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Background It is hard to prevent 5-fluorouracil (5-FU) related oral mucositis (OM). The aim of this study was to determine the association between dental prophylactic modalities and the risk of OM in HNC patients with 5-FU-related treatment. Methods During 2000 to 2008, 20,715 HNC (ICD-9-CM 140-149) patients with newly 5-FU-related chemotherapy were selected from the registry of LHID-CIP, and the date of 5-FU therapy initiation was defined as the index date. These HNC patients were stratified into three groups according to their cancer locations: oral cancers (ICD-9-CM 140-145), nasopharyngeal cancer (NPC, ICD-9-CM 147) and other cancers (ICD-9-CM 146, 148 and 149).The end date was defined as the date of OM diagnosis, withdrawal from the NHI program, or the 21thday after the day of 5-FU therapy initiation, whichever came first. Patients with OM diagnosis (ICD-9 CM 528.00, 528.01, 528.2, and 528.9). The records of dental treatment was determined for each patient within 180 days prior to the index date, which included fluoride gel application, chlorhexidine mouth rinse, scaling, and major oral surgery. Based on the different dental prophylactic modalities, all HNC subjects were stratified into different groups. Odds ratios (OR) and 95% confidence intervals (CI) were determined by multiple logistic regression model. Results 13,969 HNC participants, including 482 5-FU-related OM subjects and 13,487 controls were enrolled. Fluoride gel application and scaling were significantly related to OM development (p Conclusions This study highlighted a remarkable association between dental prophylactic modalitiesand the risk of 5-FU-related OM in HNC population.Clinical practitioners have to be vigilant about the joint effect of scaling and fluoride gel application in the increased risk of OM. Optimal timing of scaling and appropriate fluoride gel application strategy are necessary in reducing the risk of 5-FU-related OM. Editorial acknowledgement This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037), NRPB Stroke Clinical Trial Consortium (MOST 105-2325-B-039-003), Chang Gung Memorial Hospital (CMRPG3I0151), Far Eastern Memorial Hospital (FEMH-2019-C-039), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

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.

The American Heart Association (AHA) published updated infective endocarditis (IE) prevention guidelines in 2007 and continued to recommend antibiotic prophylaxis (AP) prior to invasive dental procedures for “high risk” (HR) IE patients. We therefore evaluated dental office records in Olmsted

Prophylactic instruments may cause surface deterioration of metal crown margins, which could cause or aid the retention and accumulation of plaque. In this investigation, highly polished metal disks of high content gold (RX Y), low content gold (Aspen), silver palladium (RX 91), and nickel-chrome alloy (REX III) had their surfaces tracked with an explorer, hand scaler, curette, and a Dentsply Cavitron instrument. The surface roughness was measured with a profilometer. The results indicate that the high content gold was the least resistant to surface deterioration and the ultrasonic scaler caused the most surface deterioration to all the metals.

Article Title and Bibliographic Information Efficacy of dental prophylaxis (rubber cup) for the prevention of caries and gingivitis: a systematic review of literature. Azarpazhooh A, Main PA. Br Dent J 2009;207:E14. Reviewer Alice M. Horowitz, PhD Purpose/Question To determine the efficacy of rubber cup prophylaxis before the application of fluoride for the prevention of dental caries or at a regular recall appointment for the prevention of gingivitis Source of Funding Information not available Type of Study/Design Systematic review Level of Evidence Level 1: Good-quality, patient-oriented evidence Strength of Recommendation Grade Grade A: Consistent, good-quality patient-oriented evidence

Dental prophylaxis, today considered one of the most important services of the profession, has not always been regarded as a significant aspect of dentistry by practitioners as well as by patients.

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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.

Objective Investigating patients’ perceptions regarding need for antibiotic prophylaxis during dental procedures after undergoing joint arthroplasty. Methods Questionnaire was administered to patients presenting at: 1)an orthopaedic office; 2)a dental office; regarding perceptions of antibiotic prophylaxis. Results 36 orthopaedic patients responded “Yes” to always taking prophylaxis; 36 patients responded “No” (36/72, 50.0% compliance). Five dental patients responded “Yes” to always taking prophylaxis; 19 patients responded “No” (5/24, 20.8% compliance) (p = 0.017). 67/135 orthopaedic patients (49.6%) endorsed some form of dental prophylaxis, versus 34/58 dental patients (58.6%) (p = 0.27). Conclusion Patient perceptions of the need for dental prophylaxis vary within orthopaedic and dental practices.

