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Biomedical subjects

G A van der Weijden

Publications and source records attributed to G A van der Weijden.

At least 19 recordsLinked to original sources
PubMed2006

A review of the effects of stannous fluoride on gingivitis.

AIM: To review the literature on the effects of stannous fluoride on gingivitis. MATERIAL AND METHODS: The Medline and cochrane central register of controlled trials were searched up to August 2005 to identify appropriate studies. The primary outcome measure was gingivitis. RESULTS: Independent screening of titles and abstracts of 542 papers resulted in 36 publications (inter-reviewer ê score of 0.76), out of which 15 papers finally fulfilled the criteria of eligibility. For SnF(2)dentifrices, a statistically significant reduction in gingivitis was noted in comparison with control (weighted mean difference (WMD) of 0.15 (gingival index) and 0.21 (gingivitis severity index) (test for heterogeneity p<0.00001, I(2)=91.1% and p=0.03, I(2)=80.1%, respectively)). With regard to plaque reduction inconsistent results existed. On using the plaque index no differences were found, whereas meta-analysis of the Turesky index provided a WMD of 0.31 (p=0.01, test for heterogeneity p<0.0001, I(2)=91.7%). Because of insufficient data, a meta-analysis for SnF(2)mouth rinse and dentifrice/mouthrinse formulations was not performed. CONCLUSIONS: The use of SnF(2) dentifrices results in gingivitis and plaque reduction when compared with a conventional dentifrice. The precise magnitude of this effect was difficult to assess because of a high level of heterogeneity in study outcomes.

Dental Plaque↗
PubMed2006

Comparison of two automated periodontal probes and two probes with a conventional readout in periodontal maintenance patients.

AIM: The aim of the present study was to test in periodontal maintenance patients whether the systems for pressure control that have been commercially developed contribute to more reproducible probing depth measurements as compared with a manual probe. MATERIAL AND METHODS: In 12 patients duplicate measurements were made at day 0 and 1 week later. In each patient four teeth with the deepest pockets were measured at six sites. In total 288 sites were available for comparisons. The Florida Probe (FP) (159 N/cm(2)), the Jonker Probe (JP) (153 N/cm(2)), the Brodontic probe (BP) (255 N/cm(2)) and the manual probe (MP) were used in a randomized scheme. RESULTS: Mean probing measurements showed for the FP and the JP lower recordings than for the BP and manual probe. The FP, the BP and the MP showed no differences between the duplicate measurements, except for the JP where the second measurement was deeper. Correlation coefficients between measurements at day 0 and 1 week show for the BP and the MP are 0.90 and 0.89, respectively, while for the FP and the JP they are 0.76 and 0.75, respectively. CONCLUSION: The BP and the MP appear to be reliable tools for reproducible pocket depth measurements in periodontal maintenance patients.

Bicuspid↗
PubMed2006

Risk factors for periodontitis.

This review presents a selected overview of the literature concerning risk factors for periodontitis. That in some individuals gingivitis develops into periodontitis is still a matter of extensive research. Cross-sectional studies of clinical and microbiological factors can be meaningful. Longitudinal studies of the natural history allow analysis of potential factors and conditions that may have an impact on the disease process. At present, several possible risk factors for the initiation and progression of periodontitis have been identified: age, gender, plaque, calculus, existing attachment loss. A consistent finding appears to be genetic predisposition for the development of the disease. In terms of microbiology, several micro-organisms have been identified. The results of the Java Project on natural development of Periodontal Disease clearly pinpoint Actinobacillus actinimycetemcomitans as being associated with the onset of disease. The presence of subgingival calculus was found to be associated with onset and dental plaque with progression of disease. Consistent with literature males are more susceptible to disease. The presence of pockets > or = 5 mm appear to be a useful tool, since it was found to be a prognostic factor for disease progression.

Actinobacillus Infections↗
PubMed2006

A thin or thick probe handle: does it make a difference?

