Prevalence of oral soft and hard tissue lesions related to mechanical toothcleansing procedures

Increased gingival dimensions. A significant factor for successful outcome of root coverage procedures? A 2-year prospective clinical study

The aim of this study was to evaluate whether an increased thickness of the gingiva through the use of a free connective tissue graft, in conjunction with a coronally advanced flap procedure, may positively influence the treatment outcome with respect to (i) root coverage and (ii) long-term stability of the position of the soft tissue margin following treatment of recession type defects. 67 consecutive patients having a total of 103 buccally located recession type defects of at least 3 mm were included in the study. After an initial phase of prophylaxis including instructions in a tooth brushing technique giving minimal apically directed forces to the gingival margin, the recession sites were surgically covered with a coronally advanced flap alone (control sites), or coronally advanced flap combined with a free connective tissue graft taken from the palate (test sites). Clinical examinations, including assessments of oral hygiene, gingival conditions, recession depth, gingival height, probing pocket depth and probing attachment loss, were performed before and 6, 12 and 24 months after surgical treatment. The mean initial recession depth for both treatment groups was about 4.0 mm (SD 1.0) with a gingival height apical to the recession of 1.0 mm (0.5). At the re-examination performed 6 months after surgical treatment, the mean recession depth had decreased to 0.2 mm in both the test and control groups. Complete root coverage was observed at 72% of the test sites and 74% of the control teeth. At teeth treated with the combined surgical procedure, the mean gain in probing attachment amounted to 3.7 mm and the mean gingival height had increased to 3.5 mm (0.6). The corresponding figures for control teeth were 3.6 mm and 1.5 mm (0.5), respectively. At the 24-month follow-up examination, the mean root coverage amounted to 98.9% (test) and 97.1% (control). 88% of the teeth in the test group showed complete root coverage compared to 80% for teeth in the control group. It was concluded that the 2 surgical procedures resulted in similar degree of root coverage and that changes of tooth brushing habits may be of greater importance than increased gingival thickness for long-term maintenance of the surgically established position of the soft tissue margin.

Case-control study of non-carious cervical lesions

An exploratory case-control study of non-carious cervical lesions was undertaken to examine the effects of a variety of risk factors. Candidate exposure variables were related to erosion, abrasion, and tooth flexure, the three principal putative causal mechanisms for cervical lesions. Because previous studies have tended to focus on specific causal mechanisms, evidence for a multifactorial etiology is inconclusive. Data describing exposure factors were obtained through clinical examination, dietary and behavioral questionnaires, and analysis of study casts from 264 subjects (137 cases, 127 control). Salivary data were also obtained for a subset of these subjects. Patient and tooth-level logistic regression models were constructed for the full subject group, and the subset with salivary data. For the two patient-level models, only exposures related to brushing entered. For tooth-level models, multiple exposures representing all three causal mechanisms were included in both models. The results suggest that non-carious cervical lesions do have a multifactorial etiology, and that multiple causal mechanisms may operate in the initiation and progression of individual lesions.

Risk factors for periodontal diseases in Ilala, Tanzania

The purpose of this study was to evaluate associations between periodontal diseases and the common risk factors in Ilala, Tanzania. To determine behavioural and socioeconomic background, a total of 1764 subjects (827 males and 937 females) aged 3-84 years were randomly selected and interviewed. The subjects were examined clinically for the presence of plaque, calculus, gingival inflammation, periodontal probing depths and gingival recessions. Logistic regression analyses showed that the risk factors for gingivitis were male sex, presence of plaque or calculus and use of local "mswaki", the risk factors for periodontal pockets were age of 35 years or more, presence of plaque, and rural residence. The risk factors for gingival recession were identified as age of 35 years or more, male sex, lower educational status, presence of plaque and gingival inflammation. The most significant risk factors to have periodontal diseases in this study population were age, sex, education, rural residence, plaque and calculus.

Preventive behaviors as correlates of periodontal health status

OBJECTIVES

This investigation examined current practices of brushing, flossing, and periodic dental visits and their association with periodontal health status.

METHODS

Data were collected using face-to-face interviews and 40-minute in-home dental examinations with a probability sample of adults 18 years of age or older, having at least one tooth, and living in housing units in the Detroit tricounty area. Complete examinations were performed on 319 individuals.

RESULTS

On average, subjects reported brushing their teeth about twice a day. About one-third of the population reported flossing at least once a day. Loss of periodontal attachment was related to frequency of brushing while subjects who exhibited acceptable flossing ability had less plaque and calculus, shallower pocket depths, and less attachment loss. Subjects reporting a periodic dental visit at least once a year had less plaque, gingivitis, and calculus than subjects reporting less frequent visits. In regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores. In turn, these scores were predictors of shallower pocket depths and less attachment loss.

CONCLUSIONS

Brushing, flossing, and periodic dental visits were correlated with better periodontal health. The behaviors appeared to be indirectly related to pocket depth and attachment loss through their associations with plaque, gingivitis, and calculus levels.

