Prevention and control of periodontal diseases in developing and industrialized nations

Diagnostic measures for monitoring and follow-up in periodontology and implant dentistry

This review discusses the role of diagnostic measures in the lifelong management of periodontal disease and peri-implant complications. After active treatment, these conditions require regular monitoring of the supporting structures of teeth and dental implants to assess bone and soft tissue health over time. Several clinical measures have been developed for the routine assessment of periodontal and peri-implant tissues, including periodontal and peri-implant probing, bleeding on probing, intraoral radiography, biomarker analysis, and microbiological testing. This review highlights the evolution of diagnostic practices, integrating traditional methods with emerging technologies such as resonance frequency analysis and ultrasound imaging to provide a holistic view of peri-implant health assessment. In addition to objective measurements, patient risk factors are considered. The goals of periodontal and peri-implant maintenance are to control disease activity and stabilize tissues through supportive care, which includes diagnostic measures at follow-up visits. This enables clinicians to monitor treatment outcomes, assess health status, and detect recurrence or progression early through routine evaluation, allowing additional interventions, including adjustment of supportive therapy intervals, to further improve and maintain periodontal and peri-implant stability over time.

Dietary interventions and nutritional impact on oral health and development: a review

Food and nutrients play a pivotal role in the development of dentition and oral health. While diet includes the overall forms of consumed foods, the nutrients include specific micro- (vitamins and minerals) and macro- (carbohydrates, proteins, and lipids) nutrients. As much as the assimilation of macro and micronutrients depends on proper oral health for ingesting food, oral health, in turn, depends on the availability of nutrients in the food so ingested. Age, certain medical conditions, socioeconomic status, and overall changes in the evolution of society determine the type of diet which in turn influences oral health. This article has touched upon certain salient aspects of these nutrients and their bearing on overall oral health and development.

Molecular Iodine Mouthrinse Antimicrobial Activity Against Periodontopathic Bacteria

AIM

This study compared two molecular iodine mouthrinses for their in vitro bactericidal effects against subgingival biofilm bacteria from severe periodontitis patients.

MATERIALS AND METHODS

In a subgingival biofilm eradication assay, dilution aliquots of subgingival microbial specimens from 32 adults with severe periodontitis were mixed in vitro with either a mouthrinse containing 100 parts per million (ppm) molecular iodine (Iorinse®) or one containing 150 ppm molecular iodine (iClean®), followed by mouthrinse neutralization after 60 seconds with 3% sodium thiosulfate. The mixtures, along with unexposed subgingival biofilm aliquots, were inoculated onto enriched Brucella blood agar and incubated anaerobically for 7 days to quantitate total viable bacterial counts and selected red/orange complex periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Parvimonas micra, Campylobacter rectus, and Fusobacterium nucleatum).

RESULTS

Both molecular iodine mouthrinses significantly reduced total viable bacterial counts in the subgingival biofilm samples, with iClean® providing significantly greater in vitro suppression than Iorinse®. Both molecular iodine mouthrinses also significantly reduced total red/orange complex periodontal pathogens, with significantly greater suppression also exhibited by iClean®.

CONCLUSION

The molecular iodine mouthrinses exerted marked bactericidal activity in vitro against human subgingival biofilm microbial species, including red/orange complex periodontal pathogens associated with severe periodontitis, with iClean® providing significantly better antimicrobial activity than Iorinse®.

CLINICAL SIGNIFICANCE

These findings suggest potential value of molecular iodine mouthrinses in the treatment and prevention of periodontal diseases.

A Cross-Talk between Diet and the Oral Microbiome: Balance of Nutrition on Inflammation and Immune System's Response during Periodontitis

Over the last few decades, studies on the oral microbiome have increased awareness that the balance between the host and the microbial species that coexist in it is essential for oral health at all stages of life. However, this balance is extremely difficult to maintain, and many factors can disrupt it: general eating habits, sugar consumption, tobacco smoking, oral hygiene, and use of antibiotics and other antimicrobials. It is now known that alterations in the oral microbiota are responsible for developing and promoting many oral diseases, including periodontal disease. In this context, diet is an area for further investigation as it has been observed that the intake of particular foods, such as farmed animal meat, dairy products, refined vegetable oils, and processed cereals, affects the composition of the microbiota, leading to an increased representation of acid-producing and acid-tolerant organisms and periodontal pathogens. However, little is known about the influence of diet on the oral microbiome and the creation of a suitable microenvironment for the development of periodontal disease. The aim of the present study is to evaluate current knowledge on the role of diet in the oral dysbiosis underlying periodontal disease.

QLF-D: A Contemporary Plaque Control Tool in Children

Background and objectives

The main causative factors for maximum periodontal diseases are dental plaque and oral biofilms. This study was done to check the impact of quantitative light-induced fluorescence-digital (QLF-D) as a motivational tool for plaque control among children from various schools situated in Dehradun district along with education using audiovisual aids.

Materials and methods

A total sample of 800 school-going children including both males and females aged 6 to 12 years from various schools situated in Dehradun district of Uttarakhand were surveyed. A pro forma was prepared and the demographics of the students were noted. All the students were first examined for the Oral Hygiene Index-Simplified (OHI-S) and then the random division was done into two groups, group A (Q-scan) and group B (basic diagnostic aids) for examination of plaque index.

Results

The results of the study revealed that good OHI-S scores increased significantly from 1st visit to 3rd visit. The plaque scores for the control group, when examined with basic diagnostic aids of all three visits, were significantly good which increased subsequently from 1st visit to 3rd visit. Good plaque index score increased significantly for the test group from 1st to 3rd visit when examined with QLF-D.

Conclusion

We found in our study that QLF technology is of paramount importance in epidemiological surveys and plays a pivotal role in evaluating masses in maintaining oral health care.

How to cite this article

Solanki R, Tuli A, Dhawan P, et al. QLF-D: A Contemporary Plaque Control Tool in Children. Int J Clin Pediatr Dent 2021;14(4):502–505.

