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Item 3D-Image Analysis of the Impact of Toothpaste Abrasivity on the Progression of Simulated Non-Carious Cervical Lesions(Elsevier, 2018) Sabrah, Alaa H.; Turssi, Cecilia P.; Lippert, Frank; Eckert, George J.; Kelly, Adam B.; Hara, Anderson T.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjectives To investigate the effect of toothpaste abrasive level on the progression of non-carious cervical lesions (NCCLs) using 3D-image subtraction. Methods Upper first premolars were allocated into seven groups (n = 16) of toothpaste/abrasive slurries: A-Zeodent113/5%, B-Zeodent124/10%, C-Zeodent103/15%, D-Sensodyne Pronamel, E-Crest Cavity-Protection, F-Crest Pro-Health-Whitening, and G-Deionized water (DIW). Teeth were mounted on acrylic blocks, and their root surfaces covered with acrylic resin, except for 2-mm near the cemento-enamel junction that was exposed to toothbrushing. Specimens were brushed with the slurries for 5000-, 15,000-, 35,000- and 65,000-strokes. Impressions were taken at baseline and after each brushing time, and then scanned by a 3D optical profilometer. Dentine volume loss was calculated by image subtraction software and subjected to mixed-model ANOVA and multiple comparison tests (α = 0.05). Results No significant differences among slurries were observed at 5000 and 15,000. At 35,000, F showed higher loss than all other groups except C, which did not differ from the others. At 65,000, F (4.19 ± 3.29 mm3) showed the highest loss, followed by C (2.33 ± 1.47 mm3), which differed from all the other groups except B (1.85 ± 0.91 mm3). Groups B, A (1.35 ± 0.65 mm3), D (1.17 ± 0.48 mm3), E (1.40 ± 0.68 mm3) and G (1.12 ± 0.73 mm3) did not differ from each other. Groups F and C showed significant increase of volume loss starting at 35,000, while B, A, D and E only at 65,000; no increase loss was observed for G. Conclusions 3D-image subtraction was able to quantify and differentiate tooth loss, but only at advanced stages. The progression of NCCLs was more evident and faster for highly abrasive slurries. Clinical significance Upon root dentin exposure, brushing with lower abrasive dentifrices is advisable to reduce the risk for NCCLs development.Item The ability of dual whitening anti-caries mouthrinses to remove extrinsic staining and enhance caries lesion remineralization – An in vitro study(Elsevier, 2020) Al-Shahrani, Ahid A.; Levon, John A.; Hara, Anderson T.; Tang, Qing; Lippert, Frank; Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjectives This laboratory study investigated the ability of dual whitening anti-caries mouthrinses to remove extrinsic staining from artificially stained caries lesions and to enhance their remineralization and fluoridation. Materials and Methods Early caries lesions were created in bovine enamel specimens. The lesions were artificially stained and pH cycled for 10 days with the daily cycling regimen consisting of twice daily 60s-treatments with one of 11 mouthrinses, a 4-h demineralization period and artificial saliva treatments in between. Mouthrinses were eight commercially available products, all containing 100 ppm fluoride but utilizing hydrogen peroxide, pyro-, tri- or hexametaphosphate salts and/or sodium bicarbonate. The three control mouthrinses were 100 ppm fluoride, 30 % hydrogen peroxide and deionized water. Enamel color changes (ΔE) were determined spectrophotometrically. Vickers surface microhardness (VHN) was used to determine lesion remineralization. Enamel fluoride content (EFC) was determined using the microbiopsy technique. Data were analyzed using ANOVA. Results ΔE was significantly different among groups (p = 0.0045). Thirty percent hydrogen peroxide was superior to all other mouthrinses, while there were no differences between commercial mouthrinses and deionized water. There were small, directional but non-significant differences between commercial mouthrinses with those containing hydrogen peroxide providing better whitening. There were no significant differences between mouthrinses in their ability to remineralize caries lesions (p = 0.2898). EFC differed among groups (p < 0.0001), with the two mouthrinses containing pyrophosphate salts having lower EFC than all but the deionized water group. Conclusions Artificially stained caries lesions show reduced susceptibility to fluoride remineralization and whitening effects of commercial whitening and anti-caries mouthrinses. Clinical Relevance Artificially stained caries lesions appear to require stronger than over-the-counter interventions to successfully whiten and remineralizing them.Item Acceptance of Behavior Guidance Techniques Used in Pediatric Dentistry by Parents From Diverse Backgrounds(Sage, 2019-08) Martinez Mier, E. Angeles; Walsh, Christopher R.; Farah, Christopher C.; Vinson, LaQuia A.; Soto-Rojas, Armando E.; Jones, James E.