OBJECTIVES: The aim of the present study was to assess the probing force exerted when using two manual periodontal probes with different handle diameters in hands of different dental professionals. METHODS: For this study two periodontal probes with handle diameters of 54 and 92 mm were used. The 11 subjects responsible for the measurements were periodontists, postgraduate periodontal students and dental hygienists. Per measurement session, 20 measurements were performed by each subject. Each probe was used 10 times. After the first baseline measurement session, a second session was performed 1 week later and a last third session another 3 weeks later. Orders for using each probe were randomized for each subject and each session. RESULTS: The mean overall force with the thin probe was 55.2 g and with the thick probe 59.4 g. The difference of 4.2 g between the two probe types was found to be statistically significant (P = 0.041). CONCLUSION: The present study showed that the diameter of the probe handle also had an effect on the force exerted with a periodontal probe. However, the clinical relevance of this difference may be minor, when considering the interindividual variance of forces exerted when probing.

Dental Instruments↗
PubMed2006

Evaluation of several brushing motion combinations in relation to plaque-removing efficacy with Oral-B CrossAction Power: a professional brushing study.

AIM: The aim of this study was to evaluate the additional effect of a newly developed battery-operated brush Oral-B CrossAction Power with a hybrid brush head design (CAPB). The brush combines an oscillating/rotating part, a PowerHead(R), with a non-moving part with CrissCross bristles. It was compared with a manual control toothbrush Butler GUM 311 (CTB). MATERIAL AND METHODS: Thirty subjects were requested not to brush their teeth 48 h prior to the examination, when plaque removal efficacy was assessed by scoring plaque before and after brushing. Plaque was assessed according to the Silness & Loë Index at six sites per tooth. Subjects were brushed by a dentist using one of the four randomly chosen procedures of brushing in each quadrant. The CAPB was used with three different modes of brushing each in different randomly chosen quadrants, with the manual toothbrush being used in the remaining quadrant as a control. RESULTS: The baseline plaque levels ranged from 1.69 to 1.74 and the end levels ranged from 0.39 to 0.45. In terms of percentage, the results with the four procedures run from 75% to 79%. These differences between the battery brush and manual brush irrespective of the brushing mode used were not statistically significant. CONCLUSION: The results of this Professional Brushing Study show that the CrossAction Power toothbrush was as effective as a regular manual toothbrush.

Dental Devices, Home Care↗
PubMed2006

Effects of various rinsing protocols after the use of amine fluoride/stannous fluoride toothpaste on the acid production of dental plaque and tongue flora.

The aim of this clinical study was to evaluate the effect of various rinsing protocols on oral acid production 6 h after tooth brushing with an amine fluoride/stannous fluoride (AmF/SnF2) toothpaste. After a 14-day period of using F-free toothpaste, 30 participants followed three experimental protocols each, followed by F-free washout periods in a randomized crossover trial. They used AmF/SnF2 toothpaste twice daily for 1 week, and after brushing, they either rinsed with tap water, omitted the post-brush rinse, or rinsed with an AmF/SnF2 mouthwash. In the F-free washout periods, the participants brushed their teeth without further instructions. Six hours after the last brushing (+/-rinsing) of each period, subjects rinsed with 10 ml 10% sucrose solution for 2 min. A tongue film sample and a buccal plaque sample were taken 4 and 8 min after the sucrose challenge, respectively. Metabolic acid ions were determined by capillary electrophoresis. The results show that (1) omitting the post-brush water rinse did not reduce the production of lactic, acetic or minor acids in plaque, nor on the tongue, and that (2) the additional use of AmF/SnF2 mouthwash after brushing reduced the acid production in plaque and tongue samples for at least 6 h. The distributions of acids produced in the plaque or tongue samples were not statistically different between experimental periods. It is concluded that an increase in the antimetabolic effect of AmF/SnF2 toothpaste in between two daily brushing exercises is not achieved by omitting the post-brush water rinse. The additional use of AmF/SnF2 mouthwash after brushing is effective in reducing the acid metabolism in dental plaque and tongue flora.

Acids↗
PubMed2006

Increased salivary fluoride concentrations after post-brush fluoride rinsing not reflected in dental plaque.

The aim of the present study was to assess fluoride concentrations in unstimulated saliva and buccal dental plaque 6 h after an oral hygiene procedure that consisted of brushing with an AmF/SnF2 dentifrice and different post-brush rinsing protocols: expectorating the excess of dentifrice foam and rinsing with tap water, expectorating only, or rinsing with 10 ml AmF/SnF2 mouthwash. The fluoride concentrations in plaque and saliva were increased after all three experimental protocols compared to F-free periods. The increase of the fluoride concentration in saliva was more pronounced after AmF/SnF2 mouthrinse as compared to rinsing with water and expectorating the excess of dentifrice foam. Such an effect was not seen in dental plaque. It is concluded that the potentially beneficial effect of not rinsing or fluoride rinsing after tooth brushing is not reflected in an increased fluoride concentration in newly formed dental plaque 6 h after brushing.

