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PubMed1985

Oral complications of acute leukemia: prophylactic impact of a chlorhexidine mouth rinse regimen.

The prophylactic value of twice-daily mouth rinses with a solution of 0.1% chlorhexidine gluconate in minimizing oral complications during remission-induction chemotherapy was tested in sixteen patients with acute myeloblastic leukemia. The study design was double blind with a placebo control. Standardized measurement indices were employed to assess the dental plaque levels and the degree of gingivitis and mucositis during remission-induction. The treatment group demonstrated superior oral health on the basis of each of these measurement parameters. A moderate increase in tooth staining was observed in the treatment group. The results also suggested the potential value of chlorhexidine mouth rinses in the prophylaxis of oral candidiasis in the myelosuppressed patient.

Adolescent↗
PubMed1996

Dental aesthetics--a survey of attitudes in different groups of patients.

OBJECTIVES: The aim of this study was to evaluate the attitudes of various groups of patients towards the appearance of their teeth. METHODS: A questionnaire was used which consisted of six background variables and 13 attitudinal statements concerning the appearance of the teeth. The number of responses obtained was 254. Multiple regression analysis was undertaken to reveal any statistical associations between the answers to the statements and the background variables. RESULTS: According to the results, the appearance of the teeth was found to be more important to women than to men. For older patients, the appearance of teeth was not as important as for younger patients (r = -0.144, P = 0.012). Patients with limited education had a greater preference for white teeth than patients with a high level of education (r = 0.115, P = 0.037). The perception that very white teeth are beautiful decreased with increasing age (r = 0.112, P = 0.049), and younger patients expressed a greater preference for white teeth than older patients (r = 0.11, P = 0.50). CONCLUSION: This study suggests that various groups of patients have different attitudes towards the appearance of their teeth.

Adolescent↗
PubMed1995

Dietary staining in vitro by mouthrinses as a comparative measure of antiseptic activity and predictor of staining in vivo.

Extrinsic staining of teeth is a side-effect of some antiseptic mouthrinses. However, few of the many rinse products available to the general public have been investigated for their propensity to cause staining. Dietary factors play an aetiological role in staining and have been used in vitro to study and compare the activity of rinses. The aim of this study was to assess rinse products for staining in vitro and, through the staining reaction, to compare the activity of products containing the same ingredients. Perspex blocks, with or without saliva pretreatment, were soaked in rinses for 2 min, washed and placed in a standard tea solution for 60 min and then the optical density (OD) read on a spectrophotometer. The cycle was repeated 10 times for saliva and 17 times for no saliva specimens or until the maximum OD was exceeded. A series of three separate experiments was performed by this method. The maximum OD was not exceeded by any product before seven passages and therefore data were compared at six passages. For most products OD increased with saliva pretreatment. Some cetylpyridinium chloride (CPC) rinses stained comparably to a chlorhexidine rinse. CPC rinses, most of which contained the same concentration of the antiseptic, varied considerably in their propensity to induce staining and one was little different to water controls. A 0.1% chlorhexidine rinse stained slightly more than a 0.2%. A phenolic/essential oil product produced some staining but zinc, triclosan and other essential oil rinses did not stain.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1993

A new method for dental age estimation in adults.

Several statistical methods have been proposed for estimation of age from teeth in human adults. Due to the smallness of the material or statistical shortcomings in previous reports, improvements of the methods were desirable and seemed possible. As a contribution to such improvement various age-related changes have been studied in a material of 1000 teeth. For each type of change the kind of measurement most strongly related to age was chosen, and a multiple regression analysis was run with age as the dependent variable, using SPSS/PC+ statistical program. Statistically significant formulae were calculated for each type of tooth excluding molars. Because the sex of a deceased body may be unknown and the tooth colour influenced by changes after death, separate formulae excluding these factors were calculated. For the calculated formulae the Pearson correlation (tau) varied from 0.76 in mandibular second premolars (SEX and COLOUR excluded), to 0.91 for maxillary central incisors; a rather promising result compared with other methods. In addition, the intercorrelations between the age-related factors were calculated after control for the effect of age. In some types of teeth, but not in all, some of the factors displayed significant intercorrelation. To compare these formulae with previous methods an unbiased test in another independent material is needed.

Age Determination by Teeth↗
PubMed1987

A conservative postorthodontic treatment of enamel stains.

