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PubMed2001

The comparative anticaries efficacy of a dentifrice containing 0.3% triclosan and 2.0% copolymer in a 0.243% sodium fluoride/silica base and a dentifrice containing 0.243% sodium fluoride/silica base: a two-year coronal caries clinical trial on adults in Israel.

The purpose of this two-year clinical study was to provide a comparison of the anticaries efficacy associated with two commercially available, American Dental Association-accepted dentifrices: Colgate Total Toothpaste, which contains 0.3% triclosan and 2% copolymer in a 0.243% sodium fluoride/silica base; and Crest Cavity Fighting Toothpaste with Fluoristat, which contains 0.243% sodium fluoride in a silica base. The study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward the comparison of fluoride dentifrices. The study employed a double-blind parallel-group design, and involved adults living in communities throughout Israel. Qualifying subjects were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. Two calibrated examiners performed all of the measurements. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by indoctrination in proper oral hygiene techniques by dental professionals, supplemented by pamphlets supplied by the sponsor and yearly mailings to participants, emphasizing good oral hygiene and the need to ensure compliance with the study. Post-baseline examinations were performed after one year of product use, and again after two years of product use. Three-thousand, three-hundred and ninety-two (3,392) subjects completed this two-year study. For these subjects, the mean caries scores (DFS, decayed or filled surfaces) at baseline were 21.96 for the Colgate Total Toothpaste group, and 21.49 for the Crest Cavity Fighting Toothpaste with Fluoristat group. For caries increment after one year, the respective means were 1.37 for the Colgate Total Toothpaste group, and 1.56 for the Crest Cavity Fighting Toothpaste with Fluoristat group. After two years, the mean caries increments were 1.46 for the Colgate Total Toothpaste group, and 1.75 for the Crest Cavity Fighting Toothpaste with Fluoristat group. No statically significant difference was indicated between the treatment groups at baseline. However, for both the one-year and two-year increments, there was a statistically significant difference between treatment groups. Relative to the Crest Cavity Fighting Toothpaste with Fluoristat group, the Colgate Total Toothpaste group presented a 12.2% reduction in caries increment scores at one year, and a 16.6% reduction in caries increment scores at two years. In accordance with the procedures and standards provided by the published guidelines of the American Dental Association for the comparison of the anticaries efficacy of fluoride dentifrices, the results of this study support the conclusion that Colgate Total Toothpaste provides a superior level of coronal anticaries efficacy compared to Crest Cavity Fighting Toothpaste with Fluoristat.

Adult↗
PubMedDate not supplied

A literature review: oral irrigation therapy. The adjunctive roles for home and professional use.

It is now recognized that there are several different types of periodontal infections. As we learn more about the cause of these diseases, it becomes obvious that we have treatment options. A successful choice of procedures for each individual depends on an accurate diagnosis based on comprehensive data collection of clinical and microbiological findings. Treatment choices include a non-surgical phase which consists of plaque removal, plaque control, scaling, root planing, and the use of chemical agents. For complete debridement of deep pockets, furcations or areas with root surface irregularities, surgical access may be necessary. When considering drug therapy, it must be noted that systemic antibiotics may be necessary to suppress those subgingival periodontal pathogens which have the ability to invade the tissue and resist other methods of eradication. Removal or alteration of pathogenic flora is mandatory to improve a patient's periodontal health. The extensive use of supragingival irrigation as an adjunct for treating gingivitis has led to the interest in subgingival irrigation as a possible adjunct for treatment of periodontal diseases. Targeted lavage and subgingival delivery of effective antimicrobial agents show potential as supplemental office procedures or as a component of a home oral hygiene regime. Additional research is needed to develop more efficacious chemotherapeutic substances than are currently available and to further define the optimum application of each. Substantive medicaments that react specifically against periodontopathic organisms are essential. Exact frequency and duration of professionally-applied and self-administered subgingival irrigation need to be determined for maximum results. Further investigation is required to establish the potential role of adjunctive irrigation and antimicrobial therapy in the treatment of periodontitis. Yet, another important application of irrigation has been recognized. Recently, the American Heart Association revised its guidelines for the prevention of bacterial endocarditis. The amendments to the dentistry sections have been approved by the Council on Dental Therapeutics of the American Dental Association. Included in this text is the recommendation that as an adjunct to antibiotic prophylaxis, sulcular irrigation with chlorhexidine may be useful for those patients considered high risk and/or have poor oral hygiene. Irrigation therapy is undergoing extensive scrutiny in the scientific research community. Presently, considerable conclusive evidence exists to suggest that adjunctive irrigation may play an important role in controlling gingivitis and periodontitis. The overwhelming challenge for any and all successful periodontal therapy will always remain dependent on patient compliance to regular professional and home care.

