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Biomedical subjects

H M Proskin

Publications and source records attributed to H M Proskin.

At least 55 records · Page 3Linked to original sources

Composition of plaque and saliva following a sucrose challenge and use of an alpha-tricalcium-phosphate-containing chewing gum.

Calcium phosphate concentrations in plaque, plaque fluid, and saliva play an important role in caries prevention. In this study, we used a microanalytical technique to examine the anticaries potential of a 2.5% (mass fraction) alpha-tricalcium-phosphate-fortified experimental gum by measuring the pH, free and total calcium, and total phosphate in plaque fluid, whole plaque, and saliva, and centrifuged saliva from 14 subjects who (1) accumulated plaque for 48 hours, (2) fasted overnight, (3) rinsed for 1 min with sucrose, and (4) chewed a control or experimental gum for 15 min. From these data, the hydroxyapatite (HAp) ion activity products (IAP[HAp]) of saliva and plaque fluid were calculated as a measure of tooth mineral saturation. Results, compared with those of the control gum, show significant increases in pH and in free calcium and phosphate concentrations in plaque fluid and saliva when the experimental gum was chewed following sucrose ingestion. These increases result in a rise in fluid saturation with respect to tooth mineral that, for plaque fluid, nearly cancels the decrease seen with the control gum after the sucrose rinse. This suggests that the experimental gum may be more effective than a conventional gum in ameliorating the cariogenic effects of sucrose. Similar statistically significant increases were also seen in the total calcium content of the plaque fluid, centrifuged saliva, whole saliva, and whole plaque, and in the total phosphate of whole plaque and whole saliva. These results suggest that the deposition of a mineral reservoir in plaque and saliva by the experimental gum may help resist future cariogenic challenges.

Adult↗

The effect of chewing sugar-free gum after meals on clinical caries incidence.

To determine the effect of chewing sugar-free gum on caries incidence, the authors conducted a randomized clinical study. A total of 1,402 children in Puerto Rico, in grades 5 through 7 at baseline, completed the study. They were randomized by classroom into a control group or chewing gum group; those in the gum group were instructed to chew sugar-free gum for 20 minutes after each of three meals a day. Clinical and radiographic evaluations were performed at baseline and after two and three years. The results show that all subjects and high-risk subjects, respectively, in the gum group developed 7.9 percent and 11.0 percent fewer decayed, missing or filled surfaces than subjects in the control group. Based on these findings, the authors concluded that chewing sorbitol-based sugar-free gum after eating significantly reduces the incidence of dental caries.

Aspartame↗

Adjunctive use of a subgingival controlled-release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone.

The present studies evaluated the efficacy of a controlled-release biodegradable chlorhexidine (CHX) (2.5 mg) chip when used as an adjunct to scaling and root planing on reducing probing depth (PD) and improving clinical attachment level (CAL) in adult periodontitis. Two double-blind, randomized, placebo-controlled multi-center clinical trials (5 centers each) were conducted; pooled data are reported from all 10 centers (447 patients). At baseline, following 1 hour of scaling and root planing (SRP) in patients free of supragingival calculus, the chip was placed in target sites with PD 5 to 8 mm which bled on probing. Chip placement was repeated at 3 and/or 6 months if PD remained > or = 5 mm. Study sites in active chip subjects received either CHX chip plus SRP or SRP alone (to maintain study blind). Sites in placebo chip subjects received either placebo chip plus SRP or SRP alone. Examinations were performed at baseline; 7 days; 6 weeks; and 3, 6, and 9 months. At 9 months significant reductions from baseline favoring the chlorhexidine chip compared with both control treatments were observed with respect to PD (chlorhexidine chip plus SRP, 0.95 +/- 0.05 mm; SRP alone, 0.65 +/- 0.05 mm, P < 0.001; placebo chip plus SRP, 0.69 +/- 0.05 mm, P < 0.001) and CAL (chlorhexidine chip plus SRP, 0.75 +/- 0.06 mm; SRP alone, 0.58 +/- 0.06 mm, P < 0.05; placebo chip plus SRP, 0.55 +/- 0.06 mm, P < 0.05). The proportion of patients who evidenced a PD reduction from baseline of 2 mm or more at 9 months was significantly greater in the chlorhexidine chip group (19%) compared with SRP controls (8%) (P < 0.05). Adverse effects were minor and transient toothache, including pain, tenderness, aching, throbbing, soreness, discomfort, or sensitivity was the only adverse effect that was higher in the chlorhexidine group as compared to placebo (P = 0.042). These data demonstrate that the adjunctive use of the chlorhexidine chip results in a significant reduction of PD when compared with both SRP alone or the adjunctive use of a placebo chip. These multi-center randomized control trials suggest that the chlorhexidine chip is a safe and effective adjunctive chemotherapy for the treatment of adult periodontitis.