The purpose of this presentation is to describe a method used to remove or improve superficial stains in the enamel including mild decalcification present before and after orthodontic therapy. This procedure is only successful in the treatment of stains involving the outer enamel surface and is not effective for treating generalized pigmentation of the enamel and/or dentin. A step-by-step approach for the removal of the superficial enamel stains is presented.

Color↗
PubMed1991

The effects of a 0.12% chlorhexidine gluconate mouthrinse on orthodontic patients aged 11 through 17 with established gingivitis.

The purpose of this study was to assess the effectiveness of a 0.12% chlorhexidine gluconate (CH) mouthrinse, Peridex, on orthodontic patients 11 through 17 years of age with established gingivitis. Thirty-four subjects were divided into two groups (CH and placebo) of 17 subjects each on the basis of gender, and they were evaluated at baseline, at 6 weeks, and at 12 weeks in a double-blinded manner. The gingival index (GI) of Löe and Silness, the plaque index (PI) of Silness and Löe, the Eastman Interproximal Bleeding Index, and the CWRU staining index were recorded for each subject. The subjects in the CH group, as compared with the placebo group, had statistically significant reductions, expressed as percent reductions against baseline, at the conclusion of this 3-month period: PI = 64.9%, GI = 60.0%, and gingival bleeding = 77.2%. Staining was in the moderate range, and it was concentrated on the mandibular lingual surfaces. Peridex, in combination with mechanical plaque removal, proved to be an important therapeutic agent in controlling gingival inflammation, bleeding, and plaque accumulation in orthodontic patients 11 through 17 years of age with established gingivitis.

Adolescent↗
PubMed2004

Dental discolouration after thermal treatment.

Enamel and dentin discolouration have extrinsic and intrinsic origins. Possible causes include pigmented food or drink, caries, clinical chemical treatments, trauma and, high temperature. In the oral cavity, dental hard tissues can be heated when irradiated with high-intensity lasers. This paper, reports initial results on the discolouration of enamel and dentin induced by thermal treatment. The samples used in this work were bovine incisor teeth. Enamel and dentin discolouration were verified using microscopy and transmission spectroscopy. Thermal treatment was carried out at temperatures of 140 and 200 degrees C. The natural transparent aspect of the enamel became opaque after thermal treatment, it whitened following treatment at 140 degrees C, and turned completely opaque after treatment at 200 degrees C. With the same thermal treatment, dentin became light brown after treatment, at 140 degrees C, and the brown pattern was more evident after treatment at 200 degrees C. Although there is no conclusive evidence, non-enzymatic browning, collagen denaturation or oxidation of some chemical component of the dentin, may be intensified or produced by the thermal treatment. In enamel, water loss and the consequent increase in light scattering explain the observed opacity.

Animals↗
PubMed2006

Abnormal dentin structure in two novel gene mutations [COL1A1, Arg134Cys] and [ADAMTS2, Trp795-to-ter] causing rare type I collagen disorders.

Histological and ultrastructural observations of dentin of two patients affected with rare types of type I collagen disorders are presented. In the first case, a homozygous nonsense mutation in ADAMTS2 (substitution of a codon for tryptophan by a stopcodon) causes type VIIC Ehlers-Danlos syndrome (EDS) with multiple tooth agenesis and focal dysplastic dentin defects. In the second case, a missense mutation in COL1A1 (substitution of arginine by cysteine) results in a type I EDS phenotype with clinically normal-appearing dentition. Tooth samples are investigated by using light microscopy (LM), transmission electron microscopy (TEM) and immunostaining for types I and III collagen, and tenascin. These are compared with samples from patients with types III and IV osteogenesis imperfecta (OI) in association with dentinogenesis imperfecta (DI), showing a consistently abnormal appearance of the dentin in all specimens, with variations being primarily those of degree of change. Similarities in histological changes include the alternating presence of normal and severe pathological areas in primary and secondary dentin, the latter being characterized by large canal-like structures in atubular areas. Ultrastructural evidence of pathological dentinogenesis include abnormal distribution, size and organization of collagen fibers, which may also be found in clinically unaffected teeth. The histological and ultrastructural changes seen can be explained on the basis of odontoblast dysfunction which may be secondary to the collagen defect, interfering with different levels of odontoblast cell function and intercellular communication. These observations on (ultra)structural dentin defects associated with the two novel gene mutations are the first ever reported.

Collagen Type I↗
PubMed2004

Lasers in aesthetic dentistry.