Introduction The objective of this 2-arm parallel trial was to determine the plaque removal efficacy (main outcome) and the motivation assessment (secondary outcome) comparing a manual versus an interactive power toothbrush in orthodontic patients. Methods Sixty adolescents with fixed orthodontic appliances in both arches were randomized in a 1:1 ratio in this parallel, randomized, examiner-blind controlled clinical trial. Eligibility criteria included at least 16 natural teeth, 1-6 “focus care areas,” plaque score of ≥1.75, no severe caries, gingivitis and periodontitis, no dental prophylaxis, no smoking, no antibiotics, and no chlorhexidine mouth rinse. Subjects were to brush unsupervised with either an interactive power toothbrush (Oral-B Professional Care 6000, D36/EB20) with Bluetooth technology or a regular manual toothbrush (Oral-B Indicator 35 soft). Focus care areas were each brushed for 10 additional seconds. Plaque removal was assessed with the use of the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI) to determine change from baseline at 2 and 6 weeks. Supervised brushing at screening and post-treatment visits recorded actual brushing times. Subject-reported motivational aspects were recorded at screening and week 6. Results Fifty-nine subjects aged 13-17 years completed the study. The interactive power toothbrush provided significantly (P Conclusions An interactive power toothbrush generated increased brushing times and significantly greater plaque removal versus a manual brush.

Objectives: This study tested the efficacy of a toothpaste containing enzymes and proteins reflecting those naturally occurring in saliva which play an important role in maintaining bacterial balance to improve gingival health condition and reduce supra-gingival plaque formation over a period of 13 weeks as compared to a commercial control toothpaste.Methods: This study was a double-blind, randomised, parallel group, 3 month home use study in healthy volunteers. Non-smokers with a mean modified gingival index (MGI) score of between 2.00 – 2.75 and at least 20 natural teeth, a minimum of 5 teeth in each quadrant were enrolled in the study. At screening, participants underwent a dental prophylaxis and were issued with a standard fluoride toothpaste and toothbrush to use for 4 weeks. After 4 weeks, participants demonstrating ongoing eligibility were assessed for gingival health and plaque score and randomised to either test or control toothpaste, which they used at home twice daily. After 13 weeks, gingival health and plaque were re-scored. Results: 229 participants completed the study. There were no treatment associated adverse events. Plaque and gingival scores were significantly better in the test group as compared to the control group. Furthermore, in the test group plaque and gingival scores fell, while those in the control group rose over the 13 week period.Conclusions: The test toothpaste containing enzymes and proteins demonstrated significant plaque and gingival benefit compared to the control toothpaste, and was well tolerated. Clinical SignificanceToothbrushing with the test product derived from naturally occurring enzymes and proteins had a clinical adjunctive improvement on gingival health compared to brushing alone with a commercially available fluoride toothpaste.The study was registered on the ClinicalTrials.gov database (identifier: NCT03027908)

Objective The aim of this study was to determine the incidence of bacteremia resulting from dental cleaning and of subsequent established bloodstream infection (BSI) caused by oral microorganisms in patients with cancer with central venous catheters (CVCs). Study Design Twenty-six patients with cancer with CVCs and absolute neutrophil count over 1000 cells/µL received dental cleaning without antibiotic prophylaxis. Periodontal status was assessed at baseline by using the Periodontal Screening and Recording (PSR) score. Blood cultures were drawn via the CVCs at baseline, 20 minutes into cleaning, and 30 minutes and 24 hours after cleaning. Medical records were monitored for 6 months. Results Baseline blood culture results were negative in 25 patients. Nine of 25 patients (36%) had positive blood culture 20 minutes into cleaning, all associated with at least 1 microorganism typically found in the mouth. These 9 patients had significantly higher mean PSR score (3.22) compared with the other 16 (2.56; P = .035). These expected bacteremias did not persist, with blood culture results (0/25) at 30 minutes and 24 hours after cleaning showing no positivity (P = .001). There were no cases of CVC-related infection or BSI attributable to dental cleaning. Conclusions Bacteremia resulting from dental cleaning is transient and unlikely to cause CVC-related infection or BSI in patients with absolute neutrophil count greater than 1000 cells/µL.

