Partial pulpotomy on caries-free teeth using enamel matrix derivative or calcium hydroxide: a randomized controlled trial

Aim  To compare the effect of enamel matrix derivative (EMD) and calcium hydroxide [Ca(OH)₂] on exposed human pulp.
Methodology  Fifteen pairs of human contralateral premolars were intentionally and partially pulpotomized. The exposed pulps were randomly capped with either EMDgel (Emdogain^®) or a mix of Ca(OH)₂ and sterile water. The subjects recorded pain or discomfort during the first 10 days and were also interviewed and examined by a blinded examiner at 1 day, 2 weeks, 3 and 6 months post-operation. Periapical radiographs were taken prior to the operation, and 3 and 6 months post-operation. After 6 months, the teeth were extracted and processed for histological evaluation. The data were described and analysed using McNemar test and Kaplan–Meier survival analysis.
Results  The EMDgel-treated teeth had significantly less tooth hypersensitivity than the Ca(OH)₂-treated teeth during the first 2 weeks ( P  =   0.031) but were not significantly different after 2 weeks ( P  =   0.125). No detectable periapical radiographic changes were observed in any teeth and radiographic evidence of dentine bridge formation from both groups were not significantly different during the follow-up periods ( P  >   0.05). Histological evaluation demonstrated that the Ca(OH)₂-treated teeth had less inflammation and more dentine bridge formation than those in the EMDgel-treated teeth.
Conclusions  After 6 months, healthy pulps capped with Ca(OH)₂ had more favourable results than counterparts capped with EMDgel. However, similar clinical and radiographic results were seen in both groups.     

Elementary school staff knowledge about dental injuries

Abstract –  Elementary school staff can play a crucial role in managing traumatic dental injuries (TDIs) because they are often in proximity to children and are frequently called upon to assist with children's accidents. International studies reveal that elementary school personnel have little knowledge about emergency dental care and management. The purpose of this study was to assess the knowledge, practice and experience regarding TDIs among a sample of elementary school personnel in the USA. Assessment was performed using a demographic questionnaire and a newly developed TDI survey instrument. Results revealed a wide distribution of responses. Overall, dental trauma knowledge among this group was poor. The majority of respondents were not well-versed regarding TDIs, their management, the benefits of timely care or treatment costs. However, staff reported a keen interest in receiving more TDI information and training. TDI education and management are needed among all elementary school staff members to improve the prognosis of these accidents when they occur.     

Trans-enamel and trans-dentinal cytotoxic effects of a 35% H2O2 bleaching gel on cultured odontoblast cell lines after consecutive applications

Aim  To evaluate the trans-enamel and trans-dentinal cytotoxic effects of a 35% H₂O₂ bleaching gel on an odontoblast-like cell lines (MDPC-23) after consecutive applications.
Methodology  Fifteen enamel/dentine discs were obtained from bovine central incisor teeth and placed individually in artificial pulp chambers. Three groups ( n  = 5 discs) were formed according to the following enamel treatments: G1: 35% H₂O₂ bleaching gel (15 min); G2: 35% H₂O₂ bleaching gel (15 min) + halogen light (20 s); G3: control (no treatment). After repeating the treatments three consecutive times, the extracts (culture medium + gel components that had diffused through enamel/dentine discs) in contact with the dentine were collected and applied to previously cultured MDPC-23 cells (50 000 cells cm⁻²) for 24 h. Cell metabolism was evaluated by the MTT assay and data were analysed statistically (α = 5%; Kruskal–Wallis and Mann–Whitney U -test). Cell morphology was analysed by scanning electron microscopy.
Results  Cell metabolism decreased by 92.03% and 82.47% in G1 and G2 respectively. G1 and G2 differed significantly ( P  < 0.05) from G3. Regardless of halogen light activation, the application of the bleaching gel on the cultured odontoblast-like cells caused significantly more severe cytotoxic effects than those observed in the nontreated control group. In addition, significant morphological cell alterations were observed in G1 and G2.
Conclusion  After three consecutive applications of a 35% H₂O₂ bleaching agent, the diffusion of the gel components through enamel and dentine caused severe toxic effects to cultured pulp cells.     