Association between Dietary Pattern and Periodontitis-A Cross-Sectional Study

The aim of the study was to investigate the relationship between specific known dietary patterns and the prevalence of periodontal disease in a northern population-based cohort study. We evaluated data from 6209 participants of the Hamburg City Health Study (HCHS). The HCHS is a prospective cohort study and is registered at ClinicalTrial.gov (NCT03934957). Dietary intake was assessed with the food frequency questionnaire (FFQ2). Periodontal examination included probing depth, gingival recession, plaque index, and bleeding on probing. Descriptive analyses were stratified by periodontitis severity. Ordinal logistic regression models were used to determine the association. Ordinal regression analyses revealed a significant association between higher adherence to the DASH diet/Mediterranean diet and lower odds to be affected by periodontal diseases in an unadjusted model (OR: 0.92; 95% CI: 0.87, 0.97; p < 0.001/OR: 0.93; 95% CI: 0.91, 0.96; p < 0.001) and an adjusted model (age, sex, diabetes) (OR: 0.94; 95% CI: 0.89, 1.00; p < 0.0365/OR: 0.97; 95% CI: 0.94, 1.00; p < 0.0359). The current cross-sectional study identified a significant association between higher adherence to the DASH and Mediterranean diets and lower odds to be affected by periodontal diseases (irrespective of disease severity). Future randomized controlled trials are needed to evaluate to which extent macro- and micronutrition can affect periodontitis initiation/progression.

Interdental Plaque Microbial Community Changes under In Vitro Violet LED Irradiation

Oral microbiome dysbiosis has important links to human health and disease. Although photodynamic therapy influences microbiome diversity, the specific effect of violet light irradiation remains largely unknown. In this study, we analyzed the effect of violet light-emitting diode (LED) irradiation on interdental plaque microbiota. Interdental plaque was collected from 12 human subjects, exposed to violet LED irradiation, and cultured in a specialized growth medium. Next-generation sequencing of the 16S ribosomal RNA genes revealed that α-diversity decreased, whereas β-diversity exhibited a continuous change with violet LED irradiation doses. In addition, we identified several operational taxonomic units that exhibited significant shifts during violet LED irradiation. Specifically, violet LED irradiation led to a significant reduction in the relative abundance of Fusobacterium species, but a significant increase in several species of oral bacteria, such as Veillonella and Campylobacter. Our study provides an overview of oral plaque microbiota changes under violet LED irradiation, and highlights the potential of this method for adjusting the balance of the oral microbiome without inducing antibiotic resistance.

Tooth brushing performance in adolescents as compared to the best-practice demonstrated in group prophylaxis programs: an observational study

BACKGROUND

Research indicates that adolescents may have difficulties to adopt the tooth brushing recommendations delivered in prophylaxis programs. However, it is not clear whether these difficulties are seen amongst the entire age range of adolescence (10-19 years) or only occur at certain developmental stages of the adolescence. The present study analyzes the tooth brushing performance of adolescents and compares it to the best-practice of tooth brushing demonstrated during prophylaxis programs.

METHODS

A random sample of N = 66 adolescents, comprising 10-year-olds (n = 42) and 15-year-olds (n = 24), were asked to perform oral hygiene to the best of their abilities in front of a tablet camera. Videos were analyzed for tooth brushing duration, location, and brushing movements, and the difference between the actual and expected behaviour was tested for consistency using repeated measures ANOVAs and Student's t-tests. For the direct comparison across different age groups, already available data from 12- and 18-year-olds were reanalysed.

RESULTS

The average brushing time (mean ± SD) of the 10-year-olds and 15-year-olds was 195.8 s (74.6 s) and 196.1 s (75.8 s), respectively. Regardless of age, the adolescents distributed their brushing time unevenly across the inner, outer and occlusal surfaces. The inner surfaces in particular were neglected to a considerable extent, as no age group spent more than 15.8% of the total brushing time on them. Furthermore, all age groups showed a high proportion of horizontal movements on the inner and outer surfaces, regardless of the movements instructed for the respective surfaces.

CONCLUSION

Even if adolescents brush to the best of their abilities, they neglect or skip one or many of the tooth surfaces. The reasons for the lack of compliance to tooth brushing instructions are discussed in light of the methods used in prophylaxis programs and the influence of parents.

Reductions in clinical inflammation and oral neutrophils with improving oral hygiene

OBJECTIVE

This study compared the effects of oral hygiene with a toothpaste formulated with zinc (test) to a fluoride dentifrice (control) for effects on oral polymorphonuclear leukocyte (PMN) as a measure of whole mouth inflammation along with effects on clinical parameters of dental plaque and gingivitis.

MATERIALS AND METHODS

Adults (age range 18-60 years, n = 212) completed this double-blind, parallel design study. After washout, a baseline oral rinse sample was evaluated for PMN prior to clinical assessments for gingivitis and dental plaque. Subjects were randomly assigned to brush twice daily with either the test or the control toothpaste. Post-treatment evaluations repeated all baseline assessments after 4-week, 6-week and 12-week use of dentifrice with all assessments conducted 12 hours after brushing.

RESULTS

PMN reductions in the test were 16.8%, 18.7% and 42.5% at the 4-week, 6-week and 12-week evaluations respectively and significantly different from the control (p < 0.05). The test toothpaste also demonstrated progressively increasing reductions in gingivitis and dental plaque that ranged from 7.6 to 33.3% and 2.3 to 9.1% respectively versus the control (p < 0.05).

CONCLUSIONS

The test dentifrice demonstrated progressive reductions in oral PMN representing whole mouth inflammation in conjunction with improvements in oral hygiene as compared to the control toothpaste.

CLINICAL RELEVANCE

A hallmark of oral inflammation includes the accumulations of PMN in the afflicted gingival regions to reduce the influences of proliferating microorganisms. Brushing with a zinc dentifrice demonstrated progressive reductions in oral PMN and improvements in oral hygiene as evidenced by progressively lower dental plaque and gingival indices.