Adult↗
PubMed2006

Plaque removal by young children using old and new toothbrushes.

There is inconclusive evidence about the relationship between toothbrush wear and plaque removal. This randomized cross-over clinical trial aimed to validate or invalidate non-inferiority in the plaque-removal efficacy of old vs. new toothbrushes in the hands of 7- and 8-year-old children. The lower limit for non-inferiority was set a priori as a difference in plaque score<15%. Children (n=101) brushed, in the first session, with either their 14-month-old toothbrush or a new one, and in the second session vice versa. The mean Quigley-Hein plaque score, before and after children brushed with old brushes, was 2.9 and 2.4, and with new brushes 2.8 and 2.1. The plaque score after they brushed with the new toothbrush was 10.9% lower (p<0.001) than after they brushed with the old toothbrush. The confidence interval of 7.6%-13.9% was within the acceptance band (<15%), and non-inferiority of old toothbrushes in the hands of these children was validated.

Child↗
PubMed2006

Additional effect of dentifrices on the instant efficacy of toothbrushing.

BACKGROUND: Inconclusive evidence exists in the literature with regard to the additional effect of the use of dentifrice on plaque removal. The present study was undertaken to test whether the use of dentifrice during toothbrushing contributes to the instant cleaning efficacy of the brushing procedure. METHODS: Three groups of patients, 40 subjects each, were randomly assigned to one of three dentifrices that differed with respect to the relative dentin abrasivity (RDA) value. After a 48-hour plaque accumulation, subjects brushed under supervision in a split-mouth order with or without the use of dentifrice (total time=2 minutes). RESULTS: Plaque reductions varied between 51% and 58% for the three dentifrices. The overall analysis showed a mean difference of 3% in plaque reduction in favor of brushing without dentifrice (P=0.017). The type of dentifrice did not influence this observed difference (P=0.506). Also, the order of the brushing procedure (starting the brushing procedure with or without dentifrice) had no interaction with the effect of dentifrice on the brushing (P=0.187). CONCLUSIONS: The use of dentifrice does not contribute to the instant mechanical plaque removal during manual toothbrushing. A higher dentifrice abrasivity does not seem to contribute to increased plaque removal with a manual toothbrush. It appears that the mechanical action provided by the use of a toothbrush is the main factor in the plaque-removing process.

Adult↗
PubMed2006

[Tooth brushing and gingival abrasion].

It has been known for some time that tooth brushing can have unwanted effects on the gingiva and hard dental tissues. The aim of this study is to evaluate two factors that may be of influence on the incidence of gingival abrasion during tooth brushing. The first factor being the possible influence of feedback through oral sensory perception and the second the possible abrasive effects of dentifrice. From the sensory feedback experiment it became clear that a significantly greater number of abrasions occurred when the test subjects would brush their own teeth than when they would have their teeth brushed by a dental hygienist. From the dentifrice experiment it became clear that the use of dentifrice has no significant effect on the occurrence of gingival lesions.

Adolescent↗
PubMed2005

Plaque inhibition of two commercially available chlorhexidine mouthrinses.

