Clinical lasers are of two types; soft lasers are essentially an aid to healing with relatively few rigorous studies available to support their use. Surgical hard lasers, however, can cut both hard and soft tissues and replace the scalpel and drill in many areas. From initial experiments with the ruby laser most clinicians are using Argon, CO2 and now NdYAG systems. The first dental laser based on a NdYAG engine provides handpieces of similar size to conventional instrumentation and, being fed by a fibre-optic 'cable', has the flexibility for intra-oral use that the CO2 lasers, widely used in oral surgery, lack. Furthermore, extensive clinical investigation has demonstrated their safety in clinical practice and the fact that procedures can usually be performed without a local anaesthetic is obviously seen as a considerable advantage by patients. Sterilising as it cuts, the NdYAG laser promises to find uses not only in caries removal and soft tissue surgery, but also in endodontics and gingival curettage.
Eighteen per cent of all patients have some degree of sensitivity and a range of therapies has been devised to alleviate this condition. An electronic monitoring machine was constructed which allowed for air stream, directed at a patient's tooth, to be started by the clinician and halted by the patient when the sensation of pain in the tooth became too unpleasant to tolerate. The time for which the patient could tolerate the air flow was electronically measured in units of 1/50th second. By measuring the patient's reaction time on each visit and correcting the readings obtained for 'tooth pain time' using these figures, a quantitative measure of sensitivity change is achieved. Using this system, a clinical trial has been conducted to test the efficacy of the NdYAG dental laser. The 30 patients treated had an average tooth pain time initially of 1.2 seconds. Following laser treatment patients were recalled at 3, 7 and 14 days. At the 2-week review, this figure had increased to 7.8 seconds, which was found to be statistically significant. Control (unlased) teeth demonstrated an average improvement of only 1.7 seconds (not statistically significant). Patients' subjective assessment of sensitivity pain on a 0-10 scale averaged 8.0 before treatment. This reduced to 3.7 after treatment. Treatment of this condition can thus be performed easily and painlessly with a predictable response and considerable patient satisfaction.
There are a large number of mouthrinse products available to the general public for use as adjuncts to oral hygiene. Many have not been evaluated and relatively few comparisons of products have been made. This study compared 4 mouthrinse products containing cetylpyridinium chloride (CPC), chlorhexidine, C31G, or triclosan with saline rinse included as a placebo control. Twenty dentate volunteers took part in this 4-day plaque regrowth study which had a single blind, randomized cross-over design balanced for residual effects. On day 1 of each study period, volunteers were rendered plaque free by a professional prophylaxis, suspended normal oral hygiene measures, and rinsed twice daily for 1 minute with 15 mL of the allocated rinse. On day 5, subjects were scored for disclosed plaque by plaque index and plaque area. By both measures the order of decreasing product efficacy was chlorhexidine, CPC and triclosan, C31G, and saline. All the differences in favor of the chlorhexidine product were highly significant as were those in favor of the other rinses compared to saline. It is concluded that the findings of this study reflect the actual chemical benefits of the products divorced from the indeterminate variable of toothbrushing.
Periodontal disease appears to arise from the interaction of pathogenic bacteria with a susceptible host. The main aims of disease management have been to establish a high standard of oral hygiene and to professionally and thoroughly debride the root surface Chemical agents could be considered for both aspects of management. Chemoprevention using supragingivally delivered agents such as chlorhexidine may be questioned for value in the pre-treatment hygiene phase but have well-established efficacy immediately preoperatively and during the post-operative weeks. Long-term maintenance use of chlorhexidine is problematic due to local side effects. Antiplaque toothpastes show modest benefits to gingivitis but are not proven to prevent recurrence of periodontitis. Chemotherapy may be directed at subgingival plaque, using antimicrobials, or at the host response using anti-inflammatory agents. Antimicrobials can be locally or systemically delivered. In most cases antimicrobial chemotherapy should be considered adjunctive to mechanical debridement. The advantages of local and systemic chemotherapy must be balanced against the disadvantages and potential side effects of agents. Antimicrobial chemotherapy offers little or no benefit to the treatment of most chronic adult periodontitis patients and should be reserved for the more rapid or refractory types of disease, and after the debridement phase. Despite the large number of studies there are insufficient comparative data to support any one local delivery system or systemic regimen as superior to another. Systemic versus local antimicrobials have not been compared to date. Host response modifying drugs such as non-steriodal anti-inflammatory drugs (NSAIDS) offer the potential to reduce breakdown and promote healing, including bone regeneration. However until more data are available, NSAIDs should not be used in the management of chronic periodontal diseases, there being no specific agent(s) or regimen established for use. Chemotherapy has an important place in the management of chronic periodontal diseases but routine use must be considered as an over prescription of these valuable agents.
There has been a resurgence of interest in stannous fluoride (SF) products in particular to provide oral hygiene and gingival health benefits. The aim of this study was to assess the persistence of antimicrobial action of a number of SF formulations in the mouth and relate these to plaque inhibitory activity. The formulations were 2 SF toothpastes (SF1, SF2), 2 SF plus stannous pyrophosphate toothpastes (SFSP1, SFSP2), a SF gel (G), a NaF toothpaste (C) and saline (S) as control. Both studies involve 2 different groups of 21 healthy dentate volunteers. The studies were single, blind, randomised, crossover designs balanced for residual effects, with a minimum 2 1/2 day washout period. Salivary bacterial counts were determined before and to 7 h after a single rinse with the formulations. Plaque regrowth from a zero baseline (day 1) was measured by index and area on day 5, after 2x daily rinsing with slurries of the formulations or saline. For bacterial counts, highly significant treatment differences were found. Bacterial counts were variably reduced by all treatments to 30 min then showed a variable rate of return towards baseline. All test agents were significantly better than S at some timepoints. The order for greatest persistence of action downwards was; (1) SFSP2; (2) SFSP1, G, and SF1; (3) SF2; (4) C; (5) S. Highly significant differences in plaque regrowth between treatments were found with similar mean ordering of efficacy as for salivary bacterial counts from most effective downwards namely; (1) SFSP1 and SFSP2; (2) SF1; (3) SF2; G and C; (4) S. The results were consistent with a parallel study measuring tea staining in vitro, whereby formulations causing the most staining produced the greatest persistence of action and plaque inhibitory activity. This suggests the availability of stannous ions was important for the clinical effects. It is concluded that stannous ions can enhance the plaque inhibitory action of toothpaste via a persistent antimicrobial action.
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