This article focuses on lasers and aesthetic dentistry and their unique parallel in history from their early development to their present day usage and application. The demand for aesthetic dentistry has had a major impact not only on treatment planning but also on the choice of materials, techniques, and equipment. It is this demand that has married the use of lasers with aesthetic dentistry. A short literature review on the five basic laser types precedes the basic premise of smile design and its critical importance in attaining the desirable aesthetic end result. A short review on biologic width and biologic zone reinforces their importance when manipulating gingival tissue. Four case reports highlight the use of diode, erbium, and carbon dioxide lasers. The end results show the power of proper treatment planning and the use of a smile design guide when using these instruments and confirm a conservative, aesthetic treatment without compromising the health and function of the patients.

Adult↗
PubMed2005

Clinical challenges and the relevance of materials testing for posterior composite restorations.

Posterior composite restorations have been in use for approximately 30 years. The early experiences with this treatment indicated there were more clinical challenges and higher failure rates than amalgam restorations. Since the early days of posterior composites, many improvements in materials, techniques, and instruments for placing these restorations have occurred. This paper reviews what is known regarding current clinical challenges with posterior composite restorations and reviews the primary method for collecting clinical performance data. This review categorizes the challenges as those related to the restorative materials, those related to the dentist, and those related to the patient. The clinical relevance of laboratory tests is discussed from the perspective of solving the remaining clinical challenges of current materials and of screening new materials. The clinical problems related to early composite materials are no longer serious clinical challenges. Clinical data indicate that secondary caries and restoration fracture are the most common clinical problems and merit further investigation. The effect of the dentist and patient on performance of posterior composite restorations is unclear and more clinical data from hypothesis-driven clinical trials are needed to understand these factors. Improvements in handling properties to ensure void-free placement and complete cure should be investigated to improve clinical outcomes. There is a general lack of data that correlates clinical performance with laboratory materials testing. A proposed list of materials tests that may predict performance in a variety of clinical factors is presented. Polymerization shrinkage and the problems that have been attributed to this property of composite are reviewed. There is a lack of evidence that indicates polymerization shrinkage is the primary cause of secondary caries. It is recommended that composite materials be developed with antibacterial properties as a way of reducing failures due to secondary caries. Post-operative sensitivity appears to be more related to the dentin adhesives' ability to seal open dentinal tubules rather than the effects of polymerization shrinkage on cuspal deflections and marginal adaptation.

Bicuspid↗
PubMed2004

In vitro evaluation of a novel 6% hydrogen peroxide tooth whitening product.

OBJECTIVES: The aims of this study were to evaluate the in vitro tooth whitening effects of a novel 6% hydrogen peroxide containing tooth whitener Xtra White (XW) on extrinsic stain and intrinsic tooth colour and the effects on enamel and dentine microhardness. In addition, to determine the levels of peroxide found in tooth pulp chambers after treatment with XW in vitro. METHODS: Extrinsic stain changes were determined by measuring colour changes of tea stained hydroxyapatite discs after treatment with water, placebo gel, XW or Colgate Simply White (CSW). Intrinsic tooth colour changes were determined by treating extracted human teeth in vitro with a placebo gel, XW or CSW for a simulated two weeks use and measuring colour differences with a chroma meter. Teeth treated with placebo gel and XW were cross-sectioned and the subsurface enamel and dentine was polished and the microhardness determined. The peroxide concentration found in extracted tooth pulp chambers was determined spectrophotometrically. RESULTS: XW gave significantly more extrinsic stain removal (p<0.0001) and an increase in tooth whiteness (p<0.05) than a placebo gel, but was not significantly different to CSW. There were no significant differences in subsurface enamel and dentine microhardness values for the placebo and XW treated teeth. The mean concentration of peroxide found in the tooth pulp chambers was 0.44 mM, which is over 3000 times below the concentration reported to cause pulpal enzyme damage. CONCLUSIONS: XW has been shown to be an effective tooth whitening product in vitro with support for its safety on subsurface enamel and dentine together with its safety on tooth pulp tissue.

Color↗
PubMed2004

Clinical evaluation of a novel whitening gel, containing 6% hydrogen peroxide and a standard fluoride toothpaste.

