An evaluation of 10 percent and 20 percent benzocaine gels in patients with acute toothaches: Efficacy,tolerability and compliance with label dose administration directions

BackgroundThe authors evaluated the efficacy and tolerability of 10 percent and 20 percent benzocaine gels compared with those of a vehicle (placebo) gel for the temporary relief of toothache pain. They also assessed the compliance with the label dose administration directions on the part of participants with toothache pain.MethodsUnder double-masked conditions, 576 participants self-applied study gel to an open tooth cavity and surrounding oral tissues. Participants evaluated their pain intensity and pain relief for 120 minutes. The authors determined the amount of gel the participants applied.ResultsThe responders’ rates (the primary efficacy parameter), defined as the percentage of participants who had an improvement in pain intensity as exhibited by a pain score reduction of at least one unit on the dental pain scale from baseline for two consecutive assessments any time between the five- and 20-minute points, were 87.3 percent, 80.7 percent and 70.4 percent, respectively, for 20 percent benzocaine gel, 10 percent benzocaine gel and vehicle gel. Both benzocaine gels were significantly (P ≤ .05) better than vehicle gel; the 20 percent benzocaine gel also was significantly (P ≤ .05) better than the 10 percent benzocaine gel. The mean amount of gel applied was 235.6 milligrams, with 88.2 percent of participants applying 400 mg or less.ConclusionsBoth 10 percent and 20 percent benzocaine gels were more efficacious than the vehicle gel, and the 20 percent benzocaine gel was more efficacious than the 10 percent benzocaine gel. All treatments were well tolerated by participants.Practical ImplicationsPatients can use 10 percent and 20 percent benzocaine gels to temporarily treat toothache pain safely.     

The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: a meta-analysis

BackgroundThe authors evaluated published evidence from controlled clinical trials regarding the efficacy of two local anesthetic solutions in providing successful pulpal anesthesia.MethodsThe authors searched MEDLINE and Embase databases to identify peer-reviewed randomized controlled trials in which researchers directly compared articaine and lidocaine local anesthetic solutions in adult participants. They extracted study characteristics and outcomes data as a basis for meta-analysis. They completed subgroup analyses for both infiltration and mandibular inferior alveolar block anesthetic techniques.ResultsArticaine solutions had a probability of achieving anesthetic success superior to that of lidocaine, with an odds ratio of 2.44 (95 percent confidence interval [CI], 1.59–3.76; P < .0001). The greater odds ratio for articaine increased to 3.81 (95 percent CI, 2.71–5.36; P < .00001) when the authors analyzed only infiltration data. There was weaker, but still significant, evidence of articaine’s being superior to lidocaine for mandibular block anesthesia, with an odds ratio of 1.57 (95 percent CI, 1.12–2.21; P = .009), and no difference when the authors considered only symptomatic teeth.Clinical ImplicationsResearch evidence supports using articaine versus lidocaine for achieving pulpal anesthesia when the infiltration mode of administration is used. It is premature to recommend articaine for mandibular block anesthesia in cases involving irreversible pulpitis.     

Anesthetic Efficacy of Intranasal 3% Tetracaine plus 0.05% Oxymetazoline (Kovanaze) in Maxillary Teeth

Introduction

Needle-free anesthetic delivery is a promising alternative to traditional anesthetic routes of administration. The purpose of this study was to determine the patient preference for and pulpal anesthetic efficacy of a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray in maxillary lateral incisors and first premolars.