Dietary Factors Affecting the Prevalence and Impact of Periodontal Disease

In the last few decades, growing evidence have shown a possible impact of diet and nutrients on oral health. This review aims to describe, in the light of current knowledge, the role of diet, nutrients, and micronutrients in periodontal health and periodontal diseases. A variety of macronutrients and micronutrients could have an impact on periodontal health. The balanced intake of unprocessed complex carbohydrates, vegetable proteins, omega-3 fatty acids, minerals, and vitamins positively affects periodontal inflammation. On the other way, refined carbohydrates, non-vegetable proteins, proinflammatory saturated fatty acids and an unbalanced supply of vitamins and minerals may increase periodontal inflammation. This review will discuss the current evidence that shows how a healthy and balanced diet has anti-inflammatory and protective effects on periodontal health. Therefore, it appears that adopting a correct lifestyle and diet should be encouraged in patients with oral and periodontal disease.

Influence of one-step professional mechanical tooth cleaning pastes on surface roughness and morphological features of tooth substrates and restoratives

PURPOSE

This study investigated the influence of professional mechanical tooth cleaning (PMTC) pastes on the surface texture of different subject materials.

METHODS

Two one-step PMTC pastes, Clinpro Cleaning Paste for PMTC (CP) and PRG Pro-Care Gel (PG), and multiple-step PMTC pastes, Merssage Regular (MR), Merssagge Fine (MF), and Merssage Plus (MP), were used. For comparison, PMTC was performed using distilled water without paste (DW). The subjected materials used were bovine enamel (ENA) and dentin (DEN), a resin composite (FSU), and lithium disilicate (IEC). The prepared specimens were polished using a #2000-grit silicon carbide paper. PMTC was performed using a brush at 1,000 rpm for 15 s.

RESULTS

The surface roughness (Ra) values of the specimens before and after PMTC were measured by laser scanning microscopy. The Knoop hardness number (KHN) of the subjected material was obtained. The types of PMTC pastes and subject materials had a significant influence on the Ra values and KHN. For the majority of subject materials, the descending order of Ra values after PMTC was MR > MF > CP > PG > MP > DW. The descending order of KHN of the materials was IEC > ENA > FSU > DEN.

CONCLUSION

Although one-step PMTC pastes appeared to be effective, it is important to consider the subject material during PMTC.

Antimicrobial and Antibiofilm Effect of Cranberry Extract on Streptococcus mutans and Lactobacillus acidophilus: An In Vitro Study

Background

Nature has been a source of medicinal treatments since millennia and plant-based systems continue to play an essential role.

Aim

To study the antimicrobial and antibiofilm effect of cranberry on Streptococcus mutans and Lactobacillus acidophilus.

Materials and methods

The ethanolic extract of cranberry was tested against standard MTCC strains of S. mutans (MTCC 25175) and L. acidophilus (MTCC 8129) for minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The time kill assay was performed to check the time-dependent bactericidal effect of the cranberry extract on microorganisms. Percentage of cell adhesion and biofilm inhibition of the dental microorganism at various doses of cranberry extract was measured by a spectrophotometer and biofilm morphology characteristics were observed under scanning electron microscopy. All the tests were carried out in triplicates. Data were computed in the SPSS software and mean/SD was determined. The results are presented in a descriptive manner; Kruskal–Wallis analysis of variance (ANOVA) and the Friedman's test were applied for comparative evaluation of the groups. p value <0.05 was considered statistically significant.

Results

The results showed that MICs of cranberry extract against S. mutans and L. acidophilus are 12.5 mg/dL and 6.125 mg/dL, respectively, and MBCs are 25 mg/dL and 12.5 mg/dL, respectively. A significant decrease in the biofilm formation and cell adhesion of microorganisms at MIC (50%) and MBC (70%) was observed as compared to control as observed under a spectrophotometer and a scanning electron microscope.

Conclusion

This study has identified bactericidal, bacteriostatic, and antibiofilm effects of cranberry extract against S. mutans and L. acidophilus in a time-dependent and dose-dependent manner.

How to cite this article

Singhal R, Patil P, Siddibhavi M, et al. Antimicrobial and Antibiofilm Effect of Cranberry Extract on Streptococcus mutans and Lactobacillus acidophilus: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(1):11–15.

Adjunct use of mouth rinses with a sonic toothbrush accelerates the detachment of a Streptococcus mutans biofilm: an in vitro study

BACKGROUND

The aim of this in vitro study was to examine the possible enhancement of the biofilm peeling effect of a sonic toothbrush following the use of an antimicrobial mouth rinse.

METHODS

The biofilm at a noncontact site in the interdental area was treated by sound wave convection with the test solution or by immersion in the solution. The biofilm peeling effect was evaluated by determining the bacterial counts and performing morphological observations. A Streptococcus mutans biofilm was allowed to develop on composite resin discs by cultivation with stirring at 50 rpm for 72 h. The specimens were then placed in recesses located between plastic teeth and divided into an immersion group and a combination group. The immersion group was treated with phosphate buffer, chlorhexidine digluconate Peridex™ (CHX) mouth rinse or Listerine® Fresh Mint (EO) mouth rinse. The combination group was treated with CHX or EO and a sonic toothbrush.

RESULTS

The biofilm thickness was reduced by approximately one-half compared with the control group. The combination treatment produced a 1 log reduction in the number of bacteria compared to the EO immersion treatment. No significant difference was observed in the biofilm peeling effect of the immersion group compared to the control group.

CONCLUSIONS

The combined use of a sonic toothbrush and a mouth rinse enhanced the peeling of the biofilm that proliferates in places that are difficult to reach using mechanical stress.

