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Lupine Publishers | Mouth Guards: Guardians of the Dontium

Lupine Publishers| Journal of Pediatric Dentistry with High Impact Factor

Abstract

Children and teens are more prone to injuries while playing, with most of the impact taken by the face especially the jaws and the teeth. The most significant factor in preventing sports-related or recreational orofacial injuries is wearing basic protective devices such as properly fitting helmets, face masks, or mouth guards. A mouth guard, custom-fitted by your dentist and worn every time you play or train, will protect against dental injury. Mouth guards are available in 3 different variants which are stock, self-adapting, custom-made mouth guards. The benefits far exceed the expenditure when considering the fees and discomfort associated with a traumatic dental injury
Keywords: Mouth Guard; Orofacial Structures; Teeth; Custom; Sports; Injuries

Introduction

Physical activity forms a very important part of life. There have been constant reports of sedentary lifestyle being associated with disease processes and over the time a lot of importance has been emphasized on physical activities be it the gym or the sports. Children and teens are more prone to injuries while playing, with most of the impact taken by the face especially the jaws and the teeth. Hence, it becomes very important to wear protective gear as these injuries might not only cause temporary impairment but also cause hindrance to the growth and development of the facial structures and also may lead to an unaesthetic appearance of the child at the later stage. The injuries occurring in sports can range from a simple ball-hit to a serious impairment of the head, face or the mouth. It is very important to wear protective gear when you are actively participating in any recreational outdoor events and also in some instances in the indoor activities with the risk of injuries. The most significant factor in preventing sports-related or recreational orofacial injuries is wearing basic protective devices such as properly fitting helmets, face masks, or mouth guards. The use of the mouth guard forms the basic minimal requirement for protecting your mouth, which should form an essential piece of the athletic equipment that the athlete should use as the standard gear equipment from a very early age.
A mouth guard, custom-fitted by your dentist and worn every time you play or train, will protect against dental injury. Well-fitted mouth guards prevent violent contact between the maxillary and mandibular dentition, which can result in soft tissue lacerations, tooth avulsions, tooth or bone fractures, endodontic injuries, and concussions [1]. This being said it has been found that injury to teeth are 60 times more likely when the athlete is not wearing the mouth guard than when he/she is wearing it. Statistically, sporting activities contribute to nearly one-third of all dental injuries [2-4]. Mouth guards help buffer an impact or blow that otherwise could cause broken teeth, jaw injuries or cuts to the lip, tongue or face. Mouth guards also may reduce the rate and severity of concussions Consequently, the dentist plays an important role in informing patients, athletes and their parents, and coaches of the importance of prevention, diagnosis, and treatment of orofacial injuries in sports and recreational activities [1].
A mouth guard should be able to fulfill the following basic requirements:
a) Encompass all maxillary teeth extending up to the distal surfaces of the second molars in class I and class II patients [4-7].
b) Encompass all mandibular teeth extending up to the distal surfaces of the second molar on class III patients [4-7].
c) Mouth guard may be abridged to cover until the distal surfaces of the first molars, in case it is known to trigger the gag reflex of the patient [4].
d) The labial flange should range to within 2mm of the sulcus [5].
e) The palatal flange should range around 2mm above the gingival margin [5].
f) The margins of the labial flange should be rounded.
g) The margins of the palatal edge should be tapered [5].
h) Be easy to clean [8,9].
i) Not impede with breathing or speech activity [4].
j) Be fabricated from a material approved by the U.S. Food and Drug Administration that can reduce the impact force to teeth, surrounding soft tissues, and bone [4,9].
k) Be comfortable and retentive and fit properly [9].
Mouth guards are available in different variants
A. Stock
B. Self-adapting
C. Custom-made
A. Stock
These are readily available over the counter in different sizes, made from polyurethane, a copolymer of vinyl acetate, or ethylene. As they are produced in bulk and are of standard sizes, they remain inexpensive, however they offer a low level of protection with little retention and is not so easily accepted by the athlete. The need to hold the mouth guard in place by clenching his or her teeth together is another disadvantage.
B. Self-Adapting
Also known as the “boil-and-bite” type mouth guard. It is readily available over the counter and made from ethylene-vinyl acetate (EVA). Herein, it is heated in hot water and then placed in the mouth to be adapted to the teeth by biting down. It is relatively inexpensive and can be replaced frequently in athletes with a mixed dentition or by individuals who are experiencing rapid growth. It has the property of re-adaptability. However, it is often bulky and does not retain its shape over time.
C. Custom-Made
The custom-made mouth guard is fabricated in a dental laboratory on a cast taken from an impression made by a dentist. The custom-made mouth guard offers the best fit and the most protection of any of the protective devices [4,5,9]. It is usually made of a thermoplastic material that is heated and adapted to the cast under pressure or with a vacuum form machine. Due to the laborious work involved in the fabrication of this type of appliance, it is expensive but retentive. The American College of Prosthodontists (ACP) recommends the use of custom mouth guards for all contact sports and for any recreational activities that may hypothetically end in orofacial injuries. Accurate maxillary and mandibular alginate impressions in centric occlusion registration recorded by a qualified dentist at approximately 5-mm opening anteriorly shall be used for fabrication of the custom trays as recommended by the ACP.4,5 The standard thickness is 4-mm, however 5- or 6-mm thickness is recommended as it will be able to protect the athlete better in case of extreme sports [4].
Mouth guards can be either single-layered or multi-layered. Currently, the most commonly used materials in the construction of custom mouth guards are EVA copolymer, soft acrylic resin, polyvinyl chloride, polyvinyl acetate-polyethylene (pEVA), and elastomers [1,8,9]. Many different designs of multi-layered materials are available. The most frequently used is a double layer made of similar materials. Dual laminated mouth guards possess an outer hard shell of styrolbutadiene co-polymerisate, and a soft inner layer of ethylene copolymer and vinyl acetate. This design of a more rigid outer material with an inner softer material will reduce the impact force transferred to the teeth due to the shock-absorbing capability of the softer layer [4,5]. The critical areas in terms of energy absorption and transmitted forces are the incisal edges of the anterior teeth and the attached (marginal) gingiva. Therefore, an optimal thickness of the device is achieved by the application of vacuum forming pressure-lamination technique of two layers of a thermoplastic sheet (EVA copolymer) and if necessary, by placing two layers of protective air-cells against the critical areas. An acrylic-resin-based elastomer may be processed over the thermoplastic sheet to improve protection for the athlete [4]. Custom-made mouth guards have proved to be the most effective means of prevention of injuries to the orofacial structures [1,4,5]. They are superior in quality, comfort, retention, and prevention of injuries when compared to stock or self-adapting devices. Although custom-made mouth guards are the most expensive type of protective oral device, they are the most highly recommended.

