Prevention

9. Oscillating-rotating reduces recession

In order to compare long-term effects of brushing with an oscillating-rotating power toothbrush or an ADA reference manual toothbrush on pre-existing gingival recession, this study included healthy subjects with pre-existing recession. After randomisation they brushed with either a power (n=55) or manual brush (n=54) for a 3-year study period, twice daily for two minutes using a standard fluoride toothpaste. During the study, subjects were assessed for clinical attachment loss (CAL) and probing pocket depths (PPD) to the nearest mm at six sites per tooth by the same calibrated examiner. Gingival recession was calculated at pre-existing sites as the difference between CAL and PPD. Hard and soft oral tissues were examined to assess safety. After 35±2 months, mean gingival recession did not differ significantly between groups, but was significantly reduced from baseline (2.35±0.35 mm to 1.90±0.58 mm/power and 2.26±0.31 mm to 1.81±0.66 mm/manual). Gingival recession in subjects with pre-existing recession was significantly reduced after three years of brushing with either a power or manual toothbrush.

Dörfer CE, Staehle HJ, Wolff D. 3-year randomised study of manual and power toothbrush effects on pre-existing gingival recession. Clin Periodontol 2016 doi: 10.1111/jcpe.12518.

Q Gingival recession in subjects with pre-existing recession:
A Was significantly reduced by using a manual toothbrush
B Was significantly reduced by using an oscillating-rotating power toothbrush
C Was calculated using CAL and PPD measurements
D All of the above

10. Stannous fluoride protects from erosion

In this study, sound enamel cores from extracted, human enamel were cleaned, ground and polished, soaked in pooled saliva (pellicle formation) and treated with a 1:3 slurry of dentifrice and saliva. The aim was to investigate the relative erosion protection potential of marketed dentifrices formulated variously with fluoride. Specimens were subjected to daily challenges with 1% citric acid, a potentially damaging acid found in common food and drinks. Marketed dentifrices compared were: (1) stannous fluoride formulated with 1,100 ppm F as SnF2; (2) and (3) cavity protection products containing respectively 1,100 ppm F as NaF; and 1,000 ppm F as SMFP + 450 ppm F as NaF; and (4) a sensitivity product containing 1,450 ppm F as SMFP + 8% arginine bicarbonate. Specimens from Group 1 demonstrated an average loss of 5.5 (±1.2) μm of tooth surface enamel; The other groups lost an average of 18.3 (±0.9) μm, 16.0 (±2.0) μm and 17.1 (±1.1) μm, respectively, of tooth surface enamel. Group 1 provided a statistically significant difference in protection compared with the other products.

Eversole SL, Saunders-Burkhardt K, Faller RV. Erosion protection comparison of stabilised SnF2, mixed fluoride active and SMFP/arginine-containing dentifrices. Int Dent J 2014 64 Suppl 1: 22-28.

Q Which of the following fluoride formulations provided a significant difference in protection against erosion?
A 1,450 ppm F as SMFP
B 1,000 ppm F as SMFP
C 1,100 ppm F as SnF2
D 1,100 ppm F as NaF

11. Money, time and compliance

To assess gender and age differences in NHS dentists’ knowledge, attitudes and behaviours in providing preventive care a cross-sectional questionnaire survey was conducted with dentists working in north London. The sample displayed limited knowledge in certain key aspects of prevention, but expressed generally positive attitudes towards preventive care. More female and younger dentists reported that a child should attend the dentist before the age of 3 years. No other differences in knowledge or attitudes were found by age and gender. The majority of the sample reported routinely providing oral hygiene (95.7%), diet (85.4%) and smoking cessation advice (76.7%), but provision of alcohol advice was much less common (38%). A significantly higher proportion of younger dentists were more likely to give diet advice and smoking cessation support than their older colleagues. The main perceived barriers were related to organisational factors including insufficient remuneration (86.3%), lack of time (84%) and poor patient compliance (66%). There were no significant differences in perceived barriers by gender.

Yusuf H et al. Differences by age and sex in general dental practitioners’ knowledge, attitudes and behaviours in delivering prevention. Br Dent J 2015 219: E7.

Q Which were the most and least common preventive activities reported by this cohort of dentists?
A Oral hygiene and smoking cessation
B Diet and alcohol advice
C Smoking and oral hygiene
D Oral hygiene and alcohol advice

12. Eruption studies

A study group of 189 patients, 5-14 years of age, with one 1st or 2nd permanent molar in the process of eruption helped in comparing the caries preventive effect of a chlorhexidine/thymol-containing antibacterial varnish with a fluoride varnish when topically applied during eruption. After stratification for type of molar and stage of eruption, the patients were randomised to either quarterly topical applications with an antibacterial varnish (Cervitec Plus; CV group) or biannual applications with a fluoride varnish plus biannual treatments with placebo varnish (Fluor Protector; FV group). The duration of the study was two years. The primary endpoint was caries incidence (initial and cavitated) in the erupting molars and the secondary outcome was salivary mutans streptococci (MS) counts. The caries incidence was low (< 10 %) in both groups and there was no significant difference between the CV and FV groups with respect to occlusal caries development in the erupting molars. Significantly lower levels of salivary MS were disclosed in the CV group at the end of the study.

Flamee S et al. Effect of a chlorhexidine/thymol and a fluoride varnish on caries development in erupting permanent molars: a comparative study. Euro Archives Paediatric Dent 2015 16: 449-454.

Q Which group proved to have the highest caries rate?
A The antibacterial varnish
B The fluoride varnish
C Neither, they were equivalent
D The salivary mutans streptococci group