Validity and reliability of autofluorescence-based quantification method of dental plaque

A scoping review of new technologies for dental plaque quantitation: Benefits and limitations

OBJECTIVES

To determine the validity and reliability of novel digitalized tools for dental plaque detection and explore the benefits and limitations connected to their use.

DATA

Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. All human clinical studies comparing dental plaque detection using digitalized systems against a standard reference were included.

SOURCES

PubMed and Scopus were screened from 01 January 2013 to 28 September 2023. Bibliographies of primary studies and principal peer-reviewed scientific journals were manually searched.

STUDY SELECTION

The initial search identified 576 articles, with a total of 13 included in the review, published between 2015 and 2023. Most of the studies included (77 %) were cross-sectional with three being prospective. Digital devices captured 2D and 3D images via cameras and intra-oral scanners, respectively. The Turesky's modified plaque index was the most frequent clinical index. Correlation with clinical examination was moderate to strong, with good to excellent intra- and inter-system agreement.

CONCLUSIONS

Within the limitations of this scoping review, image analysis-based plaque detection systems demonstrated good correlations with clinical plaque indices, using both 2D and 3D imaging systems. Whilst digital plaque detection devices offer advantages in terms of procedural standardization and reproducibility, they also have limitations, therefore currently, their application should be underpinned by a comprehensive clinical examination.

CLINICAL SIGNIFICANCE

Digital plaque detection tools, that provide standardized measurements and store acquired images, facilitate more informed feedback to patients. This objective analysis may enhance clinician confidence in their utility for clinical trials and other applications.

Methods for Evaluating the Effectiveness of Home Oral Hygiene Measures-A Narrative Review of Dental Biofilm Indices

Dental plaque is a biofilm structured in an extracellular matrix of polymers of host and microbial origin; the microorganisms can coexist in harmony with the host, thus guarantying oral health. Environmental modifications can lead to dysbiosis and onset of oral diseases; in fact, plaque is the etiological agent both of periodontal disease and dental decay. The use of an effective oral hygiene index should be considered as a relevant goal for the clinicians and the researchers, and consequently, numerous plaque indices have been proposed during the years. The present literature review aims primarily to obtain a complete summary of these scores to assess plaque deposits. It is useful because the clinician/researcher will select the right scoring method for the specific situation only if he knows the available options and if he is aware of both their strengths and weaknesses. This review applies a basic classification of plaque indices that distinguishes the ones that use non-quantitative methods from the ones that use quantitative methods. Non-quantitative methods are more subjective because they are based on the ability of the clinician to point out the presence or the entity of deposits, while quantitative methods introduce objectifiable means to measure plaque deposits.

Repeatability of dental plaque quantitation by light induced fluorescence technology in current, former, and never smokers

BACKGROUND

The effects of smoking on the accumulation of dental plaque have not been studied in depth. We compared dental plaque quantitation obtained with a novel light induced fluorescence technology among current, former, and never smokers and verified measurements' repeatability.

METHODS

Dental plaque quantitation was objectively assessed by quantitative light induced fluorescence (QLF) technology on three separate study visits in current, former, and never smokers: baseline (day 0), day 7, day 30. Increase in the fluorescence intensity of at least 30% (ΔR30) and 120% (ΔR120) together with the simple oral hygiene (SOH) scoring were considered for analysis.

RESULTS

The QLF parameters were highly repeatable in each study group (p < 0.0001, by regression analyses). All QLF parameters showed a significant difference between never smokers and current smokers (p = 0.041 for ΔR30; p = 0.027 for ΔR120; p = 0.04 for SOH). No significant differences were observed between never and former smokers and between current and former smokers except for ΔR120 (p = 0.033).

CONCLUSION

Dental plaque measurements by QLF technology were highly reproducible and showed greater plaque formation among current smokers compared to non-smokers. Objective and reproducible quantitation of dental plaque can be a valuable clinical and regulatory science endpoint to investigate the effect of smoking cessation medications, combustion-free tobacco products, and consumer care products on oral health.

CLINICAL RELEVANCE

There is a need to objectively evaluate the relationship between smoking and plaque build-up as well as maturation. Current smokers demonstrated greater and more mature plaque buildup when compared to never and former smokers. Differences in plaque build-up and maturation between current, former and non-smokers may be utilized as an effective tool for patient motivation, identifying therapeutic end-points, translational research as well as prognostication.