BACKGROUND: Chlorhexidine (CHX) 0.2% solution is still "the leading oral antiseptic" for controlling gingivitis. Side effects, however, limit the acceptability to users and the long-term employment of a 0.2% CHX antiseptic in preventive dentistry. This stimulated the development of new formulations. The aim of the present study was to assess the effect on plaque inhibition and taste perception of two commercially available mouthrinses (0.12% CHX non-alcohol base with 0.05% cetyl pyridinium chloride (Cpc) versus 0.2% CHX alcohol base). METHODS: The study was designed as a single-blind, randomized two group parallel experiment, to compare two different commercially available mouthrinses, during a 3-day plaque accumulation model. Forty healthy volunteers were enrolled in the study and received a thorough dental prophylaxis at the beginning of the test period. Over a 72-h experimental non-brushing period, during which subjects abstained from all forms of mechanical oral hygiene, one group (test) used a 15 ml alcohol free 0.12% CHX (=18 mg) mouthrinse on a Cpc base (Perioaid), CHX plus sign in circleCpc), twice daily for 30 s. The other group (control) used a 10 ml 0.2% CHX (=20 mg) mouthrinse on an 11.8% ethanol alcohol base (Corsodyl), CHX plus sign in circleAlc), twice daily for 60 s. After 72 h of plaque formation, the amount of plaque was evaluated. By the use of visual analogue scale, the subjects were asked for their appreciation of the taste of the mouthrinse they had used. RESULTS: The mean plaque index for the CHX plus sign in circleCpc group was 0.97 and for the CHX plus sign in circleAlc group 0.78. After 72 h of non-brushing, there was no significant difference in plaque accumulation between the two groups. The answers to the questions (taste perception and after-taste) showed a statistically significant difference between the two groups. The mean visual analogue scale (VAS) scores for taste appreciation on a scale from very bad to very good taste (0-10) were 5.92 for the CHX plus sign in circleCpc group and 4.10 for the CHX plus sign in circleAlc group (p=0.02). The mean visual analogue scale (VAS) scores for the after-taste on a scale from very short to very long (0-10) were 7.24 for the CHX plus sign in circleCpc group and 5.38 for the CHX plus sign in circleAlc group. CONCLUSIONS: Within the limitations of the present study design, it can be concluded that rinsing with a 0.12% CHX mouthrinse on a non-alcohol base with 0.05% Cpc (Perio-Aid) is not significantly different from rinsing with a 0.2% CHX mouthrinse on an alcohol base (Corsodyl). It appears that the subjects appreciated the taste of the non-alcohol CHX solution better but the after-taste of the rinse remained longer in the mouth.

Anti-Infective Agents, Local↗
PubMed2005

Approximal brush head used on a powered toothbrush.

AIM: This study was designed to test whether the approximal efficacy of a powered toothbrush (Braun Oral-B 3D Plaque Remover) can be improved when a pointed-shaped brush head (PBH) specifically designed for these approximal areas is used as compared with the standard cup-shaped brush head (CBH). MATERIAL AND METHODS: Forty non-dental students were included. They all received the powered toothbrush and two different brush heads (CBH+PBH). Instructions were given to use each brush head twice every day (2 min. with the CBH followed by 1 min. with the PBH). Two weeks later they received an appointment for the first experiment (Exp 1), prior to which they abstained from all oral hygiene procedures for 48 h. Plaque was assessed at 6 sites/tooth. Next, the dental hygienist brushed for 2 min. (30 s/quadrant) with the CBH. Plaque was scored again. Subsequently, the dental hygienist brushed the approximal areas for another minute: in two randomly selected contra-lateral quadrants for 30 s with the CBH and in the opposing quadrants for 30 s with the PBH. The next approximal plaque was scored a third time. After 2-3 weeks, Exp 2 was carried out comparable to Exp 1; only this time the panelists brushed themselves. RESULTS: Exp 1 showed approximal plaque scores at the baseline of 1.70 and 1.72 and at post-brushing 0.21 and 0.26 for the CBH + PBH and CBH only, respectively (p<0.05). The additional increase in approximal plaque reduction after 30 s of brushing with PBH was 22% and for the CBH 19% (p<0.05). Exp 2 showed approximal plaque scores at baseline of 1.76 and 1.74 and post-brushing of 0.21 and 0.24 for the CBH+PBH and the CBH, respectively. The additional approximal plaque reduction of 30 s brushing with PBH was 19% and 18% with the CBH (no significant difference). DISCUSSION/CONCLUSION: An additional 1 min. showed minor differences (1-3%) between brush heads. The effect of the 1 min. extra brushing (+/-18%) itself was much larger. It seems therefore beneficial to advise the patient to brush longer. A second different brush head may stimulate to do so.

Dental Plaque↗
PubMed2005

Optimal rinsing time for intra-oral distribution (spread) of mouthwashes.

