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Tooth brushing and oral health: how frequently and when should tooth brushing be performed?
Oral Health Prev Dent. 2005;3(3):135-40.
Attin T, Hornecker E.
This review shows that there is consensus in the literature that (meticulous) tooth brushing
once per day is sufficient to maintain oral health and to prevent caries and periodontal
diseases. Tooth brushing is also regarded as an important vehicle for application of
anti-caries agents, such as fluorides. However, most patients are not able to achieve
sufficient plaque removal by performing oral hygiene measures at home. Therefore,
tooth brushing twice daily is recommended by most of the dentists in order to improve
plaque control. This rule is followed by most of the patients taking care for their
oral health and has shown to be effective in maintenance of oral health in numerous
studies. Study of the literature gives no clear evidence as to the optimal time-point
of tooth brushing (before or after meals). However, in order to eliminate food
impaction and to shorten the duration of sucrose impact by tooth cleaning after
meals seems to be recommendable. Although--with our current knowledge of potential
harm due to brushing of erosively altered and softened tooth surfaces--giving
advice on a more individual basis is recommended for patients suffering from erosion.
Increasing the public health effectiveness of fluoridated salt.
Schweiz Monatsschr Zahnmed. 2005;115(9):785-92.
Marthaler TM.
This paper aims at assessing the public health potential of salt fluoridation schemes.
There is now solid evidence which shows that the cariostatic effectiveness of universal
salt fluoridation is equivalent to that of water fluoridation in both the permanent
and primary dentition. In countries of continental Europe, only domestic salt is
fluoridated, and its consistent use may be expected to warrant a 30% reduction
of caries prevalence. However, the effectiveness in the population at large is
lower because only part of the population uses the fluoridated domestic salt.
Under these conditions, it must be assumed that the effectiveness is further
reduced because families in low S-E strata use fluoridated salt (FS) less
frequently than those in the higher S-E strata who are known to use preventive
methods like toothbrushing twice a day with a fluoride dentifrice more
regularly. Model calculations tend to show that in Germany, where FS has
reached a market share of 60%, the overall effectiveness is 14% instead of 30%.
For France with a market share of 30% of the fluoridated domestic salt,
model calculations lead to an overall effectiveness of 8%. In order to
obtain a substantial decline of caries in the entire population, it is
important to aim for a high market share of the FS of 80%, or preferably 90%.
This goal can be reached with a relatively small budget. The task of health
ministries would be to promote the switch from unfluoridated salt to FS; however,
such promotion is often withheld by health ministries. It is possible,
through modest price increases of salt, to finance effective campaigns
inducing the majority of the population to use the fluoridated variety.
On a world wide scale, fluoridation of salt has established itself as an
efficient public health measure. It may be particularly beneficial for
developing countries because it is by far
the cheapest method and it is compatible with the use of fluoridated toothpastes.
The effective use of fluorides in public health. (Free Full Text)
Bull World Health Organ. 2005 Sep;83(9):670-6.
Jones S, Burt BA, Petersen PE, Lennon MA.
Dental caries remain a public health problem for many developing countries and for
underprivileged populations in developed countries. This paper outlines the historical
development of public health approaches to the use of fluoride and comments on their
effectiveness. Early research and development was concerned with waterborne fluorides,
both naturally occurring and added, and their effects on the prevalence and incidence
of dental caries and dental fluorosis. In the latter half of the 20th century, the
focus of research was on fluoride toothpastes and mouth rinses. More recently,
systematic reviews summarizing these extensive databases have indicated that water
fluoridation and fluoride toothpastes both substantially reduce the prevalence
and incidence of dental caries. We present four case studies that illustrate the
use of fluoride in modern public health practice, focusing on: recent water
fluoridation schemes in California, USA; salt fluoridation in Jamaica; milk
fluoridation in Chile; and the development of "affordable" fluoride toothpastes
in Indonesia. Common themes are the concern to reduce demands for compliance
with fluoride regimes that rely upon action by individuals and their families,
and the issue of cost. We recommend that a community should use no more than one
systemic fluoride (i.e. water or salt or milk fluoridation) combined with the use
of fluoride toothpastes, and that the prevalence of dental fluorosis should
be monitored in order to detect increases in or higher-than-acceptable levels.
Effect of after-meal sucrose-free gum-chewing on clinical caries.
SADJ. 2005 Jul;60(6):248-51.
Szoke J, Banoczy J.
Previous in situ and in vitro studies have demonstrated that the chewing of sucrose-free
gum after eating reduces the development of dental caries. To investigate the extrapolation
of these findings to the clinical setting, we conducted a two-year study on 547
schoolchildren in Budapest, Hungary. Subjects in the "Gum" group were instructed to chew
one stick of a commercially available sorbitol-sweetened chewing gum for 20 minutes after
meals, three times daily. The "Control" group was not provided with chewing gum.
After two years, the "Gum" group exhibited a 38.7% reduction in incremental caries,
excluding white spots, compared with the "Control" group. Including white spots,
a corresponding 33.1% reduction was indicated. These results clearly suggest that
even in a moderate caries population practicing normal oral hygiene, including the
use of fluoride dentifrices, an
after-meal gum-chewing regimen can significantly reduce the rate of caries development.
Children's acceptance of milk with xylitol or sorbitol for dental caries prevention. (Free Full Text)
BMC Oral Health. 2005 Jul 22;5(1):6.
Castillo JL, Milgrom P, Coldwell SE, Castillo R, Lazo R.
