The effect of using a pre-brushing mouthwash (Plax) on oral hygiene in man

Abstract The aim of this study was to investigate whether the use of a pre-brushing mouthwash (Plax) improved subjects' oral hygiene over a 2-week period. In a double-blind placebo controlled cross-over study, 33 adult subjects (mean age 35.3 years) used either Plax or a placebo mouthwash for 30 s prior to tooth brushing during a 2-week period. After a washout period of 4 weeks, the subjects used the other mouthwash in the same way. The modified plaque index of Quigley and Hein (QHI) was recorded for 16 teeth (16, 14, 13, 11, 21, 23, 24, 26, 36, 34, 33, 31, 41, 43, 44, 46) at each visit. The bleeding index ( BI ) was recorded at the beginning and end of the study. Results were analysed using a paired one-tailed t-test. Neither plax nor placebo mouth washes reduced plaque scores significantly (p>0.05) below baseline. There was no statistically significant difference between the mean BI at the beginning of the trial (0.42) and at the end (0.44). These results suggest that the routine use of Plax is not a useful adjunct to toothbrushing.     

Comparison of a conventional and modified tooth stain index

OBJECTIVES: To evaluate a modified tooth stain index and determine the effect of dietary factors on stain formation. METHODS: At baseline, 182 adult volunteers were given a full oral prophylaxis followed by stain assessment using a modification of the Lobene index. This involved assigning separate scores to the mesial (M) and distal (D) sites of each tooth, in addition to the standard gingival area (G) and tooth body (B). For each site, stain intensity and areas were scored. The sum of (intensity X area) scores was calculated for all sites (GBMD-value) and for the gingival and body sites only (GB-value). The subjects used a standard abrasive dentifrice and a soft toothbrush for 6 weeks. RESULTS: Stain was reassessed and the average increase in GBMD-value was 20.9 (sd=9.9) (buccal aspect) and 29.9 (sd=18.0) (lingual aspect). The corresponding GB-values were 4.4 (sd=4.8) and 12.5 (sd=10.2). The coefficients of variation of the GBMD index values were consistently lower than those of the GB values. Smoking and tea-drinking were found to be the only significant (p<0.001) factors investigated for stain formation. CONCLUSIONS: It is concluded that the modified index may well be advantageous to its conventional counterpart because sites with most visible stain are assessed separately and because it may also offer higher discriminatory power due to a lower coefficient of variation.     

两种漂白剂去除牙面色斑效果的分析

目的研究两种漂白剂去除牙面色斑的效果。方法使用洛贝指数和数码照像计算机色度分析,系统分析并比较实验前、后牙面洛贝指数和色斑占牙面百分比的变化。结果两种漂白剂使用2周后与空白对照组比较洛贝指数的3个指标相差显著(P<0.01);色斑占牙面百分比减小。结论两种漂白剂都能去除牙面色斑。     

The effect of a calcium carbonate/perlite toothpaste on the removal of extrinsic tooth stain in two weeks

Objective : To assess the effect of a calcium carbonate/perlite toothpaste on the levels of extrinsic stain removed at two weeks compared to a silica control toothpaste. Design : In this parallel group, double‐blind study, subjects were stratified by natural baseline stain and tobacco use and allocated at random to one of the two study toothpastes. Subjects brushed with their allocated toothpaste twice daily for two weeks before extrinsic tooth stain was again assessed. Setting : The study was performed at 4‐Front Research UK Limited, Maldon, UK. Participants : 152 adult subjects with at least eight assessable incisors/canines with natural extrinsic tooth stain completed the study. Methods : The extrinsic tooth stain on the facial surfaces of incisors and canines was measured using the Macpherson modification of the Lobene Stain Index. Results : Both of the toothpaste groups had significantly less stain after two weeks of use compared to the baseline value (p<0.001). Analysis of covariance on the sum of the whole mouth stain scores showed that the calcium carbonate/perlite toothpaste removed significantly more stain over the two week study than the silica control toothpaste (p<0.05). Conclusions : Twice daily brushing for two weeks with a calcium carbonate/perlite toothpaste removes more extrinsic stain than a silica control toothpaste.     