AIM: To investigate the intra-oral spread of an erythrosine mouthwash in relation to the rinsing period. MATERIAL AND METHODS: Thirty subjects were randomly divided into two equal groups and asked to rinse with 10 ml erythrosine mouthwash for cumulative periods of 15, 30 and 60 s (Group I) and 30, 60 and 90 s (Group II). Each rinsing session was followed by new plaque measurements. After rinsing plaque was finally assessed using the erythrosine mouthwash applied by means of a cotton swab. RESULTS: In Group I there was a difference observed between the 15 s rinsing period and those of 30 and 60 s. Explorative analysis for Group I suggested that differences in both jaws and approximal sites on both vestibular and lingual surfaces appeared to have contributed to the overall difference seen between 15 and 30 s rinsing periods. Also, pre-molars and front teeth seem to have contributed to this observed difference. No differences were noted between rinsing sessions and cotton swab application for Group II or Groups I+II combined. CONCLUSIONS: Rinsing for 30 s appeared to be sufficient for all plaque-covered surfaces of the dentition to come into contact with the mouthwash.

Dental Plaque↗
PubMed2005

A systematic review of the effectiveness of self-performed mechanical plaque removal in adults with gingivitis using a manual toothbrush.

OBJECTIVE: To assess the effectiveness of self-performed mechanical plaque removal in adults with gingivitis using a manual toothbrush with respect to the level of plaque and gingivitis in controlled studies of at least 6 months duration. SEARCH: Medline-PubMed up to and including September 2004. RESULTS: Out of 3223 titles and abstracts, 33 trials were found for data extraction. A meta-analysis was conducted of studies (n=9) in which, for the manual toothbrush group at baseline, only a professional prophylaxis provided. The weighted mean differences (WMD) between baseline and end-trial for the Quigley & Hein plaque index was 0.28 and 0.21 for the Gingival Index (p<0.05). Eight studies provided both a professional OHI and prophylaxis at baseline. The WMD for the Silness & Löe Plaque Index was 0.10 (ns). The WMD of the proportion of bleeding sites was 5.84% (p<0.05). CONCLUSION: In adults with gingivitis the quality of self-performed mechanical plaque removal is not sufficiently effective and should be improved. Based on studies > or = 6 months of duration, it appears that a single oral hygiene instruction, describing the use of a mechanical toothbrush, in addition to a single professional 'oral prophylaxis' provided at baseline, had a significant, albeit small, positive effect on the reduction of gingivitis.

Adult↗
PubMed2005

The effectiveness of self-performed mechanical plaque control with triclosan containing dentifrices.

OBJECTIVE: To assess the effectiveness of self-performed mechanical plaque control with triclosan (5-chloro-2-(2,4 dichlorophenoxy)phenol) containing dentifrice. SEARCH STRATEGY: An electronic search of the National Library of Medicine, Washington DC (Medline-PubMed; up to and including March 2005) was performed using specific search terms to identify clinical trials of >or=6 months in duration, which assessed the effect of various forms of plaque control in gingivitis subjects. In those trials the manual toothbrush group (frequently the control group) served to provide data for the assessment of the effectiveness of self-performed mechanical plaque control with a triclosan-containing dentifrice. The data were analysed depending on the (baseline) intervention, being either a professional oral hygiene instructions, a prophylaxis, or both. DATA COLLECTION AND ANALYSIS: Two reviewers extracted information (KPKJH and GAW). Where appropriate plaque and gingivitis data for baseline and end-trial were used to calculate weighted mean differences (WMD) with the appropriate 95% confidence intervals (CI) using a random effect models. MAIN RESULTS: Of 105 titles and abstracts, 18 trials were found suitable for clinical data were extracted. Meta-analysis were conducted. In studies (n=9) evaluating a triclosan/copolymer dentifrice, plaque control [Quigley and Hein (1962) Journal of American Dental Association, Vol. 65: pp. 26-29] was significantly improved compared with a control fluoride dentifrice, with a WMD of -0.48 (95% CI: -0.73 to -0.24). For gingival inflammation as assessed with the gingival index [Löe and Silness (1963) Acta Odontologica Scandinavica, Vol. 21: pp. 533-551] a significant WMD of -0.24 (95% CI: -0.35 to -0.13) was found. From studies (n=6) evaluating the Triclosan zinc/citrate dentifrices a small but significant WMD for plaque control [Silness and Löe (1964) Acta Odontologica Scandinavica, Vol. 22: pp. 121-135] was observed in favour of the test group as compared with the standard fluoride dentifrice formulations (WMD -0.07, 95% CI: -0.10 to 0.05). While at baseline the proportion of bleeding was comparable, at the end of the studies a significant -10.81% WMD (95% CI: -12.69 to -8.93) in favour of the triclosan/zinc citrate dentifrice was observed. CONCLUSION: This systematic review indicates, based on studies >or=6 months of duration in adults with gingivitis, that the effectiveness of self-performed mechanical plaque control with a triclosan-containing dentifrice, had a significant albeit small positive effect on the reduction of plaque and gingivitis.