The micromorphology in vivo of the buccocervical region of premolar teeth in young adults. A replica study by scanning electron microscopy

The buccal surfaces of premolar teeth are common sites of gingival recession, generally attributed to overzealous oral hygiene. Scanning electron microscopy (SEM) of replicas made from dental impressions was applied to document the micromorphology of the buccocervical region of all premolar teeth in 27 dentally healthy, young adults. The SEM observations were correlated with clinical examination. Of the 216 sites, one-third, predominantly the maxillary first premolars, had gingival recession, but fewer than 50% were clinically discernible. The exposed roots were devoid of cementum, and the dentinal surface was smear-like or dotted with tubular apertures from which droplets of fluid extruded. SEM of replicas of gingiva, recorded as clinically healthy, frequently showed signs of inflammation: fluid exudate and distortion of gingival contour by swelling. The cervical enamel of healthy and affected sites showed characteristic periodic fissure-like cracks, probably enamel tufts. The high frequency of subclinical gingival recession, exposed cervical dentin, and gingival inflammation in dentally healthy young adults, in the absence of abrasion of hard or soft tissues, indicates the need to review conventional concepts of initiation of buccal recession and root exposure.

Gingival recession: intra-oral distribution and associated factors

This study assesses the role of poor oral hygiene and forceful toothbrushing as risk factors for recession. As part of a cross-sectional root surface caries study, 298 subjects, 42 to 67 years of age, with at least one exposed root surface, were examined. Since 66% of the root surface exposure and practically all the abrasion was on buccal surfaces, the analyses focused only on the buccal surface. Analysis of variance on subject means for buccal recession showed both calculus and presence of buccal root surfaces with abrasion to be significantly associated with recession after adjusting for age and gender. Root surface abrasion was considered a surrogate variable for forceful brushing. An additional analysis utilized means for each tooth, aggregating across subjects. For each of the 32 tooth types mean buccal recession, percent of exposed root surfaces with abrasion (%ra), and mean debris and calculus scores were calculated. Partial correlation coefficients across tooth types between recession and calculus, adjusting for abrasion, and for recession and abrasion adjusting for calculus, were 0.55. Interpretation of the %ra as a crude measure of forceful brushing is supported by its strong negative correlation across tooth types, with mean debris (r = -0.8) and mean calculus (r = -0.7). Separate analyses on premolars and on molars suggested that recession on premolars may be primarily due to brushing force and on the molars may be primarily due to debris and calculus. The findings suggest that recession is positively associated with percent abrasion (reflecting forceful brushing) and with poor oral hygiene.

Non-carious cervical lesions

Non-carious cervical lesions are commonly encountered in clinical practice and present in a variety of forms. A knowledge of the aetiology of these lesions is important for preventing further lesions, halting progression of lesions already present, and determining appropriate treatment. The most commonly cited aetiological factors thought to lead to the development of cervical lesions are erosion, abrasion and tooth flexure. Evidence supports a multifactorial aetiology for non-carious cervical lesions. The purpose of this paper is to review the evidence for each of these aetiological factors as it relates to the development of non-carious cervical lesions. Specific features of cervical lesions linked to these factors, including their morphology, location, prevalence and distribution by age and sex will be discussed. Suggestions for future research into the cause and prevention of non-carious cervical lesions will be presented.

The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene

The aim of this study was to evaluate the prevalence and the development/progression of attachment loss and gingival recession at buccal tooth surfaces in a population sample with a high standard of oral hygiene. An additional aim was to study the relationship between attachment loss and gingival recession. The subject sample examined comprised 225 regular dental care attendants at 12 community dental clinics in Sweden. All subjects were subjected to a baseline examination in 1977-78 and were re-examined after 5 years and 12 years. The clinical examinations involved assessment of plaque, gingivitis, probing depth, probing attachment loss and gingival recession. A full-mouth set of intraoral radiographs was obtained at each examination and used for determination of the height of periodontal bone support. The results of the cross-sectional and longitudinal analyses performed showed that in subjects with a high standard of oral hygiene (i) buccal gingival recession was a frequent finding, (ii) the proportion of subjects with recession increased with age, (iii) the prevalence as well as the incidence of recessions within the dentition showed different patterns depending on age, (iv) sites with recession showed susceptibility for additional apical displacement of the gingival margin and (v) loss of approximal periodontal support was associated with gingival recession at the buccal surface.