Adult↗

Efficacy of a dentifrice containing zinc citrate for the control of plaque and gingivitis: a 6-month clinical study in adults.

The objective of this 6-month, double-blind, clinical study, conducted in harmony with American Dental Association (ADA) guidelines, was to evaluate the efficacy of a dentifrice containing 2% zinc citrate and 0.76% sodium monofluorophosphate in a silica base (zinc citrate dentifrice) for the control of supragingival plaque and gingivitis, compared to a control dentifrice containing 0.76% sodium monofluorophosphate in a silica base (control dentifrice). Adult men and women from the Atlanta, Georgia, area were entered in the study and stratified into two treatment groups, which were balanced for baseline Quigley-Hein Plaque Index scores and baseline Löe-Silness Gingival Index scores. Participants received an oral prophylaxis and were instructed to brush their teeth twice daily (morning and evening) for 1 minute with their assigned dentifrice, using a soft-bristled toothbrush. Examinations for supragingival plaque and gingivitis were conducted after 3 months and again after 6 months' use of the study dentifrices. Ninety-nine participants complied with the protocol and completed the entire 6-month clinical study. At both the 3- and 6-month study examinations, the zinc citrate dentifrice group exhibited statistically significant reductions in both plaque and gingivitis compared to the control dentifrice group, based on whole-mouth data. At the 6-month examination, the magnitude of these reductions met or exceeded 18% for both plaque and gingivitis (25.3% for plaque; 18.8% for gingivitis). The effect of the zinc citrate dentifrice was most pronounced on the more severe manifestations of plaque and gingivitis, indicating a statistically significant (50.2%) reduction in severe plaque and a statistically significant (66.7%) reduction in severe gingivitis over the control dentifrice after 6 months of use. Similar findings were observed for data obtained from proximal, lingual, and posterior sites. Among the sites that indicated a tendency toward high levels of plaque or gingivitis based on the baseline scores, substantially fewer sites tended to continue to present such high levels at follow-up exams in the zinc citrate dentifrice group than in the control dentifrice group. Thus, in accordance with the 1986 guidelines published by the ADA and the 1994 revision published by the Task Force on Design and Analysis in Dental and Oral Research, the results of this study support the conclusion that a dentifrice containing 2% zinc citrate and 0.76% sodium monofluorophosphate in a silica base is clinically efficacious for the control of supragingival plaque and gingivitis.

Adolescent↗

Clinical efficacy of a dentifrice containing zinc citrate: a 12-week calculus clinical study in adults.

The objective of this double-blind clinical study, conducted following the Volpe-Manhold design for studies of dental calculus, was to investigate the efficacy of a dentifrice containing 2% zinc citrate and 0.76% sodium monofluorophosphate in a silica base (zinc citrate dentifrice) as compared to a control dentifrice containing 0.76% sodium monofluorophosphate in a silica base (control dentifrice). Adult men and women from the Northern New Jersey area were provided a full oral prophylaxis and assigned the use of a control (non-tartar-control) dentifrice for 8 weeks. At the completion of this initial period, participants were assessed for baseline Volpe-Manhold Calculus Index scores, provided another full prophylaxis, and stratified into two treatment groups that were balanced for age, sex, and baseline calculus. Participants were instructed to brush their teeth twice daily (morning and evening) for 1 minute with their assigned dentifrice, using a soft-bristled toothbrush. Examinations for dental calculus were again performed after 12 weeks' use of the study dentifrices. Seventy-five participants complied with the protocol and completed the entire study. At the 12-week examination, the zinc citrate dentifrice group exhibited a statistically significant 31.9% reduction in mean Volpe-Manhold Calculus Index score as compared to the control dentifrice group. Thus, the results of this clinical study support the conclusion that a dentifrice containing 2% zinc citrate and 0.76% sodium monofluorophosphate in a silica base is efficacious for the control of the development of supragingival calculus.