Conclusion

The benefits far exceed the expenditure when considering the fees and discomfort associated with a traumatic dental injury. Further, it becomes the duty of the dentist to create awareness among the athletes and make it a habit for them to wear mouth guard as a part of their equipment for sports.

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Lupine Publishers | Comparison of the Efficacy of Plaque Removal of Listerine Smart Rinse Kids and Vi– One Junior Fluoridated Mouthwash in Children Aged 6 To 10 Years

Lupine Publishers | Journal of Pediatric Dentistry with High Impact Factor

Abstract

Objectives: In this study, a comparative study was done on the effects of Vi-One and Listerine fluoridated mouthwashes on the reduction of dental plaque in pediatric patients between 7-11 years of age in dental clinics of Sepideh and apple in Shiraz, Iran. Listerine Smart Rinse Kids is a product of the United States and Vi-One Junior mouth wash is the domestic production of the country at Rozhin Corporation. This research was conducted by Mohammad Karimi and Hassan Dehghan in 2018-2019.
Material and Methods: In this study, 100 individuals were selected and divided into two groups of 50. During the study, no other method of controlling the plaque was used. In this method, the first group first used Vi-One mouthwash for 10 days and after two weeks of rest and minimizing dental plaque, they used Listerine for 10 days. While the second group used Listerine first, then they applied Vi- One in the same way. The results of this review were then evaluated.
Results: The mean of plaque index in total mouth and in the posterior teeth area with the use of Listerine Smart Rinse Kids was lower than that of Vi-One Junior mouth rinse. In another words, Listerine had a better effect on plaque removal than the Vi-One mouthwash in the posterior mandibular region.
Conclusion: The results show that although Listerine mouthwash had a better effect on dental plaque removal, none of the two mouthwashes had a significant difference in effects on maxillary and mandibular jaws.
Keywords: Dental Plaque; Vi- One, Listerine, Fluoridated Mouthwash; Periodontal Diseases; Plaque Index

