Effect of pre-experimental maintenance care duration on the development of gingivitis in a partial mouth experimental gingivitis model

Clinical efficacy of a new cetylpyridinium chloride-hyaluronic acid-based mouthrinse compared to chlorhexidine and placebo mouthrinses-A 21-day randomized clinical trial

OBJECTIVE

To compare the effectiveness of a novel cetylpyridinium chloride (CPC)-hyaluronic acid (HA)-based mouthrinse with chlorhexidine (CHX) and placebo mouthrinses in preventing plaque and gingivitis. The secondary outcomes were calculus, extrinsic stains, oral malodour and occurrence of adverse events.

METHODS

A 21-day randomized, double-blind, three-arm parallel study with random allocation of young dental students to any of the three mouthrinse groups. Thorough prophylaxis was done at baseline followed by a baseline examination for oral malodour, extrinsic stains, calculus, gingivitis and plaque by a single examiner. All the subjects used the allocated mouthrinse twice daily for 21 days and were examined again at the end of the experimental period. They were also interviewed for adverse events. Change in the scores of clinical indices was calculated and compared between the groups.

RESULTS

A total of 75 subjects were included and completed the experiment. There was a significant difference for change in plaque index scores between the groups (P = .015); subjects in the placebo group experienced higher levels of plaque accumulation than the other groups. Teeth staining increased in the CHX (P < .001) and placebo groups (P = .002), but not in CPC-HA users (P = .573). No significant differences were found between the three experimental groups for change in the gingival index (P = .08), calculus scores (P = .494), oral malodour (P = .870) and reporting of adverse events (P = .249).

CONCLUSIONS

CPC-HA and CHX had similar effectiveness in preventing plaque accumulation, while no differences were observed between the mouthrinses for preventing gingivitis. Dental staining was caused by CHX and the placebo mouthrinses but not by CPC-HA mouthrinse.

Routine scale and polish for periodontal health in adults

BACKGROUND

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even for those at low risk of developing periodontal disease. There is debate over the clinical and cost effectiveness of 'routine scaling and polishing' and the optimal frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing, or both, of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), which does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing. Routine scale and polish treatments are typically provided in general dental practice settings. The technique may also be referred to as prophylaxis, professional mechanical plaque removal or periodontal instrumentation.This review updates a version published in 2013.

OBJECTIVES

1. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health.2. To determine the beneficial and harmful effects of routine scaling and polishing at different recall intervals for periodontal health.3. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health when the treatment is provided by dentists compared with dental care professionals (dental therapists or dental hygienists).

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 10 January 2018), and Embase Ovid (1980 to 10 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials of routine scale and polish treatments, with or without oral hygiene instruction, in healthy dentate adults without severe periodontitis. We excluded split-mouth trials.

DATA COLLECTION AND ANALYSIS

Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (or standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data. We calculated risk ratios (RR) and 95% CIs for dichotomous data. We used a fixed-effect model for meta-analyses. We contacted study authors when necessary to obtain missing information. We rated the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included two studies with 1711 participants in the analyses. Both studies were conducted in UK general dental practices and involved adults without severe periodontitis who were regular attenders at dental appointments. One study measured outcomes at 24 months and the other at 36 months. Neither study measured adverse effects, changes in attachment level, tooth loss or halitosis.Comparison 1: routine scaling and polishing versus no scheduled scaling and polishingTwo studies compared planned, regular interval (six- and 12-monthly) scale and polish treatments versus no scheduled treatment. We found little or no difference between groups over a two- to three-year period for gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis when comparing six-monthly scale and polish treatment versus no scheduled treatment was -0.01 (95% CI -0.13 to 0.11; two trials, 1087 participants), and for 12-monthly scale and polish versus no scheduled treatment was -0.04 (95% CI -0.16 to 0.08; two trials, 1091 participants).Regular planned scale and polish treatments produced a small reduction in calculus levels over two to three years when compared with no scheduled scale and polish treatments (high-certainty evidence). The SMD for six-monthly scale and polish versus no scheduled treatment was -0.32 (95% CI -0.44 to -0.20; two trials, 1088 participants) and for 12-monthly scale and polish versus no scheduled treatment was -0.19 (95% CI -0.31 to -0.07; two trials, 1088 participants). The clinical importance of these small reductions is unclear.Participants' self-reported levels of oral cleanliness were higher when receiving six- and 12-monthly scale and polish treatments compared to no scheduled treatment, but the certainty of the evidence is low.Comparison 2: routine scaling and polishing at different recall intervalsTwo studies compared routine six-monthly scale and polish treatments versus 12-monthly treatments. We found little or no difference between groups over two to three years for the outcomes of gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis was 0.03 (95% CI -0.09 to 0.15; two trials, 1090 participants; I² = 0%). Six- monthly scale and polish treatments produced a small reduction in calculus levels over a two- to three-year period when compared with 12-monthly treatments (SMD -0.13 (95% CI -0.25 to -0.01; 2 trials, 1086 participants; high-certainty evidence). The clinical importance of this small reduction is unclear.The comparative effects of six- and 12-monthly scale and polish treatments on patients' self-reported levels of oral cleanliness were uncertain (very low-certainty evidence).Comparison 3: routine scaling and polishing provided by dentists compared with dental care professionals (dental therapists or hygienists)No studies evaluated this comparison.The review findings in relation to costs were uncertain (very low-certainty evidence).

