Power bleaching enhances resin infiltration masking effect of dental fluorosis. A randomized clinical trial

Objectives: Patients with moderate dental fluorosis often feel esthetically compromised. Aim of this RCT was to evaluate the objectively and self-assessed masking effect of resin infiltration alone or in combination with inoffice bleaching on dental fluorosis in adults. Methods: Twenty-seven patients (9 male, 18 female, 24.81 +/- 3.7 yrs) with 410 fluorotic teeth (TF 1-4) were randomly assigned to a treatment (BLI) or control group (NBLI). Patients underwent in-office bleaching (25% H2O2) in the BLI or a placebo bleaching (ACP gel) in the NBLI group followed by resin infiltration after two weeks. Standardized digital photographs were obtained at baseline; after bleaching; before and after resin infiltration and after 1, 3, and 6 months. Color differences (AE) between sound and fluorotic areas were calculated and patient satisfaction was evaluated using a VAS (1-10). Results: Statistical analysis revealed significant differences in the mean AE values 6 months after resin infiltration between the BLI (Delta E = 1.41) and the NBLI group (Delta E = 4.33) (p = 0.024). VAS values increased after resin infiltration (p < 0.05) in both groups. After 3 months patients in the BLI group had higher VAS values than in the NBLI group (p = 0.029). Conclusions: Findings of this study suggest that resin infiltration alone can effectively mask mild to moderate dental fluorosis in young adults. In-office bleaching with 25% H2O2 before resin infiltration provides significantly better masking effects. Clinical Significance: Resin infiltration is a safe and efficient treatment option for masking fluorotic opacities. A priori in-office bleaching with 25% H2O2 enhances the masking effect

Influence of intra-pocket anesthesia gel on treatment outcome in periodontal patients: a randomized controlled trial

Aim Compare the treatment outcome after scaling and root-planing using local anesthesia gel or injected local anesthesia. Material and method Thirty-eight patients with periodontitis and good general health were included in a randomized, single-blind, split-mouth clinical trial. Probing depths and clinical attachment levels were recorded at baseline and 6weeks after treatment. Performed treatment procedures were scaling and root planing using two types of local anesthesia for separate treatment appointments. Anesthetics used were intra-pocket lidocaine and prilocaine gel (2.5% each) and injected articaine (1:100,000 adrenaline). Type of anesthesia for first appointment was randomized and switched for second appointment. Patients ' pain perception and anesthesia acceptance were recorded on questionnaires. Results No influence of applied type of anesthesia could be detected for change of probing pocket depths and clinical attachment level (p>0.05). These findings are valid even for deeper pockets. Gel-group had significant higher intra-operative pain perception. In retrospect 69% of patients favored gel. Conclusion Treatment outcome is not compromised by use of anesthesia gel in comparison to injected anesthesia. The same beneficial results for probing pocket depths and clinical attachment gain could be detected. The majority of patients prefer local anesthesia gel despite a slightly greater procedural discomfort

Does a pretreatment with a dentine hypersensitivity mouth-rinse compensate the pain caused by professional mechanical plaque removal? A single-blind randomized controlled clinical trial

Objectives!#!Pain is affecting acceptance of supportive periodontal therapy and primary periodontitis prevention. Our objective was to evaluate the efficacy of a 1-week pre-treatment use of dentinal-hypersensitivity-reducing mouth-rinses (DHM) in periodontal maintenance (SPT) or dental prophylaxis patients.!##!Material and methods!#!One hundred fifty-five participants attending for professional mechanical plaque removal (PMPR) were randomly assigned to use a mouth-rinse twice daily for 1 week prior to their next PMPR. Rinses were containing either potassium oxalate (n = 52), arginine (n = 52), or herbal extracts (n = 51). At baseline and reassessment, procedural pain was assessed by visual analogue scale (VAS) and verbal rating scale (VRS). Self-reported efficacy was documented.!##!Results!#!No inter-group differences were estimated between both test groups and the control for baseline and reassessment means (VAS, VRS). In the SPT group, VAS reduction and self-reported efficacy were found (p &amp;lt; 0.05).!##!Conclusion!#!The 1-week use of DHM failed to show a predictable effect on discomfort during PMPR overall. Around 20% of the patients showed a quantifiable benefit from both test mouth-rinses, whereas more than 50% reported a subjective pain reduction. Focusing patients undergoing supportive periodontal therapy, quantifiable effects were found for both test groups. From a patient's point of view, DHM might be a suitable adjunct to enhance procedural comfort, especially in patients with a history of periodontitis.!##!Clinical relevance!#!The 1-week use of the dentinal-hypersensitivity-reducing mouth-rinses prior to professional-mechanical-plaque-removal showed to be a suitable adjunct to enhance procedural comfort during instrumentation, especially in patients undergoing supportive periodontal therapy. Registration number: DRKS00010811

