Oral Health and Preventive Dentistry, 04/2004

The purpose of this study was to test and describe in detail a newly developed comprehensive system for washing, pre-disinfecting and sterilizing of dental and surgical instruments. The system consists of a combined washing and steam-operated pre-disinfection apparatus and newly developed trays, in which assorted instruments can be washed and disinfected without handling individual instruments. The system was subjected to a large number of tests. The cleaning efficiency of blood-soiled instruments was found to be excellent. The disinfection of dental instruments contaminated with bacteria, yeast and non-enveloped virus showed decimal reduction factors that were equivalent to sterilization. The trays had optimal sealing qualities. Their steam permeability was perfect even after prolonged use in N-, S- and B-type autoclaves. However, long-term tests in a clinic revealed shortcomings with regard to insufficient drying of instruments in the wash/disinfection apparatus. Furthermore, the mechanical stability of the polysulfonate tray covers needs to be improved. Occasionally, after extended use, the fit of the filters in metal trays became inadequate, in particular when trays were sterilized for 18 min at 134°C for a prolonged period of time. In spite of the above-mentioned shortcomings, the system shows great labor and cost-saving potential, allowing a new approach to instrument recirculation and workflow in the dental office. Keywords: dental office hygiene, pre-disinfection of instruments, new dental trays

An association between diet and calculus deposits was suggested by animal studies. The objective of the present analysis was to examine whether or not there is an association between overall diet quality, as measured by the healthy eating index, and extent of dental calculus deposits using a subset of the third National Health and Nutrition Examination Survey (NHANES III) data. NHANES III participants 18-years of age or older who had data on dental calculus and diet quality were selected (n = 12405). The healthy eating index (HEI), used as an indicator of overall diet quality, has a minimum score of zero (poorest) and a maximum score of 100 (best) and was divided into three categories, poor (HEI < 51), fair (HEI, between 51 - 80) and good (HEI > 80). Ordinal logistic regression models were used to examine the association between the HEI and the percentage of sites with calculus deposits. Overall diet quality was found to be significantly associated with calculus deposits controlling for: age, gender, race, education, poverty income ratio, smoking, diabetes, history of vitamin and mineral use, body mass index, time elapsed since last dental visit and gingival bleeding. The adjusted odds ratios for having a greater percentage of sites with calculus were 1.54 (1.19 - 1.98), 1.30 (1.02 - 1.60) and 1.00 (reference) for subjects with poor, fair, and good diet quality respectively. Poor diet quality is significantly associated with more calculus deposits. Further studies are needed to examine if poor diet quality is a predisposing factor for calculus formation and/or a risk factor for periodontal diseases. Keywords: calculus, diet, healthy eating index, NHANES III

While cigarette smoking is recognized as being detrimental to periodontal health, the effect of water pipe smoking on gingival health is not known. The present study was conducted to determine whether water pipe smoking has an influence on gingival health. A cross-sectional study was carried out in 244 individuals aged 25-70 years. The levels of plaque and gingivitis were recorded on four sites of all present teeth, using the plaque index (PI) and gingival index (GI). Information about oral hygiene practices, dental care and smoking habits was obtained at the time of the clinical examination in accordance with a predetermined questionnaire. The means of plaque index and gingival index values were 1.2 and 0.9, respectively. Similarly, the mean percentages of surfaces with plaque and gingival bleeding sites were 66.7% and 30.4%, respectively. There was an overall significant association between smoking and plaque index and gingival index (F = 22.9 and F = 10.8, respectively, p < 0.001). Oral hygiene was inferior in water pipe smokers, cigarette smokers, and mixed smokers when compared to non-smokers. The correlation between plaque % and gingival bleeding % in cigarette smokers was significantly weaker than in non-smokers. It was also weaker in water pipe smokers, but the difference was not statistically significant. The gingival bleeding response to plaque was significantly suppressed in cigarette smokers. There was a tendency towards suppression also in water pipe smokers. Keywords: cigarettes, gingival bleeding, Saudi Arabia, tobacco smoking, water pipe