TRIAL REGISTRATION

The study is a pilot study parts of a larger project with registration ID: NCT04649645. As preliminary study, the pilot study referred into this paper started before the larger study registered in ClinicalTrials.gov.

Comparison of different plaque indices with regard to sensitivity and specificity for the quantification of plaque during orthodontic therapy

To compare four plaque indices used in orthodontics. An objective, quantitative plaque index and three subjective conventional plaque indices were analyzed. The study included n = 50 photographs of n = 50 subjects with a multibracket appliance (MB) in the maxilla and mandible. Photographs were taken using Digital Plaque Imaging Analysis (DPIA) and the Percentage Plaque Index (PPI) was calculated. The conventional plaque indices, a modified version of the Turesky-modification of the Quigley & Hein Index (TQH index), Attin index, and modified bonded bracket index (mBB index) were collected from n = 14 evaluators using the DPIA photographs. The evaluators had different levels of orthodontic experience: n = 4 evaluators had little orthodontic experience, n = 5 evaluators had moderate orthodontic experience, and n = 5 evaluators had a lot of orthodontic experience. Plaque accumulation was assessed differently with the plaque indices. Thus, the plaque indices are not interchangeable. We recommend DPIA as an objective, quantitative and sensitive method for plaque determination in scientific studies. The simple statistical evaluation offers a great advantage over conventional plaque indices.

A Semi-Automated Method for Measuring Biofilm Accumulation on the Teeth Using Quantitative Light-Induced Fluorescence in Dogs and Cats

Oral health conditions (eg, plaque, calculus, gingivitis) cause morbidity and pain in companion animals. Thus, developing technologies that can ameliorate the accumulation of oral biofilm, a critical factor in the progression of these conditions, is vital. Quantitative light-induced fluorescence (QLF) is a method to quantify oral substrate accumulation, and therefore, it can assess biofilm attenuation of different products. New software has recently been developed that automates aspects of the procedure. However, few QLF studies in companion animals have been performed. QLF was used to collect digital images of oral substrate accumulation on the teeth of dogs and cats to demonstrate the ability of QLF to discriminate between foods known to differentially inhibit oral substrate accumulation. Images were taken as a function of time and diet. Software developed by the Cytometry Laboratory, Purdue University quantified biofilm coverage. Intra- and intergrader reproducibility was also assessed, as was a comparison of the results of the QLF software with those of an experienced grader using undisclosed coverage-only metrics similar to those used for the Logan and Boyce index. Quantification of oral substrate accumulation using QLF-derived images demonstrated the ability to distinguish between dental diets known to differentially inhibit oral biofilm accumulation. Little variance in intra- and intergrader reproducibility was observed, and the comparison between the experienced Logan and Boyce grader and the QLF software yielded a concordance correlation coefficient of 0.89 (95% CI = 0.84, 0.92). These results show that QLF is a useful tool that allows the semi-automated quantification of the accumulation of oral biofilm in companion animals.

Detection of nosocomial pneumonia pathogens using a fluorescence-based device

BACKGROUND

Early detection of nosocomial pneumonia pathogens is a significant factor in hospital-acquired pneumonia care. This study aimed to determine the autofluorescence properties of five nosocomial pneumonia pathogens using a fluorescence-based device and to establish evidence for clinical guidelines.

METHODS

The following bacterial strains were assessed: Acinetobacter baumannii (AB), Escherichia coli (EC), Enterococcus faecalis (EF), Klebsiella pneumoniae (KP), and Staphylococcus aureus (SA). The bacteria were cultured separately on tryptic soy agar at 37°C under aerobic conditions for 168 h. Fluorescence photographs of each species were captured every 24 h using a fluorescence-based device with fixed camera settings. The images were analyzed by measuring the red and green values (R/G ratio) at a central point in each colony, and the R/G ratios were analyzed using the Kruskal-Wallis non-parametric test.

RESULTS

KP and SA showed red fluorescence with their R/G values, which were significantly higher than those of the other strains (p < 0.001). In particular, the R/G ratio of KP increased steadily until 72 h of incubation, peaking at 3.65. In addition, AB and EC showed orange fluorescence with higher red ratios than green ratios. EF and SA showed green fluorescence all through 168 h of incubation, with R/G values less than 1.0.