A comparison of the local anesthetic efficacy of the extraoral versus the intraoral infraorbital nerve block

BackgroundThe efficacy of the extraoral infraorbital nerve block has not been studied sufficiently to ensure its appropriate clinical use. To compare the local anesthetic efficacy of the extraoral versus the intraoral infraorbital nerve block, the authors conducted a prospective, randomized crossover study.MethodsForty adult participants randomly received extraoral infraorbital nerve blocks of 1.8 milliliters of 2 percent lidocaine with 1:100,000 epinephrine at one appointment and intraoral infraorbital nerve blocks of 1.8 mL of 2 percent lidocaine with 1:100,000 epinephrine at another appointment in a crossover design. After administering the injections, the authors used an electric pulp tester to assess the maxillary central and lateral incisors, canine, premolars and first molar for pulpal anesthesia in four-minute cycles for 60 minutes. They considered anesthesia to be successful when the participant had no response to two consecutive 80 readings (the maximum output) with the electric pulp tester.ConclusionsThe authors found that the extraoral and intraoral infraorbital nerve blocks were ineffective in providing profound pulpal anesthesia of the maxillary central incisor (15 percent success rate) and lateral incisor (22 percent success rate). The pulpal anesthesia success rate was 92 percent for the canine for both types of nerve blocks, 80 to 90 percent for first and second premolars and 65 to 70 percent for the first molar, with no significant differences (P < .05) between the two nerve blocks. Pulpal anesthesia did not last for an hour in any of the teeth. Needle insertion pain and postoperative sequelae were more common after the extraoral infraorbital nerve block was administered.Clinical ImplicationsBoth nerve blocks would be ineffective in the central and lateral incisors. Both nerve blocks would be somewhat successful in the canine and premolars but not in the first molar.     

Sleep bruxism and myofascial temporomandibular disorders: A laboratory-based polysomnographic investigation

BackgroundMany dentists believe that sleep bruxism (SB) is a pathogenic factor in myofascial temporomandibular disorder (TMD), but almost all supportive data rely on patients' self-reports rather than on direct observation.MethodsThe authors administered a structured self-report interview to determine whether a large and well-characterized sample of patients with myofascial TMD (124 women) experienced SB more often than did matched control participants (46 women). The authors then used data from a two-night laboratory-based polysomnographic (PSG) study to determine whether the case participants exhibited more SB than the control participants.ResultsThe results of independent sample t tests and χ² analyses showed that, although self-reported rates of SB were significantly higher in case participants (55.3 percent) than in control participants (15.2 percent), PSG-based measures showed much lower and statistically similar rates of SB in the two groups (9.7 percent and 10.9 percent, respectively). Grinding noises were common in both case participants (59.7 percent) and control participants (78.3 percent).ConclusionsMost case participants did not exhibit SB, and the common belief that SB is a sufficient explanation for myofascial TMD should be abandoned.Clinical ImplicationsAlthough other reasons to consider treating SB may exist, misplaced concern about SB's sustaining or exacerbating a chronic myofascial TMD condition should not be used to justify SB treatment.     

Trigeminal nerve injury associated with injection of local anesthetics: Needle lesion or neurotoxicity?

BackgroundThe authors used comprehensive national registry and clinical data to conduct a study of adverse drug reactions (ADRs), in particular neurosensory disturbance (NSD), associated with local anesthetics used in dentistryMethodsThe study included data sets of annual sales of local anesthetics (from 1995 through 2007), 292 reports to the Danish Medicines Agency, Copenhagen, Denmark, of adverse reactions to local anesthetic drugs, and a clinical sample of 115 patients with NSD associated with local anesthetics. The authors assessed lidocaine 2 percent, mepivacaine 2 percent and 3 percent, prilocaine 3 percent, and articaine 4 percent sold in cartridges.ResultsThe study results showed a highly significant overrepresentation of NSDs associated with articaine 4 percent, in particular with mandibular blocks.ConclusionsThe distribution of NSDs was disproportionate to the market share of three of the four drugs in both national registry data and clinical data. These findings indicate that the main cause of injury was neurotoxicity resulting from administration of the local anesthetic rather than the needle penetration.Clinical ImplicationsClinicians may consider avoiding use of high-concentration (4 percent) anesthetic formulations for block anesthesia in the trigeminal area in cases in which there are viable alternatives.     