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjective. To investigate if parental background affects acceptance of behavior guidance techniques. Background. Behavior guidance techniques are used for the safe and effective treatment of pediatric patients. Acceptance of these techniques may vary by racial and ethnic background. Methods. A total of 142 parents were recruited and asked to rate videos showing: active restraint/protective stabilization (AR), general anesthesia (GA), nitrous oxide sedation (N2O), oral premedication/sedation (OP), passive restraint/protective stabilization (PR), tell-show-do (TSD), and voice control (VC) techniques. Results. Hispanic parents rated VC most acceptable, followed by TSD, PR, and pharmacologic techniques. Black and white parents rated TSD, followed by N2O, as most acceptable, and AR and PR as least favorable. Hispanics found GA significantly less acceptable than whites or blacks. Hispanics were less accepting of AR than blacks; but more accepting of PR than whites. TSD was highly rated among all 3 cohorts. Parental background affected acceptance of the techniques in this study.Item Advancing cognitive engineering methods to support user interface design for electronic health records(Elsevier, 2014-04) Thyvalikakath, Thankam P.; Dziabiak, Michael P.; Johnson, Raymond; Torres-Urquidy, Miguel Humberto; Acharya, Amit; Yabes, Jonathan; Schleyer, Titus K.; Department of Cariology, Operative Dentistry and Dental Public Health, IU School of DentistryBackground Despite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data. Objective In this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface. Methods We conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol. Results Dentists first reviewed the patient’s demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient’s intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists’ patterns of navigation through patient’s information and additional information needs during a typical clinician-patient encounter. Conclusion This study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants’ knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists’ patterns of information retrieval and review will significantly contribute to designing flexible and task-appropriate information presentation in electronic dental records.Item Aesthetical perception of dental fluorosis in a Colombian low income community(Universidad CES, 2020-12) Fragelli, Camila; Restrepo, Manuel; Bussaneli, Diego Girotto; Jeremias, Fabiano; de Cássia Loiola Cordeiro, Rita; Escobar-Rojas, Alfonso; Martinez-Mier, E. Angeles; dos Santos-Pinto, Lourdes; Cariology, Operative Dentistry and Dental Public Health, School of DentistryIntroduction and objective : Dental fluorosis (DF) is a defect in the development of enamel as a result of overexposure to fluoride and can aesthetically compromise the patient. This study aims to investigate the relationship between aesthetic perception and dental fluorosis in a low-income community with a high prevalence of DF. Materials and methods: A cross-sectional study was carried out with 171 schoolchildren aged 8 to 12 who live in a low socioeconomic community (El Cedro, Ayapel district, Córdoba, Colombia). The students were examined for dental caries (DMFT and dmft indexes (WHO criteria) and for dental fluorosis (TF index). Aesthetic perception was verified with the questionnaire on children's perceptions of the appearance of teeth (CQATA) Data analysis was performed using descriptive statistics and chi-square tests, Student's t, one-way ANOVA and linear regression (p ≤ 0.05). Results: The prevalence of DF was 84.8% (n = 145). Only the presence of caries (DMFT / deft ≠ 0) had a significant impact on aesthetic perceptions. A significantly lower rate was found in girls for the pleasant color report. The number of teeth affected by FD had a significant positive correlation with the general perception of dental health. Conclusion : The presence of mild DF in children with low socioeconomic status, in a population with a high prevalence of this enamel defect, did not seem to have an impact on accepting the appearance of tooth color.Item Anticaries Potential of a Sodium Monofluorophosphate Dentifrice Containing Calcium Sodium Phosphosilicate: Exploratory in situ Randomized Trial(Karger, 2017-03) Parkinson, C. R.; Siddiqi, M.; Mason, S.; Lippert, Frank; Hara, Anderson T.; Zero, Domenick T.