Adolescent↗

Efficacy of a mouthrinse containing 0.05% cetylpyridinium chloride for the control of plaque and gingivitis: a 6-month clinical study in adults.

The objective of this 6-month, double-blind, clinical study, conducted following the American Dental Association (ADA) guidelines, was to provide an assessment of the effectiveness of a newly developed mouthrinse containing 0.05% cetylpyridinium chloride (CPC) for the control of supragingival dental plaque and gingivitis. Adult men and women from the Manchester, England, area were entered in the study, and stratified into two treatment groups (CPC mouthrinse and control mouthrinse), which were balanced for baseline Quigley-Hein Plaque Index scores and baseline Löe-Silness Gingival Index scores. Participants were given an oral prophylaxis and instructed to brush their teeth twice daily (morning and evening) for 1 minute with a soft-bristled toothbrush and fluoride dentifrice provided, immediately followed by rinsing for 30 seconds with 15 cc of their assigned mouthrinse. Examinations for supragingival plaque and gingivitis were conducted after 3 months' and again after 6 months' participation in the study. One hundred eleven participants complied with the protocol and completed the entire 6-month clinical study. At both the 3- and 6-month study examinations, the CPC mouthrinse group exhibited statistically significantly less supragingival plaque and gingivitis than did the control mouthrinse group. At the 6-month examination, the magnitude of these differences met or exceeded 24% for all 4 parameters measured (28.2% for Quigley-Hein Plaque Index, 63.4% for Plaque Severity Index, 24.0% for Löe-Silness Gingival Index, and 66.9% for Gingivitis Severity Index). The magnitude of the reductions in supragingival plaque and gingivitis were adequately large to support a claim of efficacy, in accordance with the criteria provided by the published guidelines of the ADA for the demonstration of the efficacy of a chemotherapeutic agent for the control of supragingival plaque and gingivitis. Thus, the results of this 6-month clinical study support the conclusion that a newly developed mouthrinse containing 0.05% cetylpyridinium chloride provides a statistically significant, clinically relevant level of efficacy for the control of supragingival plaque, and for the control of gingivitis, in accordance with the criteria provided by current ADA guidelines.

Adolescent↗

The effects of dentifrice systems on oral malodor.

Chronic oral malodor is a serious concern for about one-fifth of the North American population, and a field of emerging research interest. The present three studies, one involving gas chromatography and two employing odor judge assessment, examined the efficacy of baking soda and other toothpastes in reducing breath odor. The most common cause of oral malodor is elevated levels of volatile sulfur compounds (VSC's), primarily hydrogen sulfide (H2S) and methyl mercaptan (CH3SH), in the breath. Gas chromatography, an accurate means of measuring breath VSC, was employed to evaluate the breath levels of VSC in 11 men after brushing with baking soda-containing dentifrices with or without the addition of Zn++. Dentifrices with either Zn++ or a concentration of baking soda 20% or greater significantly reduced VSC levels. The addition of Zn++ to baking soda dentifrices enhanced the anti-odor effects. In the first organoleptic study, dentifrices containing 20% baking soda and 30% baking soda demonstrated significantly greater ability to reduce breath odor than a standard sodium fluoride/silica dentifrice. The subjects' baseline mouth odor evaluations, initially rated as strong, declined after brushing with the baking soda toothpastes to a barely detectable level at one hour, then rising to a faint level at two hours and moderate levels at three hours. In the second organoleptic study, a dentifrice containing 65% baking soda demonstrated significantly greater ability to reduce breath odor than a standard sodium fluoride/silica tartar control dentifrice, but did not differ significantly from a standard dentifrice containing 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base. The results of these studies indicate that dentifrices containing 20% or more baking soda can confer a significant odor-reducing benefit for time periods up to three hours.

Adult↗

Randomized clinical trial of the effect of prenatal fluoride supplements in preventing dental caries.