Strategies for the prevention of periodontal disease and its impact on general health in Latin America. Section III: Prevention

Dental plaque removal and the understanding of risk factors, risk indicators and social determinants are important components in the prevention of periodontal disease. Periodontal diseases and dental caries are largely preventable conditions, but require a "common risk factor approach" with non-communicable diseases with the purpose of improving their prevention and control, and positive impact on health. The aim of this consensus was to identify the evidence and gaps in periodontal prevention in Latin American, and to propose individual and collective recommendations for the population, health professionals, dental practice and government. The prevention of periodontal diseases in Latin America has mainly been focused on oral hygiene instruction, use of toothbrushes and interproximal devices, but in some patients, it is necessary to use adjuncts to these measures, such as antimicrobial and/or probiotic products that are backed by broad scientific evidence. Some evidence has shown that there are inadequate knowledge, attitudes and practices among patients, dentist and other health professionals. The prevention of periodontal diseases and caries should be adopted as a healthy lifestyle routine, because of their local and systemic effects. Recently, new empowerment strategies have been proposed in order to generate behavioral changes. Periodontal diseases can often be prevented, or controlled by joined efforts between government health systems, scientific associations, universities, health professionals, private companies and communities. In conclusion, the relations between periodontal diseases, caries, healthy lifestyles and NCD's offer an ideal opportunity to change Latin American prevention strategies at both the individual level and population levels.

Matrix metalloproteinases outside vertebrates

The matrix metalloproteinase (MMP) family belongs to the metzincin clan of zinc-dependent metallopeptidases. Due to their enormous implications in physiology and disease, MMPs have mainly been studied in vertebrates. They are engaged in extracellular protein processing and degradation, and present extensive paralogy, with 23 forms in humans. One characteristic of MMPs is a ~165-residue catalytic domain (CD), which has been structurally studied for 14 MMPs from human, mouse, rat, pig and the oral-microbiome bacterium Tannerella forsythia. These studies revealed close overall coincidence and characteristic structural features, which distinguish MMPs from other metzincins and give rise to a sequence pattern for their identification. Here, we reviewed the literature available on MMPs outside vertebrates and performed database searches for potential MMP CDs in invertebrates, plants, fungi, viruses, protists, archaea and bacteria. These and previous results revealed that MMPs are widely present in several copies in Eumetazoa and higher plants (Tracheophyta), but have just token presence in eukaryotic algae. A few dozen sequences were found in Ascomycota (within fungi) and in double-stranded DNA viruses infecting invertebrates (within viruses). In contrast, a few hundred sequences were found in archaea and >1000 in bacteria, with several copies for some species. Most of the archaeal and bacterial phyla containing potential MMPs are present in human oral and gut microbiomes. Overall, MMP-like sequences are present across all kingdoms of life, but their asymmetric distribution contradicts the vertical descent model from a eubacterial or archaeal ancestor. This article is part of a Special Issue entitled: Matrix Metalloproteinases edited by Rafael Fridman.

Prevalence and Severity of Oral Diseases in the Africa and Middle East Region

This review aims to determine the prevalence and severity of oral health diseases in the Africa and Middle East region (AMER). The profile of oral diseases is not homogeneous across the AMER. There are large disparities between groups. Reliable data are scarce. The prevalence and severity of oral diseases appear to be increasing in the African region, as does associated morbidity. There are substantial differences in inequalities in oral health. Dental caries prevalence is less severe in most African countries than in developed countries, but the high rate of untreated caries reflects the limited resources available and difficulties of access and affordability to essential oral health care services. The prevalence of gingival inflammation is very high in all age groups in several African countries. The prevalence of maxillofacial trauma has increased in many countries, with a wide variation of the incidence and high prevalence of traumatic dental injuries in primary and permanent teeth. Orofacial clefts are among the most common birth defects. Annual incidence of oral cancer is estimated as 25 cases per 100,000 people in Africa. Noma is a major public health problem for the Middle East and North African (MENA) region. Data about human immunodeficiency virus/AIDS are limited, particularly in the MENA region. According to the World Health Organization Regional Committee for Africa report, some fundamental key basic knowledge gaps need to be underlined. They include inequalities in oral health, low priority for oral health, lack of adequate funding, inadequate dental student training, obstacles to medical and dental research, and poor databases. There are very few effective public prevention and oral health promotion programs in the AMER. Universal health coverage is not achievable without scientific research on the effectiveness of health promotion interventions.

Effectiveness of Oral Antiseptics on Tooth Biofilm: A Study in vivo

AIM

To evaluate the effectiveness of five different mouthwashes through measurement of the plaque index.

MATERIALS AND METHODS

Fifty subjects took part in this blind study, randomized into blocks of five groups according to the active ingredient of the mouthwash: CHX group (0.12% chlorhexidine gluconate), essential oils (EO) group, cetylpyridinium chloride (CPC) group, Tri group (triclosan) and Hamamelis virginiana (HV) group. All subjects were evaluated for a reduction in the bacterial plaque index at 7, 14 and 21 days.

RESULTS

There was a significant reduction in the mean plaque index during the period of evaluation (p < 0.01), and the reduction during the period of evaluation was different between mouthwashes (p < 0.01). The reduction in the plaque index at the end of 21 days was, in decreasing order, CHX > EO > CPC > Tri > HV.

CONCLUSION

The reduction in the plaque index during the period of evaluation was different between the types of mouth-wash. The mouthwash containing the active ingredient chlorhexidine was the most effective, followed by the essential oil, cetylpyridinium chloride, triclosan and H. virginiana.

What is the Contribution of Genetics to Periodontal Risk?

This review addresses the multicausal etiology of periodontitis, in which genetic factors play a role. The various proposed causes for periodontitis always work simultaneously, but the relative contribution of each of these varies from case to case. We are still at an early stage to identify the genes involved, in comparison with other chronic diseases. To date, the genetic variations firmly and repeatedly associated with periodontitis in some populations are found within the following genes: ANRIL, COX2, IL1, IL10, DEFB1, whereas many other proposed periodontitis candidate genes have not been firmly proven or replicated.

Evaluating awareness regarding oral hygiene practices and exploring gender differences among patients attending for oral prophylaxis

BACKGROUND

Oral hygiene is intimated in health of all parts of the body including oral cavity. The understanding of actual practices in keeping the oral heath at standard based on patient's perceptions of oral health care is vital. Understanding the effect of gender on oral health would facilitate the development of successful attitude and behavior modification approach towards sustainable oral health.

