Prevention

9. Erosion protection at lower levels

These studies aimed to determine the relative ability of various fluoride-containing products to protect enamel against the initiation and progression of tooth surface loss due to erosive acid challenges. Cores of enamel were prepared from extracted human teeth, soaked in pooled human saliva (pellicle formation), and then treated in a 1:3 slurry (product:saliva) of either over the counter (OTC) level (1,100 ppm F) or prescription level (5,000 ppm F) products, followed by a standardised erosion cycling procedure that included 10-minute challenges with an erosive dietary acid (1% citric acid at pH 2.3) applied 60 minutes after each dentifrice treatment (repeated four times per day). Enamel surface loss was measured using transverse microradiography. Two studies were conducted both with variants of fluoride content and formulation (stabilised SnF2, NaF, NaF + acidulated phosphate). Results from both studies demonstrated the OTC dentifrice formulated with stabilised SnF2 provided significantly greater protection against the initiation and progression of erosive acid damage compared to some of the most popular prescription level (5,000 ppm F) fluoride treatments available.

Eversole SL, Saunders-Burkhardt K, Faller RV. Erosion prevention potential of an over-the-counter stabilized SnF2 dentifrice compared to 5000 ppm F prescription-strength products. J Clin Dent 2015 26: 44-49.

Q In relation to erosive protection, an over the counter dentifrice containing 1,100ppm fluoride:

A When formulated with SNF2 was superior to a 5,000ppm F dentifrice

B Was equally effective whether included with as NaF or SnF2

C Was inferior to the higher strength 5,000ppm in any formulation

D Provided equal protection to all other formulations tested

10. How long do you take?

Using a cross-sectional questionnaire survey completed by 297 parents of children aged 3-6, this research sought to determine whether their judgements on how often other parents brush their children’s teeth are associated with the frequency with which they brush their own children’s teeth, and their satisfaction with their child’s brushing routine. Parents were asked how often they brushed their own child's teeth per week, how often they thought other parents did so, and how satisfied they were with their child’s toothbrushing routine. Demographic data were also collected. The mean frequency that parents brushed their children’s teeth was 12.5 times per week. Analysis tested the relationship between parents’ perceptions of other parents brushing frequency providing a mean of 10.5 times per week. There was a positive association between parents' satisfaction with their child's brushing routine and the extent to which they thought it was better than that of the average child. Re-framing oral health messages to include some form of social normative information (“most parents do this”) may prove more persuasive than simple prescriptive advice (“you should do this”).

Trubey RJ, Moore SC, Chestnutt IG. The association between parents’ perceived social norms for toothbrushing and the frequency with which they report brushing their child's teeth. Community Dent Health 2015 32: 98-103.

Q Which statement is true of the results of this study?

A Parents tend to underestimate the number of times a week they brush their children’s teeth compared to other parents

B Framing oral health messages in a more authoritative way may be more beneficial

C Parents actually brushed their children’s teeth 10.5 a week on average

D Parents actually brushed their children’s teeth 12.5 a week on average

11. Oscillating-rotating beats hard-to-reach plaque

This review of six clinical trials provided a comprehensive overview of the results of between-brush differences, specifically in the lingual, gingival marginal, and approximal (‘hard-to-clean’) areas, in post-brushing plaque removal. At each evaluation visit, subjects brushed with either the randomly assigned oscillating-rotating (O-R) power brush [Oral-B Professional Care Series 4000 (Triumph) or Oral-B Vitality with Floss Action or Precision Clean brush head] or a control brush [Sonicare FlexCare with ProResults brush head (three trials) or an American Dental Association reference manual toothbrush (three trials)]. In total, 462 subjects completed the trials and were evaluable. While all toothbrushes provided significant post-brushing versus baseline plaque removal efficacy, the magnitude of the reduction was consistently superior for the O-R brush compared to either the sonic power or manual brush control in all the ‘hard-to-clean’ region-specific analyses. Plaque indices favoured the O-R brush relative to the sonic brush or control on lingual surfaces, lingual approximal surfaces, lingual mandibular and lingual mandibular anterior regions; as they did in the whole mouth adjusted mean reduction.

Grender J et al. Plaque removal efficacy of oscillating-rotating power toothbrushes: Review of six comparative clinical trials. Am J Dent 2013 26: 68-74.

Q Is it true to say that?

A Overall the oscillating-rotating power brush removed less lingual plaque than the other brushes?

B The sonic brush had superior plaque removal properties

C Overall the oscillating-rotating power brush removed more lingual plaque than the other brushes?

D Nothing beats a manual brush for hard-to-reach areas

12. Non-, light, moderate or heavy oral hygiene?

Comparable oral hygiene habits were found in non-smokers and light smokers whereas heavy smokers were found to have worse oral hygiene habits than non-smokers. Using a 24-item questionnaire addressing both smoking and oral hygiene habits, patients from three periodontal practices were evaluated. To assess periodontal status immediately following the survey all patients were examined clinically and categorised according to the American Dental Association (ADA) classification for periodontal diseases. A total of 762 patients with ADA type I gingivitis (4.1%), type II early periodontitis (31.2%), type III moderate periodontitis (39.2%) and type IV advanced periodontitis (25.5%) were surveyed; 289 smokers (38.0%) and 402 (52.8%) non-smokers participated with 77 (10.1%) participants identified as heavy smokers (>20 cigarettes/day), 122 (16.0%) moderate smokers (10-20 cigarettes/day) and 90 (11.8%) light smokers (<10 cigarettes/day). A greater proportion of non-smokers brushed their teeth two (37.8%) or more (22.9%) times a day compared with moderate smokers (32.0%:15.6%) and heavy smokers (32.5%:15.6%). Heavy smokers used dental floss statistically significantly less frequently than non-smokers.

Santos A et al. Self-reported oral hygiene habits in smokers and non-smokers diagnosed with periodontal disease. Oral Health Prevent Dent 2015 13: 245-251.

Q The heavy smokers in this study:

A Were defined as smoking less than 10 cigarettes a day and 15.6% of them brushed less than two times a day

B Used floss more frequently than non-smokers

C Brushed two or more times a day in the same percentage as moderate smokers

D Represented 52.8% of the surveyed population