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Enamel microabrasion is a proven method of removing intrinsic and superficial defects from teeth, establishing esthetics with minimal loss of dental enamel. This article reports one case in which two different microabrasion techniques were used to remove fluorotic stains from teeth.
Dental staining, while always a significant problem, has become more important in recent years with the introduction and increased use of chlorhexidine-based mouthrinses. Not only do these rinses themselves cause staining, they also enhance staining from other sources, such as diet or tobacco use. An understanding of the etiologies of dental stains will help today's practitioners become more effective in managing dental stains in their practices. Important strategies for managing stain are patient education about the causes of staining, careful consideration of product recommendations for home use, and routine office visits for prophylaxis. Ideal products for patient use are those with effective stain-removal properties and low abrasivity, which minimizes tooth wear.
This article reports the results of a study that examined the clinical and microbiological changes associated with regular use of baking-soda dentifrices. Two dentifrice formulations were examined in a 6-month longitudinal study of 101 adult subjects with assessments for plaque, gingival inflammation, and stain at baseline and 3 and 6 months during the active phase of the study, and at 3 months after cessation of product use. One dentifrice contained 52% baking soda and 3% sodium percarbonate (Arm & Hammer PeroxiCare) while the other dentifrice contained 65% baking soda (Arm & Hammer Dental Care). Both dentifrices resulted in statistically significant reductions in dental plaque, gingival inflammation, and stain at all time periods compared to baseline. Dental plaque and buccal soft-tissue samples were obtained for microbiological analysis from a 50-subject subset. Microbiological assays, including bacterial culture, phase-contrast microscopy, and immunofluorescence microscopy, confirmed the safety of both formulations. Beneficial alterations in dental plaque bacteria were noted, including significant reductions in the levels of Actinomyces species. The data from this study indicate that dentifrices containing high levels of baking soda are clinically effective and microbiologically safe.
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Chlorhexidine remains the gold standard to which other antiplaque and gingivitis agents are compared. Its effectiveness can be attributed to it bactericidal and bacteriostatic effects and its substantivity within the oral cavity. While other agents may possess one or more of these properties, few possess all three and perform so well. The antimicrobial properties of chlorhexidine are attributed to it di-cationic structure, and it is this same property that is the basis of its most common side effect, extrinsic tooth staining. By understanding the biochemical properties of chlorhexidine, an appreciation for the efficacy and use of chlorhexidine can be developed. It is only in such a way that the efficacy can be maximized and the side effects minimized, allowing chlorhexidine to remain the gold standard.
OBJECTIVE: The purpose of this study was to assess Pertac II restorations placed in general dental practice. METHOD AND MATERIALS: A total of 86 restorations (14 Class I, 10 Class II, 17 Class III, 5 Class IV, and 40 Class V) using a hybrid composite material (Pertac II) placed in 56 patients (mean age, 39 years) in 5 dental practices in the United Kingdom were assessed after 1 year by a trained evaluator and the dental practitioner who had placed the restoration. All the restorations were assessed for anatomic form, marginal adaptation, surface roughness, sensitivity or discomfort, gingival condition, and the presence or absence of secondary caries. RESULTS: Thirty-five (43%) restorations were placed in load-bearing situations, 9% of which were assessed as being in "heavy" occlusion. Five (6%) of the restorations were lost (all Class V restorations), 4 from premolars and 1 from a molar. Four were in wedge-shaped cavities and 1 small restoration was actually dislodged during examination. The remaining 81 (94%) restorations were found to be intact, with no secondary caries detected. A high percentage of optimal scores were recorded for both anatomic form and surface roughness. CONCLUSION: It is concluded that the evaluation demonstrated satisfactory clinical performance of Pertac II restorations after 1 year of clinical service in the wide variety of clinical situations seen in general dental practice. However, the potential for failure of hybrid composite materials in Class V situations appears high. It may be argued that clinicians who wish to use a resin-based material in a Class V situation should use a compomer or microfilled composite.
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PURPOSE: A randomized, double blind clinical trial was conducted to evaluate initial color improvement and post-treatment color retention following vital bleaching with a strip-based tooth whitening system. MATERIALS AND METHODS: After balancing for baseline color, 57 healthy adults were randomized to either whitening strips with a 5.3% hydrogen peroxide bleaching gel (Crest Whitestrips) or placebo strips without hydrogen peroxide. Maxillary and mandibular anterior teeth were treated twice daily for 30 minutes each over a 2-week period, and efficacy was measured objectively by comparing digital images of teeth collected at baseline, end-of-treatment (Week 2) and 6 months after treatment (Month 6). RESULTS: The whitening strip group experienced a highly significant (P< 0.0001) reduction in yellow of -2.0 deltab* units versus baseline and -1.95 deltab* units versus placebo, with similar results noted for the other color parameters in the study. Most of the initial color change remained at 6 months post-treatment, with the whitening strip group continuing to demonstrate highly significant (P< 0.0001) improvements in tooth color relative to baseline and placebo. Age was found to significantly contribute to initial color improvement, with younger subjects experiencing a greater initial reduction in yellowness compared to older participants, but not to post-treatment color retention. The whitening strips were well tolerated, with minor tooth sensitivity and oral irritation representing the most common findings during treatment. There were no persistent or new treatment-related adverse events during the 6-month monitoring period.