PURPOSE OF STUDY

To evaluate awareness regarding oral hygiene practices and exploring gender differences among patients attending for oral prophylaxis.

MATERIALS AND METHODS

A survey was conducted among 250 patients attending the department of periodontology, Maulana Azad institute of dental sciences for oral prophylaxis. A structured questionnaire was used to collect information regarding practices and perception about oral hygiene.

RESULTS

Majority of the patients (60.4%) felt that oral hygiene is mandatory for overall health of the body. The use of toothpaste and toothbrush (83.6%) was the most preferred cleaning aid among the study population in the present study. The major constraint for avoiding dental examination was no felt need (41.2%) followed by cost of dental treatment (26.8%) and time constraints (24.0%).

CONCLUSIONS

Professional plaque removal and regular follow-up combined with oral hygiene instructions to the patients can minimize the level of gingival inflammation and swelling. The poor resources for dental care, common malpractices and nonavailability of professional care are the main barriers in seeking optimum oral hygiene.

Preventive oral health practices of school pupils in Southern Nigeria

Background

One of the goals of the World Health Organisation goal is to ensure increased uptake of preventive oral self-care by 2020. This would require the design public health programmes that will ensure children place premium on preventive oral health care uptake. One effort in that direction is the need for countries to define baseline measures on use of preventive oral self-care measures by their population as well as identify factors that impact on its use. This study aims to determine the prevalence and the impact of age and sex on the use of recommended oral self-care measures by pupils in Southern Nigeria.

Methods

Pupils age 8 to 16 years (N = 2,676) in two urban sites in Southern Nigeria completed a questionnaire about recommended oral self-care (use of fluoridated toothpaste, flossing, regularity of consuming sugary snacks between main meals), time of the last dental check-up and cigarette smoking habit. Chi square was used to test association between age (8-10years, 11–16 years), sex, and use of recommended oral self-care. Logistic regression analysis was used to determine the predictors of use of recommended oral self-care.

Results

Only 7.8% of the study population practiced the recommended oral self-care. Older adolescents had an 8.0% increased odds (OR: 1.08; CI:0.81–1.43; p = 0.61) and males had a 20.0% decreased odds (OR: 0.80; CI:0.60-1.06; p = 0.12) of practicing recommended oral self-care though observed differences were not statistically significant. Very few respondents (12.7%) had visited the dental clinic for a check-up in the last one year. Majority of the respondents (92.2%) were non-smokers.

Conclusions

The use of a combination of oral self-care approaches was very low for this study population. Age and sex were predictive factors for the use of components of the oral self-care measures but not significant predictors of use of recommended oral self-care. Future studies would be required to understand ‘why’ and ‘how’ age and sex impacts on the use of caries preventive oral self-care measures to be able to design effective prevention educational programmes for the study population.

Evaluating dental awareness and periodontal health status in different socioeconomic groups in the population of Sundernagar, Himachal Pradesh, India

Context:

Survey.

Aims:

To evaluate dental awareness and periodontal health status in different socioeconomic groups in the population of Sundernagar, Himachal Pradesh, India.

Settings and Design:

Cross-sectional study.

Malerials and Methods:

This cross-sectional study was conducted in 300 patients with different socioeconomic status who visited Himachal Dental College, Sundernagar, and Dental OPD of the Civil Hospital, Sundernagar. Mouth mirror, CPI probe, and illuminated light source were used for examination. Periodontal health status was recorded using CPI index. Information about their lifestyle, education level, and socioeconomic status was recorded using a questionnaire and correlated with the periodontal status.

Statistical Analysis Used:

Chi-square test.

Results:

Majority of the subjects used toothbrush and toothpaste to clean their teeth once daily. Lower socioeconomic groups exhibited higher CPI scores characterized by bleeding gums and calculus deposition. The differences were statistically significant across various social strata (P < 0.01).

Conclusions:

The utilization of the questionnaire on dental awareness facilitates the inclusion of multiple aspects of patient information. The study revealed that oral hygiene awareness and periodontal condition were significantly associated with socioeconomic status. The socioeconomic status and oral hygiene practices were significantly associated with CPI (P < 0.01).

Routine prophylaxes every 3 months improves chronic periodontitis status in type 2 diabetes

BACKGROUND

Periodontitis and type 2 diabetes mellitus (T2DM) are major health problems, especially in low-income populations with little access to dental care. Low-cost models for treatment of periodontal disease have not been tested in controlled studies in low-income populations. Dental prophylaxis, which includes removal of supragingival calculus and plaque, has been shown to arrest the progression of periodontitis. A controlled clinical trial was conducted to determine the effect of dental prophylaxis on periodontitis in T2DM.

METHODS

Twenty-six patients with T2DM and chronic periodontitis (CP) and 26 without T2DM with CP were selected. Periodontal probing depth (PD), gingival bleeding on probing (BOP), clinical attachment level (CAL), and surfaces with plaque were recorded at baseline and 3, 6, and 9 months after initial treatment. All the participants received instructions on oral hygiene and one session of dental prophylaxis at baseline and every 3 months. Glycated hemoglobin (HbA1c) levels were measured at baseline and every 3 months in patients with T2DM.

RESULTS

A significant improvement of PD, BOP, and sites with plaque was observed 3 months after treatment in patients with T2DM (P = 0.001). In controls, mean PD significantly improved after 6 months compared with baseline (P = 0.001). No significant improvement of CAL occurred in either group. No significant differences in periodontal parameters between the groups were detected, and no participant showed progression of CP during the 9-month study period. Dental prophylaxis did not influence HbA1c levels, and no association among HbA1c concentration, pretreatment metabolic status, and severity of CP was found.

CONCLUSION

Routine prophylaxes every 3 months significantly improve periodontal health and prevent progression of CP in both poorly controlled and well-controlled patients with T2DM.