Effect of a Combination of Intranasal Ketorolac and Nitrous Oxide on the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective,Randomized, Double-blind Study

Introduction

Previous studies in patients with irreversible pulpitis have reported increased success of the inferior alveolar nerve block (IANB) using premedication with ketorolac. Preemptive nitrous oxide administration has also shown an increase in the success of the IANB. Recently, ketorolac has been made available for intranasal delivery. Perhaps combining ketorolac and nitrous oxide would increase success. Therefore, the purpose of this prospective, randomized, double-blind study was to determine the effect of a combination of intranasal ketorolac and nitrous oxide/oxygen on the anesthetic success of the IANB in patients presenting with symptomatic irreversible pulpitis.

Tooth sensitivity and bleaching effectiveness associated with use of a calcium-containing in-office bleaching gel

BackgroundThe authors conducted a study to evaluate tooth sensitivity (TS) and the bleaching effectiveness associated with use of a calcium-containing (CC) in-office bleaching gel.MethodsThe authors used a 35 percent calcium-free (CF) hydrogen peroxide gel and a 35 percent CC hydrogen peroxide gel according to the manufacturer's instructions in 40 caries-free participants 18 years or older. They performed two bleaching sessions with a one-week interval between sessions. The authors registered the color at baseline and after the first and second bleaching sessions by using a shade guide and by gauging the participant's perception of TS as registered on a scale from 0 (none) to 4 (severe). The authors evaluated the bleaching effectiveness at each week's recall visit by means of the Friedman test, and they compared the groups at each assessment point by means of the Mann-Whitney test. They evaluated the percentage of participants with TS and the intensity of the TS by using the Fisher exact and Mann-Whitney tests.ResultsBoth groups demonstrated equivalent and significant tooth color enhancement compared with color values at baseline (P < .05), with an average bleaching of 7 to 8 shade guide units. Most of the participants from the CF group (80 percent) experienced sensitivity while undergoing the bleaching regimen, whereas only 40 percent of participants from the CC group reported experiencing TS (P = .02). The intensity of TS was significantly higher (P < .01) for the CF group during in-office dental bleaching.ConclusionsThe CC 35 percent hydrogen peroxide gel reduced the TS during in-office dental bleaching without jeopardizing the bleaching effectiveness.Clinical ImplicationsThe results of this study support the findings that a CC 35 percent hydrogen peroxide gel can reduce TS during in-office dental bleaching.     

Assessing the association between bisphosphonate exposure and delayed mucosal healing after tooth extraction

BackgroundTooth extraction in patients exposed to bisphosphonates (BPs) is considered a risk factor for osteonecrosis. The authors evaluated the time to mucosal healing and frequency of osteonecrosis after tooth extraction in participants exposed to BPs.MethodsThe authors compared wound healing after tooth extraction in participants exposed to BPs with that in control participants who had not been exposed to BPs. Variables included age, sex, type of BP therapy (oral or intravenous), BP exposure time and C-terminal telopeptide (CTX) test results. The authors followed up patients weekly or biweekly until healing was complete. They used multivariable analyses to model time to healing in the presence of covariates, and estimates provided hazard ratios (HRs) and 95 percent confidence intervals (CIs) adjusted for all variables in the model.ResultsThe authors enrolled 53 participants with BP exposure and 39 control participants. Postextraction healing was significantly longer in participants exposed to BPs (P < .001) than it was in control participants. One patient (1.9 percent) developed osteonecrosis. A Cox proportional hazards model in which the authors controlled for age, sex and CTX values showed that BP exposure alone significantly (adjusted HR, 0.27; 95 percent confidence interval, 0.16–0.48) increased mucosal healing time.ConclusionsThe study results showed that postextraction healing was impaired in patients exposed to BPs. CTX values were not associated with delayed healing after tooth extraction.Practical ImplicationsPostextraction healing was delayed in patients receiving BP therapy. However, the risk of developing osteonecrosis was low.     