Summary Introduction Joint implant infection rates range between 0.5% and 3%. Contamination may be hematogenous, originating in oro-dental infection and, as in endocarditis, antibiotic prophylaxis has been recommended to cover oro-dental surgery in immunodepressed patients with joint implants less than 2 years old, despite the lack of any formal proof of efficacy. In this context, the cost and side effects of such prophylaxis raise the question of its real utility. Materials and methods A search of Pubmed was performed using the following keywords: prosthetic joint infection, dental procedure, antibiotic prophylaxis, hematogenous infection, dental infection, bacteremia, and endocarditis. Six hundred and fifty articles were retrieved, 68 of which were analyzed in terms of orthopedic prosthetic infection and/or endocarditis and oro-dental prophylaxis, as relevant to the following questions: frequency and intensity of bacteremia of oro-dental origin, frequency of prosthetic joint infection secondary to dental surgery, and objective efficacy of antibiotic prophylaxis in dental surgery in patients with joint implants. Results Bacteremia of oro-dental origin is more frequently associated with everyday activities such as mastication than with tooth extraction. Isolated cases of prosthetic contamination from dental infection have been reported, but epidemiological studies in joint implant bearers found that absence of antibiotic prophylaxis during oro-dental surgery did not increase the rate of prosthetic infection. The analysis was not able to answer the question of the efficacy of dental antibiotic prophylaxis in immunodepressed patients; however, oro-dental hygiene and regular dental treatment reduce the risk of prosthetic infection by 30%. Discussion and conclusion The present update is in agreement with the conclusions of ANSM expert group, which advised against antibiotic prophylaxis in oro-dental surgery in implant bearers, regardless of implant duration or comorbidity: the associated costs and risks are disproportional to efficacy. Level of evidence and type of study Level V; expert opinion.

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.

Late periprosthetic joint infection (PJI) occurs in 0.3%–1.7% of total hip arthroplasties (THAs) and 0.8%–1.9% of total knee arthroplasties (TKAs). Surgical debridement, explant, and appropriate antibiotics are imperative for successful treatment. We analyzed organisms from PJIs at one institution for temporal trends over 14years. Poisson regression model demonstrated a linear increase in infection rate for the following bacteria as the primary organism: MRSA (incidence rate ratio [IRR]=1.11, P =0.019), Streptococcus viridans (IRR=1.18, P =0.002), and Propionibacterium acnes (IRR=1.21, P =0.024). The increase in proportion of these organisms may warrant further discussion on pre-surgical MRSA screening and empiric therapy to include MRSA coverage, increased incubation time to detect P. acnes , and dental prophylaxis against S. viridans .

Background The aim was to assess the efficacy of antimicrobial photodynamic therapy (aPDT) in the treatment of aggressive periodontitis (AgP). Methods The addressed focused question was “Is aPDT effective in the treatment of AgP?” MEDLINE/PubMed, EMBASE, Scopus, ISI Web of knowledge and Google-Scholar databases were searched from 1977 till May 2015 using combinations of the following keywords: antimicrobial; photochemotherapy; photodynamic therapy; photosensitizing agents; AgP; scaling and root-planing (SRP). Reviews, case reports, commentaries, and articles published in languages other than English were excluded. Results Seven studies were included. In 5 studies, aPDT was performed as an adjunct to SRP. Laserwavelengths and duration of irradiation ranged between 660–690 nm and 60–120 s, respectively. Laser power output as reported in 2 studies was 75 mW. One study showed significant improvement in periodontal parameters for subjects receiving aPDT as an adjunct to SRP as compared to treatment with SRP alone at follow up. However, comparable periodontal parameters were reported when aPDT as an adjunct to SRP was compared to SRP alone in the treatment of AgP in one study. One study showed comparable outcomes when aPDT was compared to SRP in the treatment of AgP. In two studies, adjunctive antibiotic administration to SRP showed significantly better outcomes when compared to application of adjunctive use of aPDT to SRP. Conclusion aPDT is effective as an adjunct to SRP for the management of AgP, however, further randomized clinical trials with well defined control groups are needed in this regard.

Background Although hepatitis B virus (HBV) transmission in dental settings is rare, in 2009 a cluster of acute HBV infections was reported among attendees of a two-day portable dental clinic in West Virginia. Methods The authors conducted a retrospective investigation by using treatment records and volunteer logs, interviews of patients and volunteers with acute HBV infection as well as of other clinic volunteers, and molecular sequencing of the virus from those acutely infected. Results The clinic was held under the auspices of a charitable organization in a gymnasium staffed by 750 volunteers, including dental care providers who treated 1,137 adults. Five acute HBV infections—involving three patients and two volunteers—were identified by the local and state health departments. Of four viral isolates available for testing, all were genotype D. Three case patients underwent extractions; one received restorations and one a dental prophylaxis. None shared a treatment provider with any of the others. One case volunteer worked in maintenance; the other directed patients from triage to the treatment waiting area. Case patients reported no behavioral risk factors for HBV infection. The investigation revealed numerous infection control breaches. Conclusions Transmission of HBV to three patients and two volunteers is likely to have occurred at a portable dental clinic. Specific breaches in infection control could not be linked to these HBV transmissions. Practical Implications All dental settings should adhere to recommended infection control practices, including oversight; training in prevention of bloodborne pathogens transmission; receipt of HBV vaccination for staff who may come into contact with blood or body fluids; use of appropriate personal protective equipment, sterilization and disinfection procedures; and use of measures, such as high-volume suction, to minimize the spread of blood.