AUTHORS' CONCLUSIONS

For adults without severe periodontitis who regularly access routine dental care, routine scale and polish treatment makes little or no difference to gingivitis, probing depths and oral health-related quality of life over two to three years follow-up when compared with no scheduled scale and polish treatments (high-certainty evidence). There may also be little or no difference in plaque levels over two years (low-certainty evidence). Routine scaling and polishing reduces calculus levels compared with no routine scaling and polishing, with six-monthly treatments reducing calculus more than 12-monthly treatments over two to three years follow-up (high-certainty evidence), although the clinical importance of these small reductions is uncertain. Available evidence on the costs of the treatments is uncertain. The studies did not assess adverse effects.

Routine scale and polish for periodontal health in adults

BACKGROUND

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing or both of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), that does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing.

OBJECTIVES

The objectives were: 1) to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; 2) to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; 3) to compare the effects of routine scaling and polishing with or without oral hygiene instruction (OHI) on periodontal health; and 4) to compare the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 15 July 2013), CENTRAL (The Cochrane Library 2013, Issue 6), MEDLINE via OVID (1946 to 15 July 2013) and EMBASE via OVID (1980 to 15 July 2013). We searched the metaRegister of Controlled Trials and the US National Institutes of Health Clinical Trials Register (clinicaltrials.gov) for ongoing and completed studies to July 2013. There were no restrictions regarding language or date of publication.

SELECTION CRITERIA

Randomised controlled trials of routine scale and polish treatments (excluding split-mouth trials) with and without OHI in healthy dentate adults, without severe periodontitis.

DATA COLLECTION AND ANALYSIS

Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data and, where results were meta-analysed, we used a fixed-effect model as there were fewer than four studies. Study authors were contacted where possible and where deemed necessary for missing information.

MAIN RESULTS

Three studies were included in this review with 836 participants included in the analyses. All three studies are assessed as at unclear risk of bias. The numerical results are only presented here for the primary outcome gingivitis. There were no useable data presented in the studies for the outcomes of attachment change and tooth loss. No studies reported any adverse effects.- Objective 1: Scale and polish versus no scale and polish Only one trial provided data for the comparison between scale and polish versus no scale and polish. This study was conducted in general practice and compared both six-monthly and 12-monthly scale and polish treatments with no treatment. This study showed no evidence to claim or refute benefit for scale and polish treatments for the outcomes of gingivitis, calculus and plaque. The MD for six-monthly scale and polish, for the percentage of index teeth with bleeding at 24 months was -2% (95% CI -10% to 6%; P value = 0.65), with 40% of the sites in the control group with bleeding. The MD for 12-monthly scale and polish was -1% (95% CI -9% to 7%; P value = 0.82). The body of evidence was assessed as of low quality.- Objective 2: Scale and polish at different time intervals Two studies, both at unclear risk of bias, compared routine scale and polish provided at different time intervals. When comparing six with 12 months there was insufficient evidence to determine a difference for gingivitis at 24 months SMD -0.08 (95% CI -0.27 to 0.10). There were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals, in particular between three and 12 months for the outcome of gingivitis at 24 months, with OHI, MD -0.14 (95% CI -0.23 to -0.05; P value = 0.003) and without OHI MD -0.21 (95% CI -0.30 to -0.12; P value < 0.001) (mean per patient measured on 0-3 scale), based on one study. There was some evidence of a reduction in calculus. This body of evidence was assessed as of low quality.- Objective 3: Scale and polish with and without OHIOne study provided data for the comparison of scale and polish treatment with and without OHI. There was a reduction in gingivitis for the 12-month scale and polish treatment when assessed at 24 months MD -0.14 (95% CI -0.22 to -0.06) in favour of including OHI. There were also significant reductions in plaque for both three and 12-month scale and polish treatments when OHI was included. The body of evidence was once again assessed as of low quality.- Objective 4: Scale and polish provided by a dentist compared with a dental care professionalNo studies were found which compared the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine the effects of routine scale and polish treatments. High quality trials conducted in general dental practice settings with sufficiently long follow-up periods (five years or more) are required to address the objectives of this review.

