Preventive

9.Oscillating-rotating prevention 

An evaluation of the effect of an oscillating-rotating (O-R) power toothbrush versus a manual toothbrush was undertaken on gingival margin stability following mucogingival plastic surgery. Sixty healthy subjects having a minimum of one buccal recession site >2mm underwent a surgical root coverage procedure and were then randomly assigned to use either an O-R power toothbrush (Oral-B® Triumph with Oral-B® Sensitive brush head) or a soft-bristled manual toothbrush (Oral-B® Indicator®). A range of periodontal indices were recorded including full-mouth plaque, bleeding scores and pocket depth at baseline and 1, 3, and 6 months after the surgical procedure. Subjects using the O-R toothbrush showed significantly higher complete root coverage after mucogingival plastic surgery than subjects using a soft-bristle manual toothbrush (96.7% vs 66.7%). Both brushes significantly reduced plaque and bleeding versus baseline, however, the O-R toothbrush resulted in significantly less plaque and bleeding compared to the manual toothbrush after six months. This suggests that improved outcomes of mucogingival surgery are possible by recommending use of an O-R power toothbrush.

Gingival margin stability after mucogingival plastic surgery. the effect of manual versus powered toothbrushing: a randomized clinical trial. Acunzo R et al. J Periodontol 2016. DOI: 10.1902/jop.2016.150528.

Q In order to improve the outcome of mucogingival surgery which measure might be best to consider? Recommending:
A Use of an oscillating-rotating power toothbrush
B Using mouthwash only for six months
C One daily brushing with a manual toothbrush
D Not using floss until the sutures are removed

10.Wearing thin

A recent consensus report on erosive tooth wear (ETW) has been published by the European Federation of Conservative Dentistry based on a compilation of the scientific literature and an expert conference, which concludes that: ETW is a chemical-mechanical process resulting in a cumulative loss of hard dental tissue not caused by bacteria, characterised by loss of the natural surface morphology and contour of the teeth. A suitable index for classification is the basic erosive wear examination (BEWE) and the aetiology is patient-related factors including the predisposition to erosion, reflux, vomiting, drinking and eating habits, as well as medications and dietary supplements. Nutritional factors relate to the composition of foods and beverages, e.g., with low pH and high buffer capacity (major risk factors), and calcium concentration (major protective factor). Preventive management of ETW aims at reducing or stopping the progression of the lesions. Additionally, products (e.g. toothpastes or mouthrinses) containing stannous fluoride or stannous chloride have the potential for slowing the progression of ETW.

Carvalho TS et al. Consensus report of the European Federation of Conservative Dentistry. Clin Oral Investigations 2015 19: 1557-1561.

Q Which of the following statements is NOT true? 
A ETW stands for erosive tooth wear
B Toothpastes containing stannous fluoride are useful in preventing ETW
C Foods and beverages with a low pH have a high protective effect against ETW
D ETW is not caused by bacteria

11.Parents’ wishes recorded

Quantitative and qualitative responses were collected from a sample of 123 parents/guardians during their child’s sedation appointment at King's College Hospital to report on the profile of children who required treatment under conscious sedation. Also, to obtain views on their experiences of oral health preventive services and the support they would like in order to improve their child's oral health. Caries was the main reason for the children’s sedation treatment and 77.2% of them were high caries risk. Parents reported that their general dentist had given advice about sugar (80%) and toothbrushing (74%), but few had prescribed fluoride varnish (15%), fissure sealants (12%) or a fluoride rinse (36%). Parents felt challenged by the ready availability of sugar, and others suggested difficulty in maintaining healthy oral habits in complex families. Overall, the majority of parents thought leaflets, health professionals’ advice and websites could be informative, and they requested school- and hospital-based prevention programmes. 

Ogretme MS, AbualSaoud D, Hosey MT. What preventive care do sedated children with caries referred to specialist services need? Br Dent J 2016 221: 777-784.

Q Children who required treatment under conscious sedation:
A Are rarely accompanied by their parents or guardians
B Have behavioural problems as their main reason for needing sedation
C Had fissure sealants prescribed by their dentist in 74% of cases
D Had parents/guardians who requested school- and hospital-based prevention programmes

12.Eruptive caries patterns

What is the prevalence of distal caries (DC) in mandibular second molars and what are the outcomes of these diseased teeth? Clinical and radiographic data from 210 consecutive patients were studied over a three-month period for all patients referred to a hospital oral surgery department for a lower wisdom tooth assessment. Of 224 mandibular third molars, caries affected the distal aspect of the second molar in 38% (n=85) of cases. In 18% of patients there was evidence of early enamel caries: 58% of caries was managed with restorative treatment but 11% of patients required second molar extraction and 13% of patients required the removal of the second and third molars. The prevalence of distal caries was significantly higher in patients with partially erupted wisdom teeth positioned below the amelocemental junction of the adjacent second molar and in patients who presented with mesioangular impactions. If patients’ third molar teeth are not removed, then consideration needs to be given to prevention and regular monitoring.

Toedtling V, Coulthard P, Thackray G. Distal caries of the second molar in the presence of a mandibular third molar - a prevention protocol. Br Dent J 2016 221: 297-302.
 
Q Which of these patients has the greatest likelihood of a caries process occurring on the distal aspect of a second mandibular molar? A patient with:
A All four wisdom teeth unerupted
B Partially erupted, mesioangular impacted wisdom tooth positioned below the amelocemental junction of the adjacent second molar 
C Partially erupted, mesioangular impacted wisdom tooth positioned above the amelocemental junction of the adjacent second molar
D Fully erupted wisdom tooth in tight mesial contact with the second molar