Oral health behavior and HbA1c in Indian adults with type 2 diabetes

Prevention and treatment of oral diseases and diabetes require persistent daily self-care, as there is a mutual association between periodontitis severity and level of diabetes control. In this questionnaire study, we investigated oral health behavior, attitudes, and knowledge of diabetes-related factors among 500 Indian adults with type 2 diabetes mellitus. The questionnaire asked about oral self-care, dental visits, self-perceived problems, and knowledge of the relationship between diabetes and oral health. The most recent glycosylated hemoglobin (HbA1c) value was obtained from patient medical records. Overall, 22% of participants reported twice-daily toothbrushing; women were more likely than men to brush twice daily (P< 0.001). With respect to age and diabetes control, participants aged 35-44 years with good diabetes control had the highest rate of twice-daily brushing (P< 0.001). Oral self-care and use of dental services were poor among participants. The present results indicate that Indians with type 2 diabetes need further promotion of oral self-care and regular dental checkups to compensate for their increased risk of oral disease.

Expectations and satisfaction with care for periodontal specialist patients

OBJECTIVE

The aim of this study was to investigate expectations on and satisfaction with treatment among patients referred for comprehensive treatment to specialist clinics in periodontology and to explore factors associated with satisfaction in regression analysis.

MATERIALS AND METHODS

Patients referred for comprehensive periodontal treatment were sampled for the study. The study was based on a questionnaire in a before-and-after design. The first questionnaire was sent to the patients before their first appointment at the specialist clinic. The second questionnaire was sent after ≈ 6 months. Three questions were used to measure expectations and four questions to measure satisfaction. The first questionnaire was sent to 273 patients with a response rate of 31% and the second questionnaire was sent to 85 patients with a response rate of 73%. In non-response analysis, no difference between respondents and non-respondents were detected as to age and gender.

RESULTS

Many of the patients viewed it as important or very important to have healthy teeth (98%) and improved well-being (93%) after periodontal treatment. More than 50% of the patients were satisfied with the relation to the caregiver. When measuring the satisfaction in general, 42% indicated the highest score on the summarized Dental Visit Satisfaction Scale. Having confidence (p ≤ 0.001) and a good relation (p = 0.001) to the caregiver indicated higher satisfaction.

CONCLUSION

Having a good relation to the caregiver and having confidence in the caregiver seems to indicate satisfied patients receiving periodontal treatment at periodontal clinics.

Low-cost periodontal therapy

Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.

Oral hygiene and periodontal status of 12 and 15-year-old Greek adolescents. A national pathfinder survey

AIM

To investigate oral hygiene and periodontal status of 12- and 15-year old Greek adolescents, in relation to sociodemographic and behavioural parameters.

METHODS

A stratified cluster sample of 1,224 12-year old and 1,257 15-year old adolescents of Greek nationality were selected and examined by calibrated examiners. Periodontal and oral hygiene status were assessed using the Community Periodontal Index (CPI) and the simplified Debris Index (DIs) respectively. The socio-demographic and behavioural data collected included region, location, gender, parental educational level, tooth brushing frequency and reason for dental attendance.

RESULTS

The majority of adolescents aged 12 (75.0%) and 15-years (61.4%) had fair oral hygiene levels. The most frequently observed condition in both ages was calculus with or without bleeding (42.8% in the younger and 53.3% in the older age group). Bleeding on probing was found in 41.5% of the 12-year-olds and in 30.0% of the 15-year-olds. The occurrence of shallow and/ or deep periodontal pockets was very low (0.2%). Multivariable modelling revealed that gender, location and tooth brushing frequency were strongly associated with oral hygiene status in both ages; girls, those living in urban areas and brushing teeth more frequently had significantly lower DI-s. Tooth brushing frequency was also associated with periodontal status in both ages, while living in urban areas was associated with better periodontal health only in the 15-year-olds.

CONCLUSIONS

The study demonstrated that oral hygiene conditions among Greek children and adolescents are not satisfactory and that the occurrence of gingivitis is high. More efforts on oral health education and oral hygiene instruction are needed to improve their periodontal and oral hygiene status.

Comparison of intraoral distribution of two commercially available chlorhexidine mouthrinses with and without alcohol at three different rinsing periods

Objectives:

This study compared the intraoral distribution of 0.1% chlorhexidine with alcohol (CHX+Alc) and 0.2% chlorhexidine without alcohol (CHX-Alc) with shorter rinsing times (10s,20s,30s) following a 72h non brushing period.

Materials and Methods:

This study was designed as a single blind, randomized two group parallel experiment with a total of 30(15male,15 female) dental students. To disclose the plaque, erythrosine-containing disclosing agent was added to both the mouthrinses. Group I (0.1% CHX+Alc) & Group II (0.2% CHX-Alc) were asked to rinse with respective mouthrinse for cumulative periods of 10,20 and 30s, following which plaque was scored.

Results:

In Group I, comparison between 10&20, 10&30s was statistically significant but no significance was observed between 20&30s, whereas in Group II, comparison between all the time points were statistically significant. On comparison of plaque scores, plaque scores of both the groups at 10 & 30s sec, show no statistical significance but at 20 seconds was significant (P<0.001). The mean plaque scores of lingual surfaces were lesser in group II whereas in group I lingual surfaces recorded more plaque than the vestibular surfaces.

Conclusions:

Within the limitations of this study, it can be concluded that rinsing for 30 seconds with 0.2% CHX-Alc (Rexidin) is enough for intraoral spread of the mouthrinse whereas rinsing with 0.1% CHX+Alc(Eludril) for achieves the same in 20 seconds, for effective plaque inhibition, both of which will have a positive influence on patient compliance.

