Use Of Mouthrinses Research Articles

Antimicrobial mouthrinses and the management of periodontal diseases: Introduction to the supplement

Periodontal diseases are complex disorders that have been associated with multiple risk factors. These disorders are triggered by the accumulation of dental plaque, and the clinical signs are caused by the resultant inflammatory and immune responses. Tissue destruction that defines periodontitis has been linked to excessive production of proinflammatory molecules including matrix metalloproteinases, interleukin-1 beta and prostaglandin E(2). Important risk factors for periodontitis can be grouped into four categories: microbial, systemic, behavioral and local. These risk factors can be considered modifiable or unmodifiable. Controlling risk factors is important in the management of chronic diseases and is a valid strategy for controlling periodontal diseases. Limiting the accumulation of dental plaque is an important part of controlling the development and progression of periodontal diseases. By adhering to a daily oral hygiene regimen that includes brushing, flossing and rinsing, patients play an essential role in disease management. Patients play an important role in controlling the oral microbial biofilm that is essential to the initiation, development and progression of periodontal diseases. A daily oral hygiene regimen that includes the use of an antimicrobial mouthrinse can modify patients' microbial risk of developing periodontal disease. Patients can help reduce their risk of developing periodontal disease by controlling the accumulation of plaque. This can be accomplished, in part, by adhering to a daily oral hygiene regimen that includes brushing, flossing and using an antimicrobial mouthrinse.

The rationale for the daily use of an antimicrobial mouthrinse

This article reviews the rationale for incorporating effective antimicrobial mouthrinses into a daily oral hygiene regimen along with mechanical plaque control methods. The author reviewed studies demonstrating the essential etiologic role of a pathogenic dental plaque biofilm in the development of gingivitis, as well as studies indicating that most people fail to maintain a level of mechanical plaque control sufficient to prevent disease. In addition, he did a brief review of studies of oral microbial ecology that identified the oral mucosal tissues as a reservoir of bacteria that colonize tooth surfaces, and he summarized six-month clinical studies of marketed antimicrobial mouthrinse ingredients and products. There is a twofold rationale for daily use of antimicrobial mouthrinses: first, given the inadequacy of mechanical plaque control by the majority of people, as a component added to oral hygiene regimens for the control and prevention of periodontal diseases; second, as a method of delivering antimicrobial agents to mucosal sites throughout the mouth that harbor pathogenic bacteria capable of recolonizing supragingival and subgingival tooth surfaces, thereby providing a complementary mechanism of plaque control. The efficacy of several mouthrinse ingredients and products is supported by published six-month clinical trials. The daily use of an effective antiplaque/antigingivitis antimicrobial mouthrinse is well-supported by a scientific rationale and can be a valuable component of oral hygiene regimens.

Influence of a Fluoride Mouthrinse on Mutans Streptococci in Schoolchildren

This study aimed to determine whether the long-term use of a fluoride mouthrinse affects the salivary levels of mutans streptococci. Two hundred and fifteen schoolchildren (aged 9–10 years) participated. One hundred and forty-nine of these children had used a fluoride mouthrinse since 5 years of age at nursery school, and the remaining 66 children had not. DFT (decayed and filled teeth) was recorded, and the salivary levels of Streptococcus mutans and Streptococcus sobrinus were measured using mitis salivarius bacitracin agar. The group that had used a fluoride mouthrinse had a significantly lower prevalence of both S. mutans and S. sobrinus (p = 0.038) and a significantly lower DFT score (p < 0.001) than the other group. Using logistic regression analysis including caries experience at baseline as a dependent variable, the odds ratio of carrying S. mutans alone was 8.0 (p = 0.066) and that of carrying both S. mutans and S. sobrinus was 16.5 (p = 0.022) in the group that had not used the fluoride mouthrinse. Children carrying both S. mutans and S. sobrinus had a higher caries incidence in 1 year than the others, with odds ratios of 5.73 (p = 0.067) in the group with a fluoride mouthrinse and 3.47 (p = 0.035) in the group without it. These results show that the long-term use of a fluoride mouthrinse is associated with reduced salivary levels of mutans streptococci and this bacterial reduction may partly contribute to the suppression of dental caries in children using a long-term fluoride mouthrinse.

