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Long-term effects of Meridol and chlorhexidine mouthrinses on plaque, gingivitis, staining, and bacterial vitality.

The aim of the present study was to compare the effect on plaque growth and gingival response of Meridol, an amine/stannous fluoride solution, during a three-month investigation, with those of a placebo preparation as a negative control and a chlorhexidine solution as a positive control, in a double-blind study. After having their teeth professionally cleaned, 36 volunteers continued their usual oral hygiene for a period of two weeks. Their teeth were then polished again (month 0) after which they rinsed twice daily (morning and evening) with one of the three mouthrinses in addition to their habitual toothcleaning. After three months of rinsing, plaque indices remained lowest in the chlorhexidine group, although the subjects using Meridol had indices significantly lower than those of individuals rinsing with the placebo solution. The gingival index scores in the Meridol group were higher than in the chlorhexidine group and lower than in the placebo group. The plaque vitality scores showed a bactericidal effect in vivo with chlorhexidine and Meridol during the entire experiment. The use of Meridol resulted in more toothstaining than with the placebo, but significantly less than with chlorhexidine. This study demonstrated that Meridol reduced plaque accumulation, retarded gingivitis development, possessed a definite bactericidal action, and produced only slight toothstaining.

Adult↗

Reduced chlorhexidine tooth stain coverage by sequential administration of monoperoxyphthalic acid in the beagle dog.

Extrinsic tooth stain is sometimes a side-effect observed with the chronic use of chlorhexidine-containing oral care products. This chlorhexidine (CHX)-induced tooth staining is observed both in humans as well as in experimental animals. The present study tested the hypothesis that the sequential administration of monoperoxyphthalic acid (MPA) will reduce the development of chlorhexidine-induced tooth stain coverage in a beagle dog. For this study, dogs were treated with 30 mL of mouthrinse b.i.d. for 28 days. The following treatment groups ( = 12 dogs/group) were tested: water (negative control), 1.0% MPA rinse, 0.12% CHX rinse, and 1.0% MPA rinse followed by 0.12% CHX rinse. The sequential dosing of 1.0% MPA followed by 0.12+ CHX resulted in significantly (p < or = 0.05) less tooth stain than when dogs were dosed with 0.12% CHX alone. Additionally, the sequential dosing of MPA followed by chlorhexidine resulted in a 75% reduction in plaque formation in this model, which was significantly different (p < or = 0.05) from results with either treatment alone. A further study demonstrated that similar results could be obtained when MPA plus CHX treatment alone. A further study demonstrated that similar results could be obtained when MPA plus CHX treatments were separated by approximately a five-hour period in an AM and PM schedule. We conclude that the oxidizer, MPA, can significantly reduce tooth stain induced by CHX while enhancing its antiplaque and antigingivitis activity.

Animals↗

Review of terminology, classifications, and indices of developmental defects of enamel.

A wide variety of terms and definitions are used to describe various developmental defects of enamel. Some are simple descriptive clinical terms, and others are linked with the causative agent or the histopathology of the defect. Some confusion exists as to the most appropriate type of index to use to measure defects of enamel due to fluoride ingestion (dental fluorosis). This is primarily due to difficulties some researchers have in distinguishing between defects of fluoride and non-fluoride origin. This problem has resulted in the development of specific fluorosis indices and purely descriptive indices. The main fluorosis indices are those of Dean, Thylstrup and Fejerskov, and the TSIF Index. Dean's Index does not provide adequate information on the distribution of fluorosis within the dentition and is not sensitive at high fluorosis levels. The Thylstrup and Fejerskov Index is related to the histology of florosis; however, the initial minute changes observed on dry enamel surfaces are of little esthetic importance. The TSIF Index does overcome some of the limitations of Dean's Index. The DDE Index has replaced the Al-Alousi Index as the main descriptive index. The DDE Index is time-consuming, and the analyses of data are complicated. Modifications have now been proposed to make it simpler to use and the data more meaningful. Further research needs to be carried out into both the validity of the fluorosis indices and making the DDE Index more universally acceptable.

Dental Enamel↗

Cleaning power and abrasivity of European toothpastes.