Physical-mechanical properties of glass ionomer cements indicated for atraumatic restorative treatment

Background:  This study evaluated mechanical properties of glass ionomer cements (GICs) used for atraumatic restorative treatment. Wear resistance, Knoop hardness (Kh), flexural (F_s) and compressive strength (C_s) were evaluated. The GICs used were Riva Self Cure (RVA), Fuji IX (FIX), Hi Dense (HD), Vitro Molar (VM), Maxxion R (MXR) and Ketac Molar Easymix (KME).
Methods:  Wear was evaluated after 1, 4, 63 and 365 days. Two-way ANOVA and Tukey post hoc tests (P = 0.05) analysed differences in wear of the GICs and the time effect. F_s, C_s, and Kh were analysed with one-way ANOVA.
Results:  The type of cement (p < 0.001) and the time (p < 0.001) had a significant effect on wear. In early-term wear and Kh, KME and FIX presented the best performance. In long-term wear, F _s and C_s, KME, FIX and HD had the best performance. Strong explanatory power between F_s and the Kh (r² = 0.85), C_s and the Kh (r² = 0.82), long-term wear and F_s of 24 h (r² = 0.79) were observed.
Conclusions:  The data suggested that KME and FIX presented the best in vitro performance. HD showed good results except for early-term wear.     

Impact of treated and untreated dental injuries on the quality of life of Ontario school children

Abstract –  A population-based, matched case–comparison study was undertaken in 30 schools in two Ontario communities to measure the impact of dental trauma on quality of life (QoL) in Canadian school children. Dental hygienists screened 2422 children aged 12–14 years using the dental trauma index, the decayed, missing and filled teeth index (DMFT) and the aesthetic component of the index of orthodontic treatment needs (AC-IOTN). Cases ( n  = 135) were children with evidence of previous dental trauma. Controls ( n  = 135) were classmates matched for age and gender. Oral-health-related QoL was assessed using mailed Child Perception Questionnaires (CPQ_11-14) completed by all children. Data were analyzed using simple and multiple conditional logistic regressions after adjusting for DMFT and AC-IOTN, CPQ_11-14, overall impact and item-specific impacts. Approximately 64% of injuries were untreated enamel fractures and just over 30% were previously injured restored teeth. Untreated children experienced more chewing difficulties ( P  = 0.026), avoided smiling ( P  = 0.029) and experienced affected social interactions ( P  = 0.032) compared with their non-injured peers. When treated and non-injured groups were compared, the only statistically significant effect was difficulty in chewing ( P  = 0.038). Injured children who were untreated experienced more social impact than their non-injured peers. Restoration of injured teeth improved aesthetics and social interactions but functional deficiencies persisted as a result of periodontal or pulpal pain.     

Oxygen release of tetra acetyl ethylene diamine (TAED) and sodium perborate combination

Aim  To evaluate the effect of tetra acetyl ethylene diamine (TAED) on oxygen release from sodium perborate and to compare it with sodium perborate–hydrogen peroxide (H₂O₂) and sodium perborate–distilled water mixtures.
Methodology  Six groups were evaluated: control groups (groups I–III), sodium perborate was mixed with distilled water or 3% or 30% H₂O₂; experimental groups (groups IV–VI), sodium perborate was mixed with TAED in different ratios and then distilled water was added to these mixtures. The amount of oxygen released from the samples was measured with a digital oxygen meter at room temperature (25 °C) and body temperature (37 °C) after 1 min, 1–6 h and 12 h and on each day up to 1 week. The results were statistically evaluated by one-way analysis of variance and post hoc Tukey's tests.
Results  The TAED groups demonstrated significantly higher amounts of released oxygen after 1 min and 1 h at 25 °C and 1 min at 37 °C ( P  < 0.05). At all other measurement times, the amount of TAED in each mixture did not alter the amount or speed of oxygen release ( P  > 0.05).
Conclusions  Tetra acetyl ethylene diamine groups achieved their maximum oxygen release 2 h earlier at 25 °C and 1 h earlier at 37 °C than the other groups. Thus, TAED accelerated oxygen release from sodium perborate–distilled water mixtures regardless of its proportions up to 24 h.     