The clinical measurement of tooth colour and stain

There are many contributory factors to tooth colour and different techniques for its measurement. The aim of this paper is to evaluate methods of tooth colour and stain measurement, with an emphasis on recent advances in objective clinical measurement techniques. The overall colour effect of natural teeth is created by a combination of light which is reflected and scattered by tooth enamel and the underlying dentine. Developmental defects of the dentition can affect the intrinsic discolouration of teeth, for example, amelogenesis imperfecta and dentinogenesis imperfecta. Extrinsic discolouration is predominantly caused by stain build up on a tooth surface from bacteria, foodstuffs or metalic compounds. Tooth colour and stain measurement are currently assessed using a wide range of measurement methods divided into subjective (visual shade matching) and objective instrumental assessment such as by colourimetry, spectrophotometry and digital image analysis. The most popular method of assessing tooth colour clinically is visual shade matching, as this approach is quick and simple to use. However, variation in results can occur as a consequence of the subjective nature of this method. The instrumental approaches including quantitative light-induced fluorescence remove or significantly reduce the subjective component. Image analysis appears to be the most suitable method for tooth colour measurement and further work is being carried out to establish this approach.     

Evaluation of the effectiveness of a pre-brushing rinse in plaque removal: a meta-analysis

OBJECTIVES: A meta-analysis technique was used to pool data from studies to assess the effectiveness of the pre-brushing rinse PLAX on existing plaque and gingivitis. METHODS: Studies were identified using MEDLINE and other sources, and grouped according to whether PLAX was used in short- or long-term treatment. The quality of trials was assessed by 2 independent readers. The DerSimonian and Laird random effects model was used. Meta-analyses were performed according to duration and type of PLAX treatment. In "1-day" studies, the effect of PLAX after rinsing and after rinsing and brushing was evaluated, whereas in longitudinal studies, this was done at several follow-up times. RESULTS: A total of 19 studies were included and mean quality scores ranged from 0.13 to 0.60, for the study protocol from 0.18 to 0.70 and for data analysis and presentation from 0.05 to 0.53. In "1-day" studies, PLAX significantly reduced plaque after rinsing (difference=0.143; 95% CI=0.02-0.27;p=0.022), whereas no significant reduction was observed in post-brushing measures. In "longitudinal" studies, plaque was significantly reduced at 1-2 (difference=0.168; 95% CI=0.09-0.24; p<0.0001), 3-4 (difference=0.179; 95% CI=0.01-0.35; p=0.043), 12 (difference=0.288; 95% CI=0.21-0.37; p<0.0001) and 24 (difference=0.377; 95% CI=0.19-0.57; p=0.0001) weeks. The meta-analysis that evaluated gingivitis showed a significant reduction in inflammation with PLAX treatment at 12 (difference=0.209; 95% CI=0.17-0.25; p<0.0001) and 24 (difference=0.257; 95% CI=0.22-0.29; p<0.0001) weeks follow-up. CONCLUSIONS: Although PLAX use appears to offer some benefit in plaque and gingivitis reduction, the clinical magnitude of the difference and the benefit on oral health are likely to be small.     

The efficacy of two prototype chewing gums for the removal of extrinsic tooth stain

AIM: To compare the potential efficacy of two prototype chewing gums in extrinsic stain removal on natural teeth. SETTING: Dental school clinics. DESIGN: Double-blind, two groups, parallel design. PARTICIPANTS: 76 adult volunteers (32m, 44f, mean age: 20.6 years old). METHODS: Oral hard and soft tissue health was examined. The subjects were randomly assigned to use either Product A (without active ingredients) or Product B (with active ingredients). Each subject was asked to brush their teeth for one minute twice daily (mornings and nights) and chew the gums supplied for 15 min (2 dragees each time), three times daily, once after each meal (breakfast, lunch and dinner) for the entire four-week duration. Dental stain assessment was made on the 12 incisors using the Lobene Stain Index (LSI). RESULTS: The overall difference between the stain scores after 4-weeks' use of the chewing gums was statistically significant (p<0.01) for both test Product A (10.84) and Product B (7.77) with regard to the mean baseline stain scores (21.57). This difference represented a 48% reduction in stain scores for those subjects using Product A, while the reduction was 64% for the subjects using Product B. CONCLUSIONS: The results of this in vivo study suggest that chewing gums with and without active ingredients have potential effect on stain removal after regular use for one month.     