Anti-Infective Agents, Local↗
PubMed2004

Influence of a SLS-containing dentifrice on the anti-plaque efficacy of a chlorhexidine mouthrinse.

BACKGROUND: Chlorhexidine (CHX) and sodium lauryl sulphate (SLS), the most widely used detergent in dentifrice, may counteract. Consequently, studies about this interaction suggested that care is required when combining both these compounds, even when they are introduced separately into the oral cavity. The purpose of the present study was to investigate the effect of toothbrushing with a SLS-containing dentifrice in one jaw, on the plaque inhibition of a CHX mouthrinse in the opposite jaw during a 4-day study period. METHODS: The study was an examiner-blind, randomised two-cell, crossover design. It used a 4-day plaque accumulation model to compare two different oral hygiene regimens with a washout period of 17 days. Sixteen healthy volunteers were enrolled in the study and received a thorough dental prophylaxis at the beginning of each 4-day test period. One jaw (upper or lower) was randomly assigned as the "study" jaw. The opposite jaw was assigned as the "dentifrice" jaw and served only to introduce the effect of brushing with a dentifrice in the study model. Two oral hygiene regimens were evaluated. During one randomly assigned test period, the "dentifrice" jaw was treated by toothbrushing with a 1.5% SLS-containing dentifrice and rinsed together with the "study" jaw with 0.2% CHX, thus forming regimen 1. As a control during the other test period, both the "dentifrice" jaw and "study" jaw were only rinsed with 0.2% CHX, forming regimen 2. No other oral hygiene methods were allowed. After 4 days of undisturbed plaque accumulation, the amount of plaque was evaluated (Silness & Löe 1964). The "study" jaw was used to study the effect of the two regimens on the level of plaque accumulation at the end of the 4-day period. RESULTS: The overall plaque index was 0.36 for regimen 1 and 0.34 for regimen 2. There was no significant difference in plaque accumulation between the two regimens. CONCLUSIONS: Within the limitations of the present study design, it can be concluded that ordinary brushing with a 1.5% SLS-containing dentifrice (Colgate Bi-Fluor), followed by rinsing with water does not appear to reduce the level of plaque inhibition offered by a post-brushing CHX rinse.

Adult↗
PubMed2004

Atmospheric contamination during ultrasonic scaling.

OBJECTIVE: The aim of this study was to determine the microbial atmospheric contamination during initial periodontal treatment using a piezoelectric ultrasonic scaler in combination with either high-volume evacuation (HVE) or conventional dental suction (CDS). METHODS: The study included 17 treatment sessions, consisting of a 40-min episode of continuous plaque and calculus removal using an ultrasonic unit (EMS). The treatment sessions were carried out in six patients with generalized adult periodontitis and ranged from two to four sessions per patient according to their needs. The use of HVE and CDS was randomly assigned over the sessions within each patient. Before each treatment, the operating room was not used for 15 h. To measure baseline microbial air pollution two Petri dishes containing blood agar were exposed for 10 min to the air. At the start of each treatment session, two Petri dishes were exposed for 5 min at a distance of 40 cm from the mouth of the patients. After 20 min, this procedure was repeated. At a distance of 150 cm, two Petri dishes were exposed for 20 min followed by exposure of two new Petri dishes for the rest of the session. The plates were cultured aerobically and anaerobically for 3 and 7 days, respectively. RESULTS: The mean colony forming units (CFU) before treatment never exceeded 0.6 colonies per plate. At 40 cm, the mean CFU, when considering a period of 40 min, was 8.0 for HVE and 17.0 for CDS. The mean CFU at 150 cm during this period was 8.1 with HVE and 10.3 with the CDS. With reference to the Air Microbial Index the operatory atmosphere was considered to be in a good condition during 40 min of continuous use of the ultrasonic scaler in combination with both HVE and CDS. CONCLUSION: Within the restrictions of this study, only limited atmospheric microbial contamination is produced when using a piezoelectric ultrasonic scaler.

Adult↗