PURPOSE: To compare the safety and efficacy with respect to the control of calculus and stain of two power toothbrushes. MATERIALS AND METHODS: This was a cross-over study involving a total of 81 subjects from a general population who used, in a randomized sequence, the Braun Oral-B 3D Excel (D17) and the Sonicare toothbrush with a conventional dentifrice, and a manual brush with a tartar control dentifrice. The manual toothbrush with tartar control dentifrice served as a positive control with respect to control of calculus. Following 9 weeks of manual brush use with a conventional, non-abrasive dentifrice, each test brush was used for a period of 9 weeks, after which subjects switched to the next brush in the sequence. Calculus was scored using the Volpe-Manhold Calculus Index and stain using the Lobene Stain Index. RESULTS: All three brushes were found to be safe as used in the study. All three toothbrushes significantly reduced the levels of calculus as compared to the control period. Reduction from baseline in the rate of calculus formation was greatest in the D17 group (63%), followed by the manual brush with tartar control dentifrice (60%) and Sonicare (44%). Both the D17 and the manual brush were significantly more effective than Sonicare (P< 0.001). The D17 was also more effective at controlling stain formation than either Sonicare or the manual brush with tartar control dentifrice at the gingival margin, the difference from Sonicare being statistically significant for all analyses (P< 0.0001). It is concluded that the D17 is significantly more effective in reducing both the rate of calculus and stain formation than the Sonicare toothbrush.
This study evaluated the influence of the pulp protection technique on clinical performance of amalgam restorations after three years, with particular reference to post-operative sensitivity and secondary caries. One hundred and twenty (120) Class II amalgam restorations (68 premolars, 52 molars; 78 MOD, 42 OD/MO) were placed in 30 participants (four restorations per participant). The restorations were divided into four groups according to the pulp protection technique used: copal varnish; 2% neutral sodium fluoride; adhesive resin and no pulp protection. The parameters evaluated were post-operative sensitivity, staining of the dental structure, tooth vitality, partial or total loss of the restoration and secondary caries. One hundred and eight (108) restorations were available for evaluation after three years. No partial or total loss of restorations had occurred; all teeth were vital, no tooth structure staining or secondary caries was detected in any of the restored teeth. Post-operative sensitivity was observed only in two restorations at baseline and at seven-days. The three-year clinical performance of teeth restored with a high copper dispersed phase amalgam was not affected by the choice of pulp protection technique.
Aim of the present study was to investigate whether the use of an oxidising mouthrinse as an adjunct to chlorhexidine is efficacious in reducing stain, plaque and gingivitis. This study had a single-blind, 2-group parallel design, including a 14-day experimental non-brushing period during which 1 group (n = 14) used chlorhexidine alone (CHX) and the other (n = 14) used chlorhexidine in combination with an oxidising agent. Patients were randomly assigned to either group. The gingival condition was evaluated at baseline by means of bleeding on marginal probing. The examination after 14 days of rinsing included the evaluation of plaque, bleeding on marginal probing and stain (GMSI: gingival modification of the stain index). The results showed at day 14 a significant difference between the 2 groups for plaque and gingival bleeding. The proportion of stained surfaces was less in the CHX + PER-group (28%), than in the chlorhexidine group. The adjunctive use of an oxidising agent peroxyborate to chlorhexidine, proved to be superior to chlorhexidine alone with regard to the inhibition of plaque and development of gingivitis.
A major drawback to clinicians prescribing and patients using chlorhexidine rinse is the development of extrinsic staining. In order to assess the effectiveness of a whitening dentifrice in controlling chlorhexidine stain, fifty-seven subjects rinsed with chlorhexidine twice daily while brushing twice daily with either fluoridated whitening or a fluoridated regular dentifrice. Stain was assessed at 1, 2, and 3 month intervals using a stain index with two components; one with parameters for color intensity and one for tooth percentage covered with stain. Facial surfaces accumulated less stain than lingual surfaces. For many, although not all surfaces, and at many, although not all time periods, the group utilizing the whitening dentifrice exhibited less staining. It is advantageous to recommend a whitening dentifrice that has demonstrated stain suppression when prescribing a chlorhexidine rinse. Improved patient satisfaction leading to increased compliance with the antimicrobial regimen is a desired outcome.