Effect of toothbrush grip on plaque removal during manual toothbrushing in children

Toothbrushing is fundamental to oral hygiene. Children differ in manual dexterity and their grip on toothbrushes. We videotaped toothbrushing sessions and observed the grip type, duration of brushing, and brushing technique used among 100 children aged 8-12 years. We then investigated the association between grip type and plaque removal, using plaque scores obtained at various time points. We further examined the effect on plaque scores of standardizing both brushing technique and duration among the same participants. The most common grip was the distal oblique, followed by the oblique; the spoon and precision grips were rare, and no child used a power grip. Mean brushing duration for most children was 1.43 ± 0.85 min, and the most common brushing technique was horizontal scrubbing. We conclude that grip preference is inherent and that the distal oblique grip was better than the oblique grip in removing plaque.

Antiplaque and antigingivitis effect of Lippia Sidoides: a double-blind clinical study in humans

Objectives:

The antiplaque and antigingivitis effect of Lippia Sidoides (LS) was evaluated in this in vivo investigation.

Material and Methods:

Twenty-three subjects participated in a cross-over, double-blind clinical study, using 21-day partial-mouth experimental model of gingivitis. A toothshield was constructed for each volunteer, avoiding the brushing of the 4 experimental posterior teeth in the lower left quadrant. The subjects were randomly assigned initially to use either the placebo gel (control group) or the test gel, containing 10% LS (test group).

Results:

The clinical results showed statistically significant differences for plaque index (PLI) (p<0.01) between days 0 and 21 in both groups, however only the control group showed statistically significant difference (p<0.01) for the bleeding (IB) and gingival (GI) index within the experimental period of 21 days. On day 21, the test group presented significantly better results than the control group with regard to the GI (p<0.05).

Conclusions:

The test gel containing 10% LS was effective in the control of gingivitis.

Low-level laser efficiency in the therapy of chronic gingivitis in children

Background/Aim. Gingivitis is a frequent phenomenon in children considered to be a risk factor for the occurrence and progression of paradontal tissue disease. So, it is necessary not only to identify inflammation, but also to react in due time and adequately in order to avoid further disease spread and the beginning of periodontitis. The aim of this study was to determine the efficiency of a low-level laser application in the therapy of chronic gingivitis in children. Methods. The study a included hundred of children with permanent dentition suffering from chronic gingivitis. All the examinees were divided into two groups: group I - 50 examinees with chronic gingivitis, who underwent the basic therapy; group II - 50 examinees with chronic gingivitis, who underwent the basic therapy and also a therapy with a low-level laser. Evaluation of the condition of oral hygiene, the health of gingiva and periodontium were done using appropriate index before and after the therapy. Results. For the plaque index (PI) following results were obtained: in the group I PI = 1.94, and in the group II PI = 1.82. After the therapy in both groups PI was 0. In the group I sulcus plaque index (SPI) was 2.02 before the therapy and 0.32 after the therapy. In the group II SPI was 1.90 before the therapy, and 0.08 after the therapy. In the group I Community Periodontal Index of Treatment Needs (CPITN) was 1.66 before the therapy, and 0.32 after the therapy, and in the group II CPITN was 1.60 before the therapy, and 0.08 after the therapy. Conclusion. Chronic gingivitis in children can be successfully cured by the basic treatment. The use of a low-level laser can significantly improve this effect.

Human ? defensin-1 and -2 expression in the gingiva of patients with specific periodontal diseases

BACKGROUND AND OBJECTIVE

beta defensin antimicrobial peptides are important in epithelial innate immunity, and their differential expression is associated with periodontal diseases. The aims of this study were to determine the mRNA expression of human beta defensin-1 and -2 in the gingival tissue of patients with gingivitis, aggressive periodontitis and chronic periodontitis, and to evaluate the relationship between defensin expression and type and/or severity of periodontal destruction.

MATERIAL AND METHODS

Fifteen patients in each group with gingivitis, aggressive periodontitis and chronic periodontitis, and 10 healthy subjects, were included in the study (n=55). The periodontal status of the subjects was determined by periodontal clinical measurements and radiographical evaluations. Transcriptional levels of human beta defensin-1 and -2 genes in gingival samples were assessed by using the quantitative real-time polymerase chain reaction technique, and the data were evaluated statistically by the relative expression Software Tool 2 for groupwise comparisons.

RESULTS

Expression of the human beta defensin-1 gene was lower in gingivitis and aggressive periodontitis groups, and significantly higher in the chronic periodontitis group, than in the control group (p<0.001). Human beta defensin-2 mRNA expression in the gingivitis group was lower than in the control group; however, the difference was statistically significant only in half of the gingivitis patients (p<0.001). Human beta defensin-2 mRNA levels were higher in some chronic periodontitis patients, but lower in the others when compared with the control group (p<0.001). Expression of the human beta defensin-2 gene increased in the aggressive periodontitis group relative to the control group.

CONCLUSION

This study suggests that human beta defensin-1 and -2 genes in the gingival epithelium show differential expression in patients with specific periodontal diseases, and aggressive and chronic periodontitis types demonstrate different gingival beta defensin-1 and -2 expression patterns.

