Clinical efficacy of casein derivatives: a systematic review of the literature

BACKGROUND: The objective of this article was to review systematically the clinical trials of casein derivatives (specifically casein phosphopeptide-amorphous calcium phosphate [CPP-ACP] complex) used in dentistry. TYPES OF STUDIES REVIEWED: The authors included clinical studies that examined the efficacy of casein derivatives in dentistry. They excluded in vitro studies, case series, case reports, letters to editors (not containing primary data), editorials, review articles and commentaries, but read them to identify any potential studies. RESULTS: The authors searched 98 articles for relevance, determined according to title, abstract and full text, resulting in a yield of 12 original studies. Nine were clinical trials that focused on caries prevention, seven of which showed that CPP-ACP (as found in sugar-free pellet or slab chewing gum, lozenges, milk or mouthrinse) was effective in preventing dental caries by remineralizing subsurface carious lesions in situ in a dose-response fashion. One was a clinical trial with conflicting results regarding the effect of CPP-ACP on the regression of white-spot lesions; one was a survey of the relief of dry-mouth symptoms; and one was an uncontrolled clinical study that showed the lack of effectiveness and lack of short-term therapeutic effect in treating dentin hypersensitivity. CLINICAL IMPLICATIONS: The quantity and quality of clinical trial evidence are insufficient to make conclusions regarding the long-term effectiveness of casein derivatives, specifically CPP-ACP, in preventing caries in vivo and treating dentin hypersensitivity or dry mouth.     

Clinical application of erbium:YAG laser in periodontology

Various lasers have been introduced for the treatment of oral diseases and their applications in dental clinics have become a topic of much interest among practitioners. Technological advances and improvements have increased the choices of the available laser systems for oral use. Among them, a recently developed erbium-doped:yttrium aluminum garnet (Er:YAG) laser system possesses suitable characteristics for oral soft and hard tissue ablation. Due to its high absorption in water, an effective ablation with a very thin surface interaction occurs on the irradiated tissues without any major thermal damage to the irradiated and surrounding tissues. In the field of periodontics, the application of Er:YAG laser for periodontal hard tissue has begun with studies from Japanese and German researchers. Several in vitro and clinical studies have already demonstrated an effective application of the Er:YAG laser for calculus removal and decontamination of the diseased root surface in periodontal non-surgical and surgical procedures. However, further studies are required to better understand the various effects of Er:YAG laser irradiation on biological tissues for its safe and effective application during periodontal and implant therapy. Randomized controlled clinical trials and more basic studies have to be encouraged and performed to confirm the status of Er:YAG laser treatment as an adjunct or alternative to conventional mechanical periodontal therapy. In this paper, the advantages and current clinical applications of this laser in periodontics and implant dentistry are summarized based on current scientific evidence.     

Dental Patient-Reported Outcome Measures Are Essential for Evidence-Based Prosthetic Dentistry

For evidence-based dental treatment decision-making in prosthetic dentistry, evidence from scientific studies performed in the appropriate population with state-of-the-art interventions, reasonable controls, and relevant outcomes is required. This article will briefly review patient populations involved and interventions applied in prosthetic dentistry and more extensively review outcomes used for evidence-based dental treatment decision-making in prosthetic dentistry. Dental patient populations in prosthetic dentistry usually suffer from extensive loss of tooth substance and/or tooth loss. Typical interventions in prosthetic dentistry are replacement of a substantial amount of tooth structure and lost teeth with conventional or implant-supported fixed or removable dental protheses. Sufficient controls or comparisons should also involve no treatment for tooth loss as a legitimate option. For many years, prosthodontic treatment almost solely focused on disease-oriented outcomes such as numerical replacement of missing teeth to restore current oral health and prevent further deterioration, and now, dental patient-reported outcomes (dPROs), the outcomes that are directly reported by the patient, are gaining increasing attention. dPROs are what matters most for the patient, and dPRO measures have several advantages when applied in clinical practice and research settings compared with traditional disease-oriented measures such as ease of applicability and less burdensome for the clinicians. In evidence-based prosthetic dentistry, there should be a shift to fewer applied dPRO measures, with only one instrument becoming standard. Furthermore, dPROs will probably also become tools to assess patients' oral health status in clinical practice in a standardized manner. Finally, information on dPROs will become an integral part of evidence-based treatment decision-making in prosthetic dentistry.     