A systematic review of the literature was undertaken to assess the evidence to support a specific time interval between periodontal maintenance (PM) visits.Relevant articles were identified through searches in MEDLINE, EMBASE and PubMed using specific search terms, until April, 2014, resulting in 1095 abstracts and/or titles with possible relevance. Critical Appraisal Skills Programme (CASP) guidelines were used to evaluate the strength of studies and synthesize findings. If mean recall interval was not reported for study groups, authors were contacted to attempt to retrieve this information.Eight cohort studies met the inclusion criteria. No randomized control trials were found. All included studies assessed the effect of PM recall intervals in terms of compliance with a recommended regimen (3-6 months) as a primary outcome. Shorter PM intervals (3-6 months) favored more teeth retention but also statistically insignificant differences between RC and IC/EC, or converse findings are also found. In the 2 studies reporting mean recall interval in groups, significant tooth loss differences were noted as the interval neared the 12 month limit.Evidence for a specific recall interval (e.g. every 3 months) for all patients following periodontal therapy is weak. Further studies, such as RCTs or large electronic database evaluations would be appropriate. The merits of risk-based recommendations over fixed recall interval regimens should be explored.

Objective The aim of this study was to record preventive oral health care planned by dental therapists and oral health therapists (therapists) for patients with poor oral hygiene undergoing orthodontic treatment. Materials and methods A cross-sectional survey, using a clinical vignette of a patient with poor oral hygiene undergoing therapy with a fixed appliance, was undertaken to record the preventive care offered to this individual by therapists working across 15 Local Health Districts (LHDs). This orthodontic vignette was inserted between two dental caries-related vignettes. Data were coded and descriptive statistics were used to report the findings. Results One-hundred and seventeen therapists returned questionnaires (giving a response rate of 64.6%), of whom 82.0% (n = 95) completed the orthodontic vignette. Adopting motivational interviewing techniques to facilitate communication with the patient and their parent was recommended by 88.4% (n = 84) respondents, 98.0% (n = 93) offered oral-hygiene instruction, 70.5% (n = 67) recorded plaque levels and used disclosing solution and 60.0% (n = 57) offered dietary advice. Products recommended for use at home included fluoride toothpaste [1,450 ppm F (80.0%; n = 76) and 5,000 ppm F (59.0%; n = 24)] and casein phosphopeptide amorphous phosphates plus fluoride (CPP-ACPF) paste (33.3%; n = 32). Less than 20% offered fissure sealants. Conclusion Preventive advice and care was offered inconsistently by therapists in this study. To ensure that all therapists adopt a scientifically based approach to prevention, LHD clinical directors should implement continuous professional education programmes for therapists to improve patient's health outcomes.

Background The design of periodontal curette handles may cause or aggravate arm pain in dental practitioners. The authors conducted a four-month randomized controlled trial to evaluate the effects of curette handle diameter and weight on arm pain among dental hygienists and dentists. Methods One hundred ten dental hygienists and dentists who performed scaling, root planing or dental prophylaxis procedures participated in this study. The authors assessed right wrist/hand, elbow/forearm and shoulder pain levels weekly. They randomized participants to receive either a set of light (14 grams) periodontal curettes with a large diameter (11 millimeters) or a set of heavy (34 g) periodontal curettes with a narrow diameter (8 mm). The authors compared changes in mean pain scores across the study period between intervention groups by using general linear models and controlling for covariates. Results The improvement in pain scores across the three body regions was greater for participants who used the lighter, wider-diameter curettes. In the final adjusted model, the differences were statistically significant only for the shoulder region ( P = .02). Conclusions The study results show that dental instrument design has an effect on upper-extremity pain in dental practitioners. Using a lighter instrument with a wider diameter may be an easy and cost-effective intervention to reduce or prevent upper-extremity pain associated with dental hygiene procedures. Clinical implications To prevent or reduce arm pain, practitioners should consider using lightweight instruments with large diameters when performing scaling and root planing procedures.