Gingival recession in relation to history of hard toothbrush use

Gingival recession studies in the U.S. have related primarily to sex and age with little consideration of toothbrush hardness. This preliminary study examined the relation between a history of hard toothbrush use and gingival recession. A total of 182 subjects, male and female, between 18 and 65 years of age, with a minimum of 18 natural teeth, no advanced periodontitis or history of periodontal surgery were examined. Gingival recession was scored as present whenever the free gingival margin was apical to the cemento-enamel junction and root surface was exposed. History of hard toothbrush use was ascertained. Eighty-two subjects had a history of hard toothbrush use, 77 did not, and 23 did not know. The percentage of subjects with recession increased with age from 43% to 81%, with a figure of 63% for all age groups combined. Males tended to show slightly greater levels of recession than females. Regression analysis showed that females had about 4 percentage points less receded surfaces than males. Recession was also found to be more pronounced for subjects with a history of hard toothbrush use, with a mean of 9.4% receded surfaces versus 4.7% for those who had never used a hard brush. For users of hard toothbrushes, the percent of surfaces with recession showed a significant and dramatic increase with increasing brushing frequency; this effect did not exist for those without a history of hard brush use. The relation with age was highly significant, with regression analysis showing that the percent of surfaces with recession tends to increase about 3.5 percentage points per decade.(ABSTRACT TRUNCATED AT 250 WORDS)

Extent and severity of periodontal destruction based on partial clinical assessments

The aim of the present study was (i) to identify the 10 approximal tooth sites that provide Extent and Severity estimates of clinical attachment loss which are maximally coherent to the full mouth scores, and (ii) to evaluate the applicability of such a partial recording system. Data from two subject samples, comprising 192 subjects aged 30-64 yr (sample A) and 175 subjects aged 35-80 yr (sample B), were involved in the development and the evaluation of the system, respectively. Approximal probing attachment loss (PAL) measurements were available from all subjects. A PAL value of > 1 mm was required for a tooth site in order to qualify for the Extent and Severity computations. A full mouth bivariate Extent and Severity Index (FESI) was firstly calculated for every subject in sample A. Multiple regression models applied on data derived from the same sample identified the 10 approximal tooth sites which provided the best correlation to the full-mouth scores (correlation coefficients between partial and full mouth scorings of Extent and Severity 0.85 and 0.88, respectively). All tooth types were found to be represented in this set of sites and the ratio of mesial/distal sites was 6/4. The applicability of a partial recording system (PESI) based on these sites was evaluated in sample B. Fully comparable estimates between PESI and FESI values were obtained, but the degree of correlation varied at different ages. Further adjustments by means of regression models failed to increase the validity and reliability of the PESI.(ABSTRACT TRUNCATED AT 250 WORDS)

How dentists classified and treated non-carious cervical lesions

All North Carolina general dentists were shown color photographs of three non-carious cervical lesions. A fourth picture showed cervical caries. Respondents were asked how they defined each lesion, its cause, treatment and frequency of appearance in practice. Cervical caries was identified and treated by almost all responding dentists, but they applied more varied terms, causes and treatments to non-carious defects.

Cleaning effectiveness of chewing sticks among Tanzanian schoolchildren

The oral hygiene of habitual chewing stick and toothbrush users who participated in an oral health education (OHE) programme in schools was evaluated. The study comprised all chewing stick users (n = 45) in standard 4 in 8 randomly selected experimental schools and all chewing stick users (n = 17) in standard 4 in 4 randomly selected control schools. Each chewing stick user was randomly matched with a toothbrush user of the same sex, age and school. Their ages ranged from 10 to 13 years with a mean of 11.5 years. The children in standard 4 of the 8 experimental schools received OHE. Among many topics aiming to improve oral health of children, the practice of systematic brushing was taught. The children practised weekly brushing sessions in schools under the supervision of instructed teachers. At baseline, the chewing stick users exhibited statistically significant more plaque, but their gingival condition was comparable with their matched toothbrush counter-parts. After 3 months, the chewing stick and the toothbrush users in the experimental schools, had reduced their plaque and gingival bleeding scores significantly to the same extent, whereas no substantial changes in oral hygiene occurred in the control group. The findings show that schoolchildren who participated in a school programme that emphasizes effective toothbrushing were able to improve their oral hygiene regardless of whether they were habitual chewing stick or toothbrush users.

Buccal attachment loss in Swedish adolescents

A case referent study was performed to identify factors connected with loss of buccal attachment in adolescents. The study group was identified among 18-year-olds who had participated 2 years earlier in a study of periodontal conditions in adolescents. The criterion for inclusion in the case group was buccal attachment loss (greater than or equal to 1 mm) in one or more sites. Information on 28 variables, identified earlier as being related to recessions, was collected in a clinical examination, interview and observation. The referent group consisted of 66 subjects and the case group of 71 subjects. The case group comprised 2 subgroups, one identified as having buccal attachment loss in 1987 and the other with attachment loss occurring in the years 1987-89. Statistical analyses, using the chi 2 test, logistic regression and a variance component model, were performed to detect factors related to buccal attachment loss. These factors were thin alveolar tissue, narrow width of the attached gingiva and presence of teeth with buccal displacement. The results indicate that the anatomy of the buccal alveolar process is related to the presence of buccal attachment loss in populations with a high level of oral hygiene. To evaluate the importance of possible risk factors or etiological factors for development of buccal loss of tooth support, prospective epidemiological or experimental studies are needed.