Review of the extrinsic stain removal and enamel/dentine abrasion by a calcium carbonate and perlite containing whitening toothpaste

There has been an increase in the demand from consumers and patients for products that whiten teeth. To meet this demand, a whitening toothpaste containing calcium carbonate and perlite as the abrasive system and an efficacious fluoride source has recently been launched. The aim of the current paper is to review the toothpaste's stain removal efficacy and its effects on enamel and dentine wear. It has been shown to be effective at removing model extrinsic stain in vitro. Further, it has been shown to be more effective in removing naturally occurring extrinsic tooth stain than a silica non-whitening control toothpaste after two weeks of twice daily brushing in a parallel group, double-blind clinical study using 152 adult volunteers. In addition, the enhanced whitening effect did not give a clinically relevant level of wear to enamel or a significant increase in dentine wear compared to marketed non-whitening toothpaste formulations, as shown by using an in situ type model with ex vivo brushing.     

乳牙列色素沉着相关因素及患龋情况探讨

目的: 探讨3~5岁儿童乳牙色素沉着形成的相关因素及有色素沉着儿童乳牙列的患龋情况。方法: 对2019年12月—2020年8月于南京医科大学附属儿童医院就诊的182名3~5岁乳牙有色素沉着的儿童及200名无色素沉着儿童进行口腔检查及对监护人问卷调查,分析口腔内有色素沉着儿童的乳牙列患龋情况,色素沉着的分布范围、严重程度及色素沉着形成的相关因素。采用SPSS 20.0软件包对数据进行统计学分析。结果: 3~5岁有色素沉着儿童的患龋率及龋均低于全国和江苏省相应年龄儿童的平均水平。下颌乳切牙舌侧面为色素沉着最好发区域。色素沉着发生与进食含酱油食物的频率及儿童刷牙的执行者有关。结论: 乳牙列色素沉着的发生与患龋情况呈负相关,色素沉着的形成与大部分环境因素无明显关联,未来可能需要更多基于个体基因层面的研究。     

学龄前儿童牙面色素沉着形成原因及与龋病关系的研究

目的了解学龄前儿童牙面色素沉着形成的原因及其形成与乳牙龋病的关系。方法于2012年5—6月随机选取青岛市市南区3所公立幼儿园的434名3—6岁乳牙列儿童,由2名医生按WHO推荐的龋齿检查方法,对其进行龋齿及牙面色素检查,并对儿童家长进行关于儿童饮食结构及习惯、口腔卫生、刷牙习惯、用药史等方面的调查,调查结果采用SPSS15．0统计软件进行分析。结果学龄前儿童牙面色素沉着发生率为14．75％,男、女性儿童差异无统计学意义（13．95％VS15．53％,Х^2=0．21,P〉0．05）;有色素儿童患龋率为43．75％,无色素儿童患龋率为62．7％,二者比较差异有统计学意义（Х^2=8．16,P〈0．05）;色素的发生与进食含色素的食物或饮料的频率、进食海产品的频率以及使用抗生素的频率有关。结论学龄前儿童牙面色素沉着形成原因复杂,并且其形成与龋病发生呈负相关。     

Tooth stain during 2 years' use of chlorhexidine- and fluoride-containing

abstract — The purpose of the present study was to evaluate the effect of fluoride upon the stain-inducing capacity of chlorhexidine. Ninety-one children, 13 years of age, volunteered for the experiment. Three test dentifrices were used, containing 0.1% NaF, 0.1% NaF +2% chlorhexidine, and 2% chlorhexidine respectively. The experiment was carried out as a double-blind test, and the degree of staining was recorded after 1 and 2 years. Four methods were used for stain scoring. The results after 1 year showed that chlorhexidine induced less stain when applied together with fluoride than when applied alone. After 2 years this difference disappeared, indicating that fluoride only retarded chlorhexidine-induced staining of teeth.     