Nosocomial and ventilator associated pneumonias that plague critically ill, elderly and long-term care residents could be reduced with effective oral hygiene practices facilitated collaboratively between nurses and dental hygienists. Background Nosocomial pneumonias, specifically aspiration pneumonias and ventilator-associated pneumonias in the elderly and infirm have become a major health care issue, The provision of oral care in hospital and hospital-like facilities presents challenges that can prevent patients from receiving optimal oral care One sequela can be aspiration pneumonia which ranks first in mortality and second in morbidity among all nosocomial infections. Since aspiration pneumonia is linked to the colonization of oral bacteria in dental plaque and biofilm, it is time to look for creative solutions to integrating the expertise of dental hygienists into health care teams in these institutional settings. Methods A comprehensive review of the literature was conducted regarding the etiology and prevalence of health care related pneumonias. Evidence describing the challenges and barriers that the nurses, nursing staff, and dental hygienists face in the provision of oral care in hospitals and long-term care facilities is provided. Intercollaborative solutions to providing optimal oral care in hospitals and long-term care facilities are suggested. Conclusion Dental hygienists have the expertise and practice experience to provide oral care in hospitals, long-term care and residential facilities. They can contribute to solving oral care challenges through intercollaboration with other health care team members. Yet, there are long-standing systemic barriers that must be addressed in order to provide this optimal care. Dental hygienists becoming better assimilated within the total health care team in hospital and residential facilities can positively impact the suffering, morbidity and mortality associated with aspiration pneumonias.

Background. The authors report adverse events (AEs) related to the use of chlorhexidine gluconate mouthrinse in a clinical trial of the efficacy of periodontal treatment in older adults with diabetes. Methods. Participants were U.S. veterans with uncontrolled diabetes (hemoglobin A 1c value ≥8.5 percent) and periodontal disease. Treatment included periodontal scaling, 0.12 percent chlorhexidine lavage during ultrasonic scaling and use of chlorhexidine mouthrinse at home. Results. Forty-four (31 percent) of 140 subjects reported having AEs. Most common were taste changes and tooth staining, sore mouth and/or throat, tongue irritation and wheezing/shortness of breath; the latter was reported more commonly before chlorhexidine use than after. Only body mass index greater than 30 was significantly related to AEs. Conclusions. AEs are common among subjects using chlorhexidine mouthrinse. Most AEs (taste change and staining) were resolved easily by subjects' discontinuing mouthrinse use and receiving dental prophylaxis. No serious AEs were reported. Clinical Implications. Clinicians should advise patients using chlorhexidine mouthrinse of possible side effects. If necessary, patients should discontinue mouthrinse use and obtain medical care. Careful monitoring of AEs in patients using chlorhexidine is warranted.

Background Mechanical methods of oral hygiene can be complemented by the use of chemotherapeutic mouthrinses. The authors sought to quantify the additional benefit provided by an essential oil–, or EO–, containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly. Methods The authors randomly assigned patients with gingivitis to one of three treatment groups: brushing and rinsing with a control mouthrinse, or BC; brushing, flossing and rinsing with a control mouthrinse, or BFC; or brushing, flossing and rinsing with an EO–containing mouthrinse, or BFEO. Patients received a dental prophylaxis at baseline, and the authors followed them for six months. Results Of 246 enrolled subjects enrolled in the study, 237 subjects were evaluable at the study's conclusion. After six months, the subjects using the BFEO regimen had statistically and clinically significant lower mean Modified Gingival Index, or MGI, scores and Plaque Index, or PI, scores than did subjects in the BC group (29.9 percent and 56.3 percent, respectively; P P P Conclusions This study confirms that for patients with gingivitis who brush and floss routinely, the adjunctive use of an EO–containing mouthrinse provides a clinically significant and meaningful additional benefit in reducing plaque and gingivitis. Clinical Implications An EO–containing mouthrinse is an effective adjunct to regular brushing and flossing. Therefore, the BFEO regimen can be beneficial for patients with gingival inflammation.

Background. The use of dental floss has long been considered to be effective in controlling interproximal plaque and gingivitis. The authors compared this method with that of use of a mouthrinse. Methods. Subjects with mild-to-moderate gingivitis enrolled in a long-term, six-month study. They received a dental prophylaxis and were randomized into one of the three following treatment groups: brushing and rinsing with an essential oil-containing mouthrinse (the BEO group), brushing and flossing (the BF group) and brushing and rinsing with a control rinse (the B group). Results. A total of 326 subjects were evaluated. The BEO and BF had significantly lower ( P Conclusions. In conjunction with professional care (prophylaxis) and toothbrushing over six months, rinsing twice daily with an essential oil–containing mouthrinse was at least as good as flossing daily in reducing interproximal plaque and gingivitis. Clinical Implications. When weighing recommendations for oral hygiene home care, clinicians should consider that an essential oil–containing mouthrinse may be a useful adjunct in patients with gingival inflammation.

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.

No published methodologies currently exist for quantitative, reproducible evaluation of feline dental plaque and calculus, which could be used to assess oral health benefits to cats of therapeutic agents and devices, chew toys, and other products with dental efficacy claims. This article describes experimental methods commonly used for human and canine studies and reports the development of feline methods adapted from the author’s experience with canine dental evaluations. The author’s studies of the kinetics of plaque and calculus development indicate that scorable plaque forms within a few days of dental prophylaxis and does not increase significantly after 1 or 2 weeks. Significant amounts of calculus are present within 1 or 2 weeks of dental prophylaxis and do not increase significantly after 4 weeks.