To epidemiologically assess the periodontal conditions of the adult population in Switzerland. During a ten-year period, a total of 1318 subjects were randomly selected on the basis of a process involving the community rosters in seven regions (Cantons) of Switzerland: (Canton of Berne; Canton of Zurich; Western cantons (GE,VD,NE); Eastern cantons (SG,AI,AR,TG,SH); Southern cantons (VS,GR,TI); Central cantons (LU,GL,ZG,UR,SZ,OW,NW) and Northern cantons (JU,FR,SO, AG,BL)) and encompassing all adult age groups (20-89 years). The subjects were examined in dental offices randomly distributed throughout the country. The number of teeth present, the mean Plaque and Gingival as well as Retention Indices were assessed. Furthermore, pocket probing depths and loss of periodontal attachment were determined on all teeth. Ninety-four (7.1%) of the subjects were completely edentulous leaving 1224 dentate individuals with an average of 21.65 teeth for analysis. In the youngest cohort (20-29 years) 27.03 teeth were present. During the fourth to the seventh decade of life, tooth loss appeared to follow a linear pattern leaving 17.63 teeth in the age group of 60-69 years. The oldest age group of the 80-89 years old yielded 11.08 teeth. The mean scores of all clinical parameters increased significantly with increasing age. Mean PlI in the youngest age group was PlI: 0.72 (SD: 0.38) and reached PlI: 1.55 (SD: 0.68) in the oldest. The corresponding mean GI were 1.17 (SD: 0.31) and GI: 1.64 (SD: 0.50), respectively. The mean RI increased from 0.24 (SD: 0.29) to RI: 1.34 (SD: 0.70) in the oldest. Mean probing depth increased slightly from 20 to approximately 49 years. Thereafter, mean PPD remained around 3.0 mm. The loss of periodontal attachment increased dramatically after the age of 50. Periodontitis manifests itself after the age of 50. The pronounced progressive attachment loss in the age cohorts over fifty years explained the marked loss of teeth in some individuals. From a public health point of view, it is indicated to make a major effort for periodontal prevention in the population approaching the second third of life. Keywords: epidemiology, periodontology, prevalence, severity, Switzerland, periodontitis, gingival index, attachment loss

A double blind, controlled, parallel group trial utilizing the experimental gingivitis model was performed on thirty young adults to evaluate the clinical effects of a 0.45% stannous fluoride dentifrice used as a slurry on dental biofilm formation and the development of gingivitis. Following a thorough examination and oral prophylaxis procedures, subjects were randomly assigned to apply one of the following dentifrices twice daily over a three-week period: A) dentifrice slurry without active ingredients; B) 0.45% stannous fluoride gel; and C) Colgate® Total dentifrice slurry (0.30% triclosan, 0.24% sodium fluoride, 2% copolymer). After three weeks, the stannous fluoride dentifrice significantly (p < 0.05) reduced gingivitis compared with the Colgate® Total group by 39.7%. Gingival bleeding was also reduced relative to the Colgate® Total group. This difference was statistically significant (P < 0.05). During the experimental period, the mean PlI scores increased almost linearly in all three groups without yielding any statistically significant differences. The results of this clinical trial demonstrated that, over a three-week period, the application of a 0.45% SnF2 gel significantly inhibited the onset of gingivitis compared to Triclosan/sodium fluoride/copolymer (Colgate® Total). However, neither stannous fluoride nor Triclosan/sodium fluoride/copolymer (Colgate® Total) possessed sufficient antimicrobial activity to suppress biofilm formation in the absence of regular oral hygiene practices. Keywords: prevention, gingivitis, stannous fluoride, dentifrice, plaque, discolorations

The use of transverse microradiography (TMR) to quantify the amount of mineral lost during demineralization of tooth tissue has long been established. In the present study, the use of an en-face Optical Coherence Tomography (OCT) technology to detect and quantitatively monitor the mineral changes in root caries was investigated and correlated with TMR. We used an OCT system, developed initially for retina imaging, and which can collect A-scans, B-scans (longitudinal images) and C-scans (en-face images) to quantitatively assess the development of root caries. The power to the sample was 250 µW, wavelength λ = 850 nm and the optical source linewidth was 16 µm. Both the transversal and longitudinal images showed the caries lesion as volumes of reduced reflectivity. Quantitative analysis using the A-scan (reflectivity versus depth curve) showed that the tissue reflectivity decreased with increasing demineralization time. A linear correlation (r = 0.957) was observed between the mineral loss measured by TMR and the percentage reflectivity loss in demineralized tissue measured by OCT. We concluded that OCT could be used to detect incipient root caries, and that the reflectivity loss in root tissue during demineralization, measured by OCT, could be related to the amount of mineral lost during the demineralization. Keywords: optical coherence tomography, root caries, confocal imaging, dentin caries, quantitative transverse microradiography

