 seconds, acid-etched with 30% phosphoric acid for 30 seconds, and treated for 60 seconds with laser; and group 4 (laser only), teeth were treated for 60 seconds with laser. A specially designed (oversized) orthodontic band was fitted on each of the premolars to create a pocket for decalcification. The bands were cemented in place for 5 weeks. After extraction, the teeth were sectioned and examined under polarized light microscopy. Images of lesions were digitally analyzed and measured. Average lesion depths were calculated from 3 depth measurements recorded 10 microm apart. Average lesion area was calculated with the aid of imaging analysis software. Data were analyzed with analysis of variance (P <.05) and Student t tests. Significant differences were found in lesion depth (P <.001) and lesion area (P <.01) among the 4 test groups. The average lesion depths were 15.93 +/- 9.31 microm (control), 6.45 +/- 8.70 microm (pumice-laser), 1.71 +/- 4.82 microm (pumice-etch-laser), and 1.34 +/- 3.80 microm (laser only). The average lesion areas were 1028.67 +/- 725.68 microm (2) (control), 555.49 +/- 948.20 microm (2) (pumice-laser), 79.91 +/- 226.03 microm (2) (pumice-etch-laser), and 55.71 +/- 157.59 microm (2) (laser only). The average lesion depth in the laser-only group was reduced by 94.1% and the average lesion area was reduced by 94.4% when compared with the control group. In the pumice-etch-laser group, the average lesion depth was reduced by 89.1% and the average lesion area was reduced by 92.2% when compared with the control group. There were no significant differences in lesion depth and lesion area between maxillary and mandibular teeth (P <.06 and P <.08, respectively) and between the teeth on the right and left sides (P <.68 and P <.55, respectively). These results show that argon laser irradiation is effective in reducing enamel decalcification during orthodontic treatment. Pumicing and etching do not appear to reduce the effect of laser on enamel solubility.

The purpose of this study was to evaluate the bond strength of rebonded mechanically retentive ceramic brackets. Twenty new and 100 sandblasted rebonded ceramic brackets (Clarity, 3M Unitek, Monrovia, Calif) were bonded to 120 extracted human premolars with composite resin and divided into 6 equal groups according to how the bracket bases were treated: (1) new brackets, (2) rebonded/sandblasted, (3) rebonded/sandblasted/sealant, (4) rebonded/sandblasted/hydrofluoric acid (HF), (5) rebonded/sandblasted/HF/sealant on bracket base, and (6) rebonded/sandblasted/silane. Shear bond strength of each sample was tested with a testing machine. Results showed that the new brackets group had the highest mean strength (15.66 +/- 7.05 megapascals [MPa]), followed by the rebonded/sandblasted/sealant group (7.65 +/- 5.62 MPa), the rebonded/sandblasted/silane group (5.94 +/- 5.33 MPa), the rebonded/sandblasted group (2.97 +/- 2.29 MPa), the rebonded/sandblasted/HF group (1.22 +/- 1.66 MPa), and the rebonded/sandblasted/HF/sealant group (0.82 +/- 1.16 MPa). Statistical analysis showed that only the rebonded/sandblasted/sealant group was comparable with the new brackets group in bond strength (P >.05). It was concluded that in the process of rebonding mechanically retentive ceramic brackets, (1) new brackets have the highest mean bond strength when compared with rebonded brackets, (2) the bond strength of sandblasted rebonded brackets with sealant is not significantly different from new brackets, (3) silane does not increase bond strength of rebonded brackets significantly, and (4) HF treatment on sandblasted rebonded brackets significantly decreases bond strength.

Dental practitioners have traditionally neglected halitosis despite its high priority for the public, but practitioners' interest in halitosis has recently increased. Although oral pathologic or physiologic halitosis is easily reduced by a suitable treatment based on the treatment needs, systemic and psychological conditions sometimes confuse practitioners. Since a halitophobic patient never agrees with the result that his/her oral malodour has been reduced or eliminated after treatment, this may cause a dilemma for practitioners. Generally, halitosis patients, even genuine ones, have different psychological characteristics concerning their own breath than other individuals. Adverse psychological aspects of these patients are often promoted by the practitioner's mismanagement. Treatment Needs (TN) were, therefore, established to prevent practitioners' mismanagement of halitosis patients. By following these TN, patients can receive proper treatments for halitosis. However, to choose proper treatment measures, practitioners must refer to articles published in peer-reviewed journals, then use critical thinking to judge whether a product is effective in reducing oral malodour. Although it is challenging for dental practitioners to deal with patients with psychological conditions such as pseudo-halitosis or halitophobia, if appropriate treatments are administered accurately the practitioner does not risk mismanagement.

This article describes a step-by-step procedure for bonding lower anterior retainers with a rubber dam. Because of a significant rate of failures, the rubber dam was used in order to have a better access to the lingual aspects of lower incisors and canines, while providing dry conditions.

To examine the effectiveness of advising patients who use tobacco to quit, the authors conducted a randomized clinical trial to test a brief office-based intervention with all tobacco users in 75 fee-for-service dental practices in Oregon. The authors found that the dental hygienist-delivered intervention was effective in getting smokeless tobacco users to quit at three and 12 months and to sustain abstinence at both three and 12 months. They found that the program was not effective for cigarette smokers. The authors discuss the public health implications of program dissemination and widespread program adoption.