Background The efficacy of an essential oil–containing antiseptic mouthrinse (Listerine Antiseptic, Pfizer) and an antiplaque/antigingivitis dentifrice (Colgate Total, Colgate-Palmolive) has been demonstrated in numerous double-blind clinical studies. This study was conducted to determine their comparative efficacy. Methods Three hundred sixteen subjects with mild-to-moderate gingival inflammation and plaque received a dental prophylaxis and began their randomly assigned brushing and rinsing regimen in an unsupervised setting. Subjects brushed for one minute and rinsed with 20 milliliters for 30 seconds twice daily for six months. The three groups were L (control toothpaste/Listerine rinse), T (Colgate Total toothpaste/control rinse) and P (control toothpaste/control rinse). Results Subjects in the L and T groups demonstrated statistically significantly lower ( P P Conclusion Although the Listerine Antiseptic and Colgate Total antiplaque/antigingivitis products produced similar, clinically significant reductions in gingivitis (as measured by MGI and BI), Listerine, when used in conjunction with a fluoride dentifrice and usual oral hygiene, provided a greater benefit in reducing plaque. Clinical Implications When considering an antiplaque/antigingivitis product to recommend to patients, clinicians should consider Listerine Antiseptic, in conjunction with usual oral hygiene, if more rigorous plaque control is desired.

When you have completed this article, you will be able to (1) understand and grade patients with periodontal disease and prescribe proper treatment for them; (2) describe the AVDC Stages of Tooth resorption and the treatment; (3) describe the non-clinically aggressive and aggressive oral tumors; (4) be knowledgeable of the American Animal Hospital Association Guidelines on Veterinary Dental Procedures and how to obtain them; and (5) understand the disadvantage of Non-Professional Dental Scaling (NPDS) and why it should not be performed.

The literature contains few studies regarding the relationships between receipt of regular dental care and medical outcomes for people with type 2 diabetes.The authors compared hemoglobin A(1c) (HbA(1c)) levels (7 percent versus7 percent), low-density lipoprotein cholesterol levels (100 milligrams/deciliter versus ≥ 100 mg/dL) and diabetes-specific hospital admissions and emergency department (ED) visits (one or more visits versus no visits) in 493 people with type 2 diabetes who received regular dental care (≥ two prophylactic visits, periodontal treatment visits or both during a 12-month period) with measures in 493 people with type 2 diabetes who did not receive any dental care. The authors matched patients, all of whom had private medical and dental insurance benefits during the study period, with regard to age, sex and previous utilization of ED visits and hospital admissions, and they followed them for three years.The authors analyzed the data by using multiple logistic regression, which showed that receipt of regular dental care was associated with lower diabetes-specific ED utilization (odds ratio [OR] = 0.61, 95 percent confidence interval [CI] = 0.40-0.92) and hospital admissions (OR = 0.61, 95 percent CI, 0.39-0.95) after they adjusted for age, sex, previous hospital admissions, previous ED utilization, race, baseline HbA(1c) values, Charlson comorbidity index score, body mass index status, periodontal risk status and primary care utilization. The authors found no significant association between receipt of dental care and control of HbA(1c) levels.The study results show an association between regular receipt of dental care and reduced diabetes-specific medical care utilization (that is, ED visits and hospital admissions).Although the results of this study could not show causality, they suggest that receipt of dental care may reduce diabetes-specific health care utilization. Prospective studies are needed to better understand the relationship of receipt of dental care with diabetes control and health care utilization measures.

Introduction The aim of this prospective randomized clinical trial was to determine the effect of using fluoridated paste (Dentsply, York, Pa) compared with plain pumice (Ortho Technology, Tampa, Fla) on the clinical bond failure rates of precoated brackets bonded with self-etching primer. Methods A split-mouth technique was used. The teeth in the maxillary right and mandibular left quadrants were prepared with a fluoridated paste only, and the teeth in the maxillary left and mandibular right quadrants were prepared with plain pumice before bonding the precoated brackets. A total of 627 brackets in 34 orthodontic patients (20 female, 14 male) were included in this study; 315 brackets were bonded after pumice treatment, and 312 were bonded after paste treatment. The patients were followed for 6 months to determine the rates of bracket failure. Results The overall failure rate was 8%. The failure rates for pumice and paste were 4.8% and 11.2%, respectively. The McNemar test showed a statistically significant difference between the 2 groups. Based on tooth type, the failure rate of the maxillary canine and the mandibular central incisor brackets were significantly different for paste and pumice. There was also a difference in the survival rates of the brackets in both groups. Conclusions Preparation of the enamel surface with fluoridated paste before bonding with self-etching primer is not recommended. However, the use of plain pumice is recommended, even if it is time-consuming.