Time as a factor in the identification of subjects with different susceptibility to plaque-induced gingivitis

OBJECTIVES

The purpose of this study was to assess whether identification of subjects with different susceptibility to plaque-induced gingival inflammation is dependent on the length of time of de novo plaque accumulation.

METHODS

Retrospective analysis of data obtained from a recently reported randomized split-mouth localized experimental gingivitis trial involving 96 healthy non-smokers. Gingival and plaque index, gingival crevicular fluid volume (GCF), angulated bleeding score, and the derived parameter cumulative plaque exposure (CPE) were recorded at days 0, 7, 14, and 21. The primary outcome variable to express severity of inflammation was GCF and each subject was a statistical unit. Based on subject distribution of GCF-day 21 residuals after standardization for CPE-day 21, two sub-populations (upper and lower distribution quartiles) were selected. They were, respectively, defined as "high responders" (HR) (n=24) and "low responders" (LR) (n=24) and characterized by significantly different severity of gingivitis to similar amounts of plaque deposits. The same analysis was repeated at days 7 and 14. Prevalence of HR and LR was compared between days using the chi(2) [ML] test.

RESULTS

For both day 7 and day 14, the quartile distribution of LR and HR was statistically significant (p=0.02). Fifty percent of LR and 71% of HR presented a consistent level of susceptibility to plaque-induced gingival inflammation even after only 7 and/or 14 days of plaque accumulation.

CONCLUSIONS

These findings support the concept that the subject-based susceptibility to plaque-induced gingival inflammation is an individual trait, only partly related to the length of time of exposure to plaque.

Chlorhexidine mouthrinse in combination with an SLS-containing dentifrice and a dentifrice slurry

OBJECTIVES

The aim of the present study was to compare the plaque-inhibitory effect of a 0.2% chlorhexidine digluconate (CHX) rinse when preceded by ordinary toothbrushing with a 1.5% sodium lauryl sulphate (SLS)-containing dentifrice to the effect of the same rinse when used alone, or when preceded by rinsing with an SLS-containing slurry.

METHODS

The study was an examiner blinded, randomized three-arm, parallel design. It used a 4-day plaque accumulation model to compare three different oral hygiene regimens, which were performed under supervision. One hundred and twenty healthy volunteers were enrolled in the study and were randomly assigned to one of each group. At the beginning of each test period, they received a thorough dental prophylaxis. The experiment was performed in one randomly assigned (upper or lower) jaw, called the study jaw. The opposite jaw, referred to as the dentifrice jaw, served only to introduce the influence of toothbrushing with a dentifrice on the anti-plaque efficacy of the CHX in the study jaw of the same mouth. At the end of the 4-day test period, plaque and gingival bleeding were scored in the study jaw. In all the regimens, the oral hygiene procedure was finalized by rinsing with a CHX 0.2% solution for 1 min. The study jaw was not brushed during the experiment. Regimen A (positive control) consisted of rinsing with CHX alone. In regimen B, rinsing with CHX was preceded by rinsing with an SLS-containing slurry, while in regimen C rinsing with CHX was preceded by toothbrushing with an SLS-containing dentifrice in the dentifrice jaw. No other oral hygiene measures were allowed. After 4 days of undisturbed plaque accumulation, the amount of plaque and level of gingival health were evaluated.

RESULTS

The overall plaque index for regimens A, B and C was 1.17, 1.62, and 1.14, respectively. There was no significant difference in plaque accumulation between the CHX alone regimen (A) and the SLS-dentifrice-CHX regimen (C). Regimen B differed significantly from regimens A and C. The overall bleeding index for regimens A, B and C was 0.24, 0.18, and 0.20, respectively. There was no significant difference between the three regimens.

CONCLUSIONS

The present study shows that the anti-plaque efficacy of a 0.2% CHX rinse was not reduced when preceded by everyday toothbrushing with a SLS-containing dentifrice. However, when preceded by rinsing with an SLS-containing slurry, the anti-plaque efficacy of a 0.2% CHX rinse was reduced.

Modulation of clinical expression of plaque-induced gingivitis: response in aggressive periodontitis subjects

AIM

The aim of this study was to characterize the gingival inflammatory response to de novo plaque accumulation in subjects treated for aggressive periodontitis (AP). The gingival inflammatory response of the AP subjects was retrospectively compared with that of periodontally healthy individuals (PH) matched for exposure to plaque and of periodontally healthy subjects previously identified as "high responders" (HR) and "low responders" (LR).

MATERIALS AND METHODS

13 AP subjects and 26 matched PH subjects participated in a 21-day experimental gingivitis trial. Plaque index (PlI), Gingival index (GI), gingival crevicular fluid volume (GCF) and angulated bleeding score (AngBS) were recorded at days 0, 7, 14 and 21. Cumulative plaque exposure (CPE), i.e. PlI over time, was also calculated.