BACKGROUND: Xylitol, a polyol sugar, has been shown to reduce dental caries when mixed
with food or chewing gum. This study examines the taste acceptability of xylitol in milk
as a first step toward measuring the effectiveness of xylitol in milk for the reduction
of dental caries in a public health program. METHODS: Three different types of milk
(Ultra High Temperature (UHT), powder and evaporated) were tested for acceptability
by 75 Peruvian children (25 per milk group, ages 4 to 7 years). Each group evaluated
xylitol and sorbitol in one type of milk. In the first phase, each child was presented
with a tray of four plastic cups containing 50 ml of milk with 0.021 g/ml xylitol,
0.042 g/ml xylitol, 0.042 g/ml sorbitol or no sugar. Each child was asked to taste
the samples in a self-selected order. After tasting each sample, the child placed
the milk cup in front of one of three cartoon faces (smile, frown or neutral)
representing the child's response to the taste of each sample. In the second phase,
the child was asked to rank order the milk samples within each category
(smile, frown or neutral). Ranks within categories were then combined
to obtain a rank ordering for all the test samples. RESULTS: The ranking
from best to worst for the samples across categories (UHT, powder, evaporated)
was xylitol (0.0.042 g/ml), sorbitol (0.042 g/ml), xylitol (0.021 g/ml) and
milk alone (Friedman's ANOVA). Xylitol and sorbitol were preferred over milk alone,
and xylitol (0.042 g/ml) was preferred to sorbitol (0.042 g/ml)(p < .05 sign test).
CONCLUSION:
Milk sweetened with xylitol is well accepted by Peruvian children ages 4-7 years.
Pit and fissure sealants: results at five and ten years.
Eur J Paediatr Dent. 2005 Jun;6(2):61-5.
Albani F, Ballesio I, Campanella V, Marzo G.
AIM: This was to evaluate the efficacy of pit and fissure sealant (FS) using two different
application techniques for caries prevention assessed at five and ten years. METHODS:
The study was conducted using Delton(R) pit and fissures sealant applied with either
rubber dam (RD) (Group A: 50 children, 200 first permanent molars, 120 second permanent molars)
or cotton wool rolls (CR) (Group B: 50 children, 200 first permanent molars, 112
second permanent molars). At five and ten years FS were evaluated for retention,
loss and incidence of occlusal and proximal carious lesions recorded. STATISTICS:
The data were analysed with the Chi- square test comparing the results obtained for
first permanent molars and second permanent molars at five and ten years. RESULTS:
There was no statistical difference between results in the two groups (p< or =0.05).
The highest retention rate, 81.7%, was found for second permanent molars sealed
under RD at the five year assessment. The lowest, 64.3% also for second molars
sealed under CR humidity control at ten years. CONCLUSIONS: Pit and fissure sealants
are a valid preventive
approach that can be applied with similar results with rubber dam or cotton rolls.
The anti-caries efficacy of calcium carbonate-based fluoride toothpastes.
Int Dent J. 2005;55(3 Suppl 1):175-8.
Lynch RJ, ten Cate JM.
AIM: To summarise clinical support for the anti-caries efficacy of fluoride toothpastes
containing sodium monofluorophosphate (SMFP) and to discuss the possible means by which
the abrasive particles in calcium carbonate-based SMFP toothpastes might complement and/or
enhance fluoride efficacy. BACKGROUND: The anti-caries efficacy of fluoride has been proven
beyond any reasonable doubt, and the efficacy of SMFP, when incorporated into a variety
of compatible toothpaste formulations, has been established in numerous clinical trials.
Calcium carbonate-based toothpastes may also influence caries by effecting an increase
in plaque calcium levels; an inverse relationship between plaque calcium and caries
is well-established. It has also been reported that plaque fluoride levels are
dependent on plaque calcium levels. Hence elevated plaque calcium resulting from
the use of calcium carbonate-based toothpastes has the potential to elevate plaque
fluoride, itself linked to reduced caries experience. It has been shown that calcium
carbonate particles are retained by plaque and this may also influence caries by
neutralising harmful plaque acids and concurrently liberating calcium.
CONCLUSION: Fluoride delivered from calcium carbonate-based SMFP toothpastes
is an effective means of reducing caries. Further, calcium carbonate may
confer additional benefits
through elevation of oral calcium levels and neutralisation of plaque-acids.
Optimal Er:YAG laser energy for preventing enamel demineralization.
J Dent. 2006 Jan;34(1):62-6
Liu JF, Liu Y, Stephen HC.
OBJECTIVES: The purpose of this study was to identify the optimal laser energy range
of Er:YAG laser irradiation for laser-induced caries prevention (LICP). METHODS:
Twenty-one human non-carious molars were selected. The teeth were covered with nail
varnish, except two 4 mm x 1 mm windows on both the buccal and lingual surfaces.
The windows were randomly assigned to groups A, B, C and D, receiving no irradiation,
100, 200 and 300 mJ irradiation, respectively. The pulse width 10 pps (pulse per second)
with a 1.0 mm spot size was used. After the laser treatment, each tooth was cut into
two halves longitudinally. Then a two-day pH-cycling was performed, with an 18-hour
demineralization followed by a 6-hour remineralization. Sections of 120 +/- 20 microm
in thickness were obtained from each window. Lesion depth was measured using polarized
light microscope coupled with an image analysis software. One-way ANOVA
and post-hoc Tukey tests were used for evaluation of treatment effects. RESULTS:
The laser treatments of 100 and 200 mJ have demonstrated significant protection of
enamel demineralization (p = 0.01 and 0.001, respectively), but not the treatment
with 300 mJ (p = 0.106). A smaller lesion depth was observed for the 200 mJ group
(97.1 microm) than that of the 100 mJ group (105.6 microm).
Compared with the control, a lesion reduction of 32.78 and 26.93% for the
200 mJ group and the 100 mJ group were obtained, respectively. CONCLUSION:
Caries prevention may be achieved by using
Er:YAG laser treatment if the optimal range of laser parameters for LICP can be employed.
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