The effect of toothbrushing regimens on the plaque inhibitory properties of an experimental cetylpyridinium chloride mouthrinse

The objective of this study was to determine the effect of various toothbrushing regimens with a standard fluoride dentifrice on the plaque inhibitory properties of an alcohol-free, high bioavailable 0.07% cetylpyridinium chloride (CPC) mouthrinse. The study was a randomized, single-centre, examiner blind, four-period cross-over study involving 29 healthy subjects. Four treatment regimens were evaluated: (1) Toothbrushing with dentifrice followed by a water rinse (B-W, negative control); (2) Toothbrushing with dentifrice followed by a CPC mouthrinse use (B-CPC); (3) Toothbrushing with dentifrice followed by a water rinse and then a CPC mouthrinse use (B-W-CPC); and (4) Toothbrushing with dentifrice and waiting 60 min. prior to a CPC mouthrinse use (B-60 min.-CPC). Three days before the baseline exam of treatment periods, subjects were instructed to brush only the lingual surfaces of their teeth for up to 60 s twice daily. At baseline, subjects received a plaque exam using the Turesky modification of the Quigley-Hein index (MQH) followed by a polishing on the lingual and buccal surfaces of their teeth. During treatment periods, subjects were asked to brush only the lingual surfaces of their teeth with a standard fluoride dentifrice. Rinsing with 20 ml of the experimental CPC solution was done for 30 s twice daily. The evening before the last day of treatment periods (Day 4), subjects were asked to refrain from any oral hygiene, eating, and drinking after brushing. On Day 4, plaque was scored using the MQH Index. A 10-day wash-out of normal oral hygiene was allowed between each of the four treatment periods. The data were analysed using analysis of covariance for cross-over designs. Twenty-five to 29 subjects were evaluable at any given visit. With respect to unbrushed buccal and brushed lingual surfaces, all three CPC regimens had highly significantly (p < or = 0.0006) lower mean plaque scores than the B-W regimen, reductions ranging from 20% to 38% in magnitude. With respect to unbrushed surfaces, there was a significant difference between the B-CPC regimen and the B-60 min.-CPC regimen (p < 0.01) in favour of the latter regimen. No other pairwise treatment comparisons were statistically significant for unbrushed sites. Results for brushed surfaces and all sites combined showed that both the B-W-CPC and the B-60 min.-CPC groups reduced mean plaque levels significantly (p < or = 0.013) more than B-CPC. There were no statistically significant differences between B-W-CPC and B-60 min.-CPC for measurements of brushed, unbrushed, or all sites combined. Results show that the alcohol-free, 0.07% high bioavailable CPC rinse provides an additive anti-plaque benefit beyond toothbrushing with a standard fluoride dentifrice regardless of the regimen. Of the regimens, a water rinse between toothbrushing and CPC rinsing enhances therapeutic efficacy while fitting into the patient's typical oral hygiene routine.

Decreasing Ventilator-associated Pneumonia

The prevention of ventilator-associated pneumonia (VAP) has been a quality effort that many organizations across the country have undertaken. Through a multidisciplinary approach, the best practices to prevent VAP for our organization were established. Through the interventions of securing the patient resuscitation bag in one location, maintaining the patient's head-of-bed elevation to more than 30 degrees if not contraindicated, Yankauer suction tip care, and the use of chlorhexidine mouth rinse, the incidence of VAP decreased by 43% within a 6-month time frame. Additional ventilator-associated prevention efforts such as sedation and weaning protocols have been established to further enhance preventive efforts.