The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession

This paper describes the occurrence and levels of gingival recession in 2 cohorts of individuals participating in parallel longitudinal studies in Norway (1969-1988) and Sri Lanka (1970-1990), covering the age range from 15 to 50 years. In the Norwegian cohort gingival recession had begun early in life. It occurred in greater than or equal to 60% of the 20 year-olds and was confined to the buccal surfaces. At 30, greater than or equal to 70% had recession, which still was found mainly on buccal surfaces. As the group approached 50 years of age, more than 90% had gingival recession; greater than or equal to 25% of the buccal surfaces were involved, greater than or equal to 15% of lingual, and 3 to 4% of the interproximal surfaces. In the Sri Lankan cohort greater than or equal to 30% exhibited gingival recession before the age of 20 years. By 30 years, 90% had recession on buccal, lingual, and interproximal surfaces; and at 40 years, 100% of the Sri Lankans had recession. As they approached 50 years, gingival recession occurred in greater than or equal to 70% of the buccal, greater than or equal to 50% of the lingual, and 40% of the interproximal surfaces. Based on the special features of the two cohorts, the working hypothesis is advanced that there is more than one type of gingival recession and probably several factors determining the initiation and development of these lesions.

Stress-induced cervical lesions

The increasing occurrence of dental lesions at the cervical surfaces requires more knowledge of the causes of the process. Acidic and abrasive mechanisms have clearly been documented as causes but the stress theory by Lee and Eakle is still controversial. This report describes several incidences of possible stress-induced lesions according to the characteristics described by Lee and Eakle. The occurrences of subgingival lesions lend credence to the stress-induction theory by exclusion of other superimposing etiologic factors. With the current concepts, a perceptive approach to the treatment of cervical lesions can be executed.

Episodic factitious gingival injury secondary to topical anesthesia. A case report

The contribution of topical anesthesia to the incidence of severe factitious gingival injury in an adult patient is reported. A brief review of the literature is also presented.

The effect of mechanical oral hygiene procedures on bleeding on probing

The purpose of the present study was to investigate the effect of mechanical oral hygiene procedures on bleeding on probing in relation to age and periodontal status. The study was carried out on 49 individuals divided into 7 experimental groups according to age and having been either treated for destructive periodontal disease or having an intact healthy periodontium. In order to eliminate any pre-existant gingival inflammation, all subjects received a carefully controlled oral hygiene program. At the start of the experiment, all subjects were instructed to abstain from oral hygiene procedures for 24 h. Thereafter, clinical baseline measurements were carried out, including bleeding on probing (BOP) using a standardized probing pressure. Next, all subjects cleaned their teeth according to their normal oral home care protocol using a multitufted toothbrush, toothpicks and interdental brushes. BOP scores were again assessed 30 min after completed tooth cleaning procedures. The results revealed a significant increase in BOP after the mechanical oral hygiene procedures in every individual in all experimental groups (p less than 0.05). Further analysis showed that the increase in BOP was independent of the periodontal status of the subjects. However the BOP scores after mechanical oral hygiene procedures were higher in the young age groups. It was concluded that the diagnostic predictability of BOP in the treatment of periodontal diseases might be affected by temporarily elevated BOP scores shortly after mechanical oral hygiene procedures.

Occurrence of gingival recession in adults

The occurrence of gingival recession was investigated in adults by age and gender and in relation to their dental status and frequency of toothbrushing. A total of 258 dentate subjects were clinically examined. Their mean age was 46 years and they had an average of 19.4 natural teeth. Gingival recession was recorded as present if any root surface was clearly visible without retraction of the gingival tissue. Recession was found on at least one tooth surface in 68% of subjects. Mean number of surfaces with recession was 7.2 for women and 10.4 for men. Subjects with gingival recession had fewer natural teeth than did those without recession. The two groups did not differ from each other in the number of filled teeth and decayed teeth. Mandibular teeth had more surfaces with recession than did maxillary ones. Sites of recession occurred quite symmetrically. Frequent toothbrushers had, both in the maxilla and mandible, more surfaces with recession than had those brushing their teeth infrequently. Frequent toothbrushing had a greater association with recession among women and in the youngest age group.

Methodological issues relative to the quantification of root surface caries

The purpose of this study was to assess the effect upon the quantification of root surface caries (RSC) of (1) the separation of the disease into its discrete clinical phases, (2) the confounding caused by the presence of restored abraded surfaces, and (3) the decision rule formulated for dealing with lesions and restorations which involve both crown and root. It was found that the apparent prevalence of RSC varied widely depending upon arbitrary decisions as to what stages of the disease were included in the measurement scheme. The addition of restorations (confined to the root) greatly enlarged the various disease measures, but probably also introduced some degree of error since there are several indications from the data and the clinical patterns of affected surfaces which suggest that some of the restored surfaces were formerly abraded rather than carious. The inclusion of lesions and restorations involving both root and crown produced another conspicuous increment in all disease measures, which is a cause for concern given that these components are included in some studies and ignored in others. These findings serve as the basis for several recommendations for future prevalence and incidence studies of RSC.