Evidence-based dentistry in clinical practice

BACKGROUND: Evidence-based dentistry, or EBD, is not a new concept for the dental profession in the United States. The American Dental Association has long relied on credible scientific evidence in setting policy and communicating with dentists and the general public. EBD provides an approach to oral health care that follows a process of systematically collecting and analyzing scientific evidence to answer a specific clinical question. OVERVIEW: The authors discuss applications of systematic review findings to everyday clinical practice and explore the implications of EBD for dental education, clinical research and the provision of care to patients. CONCLUSIONS AND PRACTICE IMPLICATIONS: In developing appropriate treatment plans, dentists should combine the patient's treatment needs and preferences with the best available scientific evidence, in conjunction with the dentist's clinical expertise. To keep pace with other health professions in building a strong evidence-based foundation, dentistry will require significant investments in clinical research and education to evaluate the best currently available evidence in dentistry and to identify new information needed to help dentists provide optimal care to patients.     

Screening for dysglycaemia in dental primary care practice settings: systematic review of the evidence

Introduction: Increasing prevalence of diabetes and periodontal disease is prompting identification of additional clinical settings to identify patients at risk for dysglycaemia. A systematic review of studies that have examined feasibility of screening for at-risk patients in general dentistry settings at point-of-care (POC) was undertaken. Materials and methods: Systematic review of pragmatic clinical field trials piloting POC screening for dysglycaemia risk in dental settings was undertaken in studies whose primary objective was to explore rates of dysglycaemia among undiagnosed patient populations. Results: Among 17 dental clinical field trials identified, 10 were systematically reviewed. High rates of undiagnosed dysglycaemia were detected among dental patients by biological screening in all trials. Notably, substantive differences in study design and population characteristics were identified, precluding meta-analysis. Conclusion: Screening for dysglycaemia in dental offices effectively identified high-risk patients requiring triage for glycaemic management. Considerations for future clinical trial design were advanced to establish an evidence base amenable to meta-analysis of the relative translational value of glycaemic screening in dental settings.Key words: Diabetes, dental office, screening, pragmatic clinical trials, oral health     

Clinical application of autogenous partially demineralized dentin matrix prepared immediately after extraction for alveolar bone regeneration in implant dentistry: a pilot study

The aim of this study was to examine the efficacy and safety of autogenous partially demineralized dentin matrix (APDDM) prepared onsite, for clinical application in bone regeneration procedures related to implant dentistry, including socket preservation, alveolar ridge augmentation, and maxillary sinus floor augmentation. In this study, 16 patients underwent dental implant placement using APDDM transplantation. There were no systemic or local complications (including surgical site infection) in any of the cases, and oral rehabilitation using dental implants was successful in all cases for at least 2 years after attachment of the suprastructure. This report describes the clinical application of APDDM prepared immediately after tooth extraction to bone augmentation, taking advantage of the relatively short preparation time due to partial demineralization. APDDM, as introduced in this study, is an efficient, safe, and reasonable bone substitute. Consequently, this material has the potential to become one of the options as a bone substitute in implant dentistry.     

Evolution of clinical reasoning in dental education

The approach to care in dentistry has evolved over the past couple of decades from a narrow focus on oral disease to addressing the psychosocial determinants of oral health. Subsequently, there have been many attempts to reform dental curricula through alternative models of education, such as competency-based and community-based educational models and problem-based learning. These efforts aim to improve the abilities of dental students in problem-solving, critical thinking, professionalism, and social and cultural competence to help them cope with the complexity of dealing with oral health-related issues and the constantly changing evidence underlying the practice of dentistry. However, it is not yet clear how well these educational initiatives meet their objectives or how they influence the reasoning skills of dental students. There is now a need to develop a conceptual framework for clinical reasoning in dentistry grounded on empirical evidence to direct the future evolution of dental education.     