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryCalcium sodium phosphosilicate (CSPS) is a bioactive glass material that alleviates dentin hypersensitivity and is postulated to confer remineralization of caries lesions. This single-centre, randomized, single (investigator)-blind, placebo-controlled, crossover, in situ study explored whether the addition of 5% CSPS to a nonaqueous fluoride (F) such as sodium monofluorophosphate (SMFP)-containing dentifrice affects its cariostatic ability. Seventy-seven subjects wore 4 gauze-covered enamel specimens with preformed lesions (2 surface-softened and 2 subsurface) placed buccally on their mandibular bilateral dentures for up to 4 weeks. Subjects brushed twice daily with 1 of the 5 study dentifrices: 927 ppm F/5% CSPS, 927 ppm F/0% CSPS, 250 ppm F/0% CSPS, 0 ppm F/5% CSPS, or 0 ppm F/0% CSPS. Specimens were retrieved after either 21 (surface-softened lesions; analyzed by Knoop surface microhardness [SMH]) or 28 days (subsurface lesions; analyzed by transverse microradiography). The enamel fluoride uptake was determined for all specimens using a microbiopsy technique. The concentrations of fluoride and calcium in gauze-retrieved plaque were also evaluated. Higher dentifrice fluoride concentrations led to greater remineralization and fluoridation of both lesion types and increased plaque fluoride concentrations. CSPS did not improve the cariostatic properties of SMFP; there were no statistically significant differences between 927 ppm F/5% CSPS and 927 ppm F/0% CSPS in percent SMH recovery (p = 0.6788), change in integrated mineral loss (p = 0.5908), or lesion depth (p = 0.6622). Likewise, 0 ppm F/5% CSPS did not provide any benefits in comparison to 0 ppm F/0% CSPS. In conclusion, CSPS does not negatively impact nor does it improve the ability of an SMFP dentifrice to affect remineralization of caries lesions.Item Antimicrobial photodynamic therapy alone or in combination with antibiotic local administration against biofilms of Fusobacterium nucleatum and Porphyromonas gingivalis(Elsevier, 2018-11) Tavares, Livia J.; de Avila, Erica D.; Klein, Marlise I.; Panariello, Beitriz H. D.; Spolidório, Denise M. P.; Pavarina, Ana Cláudia; Cariology, Operative Dentistry and Dental Public Health, School of DentistryAntimicrobial photodynamic therapy (aPDT) kills several planktonic pathogens. However, the susceptibility of biofilm-derived anaerobic bacteria to aPDT is poorly characterized. Here, we evaluated the effect of Photodithazine (PDZ)-mediated aPDT on Fusobacterium nucleatum and Porphyromonas gingivalis biofilms. In addition, aPDT was tested with metronidazole (MTZ) to explore the potential antimicrobial effect of the treatment. The minimum inhibitory concentration (MIC) of MTZ was defined for each bacterial species. Single-species biofilms of each species were grown on polystyrene plates under anaerobic conditions for five days. aPDT was performed by applying PDZ at concentrations of 50, 75 and 100 mg/L, followed by exposure to 50 J/cm2 LED light (660 nm) with or without MTZ. aPDT exhibited a significant reduction in bacterial viability at a PDZ concentration of 100 mg/L, with 1.12 log10 and 2.66 log10 reductions for F. nucleatum and P. gingivalis in biofilms, respectively. However, the antimicrobial effect against F. nucleatum was achieved only when aPDT was combined with MTZ at 100× MIC. Regarding P. gingivalis, the combination of PDZ-mediated aPDT at 100 mg/L with MTZ 100× MIC resulted in a 5 log10 reduction in the bacterial population. The potential antimicrobial effects of aPDT in combination with MTZ for both single pathogenic biofilms were confirmed by live/dead staining. These results suggest that localized antibiotic administration may be an adjuvant to aPDT to control F. nucleatum and P. gingivalis biofilms.Item Artificial biofilm thickness and salivary flow effects on fluoride efficacy – A model development study(2017-10-26) Lippert, Frank; Hara, Anderson T.; Churchley, David; Lynch, Richard J. M.This laboratory model development study investigated the interaction between artificial biofilm thickness and salivary flow rate on fluoride-mediated prevention of enamel caries lesion formation. This 5-day pH cycling study on sound bovine enamel specimens utilized a continuous flow model and followed a 4 (agarose biofilm thickness-‘no biofilm’/1/2/3mm)×2 (remineralizing solution flow rate-0.05/0.5ml/min)×2 (fluoride-0/383ppm as sodium fluoride) factorial design. Vickers surface microhardness change was the outcome measure. Data were analyzed with three-way ANOVA. The three-way interaction gel thickness×flow rate×fluoride concentration was significant (p=0.0006). 