The aim of this systematic review and meta-analysis was to evaluate the masking success of bleaching and/or resin infiltration treatment of fluorotic lesions in anterior teeth of adults and adolescents. PubMed, Cochrane Library, and Embase were systematically searched from the beginning of documentation to December 31, 2023. A tooth was considered masked when the color difference (ΔE CIE76) between fluorotic areas and the surrounding sound enamel was ≤3.7 and unmasked if ΔE > 3.7. Secondary outcomes were mean ΔE values between fluorotic and sound enamel reported for a treatment group at baseline and after any intervention as well as patient satisfaction. Of 1575 search results 4 publications met the inclusion criteria, comprising 230 treated anterior teeth with fluorosis in 47 patients. Meta-analyses were performed comparing the result after treatment (bleaching, resin infiltration, or bleaching followed by resin infiltration) to baseline. Bleaching and resin infiltration were suitable intervention strategies to improve the esthetics of fluorosis affected anterior teeth, with a combination of both treatment approaches being particularly effective in reducing the color difference between fluorotic defects and the surrounding sound enamel below the acceptability thresholds of 3.7 (success rate [95 %CI]: 0.75 [0.44, 1.06]). Patient satisfaction increased after treatments, indicating a beneficial impact on their mental health. The overall bias of the included studies was 2.5 (ROBINS-I analysis tool). There is evidence that resin infiltration with preceding bleaching therapy is more effective in masking fluorotic lesions in anterior teeth than bleaching alone. The combination therapy also showed a tendency towards higher success rates compared to infiltration alone. However, this difference was statistically not significant, and more studies are needed to further assess the efficacy of specific treatments and their combinations as well as the certainty in the evidence. The methodologic heterogeneity of study designs regarding estimation of color difference before and after treatment and bleaching protocols calls for unification in future studies. Results of this systematic review and meta-analysis revealed the combination of bleaching followed by resin infiltration as efficacious approach for masking fluorotic lesions in young adults. While resin infiltration alone improves the aesthetic appearance of fluorotic lesions, dentists should consider a combined bleaching-infiltration regimen to achieve more favorable clinical outcome for their patients.

This study aimed to establish whether the modified Schirmer test could serve as a diagnostic tool for dry mouth, that is, whether it could reliably measure salivary film at selected locations within the oral cavity, and to identify levels of sensitivity/specificity and determine reference values. Therefore, a cross‐sectional study (N = 120, mean age 63.5 [SD 13.9] years) was performed. The test was used at five locations (hard palate; buccal mucosa in molar region at 4 mm above occlusal plane; anterior tongue; lower lip; mouth floor), and results were recorded after 1, 2 and 3 min. A statistically significant discriminatory ability of the Schirmer test for the unstimulated salivary flow rates could be shown for the palate (at 3 min), buccal mucosa (at 1 min), mouth floor (at 1 min), and tongue (at 2 and 3 min) (areas under the curve 0.64–0.68), with individual sensitivity/specificity values depending on test location/time points. Thus, the modified Schirmer test has potential to become a simple and reproducible instrument for the detection of dry mouth based on low unstimulated salivary flow rates in dentistry and especially outreach care. Care must be taken concerning intraoral test location and measurement time.

Although dry mouth is a relatively common condition, salivary flow is not routinely measured in dental clinical practice. Moreover, existing data regarding the use of the modified Schirmer test (MST) for the screening of dry mouth has not been summarized. This systematic review and meta‐analysis, conducted in accordance with the PRISMA guidelines, aimed to determine whether the modified Schirmer test can be used to identify dry mouth. The databases of PubMed, Scopus, ScienceDirect, and CENTRAL (CRD42023393843) were systematically searched to retrieve articles published until 9th November 2023. Among the 343 original articles retrieved, six met the inclusion criteria. A total of 1150 patients, comprising 710 (61.7%) women and 440 (38.3%) men (mean age, 47.1 ± 7.3 years), were included. The meta‐analysis revealed a weak correlation coefficient of = 0.42 (95% Cl: 0.29–0.55) between MST and the unstimulated salivary flow rate. Therefore, while the MST might offer a simple and accessible alternative for initial screening in the future, especially in non‐specialized settings, its variability in sensitivity and specificity, along with an actual lack of standardization, necessitates cautious interpretation. Further studies are necessary before recommending the test in clinical routine.

Objectives: Anticholinergics cause dry mouth and are highly relevant for dentists, but little is known about the relationships between intake and the occurrence of subjective and objective dry mouth with age. The German anticholinergic burden score (GACB) is a novel anticholinergic score that re‐evaluates medications, particularly, those with classification discrepancies.Material and Methods: We retrospectively investigated the GACB in older patients receiving dental care, evaluated whether GACB is related to xerostomia and unstimulated salivary secretion, and determined the influence of increasing age (beginning at 50 years of age). The GACB score quantified cumulative anticholinergic effects: 0 for no effect, 1 for possible, 2 for moderate, and 3 for strong. Cross‐sectional data in patients ≥ 50 years were collected, including xerostomia with the visual analog scale, unstimulated salivary flow rates, and the GACB scores.Results: Among 172 patients (mean age 65.67 ± 9.51 years), 23.8% had a GACB score ≥ 1. A moderate negative correlation was observed between GACB and unstimulated salivary flow rates ( = −0.51). Patients with GACB ≥ 1 had fewer teeth (mean 21.76 ± 5.41) than those with GACB = 0 (24.07 ± 5.57). Moreover, unstimulated hyposalivation was observed in 61.0% with GACB ≥ 1 versus 6.8% with GACB = 0 (p < 0.001). Escalating chronic systemic conditions and prescribed medications were recorded with increasing age; those aged 76–80 years had the highest burden.Conclusions: The GACB quickly and reliably assesses anticholinergic exposure and risks for oral health in older patients. Routine use in those aged ≥ 50 years could enable early identification of risks and initiation of preventive dental measures.Trial Registration: German Registry for Clinical Trials: DRKS00032877 (https://www.germanctr.de; date of registration: 17.10.2023).

The authors investigated the color stability of resin-infiltrated white-spot lesions (WSL) after in-office tooth bleaching (IB) or home tooth bleaching (HB) and assessed the potential for staining and rebleaching. Sixty caries-free third molars were demineralized to create WSLs and then divided into 4 groups: (1) no treatment (control) group; (2) demineralization plus resin infiltration group; (3) demineralization plus resin infiltration plus IB group; (4) and demineralization plus resin infiltration plus HB group. After exposure to coffee solution to simulate 12-month staining potential, a second bleaching procedure was performed. Color measurements were obtained at 10 defined time points using standardized digital imaging and analyzed in the Commission Internationale de l'Eclairage-L^∗a^∗b^∗ (lightness, red-green axis, yellow-blue axis) color space. To precisely document color changes, time points included baseline, after WSL creation, after resin infiltration, after bleaching procedures, after thermocycling (aging), after coffee exposure, and after rebleaching. No significant differences in bleaching effectiveness were observed between IB and HB after initial (P = .127) or subsequent (P = .111) bleaching. Similarly, there were no significant differences (P = .867) in staining potential between the IB and HB groups after 12 days. Both bleaching methods restored the WSL color close to the baseline after staining. Both IB and HB restored the color of resin-infiltrated WSLs to near-baseline levels after staining in vitro, with no significant differences between the 2 methods. Although results of the treatments showed responsiveness to whitening protocols, color stability under staining conditions remained limited, highlighting the need for further investigation into long-term maintenance strategies. Both IB and HB approaches may be clinically viable for maintaining the esthetic stability of treated WSLs over time once sufficient evidence from clinical studies becomes available.