New laboratory methods to study tooth surface coverage and interproximal plaque control by dentifrice products

OBJECTIVE: To develop and test an in vitro tooth model for use in conjunction with laboratory methods to study interproximal effects and efficacy of dentifrices. The application of the model should offer visual evaluation of dentifrice coverage of the tooth surface, and measure dental plaque control at posterior interdental spaces with a dentifrice. METHODOLOGY: The dentifrice products tested with the model were: Colgate Total 2 in 1 Toothpaste and Mouthwash (CTTM), Colgate Total dentifrice (CTD), and Colgate Regular dentifrice (CRD). Extracted human posterior teeth were disinfected, cleaned, aligned, and mounted in denture acrylic. In the area coverage method, tooth surface coverage and penetration of two different forms of dentifrice products (CTTM and CRD) were compared using digital photography. In the interproximal plaque control method, the teeth were coated with human saliva and incubated anaerobically with a mixture of representative oral bacteria for six hours at 37 degrees C. In vitro dental plaque was assessed after brushing the facial surface with one of the three dentifrice products using a clinical plaque scoring index. RESULTS: The area coverage method demonstrated that both dentifrice products tested covered approximately 70% of the facial tooth surface; the CTTM dentifrice coverage on the lingual tooth surface was significantly higher than the coverage for the CRD dentifrice. With the interproximal plaque control method, in the presence of an active ingredient, the CTTM dentifrice had equivalent efficacy to the CTD dentifrice. Both CTTM and CTD were significantly superior to the CRD for interproximal dental plaque control. CONCLUSION: Using the developed tooth model, two assessment methods have been shown to have the potential to demonstrate tooth surface coverage, and to assess the potential efficacy of a dentifrice for the control of interproximal dental plaque. This process can indicate potential clinical evaluation of an oral care product, and support clinical findings with controlled evidence.     

The Evolution of America's Scientific Advancements in Dentistry in the Past 150 Years

BackgroundDuring the last 150 years, dentistry in the United States faced many challenges as it developed its scientific foundation. In the latter part of the 19th century, clinical practice was driven by empirical evidence, and the first few decades of the 20th century set the stage for America's scientific evolution of dentistry.ConclusionsSeminal developments in America's contribution to science in dentistry and oral health included the 1926 Carnegie Foundation for the Advancement of Teaching report and the vision of William J. Gies; the development of scientific dental journals; the role of immigrant dental scientists from Europe and oral biology as a discipline; and the establishment of the National Institute of Dental Research in 1948.Clinical ImplicationsDue in large part to America's contribution to dental science and practice, we are at the brink of a transformation that may expand the role of the dental profession dramatically and improve the oral health of people throughout the world.     

The application of novel mussel-inspired compounds in dentistry

ObjectiveTo give a current review of the mechanism of mussel adhesion, the application of mussel-inspired compounds in dentistry and the challenges associated with clinical application.MethodsInspired by the wet adhesion property of 3,4-dihydroxyphenol-l-alanine (Dopa) in mussel plaques, various chemical compounds have been synthesized to mimic the mussel as an adhesion model for medical applications. Similar to mussels in the marine environment, dental materials in the oral environment have to endure long-term water hydrolysis, mechanical stress and other chemical challenges. These challenges have influenced an increasing number of studies that are exploring the translation of mussel-inspired adhesion to clinical applications. Therefore, this review discusses the mussel adhesion chemistry and its related application in dentistry.ResultsMussel-inspired compounds have achieved relatively acceptable performances in various dental fields, including surface coating, metal ions chelation, dentin bonding and mucosal adhesion. However, two practical problems remain to be comprehensively addressed, namely the protection of catechol groups from oxidation, and the feasibility for clinical application.SignificanceThe mussel’s wet adhesion ability has attracted much research interest in the dental field because of its properties of moisture-resistant adhesion and surface coating. Despite the emergence of several mussel-inspired compounds in recent years, a comprehensive and timely review of their applications in dentistry is lacking. Therefore, the current review hopes to provide valuable information around the application of mussel-inspired compounds in dentistry with their pros and cons discussed.     

The role of guidelines and systematic reviews in oral healthcare

Clinical practice guidelines are a very appropriate means of keeping up to date, effectively and efficiently, with knowledge on a specific clinical topic. These are a compilation of clinical expertise retrieved from daily practice, scientific evidence derived from journals and the opinions of patients, which together form the core of the treasury of ideas of evidence-based dentistry. The development of clinical practice guidelines should be carried out according to a strictly defined procedure. In this procedure systematic reviews of literature should be used. The Cochrane Collaboration is an organization that develops reliable systematic reviews. Clinical practice guidelines are an essential part of evidence-based dentistry. The evidence-based approach should be fully integrated in dental education and in daily dental practice. The establishment of a national centre for evidence-based development and implementation of dental clinical practice guidelines, in cooperation with other healthcare professionals, should have the highest priority, in order to maintain the quality of oral healthcare in professional hands.     