SAA and PLTP activity in plasma of periodontal patients before and after full-mouth tooth extraction

Objective:  To assess whether treatment of advanced periodontal disease affects plasma levels of serum amyloid A (SAA) and phospholipid transfer protein (PLTP) activity.
Design:  We measured the levels of SAA and PLTP activity in plasma of 66 patients with advanced periodontal disease before and after treatment by full-mouth tooth extraction (FME).
Results:  At baseline, median SAA levels in our study population were within the normal range (2.7 μg ml⁻¹) but SAA was elevated (>5 μg ml⁻¹) in 18% of periodontitis patients. Three months after FME, SAA levels were significantly reduced ( P  =   0.04). SAA did not correlate with any of the periodontal disease parameters. PLTP activity was elevated in patients with periodontitis, compared to the PLTP activity reference group (age-matched systemically healthy adults, n  =   29; 18 μmol ml⁻¹ h⁻¹ vs 13 μmol ml⁻¹ h⁻¹, respectively, P  =   0.002). PLTP activity inversely correlated with average periodontal pocket depth (PPD) per tooth ( r _s = −0.372; P  =   0.002). Three months after FME, median PLTP activity did not change significantly.
Conclusions:  Full-mouth tooth extraction significantly reduces SAA, a marker of inflammation, while it does not affect plasma PLTP activity. However, the inverse correlation between PLTP activity and average PPD suggests that increased PLTP activity may limit periodontal tissue damage.     

Systemic treatment of anti-CD4+CD25+ T cell monoclonal antibody exacerbates sialoadenitis in submandibular glands during the early life in lupus-prone female NZB × NZWF1 mice

Background:  The maintenance mechanisms of peripheral tolerance by CD4⁺CD25⁺ T cells before the development of sialoadenitis in secondary Sjögren's syndrome (sSS) are not well understood. The aim of the present study is to examine the effect of reduction of CD4⁺CD25⁺ T cells on the development of sialoadenitis during the early life in female NZB × NZWF₁ (B/WF₁) mice, a model for human sSS.
Methods:  Female B/WF₁ mice at 3 days after birth were treated with either anti-mouse CD4⁺CD25⁺ T cells rat IgG₁ monoclonal antibody (mAb) or Rat IgG₁(control). At 25 weeks of age, autoantibodies against nucleus and cytoplasm of ductal epithelial and myoepithelial cells, and histpathology of submandibular glands were examined in the mAb-treated and control groups. Also the development of anti-Ro/SS-A antibodies was examined until 25 weeks of age in both groups.
Results:  The mAb-treated group showed severe lesions with the development of autoantibodies compared to the control group.
Conclusions:  The present results suggest that peripheral CD4⁺CD25⁺ T cells may, at least in part, contribute to down-regulate the development of sialoadenitis in submandibular glands of lupus-prone female B/WF₁ mice during their early life.     

Fracture resistance of thin-walled roots restored with different post systems

Aim  To compare the fracture resistance of thin-walled roots after restoration with different types of post systems.
Methodology  One hundred and sixty-five decoronated maxillary central incisors were root filled and randomly assigned to three groups with respect to the remaining dentine thickness of root (1.0 mm, 1.5 mm, 2.0 mm). Each group was randomly divided into five equal subgroups. The subgroups were restored with one of the following post systems: polyethylene woven fibre (R), composite resin cured by light-transmitting post + glass fibre post (L), electrical glass fibre post (E), composite corono-radicular restoration (C) and cast metal post (M). Standard cores were constructed using composite resin in the first four groups. The samples were subjected to a gradually increasing force (1 mm min⁻¹). The force required to fracture was recorded. The data was analysed with anova and Tukey test ( P  = 0.05).
Results  The cast metal post group had the highest fracture strength ( P  < 0.001). There was no significant difference in fracture resistance between the other four groups. Fracture resistance was affected largely by the remaining dentine thickness in fibre post groups; however, the difference was not significant. On the contrary in the cast metal post group load failure was inversely influenced by axio-proximal dimension of dentine walls.
Conclusion  The cast post group had a higher fracture strength than resin groups. The force required to fracture the roots was similar for all fibre post systems and for all dentine thicknesses.     