Assessing the use of 35 percent sodium ascorbate for removal of residual hydrogen peroxide after in-office tooth bleaching

BackgroundThe authors conducted a study to quantify the amount of hydrogen peroxide remaining after in-office bleaching and to investigate the effectiveness of 35 percent sodium ascorbate (SA) on removal of the bleaching agent from dentin.MethodsThe authors sectioned 70 extracted human third molars to form 4×4×2-millimeter blocks of dentin and then categorized them into eight groups as follows: group 1, no bleaching; group 2, bleaching (35 percent hydrogen peroxide) and daily measurement; group 3, bleaching plus one application of 35 percent SA for 60 minutes; group 4, bleaching plus one application of SA for 10 minutes; group 5, bleaching plus two applications of SA for 10 minutes each; group 6, bleaching plus two applications of SA for five minutes each; group 7, bleaching plus three applications of SA for one minute each; and group 8, bleaching plus two applications of SA for one minute each. They quantified the amount of residual hydrogen peroxide by using a colorimetric assay with horseradish peroxidase and o-phenylenediamine dihydrochloride as the enzyme and substrate, respectively.ResultsThe authors analyzed the data by using the Kruskal-Wallis test (α = .05). The results showed that no hydrogen peroxide remained after 120 hours in group 2 and at their respective measurement points in groups 5, 6, 7 and 8, whereas hydrogen peroxide had been removed only partially in groups 3 and 4.ConclusionTwo applications of 35 percent SA for one minute each produced the same result—complete removal of the bleaching agent—as that observed five days after tooth bleaching with 35 percent hydrogen peroxide without any application of SA.Clinical ImplicationsIn an appropriate concentration, SA facilitates rapid elimination of residual peroxide up to two minutes after bleaching with 35 percent hydrogen peroxide. This finding suggests that clinicians can perform bonding procedures shortly after the bleaching procedure.     

Osteonecrosis of the jaw in patients with cancer who received zoledronic acid and bevacizumab

BackgroundThe authors investigated the incidence of and risk factors for osteonecrosis of the jaw (ONJ) in patients with metastases to the bone who received the bisphosphonate agent zoledronic acid (ZOL) and chemotherapy combined with the antiangiogenic agent bevacizumab (BEV).MethodsThe authors evaluated 59 participants (34 with breast cancer and 25 with nonsmall-cell lung cancer). All of the participants received 4 milligrams of ZOL via intravenous (IV) infusion every four weeks and 15 mg per kilogram of BEV every three weeks. They conducted a dental examination in participants at baseline and every three months until the patients died or were lost to follow-up. If needed, participants received periodontal disease treatment and underwent tooth extraction before they started receiving ZOL and BEV.ResultsThe median time the participants received ZOL therapy was 18.8 months (range, 3.1–28.9 months); 36 participants (61.0 percent) received ZOL therapy for more than one year. The median time participants received BEV therapy was 16.7 months (range, 2.8–29.6 months). None of the participants required dentoalveolar surgery while undergoing cancer treatment. After a median follow-up period of 19.7 months, none of the participants developed bisphosphonate-related ONJ.Conclusions and Clinical ImplicationsZOL combined with BEV did not predispose to ONJ participants with cancer that had metastasized to the bone who underwent a baseline dental examination and preventive dental measures. The study results must be considered in the context of the study’s protocols and the follow-up period.     

The prevalence of substance use among patients at a dental school clinic in Michigan

BackgroundProblematic alcohol use and illicit drug use are associated with a number of physical health consequences, including poor oral health. The authors evaluate the prevalence of problematic alcohol use and illicit drug use in adults who visited a dental school clinic.MethodsThe authors recruited patients from the waiting area of the clinic. During recruitment, 85.9 percent of patients (n = 384) who the authors approached consented to participate in the study.ResultsOverall, 20.6 percent of the participants reported either recent problematic alcohol use or illicit drug use; 7.4 percent of reported problematic alcohol use and 18.6 percent reported illicit drug use. The most common illicit drugs participants reported that they used were marijuana (16.8 percent), amphetamines (2.6 percent) and cocaine (1.1 percent). Participants who reported recent problematic alcohol use or illicit drug use were more likely to identify as white, were younger and did not have a spouse or partner.ConclusionsThere was a high prevalence of illicit drug use and problematic alcohol use among the patients seen at dental school clinic. These rates were higher than those in the general population.Clinical ImplicationsThe findings suggest that dental clinics are appropriate settings in which to identify and provide interventions for adults at risk of experiencing problems due to alcohol or drug use.     