Clinical studies to determine the effectiveness of a whitening toothpaste at reducing stain (using a forced stain model)

Aims: Two single centre, randomized single‐blind, crossover studies were performed, to compare the effect of a test toothpaste with a conventional fluoride paste in the inhibition and removal of extrinsic dental stain promoted by repeated chlorhexidine/tea rinses. Methods: These studies used 24 subjects in each of two separate clinical trials. On the Friday before each trial period, the subjects received a prophylaxis to remove all staining, plaque and calculus deposits. On the following Monday, subjects were checked whether they were stain free and then under direct supervision they rinsed with a 0.2% chlorhexidine mouthrinse, immediately followed by a rinse with a warm black tea solution. This cycle was repeated hourly eight times throughout the day and on the following days until the Friday. In addition subjects also received daily a single toothpaste slurry rinse or control water rinse in the morning and lunchtime. No other form of oral hygiene was permitted during this period. On the Friday, both stain area and intensity was assessed using the Lobene Stain Index. For the stain removal study, stain was promoted again using chlorhexidine and tea rinses. After 4 days, stain was measured both prior to and immediately after brushing with the allocated toothpaste for 2 min. Subjects were then instructed to use the toothbrush at home according to their normal oral hygiene practices. On the following Wednesday, the amount of stain present was re‐assessed. Each subject subsequently received a thorough prophylaxis to remove all plaque calculus and staining before starting the following periods of the study. Results: The study showed no difference in the ability of the test whitening toothpaste, control toothpaste and water control at inhibiting stain. There was also only a small difference (3.5% for product of area and intensity) between the ability of the two toothpastes to help remove stain after a single brushing. The difference was however in favour of the test product which approached a conventional level of significance (P = 0.089). There was no evidence of superiority for either of the pastes after normal home usage. Conclusions: This study has suggested that the test product may have some advantage over the conventional paste at removing stain but the magnitude of difference would appear to be small and of little clinical relevance.     

用色度学方法研究牙齿漂白剂增白牙齿的效果

目的:研究牙齿漂白剂增白牙齿的效果,建立用色度学分析手段研究牙齿漂白剂增白牙齿效果的方法。方法:将166名受试者随机分配到三个实验组,经过两周的临床实验,分别用Vita比色板法和数码照像计算机色度分析系统,分析并比较实验前后牙面Vita色度和色差△Eab的变化。结果:118名受试者完成实验,三个实验组间受试者在性别、年龄、吸烟量等基本情况方面分布均衡;两种漂白剂使用两周后,牙面Vita色度与实验前比较相差非常显著(P<0.01),而空白对照组与实验前比较相差不显著(P>0.05);与空白对照组比较,两漂白剂组△Eab值相差非常显著(P<0.01),两漂白剂组之间△Eab值相差不显著(P>0.05)。结论:建立了用色度学分析手段研究牙齿漂白剂增白牙齿效果的方法,用该方法研究表明,两种漂白剂都具有增白牙齿的效果,并且它们增白牙齿的效果之间没有差别。     

Abrasion and stain removal by different manual toothbrushes and brush actions: studies in vitro