The relationship between levels of income inequality and dental caries and periodontal diseases

The objective of this study was to evaluate the association between income inequality at a lagged time of 2 and 11 years with two short latency outcomes (untreated dental caries and gingivitis) and two long latency outcomes (edentulism and periodontal attachment loss > 8mm). We used data from the Brazilian oral health survey in 2002-2003. Our analysis included 13,405 subjects aged 35-44 years. Different lagged Gini at municipal level were fitted using logistic and negative binomial multilevel analyses. Covariates included municipal per capita income, equivalized income, age, sex, time since last dental visit and place of residence (rural versus urban). Crude estimates showed that only untreated dental caries was associated with current and lagged Gini, but in adjusted models only current Gini remained significant with a ratio of 1.19 (95%CI: 1.09-1.30) for every ten-point increase in the Gini coefficient. We conclude that lagged Gini showed no association with oral health; and current income Gini was associated with current dental caries but not with periodontal disease.

The structure of the catalytic domain of Tannerella forsythia karilysin reveals it is a bacterial xenologue of animal matrix metalloproteinases

Metallopeptidases (MPs) are among virulence factors secreted by pathogenic bacteria at the site of infection. One such pathogen is Tannerella forsythia, a member of the microbial consortium that causes peridontitis, arguably the most prevalent infective chronic inflammatory disease known to mankind. The only reported MP secreted by T. forsythia is karilysin, a 52 kDa multidomain protein comprising a central 18 kDa catalytic domain (CD), termed Kly18, flanked by domains unrelated to any known protein. We analysed the 3D structure of Kly18 in the absence and presence of Mg(2+) or Ca(2+) , which are required for function and stability, and found that it evidences most of the structural features characteristic of the CDs of mammalian matrix metalloproteinases (MMPs). Unexpectedly, a peptide was bound to the active-site cleft of Kly18 mimicking a left-behind cleavage product, which revealed that the specificity pocket accommodates bulky hydrophobic side-chains of substrates as in mammalian MMPs. In addition, Kly18 displayed a unique Mg(2+) or Ca(2+) binding site and two flexible segments that could play a role in substrate binding. Phylogenetic and sequence similarity studies revealed that Kly18 is evolutionarily much closer to winged-insect and mammalian MMPs than to potential bacterial counterparts found by genomic sequencing projects. Therefore, we conclude that this first structurally characterized non-mammalian MMP is a xenologue co-opted through horizontal gene transfer during the intimate coexistence between T. forsythia and humans or other animals, in a very rare case of gene shuffling from eukaryotes to prokaryotes. Subsequently, this protein would have evolved in a bacterial environment to give rise to full-length karilysin that is furnished with unique flanking domains that do not conform to the general multidomain architecture of animal MMPs.

Essential oils compared to chlorhexidine with respect to plaque and parameters of gingival inflammation: a systematic review

BACKGROUND

The purpose of this review is to systematically evaluate the effects of an essential-oil mouthwash (EOMW) compared to a chlorhexidine mouthwash with respect to plaque and parameters of gingival inflammation.

METHODS

PubMed/MEDLINE and Cochrane CENTRAL databases were searched for studies up to and including September 2010 to identify appropriate articles. A comprehensive search was designed, and the articles were independently screened for eligibility by two reviewers. Articles that evaluated the effects of the EOMW compared to chlorhexidine mouthwash were included. Where appropriate, a meta-analysis was performed, and weighted mean differences (WMDs) were calculated.

RESULTS

A total of 390 unique articles were found, of which 19 articles met the eligibility criteria. A meta-analysis of long-term studies (duration ≥ 4 weeks) showed that the chlorhexidine mouthwash provided significantly better effects regarding plaque control than EOMW (WMD: 0.19; P = 0.0009). No significant difference with respect to reduction of gingival inflammation was found between EOMW and chlorhexidine mouthwash (WMD: 0.03; P = 0.58).

CONCLUSION

In long-term use, the standardized formulation of EOMW appeared to be a reliable alternative to chlorhexidine mouthwash with respect to parameters of gingival inflammation.

The effects of an essential oil and an amine fluoride/stannous fluoride mouthrinse on supragingival plaque regrowth

BACKGROUND

The side effects of chlorhexidine (CHX) have stimulated the search for alternative antiplaque agents such as amine fluoride/stannous fluoride (ASF) and essential oils (EO). The aim of the study was to investigate the plaque-inhibiting effects of two commercially available mouthrinses containing ASF and EO, respectively.

METHODS

The study was an observer-masked, randomized, 5 x 5 Latin square cross-over design, balanced for carryover effects, involving 15 volunteers in a 4-day plaque regrowth model. A 0.12% CHX rinse and a saline solution served as positive and negative controls, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On day 5, subjects were scored for disclosed plaque. The ASF rinse was tested at two dosages: 10 and 20 ml (ASF-10 and ASF-20, respectively).

RESULTS

The ASF and EO rinses showed a significant inhibition of plaque regrowth compared to saline (P <0.0001), but the lowest plaque indices were obtained with the CHX product (P <0.01). There were no significant differences among products containing ASF-10, ASF-20, and EO (P >0.05). There was no correlation between the occurrence of side effects and the use of a particular rinse product (P >0.2).

CONCLUSIONS

ASF and EO mouthrinses exerted effective and similar plaque inhibition. The two dosages tested for ASF did not differ in plaque reduction. These findings, together with those from long-term trials, suggest that ASF and EO rinses may represent effective alternatives to CHX rinse as adjuncts to oral hygiene.

Efficacy of two alcohol-free cetylpyridinium chloride mouthwashes - a randomized double-blind crossover study

AIM

(1) To determine the plaque inhibition properties of two formulations of alcohol-free mouthwash [0.1% w/w cetylpyridinium chloride (CPC) (B) and 0.05% w/w CPC (A)] versus a placebo mouthwash (C). (2) To compare the plaque-inhibiting activity between these two new CPC mouthwashes.

MATERIAL AND METHODS

A double-blind, crossover study with three 1-week periods was used. Subjects were randomly assigned to one of the following groups. Group 1 (n=10) received the mouthwashes A, C and B in the periods 1, 2 and 3, respectively, group 2 (n=11) received the mouthwashes in the order B, A, C, while group 3 (n=11) received the mouthwashes in the order C, B, A. Mean plaque areas and Quigley & Hein plaque index scores were analysed using anova (analysis of variance). Measurements were made at the start of each period (baseline) and at 16, 24 and 40 h.

