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News Bulletin : ADA News Bulletin October 2010
43 OCTOBER 2010 no false advice Please contact Garry Pammer, Alison Lacey or Heath Stewart on: Telephone (02) 9264 1111 Fax (02) 9264 1344 email firstname.lastname@example.org website clarkjacobs.com.au Dental specialists for over 20 years clinical hints This puzzles him because he never was Vice-Chairman of the Committee, but is flattered to think that the TGA thought he was, and think, four years later, he still is. COMPLEMEnTARY AnD ALTERnATIvE MEDICInES (CAMS) CAMS are big business. When you visit a pharmacy, you cannot fail to notice that there are shelves full of them, and they are not cheap. More importantly, the efficacy of many of them has not been verified by controlled clinical studies except perhaps by the placebo effect. And do not assume that because they are ‘natural’, they must be harmless. Think deadly nightshade (belladonna), foxglove (digitalis), castor oil (ricin), etc. We rely on the Therapeutic Goods Administration (TGA) to keep a close watch on all medications sold, whether CAMS or conventional medicines, imported or manufactured locally. A given plant’s active ingredients can vary enormously, and the TGA took successful action against Pan Pharmaceuticals anent consumer complaints about a product which, when tested by TGA, was found to have an active ingredient concentration varying from zero to six or seven times the label content. There was a massive recall of Pan products. TOOTHbRUSHES Many dentists probably find it discouraging that our patients have unfettered access to beautifully designed and highly effective toothbrushes and toothpastes which enhance plaque removal, remineralize (a little) the tooth surface and ensure gingival health, when used as instructed. But few patients do so. Even before the Christian Era (BCE) some health authorities advocated rubbing tooth surfaces with the finger and mild abrasives, plus flavourings, herbs or fragrant oils to maintain oral health, but one of the first to recommend the use of a brush for the teeth was the Islamic Prophet Muhammad (born circa 570 AD). He advocated using a twig about 12 mm diameter from the Salvadora Persica tree. The twig end is soaked in water for a day or so, then the end fibres are separated, the twig held like a pencil and used to brush the teeth. It is called a siwak or misswak. Similar brushes are still used in India and Asia, using twigs from the Arak or the Banyan tree. Tongue scraping and rinsing with various solutions have also been part of early oral hygiene efforts. By the 1500s tooth brushing was commonplace, but the brushes were in a primitive state of development. By the early 1800s, various toothbrush designs appeared. Some even had interchangable heads with different angulations and bristle types. Handles were of bone, ivory, wood and occasionally metal, and double-ended brushes appeared. The bristles were commonly hair from the pig or horse. The best quality brushes used Siberian hog hair, or, for a softer brush, Badger hair. Toothbrush manufacture was a labour- intensive activity until William Addis decided to make toothbrushes. He was in gaol at the time. He introduced mass production in 1780. His son, also William, carried on, and Addis descendants are still making toothbrushes. Google ’Addis’ and you will find that it has ‘an easy grip handle for maximum control, and extra hard filaments for effective removal of tobacco and food stains’. It probably also removes epithelium, and a modest amount of tooth enamel. Almost everyone now uses a toothbrush, and after decades of explaining, we dentists have at last convinced most folk to use soft brushes. Your Compiler has just counted 72 toothbrush types at a local supermarket, in a bewildering variety of shapes, sizes and bristle types, manual and electric, with messages on the packaging espousing this or that special feature. In your Expositor’s opinion, hardly any of the special features would improve significantly the effectiveness of the user’s tooth brushing, especially the one advertised recently on television: a brush with a hole through the middle of the handle, to accommodate the user’s thumb. Electric toothbrushes are an exception. They have been shown to improve effectiveness. See Clinical Hint below. Much the same situation applies to toothpastes, with more than a dozen on the shelves claiming a variety of beneficial effects. But the only ones with proven claims are those which desensitize or reduce caries. Particularly objectionable are those pastes which claim to ‘‘whiten the teeth”. The only unusual ingredient in them is titanium dioxide, which makes the toothpastes look ‘refrigerator white’, but titanium dioxide is inert, and can have no effect on the appearance of tooth enamel. It is particularly disturbing that one brand has a person pictured on the box, stated to be a ‘registered dentist’ and ‘whitening specialist’, and naming a suburb. Your Recorder wonders how one acquires a qualification as a ‘whitening specialist’.
ADA News Bulletin September 2010
ADA News Bulletin November 2010