Introduction

Currently, dental caries and gingivitis are common oral and dental diseases in this country. One element that can prevent tooth decay is Fluoride. In the oral health program of the country, fluoride mouth wash 2% was used to prevent dental caries in elementary school students all over the country [1]. In the other hand, dental plaque is an important factor in the formation of dental caries and periodontal diseases. Leo and his colleagues have identified dental plaque as the main cause of gingivitis [2]. With the use of mouthwashes, one can control the dental plaque, chemically [3,4]. In fact, mechanical plaque removal is one of the most common and effective methods for preventing caries and inflammation of the gum [5]. Fluoride mouthwash usage is contraindicated in children younger than six years of age due to the risk of swallowing and causing systemic toxicity and fluorosis [6-8]. Symptoms of acute oral fluoride toxicity in children include severe nausea, vomiting, hyper salivation, abdominal pain, and diarrhea [9]. In severe or fatal cases, these symptoms can be followed by convulsions, cardiac arrhythmias, and coma [10- 12]. Laboratory and animal data have shown that prevention the accumulation of plaque and consequently, reduction in dental plaque can be achieved when fluorides is applied topically which inhibits the bacterial multiplication [13]. The fluoride from mouth rinse is retained in dental plaque and saliva to help prevent dental caries [14]. In one review, the average caries reduction in nonfluoridated communities attributable to fluoride mouth rinse was 31% [15]. Another study in Sweden reported that the use of fluoride mouthwash along with brushing has a significant effect in decreasing of dental caries [16]. Listerine Smart Rinse Kids has been used for the purpose of this study. This product is an alcoholfree mouthwash. The ingredients include Sodium fluoride 0.02% (0.01% w/v fluoride ion), Water, Sorbitol, flavor, phosphoric acid, Sucralose, Cetylpyridinium chloride, disodium phosphate, sodium saccharin, menthol, blue 1 and green 3 [17]. One study reported that use of this mouthwash can strengthen teeth 99% better than brushing alone [18]. Another source indicated that it gives 12- hour cavity protection [19]. Vi-one Junior Mouthwash is specially designed for children. This mouth rinse contains Sodium fluoride 0.05%, Cetylpyridinium chloride 0.05% and Disodium phosphate agents. The respective flavors contain sugar-free and harmless sweetener. This brand also is an alcohol-free product [20]. The purpose of this study was to compare the efficacy of two types of mouthwashes, one the domestic mouthwash (Vi-One Junior) and the other, the brand name Listerine Smart Rinse kids fluoridated mouthwash in the removal of the dental plaque.

Material and Methods

This study was a cross-over clinical trial. The eligibilities for entering in our study were as follow:
a) Children having at least 20 teeth with no large restorative area.
b) No history of periodontal Diseases.
c) Not having any Prosthodontic or Orthodontic appliances.
The condition for withdrawal from the study, if there was any sign of reactions to any of these mouth rinses. There was no obligation to have any food regimen.
The study population consisted of 100 patients who were in a 50-member group. Before taking oral mouthwash, plaque index was minimized, and all subjects underwent tooth scaling at the beginning and, if necessary, teeth polishing were done before taking mouthwash. Oral hygiene was assessed via a plaque index. First, in both groups, the Silness-Löe plaque index was recorded. It is an Index for evaluating the thickness of the plaque in the gingival region, which measures the thickness of plaque on all surfaces (M, B, D, and L) [21].
Coding for the plaque index was carried out according to the criteria [22]:
a) Code 0: No plaque
b) Code 1: A film of plaque is adhering to the free gingival margin and adjacent area of the tooth. The plaque may be seen in situ only after application of disclosing solution or by using the probe on the tooth surface.
c) Code 2: Moderate accumulation of soft deposits can be seen with the naked eye within the gingival pocket, the tooth, or gingival margin.
d) Code 3: Abundance of soft matter can be seen within the gingival pocket and/or on the tooth, and gingival margin.
In this index, each tooth is divided into four surface area but in our purposes in the present study, we modified the surfaces area from 4 to 6; thus, we have three surfaces in the buccal area (Mesiobuccal, Midbuccal, and Distobuccal) and three surfaces in the lingual area (Mesiolingual, Midlingual and Distolingual). The first group used Vi-One & Listerine mouthwash (kids mouthwash), for 10 days in the following way. Needless to say, this process was supervised by parents at home. The kids have to gargle 5 cc ’s of Vi-One mouthwash 2 times per day for 30 seconds, and during this period of time, no other plaque control methods and tooth brushing should be used. At the end of the period of 10 days, the plaque index was recorded again. Then, the subjects were given a week to rest and stop using the mouthwash while they had permission to start brushing like before. Again, the plaque index was minimized for patients with polishing the teeth, and they used Listerine mouthwash for 10 days. In the same way, 5 cc ‘s of the mouthwash twice daily was used for 30 seconds, and at the end of the one-week period, the plaque was recorded. For the second group, in the first 10 days, mouthwash. Listerine was prescribed and in the second 10 days, the Vi-One mouthwash was applied. All procedures were performed according to the above pattern.