Use of an Essential Oil Mouth Rinse in Xerostomia

Use of an Essential Oil Mouth Rinse in Xerostomia

The Potential Use of Chlorhexidine (CHX) and Hexetidine-containing Mouth Rinse in Maintaining Toothbrush Sterility

The study was carried out with the aim of demonstrating quantitatively the presence of microorganisms adhered to toothbrush bristles and to determine the potential of using antimicrobial agent (such as chlorhexidine gluconate (CHX) and hexetidine (HX)) in commercialized mouth rinses to reduce microbial contamination. The study was carried out by enumerating the total colony counts of bristles-adhered microbes after three weeks of normal oral hygiene followed by rinsing the toothbrushes with CHX, HX, tap water and deionized water independently following a strict planned schedule. Rinsing toothbrush with tap water was included in the study as a control due to the normal way of cleaning toothbrush after use in every home. Whereas, sterilized deionized water do not contain any ions, minerals and is microbes-free. The total colony counts of microbes obtained from the toothbrush rinsed with tap water, deionized water, CHX and HX were 62.6×106 CFU mL-1, 74.4×106 CFU mL-1, 2.4×106 CFU mL-1 and 7.6×106 CFU mL-1, respectively. Staphylococcus aureus, Actinomyces naeslundii and Clostridium sp. were isolated from toothbrush rinsed with tap water. Staphylococcus aureus and Peptostreptococcus sp. were obtained from toothbrush rinsed with deionized water. Actinomyces sp. and Clostridium sp. were recovered from toothbrush rinsed with CHX and only Staphylococcus aureus was obtained from toothbrush rinsed with HX. Although toothbrush rinsed with mouth rinses containing antimicrobial agent such as CHX and HX still harbour microorganisms, but the microbial load has been very much lowered compared to the control toothbrush. Thus, this indicates that toothbrush rinsing with mouth rinse after the normal oral hygiene is very convenient and cost effective to reduce toothbrush contamination.

Bisphosphonate‐associated osteonecrosis of mandibular and maxillary bone

AbstractBACKGROUNDThe current report presented 17 patients with cancer with bone metastases and 1 patient with osteopenia who received treatment with bisphosphonates and who subsequently developed osteonecrosis of the mandible and/or maxilla.METHODSThe authors reviewed information on 18 patients who were referred to oral medicine or oral surgery specialists for evaluation and treatment of mandibular and/or maxillary bone necrosis from June 2002 to September 2004. To be included in the current review, patients must have been treated with either pamidronate or zoledronic acid to control or prevent metastatic disease, or with alendronate for osteoporosis. All patients with cancer had received chemotherapy while receiving bisphosphonate management.RESULTSThe 17 patients with cancer were receiving active medical care for a malignancy. Cancer treatment included a variety of chemotherapeutic agents. They presented with metastatic disease to bone and were treated intravenously with the bisphosphonates pamidronate or zoledronic acid for a mean time of 25 months (range, 4–41 mos). There were 14 females and 4 males with a mean age of 62 years (range, 37–74 yrs). Malignancies included breast carcinoma (n = 10), multiple myeloma (n = 3), prostate carcinoma (n = 1), ovarian carcinoma (n = 1), prostate carcinoma/lymphoma (n = 1), and breast/ovarian carcinoma (n = 1). One female patient with osteopenia received alendronate. The most common clinical osteonecrosis presentations included infection and necrotic bone in the mandible. Associated events included dental extractions, infection, and trauma. Two patients appeared to develop disease spontaneously, without any clinical or radiographic evidence of local pathology. Despite surgical intervention, antibiotic therapy, hyperbaric oxygen therapy, and topical use of chemotherapeutic mouth rinses, most of the lesions did not respond well to therapy. Discontinuation of bisphosphonate therapy did not assure healing. However, 1 patient with cancer healed after discontinuation of bisphosphonate therapy for 4 months.CONCLUSIONSThe findings in the patient population combined with recent literature reports suggested that bisphosphonates may contribute to the pathogenesis of the oral lesions. The risk factors and precise mechanism involved in the formation of the osteonecrosis are not known. This condition represents a new oral complication in patients with cancer and can be termed bisphosphonate‐associated osteonecrosis. Lesions in patients with osteoporosis are worrisome and need to be further evaluated. Cancer 2005. © 2005 American Cancer Society.