For 41 toothpastes available to European consumers in 1995, the cleaning efficacy was evaluated in comparison with abrasivity on dentin (RDA value). For cleaning power assessment, a modified pellicle cleaning ratio (PCR) measurement method was developed. The method is characterized by a five-day tea-staining procedure on bovine front teeth slabs on a rotating wheel, standardized brushing of the slabs in a V8 cross-brushing machine, and brightness measurement by a chromametric technique. All tested products were in accordance with the new DIN/ISO standard 11,609 for toothpastes in terms of dentin abrasivity. Not a single product exceeded an RDA value of 200. The majority of toothpastes (80%) had an RDA value below 100. Only three products surpassed the reference in cleaning power. Most products (73%) had a cleaning power (PCR value) between 20 and 80. The correlation between cleaning power and dentin abrasion was low (r = 0.66), which can be explained with the different influence on dentin and stains by factors like abrasive type, particle surface and size, as well as the chemical influence of other toothpaste ingredients. Some major trends could be shown on the basis of abrasive types. The ratio PCR to RDA was rather good in most silica-based toothpastes. A lower ratio was found in some products containing calcium carbonate or aluminum trihydrate as the only abrasive. The addition of other abrasives, such as polishing alumina, showed improved cleaning power. Some active ingredients, especially sequenstrants such as sodium tripolyphosphate or AHBP, also improve the PCR/RDA ratio by stain-dissolving action without being abrasive. The data for some special anti-stain products did not differ significantly from standard products. Compared with data measured in 1988, a general trend toward reduced abrasivity without loss of cleaning efficacy could be noticed on the European toothpaste market. This may be mostly due to the increased use of high-performance abrasives such as hydrated silica.

Animals↗

Salivary proteins interact with dietary constituents to modulate tooth staining.

Dietary components rich in polyphenols-for example, tea and red wine-are thought to cause tooth staining. In the present study, hydroxyapatite was used as a model of enamel for study of the influence of salivary proteins on the binding of different polyphenols to hydroxyapatite in vitro. Neither salivary protein pellicles nor salivary proteins in solution significantly altered the binding of the small polyphenol epigallocatechin to hydroxyapatite. However, hydroxyapatite binding of anthocyanin, a small grape-skin-derived polyphenol, or the larger polyphenols of black tea was increased by the presence of salivary proteins, either as a pellicle or in solution. Proline-rich proteins were enriched from parotid saliva and found to increase binding of anthocyanin and black tea polyphenols to hydroxyapatite, while enriched histatins did not increase binding. It is concluded that some salivary proteins, including proline-rich protein, can mediate increased staining of enamel by red-wine- and black-tea-derived polyphenols.

Anthocyanins↗

Adverse drug reactions in the orofacial region.

A wide spectrum of drugs can sometimes give rise to numerous adverse orofacial manifestations, particularly dry mouth, taste disturbances, oral mucosal ulceration, and/or gingival swelling. There are few relevant randomized double-blind controlled studies in this field, and therefore this paper reviews the data from case reports, small series, and non-peer-reviewed reports of adverse drug reactions affecting the orofacial region (available from a MEDLINE search to April, 2003). The more common and significant adverse orofacial consequences of drug therapy are discussed.

Drug-Related Side Effects and Adverse Reactions↗

Indelible bond location marks: an avoidable aesthetic hazard.

An increasingly popular method of aiding the precise placement of bonded brackets is to identify the long axis and centre of the crown with small pencil marks. A case is reported where marks placed with a soft pencil in the centre of the etched enamel have led to the inclusion of pigment deep in the enamel surface which has proved impossible to remove.

Adolescent↗

The hydrochloric acid-pumice microabrasion technique in the treatment of post-orthodontic decalcification.

A significant number of patients exhibit white spots of enamel decalcification after orthodontic treatment, despite the use of preventive regimes. The hydrochloric acid-pumice micro-abrasion technique offers a method for improving the appearance of these lesions where they are cosmetically unacceptable. The clinical procedure is described and the effects of the technique upon the dental structures are discussed.

Humans↗

Smoking and tooth discolouration: findings from a national cross-sectional study.