The changes in the T-lymphocyte subsets in a population of Turkish children with puberty gingivitis

Objective.   The aim of the study was to investigate the number of CD4 and CD8 T lymphocytes, analyse subjects with gingivitis and those without, and determine the role of T lymphocytes in the pathobiology of puberty gingivitis.
Material and methods.   Fifty individuals with and without puberty gingivitis were recruited for this study. The CD4⁺ and CD8⁺ T-lymphocyte counts were determined using flow cytometry on the biopsy samples, and the CD4⁺/CD8⁺ ratio was calculated. At the same time, periodontal index scores were recorded to assess the periodontal status. Acquired data were analysed statistically using a paired t -test to compare laboratory values obtained before and after the treatment in individuals with puberty gingivitis and disease-free individuals. In addition, Pearson's correlation analysis was performed to investigate the relation between laboratory values and clinical measurements.
Results.   The CD4⁺/CD8 ratio in gingival tissues obtained from test group was significantly higher ( P <  0.05) than that found in the gingival tissue obtained from control group. We found that the CD4⁺ and CD8⁺ lymphocyte counts continued to increase significantly ( P <  0.001) and the CD4⁺/CD8⁺ ratio continued to drop significantly ( P <  0.05) after treatment in test group.
Conclusions.   T lymphocytes could play a significant role in the pathobiology of puberty gingivitis     

Knowledge of lay people and dentists in emergency management of dental trauma

Abstract –  The multidisciplinary nature of the follow-up evaluations of traumatic dental injuries (TDI) requires that both the lay public and practitioners possess knowledge of the treatment strategies involved. The aim of this paper was to assess the level of knowledge of elementary public schoolteachers, parents and dentists of the city of Joaçaba, Southern Brazil, about the emergency management of TDI. Three independent cross sectional studies were carried out involving samples of elementary public schoolteachers ( n  = 245), parents ( n  = 107) and dentists ( n  = 85) in the city in 2001. Data were collected through structured interviews for schoolteachers and dentists, and questionnaires for parents, containing questions about socio-demographic characteristics and about incidents resulting in TDI. The responses in the three studies showed a wide variability of indicated procedures for the situations of TDI proposed. The results of association studies showed that older schoolteachers ( P  = 0.003), older dentists ( P  = 0.013) and dentists who had graduated more recently ( P  = 0.032) chose significantly more correct answers in some TDI incidents. The answers of schoolteachers, parents and dentists showed a wide variability of indicated procedures for the situations proposed. The great majority of them would not follow the approaches most recommended in the literature. A greater importance should be placed on TDI through educational campaigns aiming schoolteachers and parents and also through undergraduation and postgraduation dental curricula in order of improving its management.     

Gastric emptying rate in subjects with experimentally shortened dental arches: a pilot study