RESULTS

GCF was significantly higher in AP compared with PH group at each observation interval (p< or =0.001). In addition, GCF was significantly higher in AP group compared with either LR or HR groups at each observation interval (p<0.001).

CONCLUSIONS

These results suggest that susceptibility to gingival inflammation in response to de novo plaque accumulation may be related to susceptibility to periodontitis.

Effect of genetic variability on the inflammatory response to periodontal infection

AIM

To review the association between genetic variability and the inflammatory response induced by periodontal infection.

MATERIAL AND METHODS

A search of MEDLINE-PubMed was performed from January 2000 up to and including March 2005. The search included all types of publications, published in English without other limitations. The following search terms were used: "cytokine polymorphism", "gene polymorphism", "periodontitis", "gingivitis", "inflammation" and "host-response". The papers resulting from the above search were used as an additional source for relevant articles.

RESULTS

Genetic variability was examined for the correlation to clinical indicators of inflammation such as bleeding on probing (BOP), gingival inflammation, cytokine in gingival crevicular fluid (GCF) and cytokine production by inflammatory cells. According to the current literature, most of the studies found no association between genetic variability and BOP, gingival inflammation or cytokine concentrations in the GCF. These studies were hampered by inappropriate study designs and the use of inflammatory parameters as secondary rather than primary outcome variables. The data suggest that the production of inflammatory mediators by inflammatory cells may be affected by different genetic traits but further studies are needed in order to establish this association.

CONCLUSIONS

To date, there is no clear correlation between any of the gene polymorphisms and clinical indicators of inflammation. The powering of studies to reveal associations between single or multiple nucleotide polymorphisms and inflammatory parameters will need to involve a much larger number of subjects than were used in the past. The available data (including the interleukin-1 composite genotype) do not currently support the utility of such tests in the diagnosis and prognostic assessments of periodontal diseases.

Etiology and pathogenesis of periodontal diseases

The two most prevalent and most investigated periodontal diseases are dental plaque-induced gingivitis and chronic periodontitis. The last 10 to 15 years have seen the emergence of several important new findings and concepts regarding the etiopathogenesis of periodontal diseases. These findings include the recognition of dental bacterial plaque as a biofilm, identification and characterization of genetic defects that predispose individuals to periodontitis, host-defense mechanisms implicated in periodontal tissue destruction, and the interaction of risk factors with host defenses and bacterial plaque. This article reviews current aspects of the etiology and pathogenesis of periodontal diseases.

An oscillating/pulsating electric toothbrush versus a high-frequency electric toothbrush in the treatment of gingivitis

OBJECTIVES

The objective of this study was to compare the effect of an oscillating/pulsating power toothbrush (Oral-B ProfessionalCare 7000; PC 7000) and a high-frequency power toothbrush (Philips Sonicare Elite; SE) on the reversal of experimental gingivitis.

METHODS

The study had a randomised, examiner-blind, split-mouth design. After dental prophylaxis, subjects refrained from brushing mandibular teeth for 21 days to allow development of gingivitis. During a 4-week treatment phase, the right or left side of the mouth was brushed with either the PC 7000 or the SE toothbrush as randomly allocated. Plaque and gingivitis were assessed at baseline (Day 0), after 21 days of no oral hygiene, and after 1, 2 and 4 weeks of brushing twice daily. Gingival abrasion was assessed at Day 0 and after 1, 2 and 4 weeks of product use.

RESULTS

Of 38 enrolled subjects, 35 provided evaluable data. The experimentally induced gingivitis (EIG) phase resulted in higher bleeding and plaque scores as compared to Day 0. During the treatment phase, plaque and bleeding scores were significantly lower with the PC 7000 than the SE toothbrush. After 4 weeks of use, the mean plaque scores changed from 2.78 (Day 21 of EIG phase) to 0.70 for the PC 7000 and from 2.67 (Day 21) to 0.88 for the SE. The mean bleeding scores changed from 1.86 (Day 21) to 1.24 for the PC 7000 and from 1.88 (Day 21) to 1.42 for the SE. No major differences were found between brushes with regard to gingival abrasion.

CONCLUSIONS

The oscillating/pulsating power toothbrush (Oral-B ProfessionalCare 7000) was more effective than the high-frequency power toothbrush (Philips Sonicare Elite) at plaque removal and improvement of gingival condition, with no greater potential for causing gingival abrasion.

Modulation of Clinical Expression of Plaque-Induced Gingivitis: Interleukin-1 Gene Cluster Polymorphisms

BACKGROUND

The purpose of the present study was to determine the association of interleukin-1 (IL-1) gene polymorphisms with clinical parameters of gingivitis in a large experimental gingivitis trial and with each of two subgroups, high responders (HR) and low responders (LR), with distinct susceptibility to gingivitis.