Protective Buffering Capacity of Restorative Dental Materials In Vitro

Purpose: To investigate the buffering capacity of restorative materials during a simulated carious and intrinsic erosive attack. Materials and Methods: Cavities with a volume of 130 mu l were milled (Cerec MC XL) out of blocks of Ceram X Mono (CM), Quixfil (QX), Filtek Supreme (FS), Apa Fill 3 (AF), an experimental dual-curing composite containing a bioactive glass (EX), Dyract eXtra (DY), Beautifil (BE), Equia Fil (EQ), Telio CAD (TL) (negative control), TheraCal (TC; positive control), and extracted teeth (ED). 80 mu l of lactic acid (pH 4.5) and hydrochloric acid (pH 2.6) were each pipetted into the cavities of two samples of each material. Change of pH in the solutions was measured continuously for 12 min using a calibrated pH electrode. Results: CM, AF, and FS (final pH 3.0-3.2) neutralized hydrochloric acid to a significantly lesser extent than did BE, EQ, DY and QX (final pH 5.0-5.6) (p < 0.05, ANOVA Scheffo). The lactic-acid buffering capacity of CM, BE, and AF was equivalent (final pH 6.3-7.4) to that of ED (7.5), but was surpassed by FS (pH 8.0). pH values for EX and TC (final pH 9.2-11.3) increased significantly (p < 0.05) in response to both acids. Conclusions: Conventional restorative materials do not buffer better than human teeth. However, the experimental composite demonstrates that buffering against carious and intrinsic erosive acid attacks is technically feasible

Subjective and objective halitosis among patients with Parkinson's disease

ObjectivesParkinson's disease (PD) affects oral health, but prevalence of subjective and objective halitosis and the influence of hyposalivation remain unclear. We aimed to explore whether patients with PD suffer from halitosis and to define correlations between halitosis and hyposalivation. We hypothesised that patients with PD suffer more often from halitosis compared to healthy controls, influenced by dry mouth. Materials and methodsSubjective (halitosis, xerostomia visual analogue scale [VAS], short German Oral Health Impact Profile [OHIPG]-14) and objective scales (e.g., organoleptic score, volatile sulphur compounds [VSCs], stimulated whole saliva [SWS]) were assessed from 26 patients with PD and 26 healthy controls. ResultsThe mean organoleptic score was 0.7 (SD: 0.7) in all patients, and VSCs were either comparable or significantly lower (dimethyl sulphide, P=.010) in PD patients compared with controls, yet more patients with PD perceived halitosis to be stronger (77% vs 54%, respectively; P=.059). Dry mouth was significantly more likely in patients with PD than controls: mean xerostomia VAS 4 (SD: 2) vs 1 (SD: 2), P=.010; SWS 0.4 (SD: 0.4) vs 0.7 (SD: 0.6) mL/min, P<.05); SWS did not correlate with subjective or objective halitosis. Oral health-related quality of life (OHRQoL) was lower in patients with PD than controls (mean OHIPG-14 score 12 (SD: 0.2) vs 5 (SD: 7.0), respectively; P<.05). ConclusionsPatients with PD suffer from subjective and objective halitosis, dry mouth and impaired OHRQoL. Dry mouth problems do not correlate with prevalence or intensity of halitosis

Does a pretreatment with a dentine hypersensitivity mouth-rinse compensate the pain caused by professional mechanical plaque removal? A single-blind randomized controlled clinical trial

Objectives Pain is affecting acceptance of supportive periodontal therapy and primary periodontitis prevention. Our objective was to evaluate the efficacy of a 1-week pre-treatment use of dentinal-hypersensitivity-reducing mouth-rinses (DHM) in periodontal maintenance (SPT) or dental prophylaxis patients. Material and methods One hundred fifty-five participants attending for professional mechanical plaque removal (PMPR) were randomly assigned to use a mouth-rinse twice daily for 1 week prior to their next PMPR. Rinses were containing either potassium oxalate (n = 52), arginine (n = 52), or herbal extracts (n = 51). At baseline and reassessment, procedural pain was assessed by visual analogue scale (VAS) and verbal rating scale (VRS). Self-reported efficacy was documented. Results No inter-group differences were estimated between both test groups and the control for baseline and reassessment means (VAS, VRS). In the SPT group, VAS reduction and self-reported efficacy were found (p < 0.05). Conclusion The 1-week use of DHM failed to show a predictable effect on discomfort during PMPR overall. Around 20% of the patients showed a quantifiable benefit from both test mouth-rinses, whereas more than 50% reported a subjective pain reduction. Focusing patients undergoing supportive periodontal therapy, quantifiable effects were found for both test groups. From a patient's point of view, DHM might be a suitable adjunct to enhance procedural comfort, especially in patients with a history of periodontitis

Patients' preferences in periodontal disease treatment elicited alongside an IQWiG benefit assessment:a feasibility study

Background and purpose: The German Institute for Quality and Efficiency in Health Care (IQWiG) previously tested two preference elicitation methods in pilot projects and regarded them as generally feasible for prioritizing outcome-specific results of benefit assessment. The present study aimed to investigate the feasibility of completing a discrete choice experiment (DCE) within 3 months and to determine the relative importance of attributes of periodontal disease and its treatment. Patients and methods: This preference elicitation was conducted alongside the IQWiG benefit assessment of systematic treatments of periodontal diseases. Attributes were defined based on the benefit assessment, literature review, and patients' and periodontologists' interviews. The DCE survey was completed by patients with a history of periodontal disease. Preferences were elicited for the attributes tooth loss within next 10 years, own costs for treatment, follow-up visits, re-treatment, complaints and symptoms, and frequency of follow-up visits. Patients completed a self-administered questionnaire including 12 choice tasks. Data were analyzed using a random parameters logit model. The relative attribute importance was calculated based on level ranges. Results: Within 3 months, survey development, data collection among 267 patients, data analysis, and provision of a study report could be completed. The analysis showed that tooth loss (score 0.73) was the most important attribute in patients' decisions, followed by complaints and symptoms (0.22), frequency of follow-up visits (0.02), and costs (0.03) (relative importance scores summing up to 1). Conclusion: A preference analysis performing a DCE can be generally feasible within 3 months; however, a good research infrastructure and access to patients is required. Outcomes used in benefit assessments might need to be adapted to be used in preference analyses

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status