Anti-Bacterial Agents↗
PubMed2003

Essential oil mouthwashes: a key component in oral health management.

This Supplement provides clear evidence that essential oil (EO) mouthwashes can be a beneficial, safe component of daily oral health routines. However, despite the wealth of supporting evidence, several issues are worthy of discussion. Patient compliance is a clear issue with oral home-care routines, and the emphasis is on dental professionals to communicate the importance of adherence. The reasons for each step of the oral-care routine (i.e. brushing, flossing, rinsing) should be clearly explained, and if required, additional motivation should be provided. Most mouthwashes contain denatured alcohol as a delivery vehicle, and some concern has been raised about the association of alcohol with oral cancer. However, a review by the Food and Drug Administration and American Dental Association found that the supporting evidence to date is inconsistent and contradictory. Some mouthwashes have a pH below 5.5, and some researchers believe that this can lead to tooth erosion. Studies have shown that although the pH of an EO mouthwash is below 5.5, salivary pH remains above 5.5 following rinsing and for 15 min postrinse.

Anti-Infective Agents, Local↗
PubMed2001

Identifying communities with low dentist supply in California.

OBJECTIVES: This study estimates the supply and geographic distribution of dentists in California and examines the community characteristics associated with supply of dentists. METHODS: The number of practicing dentists was estimated from American Dental Association data on licensed dentists in California. Each dentist's address was geocoded and matched to a Medical Service Study Area (MSSA). Dentist-to-population ratios were computed, and the association between dentist supply and community characteristics was analyzed in regression models. RESULTS: Approximately 20 percent of California communities may have a shortage of dentists. Two-thirds of dental shortage communities are rural. Communities with a lower supply of dentists have higher percentages of minorities, children, and low-income persons. Minority dentists were more likely to practice in minority communities. CONCLUSIONS: Geographic maldistribution of dentists may contribute to poor access to dental care in many communities, especially in rural, low-income, and minority communities. Minority dentists are more likely to practice in minority communities, but are a small portion of the dental workforce.

Adult↗
PubMedDate not supplied

Infection control procedures in intraoral radiology: a survey of Michigan dental offices.

A questionnaire was mailed to members of the Michigan Dental Association to determine the extent and adequacy of infection control procedures utilized during intraoral radiography. These measures were then compared with the infection control guidelines recommended by the American Dental Association for exposing and processing radiographs. During exposure procedures, it was found that an overwhelming majority of practitioners wore disposable gloves and placed saliva-contaminated film packets in a receptacle after removing them from the mouth. Very few clinicians complied with the ADA recommendations for wrapping surfaces in the X-ray operatory, but many used disinfectants to decontaminate surfaces touched by the operator. Most respondents washed or removed their gloves before leaving the operatory to process films, thereby stopping the spread of saliva. ADA recommendations for infection control during processing were generally not followed although alternate methods were frequently used. It is emphasized that infection control regimens be employed for all patients, and not only for those who are thought to be infectious. Auxiliaries should be educated in these protocols because they expose radiographs in many dental offices.