Summary Clinical manifestations of severe periodontitis are very often associated with tooth migration. The aim of this retrospective study is to evaluate dental bone support before orthodontic-periodontal treatment, at immediate postoperative, and long-term postoperative and to compare these results with those obtained from periodontal treatment alone. Fifteen patients (11 women and four men), all with severe periodontitis, mean age 42.8 years (22–61), were followed for an average of 16 years (11–32). Comparison was made between periodontal–orthodontic treatment (Group 1) and periodontal treatment alone (Group 2). Alveolar bone height was measured at T0 (before treatment), T1 (immediate postoperative) and T2 (long-term postoperative). Assessment was performed by means of digitized radiography using Image J Software from the National Institute of Health. The average postoperative observation period between T0 (before treatment) and T2 (long-term results) was 16 years (11 to 32). Results showed an overall bone apposition in groups (1 and 2) immediately after treatment (T1), then at long-term (T2). No statistical difference was observed between both groups (1 and 2). In conclusion: an overall bone gain was observed in both treatment groups (periodontal–orthodontic and periodontal alone). The orthodontic treatment combined with periodontal treatment never compromised the benefits of periodontal treatment alone. On the opposite, it appeared to be quite beneficial.

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.

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 Conclusions Cariogenic bacteria play a leading role in the incidence of caries. CART proved effective in identifying an individual patient's risk of caries.

Objective The goal of this report is to present the current state of the evidence evaluating the efficacy of anti-plaque, anti-gingivitis mouthrinses and to determine the clinical relevance of the evidence. Material and methods To accomplish this goal a two stage approach was used. First a systematic review of the literature was done to find any systematic review that evaluated the efficacy of anti-plaque, anti-gingivitis mouthrinses from long term (six months) randomized placebo controlled clinical trials. Secondly, the clinical relevance was determined by comparing the percent reduction in plaque and gingivitis attributable to the anti-plaque, anti-gingivitis mouthrinses to change over time in the placebo groups attributable to adult prophylaxis and oral hygiene instructions. Results Three systematic reviews and one meta-analysis were found that evaluated the efficacy of anti-plaque, anti-gingivitis mouthrinses. The systematic reviews concluded that there is strong evidence supporting the efficacy of chlorhexidine and essential oils as anti-plaque, anti-gingivitis mouthrinses. The evidence for cetyl pyridinium chloride (CPC) was weaker due to few clinical trials testing the same formulations of CPC. There was one meta-analysis of studies from a manufacure of Delmopinol, but it was not a systematic review of the literature. The report based on the meta-analysis concluded that Delmopinol was an effective anti-plaque, anti-gingivitis agent. Evaluation of clinical relevance by estimating percent reduction due to the active agents and changes over time in the placebo groups, demonstrated that the clinical effect of both chlorhexidine and essential oil containing mouthrinses met or exceeded reductions over time for placebo groups. Again the results for CPC were less consistent, but were similar to reductions over time in the placebo groups. Conclusions These results suggest that the clinical benefits of anti-plaque, anti-gingivitis mouthrinses are similar to the benefits of oral prophylaxis and oral hygiene instructions at six month recall appointments.

We retrospectively investigated hemostatic management for periodontal treatments in patients on oral antithrombotic therapy.A total of 155 periodontal treatment procedures were performed in 139 patients who continued taking conventional antithrombotic drugs. Insertion of oxidized cellulose, compression, and suturing were used as local hemostatic measures. When hemostasis was difficult, hemorrhage was stopped using electrocautery and/or splint.For the warfarin patients, 49 scaling procedures were performed in patients with INR of 4.82 or less, and 52 periodontal surgeries were performed in patients with INR of 2.97 or less. As for periodontal surgeries, electrocautery and splint were used in 30% and 70% of cases, respectively. In the entire patient population, posttreatment hemorrhage was seen in 2 (1.3%) of the 155 periodontal treatment procedures.Scaling can be safely performed in patients on warfarin (INR4.0) and/or antiplatelet therapy. Periodontal surgery can be performed in patients with INR less than 3.0 with proper local hemostatic procedures.

Background: Osteonecrosis of the jaw (ONJ) is a well-described complication of bisphosphonates use in patients with multiple myeloma (MM). We investigated whether the occurrence of ONJ decreased after the implementation of preventive measures in 128 patients with MM who received zoledronic acid. Patients and methods: Patients with MM who received zoledronic acid were included in this analysis. Patients with a previous use of other bisphosphonates were excluded; patients were stratified into group A (n = 38) and group B (n = 90) if treatment was started before or after the implementation of preventive measures. Results: One hundred and twenty-eight patients were included in this analysis. Sixteen patients (12.5%) developed ONJ—group A: 8 (26.3%), group B: 2 (6.7%) (P = 0.002). The incidence rate (IR) was 0.671/100 person-months for group A and 0.230/100 person-months for group B [IR ratio 2.92, P = 0.029, 95% confidence interval 1.06–8.03]. No patient in group B developed stage III ONJ. Conclusion: In conclusion, the risk of developing ONJ after treatment of zoledronic acid is reduced (but not deleted) by the implementation of preventive measures.

