A practical application of onychomycosis cure – combining patient,physician and regulatory body perspectives

Due to the high relapse rates and the rise of predisposing factors, the need for curing onychomycosis is paramount. To effectively address onychomycosis, the definition of cure used in a clinical setting should be agreed upon and applied homogeneously across therapies (e.g. oral, topical and laser treatments). In order to determine what is or what should be used to define cure in a clinical setting, a literature search was conducted to identify methods used to evaluate treatment success. The limitations, strengths, prevalence and utility of each outcome measure were investigated. Seven ways to measure treatment success were identified; mycological cure, patient/investigator assessments, complete cure, quality of life instruments, severity indexes, clinical cure and temporary clearance. Despite its shortcomings, mycological cure is the most objective and consistent outcome measure used across onychomycosis studies. It is suggested that diagnostic goals of onychomycosis should be used to define cure in a clinical setting. Modifications to outcome measures such as incorporating molecular‐based techniques could be a future avenue to explore.     

Clinical evaluation of brushing time and plaque removal potential of two manual toothbrushes

Abstract: Aim: To compare plaque removal efficacy of Oral‐B CrossAction (CA) used for 1 min with an American Dental Association (ADA) manual toothbrush used for 2 or 5 min in an examiner‐blind, three‐treatment, six‐period crossover study. Materials and methods: After refraining from all oral hygiene procedures for 23–25 h, subjects were randomly assigned to one of nine possible six‐period (visit) treatment sequences. Plaque was assessed at baseline (Rustogi Modified Navy Plaque Index). Post‐brushing scores were recorded after brushing with a marketed dentifrice and the assigned toothbrush for the specified duration. The same procedure was followed at each of six subsequent visits. Clinical measurements were carried out by the same examiner. Results: Forty subjects completed the study. All three treatments effectively removed plaque from the whole mouth, along the gingival margin and from approximal surfaces. Whole mouth and gingival margin plaque removal scores with CA for 1 min did not differ significantly from scores with the ADA toothbrush used for 2 min. The ADA brush used for 5 min showed significantly greater whole mouth (P < 0.001) and gingival margin (P < 0.001) plaque reduction than the two other treatments. Approximal plaque removal scores did not differ between the three treatments. Conclusions: Efficient plaque removal can be achieved after 1 min of brushing with CA. The amount of plaque removed did not differ significantly from that achieved with the ADA brush after 2 min of brushing. Greater whole mouth and gingival margin plaque removal scores were seen with the ADA brush after 5 min.     

High and low brushing force in relation to efficacy and gingival abrasion

Objectives: Does a high brushing force induce more gingival abrasion than a low (regular) brushing force? Furthermore, what is the effect of a low or high force on the efficacy? Methods: Thirty-five non-dental students were selected. All received an appointment prior to which they abstained from oral hygiene for at least 48 h. At baseline the teeth and surrounding tissues were disclosed using Mira-2-Tone® disclosing solution. Next, the examiner (PAV) evaluated the number of sites with gingival abrasion and the amount of dental plaque (Quigley & Hein) at 6 surfaces of each tooth. In the absence of this examiner, the subject's teeth were brushed by a hygienist (MP) using the Braun/Oral-B®-D17 oscillating rotating toothbrush. Brushing was performed in two randomly selected contra-lateral quadrants for 60 s with either a low force (±1.5 N) or high force (±3.5 N) and in the opposing quadrants for 60 s with the alternative force. Visual feedback was given to control force. The brush was moved from the distal tooth to the central incisor perpendicular to the tooth surface with an angle of approximately 10–15° towards the gingival margin. Next, the number of sites with abrasion and the remaining plaque were assessed again. Results: The overall baseline gingival abrasion scores were 3.1 and 3.2 sites for high and low force, respectively, and increased to 5.0 and 5.9 sites respectively after brushing. There was no significant difference with respect to incidence of abrasion. At baseline, 48 h. plaque levels were 2.2. The reduction in plaque scores with the low force was 60% and with the high force 56%. This difference was significant. Conclusion: With the oscillating rotating power toothbrush (Braun/Oral-B D17) the use of high force (±3.5 N) is less efficacious as compared to a regular low force (±1.5 N) while the incidence of gingival abrasion sites was comparable. (This study was sponsored by Gillette.)     

The effect of 1% chlorhexidine gel and 0.12% dentifrice gel on plaque accumulation: a 3-day non-brushing model

To cite this article:
Int J Dent Hygiene  8 , 2010; 294–300
DOI: 10.1111/j.1601‐5037.2010.00487.x
Slot DE, Rosema NAM, Hennequin‐Hoenderdos NL, Versteeg PA, van der Velden U, van der Weijden GA. The effect of 1% chlorhexidine gel and 0.12% dentifrice gel on plaque accumulation: a 3‐day non‐brushing model. Abstract: Aim: The purpose of the study was to compare the effects of four treatments on ‘de novo’ plaque accumulation. Treatments included tray application of 1% chlorhexidine gel (CHX‐Gel), 0.12% chlorhexidine dentifrice‐gel (CHX‐DFG), a regular dentifrice (RDF) tray application, or 0.2% chlorhexidine mouthwash (CHX‐MW) in a 3‐day non‐brushing model. Material and methods: The study was designed as a single blind, randomized parallel clinical trial. After professional prophylaxis, subjects abstained from all other forms of oral hygiene during a 3‐day non‐brushing period. Subjects were randomly assigned to one of the four test groups (CHX‐Gel, CHX‐DFG, RDF applied in a fluoride gel tray or rinsing with a CHX‐MW). After 3 days, the Quigley & Hein plaque index (PI) and Bleeding on Marginal Probing (BOMP) index was assessed. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale. Results: After 3 days, the full‐mouth PI means were 0.88 for the CHX‐gel regimen, 0.79 for CHX‐MW, 1.16 for CHX‐DFG and 1.31 for the RDF regimen. The two dentifrices (CHX‐DFG and RDF) were significantly less effective than the CHX‐Gel or the CHX‐MW. Conclusion: Within the limitations of the present 3‐day non‐brushing study design, it can be concluded that the effect of a 1% CHX‐Gel application tray is significantly greater than that of 0.12% CHX‐DFG or RDF in inhibiting plaque accumulation. The 1% CHX‐Gel applied via a tray and 0.2% CHX‐MW rinse were comparably effective.     

Return of autologous blood donors as homologous blood donors

Autologous blood donors (ABDs) have been reported to have favorable attitudes toward returning as homologous blood donors (HBDs), but the frequency of return has not been well documented. ABDs eligible by history to be HBDs were followed at one blood center: 255 donating for elective surgery and 234 donating during pregnancy were followed for an average of 18 months and 20 months, respectively, from time of eligibility after surgery or postpartum. Male ABDs had a higher rate of return as HBDs, as 34 percent (21/62) returned to donate an average of 3 units, whereas 13 percent (56/427) of female ABDs returned as HBDs to donate an average of 2 units. Although a history of donation was associated with a higher rate of return (30%, 34/113), 11 percent (43/376) of ABDs with no history as HBDs returned to donate homologous units, despite having been recruited less frequently than prior HBDs. Overall, all male ABDs and female ABDs with an HBD history returned most frequently. The extra effort required for an autologous donor program may result in the recruitment of new donors into the HBD pool.