METHODS

Ninety-six systemically and periodontally healthy non-smokers, 46 males (mean age: 23.9+/-1.7) and 50 females (mean age: 23.3+/-1.6) were included in a randomized, split-mouth, localized 21-day experimental gingivitis trial. Plaque index (PI), gingival index (GI), gingival crevicular fluid volume (GCF), and angulated bleeding score (AngBS) were recorded. Two subgroups were defined from the total study population (HR, LR) characterized by substantially different severity of gingival inflammation despite similar plaque accumulation rate. The study population was typed for interleukin-1 alpha (IL-1A+4845), interleukin-1 beta (IL-1B+3953, IL-1B-511), and IL-1 receptor antagonist (IL-1RN, intron 2 variable number tandem repeats) gene polymorphisms. Gene variants were analyzed by amplifying the polymorphic region using polymerase chain reaction, followed by restriction-enzyme digestion and agarose gel electrophoresis.

RESULTS

Neither IL-1A+4845, IL-1B+3953, or the combined (IL-1A+4845 x 2 - IL-1B+3953 x 2) genotype was associated with clinical parameters in the overall population. IL-1RN was significantly associated with test quadrant PI (P= 0.046), GCF (P= 0.05), and GI (P= 0.018). The genotype distribution in HR and LR subjects was significantly different for IL-1RN (P= 0.045) and for IL-1B-511 (P= 0.023).

CONCLUSION

The results of the present study suggest an association between IL-1RN polymorphism and subject-based clinical behavior of the gingiva in response to de novo plaque accumulation, as well as a possible association between IL-1B-511 polymorphism and gingivitis susceptibility.

Modulation of clinical expression of plaque-induced gingivitis. II. Identification of "high-responder" and "low-responder" subjects

AIM

The aims of this study were to validate a randomized, split-mouth, localized experimental gingivitis model and to identify subjects with different gingivitis susceptibility.

MATERIAL AND METHODS

In each of 96 healthy subjects, one maxillary quadrant was randomly assigned as "test" (experimental gingivitis) and the contralateral quadrant as "control". Plaque index (PlI), gingival index (GI), gingival crevicular fluid volume (GCF), and angulated bleeding score (AngBS) were recorded in both quadrants at days 0, 7, 14, and 21. Cumulative plaque exposure (CPE), i.e. PlI over time, was calculated. Day-21 GCF was standardized according to CPE, and residuals of GCF on CPE were calculated. Two subpopulations were then defined, based on upper and lower quartiles of GCF-residual distribution and were, respectively, identified as "high-responder" (HR; n=24) and "low-responder" (LR; n=24).

RESULTS

At test quadrants, all parameters significantly increased throughout the trial, while in control quadrants, PlI, GI, and AngBS remained low. Significant differences were noted between test and control quadrants on days 7, 14, and 21 for all parameters. Significant increases in GI, AngBS, and GCF were observed in test quadrants over the course of the study in both HR and LR groups. Significant differences were noted between HR and LR groups for all gingivitis parameters on day 21 in test quadrants, without any significant differences in PlI or CPE between the groups.

CONCLUSIONS

We identified two subpopulations characterized by significant differences in clinical parameters of plaque-induced gingival inflammation, despite similar amounts of plaque deposits and plaque accumulation rates.

Modulation of clinical expression of plaque-induced gingivitis. I. Background review and rationale

OBJECTIVES

The purpose of this article is to provide the necessary background and rationale for the accompanying studies, which are ultimately aimed at identifying genetic and environmental factors determining gingivitis susceptibility.

MATERIALS AND METHODS

The literature on factors reported to modify the clinical expression of gingivitis, i.e., factors that determine individual variability in gingival inflammatory response to plaque, is presented.

RESULTS

Clinical evidence suggests that the gingival inflammatory response to plaque accumulation may differ substantially among individuals. However, most of the available studies are of small scale and not purposely designed to address the issue. Systemic factors implicated in modulation of the clinical expression of gingivitis include metabolic, genetic, environmental and other factors. The significance of such factors in designing and conducting a large-scale experimental gingivitis trial and means to account for them are discussed.

CONCLUSION

Although several factors have been implicated, genetic or environmental factors underlying differences in gingivitis expression are not fully elucidated. The accompanying studies aim to identify and characterize, among participants in a specifically designed large-scale experimental gingivitis trial, subjects that differ significantly in their gingival inflammatory response to plaque. This is the first step in an effort to determine genetic or environmental factors underlying such differences.

