The quality of the assigned values is dependent, to a large extent, on the skills of the examiners and on the validity of the assessment methods that are used. Therefore, much attention has to be paid to the common sources of error and bias that can lead to difficulties in standardizing examiners [68]. Personal oral hygiene is often combined with therapeutics such check details as fluoride or xylitol, which have an effect on dental diseases and possibly tooth loss, making the evaluation of the pure effects of oral hygiene behavior difficult. Because the evidence for the effectiveness of these chemo-therapeuticals

is sufficiently convincing that withholding them may be considered unethical. However, alternative delivery mechanisms, such as chewing gum, may be viable, more practical, and more reliable than personal oral hygiene tools. Another possibility is to evaluate variations in the level of personal oral hygiene (much like studying varying levels of fat intake, physical activity, etc.). Advances in toothbrush technology are associated with more effective plaque removal, but excessive plaque regrowth can also be a problem for individuals. Therefore, there is a need for products that not only help users achieve optimal plaque removal, but also ensure that plaque levels remain controlled overnight and throughout

the day, Luminespib cell line thereby reducing the risk of oral hygiene becoming suboptimal. The choice of dentifrice had a significant effect on the inhibition of plaque regrowth in a study with manual toothbrushes and may also play an important role in optimizing the level of plaque control achieved with power brushing. The systematic review of the Cochrane database by Walsh et al. [69] confirmed the benefits of using fluoride toothpaste to

prevent caries in children and adolescents, Immune system but only for fluoride concentrations of 1000 ppm and above. The relative caries preventive effect of fluoride toothpastes increases with higher fluoride concentration. However, the choice of fluoride level to use for children under 6 years should be balanced with the risk of fluorosis. Haftenberger et al. [70] reported that most 1–3-year-old children in Brazil are exposed to a daily fluoride intake above the suggested threshold for dental fluorosis. The dentifrice alone was responsible for an average of 81.5% of the daily fluoride intake, while the diet, water and milk were the other most important contributors. Although the efficacy of fluoride paste has been confirmed, information about its risks should be given more emphasis. Accordingly, detailed longitudinal studies of fluoride intake during tooth brushing with toothpaste in large populations are still needed, especially of very young children in various countries and areas. There is evidence that casein phosphopeptide-amorphous calcium phosphate, CPP-ACP, can bolster the effects of fluoridated toothpaste alone to prevent caries.