The purpose of this 30-month study was to explore the effectiveness of a caries-preventive regimen in lowering the salivary mutans streptococci level in pregnant women and, subsequently, in inhibiting the growth of these bacteria in their young children. Beginning at the end of the sixth month of pregnancy and continuing until delivery, subjects rinsed daily with 0.05 percent sodium fluoride and 0.12 percent chlorhexidine. The authors monitored the salivary mutans streptococci levels during the last six months of pregnancy and every six months thereafter for 24 months. They also measured bacterial levels in the children every six months until they reached age 24 months. The results show that treatment significantly reduced salivary mutans streptococci levels in mothers and delayed the colonization of bacteria in their children for about four months.

The rationale for the adjunctive use of chemical anti-plaque agents depends on many factors in addition to the inherent antimicrobial properties of those agents. What is indicated generally is a basic oral hygiene regimen, as simple as it can be, bearing in mind the practical difficulties of getting people to clean their teeth optimally. Chemical adjuncts in many cases have the potential to simplify plaque control regimens. The mode of delivery may be critical to the success or otherwise of an adjunct. Adjuncts may simplify and accelerate the work of hygienists as well as patients. They may also serve to control plaque in severe forms of infectious inflammatory periodontal disease, as well as providing practical means of plaque control in the handicapped, or in those unable to practice optimal conventional home care oral hygiene. Chemical anti-plaque adjuncts offer a prospect of re-establishing the homeostasis of oral microbial biofilms fully consonant with the aims of modern periodontal medicine.

The differences in approach between screening for and diagnosis of periodontal diseases are highlighted. The Periodontal Screening and Recording procedure is discussed in terms of its evolution and current application. For patients screened and found to have more advanced periodontal problems a panoramic dental radiograph with restricted supplemented periapicals are recommended. A comprehensive clinical periodontal examination should be performed for these patients, but it is argued that this may be performed after the initial hygiene phase of treatment. In establishing a diagnosis it is suggested that attention be paid to possible risk exposures. Newer, non-anatomic diagnostic procedures are discussed in principle and it is concluded that these do not have a practical application at present.

Data from CPITN studies indicate that severe periodontitis affects approximately 10 per cent of most populations. These data have remained static for a number of years. Of interest, however, is that despite the dramatic increase in the use of oral hygiene aids, efforts by the dental profession in oral hygiene instruction, and the associated general improvement in oral hygiene levels in the community, the incidence of severe chronic inflammatory periodontal disease has remained largely unaffected. The effects of changing oral hygiene may be reflected in slight shifts in the mild and moderate classifications of periodontal disease but the prevalence of advanced disease in presumably susceptible subjects has remained relatively unchanged. The ramifications of relatively non-specific plaque control measures in the management of advanced disease in susceptible subjects are still unclear and it may not be until the adoption of a more specific approach to the control of specific pathogens which inhabit the subgingival biofilm that major changes in the general incidence of the severe inflammatory periodontal diseases will be seen.

The multimedia portrayals of dentists and dentistry have expanded in scope. Prevention and esthetics have replaced drilling and extraction in the public perception of dental practice. According to the author, dentists themselves are no longer treated exclusively as buffoons or sadists. Instead, he writes, they are more apt to be seen as solid citizens, occasionally as romantic figures and even as complex, realistic human beings.

Concerns about ergonomic risk factors have been growing among health care and other workers. The authors undertook a study to determine the presence of certain ergonomic risk factors in typical tasks performed by dentists and dental hygienists. They further investigated--by means of electromyography and goniometry--the force, frequency and duration of the task. The study suggests that when a task's duration, force and frequency are accounted for, scaling, polishing, flossing and probing activities do not represent exposure to high ergonomic risk.

The Survey Center of the American Dental Association conducts an annual survey of approximately 5 percent of all private practitioners in the United States. This survey is sent to a randomly selected group of dentists in private practice, including general practitioners and specialists and ADA members and nonmembers. It attempts to collect information on various practice characteristics such as work schedules, patient visits, non-dentist staff employment, expenses and wages. Using information from the 1991 to 1995 Survey of Dental Practice reports, this article examines the employment of dental hygienists.

This study compared the effectiveness of three different types of electric toothbrushes, i.e., Interplak, Philips, and Rotadent, with a manual multitufted toothbrush (Blend-a-Med), in removing supragingival plaque and in preventing the development of gingivitis in adolescent patients with fixed orthodontic appliances. A single blind, cross-over, clinical trial was carried out in 36 adolescent patients, randomly divided into four equal groups. Every group tested each type of toothbrush, in a different sequence. Plaque and gingival scores were recorded at baseline and after 1 and 2 months of the test period. All patients received a professional prophylaxis after each clinical evaluation, except during the test period. The analysis of the data was performed with the nonparametric Friedman test. The results demonstrated, in essence, for all parameters that the manual toothbrush was the most effective. Of the three electric toothbrushes tested, the Philips toothbrush seemed to give slightly better results than the Interplak toothbrush, whereas Rotadent very clearly gave results inferior to all others. Personal preference on the four toothbrushes used revealed that the group as a whole least preferred a manual brush. However, the answers on the questionnaire did not always show a logical consistency. Therefore it should be interpreted with some caution.

In a retrospective study, the authors evaluated the effectiveness of periodontal treatment in preventing tooth loss in patients with moderate to advanced periodontitis. Patients had received maintenance therapy for an average of 12.5 years. Of the 2,899 teeth present after active treatment, 152 were lost to periodontal disease and 68 were lost to other causes during maintenance therapy. The authors evaluated causes and patterns of tooth loss after surgical vs. nonsurgical treatment. Surgery did not significantly improve tooth retention in the high-risk patients. This study and other retrospective studies suggest that tooth loss may be related more to the type of periodontal disease present than to the treatment rendered.