A comparison of the effects of two commercially available nonprescription mouthrinses on salivary flow rates and xerostomia

Objectives. To determine if 2 commercial mouthrinses, 1 alcohol based (Cool-Mint Listerine) and 1 nonalcohol based (Mint Act), affect salivary flow and symptoms of dry mouth in nonxerostomic adults. Study design. Observer-blinded, randomized, crossover pilot study involving 20 adults randomized, 10 each, into 1 of the 2 mouthrinse groups. Objective measurements of whole salivary flow rates (mL/min) and subjective measurement of perceived mouth dryness (VAS scores) were recorded before and 5 minutes after 30 seconds of mouthrinse use both at baseline (visit 1) and at 1 week following daily standard mouthrinse use (visit 2A). Crossover occurred after a 90-minute washout period at the 1-week visit (visit 2B); subjects were given the second mouthrinse and the identical protocol was followed for another 1-week period (visit 3). The primary endpoints of interest were whole salivary flow rates and the perceived mouth dryness VAS scores following 1 week of use. ANOVA was used to determine differences in these endpoints between groups, and ANCOVA was used to control for any variation in baseline flow rates and VAS scores (P < .05). Results. All 20 subjects completed the study. There were no significant differences in gender, age, baseline resting whole salivary flow rates, or VAS scores between the mouthrinse groups. After 1 week of mouthrinse use ANOVA and ANCOVA of combined data (before and after crossover) revealed no significant differences in either flow rates or VAS scores between groups (P > .05). Conclusions. Based upon 20 healthy subjects with normal salivary flow rates who rinsed their mouth for 1 week with a commercially available mouthrinse, there were no differences in objective and subjective measures of mouth dryness between alcohol- and nonalcohol-containing mouthrinses.

An in vitro antimicrobial comparison of miswak extract with commercially available non‐alcohol mouthrinses

The aim of this study was to assess the antimicrobial activity of eight commercially available mouthrinses and 50% miswak extract against seven microorganisms. Corsodyl, Alprox, Oral-B advantage, Florosept, Sensodyne, Aquafresh Mint, Betadine and Emoform mouthrinses were used while 50% aqueous extract of miswak (Salvadora persica) was used against Streptococcus faecalis, Streptococcus pyogenis, Streptococcus mutans, Candida albicans, Staphylococcus aureus and Staphylococcus epidermidis. The ditch plate method was used to test the antimicrobial activity. Inhibition zones of microorganisms around ditches were measured in millimetres. Range, mean and standard deviations were used for comparison of antimicrobial activity. Mouthrinses containing chlorhexidine was with maximum antibacterial activity, while cetylpyridinium chloride mouthrinses were with moderate and miswak extract was with low antibacterial activity. Further research is needed for the substantivity of these mouthrinses and further in vivo/in vitro studies are needed using Biofilm model to substantiate present findings. Dental professionals must exercise caution and provide guidance in assisting their patients in making informed choices regarding their use of mouthrinses for clinical efficacy.

The Effect of German Chamomile Mouthwash on Dental Plaque and Gingival Inflammation

Dental plaque is a well known etiologic factor for gingivitis. Recently, herbal extracts are a matter of scientific interest to inhibit plaque accumulation on teeth. The purpose of this study was to evaluate the effects of German Chamomile (GC) mouth wash on plaque and gingival indices. Twenty five gingivitis patients (15 female and 10 male, mean age 27±7.76 years) participated in this controlled, double blind cross-over study. The subjects used either GC or a control rinse for 2 min twice a day during a 4 weeks period. The other mouth rinse was used after a wash-out period of 4 weeks in the same way. The plaque and gingival indices were recorded at baseline and after each experimental or wash-out period. Furthermore, stain indices for intensity and extend were recorded to evaluate the tooth staining effects of the mouthrinses. The mean reduction in plaque and gingival scores were determined by using the test or control mouthwash and statistically analyzed by paired sample t- test. The stain intensity and extend in each period of the study were also analyzed by the two-way ANOVA. The GC mouthwash lowered both plaque and gingival scores significantly in comparison to the control rinse (p≤0.001), whilst there was no significant difference in stain intensity or extend between the baseline and after each period of the study. There was also no report of any adverse reactions during the use of mouth rinses in this the study. Using GC mouthwash appears to offer benefit in plaque and gingival reduction without any significant adverse effects on tooth staining.