CONCLUSIONS

Nosocomial pneumonia pathogens can be identified and classified via bacterial autofluorescence emission. It is possible to develop a rapid and easy-to-use identification technology based on bacterial autofluorescence for clinical applications.

Evaluation of Periodontal Risk Factors with Quantitative Light-Induced Fluorescence Based Fluorescent Plaque Index, in Comparison to Radiographic and Oral Health Habit Scoring: A Retrospective Case Study

The aim of this study was to evaluate periodontal risk factors with oral health habits and fluorescent plaque index (FPI) using quantitative light-induced fluorescence (QLF) images, and to evaluate their effect on the degree of radiographic bone loss (RBL). Selected were 276 patients over 19 years of age to complete the questionnaire for oral health habit and take QLF images, periapical and panoramic radiographs. Oral health habit score, age, and sex showed a statistically significant correlation with FPI. FPI showed a lower value as the oral health habit score increased and the age decreased. Moreover, females showed lower FPI values than did males. RBL showed a statistically significant positive correlation with age but did not show any correlation with oral health habit scores and sex. There was no correlation between FPI and RBL. The results of this study suggest that the clinical use of QLF allows plaque detection by non-invasive procedures and can aid in a more objective estimation for oral hygiene status.

Oral health status of inpatients with varying physical activity limitations in rehabilitation wards: A cross-sectional study

Poor oral hygiene can be potentially life-threatening in inpatients. However, no basic protocol on oral hygiene customized for inpatients exists, and lack of oral care related knowledge, attitude, and skills among caregivers could be detrimental to the general health of patients. This study sought to identify the oral care practices and oral health status of inpatients with varying physical activity limitations in a rehabilitation ward.Sixty-one inpatients in a rehabilitation ward were evaluated for their medical and physical conditions and oral health status. These were assessed using the bedside oral exam, decayed, missing, filled teeth index, plaque index, gingival index, and caries activity test.In total, 40 men and 21 women (mean age, 56.6 years) were included in this study. Among them, 50.8% of the patients could brush their teeth unassisted, whereas 49.2% required assistance from an assistant for oral care. The proportion of patients receiving nasogastric tube feeding was higher in the group that could not provide oral self-care; 36.7% and 33.3% of these patients showed moderate and severe dysfunction, respectively, based on bedside oral exam. Scores for the swallowing, tongue, and total domains of bedside oral exam were poorer for patients who could not provide oral self-care (P < .01). The caries activity test indicated a moderate risk for both groups.Our findings suggest that an oral care protocol that considers the physical activity limitations in inpatients in rehabilitation wards is necessary to minimize negative influences on the systemic health of these patients.

Quantitative light-induced fluorescence as a potential tool for detection of enamel chemical composition

BACKGROUND

Little is known about how the chemical composition of enamel affects the optical properties of teeth, but advances in technology allow this to be studied using white-light and fluorescent images. This study aimed to identify the variation in enamel chemical composition that may affect tooth optical properties, such as tooth color and autofluorescence.

METHODS

Sixty-one specimens of extracted human molars were prepared. Raman spectrometry was used to assess chemical composition of enamel, and tooth color, and autofluorescence from enamel were evaluated by quantitative light-induced fluorescence (QLF) images. Pearson correlation and multiple linear regression analyses were used.

RESULTS

Enamel fluorescence was related to enamel composition rather than tooth color. The b* value from the fluorescence image had a moderate correlation with crystallinity (full-width at half-maximum: r = -0.433, p < 0.001) and laser-induced fluorescence intensity (r = 0.450, p < 0.001) from Raman spectroscopy. In multiple linear regression analysis, the chemical composition of the tooth had a significant effect on the b* value from the fluorescent image (R² = 0.433, p < 0.001). In contrast, tooth color values (L*, a*, and b*) were not correlated with chemical composition.

CONCLUSIONS

The present study revealed that enamel autofluorescence in QLF was related to chemical composition of the enamel, particularly the inorganic‒organic interface. While enamel chemical composition can be detected only in a laboratory environment, enamel fluorescence by QLF may enable estimation in a dental clinic, which has implications for the field of tooth bleaching or esthetic restorative materials.