The aim of this study was to compare the enamel abrasivity of a whitening toothpaste with a standard silica toothpaste. Polished human enamel blocks (4 x 4 mm) were indented with a Knoop diamond. The enamel blocks were attached to the posterior buccal surfaces of full dentures and worn by adult volunteers for 24 hours per day. The blocks were brushed ex vivo for 30 seconds, twice per day with the randomly assigned toothpaste (n = 10 per treatment). The products used were either a whitening toothpaste containing Perlite or a standard silica toothpaste. After four, eight and twelve weeks, one block per subject was removed and the geometry of each Knoop indent was re-measured. From the baseline and post-treatment values of indent length, the amount of enamel wear was calculated from the change in the indent depth. The mean enamel wear (sd) for the whitening toothpaste and the standard silica toothpaste after four weeks was 0.20 (0.11) and 0.14 (0.10); after 8 weeks was 0.44 (0.33) and 0.18 (0.17), and after 12 weeks was 0.60 (0.72) and 0.67 (0.77) microns respectively. After four, eight and twelve weeks, the difference in enamel wear between the two toothpastes was not of statistical significance (p > 0.05, 2 sample t-test) at any time point. The whitening toothpaste did not give a statistically significantly greater level of enamel wear as compared to a standard silica toothpaste over a 4-, 8- and 12-weeks period. Keywords: tooth wear, tooth whitening, abrasion, toothpaste

To analyze prevailing oral hygiene practices and oral health awareness among urban Saudi Arabians in relation to age, gender and educational level. Structured interviews with 1155 regular patients at two centers providing dental care for university and military staff and their families, respectively, in the city of Makkah. Consecutive patients were stratified by gender and age, into 6 categories from 10 to 60 years, with 50 male or female subjects in each group at each center. Oral hygiene habits and attitudes to oral health were correlated with age, gender and educational levels, using ANOVA. For the majority (> 88%) oral hygiene routines were introduced very late, after the age of 7 yr. Habits were strongly correlated to the level of education (p < 0.001); subjects with less education favored the miswak. Among the better educated, toothbrushing started earlier (p < 0.001). Regular miswak use was more frequent in older age groups (p < 0.001). Females used a toothbrush more often than males (p < 0.001), and miswak use by women was less frequent than by men (p < 0.001). Despite the availability of free dental care at the public health centers, 89% of the participants at the military center sought only emergency care, in contrast to 54% at the university center. Among urban Saudi Arabians, oral hygiene routines are introduced relatively late in life and knowledge and awareness of oral health is very low. There are pronounced variations in oral hygiene habits, related mainly to age and educational levels. Such factors should be taken into account when planning oral health strategies. Keywords: chewing stick, dental, education, oral hygiene, practice

The aim of the study was to determine the longitudinal effect of an oral hygiene program on oral levels of volatile sulfur compounds (VSC). The study subjects were randomly selected from patients attending a student course in operative dentistry and from staff members of our dental clinic. The test group (n = 30) received an oral hygiene training including professional toothcleaning (PTC), oral hygiene instruction, and motivation. The control group (n = 10) received no particular treatment. None of the subjects suffered from bad breath nor performed regular tongue cleaning. At baseline, immediately after PTC, one week, and four weeks thereafter we measured the oral hygiene status by means of the papillary bleeding index (PBI) and the oral concentrations of VSC by using a portable sulfide monitor (Halimeter"). Immediately after PTC, as well as one week, and four weeks after entering the program the PBI and the VSC-levels were significantly decreased as compared to the baseline values and the control group. VSCs were decreased by 34.9% (± 6.3) after PTC, 33.2% (± 7.1) one week, and 27.9% (± 5.8) four weeks thereafter. The present study shows that in a group of patients without bad breath, an oral hygiene training program including professional toothcleaning, motivation and instruction of self-applied oral hygiene procedures is capable of reducing both papillary bleeding and oral levels of VSC Halimeter" readings over the observation period of four weeks. Keywords: oral hygiene, oral volatile sulfur compounds (VSC), sulfide monitor