Cervical abrasion in relation to toothbrushing and periodontal health

Cervical abrasion and some factors related to oral hygiene habits and periodontal health were investigated in 250 subjects aged 21-60 yr. The subjects were considered dentally aware since they had visited their dentist on a regular basis over the past several years. A high occurrence rate of cervical abrasion was noted with 85% of subjects exhibiting at least one superficial lesion. Manifest or deep lesions, although less common, were present in 22% of subjects. Both prevalence and severity increased with age. The severity expressed as the mean number of lesions was 7.3 for the total sample. It increased significantly with calculus index, frequency of periodontal pockets, and reduction of the alveolar bone height. No significant associations were observed between abrasion and oral hygiene factors. It is concluded that cervical abrasion, although most likely related to toothbrushing, may not be synonymous with periodontal health. Ineffective toothbrushing may not only fail to prevent disease but may also cause cervical abrasion.

Periodontal diseases in adult Kenyans

This study comprised 1131 persons who constitute a stratified random sample of the entire population aged 15-65 years in Machakos District, Kenya. Each person was examined for tooth mobility, plaque, calculus, gingival bleeding, loss of attachment and pocket depth on the mesial, buccal, distal and lingual surface of each tooth. The oral hygiene was poor with plaque on 75-95% and calculus on 10-85% of the surfaces depending on age. Irrespective of age, pockets greater than or equal to 4 mm was seen on less than 20% of the surfaces, whereas 10-85% of the surfaces had loss of attachment greater than or equal to 1 mm. The proportion of surfaces per individual with loss of attachment greater than or equal to 4 mm or greater than or equal to 7 mm, and pocket depths greater than or equal to 4 mm or greater than or equal to 7 mm, respectively, showed a pronounced skewed distribution, indicating that in each age group, a subfraction of individuals is responsible for a substantial proportion of the total periodontal breakdown. The individual teeth within the dentition also showed a marked variation in the severity of periodontal breakdown. Our findings provide additional evidence that destructive periodontal disease should not be perceived as an inevitable consequence of gingivitis which ultimately leads to considerable tooth loss. A more specific characterization of the features of periodontal breakdown in those individuals who seem particularly susceptible is therefore warranted.

Aspects of the validity of buccal loss of attachment greater than or equal to 1 mm in studies of early periodontitis

The aim of this study was to consider the validity of measurements of loss of attachment on buccal surfaces in studies of early periodontitis and in particular to monitor the development of loss of attachment greater than or equal to 1 mm on buccal surfaces over a 2-year study period in 229 subjects initially aged 14.3 years and to relate this loss of attachment to gingival status and oral cleanliness at baseline. 3 subgroups were considered: the first comprised 83 subjects who developed no loss of attachment over the 2-year study period; subgroup 2 comprised 56 subjects who developed loss of attachment greater than or equal to 1 mm on buccal surfaces only; subgroup 3 comprised 75 subjects who developed loss of attachment greater than or equal to 1 mm on at least 1 buccal surface and on at least 1 mesio-buccal surface over the study period. The mean number of buccal sites with plaque, subgingival calculus, gingival colour change and gingival bleeding at baseline was lower in subgroup 2 than subgroup 3, the differences being significant for the latter three variables. The data failed to reject the null hypothesis of no differences between subgroups 2 and 1. It was concluded that the buccal loss of attachment greater than or equal to 1 mm found in subgroup 2 at age 16 years was associated with few oral deposits and little gingival inflammation and could probably be related to toothbrushing practices.(ABSTRACT TRUNCATED AT 250 WORDS)

Gingival abrasion and plaque removal after toothbrushing with an electric and a manual toothbrush

The aim of the study was to evaluate the cleanliness achieved with and the number of gingival lesions caused by brushing with a manual, multitufted toothbrush and an electric toothbrush that oscillated horizontally and vertically. Fifteen female dental assistant students participated in the crossover clinical trial. Eight students brushed their teeth for the first 2 weeks with the multitufted manual brush and seven with the electric brush. For the next 2 weeks the brush assignment was reversed. After the two brushing periods the number of gingival lesions and the amount of stained plaque were recorded. The manual toothbrush caused more gingival lesions than the electric brush (P less than 0.05). With regard to plaque scores, no difference was found between manual and electric brushing.

Periodontal status in university students

The periodontal status of 217 5th-year students (aged 25-26 years and born in Helsinki) at the University of Helsinki was assessed. The students had been eligible for community-based dental care free of charge until the age of 18 years, after which they could obtain low-cost dental care from the Helsinki Student Health Service. Their periodontal status was determined according the community periodontal index of treatment needs; gingival retraction was recorded when 1 mm or more of the cementum was exposed. Code 0 sextant was found for 67% of the women and 57% of the men. 20% of the students examined had sextant scoring of code 3; no-one had code 4 sextants. 69% of the women and 49% of the men had gingival retraction, in average 1.5 +/- 0.5 mm. No correlation was found between the frequency of toothbrushing or the hand used for brushing and the number of retractions, nor did the number of healthy sextants correlate with the frequency of retractions. The findings emphasize the importance of better guidance regarding qualitative aspects of oral hygiene at home.