RESULTS

Mean plaque scores were similar across the groups at baseline. At all time points thereafter, volunteers using mouthwash A or B had significantly lower plaque areas and plaque index scores than those using mouthwash C (p<0.05), but there were no significant differences between the test formulations. At 16 h, the reduction in plaque area relative to mouthwash C was 22% for mouthwash A and 18% for mouthwash B; at 24 h, 11% for mouthwash A and 15% for mouthwash B; and at 40 h, 15% for mouthwash A and 16% for mouthwash B.

CONCLUSIONS

The use of both CPC mouthwashes resulted in less plaque accumulation compared with the control. There was no statistically significant difference in plaque accumulation between the two CPC mouthwashes.

Determinants of oral health behaviour among Iranian dentists

AIM

To study the oral health behaviour of Iranian dentists.

DESIGN

A cross-sectional study.

SETTING

Two annual dental meetings in Tehran, Iran.

PARTICIPANTS

1,033 dentists responded, 980 were eligible for this study.

METHOD

Data were collected using a self-administered questionnaire which covered dentists' oral self-care, dental attendance, and smoking. Recommended oral self-care (ROSC) included tooth brushing > 1/day, eating sugary snacks < daily, and regularly using fluoride toothpaste. Knowledge of preventive dental care was assessed by nine Likert-scale statements. Dentist's gender, age, and professional reading were recorded. Statistical evaluation was by the Chi-square test and logistic regression.

RESULTS

In total, 59% of respondents reported brushing their teeth at least 2/day, 59% consumed sugary snacks < daily, 74% used fluoride toothpaste regularly, and 76% were non-smokers. Of all, 27% followed ROSC. Women reported desirable behaviours more frequently than did the men (p < 0.01). Female gender (OR 1.4-2.3), being a non-smoker (OR 1.3-1.5), and wider professional reading (OR = 1.2) were the major factors that contributed to dentists' desirable oral health behaviour.

CONCLUSIONS

That only a small number of Iranian dentists follow the ROSC calls for more attention to behavioural contributions to oral diseases and its consequences with general and oral health, regarding both dental curriculum and continuing education.

Occurrence of Periodontopathic and Superinfecting Bacteria in Chronic and Aggressive Periodontitis Subjects in a Colombian Population

BACKGROUND

Differences in the composition of subgingival microbiota in periodontitis have been observed in different geographic locations. Some of these microbial differences could have clinical significance. This study describes clinical parameters and the composition of the subgingival microbiota in chronic periodontitis (CP) and aggressive periodontitis (AgP) patients in a Colombian population.

METHODS

Clinical parameters (probing depth, clinical attachment level, bleeding on probing, and plaque index) and plaque samples from 68 CP, 12 AgP, and 30 periodontally healthy subjects were analyzed. Subgingival samples were processed using culture, biochemical tests, and polymerase chain reaction for the detection of periodontal and superinfecting pathogens. The analysis of variance, chi(2), and Kruskal-Wallis tests were used to evaluate differences between groups for clinical parameters and microbiologic composition (P <or=0.05).

RESULTS

Clinical parameters were significantly increased in CP and AgP patients compared to healthy subjects (P <0.001), but no differences were found between periodontitis groups. Porphyromonas gingivalis, Tannerella forsythensis, and Eikenella corrodens showed higher frequencies in AgP compared to CP and healthy subjects (P <0.05). Extension (localized and generalized) of the periodontal destruction had no effect on the composition of the subgingival microbiota. Gram-negative enteric rods were more frequent in AgP patients (P <0.01).

CONCLUSIONS

This study demonstrated a high prevalence of P. gingivalis, T. forsythensis, and E. corrodens in AgP patients. Gram-negative enteric rods were frequent in AgP and CP patients. Differences in the composition of subgingival microbiota in periodontitis patients need to be taken into account when considering the best therapeutic approach for each individual, including the use of antibiotics.

Periodontal conditions in 35-44 and 65-74-year-old adults in Denmark

OBJECTIVES

To assess the periodontal health status in the Danish adult population and to analyze how the level of periodontal health is associated with age, gender, urbanization, socio-economic factors, and dental visiting habits; furthermore, to compare the periodontal health status of Danish adults with that of adults in other industrialized countries.

MATERIAL AND METHODS

A cross-sectional study of a random sample of 1,115 Danish adults aged 35-44 years and 65-74 years. Data were collected by means of personal interviews and by clinical examinations in accordance with the World Health Organization Basic Methods Criteria.

RESULTS

The clinical examination revealed a low prevalence of healthy periodontal conditions in both age groups: at age 35-44 years 7.7% and at age 65-74 years 2.4% had healthy periodontal conditions. A high proportion of the elderly had scores of severe periodontal health; more than 82% of older participants had pockets of 4-5 mm or deeper against 42% in younger adults. In both age groups, the mean number of teeth with periodontal pockets deeper than 4-5 mm was high in individuals with low education. Only a weak association between periodontal health and income was found. High Community Periodontal Index scores were seen for irregular dental visitors, but in the 35-44-year-olds deep periodontal pockets were more often seen among young regular dental visitors. The multivariate analysis showed that participants with low or medium levels of education had significantly more teeth with shallow and deep pockets than those with high education. Persons with regular dental visiting habits had fewer teeth with gingival bleeding, shallow and deep pockets than individuals with irregular dental visiting habits.

CONCLUSION

Reorientation of the Danish dental health-care services is needed with further emphasis on preventive care, and public health programs should focus on risk factors shared by chronic diseases in order to improve the periodontal health of Danish adults.

Prevention of periodontal diseases

The ultimate goal of periodontal disease prevention is to maintain the dentition over a lifetime in a state of health, comfort, and function in an aesthetically pleasing presentation. This article focuses on primary and secondary periodontal disease prevention as they relate to gingivitis and periodontitis. Risk assessment, mechanical plaque control, chemical plaque control, current clinical recommendations for optimal prevention, and future preventive strategies are discussed.