Randomized controlled trial to evaluate tooth stain reduction with nicotine replacement gum during a smoking cessation program

Israeli dentists' knowledge, attitudes, and practices regarding smoking cessation care

BACKGROUND

The 5A's model for brief smoking cessation care (SCC) is recommended for dentists to reduce the negative impacts of smoking on oral health. This study investigates Israeli dentists' adherence to the 5A's guidelines and explores factors influencing their knowledge, attitudes, and practices.

METHODS

An online cross-sectional survey was conducted among Israeli dentists during June-August 2020. The questionnaire included sociodemographic, smoking, and professional characteristics; knowledge (10 true/false statements); attitudes regarding SCC [based on the Theoretical Domains Framework (TDF)] using 13 statements (1-5 Likert scale), for a composite mean attitude score; and 5A's performance (1-5 Likert scale, never to always). Two primary outcomes were analysed: (1) performing all of the 5A's 'often or always'; and (2) performing 'always' the first two steps ("Ask" and "Advise"). Multivariable logistic regression explored the association between the various characteristics and the primary outcomes.

RESULTS

Overall, n = 410 responded. Mean knowledge score was 2.58 (SD = 1.51). Mean attitude score was 2.65 (SD = 0.60). Performance of all 5A's was low with 14.1% (n = 57) reporting completing all 5A's 'often or always', while 34.1% (n = 139) reported 'always' performing 'Ask' and 'Advise'. Specialists had better odds of 'often or always' performing the 5A's (adjusted OR = 2.01, p = .022) and 'always' performing 'Ask and Advise' (adjusted OR = 1.71, p = .022).

CONCLUSIONS

This study highlights the insufficient performance of SCC among Israeli dentists, revealing gaps in knowledge and attitudes related to SCC. Various measures, such as training, automatic referral systems, and integrating SCC as quality measures, may improve SCC provision among Israeli dentists.

Effect of tobacco and nicotine in causing staining of dental hard tissues and dental materials: A systematic review and meta-analysis

INTRODUCTION

Dental staining is a common concern for tobacco users. However, little is known about which components of tobacco are responsible for the staining and whether nicotine may be implicated. This is of increasing relevance with the popularity of novel products such as heated-tobacco products and electronic cigarettes (E-cigarettes).

OBJECTIVES

This systematic review aimed to establish the evidence base for the effect if any, of the various tobacco and nicotine products in causing staining of dental hard tissues and materials.

MATERIAL AND METHODS

This systematic review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. There were four structured population intervention comparison outcomesquestions. A search was conducted up to December 2021 in three databases: MEDLINE, EMBASE, and Web of Science, and manual searching of relevant sources was also completed. Two researchers individually reviewed the titles then abstracts and finally full articles. A reporting quality appraisal was conducted appropriately to the study methodology.

RESULTS

Of the 815 records titles identified, 56 full-text articles were assessed for eligibility, of which 27 were included for analysis. The included studies were mainly laboratory studies of varying reporting quality. There was evidence from 18 studies that tobacco exposure caused staining of dental hard tissues (pooled results from three studies- enamel/dentine; mean difference [MD]: 16.22; 95% confidence interval[12.11, 20.32; I2 : 96%)and materials (pooled result from four studies-resin composite; MD: 11.90; 95% CI: 11.47, 12.34; I2 : 100%). There was limited evidence that E-cigarettes 99%) and heated tobacco products (HTPs; pooled results from three studies--1.07, 6.54; I2 : 99%) cause staining, but this was lower than with traditional tobacco/found 11 compounds, of which 8 were terpenoids, from tobacco products implicated in causing staining. Finally, there was some evidence that resin composites stained more than other materials.

CONCLUSIONS

Tobacco smoking causes dental staining. There was limited evidence that E-cigarettes and HTPs did cause dental staining that was less intense than that caused by traditional tobacco products.

Effects of tobacco product use on oral health and the role of oral healthcare providers in cessation: A narrative review

Tobacco use has detrimental effects on health, including oral health. The emergence and increasing popularity of newer tobacco and nicotine products make tobacco use one of the major public health problems in the world. Tobacco use increases the risk of oral diseases such as oral cancer, oral mucosal lesions, periodontal disease, and dental caries, among many other oral diseases and conditions. The dental office is an excellent venue for providing cessation intervention. However, there is a lack of knowledge and training in tobacco use prevention among dental professionals. More efforts are needed for smoking cessation interventions in the dental office. Smoking cessation interventions provided by oral healthcare providers include brief educational, behavioral, and pharmacological interventions. This review provides an overview of the ill effects of tobacco use on oral health and the role of oral healthcare providers in managing and preventing tobacco dependence.