Abrasivity of toothpastes. An in vitro study of toothpastes marketed in Norway

The purpose of this study was to measure the abrasivity of 23 toothpastes available on the Norwegian market. Additionally, the pH was registered. The testing was based on The British Standards Institution's specification for toothpastes, using a profilometer technique to evaluate the abrasion. The results showed that the abrasivity ranged from 0.049 to 1.367 relative to a standard reference paste. The products were classified as having 'none/slight', 'medium', or 'high' abrasivity. The pH varied between 3.7 and 10.1. Products with low pH showed evidence of a combined erosive/abrasive effect. For some brands there were statistically significant differences between the fluoride and the nonfluoride version.

Pattern of periodontal breakdown in adult Tanzanians

A total of 170 adult Tanzanians aged 30-69 yr were examined for loss of attachment, gingival recession, plaque, calculus and gingival bleeding on all surfaces of all teeth. The severity of loss of attachment varied considerably between tooth types. Irrespective of age, mandibular incisors and first and second molars were the teeth most affected by loss of attachment. In all age groups heavy plaque deposits and gingival bleeding occurred more frequently in posterior than in anterior teeth. Dental calculus was most frequently observed in the maxillary posterior and mandibular anterior teeth. The distribution of calculus within the dentition showed a close resemblance with the patterns of loss of attachment and gingival recession. The variation of the severity of periodontal breakdown within individuals indicates that the use of mean values to describe periodontal breakdown may give the impression of a greater uniformity than really exists.

Periodontal status of secondary crowded mandibular incisors. Long-term results after orthodontic treatment

The present study was undertaken to examine whether secondary crowded mandibular incisors experience more periodontal breakdown than aligned lower incisors long-term after orthodontic treatment. Patients from 19 to 35 years after active treatment were selected. 2 groups were established: 1 with crowded mandibular incisors and 1 with aligned incisors. The groups were matched according to age, time after treatment, gender and periodontal disease classification. A separate group with crowded and aligned incisors within the same individual was established. Accumulation of plaque, gingival inflammation, probing pocket depth and probing attachment level were registered at 6 locations around each incisor. Among the patients studied, the oral hygiene level was high. In both groups, the loss of connective tissue attachment was largely due to periodontal pocket formation in interproximal areas and gingival retraction in buccal and lingual areas. A small but statistically significant difference in probing attachment level was found between crowded and aligned interproximal areas within the same individual (P less than 0.05). No differences in accumulation of plaque or in gingival inflammation were found. No differences were found for any of the dependent variables between the groups with crowded and aligned incisors.

Periodontal status of mandibular incisors following excessive proclination. A study in adults with surgically treated mandibular prognathism

The present study was undertaken to examine whether excessive proclination of mandibular incisors results in gingival retraction. In patients with surgically treated mandibular prognathism, 29 with more than 10 degrees proclination of mandibular incisors and 33 with minimal change in incisor inclination during presurgical orthodontic phase were selected. A total of 21 and 19 patients, respectively, could meet for a clinical follow-up examination including Visible Plaque Index, Gingival Bleeding Index, probing pocket depth, and length of supracrestal connective tissue attachment. Study models and intraoral color slides were also made. The mean postoperative times at this examination were 7.8 (SD 2.5) and 8.1 (SD 2.8) years, respectively. Clinical crown height was measured on the study models taken before and after appliance therapy, at the 3-year postoperative control (check) and at the follow-up examination. The number of teeth with recession was determined from the color slides taken at the same intervals; the thickness of the symphysis was measured on the cephalograms taken before treatment. The results demonstrated significantly more increase in clinical crown height and significantly more teeth developing recession both during appliance therapy and during the period from removal of appliance to the 3-year postoperative control in the patients with excessive proclination than in the patients with minimal change in incisor inclination. The correlation coefficient between width of symphysis and increase in clinical crown height in patients with excessive proclination was statistically significant. Only minimal changes were observed from 3 years postoperatively to the follow-up examination. No differences in clinical measurements were observed between the groups and bone dehiscences were not found.

The effect of toothbrush grip on gingival abrasion and plaque removal during toothbrushing

The aim of the present study was to determine whether the type of toothbrush grip affects gingival injury during brushing. The cleanness of the teeth achieved by use of 2 different brush grips was also evaluated. The teeth of 13 dental nurse students were brushed by a dental hygienist. Using the split mouth technique, one side of the mouth was brushed for 2 min holding the toothbrush with a pen grip and the other side for another 2 min using the palm grip. The procedure was repeated 11 days later with reversed brush grips on the 2 sides of the jaws. More gingival injuries were found when the toothbrush was held with the palm grip than with the pen grip. This difference was statistically significant (P less than 0.01). No statistically significant difference were observed between corresponding plaque scores as measured according to the PLQ-index, irrespective of whether the plaque scores were presented as plaque remaining after experimental brushing or as the difference between the PLQ scores before and after brushing.