Control of gingival inflammation in a teenager population using ultrasonic prophylaxis

Gingival inflammation is clinically characterized by gingival redness, swelling and increased tendency of bleeding of the soft tissue. Bacterial biofilm is the etiological agent. If, at this stage, the bacterial biofilm is removed and appropriate control methods are applied, remission of gingival inflammation occurs. This study evaluated the effectiveness of a single session of ultrasonic prophylaxis for the reduction of gingivitis in an adolescent population using the Plaque Index (PI) and Gingival Index (GI). The study sample consisted of 15 male adolescent students selected at a dentist's office of a public high school. Prior to treatment (baseline), plaque index (PI) and bleeding on probing (BOP) were recorded. The patients then received oral hygiene instructions and ultrasonic prophylaxis. Follow-up exams were made 15 and 30 days after the ultrasonic prophylaxis, again recording PI and BOP. The data were analyzed by the Student's t-test for dependent samples. Correlation analysis between presence of biofilm and bleeding on probing was also made using the Pearson correlation test. There was a statistically significant decrease in the plaque index and bleeding on probing between baseline and examinations at both 15 days and 30 days (p<0.05). However, the difference between the means at 15 and 30 days was statistically similar. The correlation analysis showed correlation between both parameters (p<0.05). The results indicate that a single session of ultrasonic prophylaxis associated to oral hygiene instructions is efficient to reverse gingivitis in adolescents.

Periodontal diseases: current and future indications for local antimicrobial therapy

The microbial etiology of gingivitis and periodontitis provides the rationale for use of adjunctive antimicrobial agents in the prevention and treatment of periodontal diseases. Although mechanical removal of supra- and subgingival calcified and non-calcified plaque deposits has been proved effective to control the gingival inflammatory lesions as well as to halt the progression of periodontal attachment loss, some patients may experience additional benefits from the use of systemic or topical antimicrobial agents. Such agents are able to significantly affect supra- and subgingival plaque accumulation and/or suppress or eradicate periodontal pathogenic microflora. Currently, properly selected local antiseptic and systemic antibiotic therapies can provide periodontal treatment that is generally effective, low-risk and affordable. This paper will briefly review the host-related conditions in which the periodontal preventive and therapeutic approaches may be effectively assisted by a local antimicrobial regimen. Potential future indications for adjunctive local antimicrobial therapy will also be discussed.

Interleukin-1 gene polymorphisms and experimental gingivitis

BACKGROUND

Recently, an association between the severity of periodontitis and specific variations in the interleukin-1 (IL1) alpha and beta genes has been demonstrated.

AIM

: The purpose of this study was to evaluate the relationship of the IL1 genotype to the development of experimental gingivitis.

MATERIALS AND METHODS

Twenty young adult subjects presenting with healthy gingival conditions participated after giving their informed consent. The group included 10 risk genotype positive (P+) and 10 risk genotype negative (P-) individuals. The IL1 genotypes were determined on DNA samples from peripheral blood using PCR-RFLP analyses for the IL1alpha and IL1beta polymorphisms. Experimental gingivitis was allowed to develop in two posterior sextants per subject. Bleeding on probing (BOP%) and gingival crevicular fluid volume (GCF) were assessed at baseline and days 2, 7, 9, 14, 16 and 21. The day 21 results for BOP and GCF as well as the rate of increase of these parameters - mean area under the curve (AUC) and mean increase per day (slope) - were evaluated using risk analyses for IL1 genotype, smoking status and gender.

RESULTS

Experimental gingivitis developed with a gradual increase in BOP scores and GCF values (expressed as Periotron units=PU) from baseline to day 21 (BOP, P+: 0.5 to 26.0%; P-: 1.0 to 28.1%; GCF, P+: 36.8 to 138.5 PU, P-: 43.1 to 143.4 PU). No significant risk was associated with P+ and P- for day 21 results, AUC or slope.

CONCLUSION

The results of this study failed to provide evidence that the IL1 risk genotype was associated with higher GCF volume and percentage BOP during the development of experimental gingivitis.

A clinical study to compare the efficacy of 2 electric toothbrushes in plaque removal

OBJECTIVES

To compare the cleaning efficacy of a powered toothbrush with 3-dimensional brush head action (Braun Oral-B 3D Plaque Remover D15) and a high-speed "microtation" brush with an additional "microbrush-clip" (Rowenta Dentasonic MH921S).

MATERIAL AND METHODS

82 healthy subjects took part in the study. After a familiarization period of 8 days, the subjects abstained from all oral hygiene procedures for 48 h. After plaque was scored, the subjects brushed their teeth under supervision with the two brushes according to a split-mouth design. Immediately after brushing, subjects completed a questionnaire and plaque was scored again.

RESULTS

The overall plaque scores were found to be significantly reduced from 3.05+/-0.60 to 1.96+/-0.63 by the D15 and from 3.02+/-0.58 to 2.24+/-0.64 by the Dentasonic (p<0.05). The proximal surface plaque scores were reduced from 3.20+/-0.63 to 2.17+/-0.69 by the D15 and from 3.17+/-0.60 to 2.44+/-0.69 by the Dentasonic. The relative plaque reduction was overall 36.6+/-12.2% for the D15 compared to 26.1+/-13.5% for the Dentasonic and at proximal surfaces, 33.1+/-12.3% and 23.2+/-13.0%, respectively. 75% of the subjects stated that they would prefer to keep the D15.