Clinical assessment of an automated fluorescent plaque index scoring with quantitative light-induced fluorescence

OBJECTIVE

The aims of this study were to evaluate the clinical applicability of a new fluorescent plaque index scoring (FPI) with the Turesky modified Quigley-Hein plaque index (mQH) and to evaluate its relationship with plaque maturity.

METHODS

In total 69 subjects participated in this study. White-light and fluorescent images of anterior teeth were acquired using a Qraycam (AIOBIO, Seoul, Korea). FPI was obtained from fluorescent images using the proprietary software (Q-Ray v.1.39, Inspektor Research System BV, Amsterdam, The Netherlands). Teeth were stained with a two-tone disclosing agent. mQH was used to manually score the combined red and blue disclosed plaque (Combi-mQH) and blue disclosed plaque (Blue-mQH) with the white-light images. Linear relationships between FPI and Combi-mQH (or Blue-mQH) were evaluated by using simple linear regression analysis. Differences of Combi-mQH (or Blue-mQH) with respect to FPI scores were statistically evaluated by using ANOVA with Duncan post hoc correction.

RESULTS

FPI showed a moderate positive correlation with Combi-mQH (r = 0.66, P < 0.001) and a high positive correlation with Blue-mQH (r = 0.78, P < 0.001). The model explanatory power (R²) between FPI and Blue-mQH was 60.8 %, which is 16.8 % higher than the explanatory power observed with Combi-mQH (44.0 %). Both Combi-mQH and Blue-mQH increased significantly with increasing FPI score (P < 0.001).

CONCLUSION

In this study we found that the FPI scoring system can be used to detect plaque and quantitatively distinguish plaque levels. In addition, FPI was determined to be useful in clinic because of its ability to detect and distinguish old and mature plaque.

DenTiUS Plaque, a Web-Based Application for the Quantification of Bacterial Plaque: Development and Usability Study

Background

In the dentistry field, the analysis of dental plaque is vital because it is the main etiological factor in the 2 most prevalent oral diseases: caries and periodontitis. In most of the papers published in the dental literature, the quantification of dental plaque is carried out using traditional, non-automated, and time-consuming indices. Therefore, the development of an automated plaque quantification tool would be of great value to clinicians and researchers.

Objective

This study aimed to develop a web-based tool called DenTiUS and various clinical indices to evaluate dental plaque levels using image analysis techniques.

Methods

The tool was executed as a web-based application to facilitate its use by researchers. Expert users are free to define experiments, including images from either a single patient (to observe an individual plaque growth pattern) or several patients (to perform a group characterization) at a particular moment or over time. A novel approach for detecting visible plaque has been developed as well as a new concept known as nonvisible plaque. This new term implies the classification of the remaining dental area into 3 subregions according to the risk of accumulating plaque in the near future. New metrics have also been created to describe visible and nonvisible plaque levels.

Results

The system generates results tables of the quantitative analysis with absolute averages obtained in each image (indices about visible plaque) and relative measurements (indices about visible and nonvisible plaque) relating to the reference moment. The clinical indices that can be calculated are the following: plaque index of an area per intensity (API index, a value between 0 and 100), area growth index (growth rate of plaque per unit of time in hours; percentage area/hour), and area time index (the time in days needed to achieve a plaque area of 100% concerning the initial area at the same moment). Images and graphics can be obtained for a moment from a patient in addition to a full report presenting all the processing data. Dentistry experts evaluated the DenTiUS Plaque software through a usability test, with the best-scoring questions those related to the workflow efficiency, value of the online help, attractiveness of the user interface, and overall satisfaction.

Conclusions

The DenTiUS Plaque software allows automatic, reliable, and repeatable quantification of dental plaque levels, providing information about area, intensity, and growth pattern. Dentistry experts recognized that this software is suitable for quantification of dental plaque levels. Consequently, its application in the analysis of plaque evolution patterns associated with different oral conditions, as well as to evaluate the effectiveness of various oral hygiene measures, can represent an improvement in the clinical setting and the methodological quality of research studies.