BACKGROUND: Smoking is a risk factor of a number of oral diseases; the extent to which tobacco products influence dental aesthetics has not been widely investigated. The aim of this study was to determine satisfaction with own tooth colour of smokers and non-smokers and to investigate whether smokers have higher levels of self-assessed tooth discolouration compared to non-smokers METHODS: A cross sectional national study was conducted on sample of 6,000 UK adults. A total of 3,384 adults was interviewed. Smoking behaviour was recorded together with satisfaction with own tooth colour. Prevalence of perceived discolouration was measured by asking respondents to match their own tooth colour to one of a set of seven photographs of differing severities of discolouration. RESULTS: Twenty eight percent of smokers reported having moderate and severe levels of tooth discolouration compared to 15% in non-smokers. As well as more often perceiving discolouration smokers were also more likely to be dissatisfied with their own tooth colour compared to non-smokers. CONCLUSION: The study provides further evidence of the negative impact of tobacco smoking on dental aesthetics in the general public. The evidence provided by the study may be of value in short interventions for smoking cessation in the dental setting.

Adult↗

Enamel microabrasion.

A significant number of patients complain of discoloured teeth. The enamel microabrasion technique described in this article is a simple conservative method for improving the appearance of discoloured enamel.

Contraindications↗

The benefits of toothpaste--real or imagined? Review of its role in tooth whitening.

The market for whitening toothpastes in the UK is burgeoning at present, but little has been published about the modes of action or efficacy of such pastes. Much is known about how the individual ingredients work, but toothpaste formulations are complex and there is potential for interaction. Studies have been undertaken to compare the efficacy of various test products, but these have used different types of trial design and consequently direct comparisons are difficult, not least because there are several ways of measuring 'whiteness', and there is no consensus of opinion between workers in this field as to the best way to record it.

Anti-Infective Agents, Local↗

What's in toothpaste and why?

This article reviews the ingredients of toothpastes and their role in providing medicinal and cosmetic benefits to the consumer.

Chemistry, Pharmaceutical↗

Amelogenesis imperfecta--clinical presentation and management: a case report.

Amelogenesis imperfecta (AI) is an inherited disorder which results in enamel defects. The presentation of AI can vary depending on the type and severity of AI. The management of this condition is important for the patient, both functionally and aesthetically. This report describes the management of a young man who was referred to Birmingham Dental Hospital with AI. The patient's primary complaint was the appearance of his front teeth and the sensitivity he was experiencing from his worn molar teeth.

Adolescent↗

Vital tooth bleaching in dental practice: 1. Professional bleaching.

UNLABELLED: As dental health improves, with the concurrent drop in the provision of basic restorative care, patients are now asking their dentists to provide aesthetic treatments rather than the treatment of disease. Tooth bleaching is one such treatment that is frequently described in consumer magazines and television shows, driving consumer interest in this, apparently, benign therapy. This three-part series demonstrates the techniques that can be employed, within the dental practice or under the supervision of a clinician, those systems that can be bought by patients over the counter and, finally, a discussion of the biological effects of peroxide-containing solutions and the legal position on such products in the UK. In this section, we will describe the common methods by which teeth can be bleached, either by the clinician directly, or under his/her supervision by the use of'at home' kits. Efficacy and safety issues will be described. CLINICAL RELEVANCE: Clinicians should be able to discuss the merits, risks and likely success of a variety of bleaching treatments with their patients and, in doing so, assist in the process of obtaining informed consent.

Dental Devices, Home Care↗

Vital tooth bleaching in dental practice: 2. Novel bleaching systems.

UNLABELLED: This paper describes some of the novel commercial approaches to tooth bleaching. Known as 'direct-to-consumer' products there are two main systems available, one employing coated, cellulose strips and the other a paint-on gel. A further development is the production of dentifrices that contain active hydrogen peroxide, made possible by the use of dual chambered tubes. Each of the systems is described and demonstrated and an overview of the research supporting their safe, effective use is presented in each case. It is likely that our patients have access to these products and, hence, it is important that we are aware of their strengths and weaknesses. CLINICAL RELEVANCE: The systems described within this paper are available for sale in Europe and over the internet. Patients may well be using, or planning to use, them and may ask for professional advice.

Age Factors↗