Results

Paired T-test was used for statistical analysis of the findings. The findings showed when Listerine Smart Rinse Kids was used; the mean of plaque index in all area of the mouth (especially in the mandibular jaw and the posterior region) was significantly less than the time Vi-One was applied. However, there was no significant efficacy difference between the use of both types of mouthwash in the upper jaw and the anterior region.
There was no significant difference between the mean plaque index in Vi-One mouthwash between upper and lower jaw, and there was no significant difference between the maxillary and lower jaw in the case of Listerine Smart Rinse Kids either. The presence of this indicator in both types of mouthwash in the anterior region was significantly less than the posterior region. The mean and standard deviation of the plaque index in both groups, as well as in different regions of the mouth, are listed in Table 1.

Table 1: The amount of dental plaque in terms of area and type of Mouthwash.

Discussion

In general, the anti-plaque properties of mouthwashes are completed through bactericidal and bacteriostatic effects, separation of microorganisms from dental surfaces, loosening of joints to these surfaces or lowering of the surface tension of the tooth [2,21,23]. Some mouthwashes can be useful for preventing tooth decay or periodontitis [6,24]. Furthermore, mouthwashes are recommended for children and adolescents with orthodontic appliances or adults who need deep cleansing (such as curettage) [6]. These types of mouthwashes were generally used before and after surgery (especially Chlorhexidine) and have a very positive effect on the treatment of gum and ulcerative inflammation [6]. Use of this type of mouthwash should not last longer than 2 to 3 weeks due to some side effects such as staining the teeth and soft tissue staining, increased calculus deposition, unpleasant taste, burning sensation, and mucosal irritation [6]. It’s time to use this mouthwash after brushing and before bedtime, and it’s best not to eat anything after half an hour after use. Fluoride-containing mouthwashes are another type of mouth rinse that has a fairly large use. These mouthwashes have a significant effect on teeth strengthening. Fluoride in the mouthwash cause bonding with enamel and dentin, and with bonding with calcium and phosphorus, they form Fluorapatite, which is more resistant to caries than Hydroxyapatite. Fluorides also accelerate the mineralization, repair the decayed teeth surfaces, and help to increase the reverse processing of damaged tooth surface area [25,26]. Fluoride also reduces the effect of oral bacteria on teeth. It is done by interfering with the function and formation of the microorganisms. The best fluoride mouthwash protects the teeth against the acids which are produced by dental plaques. “Neglecting the oral hygiene of children leads to the accumulation of plaque and as a consequent the formation of dental calculus which will have a devastating effect on the both child’s gums and teeth” [27].
In one study, the statics showed an alcohol-free mouthwash containing a combination of 0.075% CPC and 0.05% Na F produces statistically significant reductions in dental plaque and gingivitis after three and six months compared to baseline [28]. In another research, Jessica E. Koopman, et al argued that the oral microbial community displayed remarkable resilience towards the disturbances it was presented with. The effects of the fluoride mouthwash on the microbial composition were trivial [29]. On the other side, in another study, the research showed that all four fluoride mouth rinses were effective in decreasing the plaque levels of S. Mutans [30]. In this study, we investigated the effect of two mouthwashes of Listerine Smart Rinse Kids and Vi-One in which Vi-One mouthwash in the posterior region was less efficient than the Listerine mouthwash, and the interesting point that most kids mentioned the taste of Listerine was more acceptable. Given that the contents of sodium fluoride were equal in both mouthwashes, due to the fact that Listerine mouthwash was more acceptable than the mouthwash, it could be related to the other materials present in this product which can be a part of the manufacturer’s secrets. This difference in taste can be a factor in the effect of improving Listerine’s efficacy in the posterior regions.

Conclusion

Listerine Smart Rinse Kids had a better effect on plaque removal than the Vi-One mouthwash in the posterior mandibular region. Both types of mouthwash had a better effect on the anterior region than the posterior region, but none of the two mouth rinses had a different effect on the maxillary and lower jaw. Although many popular types of mouthwash may help to control dental plaque and gingivitis, they should only be used as an adjunct to other oral hygiene measures such as brushing and flossing. Fluoride mouthwashes should be encouraged in children above the age of 6 with a high risk of caries.

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