Original ContributionsA method of determining the presence of blood in and on a dental needle after the administration of local anesthetic

Background.In the study reported in this article, the authors aimed to demonstrate the presence of blood on the surface and in the lumen of two gauges of dental needles after administration of local anesthetic (LA) by using three LA-administering techniques normally used for the extraction of teeth.Methods.The authors obtained standardized photographs of 200 urine dipsticks after moistening the dipstick's chemical pads for blood with the first drop of liquid discharged from the needle lumen after LA administration. Using the histogram function of a software program, the authors analyzed differences in gray-scale values of the different blood parameters for the presence of blood. They used luminol spray to expose small quantities of blood on the surface of the needle after LA administration.Results.Blood was identified at 39 percent in the lumen and at 16 percent on the surface of the needles when analyzed after LA administration.Conclusions.With the method used, it was possible to demonstrate and quantify the percentage of blood present in the lumen of needles (39 percent) after the administration of dental LA. Furthermore, the technique was adequately sensitive for demonstrating the quantity of blood in two needles of different diameters.Practical Implications.By demonstrating the presence, as well as quantifying the percentage, of blood on two dental needles of different gauges after the administration of LA, dental health care workers can be motivated to report needlestick injuries and to follow the approved protocols recommended by their institutions.     

The Relationship Between Methamphetamine Use and Increased Dental Disease

BackgroundMethamphetamine (MA) use has been linked anecdotally to rampant dental disease. The authors sought to determine the relative prevalence of dental comorbidities in MA users, verify whether MA users have more quantifiable dental disease and report having more dental problems than nonusers and establish the influence of mode of MA administration on oral health outcomes.MethodsParticipating physicians provided comprehensive medical and oral assessments for adults dependent on MA (n = 301). Trained interviewers collected patients' self-reports regarding oral health and substance-use behaviors. The authors used propensity score matching to create a matched comparison group of nonusers from participants in the the Third National Health and Nutrition Examination Survey (NHANES III).ResultsDental or oral disease was one of the most prevalent (41.3 percent) medical cormorbidities in MA users who otherwise were generally healthy. On average, MA users had significantly more missing teeth than did matched NHANES III control participants (4.58 versus 1.96, P < .001) and were more likely to report having oral health problems (P < .001). Significant subsets of MA users expressed concerns with their dental appearance (28.6 percent), problems with broken or loose teeth (23.3 percent) and tooth grinding (bruxism) or erosion (22.3 percent). The intravenous use of MA was significantly more likely to be associated with missing teeth than was smoking MA (odds ratio = 2.47; 95 percent confidence interval = 1.3–4.8).ConclusionsOvert dental disease is one of the key distinguishing comorbidities in MA users. MA users have demonstrably higher rates of dental disease and report long-term unmet oral health needs. Contrary to common perception, users who smoke or inhale MA have lower rates of dental disease than do those who inject the drug. Many MA users are concerned with the cosmetic aspects of their dental disease, and these concerns could be used as behavioral triggers for targeted interventions.Clinical ImplicationsDental disease may provide a temporally stable MA-specific medical marker with discriminant utility in identifying MA users. Dentists can play a crucial role in the early detection of MA use and participate in the collaborative care of MA users.     