Drug-induced tooth discoloration: An analysis of the US food and drug administration adverse event reporting system

Background: Certain drugs can cause intrinsic or extrinsic tooth discoloration, which is not only a clinical issue but also an esthetic problem. However, limited investigations have focused on drug-induced tooth discoloration. The present work aimed to determine the drugs causing tooth discoloration and to estimate their risks of causing tooth discoloration. Methods: An observational, retrospective, and pharmacovigilance analysis was conducted, in which we extracted adverse event (AE) reports involving tooth discoloration by using the data of the US Food and Drug Administration's Adverse Event Reporting System (FAERS) from the first quarter (Q1) of 2004 to the third quarter (Q3) of 2021. Disproportionality analyses were performed to examine risk signals for tooth discoloration and determine the drugs inducing tooth discoloration. Results: Based on predefined inclusion criteria, 1188 AE reports involving 302 suspected drugs were identified. After data mining, 25 drugs generated positive risk signals for tooth discoloration, of which 10 were anti-infectives for systemic use. The top reported drug was tetracycline (n = 106), followed by salmeterol and fluticasone (n = 68), amoxicillin (n = 60), chlorhexidine (n = 54), and nicotine (n = 52). Cetylpyridinium (PRR = 472.2, ROR = 502.5), tetracycline (PRR = 220.4, ROR = 277), stannous fluoride (PRR = 254.3, ROR = 262.8), hydrogen peroxide (PRR = 240.0, ROR = 247.6), and chlorhexidine (PRR = 107.0, ROR = 108.4) showed stronger associations with tooth discoloration than the remaining drugs. Of 625 AE reports involving 25 drugs with positive risk signals, tooth discoloration was mostly reported in patients aged 45-64 (n = 110) and ≤18 (n = 95), and 29.4% (192/652) of the reports recorded serious outcomes. Conclusion: This study revealed that certain drugs are significantly associated with tooth discoloration. Caution should be exercised when using these drugs, especially during pregnancy and early childhood.

Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis

BACKGROUND

Cigarette smoking is one of the leading causes of early death. Varenicline [Champix (UK), Pfizer Europe MA EEIG, Brussels, Belgium; or Chantix (USA), Pfizer Inc., Mission, KS, USA], bupropion (Zyban; GlaxoSmithKline, Brentford, UK) and nicotine replacement therapy are licensed aids for quitting smoking in the UK. Although not licensed, e-cigarettes may also be used in English smoking cessation services. Concerns have been raised about the safety of these medicines and e-cigarettes.

OBJECTIVES

To determine the clinical effectiveness, safety and cost-effectiveness of smoking cessation medicines and e-cigarettes.

DESIGN

Systematic reviews, network meta-analyses and cost-effectiveness analysis informed by the network meta-analysis results.

SETTING

Primary care practices, hospitals, clinics, universities, workplaces, nursing or residential homes.

PARTICIPANTS

Smokers aged ≥ 18 years of all ethnicities using UK-licensed smoking cessation therapies and/or e-cigarettes.

INTERVENTIONS

Varenicline, bupropion and nicotine replacement therapy as monotherapies and in combination treatments at standard, low or high dose, combination nicotine replacement therapy and e-cigarette monotherapies.

MAIN OUTCOME MEASURES

Effectiveness - continuous or sustained abstinence. Safety - serious adverse events, major adverse cardiovascular events and major adverse neuropsychiatric events.

DATA SOURCES

Ten databases, reference lists of relevant research articles and previous reviews. Searches were performed from inception until 16 March 2017 and updated on 19 February 2019.

REVIEW METHODS

Three reviewers screened the search results. Data were extracted and risk of bias was assessed by one reviewer and checked by the other reviewers. Network meta-analyses were conducted for effectiveness and safety outcomes. Cost-effectiveness was evaluated using an amended version of the Benefits of Smoking Cessation on Outcomes model.

RESULTS

Most monotherapies and combination treatments were more effective than placebo at achieving sustained abstinence. Varenicline standard plus nicotine replacement therapy standard (odds ratio 5.75, 95% credible interval 2.27 to 14.90) was ranked first for sustained abstinence, followed by e-cigarette low (odds ratio 3.22, 95% credible interval 0.97 to 12.60), although these estimates have high uncertainty. We found effect modification for counselling and dependence, with a higher proportion of smokers who received counselling achieving sustained abstinence than those who did not receive counselling, and higher odds of sustained abstinence among participants with higher average dependence scores. We found that bupropion standard increased odds of serious adverse events compared with placebo (odds ratio 1.27, 95% credible interval 1.04 to 1.58). There were no differences between interventions in terms of major adverse cardiovascular events. There was evidence of increased odds of major adverse neuropsychiatric events for smokers randomised to varenicline standard compared with those randomised to bupropion standard (odds ratio 1.43, 95% credible interval 1.02 to 2.09). There was a high level of uncertainty about the most cost-effective intervention, although all were cost-effective compared with nicotine replacement therapy low at the £20,000 per quality-adjusted life-year threshold. E-cigarette low appeared to be most cost-effective in the base case, followed by varenicline standard plus nicotine replacement therapy standard. When the impact of major adverse neuropsychiatric events was excluded, varenicline standard plus nicotine replacement therapy standard was most cost-effective, followed by varenicline low plus nicotine replacement therapy standard. When limited to licensed interventions in the UK, nicotine replacement therapy standard was most cost-effective, followed by varenicline standard.