Self-etching adhesives: review of adhesion to tooth structure part II.

Self-etching adhesives are steadily increasing in popularity among dental practitioners with their easy handling technique and their promise of no post-op sensitivity. As with any new bonding material, in vitro and in vivo investigations are required to assess the clinical efficacy of these systems. OBJECTIVES: The current literature was reviewed to provide information on these systems, including the influence of their acidity and permeability on the quality of the bond, the role of water in long-term degradation of the bond in in vivo and in vitro studies, and the clinical efficacy of the self-etching adhesives in clinical research studies. DATA SOURCES: Published abstracts, reviews, laboratory reports and clinical research papers in the dental literature. CONCLUSIONS: Very little information is available on self-etching systems pertaining to the long-term in vitro and in vivo durability of their bond and their medium- to long-term clinical outcome. Although post-op sensitivity seems to be something of the past, short-term clinical studies show that some self-etching adhesives do not perform as well as total-etch systems.     

A community of learners in the evidence‐based dental clinic

An increasing emphasis has been placed on the need for an evidence‐based approach in dentistry. This calls for effort in dental education to develop and implement tools for the application of evidence in clinical decision‐making (evidence‐based decision‐making, EBDM). Aim: To evaluate whether the implementation of a community of learners (COL) within a clinical EBDM course enables students, clinical teachers and scientists to discuss the application of evidence in clinical decision‐making and whether it stimulates a scientific approach in students. Material and Methods: A clinical course in EBDM was created. Students presented and discussed patient cases in a COL of student‐peers, clinical teachers and scientists. From the discussion, clinical questions arose and were translated into PICO format (Problem, Intervention, Comparison and Outcome). Students searched for evidence in the literature. Four weeks later, they presented and discussed the evidence found. Before and after the implementation of the course, students, clinical teachers and scientists completed a questionnaire anonymously on the procedure adopted, its content, the learning outcomes and their appreciation of this course. Assessment of the competence EBDM was performed at the end of the course. Grading scores of students in the COL were compared with scores of a student group that did not participate in the COL and were not advised by scientists. Results: Evaluation showed that scientists, clinical teachers and students gradually became more positive on the adopted procedure, content, learning outcomes and the appreciation of this course (ANOVA Bonferoni P < 0.05). The student’s evaluation showed the development of a more scientific approach. Assessment scores of EBDM were sufficient and promising. Conclusion: A stimulating arena was created: a COL, in which the evidence used in clinical decision‐making, was discussed. The COL involved dental students, clinical teachers and scientists. In this setting, an EBDM course appeared to result in a more scientific approach from dental students. The COL provided a good working concept for EBDM in dental education.     

Clinical Success of Zirconia in Dental Applications

The application of ceramic materials for the fabrication of dental restorations is a focus of interest in esthetic dentistry. The ceramic materials of choice are glass ceramics, spinel, alumina, and zirconia. Zirconia was introduced into dentistry in the 1990s because of its good mechanical and chemical properties and is currently being used as a material for frameworks, dowels, implants, abutments, and orthodontic brackets. Many in vitro studies about zirconia use have been published, but clinical long-term studies are very important. This article presents data regarding the incidence of clinical success and complications of zirconia in these dental applications. Clinical studies published to date seem to indicate that zirconia is well tolerated and sufficiently resistant.     