OBJECTIVES: The aim of this study was to determine the effect on tooth colour (after 1 and 2 weeks use) of a self-applied tooth-whitening gel containing 6% hydrogen peroxide using a novel applicator, compared to a standard fluoride toothpaste. METHODS: A 2-week, examiner-blind, stratified, parallel design clinical trial was conducted. Efficacy was measured by comparing the Vita shade scores recorded at baseline and after 1 and 2 weeks of product application. To qualify for the study, subjects were required to have at least one upper incisor/canine tooth measuring Vita shade A3 or darker. All upper incisors/canines of qualifying subjects were evaluated for change in Vita shade irrespective of their level of whiteness at baseline, allowing for the whitening gel to be tested on the full range of Vita tooth shades. One hundred and seventeen subjects were divided into two groups, balanced according to their darkest tooth shade. One group followed a 2-week, twice-daily regimen of brushing with toothpaste followed by the application of the hydrogen peroxide whitening gel. The other group brushed twice daily with toothpaste for 2 weeks. RESULTS: Subjects using the whitening gel showed a statistically significant improvement, (p<0.05) in mean tooth shade score of 0.75 and 1.02 units after 1 and 2 weeks, compared to baseline. These improvements from baseline were significantly greater than those observed for the toothpaste only group (0.14 and 0.35 units change after 1 and 2 weeks). CONCLUSIONS: The self-applied tooth-whitening gel containing 6% hydrogen peroxide has been shown to significantly improve the whiteness of teeth after 1 and 2 weeks of product use, compared to the baseline and the toothpaste only group.

Adolescent↗
PubMed2004

Tooth colour: a review of the literature.

OBJECTIVES: To review current knowledge with respect to tooth colour and its measurement. METHODS: 'Medline' database for the period 1966 to the present day and 'ISI Web of Science' database for the period 1974 to the present day were searched electronically with key words tooth, teeth, colour and color. CONCLUSIONS: The colour and appearance of teeth is a complex phenomenon, with many factors such as lighting conditions, translucency, opacity, light scattering, gloss and the human eye and brain influencing the overall perception of tooth colour. The measurement of tooth colour is possible via a number of methods including visual assessment with shade guides, spectrophotometry, colourimetry and computer analysis of digital images. These methods have successfully been used to measure longitudinal tooth colour changes when the dentition has undergone tooth whitening procedures.

Color↗
PubMed2004

The effect of hydrogen peroxide concentration on the outcome of tooth whitening: an in vitro study.

AIM: This in vitro study examined the effect that various concentration of hydrogen peroxide (5-35%) had on tooth whitening. METHOD: Extracted third molars were sectioned and stained using a standardised tea solution to Vita shade C4. These stained specimens were then bleached with a series of gels containing 5, 10, 15 or 25% w/w hydrogen peroxide. Each specimen was bleached for a number of sessions with one session being defined as 3 x 10 min exposure. RESULTS: The number of applications of the various concentrations of bleaching gel varied from 12 applications for the 5% gel to one application for the 35% gel. Plotting the number of applications against hydrogen peroxide concentration showed an exponential response curve. CONCLUSIONS: The concentration of hydrogen peroxide in a proprietary bleaching gel had a marked effect on the number of applications required to produce an optimal shade outcome.

Algorithms↗
PubMed2004

Prevalence of self-assessed tooth discolouration in the United Kingdom.

AIMS: To determine the prevalence of perceived tooth discolouration in the United Kingdom and to investigate socio-demographic variations and satisfaction with own tooth colour. METHODS: A national cross-sectional questionnaire study was carried out using a multistage random probability sample. Assessment of people's perceptions of their own tooth colour was conducted by asking study participants to match colour to the closest of a set of photocards demonstrating different levels of tooth discolouration. A separate question asked how satisfied they were with their tooth colour. Information on socio-demographic characteristics of the population were gathered at the same time. ANALYSIS: Data was coded and entered into SPSS software. Descriptive statistics were used to determine the prevalence of perceived discolouration and satisfaction with own tooth colour. Bivariate and regression analyses were performed to explore the effect of socio-demographic variations. RESULTS: The self-assessment exercise was completed for 3215 subjects. Half of the study population perceived their tooth colour to be normal and 6% perceived that they had severe discolouration, the remainder reported themselves to have levels of tooth discolouration between these two extremes. Satisfaction with tooth colour decreased with increased discolouration. Sex, age, income and smoking, had statistically significant effects on the prevalence of perceived discolouration (P< 0.01). CONCLUSIONS: Half of the people in this study perceived themselves to have tooth discolouration. Results suggest that the general public is concerned about dental appearance in terms of tooth colour, indicated by public dissatisfaction with relatively mildly discoloured teeth. Findings may suggest that a further increase in the demand of tooth whitening services and cosmetic dentistry in general is likely. The changing emphasis and level of perceived dissatisfaction need to be taken into account in planning dental services. Evidence based approaches are needed for the appropriate management of patients who demand treatment of mild discolouration.

Adolescent↗