Summary  Although a shortened dental arch has been reported to provide sufficient subjective chewing ability, the loss of molar occlusion significantly reduces trituration ability, and may result in an impaired digestive function including delayed gastric emptying. This study investigated the effect of the experimental loss of molar occlusion on gastric emptying rate. Thirteen healthy dentate males underwent two sessions of gastric emptying rate measurement after ingestion of the same test meal that contained ham, bread and an egg mixed with carbon-labelled octanoic acid. A test food was divided into nine equal portions, and each was consumed in 60 cycles of chewing. In one of the two sessions, the subjects wore an intraoral appliance devised to simulate the occlusal conditions of the shortened dental arches. Two parameters of gastric emptying; namely, the lag phase ( T _lag) and gastric half-emptying time ( T _1/2), were evaluated by means of a ¹³C-octanoic acid breath test. Following the measurement of gastric emptying in each session, masticatory performance was evaluated by a conventional sieve test. Masticatory performance decreased significantly in case of loss of molar occlusion (78·1 ± 11·1% versus 33·4 ± 18·2%, P  <0·001); however, no significant changes were observed in terms of the gastric emptying parameters ( T _lag: 99 ± 19 versus 105 ± 34 min; T _1/2: 168 ± 32 versus 178 ± 48 min). Within the limitations of this study, it was concluded that reduction in food trituration caused by shortening of the dental arch does not significantly affect gastrointestinal digestive function.     

Effect of immediate intracanal placement of Ledermix Paste® on healing of replanted dog teeth after extended dry times

Abstract  – Ledermix Paste^® is a paste containing triamcinolone and demeclocycline with demonstrated anti-inflammatory activity that may slow down resorptive processes after severe traumatic injuries to the dentition. A total of 29 premolar roots of six mongrel dogs were extracted and instrumented with rotary nickel titanium files. Fifteen of these roots were then filled with a calcium hydroxide (Ca(OH)₂) slurry and 14 roots were filled with Ledermix Paste^® paste. All accesses were sealed with glass ionomer and the roots replanted after an extraoral dry time of 60 min. After 4 months, the dogs were killed and the roots prepared for histological evaluation. Five-micrometer thick cross-sections of the root and surrounding tissue taken every 90 µm were evaluated for healing. In addition, residual root mass was also measured to determine the extent of root structure loss for each treatment method. The Ledermix Paste^®-treated roots had statistically significantly more healing and less resorption than the roots treated with Ca(OH)₂. Root filling with Ledermix Paste^® also resulted in significantly less loss in root mass due to resorption compared to those roots filled with Ca(OH)₂. Immediate intracanal placement of Ledermix Paste^® at the emergency visit after an avulsion injury appears to decrease resorption and increase favorable healing.     

Effect of heat treatment on transformation temperatures and bending properties of nickel–titanium endodontic instruments

Aim  To investigate the effect of heat treatment on the bending properties of nickel–titanium endodontic instruments in relation to their transformation behaviour.
Methodology  Nickel–titanium super-elastic alloy wire (1.00 mm Ø) was processed into a conical shape with a 0.30 mm diameter tip and 0.06 taper. The heat treatment temperature was set at 440 or 500 °C for a period of 10 or 30 min. Nonheat-treated specimens were used as controls. The phase transformation behaviour was examined using differential scanning calorimetry. A cantilever-bending test was used to evaluate the bending properties of the specimens. Data were analyed by anova and the Tukey–Kramer test ( P  =   0.05).
Results  The transformation temperature was higher for each heat treatment condition compared with the control. Two clear thermal peaks were observed for the heat treatment at 440 °C. The specimen heated at 440 °C for 30 min exhibited the highest temperatures for M _s and A _f, with subsequently lower temperatures observed for specimens heated at 440 °C for 10 min, 500 °C for 30 min, 500 °C for 10 min, and control specimens. The sample heated at 440 °C for 30 min had the lowest bending load values ( P  <   0.05), both in the elastic range (0.5 mm deflection) and in the super-elastic range (2.0 mm deflection). The influence of heat treatment time was less than that of heat treatment temperature.
Conclusions  Change in the transformation behaviour by heat treatment may be effective in increasing the flexibility of nickel–titanium endodontic instruments.     

