The role of dental hygienists, assistants, and office staff in CAMBRA

The role of the dental team in caries management by risk assessment is critical to successful patient outcomes. Positive patient interactions and communication, proper appointment scheduling, diagnostics and data gathering, as well as implementation of noninvasive or minimally invasive procedures can be the responsibility of all members of the dental team. This article will evaluate the role of the clinical and administrative staff in maintaining a practice with a focus on disease prevention and management..     

Comparative efficacy of two battery-powered toothbrushes on dental plaque removal

A number of clinical studies have consistently demonstrated that power toothbrushes deliver superior plaque removal compared to manual toothbrushes. Recently, a new power toothbrush (Crest SpinBrush) has been marketed with a design that fundamentally differs from other marketed power toothbrushes. Other power toothbrushes feature a small, round head designed to oscillate for enhanced cleaning between the teeth and below the gumline. The new power toothbrush incorporates a similar round oscillating head in conjunction with fixed bristles, which allows the user to brush with optimal manual brushing technique. The objective of this randomized, examiner-blind, parallel design study was to compare the plaque removal efficacy of a positive control power toothbrush (Colgate Actibrush) to an experimental toothbrush (Crest SpinBrush) following a single use among 59 subjects. Baseline plaque scores were 1.64 and 1.40 for the experimental toothbrush and control toothbrush treatment groups, respectively. With regard to all surfaces examined, the experimental toothbrush delivered an adjusted (via analysis of covariance) mean difference between baseline and post-brushing plaque scores of 0.47, while the control toothbrush delivered an adjusted mean difference of 0.33. On average, the difference between toothbrushes was statistically significant (p = 0.013). Because the covariate slope for the experimental group was statistically significantly greater (p = 0.001) than the slope for the control group, a separate slope model was used. Further analysis demonstrated that the experimental group had statistically significantly greater plaque removal than the control group for baseline plaque scores above 1.43. With respect to buccal surfaces, using a separate slope analysis of covariance, the experimental toothbrush delivered an adjusted mean difference between baseline and post-brushing plaque scores of 0.61, while the control toothbrush delivered an adjusted mean difference of 0.39. This difference between toothbrushes was also statistically significant (p = 0.002). On average, the results on lingual surfaces demonstrated similar directional scores favoring the experimental toothbrush; however these results did not achieve statistical significance. In conclusion, the experimental Crest SpinBrush, with its novel fixed and oscillating bristle design, was found to be more effective than the positive control Colgate Actibrush, which is designed with a small round oscillating cluster of bristles.     

The caries decline: a review of reviews

The aim of this paper is to review publications discussing the declining prevalence of dental caries in the industrialized countries during the past decades, focusing on some main conferences addressing this issue. Has there been a real decline in the prevalence of dental caries? Several excellent papers and reviews have been published, and there is a general agreement that a marked reduction in caries prevalence has occurred among children in most of the developed countries in recent decades. This fact has stimulated much debate and attempts to identify the most likely explanations for this change. The conclusion made from this review is that the various authors believe that the use of fluoride in various forms has contributed most significantly to the decline in dental caries prevalence. A number of other factors must, however, also be taken into consideration, and such factors have been extensively discussed in the various publications.     

The Pre-and Posteruptive Effects of Fluoride in the Caries Decline

The widespread availability of fluoride from many sources is accepted as a major reason for the caries decline among children in developed countries. There is still controversy, however, about its principal mode of action. This article reviews the evidence on fluoride's preeruptive and posteruptive effects, and suggests reasons for its continuing role in the caries decline. Early fluoridation studies accepted that fluoride acted preruptively through incorporation into developing enamel; but further research could not explain why fluoride levels were not clearly higher in enamel exposed to fluoride, nor why there were no clear correlations between caries experience and enamel fluoride concentration. Instead, considerable evidence suggests that fluoride acts mainly, though not entirely, through posteruptive remineralization of demineralized enamel. Caries experience has declined in nonfluoridated as well as in fluoridated areas, though DMF scores are still consistently lower in fluoridated areas. Posteruptive remineralization effects are seen from fluoridated drinking water as well as with fluoride from other sources. The continuing caries decline, beyond the level suggested by early fluoridation field trials, can be attributed either to more efficient remineralization or to long-term, intraoral ecological change, or to both.