A survey of preprocedural antiseptic mouth rinse use in Army dental clinics.

The objective of this project was to evaluate the use of preprocedural mouth rinses in Army dental clinics. Three hundred six-question surveys were distributed to 10 Army dental organizations throughout the United States and Germany during the period from March 2001 to March 2002. Two hundred fifty-four surveys were completed and returned. Simple mathematics were used to evaluate answers to the questionnaires. The 254 respondents included military dentists (n = 190), civilian dentists used by the military (n = 27), registered dental hygienists (n = 20), and military-trained dental hygiene technicians (n = 17). Eighty-four and one-tenth percent of respondents (n = 216) use preprocedural rinses in their practices to prevent possible disease transmission (n = 85) or to decrease chances of postoperative infection (n = 167). Chlorhexidine gluconate (n = 170) and phenol-based essential oil preparations (n = 84) are the most commonly used products. The perceived greatest benefits of preprocedural rinsing are to decrease oral bacterial load (38%), to decrease incidence of postoperative infection (21%), and to decrease aerosolization of bacteria (8.66%). Army dental clinics make extensive use of antimicrobial preprocedural rinses. Chlorhexidine and Listerine (Warner-Lambert Consumer Healthcare, Morris Plains, NJ) are the most commonly used products. Currently available literature appears to support the use of these products in preventing or diminishing the chances of postoperative infection.

Adjunctive benefit of an essential oil–containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly: A six-month study

Mechanical methods of oral hygiene can be complemented by the use of chemotherapeutic mouthrinses. The authors sought to quantify the additional benefit provided by an essential oil-, or EO-, containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly. The authors randomly assigned patients with gingivitis to one of three treatment groups: brushing and rinsing with a control mouthrinse, or BC; brushing, flossing and rinsing with a control mouthrinse, or BFC; or brushing, flossing and rinsing with an EO-containing mouthrinse, or BFEO. Patients received a dental prophylaxis at baseline, and the authors followed them for six months. Of 246 enrolled subjects enrolled in the study, 237 subjects were evaluable at the study's conclusion. After six months, the subjects using the BFEO regimen had statistically and clinically significant lower mean Modified Gingival Index, or MGI, scores and Plaque Index, or PI, scores than did subjects in the BC group (29.9 percent and 56.3 percent, respectively; P < .001). Subjects in the BFC group had statistically significantly lower mean MGI and PI scores than did subjects in the BC group (11.2 percent and 9.3 percent, respectively; P < .001). Subjects in the BFEO group exhibited statistically and clinically significantly lower mean scores for MGI and PI than did subjects in the BFC group (21 percent and 51.9 percent, respectively; P < .001). This study confirms that for patients with gingivitis who brush and floss routinely, the adjunctive use of an EO-containing mouthrinse provides a clinically significant and meaningful additional benefit in reducing plaque and gingivitis. An EO-containing mouthrinse is an effective adjunct to regular brushing and flossing. Therefore, the BFEO regimen can be beneficial for patients with gingival inflammation.

Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents.