Effect of rhBMP-2 with PLGA/gelatin sponge type (PGS) carrier on alveolar ridge augmentation in dogs

Summary  Recombinant human bone morphogenetic protein-2 has been shown to promote bone formation because of its osteoinductive property. The purpose of this study was to evaluate the efficacy of rhBMP-2 delivered on a poly ( d , l -lactic-co-glycolic acid) copolymer/gelatin sponge (PGS) in vertical alveolar ridge augmentation on height-reduced edentulous mandible to verify the retention of rhBMP-2 withstanding the pressure of soft tissues. Coronal defects of the alveolar bone were created in six adult beagle dogs. After a healing period of 9 weeks, PGSs with or without rhBMP-2 (0 or 0·4 mg mL⁻¹) were implanted on the defects(6 mm in height, 30 mm in length, 8 mm in width). Sixteen weeks after implantation, the bone mineral content (BMC) and the total bone area were measured by peripheral quantitative computed tomography. The BMC and the total bone area of the defect sites with rhBMP-2 group were significantly greater (133 ± 33 mg mm⁻¹, 277 ± 54 mm², respectively) than those of the control group (80 ± 19 mg mm⁻¹, 155 ± 49 mm², respectively) ( P  <   0·01, P  <   0·0001, respectively; paired t -test). From the histological analyses, the height of newly formed bone in the experimental group was greater than that of the control group (4·3 ± 0·9 mm, 0·22 ± 0·28 mm, P  <   0·0001, n  = 6, paired t -test). These results indicate that PGS has characteristics of effective bone graft substitutes for implantation of rhBMP-2 on vertical alveolar ridge augmentation in huge defect of mandibles in dogs.     

Serum sCD14, polymorphism of CD14−260 and periodontal infection

Background and Aims:  CD14 is a co-receptor involved in the recognition of Gram-negative and positive bacteria. Infections are known to influence serum sCD14 levels, and CD14 gene promoter polymorphism (CD14 C−260T) has been reported to be associated with many infectious diseases. Our aim was to investigate whether serum sCD14 concentration is associated with periodontal infection and the CD14⁻²⁶⁰ genotype.
Subjects and Methods:  The periodontal status of 56 subjects with chronic periodontitis and 28 controls was clinically examined. Serum sCD14 concentration was analyzed using ELISA and CD14⁻²⁶⁰ genotype using polymerase chain reaction (PCR).
Results:  The mean concentration of sCD14 in serum was significantly higher in subjects with periodontitis than in control subjects (4.9  μ g ml⁻¹ vs 3.8  μ g ml⁻¹, P  < 0.001). Serum sCD14 concentration associated significantly with the extent of advanced periodontal disease. In a regression analysis including both subject groups, the CD14⁻²⁶⁰ genotype was a significant determinant for serum sCD14 concentration. After stratification by periodontal health status (periodontitis vs controls), the influence of the CD14⁻²⁶⁰ genotype on serum sCD14 concentration was seen only in the control group.
Conclusions:  Periodontal infection is associated with the serum concentration of sCD14. Moderate to severe periodontal infection overshadows the influence of the genotype on serum sCD14 concentration.     

Viability of human fibroblasts in coconut water as a storage medium

Aim  To evaluate the effectiveness of a new storage medium for avulsed teeth, coconut water, in maintaining the viability of human fibroblasts.
Methodology  Cell viability after different time periods was evaluated in the following storage media: coconut water, coconut water with sodium bicarbonate, milk, saline and still mineral water. Human fibroblasts were seeded in Eagle's minimal essential medium (EMEM) supplemented with 7.5% foetal calf serum. After trypsinisation, 100 μL of culture medium containing approximately 10⁴ cells mL⁻¹ were collected and pipetted into the wells of 96-well plates, which were incubated overnight in 5% CO₂ and 95% air mixture at 37 °C. EMEM was then replaced by the storage media and the plates were incubated at 37 °C for 1, 2 and 4 h. Cell viability was determined using the neutral red assay. The proportions of viable cells after exposure to the storage media were analysed statistically by anova and the least significant difference (LSD) test (α = 5%).
Results  Milk had the greatest capacity to maintain cell viability ( P  < 0.05), followed by coconut water with sodium bicarbonate and saline. Coconut water was significantly worse at maintaining cell viability compared to milk, coconut water with sodium bicarbonate and saline. The smallest number of viable cells was observed for mineral water ( P  < 0.05).
Conclusion  Coconut water was worse than milk in maintaining human fibroblast cell viability.     