Comparison of Quantitative light-induced fluorescence-digital (QLF-D) images and images of disclosed plaque for planimetric quantification of dental plaque in multibracket appliance patients

The purpose of the present cross-sectional clinical study was to check the ability of plaque detection and quantification by QLF-D against conventional digital photographs of disclosed plaque in multibracket appliance (MB) patients. 20 patients were included according to the following criteria: (1) upper and lower jaw treated by MB appliance, (2) patients being 16 years of age or older, (3) all central and lateral incisors as well as canines in situ, (4) absence of developmental defects, carious lesions, surface fillings, prosthetic restorations or recessions greater than 1/3 of root length in central/lateral incisors and canines as well as (5) declaration of consent. QLF-D and conventional photographs were analyzed planimetrically regarding plaque coverage on buccal and oral surfaces of central/lateral incisors and canines. The conventional photographs of stained plaque served as gold standard. On average, in QLF-D pictures 20.7% ± 17.4 of the tooth surfaces were covered with plaque, while the conventional photographs of disclosed plaque presented a mean plaque-covered area of 36.2% ± 23.5. The Bland-Altman plot for both imaging modalities showed a very large inconsistent scattering with both negative and positive deviations. The method discrepancy increased with increasing plaque coverage, thus indicating a systematic method error. On average, the deviation of the methods from the optimal line of accordance was -15.5%. In patients wearing MB appliances, there was no clinical significant agreement regarding the plaque-covered tooth surface depicted by QLF-D respectively conventional images of disclosed plaque. Due to the large method discrepancy, QLF-D is currently not reliable for precise plaque quantification in MB patients.

Presenting patients with information on their oral health risk: the PREFER three-arm RCT and ethnography

Background

A new NHS dental practice contract is being tested using a traffic light (TL) system that categorises patients as being at red (high), amber (medium) or green (low) risk of poor oral health. This is intended to increase the emphasis on preventative dentistry, including giving advice on ways patients can improve their oral health. Quantitative Light-Induced Fluorescence (QLF™) cameras (Inspektor Research Systems BV, Amsterdam, the Netherlands) also potentially offer a vivid portrayal of information on patients’ oral health.

Methods

Systematic review – objective: to investigate how patients value and respond to different forms of information on health risks. Methods: electronic searches of nine databases, hand-searching of eight specialist journals and backwards and forwards citation-chasing followed by duplicate title, abstract- and paper-screening and data-extraction. Inclusion criteria limited studies to personalised information on risk given to patients as part of their health care. Randomised controlled trial (RCT) – setting: NHS dental practice. Objective: to investigate patients’ preferences for and response to different forms of information about risk given at check-ups. Design: a pragmatic, multicentred, three-arm, parallel-group, patient RCT. Participants: adults with a high/medium risk of poor oral health attending NHS dental practices. Interventions: (1) information given verbally supported by a card showing the patient’s TL risk category; (2) information given verbally supported by a QLF photograph of the patient’s mouth. The control was verbal information only (usual care). Main outcome measures: primary outcome – median valuation for the three forms of information measured by willingness to pay (WTP). Secondary outcomes included toothbrushing frequency and duration, dietary sugar intake, smoking status, self-rated oral health, a basic periodontal examination, Plaque Percentage Index and the number of tooth surfaces affected by caries (as measured by QLF). Qualitative study – an ethnography involving observations of 368 dental appointments and interviews with patients and dental teams.

Results

Systematic review – the review identified 12 papers (nine of which were RCTs). Eight studies involved the use of computerised risk assessments in primary care. Intervention effects were generally modest, even with respect to modifying risk perceptions rather than altering behaviour or clinical outcomes. RCT – the trial found that 51% of patients identified verbal information as their most preferred form, 35% identified QLF as most preferred and 14% identified TL information as most preferred. The median WTP for TL was about half that for verbal information alone. Although at 6 and 12 months patients reported taking less sugar in drinks, and at 12 months patients reported longer toothbrushing, there was no difference by information group. Qualitative study – there was very little explicit risk talk. Lifestyle discussions were often cursory to avoid causing shame or embarrassment to patients.

Limitations

Only 45% of patients were retained in the trial at 6 months and 31% were retained at 12 months. The trial was conducted in four dental practices, and five dental practices were involved in the qualitative work.

Conclusions

Patients prefer personal, detailed verbal advice on oral health at their check-up. A new NHS dental practice contract using TL categorisation might make this less likely.

Future work

Research on how to deliver, within time constraints, effective advice to patients on preventing poor oral health. More research on ‘risk work’ in wider clinical settings is also needed.