This randomized, double-blind study tested the caries-preventive efficacy of prenatal fluoride supplementation in 798 children followed until age 5. Initially, 1,400 women in the first trimester of pregnancy residing in communities served by fluoride-deficient drinking water were randomly assigned to one of two groups. During the last 6 months of pregnancy the treatment group received 1 mg fluoride daily in the form of a tablet and the control group received a placebo. Both treatment and control subjects were encouraged to use postnatal dietary fluoride supplements. Caries was measured in children at age 3 and 5 while fluorosis was assessed at age 5. Caries activity was very low in both study groups: 92% of children remained caries-free in the treatment group and 91% remained caries-free in the placebo group. Fluorosis was observed in 26 subjects, all classified as very mild. Overall, there were no statistically significant differences in the study groups with respect to caries and fluorosis in deciduous teeth. The study had sufficient power to detect an absolute risk reduction of 5.1% while only a 1.5% reduction was observed. These findings do not support the hypothesis that prenatal fluoride has a strong caries-preventive effect.

Cariostatic Agents↗

Clinical efficacy of an optimized stannous fluoride dentifrice, Part 2: A 6-month plaque/gingivitis clinical study, northeast USA.

The objective of this 6-month, double-blind clinical study, conducted following the American Dental Association guidelines, was to investigate the efficacy of Colgate Optimized Stannous Fluoride (COSF) dentifrice for the control of supragingival dental plaque and gingivitis. This dentifrice contains 0.454% stannous fluoride, stannous chloride, polyphosphate, and citrate in a silica base. At the 3- and 6-month study examinations, the COSF dentifrice group exhibited statistically significant reductions in both plaque and gingivitis compared to the control dentifrice group. At the 6-month examination, the magnitude of these percent reductions exceeded 20% for all 4 parameters measured. Thus, the results of this study support the conclusion that the COSF dentifrice is efficacious for the control of supragingival plaque and gingivitis.

Adult↗

Clinical efficacy of an optimized stannous fluoride dentifrice, Part 3: A 6-month plaque/gingivitis clinical study, southeast USA.

This 6-month, double-blind clinical study, also following the American Dental Association guidelines, investigated the efficacy of Colgate Optimized Stannous Fluoride (COSF) dentifrice in controlling supragingival dental plaque and gingivitis. The same dentifrice, containing 0.454% stannous fluoride, stannous chloride, polyphosphate, and citrate in a silica base was used. Adult men and women from the Atlanta, Georgia, area received an oral prophylaxis and were instructed to brush their teeth twice daily (morning and evening) for 1 minute with their assigned dentifrice, using a soft-bristled toothbrush. As in the first study, plaque and gingivitis examinations were conducted after 3 months and again after 6 months of using the dentifrices. At both the 3- and 6-month study examinations, the COSF dentifrice group exhibited statistically significant reductions in both plaque and gingivitis compared to the control dentifrice group. At the 6-month examination, the magnitude of these percent reductions exceeded 20% for all 4 parameters measured. Thus, the results of this study reflect those found in the New Jersey study, i.e., supporting the conclusion that the COSF dentifrice is efficacious for the control of supragingival plaque and gingivitis.

Adolescent↗

Clinical efficacy of an optimized stannous fluoride dentifrice, Part 4: A 3-month calculus clinical study, northwest USA.

The objective of this 3-month, double-blind study was to investigate the efficacy of Colgate Optimized Stannous Fluoride (COSF) dentifrice for the control of supragingival dental calculus accumulation. After 3 months' use, the COSF dentifrice group exhibited a statistically significant 56.6% reduction in supragingival calculus formation, as compared to the control dentifrice group. The results of this study support the conclusion that the COSF dentifrice is efficacious for controlling the accumulation of supragingival calculus.

Adult↗

Clinical efficacy of an optimized stannous fluoride dentifrice, Part 5: A 3-month study of extrinsic tooth staining, northeast USA.

The objective of this 3-month, double-blind clinical study was to investigate the level of tooth staining associated with the use of Colgate Optimized Stannous Fluoride (COSF) dentifrice compared to the tooth staining associated with two commercially available dentifrices. The results of this clinical study support the conclusion that the intensity and extent of extrinsic tooth stain associated with the use of the COSF dentifrice are significantly lower than that associated with Crest Gum Care Toothpaste. Further, this study provided no indication that the use of the COSF dentifrice is associated with a greater level of stain than that associated with the use of Crest Regular Toothpaste, a standard 0.243% sodium fluoride/silica dentifrice.

Adult↗

Xerostomia and associated factors in a community-dwelling adult population.