LIMITATIONS

Comparisons between active interventions were informed almost exclusively by indirect evidence. Findings were imprecise because of the small numbers of adverse events identified.

CONCLUSIONS

Combined therapies of medicines are among the most clinically effective, safe and cost-effective treatment options for smokers. Although the combined therapy of nicotine replacement therapy and varenicline at standard doses was the most effective treatment, this is currently unlicensed for use in the UK.

FUTURE WORK

Researchers should examine the use of these treatments alongside counselling and continue investigating the long-term effectiveness and safety of e-cigarettes for smoking cessation compared with active interventions such as nicotine replacement therapy.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42016041302.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 59. See the NIHR Journals Library website for further project information.

The effect of electronic cigarettes on dental enamel color

OBJECTIVE

The use of electronic cigarettes (ECIGs) has recently increased as an alternative to conventional smoking tobacco products. The literature is scarce on the effects of ECIGs on dental and oral structures. Therefore, the objective of this study was to observe whether ECIG aerosol could alter the color of dental enamel.

MATERIALS AND METHODS

Sixty-three bovine enamel specimens were randomly separated into groups (n = 7) and treated with aerosols with different e-liquid flavors (neutral, menthol, and tobacco) and nicotine content (0, 12, and 18 mg). The initial color assessment was performed using a spectrophotometer (Easy Shade-Vita). Dental enamel was exposed to 20 cycles of ECIG aerosol in a smoking machine, and the final color was measured. The color change was evaluated using ΔEab, ΔE00, and Whiteness Index (WI_D ) formulae. Differences in L* a* b* coordinates were calculated, and data were analyzed (two-way ANOVA, uncorrected Fisher's LSD post hoc test, α = 0.05).

RESULTS

Luminosity (ΔL) was reduced by aerosols with almost all levels of nicotine content and neutral and menthol flavors. Flavored e-liquids caused more color change (P < .05) according to ΔEab and ΔE00. ΔE values from both formulae exceeded the thresholds for perceptible visual alterations of color. WI_D increased after ECIGs exposure for menthol and tobacco and decreased for neutral flavors.

CONCLUSIONS

ECIG aerosol from e-liquids with different nicotine contents and flavors altered enamel color. Menthol and tobacco e-liquids may alter the enamel color decreasing the yellowness of the enamel compared to neutral e-liquid.

CLINICAL SIGNIFICANCE

Electronic cigarettes can cause perceptible changes in tooth color, altering dental esthetics.

Crosstalk between oral and general health status in e-smokers

Electronic cigarette (e-cigarette) simulates the act of tobacco smoking by vaporizing a mixture of propylene glycol, nicotine, and flavoring agents. e-cigarette has been proposed as a product able to aid to stop smoking. The aim of the study is to verify the clinical variations of periodontal health induced by e-cigarettes use and, moreover, to investigate about the awareness of the e-smokers about their health variations and about their hypothetical need to turn back to smoke combustible cigarettes.This clinical observational pilot study involved 110 out of 350 smokers, who switched to e-cigarette. Patients were subjected to oral examinations. A questionnaire to self-assess the variations of some parameters of general health, and to self-assess the need to smoke combustible cigarettes, was distributed to such subjects involved in the study.At the end of the study, we registered a progressive improvement in the periodontal indexes, as well as in the general health perception. Finally, many patients reported an interesting reduction in the need to smoke.In the light of this pilot study, the e-cigarette can be considered as a valuable alternative to tobacco cigarettes, but with a positive impact on periodontal and general health status.