Trial registration

Current Controlled Trials ISRCTN71242343.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.

Inter-rater agreement among multiple examiners for the assessment of plaque scores between quantitative light-induced fluorescence-digital and two-tone disclosing solution-stained digital images

BACKGROUND

To utilize plaque scoring indices as objective measures, a certain standard of intra-rater and inter-rater agreement must be met. Achievement of high consistency among several examiners in the assessment of images from Q-ray cam (for quantitative light-induced fluorescence-digital imaging) and digital single-lens reflex camera of stained tooth surfaces might enable more efficient undertaking of large epidemiological studies and oral tests.

METHODS

Second-year dental hygiene students and registered dental hygienists 40 examiners were randomly selected, all of whom provided informed consent. Multiple examiners assessed plaque scoring indices from the two types of images of the same 30 patients. The images were observed on a computer monitor, and the area with dental plaque was assessed using the Patient Hygiene Performance Index. The intra-class correlation coefficient was determined to evaluate the agreement among examiners and test methods for dental plaque Q-ray cam and digital single-lens reflex camera measurements were compared using a Bland-Altman plot. The intra-class correlation coefficient was analyzed using SPSS version 24 software (SPSS Inc., Chicago, IL, USA), and the exploratory graph was analyzed with MedCalc.

RESULTS

Agreement among 40 examiners was excellent with an intra-class correlation coefficient of 0.990 when the Q-ray cam was used. The intra-class correlation coefficient for the registered dental hygienists group was 0.987 and that for the dental hygiene students group was 0.980.

CONCLUSIONS

The study was high agreement in the assessment of Q-ray cam images and digital single-lens reflex camera images of stained dental plaque by multiple examiners, confirming that the two methods are validated both independently and with high mutual agreement.

Fluorescence and Near-Infrared Light Transillumination

This article describes the current applications of various technologies based on either autofluorescence or near-infrared light illumination, tailored to aid practitioners in detecting and quantitatively monitoring oral diseases such as dental caries and oral cancer at the earliest stage of their formation, or in the conservative surgical excision of necrotic bones in diseases such as chronic osteomyelitis, osteoradionecrosis, and medication-related osteonecrosis of the jaw. The data discussed are primarily based on published scientific studies and reviews from case reports, clinical trials, and in vitro and in vivo studies. References have been traced manually, by MEDLINE, or through manufacturer's websites.

Detection of residual resin-based orthodontic adhesive based on light-induced fluorescence

INTRODUCTION

This study evaluated the fluorescence of orthodontic adhesives using quantitative light-induced fluorescence-digital (QLF-D) images, and compared differences in the color characteristics of the fluorescence between adhesive and the adjacent tooth with that under white-light illumination in specimens containing residual adhesive of various thicknesses.

METHODS

Disc-shaped adhesive samples and samples comprising adhesive attached to extracted human teeth were prepared using Transbond XT, Blugloo, and Enlight, and they were ground to thicknesses ranging from 800 to 20 μm. Fluorescence and white-light images of the two types of specimens were taken with a QLF-D system. The color parameters for the fluorescence from the discs and the color difference (ΔE) between residual adhesive and the adjacent tooth were quantified in images using the CIE L*a*b* system.

RESULTS

The fluorescence color values of the discs differed significantly among the three adhesive products (P <  0.05). The ΔE values in fluorescence (ΔE_F) and white-light (ΔE_W) images for all three adhesives were lower for thinner residual adhesive specimens. The thickness of the adhesive could be perceived over a range of 50-100 μm for fluorescence images and 400-800 μm for white-light images (ΔE > 3.3). ΔE_F was significantly larger than ΔE_W for all of the residual adhesives, Blugloo specimens thicker than 100 μm, and Transbond XT and Enlight specimens thicker than 50 μm (P <  0.05).

CONCLUSIONS

Detecting and analyzing fluorescence signals can improve the ability to detect residual adhesive on a tooth and also provide thickness information.

Effect of an oral health education program based on the use of quantitative light-induced fluorescence technology in Uzbekistan adolescents

OBJECTIVES

The aim of this study was to determine whether an oral health education program using a Qscan device based on quantitative light-induced fluorescence (QLF) technology could improve the oral hygiene status and oral health literacy of adolescents.