Gingival recession in schoolchildren at 7, 12 and 17 years of age in Espoo, Finland

The present study was undertaken in response to a growing concern among clinicians about an increase in gingival recession among children and adolescents. Groups of 50 boys and 50 girls aged respectively 7, 12, and 17 yr were examined at Espoo Health Centre in 1983. Gingival recession was measured on the facial and lingual aspects of all permanent teeth. Whenever the gingival margin was located on root cementum, the distance from the gingival margin to the enamel border was measured to the nearest 0.5 mm. Recession was categorized as "slight" (0.5 or 1 mm) or "extensive" (1.5-3.5 mm). The prevalence of gingival recession was 5% at 7 yr, 39% at 12 yr, and 74% at 17 yr of age. More girls than boys had recession in the two youngest age groups. At 17 yr recession was equally common in both sexes and both "slight" and "extensive" recession was most often recorded on facial surfaces of first molars, premolars and canines. The alarmingly high prevalence of gingival recession at young age warrants further study of both the reasons and the consequences of early cementum exposure.

Long-term periodontal status of labially erupted canines following orthodontic treatment

Periodontal status was studied at the mesiobuccal, midbuccal and distobuccal aspects of contralateral pairs of canines in 22 postorthodontic patients aged 30 to 51 years with a mean time of 26.4 years (SD, 5.6) out of active treatment. The pretreatment models showed one canine erupting severely to the labial ("ectopic") with a contralateral canine in good arch alignment (control). None of the patients experienced relapse of the "ectopic" canine in a labial direction, and none had missing teeth, malalignment, overhanging restorations or open tooth contacts adjacent to the canines evaluated. Periodontal parameters were examined using a Michigan #0 probe with Williams markings. A nonstandardized light force was used and the measurements were rounded to the nearest millimeter. The results demonstrated statistically significant differences between the canines in probing attachment and bone levels (mean, 0.75; SD, 0.92; P less than 0.01) and width of attached gingiva (mean, 0.50; SD, 1.07; p less than 0.05) at the midbuccal aspects. The reason for these differences could only be speculated upon.

Flossing clefts. Clinical and histologic observations

Clinical and histologic observations of 14 marginal tissue clefts associated with improper floss manipulation are presented. Newly acquired lesions were characteristically inflamed, ulcerated and symptomatic while clefts of chronic duration were asymptomatic and un-noticed by the patient. Cleft sites exhibiting varying degrees of epithelialization generally presented apical bifurcations suggesting reinjury by the patient during lateral positional shifts of the floss. The terminology "flossing cleft" is suggested by the authors to describe linear or V-shaped interdental marginal tissue deformities that result from dental floss-induced injury. While these clefts may serve as a potential source of bacteremia during vigorous flossing and associated oral tissue manipulation, in no instances were they determined to constitute a morphologic impediment to effective plaque control efforts.

The toothbrush and gingival traumatic injury

This paper explores, by means of clinical observation, toothbrush misuse and its relationship to gingival recession/clefting. The morphology of the lesions created is correlated with the vigor, duration, frequency and direction of the toothbrush abuse. In addition, histologic observations of biopsied tissue from different types of clefts and recessions are used as a basis for discussion of the possible pathogenesis of this type of lesion.

Self-inflicted gingival injuries: literature review and case report

A case of self-inflicted gingival injury in a 25-year-old male patient caused by compulsively overzealous oral hygiene practices is presented. Such injuries are rare among adults and, therefore, can be difficult to diagnose. Most reported cases have involved children who produced their injuries during periods of emotional turmoil. Evidence in this case indicates that this patient may have initiated the destructive process as a child. Guidelines which many help the clinician recognize self-inflicted gingival injuries are presented.

Gingival sequela from a retained piece of dental floss

A case was reported where a piece of dental floss broke and was retained in an interproximal area. The patient came to the clinic a few days later with a periodontal abscess. After the retained fragment of dental floss was removed, the abscess resolved. Therefore, a retained portion of dental floss should be immediately removed to prevent gingival irritation and tissue injury.

A clinical study comparing the width of attached gingiva and the prevalence of gingival recessions

One hundred preclinical year dental students were examined. Oral hygiene status and gingival condition were determined using the Plaque Index score (Silness & Löe 1964) and the Gingival Index score systems (Löe & Silness 1963). The width of the attached gingiva and the depth of the gingival pockets were evaluated. The gingival recessions were recorded and their heights measured from the CEJ to the gingival margin. No significant correlation was found between oral hygiene and gingival recession, oral hygiene and width of attached gingival conditions and width of attached gingiva. Only a negative correlation (P less than 0.05) was found between the width of attached gingiva and the number of gingival recessions. No statistically significant differences were observed in oral hygiene status and gingival conditions among three groups of students (without, with one and with two or more recessions, respectively). The roles of toothbrushing trauma and "adequate" width of attached gingiva in the etiology of gingival recessions are questioned.

Clinical investigation of the effects of dentifrices on dentin wear at the cementoenamel junction

A two-year clinical study was conducted in vivo to assess the dentin wear caused by dentifrices; results were correlated and compared with those obtained in vitro.