383ppm fluoride caused less softening than 0ppm regardless of gel thickness or flow rate. 0.5ml/min flow rate caused less softening than 0.05ml/min for ‘no biofilm’ and 1mm biofilm thickness regardless of fluoride concentration, for 2 and 3mm with 0ppm F but not for 383ppm F. For 0.05ml/min, softening was reduced as gel thickness increased from ‘no biofilm’-1-2mm, but not from 2-3mm. For 0.5ml/min, ‘no biofilm’ caused more softening than 1, 2, and 3mm, but 1, 2, and 3mm were not different from each other for both 0 and 383ppm F. The present findings suggest that the efficacy of fluoride in preventing enamel demineralization is affected by both biofilm thickness and salivary flow rate, with both thicker biofilms and higher flow rate resulting in less demineralization.Item Artificial Caries Lesion Characteristics after Secondary Demineralization with Theobromine-Containing Protocol(MDPI, 2021-01-08) Nassar, Hani M.; Lippert, Frank; Cariology, Operative Dentistry and Dental Public Health, School of DentistryDeveloping artificial caries lesions with varying characteristics is needed to adequately study caries process in vitro. The objective of this study was to investigate artificial caries lesion characteristics after secondary demineralization protocol containing theobromine and fluoride. Sixty bovine enamel slabs (4 × 3 mm) were demineralized using a Carbopol-containing protocol for 6 days. A baseline area (2 × 3 mm) was protected with acid-resistant nail varnish, after which specimens were exposed for 24 h to a secondary demineralization protocol containing acetic acid plus one of four fluoride/theobromine combinations (n = 15): theobromine (50 or 200 ppm) and fluoride (0 or 1 ppm). Specimens were sectioned and analyzed using transverse microradiography for changes in mineral content, lesion depth, and surface layer mineralization. Data was analyzed using paired t-test and analysis of variance followed by Bonferroni test at 0.05 significance level. After secondary demineralization, fluoride-containing groups had significantly deeper lesions (p = 0.002 and 0.014) compared to the group with 0 ppm fluoride and 50 ppm theobromine. Mineral content and lesion depth were significantly different compared to baseline for all groups. Theobromine did not show an added effect on mineral uptake. Theobromine-containing groups exhibited particularly deep lesions with a more uniform mineral profile in the presence of fluoride.Item Assessing the Effectiveness of Web-Based Modules on Human Papillomavirus Among Dental and Dental Hygiene Students(Springer, 2023) Shukla, Anubhuti; Chintapalli, Aparna; Ahmed, Mohammed Khader Alisha Bin; Welch, Kelly; Villa, Alessandro; Cariology, Operative Dentistry and Dental Public Health, School of DentistryLiterature suggests that deficiencies among dental professional students in both knowledge and awareness of human papillomavirus (HPV) and its association with oropharyngeal cancers (OPC), as well as its risk factors implicating the prevalence of HPV, may be due to the lack of HPV-related education during professional schooling. The aim of this study was to assess the effectiveness of an online learning tool to educate dental and dental hygiene students about HPV and its association with OPC, rapidly evolving disease patterns, and dental professionals' role in HPV-associated OPC prevention efforts. A three-section online learning module was developed to improve dental professionals' comfort levels with, and knowledge of, HPV. The participants were recruited to participate in surveys before and after the intervention. Descriptive statistics and chi-square analysis were computed to study the effectiveness of the modules in improving the knowledge of students about this topic. Pre-intervention survey participants totaled 142, and 107 participants answered the post-intervention survey. The majority of the study participants had some baseline understanding of HPV prior to accessing the modules. After reviewing the modules, there was a statistically significant increase in the proportion of respondents who identified OPC (p = 0.01), vaginal cancer (0.02), vulvar cancer (0.04), and penile cancer (0.01) as associated with HPV. A gap in the understanding of HPV vaccine-eligible groups was noted in almost half of the participants; while most participants could correctly identify that boys and girls aged 9-12 years were eligible to get the vaccine, the gap in knowledge in this regard was related to "25-year-old with an abnormal pap result." Due to the evolving nature of this topic, there is a need to find new and effective methods of disseminating HPV-related information among the existing and future dental workforce.