Rapid innovation in vital bleaching has increased the popularity of tooth whitening among dental professionals and patients. A broad range of peroxide-based treatments are currently available including those that are professionally-administered (in-office), professionally-dispensed (custom-tray-based systems), and self-directed (over-the-counter). Recently, a novel, flexible polyethylene bleaching strip was introduced that delivers a hydrogen peroxide bleaching gel to the anterior dentition. This "trayless" system, available in professional-strength and over-the-counter versions, reportedly offers advantages with respect to overall peroxide dose, contact time, and ease-of-use compared to other delivery systems. This paper reviews the relevant published clinical research on whitening strips tested among a broad range of patients commonly encountered in contemporary dental practices.
INTRODUCTION: Common clinical experience suggests that tooth whitening agents are 100% effective. This study uses meta-analysis of data from published randomized controlled clinical trials to determine the efficacy of tooth whitening agents. METHODS: A MEDLINE search strategy was developed and implemented to systematically identify clinical trials on dentist-prescribed, home-applied tooth whitening agents, using 10% carbamide peroxide, published between 1989-1999. Inclusion criteria (e.g., in English, human clinical trials) and exclusion criteria (e.g., not placebo controlled) were established and clinical trials that met these criteria were critically appraised for validity and clinical applicability. Meta-analysis was then used to quantitatively integrate the findings. RESULTS: Seven studies were identified that met the inclusion and validity criteria. These studies indicated that: Whitening results in a significant mean change of 6 4 shade guide units (p < 0.01), while the placebo control group exhibited little change (0.7 0.6, p > 0.05). 93% of the bleached patients exhibited 2 shade guide unit change, while 20% of the placebo control group exhibited this change. The brand of bleaching agent had a significant effect on tooth whitening, but the daily application time and duration of treatment did not. Whitening is maintained for 6 months for 1/2 of the people treated. Neither gingival indices nor plaque indices were adversely or favorably affected by bleaching. CLINICAL APPLICABILITY: The data from the reviewed studies indicate that rather than being 100% effective, on average: 73% (93% for bleached group minus 20% placebo group) of people who whiten their teeth will exhibit a whitening that is 2 shade guide units greater than the placebo. 20% of the people who use dentist-prescribed, home-applied bleaching will achieve a mean whitening effect of 5 shade guide units. Re-treatment for 50% of people may be necessary to maintain this effect longer than 6 months. The methods used here are Internet applicable for other clinical topics.
Stannous fluoride has been recognized as an effective anticavity therapeutic agent since the early 1950s. There has recently been a resurgence in activity to discover ways to fully exploit its documented antimicrobial activity. Through the use of targeted in vitro methodology to predict in vivo efficacy, a highly optimized stannous fluoride dentifrice has been developed. Careful selection of stabilizing agents formulated into a unique system has resulted in a Colgate Optimized Stannous Fluoride (COSF) dentifrice that has been proven to simultaneously help control supragingival plaque, gingivitis, supragingival calculus, and caries. Furthermore, the COSF dentifrice has been clinically shown not to cause the traditional stannous fluoride staining of dentition.
The objective of this 3-month, double-blind clinical study was to investigate the level of tooth staining associated with the use of Colgate Optimized Stannous Fluoride (COSF) dentifrice compared to the tooth staining associated with two commercially available dentifrices. The results of this clinical study support the conclusion that the intensity and extent of extrinsic tooth stain associated with the use of the COSF dentifrice are significantly lower than that associated with Crest Gum Care Toothpaste. Further, this study provided no indication that the use of the COSF dentifrice is associated with a greater level of stain than that associated with the use of Crest Regular Toothpaste, a standard 0.243% sodium fluoride/silica dentifrice.
The clinical diagnosis of secondary caries is the main reason for replacement of all types of directly-placed restorations. This is an ill-defined clinical diagnosis both in teaching programs and in general practice. The criteria for the diagnosis must be improved and come in line with those for primary caries. Secondary caries are usually localized and delineated lesions and should be differentiated from stained and ditched margins. Small defects of secondary caries, stained and degraded margins may be removed by refurbishing/refinishing procedures. Larger defects may be explored by removing part of the restoration to access the defective margin. By removing part of the restoration to the full depth, a firm diagnosis can be made regarding the extent of the lesion, as the defects are often well delineated. Provided the main part of the restoration is satisfactory, the "exploratory" cavity preparation can then be filled with an appropriate material. These approaches will save tooth structure and be cost-effective. However, longevity data are lacking with such studies in progress.