Xerostomia is the subjective sensation of dry mouth. Estimates on the occurrence of xerostomia in community-dwelling adults have ranged from 10% among persons over age 50 to 40% for persons over age 65. Virtually no data are available for persons under age 50. To begin to establish a database on the occurrence of xerostomia and factors associated with it, a cross-sectional assessment of self-reported symptoms and salivary function was conducted across a broad age-range of generally healthy community-dwelling adults. A convenience sample of 710 adults who ranged from 19 to 88 years of age was drawn from various sources in the greater-Rochester, New York area. Study volunteers were administered a standardized questionnaire on general and oral health, which included questions on the symptoms of xerostomia, and were provided an oral screening examination, which included measurement of unstimulated and stimulated whole saliva flow rates. Overall, the observed prevalence of xerostomia was 24% among females and 18% among males. While xerostomia was more commonly observed in women than men, this association was only clear after age 50. Xerostomia was associated with: use of medications with hyposalivatory side-effects; difficulty with dry foods; cracked lips; dry eyes; difficulty swallowing; and, among males, current cigarette smoking. Results indicated a tendency for salivary flow rates to be lower for older persons, particularly the stimulated flow rate. There was a tendency in the younger cohorts for flow rates to be lower among individuals who reported sensation of dry mouth than among those who did not. This tendency was not apparent among older persons, suggesting that younger persons may be more likely to experience symptoms of oral dryness when salivary flow was low while older persons may relate symptoms of dry mouth to a more complex constellation of factors where salivary flow is only one component. These findings need to be examined further.

Adult↗

Comparison of the clinical anticaries efficacy of an 1100 NaF silica-based dentifrice containing triclosan and a copolymer to an 1100 NaF silica-based dentifrice without those additional agents: a study on adults in California.

Recent years have seen much work in the development of dentifrices containing the antimicrobial agent triclosan, a broad spectrum antibacterial agent manufactured for use in oral products by the Ciba-Geigy Corporation. Studies have shown that the incorporation of this agent into dental products, in combination with a PVM/MA copolymer (the non-proprietary designation for a polyvinylmethyl ether/maleic acid copolymer), can provide several important dental therapeutic benefits, including an antigingivitis effect. Much research on the therapeutic benefits of such dentifrices has been reported in the literature. The present study is a component of a large-scale program of clinical research to investigate the anticaries effectiveness of fluoride dentifrices containing 0.3% triclosan and 2.0% PVM/MA copolymer. The study included two treatment groups, each consisting of adults living within a 50 mile radius of Loma Linda, California, who were assigned to the use of one of the following sodium fluoride (NaF) dentifrices: 1) a dentifrice containing 0.3% triclosan and 2.0% PVM/MA copolymer in a 0.243% NaF/silica (1100 ppm F) base; or 2) a dentifrice containing 0.243% NaF/silica (1100 ppm F). Conducted in accordance with the guidelines for caries clinical studies published by the Council on Dental Therapeutics of the American Dental Association, the study employed clinical diagnostic criteria as described in the August, 1987 National Institute of Dental Research (NIH/NIDR) publication. Dental radiographs were not employed. Principal comparisons of the dentifrices tested were implemented through the construction of 90% confidence intervals for the ratio of mean 3-year caries increments, using Fieller's theorem. Of those subjects who met the initial inclusion/exclusion criteria for this study, 1,542 were available for the 36-month examination. DFS (resp., DFT) increments over this period were 2.07 (0.63) for the triclosan/copolymer dentifrice, and 2.16 (0.68) for the dentifrice without those additives. The confidence interval calculations for both incremental DFS and DFT support the conclusion that a dentifrice containing 0.3% triclosan and 2.0% PVM/MA copolymer in a 0.243% NaF/silica (1100 ppm F) base provides a level of anticaries efficacy which is "at least as good as" that provided by a dentifrice containing 1100 NaF/silica without those additive agents. As such, the results of this clinical study clearly indicate that the addition of triclosan and a copolymer to a 1100 NaF/silica dentifrice does not compromise its anticaries efficacy.

Adult↗

Comparison of the clinical anticaries efficacy of a 1500 NaF silica-based dentifrice containing triclosan and a copolymer to a 1500 NaF silica-based dentifrice without those additional agents: a study on adults in Israel.