MATERIALS AND METHODS

One hundred adolescents aged 14-16 years attending a school in Tashkent city were included in this study. The participants were assigned to the following two groups using permuted block randomization technique: (i) control group (traditional learning) and (ii) experimental group (Qscan device-based learning). The participants included in the experimental group received additional education and training on dental plaque removal using the Qscan device. The accumulated levels of plaque were assessed in all participants, who also completed questionnaires about their oral health status, oral health knowledge, attitude, and behavior during an 8-week period.

RESULTS

There were statistically significant improvements in the experimental group compared to the control group in the plaque index (0.46 vs 0.07, p < .05), oral health knowledge (19.4 vs 28.8, p < .05), attitude (16.7 vs 20.2, p < .05), and behavior (19.9 vs 30.5, p < .05).

CONCLUSIONS

This study has demonstrated that an oral health education program based on the use of QLF technology could be useful for improving the oral hygiene status and oral health literacy of adolescents in Uzbekistan.

Red fluorescence of dental biofilm as an indicator for assessing the efficacy of antimicrobials

The study aimed to determine whether the red fluorescence (RF) of a dental microcosm biofilm as measured with quantitative light-induced fluorescence (QLF) technology is useful for assessing the efficacy of antimicrobials. Dental microcosm biofilms were formed on bovine enamel discs and grown under 0.3% sucrose challenge and treated with chlorhexidine (CHX) solutions at different concentrations (0.05%, 0.1%, and 0.5%) plus a negative control [sterile distilled water (DW)] twice daily for 7 days. The biofilms were photographed using a QLF-digital system to evaluate the RF by calculating the red/green ratio, and pH values of the medium were measured daily. After 7 days, the bacterial viability of the biofilm was assessed by measuring the counts of viable total bacteria and aciduric bacteria, and the percentage surface microhardness changes (%SHC) was evaluated. The RF and cariogenic properties were compared for the different concentrations of CHX, and their correlations were examined. The RF and its increase rate were much lower for CHX-treated biofilms than for DW-treated biofilms. The RF after 7 days of maturation decreased significantly with increasing CHX concentrations (p<0.001) and was from 31% (for 0.05% CHX) to 46% (for 0.5% CHX) lower than that of the DW group. Strong correlations were reported between the RF of the 7-day-maturation biofilms and cariogenic properties, such as the number of total bacteria (r=0.93), number of aciduric bacteria (r=0.97), supernatant pH (r=0.43), and %SHC (r=0.98). In conclusion, the RF of dental biofilms as measured with QLF technology can be used to nondestructively assess and monitor the effect of antimicrobials against biofilm.

The New Marginal Plaque Index May Allow a More Valid Assessment of Gingival Plaque Level Than the Turesky Modification of the Quigley and Hein Index

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Establishment of a new marginal plaque index with high sensitivity for changes in oral hygiene. Deinzer R, Jahns S, Harnacke D. J Periodontol 2014; 85(12):1730-8.

SOURCE OF FUNDING

The study was supported by a sponsorship from GABA International, Therwil, Switzerland.

TYPE OF STUDY/DESIGN

Observational case-control study.

Plaque autofluorescence as potential diagnostic targets for oral malodor

The aim of this study was to determine whether the degree of tongue and interdental plaque can be used to assess oral malodor by quantifying their fluorescence as detected using quantitative light-induced fluorescence (QLF) technology. Ninety-nine subjects who complained of oral malodor were included. The level of oral malodor was quantified using the organoleptic score (OLS) and the concentration of volatile sulfur compounds (VSCs). The fluorescence properties of tongue and interdental plaque were quantified as scores calculated by multiplying the intensity and area of fluorescence in QLF-digital images, and the combined plaque fluorescence (CPF) score was obtained by summing the scores for the two regions. The associations of the scores with malodor levels and the diagnostic accuracy of the CPF score were analyzed. The two plaque fluorescence scores and their combined score differed significantly with the level of oral malodor (p<0.001). The CPF score was moderately correlated with OLS (r=0.64) and VSC levels (r=0.54), and its area under the receiver operating characteristic curve was 0.77 for identifying subjects with definite oral malodor (OLS≥2). In conclusion, plaque fluorescence from tongue and interdental sites as detected using QLF technology can be used to assess the level of oral malodor.