Potential applications of Erbium:YAG laser in periodontics

OBJECTIVES: Since lasers were introduced for the treatment of oral diseases, there has been considerable advancement in technology. As a result, numerous laser systems are currently available for oral use. Neodymium:Yttrium-Aluminum:Garnet (Nd:YAG), carbon dioxide (CO(2)) laser and the semiconductor Diode lasers have already been approved by the US Food and Drug Administration for soft tissue treatment in oral cavity. The Erbium:YAG (Er:YAG) laser was approved in 1997 for hard tissue treatment in dentistry and recent studies have reported positive results. This suggests that the Er:YAG laser system is a promising apparatus, which will be able to revolutionize and improve dental practice, in particular periodontal treatment. In this mini-review, we would like to describe the positive characteristics of the Er:YAG laser which indicate its potential as a new treatment modality in periodontics. MATERIALS AND METHODS: Recent findings are summarized briefly to evaluate the potential of the Er:YAG laser for clinical application in periodontics. RESULTS: The Er:YAG laser possesses suitable characteristics for oral soft and hard tissue ablation. Recently, it has been applied for effective elimination of granulation tissue, gingival melanin pigmentation and gingival discoloration. Contouring and cutting of bone with minimal damage and even or faster healing can also be performed with this laser. In addition, irradiation with the Er:YAG laser has a bactericidal effect with reduction of lipopolysaccharide, high ability of plaque and calculus removal, with the effect limited to a very thin layer of the surface and is effective for implant maintenance. CONCLUSION: The Er:YAG laser seems to be an effective tool for periodontal therapy, however, further clinical and basic investigations are required to confirm its clinical application.     

Infant oral health education in U.S. dental school curricula.

PURPOSE: This study was performed to determine didactic and clinical curricular content about infant oral health in predoctoral pediatric dentistry programs. METHODS: 54 dental school departments of pediatric dentistry were surveyed about: 1) curricular content devoted to teaching infant oral health (IOH) and age of first dental visit; 2) methods used to teach IOH and hours dedicated to each method; and 3) whether students receive hands-on experiences with infants. RESULTS: Eighty-six percent of programs teach students to see infants at 12 months of age or younger. Curricular time ranged from 15 minutes to 13 hours (mean = 2 hrs, 20 min, median = 1 hr, 45 min). All programs used lectures; other formats included handouts, demonstration and small group seminar. Fifty percent provide clinical experiences, albeit they are not uniform for all students. One-fourth provides uniform, clinical hands-on experiences with infant oral examinations. CONCLUSIONS: The findings indicate varying degrees of acceptance about teaching infant oral health in our dental schools.     

Sol-gel bioactive glass containing biomaterials for restorative dentistry: A review

ObjectiveBioactive glasses (BAGs) have been researched extensively for dentistry due to their favourable biocompatibility and hard tissue bonding ability. However, the specific application of BAGs produced through sol-gel synthesis in restorative dentistry has not been reviewed previously. This review provides a comprehensive account of the principles behind sol-gel derived BAGs and their investigation for dental tissue restoration materials.MethodsA search for in vitro and in vivo studies was performed using the databases Web of Science®, Medline®, Scopus® and Google Scholar®. Articles published over the past 20 years were selected and data on the BAG composition and morphology was extracted. Analysis of the effect of specific BAG additives on the properties of experimental dental materials was also performed.ResultsA majority of BAG particles investigated were spheres ranging in size from 5 nm to ~650 µm. Sol-gel BAGs are mainly applied in the treatment of hypersensitive dentine and for pulp-dentine tissue engineering, while a handful have been used in target drug delivery. BAG fillers are promising additives that result in improved biological properties, antibacterial effects, hardness, acid buffering and remineralization. Unfortunately, some detrimental effects on optical properties have been observed with BAG addition. Additionally, in vivo data, investigations into radiopacity and standardization of test protocols are identified as areas for improvement and further studies.SignificanceFuture work should consider the pertinent issues raised in order to improve the quality of available data and expand knowledge in this area of dental biomaterials research and development.     

Wear of materials used in dentistry: a review of the literature

This is a review of the literature concerning wear related to the following materials used in dentistry: dental amalgam, composite resins, and glass-ionomer cements, as well as natural tooth substance. Discussions are included on both in vivo and in vitro studies in which various methods were used to help determine wear resistance.     

Regenerative dentistry: translating advancements in basic science research to the dental practice

Scientific advances in the creation of restorative biomaterials, in vitro cell culture technology, tissue engineering, molecular biology and the human genome project provide the basis for the introduction of new technologies into dentistry. This review provides an assessment of how tissue engineering, stem cell, genetic transfer, biomaterial and growth factor therapies can be integrated into clinical dental therapies to restore and regenerate oral tissues. In parallel to the creation of a new field in general medicine called "regenerative medicine," we call this field "regenerative dentistry." While the problems of introducing regenerative therapies are substantial, the potential benefits to patients and the profession are equally ground-breaking. In this review, we outline a few areas of interest for the future of oral and dental medicine in which advancements in basic science have already been adapted to fit the goals of 21st century dentistry.