Communicable Disease Control↗
PubMed2005

Estimated impact of competing policy recommendations for age of first dental visit.

OBJECTIVE: To compare levels of dental utilization and untreated dental decay among children aged 1 to 3 years that are likely to occur under 2 potential guidance policies: (1) pediatricians refer all toddlers to dentists for screening (consistent with American Academy of Pediatric Dentistry and the American Dental Association recommendations; DENT), and (2) pediatricians receive training in caries risk assessment, screen toddlers, and refer at-risk children to dentists (consistent with American Academy of Pediatrics recommendations; PED). METHODS: Using decision analysis, we estimated the impact of PED and DENT assuming alternately unlimited dental capacity for Medicaid-insured patients and fixed Medicaid dental capacity. Results With unlimited capacity, if DENT were implemented, then dental utilization is estimated to increase from 27% under the status quo to 65% and untreated decay to decrease from a mean of 0.60 surfaces to 0.52 surfaces per child. If PED were implemented, then dental utilization and untreated decay would decrease from status quo levels to an estimated 11% and 0.47 surfaces, respectively, assuming that diagnostic sensitivity and specificity both equaled 1; they would decrease to 13% and 0.53 surfaces, respectively, if sensitivity equaled 0.76 and specificity equaled 0.95. With fixed capacity, under DENT, untreated decay is estimated to increase to 0.63 surfaces because low-risk private-pay patients would crowd out at-risk Medicaid-insured children, whereas under PED, untreated decay would still be less than under the status quo. CONCLUSIONS: Implementing PED will decrease untreated decay under most plausible scenarios, whereas switching to DENT will increase the burden of disease if Medicaid dental capacity is limited.

Child, Preschool↗
PubMed2001

Orofacial pain emerging as a dental specialty.

The emerging field of orofacial pain was considered by the American Dental Association for full status as a new dental specialty. While the recognition of orofacial pain as a specialty was denied, the American Academy of Orofacial Pain plans to continue its efforts. Many recent advances in the neuroscience of orofacial pain have led to treatments that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited, leaving many patients to suffer. Dentists are generally supportive of the efforts to develop oral pain treatment into a specialty because the field will provide benefits for both dentists and their patients. A recent survey of 805 individuals who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control--despite having the pain for more than five years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, president of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." Development of the field of orofacial pain into a dental specialty has been moved primarily by the fact that historically, patients with complex chronic orofacial pain disorders have not been treated well by any discipline of healthcare. Recent studies of chronic orofacial pain patients have found that these patients have a higher number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (see Figure 1). Complex pain patients and the clinicians who see them are often confused about who they should consult for relief of the pain. Treatment for those patients within the existing structure of dental or medical specialties has been inadequate, with millions of patients left suffering. Insurers are also confused with regard to reimbursement and may make decisions to exclude treatment for orofacial pain disorders under both dental and medical policies. However, dentistry has taken a leading role in healthcare to address the national problem of developing the field of orofacial pain into a dental specialty. A study of dentists and dental specialists has shown that there is a recognized need and broad support for developing this field into a specialty.

Adult↗
PubMed1997

Ethical codes for attorneys: a brief introduction.

Ethical standards for lawyers are contained in the Model Rules of Professional Conduct (which lays out both "shall/shall not" rules and "may" suggestions in nine broad areas) and the Model Code of Professional Responsibility (which covers essentially the same topic areas but offers more detailed commentary). Topics included in the Rules are the client-lawyer relationship, the attorney's role as an advocate and counselor, law firms and associations, public service, transactions with individuals other than clients and information about legal services including advertising, firm names, and letterhead. The American Dental Association's Principles of Ethics and Code of Professional Conduct is organized around the five ethical principles of patient autonomy, nonmaleficence, beneficence, justice, and veracity. There are substantial similarities in intent between the ethical standards of dentists and lawyers; there are also differences.