Topical fluoride therapy (TFT) in the form of toothpastes, mouthrinses, varnishes and gels are effective caries preventive measures. However, there is uncertainty about the relative value of these interventions when used together. To compare the effectiveness of two TFT modalities combined with one of them alone (mainly toothpaste) when used for the prevention of dental caries in children. We searched the Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish, gel, mouthrinse, or toothpaste in combination with each other in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the 'treatment' and 'control' groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. Eleven of the 12 included studies contributed data for the meta-analyses. For the nine trials that provided data for the main meta-analysis on the effect of fluoride mouthrinses, gels or varnishes used in combination with toothpaste (involving 4026 children) the D(M)FS pooled PF was 10% (95% CI, 2% to 17%; p = 0.01) in favour of the combined regimens. Heterogeneity was not substantial in these results (I square = 32%). The separate meta-analyses of fluoride gel or mouthrinse combined with toothpaste versus toothpaste alone favour the combined regimens, but differences were not statistically significant; the significant difference in favour of the combined use of fluoride varnish and toothpaste accrues from a very small trial and appears likely to be a spurious result. Not all other combinations of possible practical value were tested in the included studies. The only other statistically significant result was in favour of the combined use of fluoride gel and mouthrinse in comparison to gel alone (pooled DMFS PF 23%; 95% CI, 4% to 43%; p = 0.02), based on two trials. No other combinations of TFT were consistently superior to a single TFT. Topical fluorides (mouthrinses, gels, or varnishes) used in addition to fluoride toothpaste achieve a modest reduction in caries compared to toothpaste used alone. No conclusions about any adverse effects could be reached, because data were scarcely reported in the trials.

Fluoride mouthrinses provide clear reduction in caries in children

Data sources Sources of studies were the Cochrane Oral Health Group’s Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase, SCISEARCH, SSCISEARCH, ISTP, BIOSIS, CINAHL, ERIC, Dissertation Abstracts and LILACS. Searches were also made by hand of journals and reference lists of articles, and contact was made with selected authors and manufacturers.Study selection Studies included were randomised or quasi-randomised controlled trials with blind outcome assessment that compared fluoride mouthrinse with placebo or no treatment at least 1 year in children aged up to 16 years over. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces [D(M)FS].Data extraction and synthesis The primary measure of effect was the prevented fraction (PF; ie, the difference in mean caries increments between the treatment and control groups expressed as a proportion of the mean increment in the control group). Meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined by meta-regression.Results Thirty-six studies were included, with 34 contributing data for meta-analysis (involving 14 600 children). The D(M)FS pooled PF was 26% (95% confidence interval, 23–30%; P<0.0001). Heterogeneity was not substantial but was confirmed statistically (P=0.008). No significant association between estimates of D(M)FS PF and baseline caries severity, background exposure to fluorides, rinsing frequency and fluoride concentration was found. There is little information concerning possible adverse effects or acceptability of treatment in the trials included (Table 1).Conclusions This review shows that the supervised regular use of fluoride mouthrinse at two main strengths and rinsing frequencies is associated with a reduction in caries increment in children. There is a need for complete reporting of side-effects and acceptability data in fluoride mouthrinse trials.

How to select the right mouthrinses in periodontal prevention and therapy. Part I. Test systems and clinical investigations

The use of mouthrinses is increasing, especially as adjuncts to the daily mechanical oral hygiene. Different test systems may and can be used to test their antibacterial and clinical effects: bacteriology in vitro, substantivity in vivo, 4-day plaque re-growth, experimental gingivitis and long-term use. The plaque re-growth investigations of a few days are not only of limited use but may also be dangerous because often too extensive conclusions have been drawn from their design. The 'gold standard' test is the experimental gingivitis model to reveal the antiplaque as well as the antigingivitis effects of any mouthrinse preparation during 3 weeks. The last kind of investigations are of several months' duration, where the substances are used as supplements to mechanical oral hygiene measures.

Fluoride mouthrinses for preventing dental caries in children and adolescents.