Background Tooth surface cleaning before acid etching is considered to be an important step in the retention of resin-based pit-and-fissure sealants. Methods The authors reviewed and summarized instructions for cleaning tooth surfaces from five manufacturers of 10 unfilled resin-based sealants marketed in the United States. The authors also searched electronic databases for studies that directly compared the effects of different surface-cleaning methods on sealant retention and for systematic reviews of the effectiveness of sealants. They explored the association between surface-cleaning methods and sealant retention in the studies included in the systematic reviews. They calculated the summary weighted retention rates for studies that used either a handpiece or toothbrush prophylaxis. Results All of the sealant manufacturers' instructions for use (IFU) recommended cleaning the tooth before acid etching. None of the IFU directly stated that a handpiece was required to perform the cleaning, but five IFU implied the use of handpiece prophylaxis. None of the IFU recommended surface-altering procedures in caries-free teeth. Direct evidence from two clinical trials showed no difference in complete sealant retention between surfaces cleaned mechanically with pumice or prophylaxis paste and those cleaned with air-water syringe or dry toothbrushing. Indirect evidence from 10 studies found that weighted summary retention by year after sealant placement in studies that used toothbrush prophylaxis was greater than or equivalent to values for studies that used handpiece prophylaxis. Conclusions Levels of sealant retention after surface cleaning with toothbrush prophylaxis were at least as high as those associated with hand-piece prophylaxis. Clinical Implications This finding may translate into lower resource costs for sealant placement.

Background: Screening of the oral cavity and dental care was suggested as mandatory preventive measures of osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BPs). We investigated the occurrence of ONJ before and after implementation of dental preventive measures when starting BP therapy. Patients and methods: Since April 2005, 154 consecutive patients treated with BPs (POST-Group) have undergone a baseline mouth assessment (dental visit 6 orthopantomography of the jaws) to detect potential dental conditions and dental care if required. A retrospective review was also conducted of all consecutive cancer patients with bone metastases (PRE-Group) and treated for the first time with BPs from January 1999 to April 2005 in our clinic without receiving any preventive measure. Incidence proportion and incidence rate (IR) were used to estimate the incidence of ONJ. Results: Among the study population (966 patients; male/female = 179/787), 73% had breast cancer. 25% of patients were given zoledronic acid (ZOL), 62% pamidronate (PAM), 8% PAM followed by ZOL and 5% clodronate. ONJ was observed in 28 patients (2.9%); we observed a reduction in the incidence of ONJ from 3.2% to 1.3%, when comparing—pre and post-implementation of preventive measures programme. Considering the patients exposed to ZOL, the performance of a dental examination and the application of preventive measures led to a sustained reduction in ONJ IR (7.8% in the PRE-Group versus 1.7% in the POST-Group; P = 0.016), with an IR ratio of 0.30 (95% confidence interval 0.03–1.26). Conclusions: ONJ is a manageable and preventable condition. Our data confirm that the application of preventive measures can significantly reduce the incidence of ONJ in cancer patients receiving BPs therapy. Dental exams combined to the identification of patients at risk in cooperation with the Dental Team can improve outcomes and increase the number of ONJ-free patients.

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.

Objective To estimate the prevalence, intensity and microbial identity of bacteraemia associated with toothbrushing. Methods A total of 141 children and adolescents, aged between 3 and 17 years, having dental treatment under general anaesthesia at the Eastman Dental Hospital were recruited. Six millilitre of blood was taken before toothbrushing (baseline) with (1) Oral B 30 toothbrush or (2) Braun or (3) Sonicare electric toothbrush or (4) dental handpiece and rubber cup. A second 6-ml sample was taken 30 s after toothbrushing. All blood samples were processed using lysis filtration and bacteria were identified to species level. Results There was a significantly greater prevalence of bacteraemia following the dental handpiece only (p = 0.02). There was a significantly greater aerobic and anaerobic intensity of bacteraemia following brushing with both the Sonicare (p = 0.03 and p = 0.05) and the dental handpiece (p = 0.001 and p = 0.005). Conclusions Toothbrushing causes a bacteraemia that is often statistically significantly greater than baseline. Toothbrushing is an important contributory factor in cumulative dental bacteraemia.

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.