Oral care behavior after purging in a sample of women with bulimia nervosa

BackgroundBulimia nervosa (BN) is a mental health disorder associated with serious dental problems. The authors surveyed patients with a diagnosis of BN about their oral health behaviors after purging and their perspectives on barriers to patient-initiated discussion of eating disorders (EDs) with oral health professionals (OHPs).MethodsA convenience sample of women with BN who were receiving treatment at major ED treatment centers (those centers that are members of the Academy of Eating Disorders, Deerfield, Ill.) completed a 45-item, self-reported online survey that the authors use to assess oral care behaviors after purging, dental problems and barriers to communication with their dentists. Inclusion criteria were being 18 years or older, female and a U.S. resident, as well as having a clinical diagnosis of BN. A sample of 292 women began the survey, and 201 (68.8 percent) completed the survey.ResultsThe survey results indicated that 32.5 percent of participants reported brushing their teeth immediately after purging, which is contraindicated. Although 92.4 percent of participants acknowledged having dental problems, only 29.2 percent of these participants discussed their BN with a dentist.ConclusionsThe survey results show that although participants with BN had a high level of concern about their oral health and a high incidence of oral health problems, less than one-third considered their OHPs to be the most helpful source of oral health information.Practical ImplicationsOHPs must be educated about how to approach patients when an ED is suspected, develop practice protocols for discussing secondary prevention with patients and develop practice policies about disclosing ED (for example, purging) to a parent or guardian.     

Dental patients' self-reports of xerostomia and associated risk factors

BackgroundMost studies regarding xerostomia focus on elderly people. Therefore, the authors conducted a study of dental patients 18 years or older to determine the prevalence of self-reported xerostomia and associated risk factors.MethodsThe authors sent a total of 2,200 questionnaires to four dental clinics to assess patients’ self-reported xerostomia. They also collected sociodemographic data and information regarding personal behavior. They used logistic regression models to estimate odds ratios (OR) and 95 percent confidence intervals (CI) to explore the relationship between self-reported xerostomia and risk factors that reasonably might be expected to be associated with self-reported xerostomia.ResultsThe overall prevalence of xerostomia in participants was 7 percent. Participants with burning-mouth sensations were associated with having higher odds of experiencing dry mouth (OR, 2.1; 95 percent CI, 0.9–5.2). Participants 51 years or older were significantly more likely to report having dry mouth than were younger participants (P < .04). The prevalence of self-reported xerostomia increased with increasing numbers of medications patients reported using.ConclusionThe authors found that medication use and age were highly significant risk factors for dental patients reporting xerostomia.Clinical ImplicationsClinicians should interview their patients carefully regarding their use of medications and provide proper oral health care to improve xerostomia resulting from medication use.     

Concordance between clinical practice and published evidence: Findings from The National Dental Practice-Based Research Network

BackgroundDocumenting the gap between what is occurring in clinical practice and what published research findings suggest should be happening is an important step toward improving care. The authors conducted a study to quantify the concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in The National Dental Practice-Based Research Network (“the network”).MethodsNetwork dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors. The authors coded responses to each scenario/clinical practice behavior as consistent (“1”) or inconsistent (“0”) with published evidence, summed the coded responses and divided the sum by the number of total responses to create an overall concordance score. The overall concordance score was calculated as the mean percentage of responses that were consistent with published evidence.ResultsThe authors limited analyses to participants in the United States (N = 591). The study results show a mean concordance at the practitioner level of 62 percent (SD = 18 percent); procedure-specific concordance ranged from 8 to 100 percent. Affiliation with a large group practice, being a female practitioner and having received a dental degree before 1990 were independently associated with high concordance (≥ 75 percent).ConclusionDentists reported a medium-range concordance between practice and published evidence.Practical ImplicationsEfforts to bring research findings into routine practice are needed.     

Improved denture retention in patients with retracted tongues

BackgroundPatients who wear mandibular dentures and hold their tongues in retracted positions alter the dimensions of the sublingual space and disrupt the peripheral seal that is needed for optimal denture retention. The authors studied whether retention could be improved if patients moved their tongues from a retracted resting position to an ideal resting position.