Recent years have seen much work in the development of dentifrices containing the antimicrobial agent triclosan, a broad spectrum antibacterial agent manufactured for use in oral products by the Ciba-Geigy Corporation. Studies have shown that the incorporation of this agent into dental products, in combination with a PVM/MA copolymer (the non-proprietary designation for a polyvinylmethyl ether/maleic acid copolymer), can provide several important dental therapeutic benefits, including an antigingivitis effect. A considerable amount of the research on the therapeutic benefits of such dentifrices has been reported in the literature. The present study is a component of a large-scale program of clinical research to investigate the anticaries effectiveness of fluoride dentifrices containing 0.3% triclosan and 2.0% PVM/MA copolymer. The study included two treatment groups, each consisting of adults living near the Kiryat Gat area in Israel, who were assigned to the use of one of the following sodium fluoride (NaF) dentifrices: 1) a dentifrice containing 0.3% triclosan and 2.0% PVM/MA copolymer in a 0.331% NaF/silica (1500 ppm F) base; or 2) a dentifrice containing 0.331% NaF/silica (1500 ppm F). Conducted in accordance with the guidelines for caries clinical studies published by the Council on Dental Therapeutics of the American Dental Association, the study employed clinical diagnostic criteria as described in the August, 1987 National Institute of Dental Research (NIH/NIDR) publication. Dental radiographs were not employed. Principal comparisons of the dentifrices tested were implemented through the construction of 90% confidence intervals for the ratio of mean 3-year caries increments using Fieller's Theorem. Of those subjects who met the initial inclusion/exclusion criteria for this study, 1,296 were available for the 36-month examination. DFS (resp., DFT) increments over this period were 5.21 (1.30) for the triclosan/copolymer dentifrice, and 5.23 (1.39) for the dentifrice without those additives. The confidence interval calculations for both incremental DFS and DFT support the conclusion that a dentifrice containing 0.3% triclosan and 2.0% PVM/MA copolymer in a 0.331% NaF/silica (1500 ppm F) base provides a level of anticaries efficacy which is "at least as good as" that provided by a dentifrice containing 1500 NaF/silica, without those additive agents. As such, the results of this clinical study clearly indicate that the addition of triclosan and a copolymer to a 1500 NaF/silica dentifrice does not compromise its anticaries efficacy.

Adult↗

Statistical considerations related to the use of caries model systems for the determination of clinical effectiveness of therapeutic agents.

Caries model systems bear great promise for the eventual determination of clinical benefits of therapeutic agents without the time and expense involved in the conduct of a full-fledged clinical trial. However, before such models can routinely be applied for such purposes, there are several issues which must first be resolved, including the consideration of a number of statistical matters. These include the assessment of the validity and reliability of the models to be so used. A procedure presented by Proskin, Chilton, and Kingman provides a quantitative means by which a conclusion concerning clinical effectiveness can be derived on the basis of data obtained through the use of a model system given that certain fairly general underlying conditions prevail. The present paper provides some discussion and recommendations of the author related to statistical matters concerning the use of models, and discusses the derivation and logic of the Proskin, Chilton, and Kingman procedure.

Cariostatic Agents↗

Comparison of the anticaries efficacy of dentifrices containing fluoride as sodium fluoride or sodium monofluorophosphate.

The dominance of the marketplace by dentifrices containing fluoride as sodium monofluorophosphate and sodium fluoride has given rise to great academic and commercial interest regarding the comparison of those two fluoride species. Since the 1970's, several comparative clinical trials have been conducted to investigate the relative anticaries efficacy of dentifrices containing these two agents, generally giving rise to equivocal results. Recently, attention has been turned to investigative efforts which employ information derived from the collective body of relevant comparative clinical studies available in the literature to establish an omnibus conclusion concerning this issue. Beginning with the sign test of Beiswanger & Stookey (1989), and continuing through the meta-analyses of Johnson (1993) and Proskin (1993), this line of research remains vital today. The recent publication of two studies (Marks et al, 1994; Stephen et al, 1994) previously documented in the literature only in abstract form (Conti et al, 1993; Stephen et al, 1993) has given rise to the need for the present meta-analytic reconsideration of the available data. As in the previous meta-analyses, the quantitative results obtained depended on the studies which provided data for the calculations. However, as also indicated in previously-documented meta-analyses, the clinical interpretation of the results, which was based on the guidelines published by the American Dental Association (Council on Dental Therapeutics, 1988), did not vary according to study selection.(ABSTRACT TRUNCATED AT 250 WORDS)

American Dental Association↗