Advertising↗
PubMed1991

Comparative policies of two national dental associations: Norway and the United States.

The major issues and challenges confronting the dental professions in the United States and Norway were studied through speeches of and interviews with the presidents of the American Dental Association (ADA) and the Norwegian Dental Association (NDA) in the period 1980-86. The issues most frequently dealt with related to public authorities, particularly legislation and government involvement in dental practice. Anxiety concerning "busyness," the future dental market, and a drop in the quality of applicants to dental schools were also major subjects. The spokespersons of both associations were engaged in increasing the demand for dental services by marketing, but they were ambivalent regarding advertising, especially individual advertising. Both were concerned with protecting dentistry's autonomy. While the Norwegian presidents apparently feared the medical profession's influence upon dentistry, the Americans were concerned with the hygienists and denturists, and with the insurance companies which they suspected of intruding into the dentist-patient relationship. The presidents' statements, which frequently varied, were apparently influenced by the current domestic political climate, the basic socio-political principles of the two countries, and the different socio-demographic make-up of their memberships.

Humans↗
PubMed1989

Current prosthodontic practice: a dental laboratory survey.

A survey was distributed to dental laboratory owners at the 1988 annual meeting of the Minnesota Dental Laboratory Association. Current laboratory practice in infection control, the use of nonprecious alloys, the amount of time devoted to complete removable prosthodontics, and complete denture laboratory techniques were surveyed. Responses indicate a moderate level of awareness and compliance with infection control techniques recommended by the American Dental Association, a declining demand for removable prosthodontic services, a high percentage of use of nonprecious alloys, and a very high rate of porcelain occlusion requested by dental practitioners. Comparisons with other laboratory surveys and the implications of these results for undergraduate education in prosthodontics are discussed.

Communicable Disease Control↗
PubMed2000

Comparative anticaries efficacy of sodium fluoride and sodium monofluorophosphate dentifrices. A two-year caries clinical trial on children in New Jersey and Puerto Rico.

PURPOSE: To provide a head-to-head comparison of the anticaries efficacy associated with two commercially-available and American Dental Association-accepted dentifrices: Crest Cavity Fighting Toothpaste with Fluoristat, containing 0.243% sodium fluoride in a silica base, and Colgate Great Regular Flavor Fluoride Toothpaste, containing 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base. The study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward this purpose. MATERIALS AND METHODS: The study employed a double-blind, parallel-groups, multi-center two-treatment design, and involved third, fourth, and fifth grade schoolchildren from Newark, New Jersey, and from the Cidra and Lares areas of Puerto Rico. Qualifying subjects were stratified according to age and sex, and were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by the presentation of educational films and lectures at school, by semi-annual mailings to parents, and through the periodic distribution of small novelty gifts along with the dentifrice deliveries, in order to enhance the interest and enthusiasm of study participants. Post-baseline examinations were performed after 1 and after 2 yrs of product use. Two thousand four hundred seventy-nine (2,479) subjects completed this 2-yr study. For these subjects, the mean (S.D.) DFS scores at baseline were 2.77 (3.35) for the Crest group, and 2.66 (3.18) for the Colgate group. For caries increment after 1 yr, the respective means were 1.68 (2.53) and 1.70 (2.57). After 2 yrs, the mean caries increments were 3.56 (4.11) for the Crest group, and 3.56 (4.05) for the Colgate group. RESULTS: The analysis of the 2-yr caries increment scores support the conclusion that the anticaries efficacy associated with Colgate Great Regular Flavor Fluoride Toothpaste is equivalent to that associated with Crest Cavity Fighting Toothpaste with Fluoristat, in accordance with the procedures and standards provided by the published guidelines of the American Dental Association. Further, consistent with those same standards, the results of this study serve to lend additional support to the conclusion that dentifrices formulated with sodium monofluorophosphate provide an equivalent level of anticaries efficacy as to those formulated with sodium fluoride.

Calcium Phosphates↗