MethodsThe authors observed and classified the mandibular residual ridge morphologies of 85 participants who wore complete dentures. The authors recorded and compared the retention of the mandibular denture before and after repositioning the tongue to the ideal resting position.ResultsWhen the participants’ tongues were in a retracted resting position, the average retention of the mandibular denture was 75.38 gram weight (± 81.83 standard deviation [SD]). After participants repositioned their tongues to the ideal resting position, the average retention of the mandibular denture was 118.89 gw (± 93.00 SD), an increase of 57.73 percent.ConclusionsIn all morphological classes, when participants held their tongues in the ideal resting position, the average mandibular denture retention increased by 57.73 percent, a statistically significant improvement compared with when participants held their tongues in a retracted resting position.Clinical ImplicationsClinicians are encouraged to evaluate carefully the tongue resting position in all patients who wear dentures, help create reasonable therapeutic expectations by informing patients about the significant effect that tongue position will have on future denture retention and provide helpful neuromuscular training for patients with retracted-tongue habits.     

Binaural beats or 432 Hz music? which method is more effective for reducing preoperative dental anxiety?

Background The aim of this prospective clinical study was to investigate the effectiveness of binaural beats and music at a frequency of 432 Hz and compare which method is more effective for reducing preoperative dental anxiety in impacted third molar surgery. Material and Methods Ninety patients were randomly selected to the binaural beats group, music group and control group. Visual analog scale used to evaluate dental anxiety before the local anesthesia in the first measurement. Local anesthesia was applied to the all patients. Patients in the music group listened to 432 Hz tuned music using earphones for 10 minutes. Patients in the binaural beats group listened to binaural beats using earphones (for the right ear, 220 Hz and for the left ear 210 Hz) for 10 minutes. No special treatment was applied to the patients in control group. In the second measurement, dental anxiety was measured again in all three groups. For analysis of differences between three groups was used One way Anova and Kruskal Wallis test. Results Twenty seven male and 53 female patients included the study. In the first measurement, the same level of anxiety was recorded in all three groups. (p=0.811) There was a significant decrease in anxiety in both the binaural beats and music group in the second measurement. (p<0.001). Conclusions Binaural beats and 432 Hz tuned music are a valid non pharmacological adjuvant to reduce dental anxiety in impacted third molar surgery. They have a positive effect to reduce the dental anxiety. Key words:Binaural beats, 432 Hz music, dental anxiety.     

Associations between fluorosis of permanent incisors and fluoride intake from infant formula, other dietary sources and dentifrice during early childhood

ObjectivesThe authors describe associations between dental fluorosis and fluoride intakes, with an emphasis on intake from fluoride in infant formula.

MethodsThe authors administered periodic questionnaires to parents to assess children's early fluoride intake sources from beverages, selected foods, dentifrice and supplements. They later assessed relationships between fluorosis of the permanent maxillary incisors and fluoride intake from beverages and other sources, both for individual time points and cumulatively using area-under-the-curve (AUC) estimates. The authors determined effects associated with fluoride in reconstituted powdered infant formulas, along with risks associated with intake of fluoride from dentifrice and other sources.ResultsConsidering only fluoride intake from ages 3 to 9 months, the authors found that participants with fluorosis (97 percent of which was mild) had significantly greater cumulative fluoride intake (AUC) from reconstituted powdered infant formula and other beverages with added water than did those without fluorosis. Considering only intake from ages 16 to 36 months, participants with fluorosis had significantly higher fluoride intake from water by itself and dentifrice than did those without fluorosis. In a model combining both the 3- to 9-months and 16- to 36-months age groups, the significant variables were fluoride intake from reconstituted powder concentrate formula (by participants at ages 3–9 months), other beverages with added water (also by participants at ages 3–9 months) and dentifrice (by participants at ages 16–36 months).ConclusionsGreater fluoride intakes from reconstituted powdered formulas (when participants were aged 3–9 months) and other water-added beverages (when participants were aged 3–9 months) increased fluorosis risk, as did higher dentifrice intake by participants when aged 16 to 36 months.Clinical ImplicationsResults suggest that prevalence of mild dental fluorosis could be reduced by avoiding ingestion of large quantities of fluoride from reconstituted powdered concentrate infant formula and fluoridated dentifrice.