BACKGROUND AND AIMS: A limited amount of data using flat trim multitufted toothbrushes shows that abrasion of substrate surfaces by a standard toothpaste varies dependent on filament stiffness and configuration; soft brushes producing the most abrasion. The aims of these studies in vitro were to assess toothpaste abrasion of acrylic and stain removal by 5 proprietary medium toothbrushes with different head filament arrangements, and a prototype brush with rectangular filaments. The prototype brush had a medium texture in the long axis and soft texture at right angles to the long axis. MATERIAL AND METHOD: Optically clear acrylic was used as the substrate for abrasion by a standard toothpaste. Loss of substrate was determined by profilometry after 5000, 10000, 15000 and 20000 linear or rotary brushing actions. Stain removal was determined spectrophotometrically from optically clear acrylic specimens stained by chlorhexidine tea soaking sequences. Stained specimens were brushed with water using linear or rotary actions and measurements taken every 10 s to 60 s. RESULTS: Abrasion was progressive with increasing strokes and the pattern for each brush and brush action was to a first approximation linear. Overall, abrasion was significantly greater with linear compared to rotary action. Also overall brushes differed in the abrasion produced with both actions and particularly at greater exposure times. Within brush differences for the two motions were all significant by 20000 strokes except for the prototype brush. Stain removal was progressive over time with each brush but the pattern was non-linear. For the proprietary brushes the rotary motion removed less stain. For the prototype brush more stain was removed with the rotary action. Overall brushes differed significantly in stain removal within each motion and for each motion most differences between the proprietary and prototype brushes reached significance. CONCLUSIONS: The differences between brushes for both abrasion and stain removal must in large part relate to the filament contact area with the substrate surface. Whilst the model may not be predictive of clinical differences, it could find use to establish minimum criteria for toothbrush action.     

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目的观察氟化物对过氧化脲类漂白剂渗透性及漂白效果的影响。方法选取2010年1月至2012年7月就诊于第三军医大学大坪医院野战外科研究所口腔科,因正畸治疗需要拔除第一前磨牙的12例患者的36颗离体牙,用标准茶溶液染色后,其中12颗样本经NaF处理后用过氧化脲进行漂白（A、B组）,12颗样本使用过氧化脲漂白（C、D组）,12颗样本放入去离子水中作为空白对照（E、F组）。用VITA比色板对受试牙漂白前后进行比色,然后分别从近远中向（A、C、E组）和唇舌向（B、D、F组）剖开,使用图像分析软件测量并比较剩余染色面积百分比。结果所有标本染色后色度均增加,着色范围为3．66～8．33个色阶。漂白治疗后A、B、C、D组的色阶改变为5～5．53个色阶。而空白对照（E、F组）无色阶改变。（1）近远中向剖开：A组唇侧剩余染色面积为28．6％～39．4％,舌侧剩余染色面积为58％～72％;C组唇侧剩余染色面积为29．3％～37．2％,舌侧剩余染色面积为57．6％～70．1％;E组两剖面显示全部牙本质均匀染色,面积百分比约96．97％～100％;A、C组间各剖面差异无统计学意义（P〉0．05）,而二者与E组的差异均有统计学意义（P〈0．05）。（2）唇舌向剖开：B组唇侧和舌侧剖面剩余染色面积基本相等,为61．7％～68．7％;D组两剖面剩余染色面积为60．8％～66．3％,反映出相同的颜色改变的深度;F组两剖面染色面积为96．4～99．8％;B、D组间差异无统计学意义（P〉0．05）,但与F组间差异均有统计学意义（P〈0．05）。结论着色牙漂白前局部氟化物处理对漂白效果无明显影响。     

外漂白对牙体硬组织影响的研究进展

外漂白是牙美白的主要方法之一。外漂白是否会造成牙体硬组织的破坏以及破坏程度如何一直是人们关注的话题。本文从漂白后牙体硬组织的表面形态、矿物含量改变方面对外漂白对牙体硬组织的影响作一综述。     

The effect of xylitol and fluoride on remineralization for primary tooth enamel caries in vitro

The effect of fluoride and xylitol on remineralization at the early stage of the enamel caries in primary tooth was studied. The samples were divided into four groups (control, 10% xylitol, 950 ppm NaF and 10% xylitol+950 ppm NaF) and analyzed by the using single thin section method and pHcycling model in vitro. The remineralizing ratio were control –8.9%, xylitol –0.4%, NaF 8.3% and xylitol + NaF 32.4%, respectively. Xylitol+NaF group particularly showed significantly smaller ΔZ value compared with 0 days (P<0.05). Therefore we assume that the effect of xylitol and fluoride are additive. We concluded that xylitol and fluoride treatment to the tooth enamel may be an effective caries-preventive measure in both primary and permanent tooth enamel.