Fluoride mouthrinses have been used extensively as a caries-preventive intervention in school-based programmes and individually at home. To determine the effectiveness and safety of fluoride mouthrinses in the prevention of dental caries in children and to examine factors potentially modifying their effect. We searched the Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. Randomised or quasi-randomised controlled trials with blind outcome assessment, comparing fluoride mouthrinse with placebo or no treatment in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects metaregression analyses. Thirty-six studies were included. For the 34 that contributed data for meta-analysis (involving 14,600 children) the D(M)FS pooled PF was 26% (95% confidence interval (CI), 23% to 30%; p < 0.0001). Heterogeneity was not substantial, but confirmed statistically (p = 0.008). No significant association between estimates of D(M)FS prevented fractions and baseline caries severity, background exposure to fluorides, rinsing frequency and fluoride concentration was found in metaregression analyses. A funnel plot of the 34 studies indicated no relationship between prevented fraction and study precision. There is little information concerning possible adverse effects or acceptability of treatment in the included trials. This review suggests that the supervised regular use of fluoride mouthrinse at two main strengths and rinsing frequencies is associated with a clear reduction in caries increment in children. In populations with caries increment of 0.25 D(M)FS per year, 16 children will need to use a fluoride mouthrinse (rather than a non-fluoride rinse) to avoid one D(M)FS; in populations with a caries increment of 2.14 D(M)FS per year, 2 children will need to rinse to avoid one D(M)FS. There is a need for complete reporting of side effects and acceptability data in fluoride mouthrinse trials.

No need to routinely discontinue anticoagulants before dental extractions

Question: In patients who need anticoagulant therapy and require dental extraction, is it safe to continue with anticoagulation? Aim To investigate whether people taking warfarin with an international normalised ratio (INR) within the normal therapeutic range require anticoagulants to be stopped before dental extractions. Design Randomised controlled trial of 117 patients in a hospital environment. Intervention The control group stopped taking warfarin 2 days before extraction if the INR was >2 and the procedure was rebooked for following day. The intervention group continued to take medication. If the INR was >4 on the day of the procedure the patient was withdrawn. The use of tranexamic acid mouth-rinse was not permitted. Extractions were performed under local anaesthetic using as atraumatic a technique as possible. Outcome measure Clinical notes and patient logbooks were used to record any complications. Results The rate of bleeding complications was higher in the group continuing with anticoagulation but the difference was not significant. Conclusions The study shows that dental extractions can be carried out safely in a hospital without stopping anticoagulation if the patient's INR is <4.1. Evans IL, Sayers MS, Gibbons AJ, Price G, Snooks H, Sugar AW. Can warfarin be continued during dental extraction? Results of a randomised controlled trial. Br J Oral Maxillofacial Surg 2002; 40:248–242

Review of the treatment strategies for oral malodour

Breath malodour, a significant social and/or psychological handicap, may be caused by several intra- and extraoral factors. Malodour of intraoral origin is the result of microbial putrefaction, during which volatile sulphur compounds (VSC) and other volatile compounds are produced. The treatment of oral malodour can therefore be focused on the reduction of the intraoral bacterial load and/or the conversion of VSC to nonvolatile substrates. This article outlines the efficacy and mechanisms of different antimalodour approaches. Most approaches were found to be inefficient and/or short lasting. The most successful treatment involves mechanical debridement (including toothbrushing, flossing, and tongue cleaning), possibly combined with the use of an antimicrobial mouthrinse.

Diagnosing, managing, and preventing salivary gland disorders.

Salivary function provides host protection, assists in the initiation of food and fluid intake, and enables communication through speech. Without adequate salivary output, oral and pharyngeal health declines along with a person’s quality of life. The complaint of a dry mouth (xerostomia) and the objective finding of salivary dysfunction are common occurrences in older individuals, producing transient and permanent oral and systemic problems. Salivary dysfunction, however, is not a normal consequence of growing older, and is due to systemic diseases, medications, and head and neck radiotherapy. Diagnosis of salivary disorders begins with a careful medical history, head, and neck examination. While complaints of xerostomia may be indicative of a salivary gland disorder, salivary diseases can present without symptoms. Therefore, routine examination of salivary function must be part of any head, neck, and oral examination. Therapies are designed to prevent the development of oral and pharyngeal sequelae of salivary hypofunction. Current xerostomia-based treatments include replacement therapies and gustatory, masticatory, and pharmacological stimulants. Healthcare professionals can play a vital role in identifying patients at risk for developing salivary dysfunction, and should provide appropriate preventative and interventive techniques that will help preserve a person’s health, function, and quality of life.