Análise da capacidade de remoção de pigmentos da resina composta pelo peróxido de hidrogênio 35%

Resumo Objetivo Avaliar in vitro a capacidade de remoção de pigmentos ocasionados em resina composta após aplicação de peróxido de hidrogênio 35%. Material e método Confeccionaram-se 20 amostras de resina composta Opallis (FGM), cor A1, em matriz metálica circular. As amostras foram divididas em quatro grupos (n=5) dos seguintes agentes corantes: água destilada (controle), café, vinho tinto e Coca-Cola®. No manchamento, as amostras ficaram imersas nas soluções durante 72 horas, com troca diária das bebidas. Procedeu-se à aplicação do gel de peróxido de hidrogênio 35% (Whiteness HP Blue Calcium, FGM) em três sessões, sendo uma aplicação do gel por sessão, o qual permaneceu nas amostras durante 40 minutos. Medidas de cor foram feitas inicialmente, após manchamento, após aplicação do peróxido e por mais 21 dias, usando espectrofotômetro Vita Easyshade. Os dados foram submetidos à análise de variância de dois fatores (tempo vs. corante) e ao teste de Tukey, para o contraste das médias (α=0,05). Resultado Apresentaram alteração de cor (ΔE - média/desvio padrão de L*) o café (15,7 ± 2,0) e o vinho (15,2 ± 4,6), quando comparados à Coca-Cola® (4,8 ± 1,9). O peróxido de hidrogênio removeu a pigmentação das amostras, porém, para nenhum dos corantes, houve retorno à coloração inicial, principalmente no grupo manchado por café (12,9 ± 1,5); este mostrou diferença significativa quando comparado ao controle (1,6 ± 0,6), diferentemente do vinho (3,3 ± 0,6) e da Coca-Cola® (2,1 ± 0,9), que se aproximaram do grupo controle. Conclusão As soluções corantes pigmentaram a resina composta, principalmente o café. A aplicação do peróxido de hidrogênio 35% foi eficaz na remoção de pigmentos das amostras, porém, em nenhum dos grupos, com diferentes corantes, houve retorno à coloração inicial (p>0,005).

Extrinsic stain removal with a toothpowder: A randomized controlled trial

OBJECTIVES

The efficacy of a commercially available toothpowder was compared with toothpaste in removing extrinsic dental stains.

METHODS

In this single-blind, randomized controlled trial, 77 volunteers were included from a residential professional college. All study subjects (control toothpaste users and test toothpowder users) plaque control measures. All study subjects were instructed to rinse with 5 ml 0.12% chlorhexidine mouthwash for 1 minute, twice and one cup of double tea bag solution three times daily for three weeks. Subjects were randomized into test (n=36) and control (n=36) groups. Toothpaste (control) and toothpowder (test) was used for two weeks to see the effects on removing stains on the labial surfaces of 12 anterior teeth. For measuring dental extrinsic stains Lobene Stain Index (SI) was used.

RESULTS

The amount of stain following the use of toothpaste and toothpowder was more controlled with the experimental toothpowder. For all sites combined, there was evidence that the experimental toothpowder was significantly superior to toothpaste in reducing stain area (p<.001), stain intensity (p<.001) and composite/product (area × intensity) (p<.001).

CONCLUSION

Stain removing efficacy of toothpowder was significantly higher as compared with toothpaste. A toothpowder may be expected to be of benefit in controlling and removing extrinsic dental staining.

Multiple logistic regression analysis of risk factors associated with denture plaque and staining in Chinese removable denture wearers over 40 years old in Xi'an--a cross-sectional study

Background

Removable dentures are subject to plaque and/or staining problems. Denture hygiene habits and risk factors differ among countries and regions. The aims of this study were to assess hygiene habits and denture plaque and staining risk factors in Chinese removable denture wearers aged >40 years in Xi’an through multiple logistic regression analysis (MLRA).

Methods

Questionnaires were administered to 222 patients whose removable dentures were examined clinically to assess wear status and levels of plaque and staining. Univariate analyses were performed to identify potential risk factors for denture plaque/staining. MLRA was performed to identify significant risk factors.

Results

Brushing (77.93%) was the most prevalent cleaning method in the present study. Only 16.4% of patients regularly used commercial cleansers. Most (81.08%) patients removed their dentures overnight. MLRA indicated that potential risk factors for denture plaque were the duration of denture use (reference, ≤0.5 years; 2.1–5 years: OR = 4.155, P = 0.001; >5 years: OR = 7.238, P<0.001) and cleaning method (reference, chemical cleanser; running water: OR = 7.081, P = 0.010; brushing: OR = 3.567, P = 0.005). Potential risk factors for denture staining were female gender (OR = 0.377, P = 0.013), smoking (OR = 5.471, P = 0.031), tea consumption (OR = 3.957, P = 0.002), denture scratching (OR = 4.557, P = 0.036), duration of denture use (reference, ≤0.5 years; 2.1–5 years: OR = 7.899, P = 0.001; >5 years: OR = 27.226, P<0.001), and cleaning method (reference, chemical cleanser; running water: OR = 29.184, P<0.001; brushing: OR = 4.236, P = 0.007).

Conclusion

Denture hygiene habits need further improvement. An understanding of the risk factors for denture plaque and staining may provide the basis for preventive efforts.