Ill effects of improper oral hygeine procedure

Improper use of the tools that prevent tooth decay and gingival disease can also produce harmful effects. For example, dental floss can cause inflammation; toothbrushes could cause abscesses; and water-irrigation devices might drive foreign material into soft tissue. This report discusses the effects of incorrect oral hygiene, the signs the practioner should notice, and the proper corrective steps. Although effective oral hygiene is essential for the maintenance of healthy teeth and supporting tissues, analysis of the literature and clinical observation suggested that six problem areas may be associated with common oral hygiene measures. --Overly vigorous toothbrushing or using the wrong type of brush for the technique often leads to cervical tooth abrasion, gingival irritation, and gingival recession, or all of these problems. --Uncontrolled or overly vigorous dental flossing may lead to irritation, ulceration, or defects of the gingiva. Proximal root surfaces are rarely abraded. --Dentifrices, mouthwashes, and chewing gum may elicit allergic or toxic reactions in susceptible persons. These reactions take a variety of traumatic injuries, especially if used at high pressure. Perhaps, detailed individual instruction should be given by dental personnel before use. --Abscess of gingival tissues may occur from implantation of fragments of such oral hygiene aids as toothbrush bristles and toothpicks. --Bacteria may enter the bloodstream during certain oral hygiene measures, especially in patients with advanced chronic gingival disease. The rate of occurrence is unknown because of conflicting results in different studies. These bacteremias are of concern to patients who have rheumatic heart disease, prosthetic heart valves, prosthetic joints, and renal dialysis shunts, or fistulas used in renal dialysis. A classification of oral hygiene-caused disorders is proposed, based on the injury and the causative agent.

Recession: a 4-year longitudinal study after free gingival grafts

Free gingival grafts were performed on recession areas around 42 teeth in 12 patients, with postoperative evaluation of recurrent recession after 1, 6, 12, 24 and 48 months. No changes in degree of recession were observed during the 4-year period. The vestibuloplasties, which were always wider than the transplants, exhibited recurrence up to the transplant margin 6 months after surgery, while the transplants themselves exhibited an average shrinkage of 25%. In addition, 25% of the increase in vestibular depth achieved by the surgery was lost 1 month postoperatively, but there was a tendency toward increasing vestibulum depth during the ensuing 47 months. Gingival sulcus depth was not affected by the surgery.

Damaging effects of toothbrush bristle end form on gingiva

The ability of two different toothbrush bristle ends to produce traumatic gingival abrasion was assessed in a double blind study of 15 male and 15 female young adults. Brushing was performed in a circular fashion using a modified Bass Technique. An apparatus allowing continuous visual feedback of the average brushing force permitted a degree of standardization of the system. The upper left canine and bicuspid area had to be brushed for 30 seconds with cut toothbrush bristles (CP) and with round ended toothbrush bristles (RP) respectively. A two week interval separated the two brushing sessions. Traumatic lesions of the attached gingiva were stained with a disclosing solution, photographed and evaluated planimetrically. The "cut bristles" caused gingival abrasions 30% greater in extent than the round end bristles. The difference was not due to single brushing strokes accidentally greater for the "cut bristles". The size of the lesions was not sex dependent. To prevent gingival damage it is desirable to either round the bristles in production or to rid the bristle ends at least of sharp edges.

An epidemiologic approach to toothbrushing and dental abrasion

Abrasion lesions were recorded in 818 individuals representing the adult population of 430,000 residents of the Stockholm region, Sweden. The subjects were asked about toothbrushing habits, toothbrush quality and dentifrice usage; these factors were related to abrasion criteria. Abrasion was prevalent in 30% and wedge-like or deep depressions were observed in 12%. The relationship between abrasion and toothbrushing was evident, the prevalence and severity of abrasion being correlated to toothbrushing consumption. The importance of the toothbrushing technique for the development of abrasion lesions was elucidated. Horizontal brushing technique was strongly correlated to abrasion. It was demonstrated by treating the data with the statistical AID analysis that toothbrushing factors related to the individual (brushing frequency and brushing technique) exert a greater influence than material-oriented toothbrushing factor such as dentifrice abrasivity and bristle stiffness.

Periodontal treatment needs of 35-year-old citizens in Oslo

The periodontal condition was evaluated according to the PI and the Periodontal Treatment Need System (PTNS) in a random sample of 35-year-old citizens of Oslo. The study demonstrated that periodontal disease was a major dental health problem despite the fact that 88.9% of the subjects visited a dentist regularly. No statistically significant differences were found in PI, PTNS and OHI-S values among the different sexes and educational groups. Although the majority of the subjects (77.8%) brushed their teeth more than once a day, the oral hygiene status was not satisfactory (mean OHI-S 1.56). The frequency of toothbrushing did not influence the mean PI scores. Dental hard and soft tissue lesions related to toothbrushing were found in 30.0 and 6.8% of the subjects respectively, and more often among persons brushing more than once a day than among persons brushing less frequently.