Effect of filling technique and root canal area on the percentage of gutta-percha in laterally compacted root fillings

Aim  To determine the influence of filling technique and root canal area on the percentage of gutta-percha (PGP) in laterally compacted root fillings.
Methodology  Sixty extracted canine teeth were accessed and the root canals instrumented to the same size. They were then divided in three groups and filled with laterally compacted gutta-percha cones and AH Plus using different techniques. A variation of cold lateral compaction using a sequence of spreaders prior to accessory cone placement was compared to two commonly-used techniques. Twenty additional canines with prepared root canals were used as negative controls in which gutta-percha was introduced into the canals but no compaction applied. The roots were sectioned horizontally at 3 and 6 mm from the apex and micro-photographs taken. Using software, the area of the canals and gutta-percha at each level were measured and PGP calculated. A Multivariate analysis was used to determine the variables influencing PGP. A linear regression test was used to verify the variation in PGP explained by canal area.
Results  At each level the largest canal was two to three times wider than the smallest. Canal area significantly influenced the PGP at both levels ( P  <   0.05), however, the variation in PGP was only partially explained by canal area ( r ² = 0.154, 6 mm; r ² = 0.119, 3 mm). The PGP at the 3 mm level was lower than at 6 mm ( P  =   0.003). The spreader-sequence technique achieved a higher PGP than the other two techniques ( P  =   0.00002). The control group had the lowest area of GP.
Conclusions  Variations in root canal filling technique and canal area influenced the percentage of gutta-percha of laterally compacted root fillings. The percentage of gutta-percha was lower at the 3 mm level compared to the 6 mm level.     

Evaluation of Pacific Islands Early Childhood Caries Prevention Project: Republic of the Marshall Islands

Objectives: This communication reports an outcomes evaluation of the Pacific Islands Early Childhood Caries Prevention Project. Methods: The evaluation includes children in three conditions: a) topical fluoride varnish three times per school year; b) varnish plus twice-per-day toothbrushing; and c) intervention 2 plus three-times-per-day xylitol containing gummy bear snacks at school and home visits to encourage parental involvement. For this evaluation, groups 2 and 3 have been combined. Results: One year after project implementation, mean decayed, extracted, or filled primary teeth was 10.3 [standard deviation (SD)  =  4.3] teeth for group 1, and 8.2 (SD  =  4.0) teeth for the combination of groups 2 and 3 ( P <  0.05). Twenty-four percent of group 1 had cavitated lesions in any permanent molar versus 12.8 percent in groups 2 and 3 combined ( P >  0.05). Conclusion: Evaluation confirms the outcome of a program including both in-school twice-daily toothbrushing with fluoridated toothpaste and frequent applications of fluoride varnish.     

The effects of lavender scent on dental patient anxiety levels: a cluster randomised-controlled trial

Kritsidima M, Newton T, Asimakopoulou K. The effects of lavender scent on dental patient anxiety levels: a cluster randomized-controlled trial. Community Dent Oral Epidemiol 2010; 38: 83–87. © 2009 John Wiley & Sons A/S   Abstract – 
Objectives:  To review the effect of lavender scent on anticipatory anxiety in dental participants.
Methods:  In a cluster randomized-controlled trial, patients' ( N  = 340) anxiety was assessed while waiting for a scheduled dental appointment, either under the odor of lavender or with no odor. Current anxiety, assessed by the brief State Trait Anxiety Indicator (STAI-6), and generalized dental anxiety, assessed by the Modified Dental Anxiety Scale (MDAS) were examined.
Results:  Analyses of variance ( anova s) showed that although both groups showed similar, moderate levels of generalized dental anxiety (MDAS F _(1,338) = 2.17, P  > 0.05) the lavender group reported significantly lower current anxiety (STAI: F _(1,338) = 74.69, P  < 0.001) than the control group.
Conclusions:  Although anxiety about future dental visits seems to be unaffected, lavender scent reduces state anxiety in dental patients.