CONCLUSIONS

Both brushes were able to remove a significant amount of plaque, but the D15 was significantly more effective compared to the Dentasonic. The additional "microbrush-clip" for the proximal embrasures failed to improve plaque removal from these tooth surfaces, compared to the D15 alone.

Salivary cystatin activity and cystatin C in natural and experimental gingivitis in smokers and non-smokers

BACKGROUND

Recent studies show that subjects with natural gingivitis or periodontitis have elevated levels of salivary cystatins compared to periodontally healthy individuals. Increased glandular output of cystatins in inflammatory conditions suggests an active, most likely protective, rôle for these proteins in inflammatory processes. Furthermore, it has been shown that the development of gingival inflammation is suppressed in smokers during experimental gingivitis.

AIMS

The purpose of the present study was to investigate whether (i) the levels of salivary cystatins in natural gingivitis are related to smoking status, and (ii) to study whether experimentally induced gingivitis is associated with changes in salivary cystatin levels, in both smokers and non-smokers.

MATERIAL AND METHODS

Whole saliva samples were taken in relation to natural gingivitis, gingival health and 14-day experimental gingivitis in 25 non-dental students (14 non-smokers and 11 smokers). The salivary flowrate was determined. Samples were analyzed for levels of protein, cystatin and cystatin-C.

RESULTS

Salivary flow and protein concentrations in cleared human whole saliva samples of non-smokers and smokers were not different from each other at any timepoint during the trial. With regard to cystatins, the results showed that in the state of natural gingivitis cystatin activity is lower in smokers as compared to non-smokers. In smokers, the resolution of natural gingivitis to the state of gingival health did not result in a change of cystatin activity and levels of cystatin C. At the end of the 14-day experimental gingivitis period, smokers showed a decrease in cystatin activity and cystatin C as well as lower outputs of cystatin activity and cystatin C.

CONCLUSION

Smoking is associated with lower cystatin activity and output of cystatin C during gingival inflammation.

Gingival crevicular fluid inflammatory mediators and bacteriology of gingivitis in nonhuman primates related to susceptibility to periodontitis

The hypothesis to be tested was that the microbiota and resulting local host inflammatory response characteristics in oral conditions of high levels of chronic gingival inflammation increases susceptibility to progressing periodontitis. This study used cynomolgus monkeys, Macaca fascicularis (nonhuman primates), with high and low levels of long-standing gingival inflammation to define the profiles of gingival crevicular fluid mediators, cytokines and immunoglobulins; describe the subgingival microbiota; and evaluate their susceptibility to ligature-induced periodontitis. Sixteen nonhuman primates were stratified into two groups (HI, LO) based upon Bleeding Index as a measure of the natural level of inflammation (HI = 1.26 +/- 0.45; LO = 0.22 +/- 0.16). The host mediator levels, subgingival microbiota, and clinical characteristics of the LO and HI groups were compared after 30 days of oral hygiene, during a 30 day experimental gingivitis (7, 14, and 30 days), and during periodontitis (30, 60, and 90 days). The results demonstrated that nonhuman primates with high levels of long-standing gingival inflammation when compared to those nonhuman primates with low inflammation show: 1) different inflammatory mediator profiles in gingival crevicular fluid (particularly for immunoglobulin A (IgA) and IgG levels), 2) a different quantitative and qualitative subgingival microbiota; and 3) a similar progression of periodontitis. Thus, while variations in host inflammatory responses to local factors exist in the nonhuman primates, an extensive subgingival challenge (such as ligation) may negate these individual differences.

Oral microbiota in smokers and non-smokers in natural and experimentally-induced gingivitis

The present study primarily aimed at investigating the oral microbiota in smokers and non-smokers with established gingivitis and monitoring its composition during experimental gingivitis. Secondly, it aimed at examining whether the composition of the microbiota is associated with different levels of gingival inflammation during this experimental gingivitis trial. For this purpose, 25 non-dental university students with gingivitis were recruited. 11 subjects were smokers and 14 were non-smokers. After achieving gingival health, they entered a 14-day experimental gingivitis trial. Plaque and bleeding were assessed before entering into the study (intake), at day 0, day 5 and at day 14 of the experiment. Microbiological samples from mucosal sites and dental plaque (taken at intake, day 0, and day 14) were analysed for the presence of Actinomyces species, Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Campylobacter rectus, Fusobacterium nucleatum, Peptostreptococcus micros, Porphyromonas gingivalis, Prevotella intermedia and Streptococcus species. At day 14 of the experimental period, the level of plaque formation was not different between smokers and non-smokers, but bleeding scores were lower in smokers than in non-smokers (15% and 30% respectively, p=0.01). The change from natural gingivitis to a state of gingival health and a subsequent change from gingival health to experimentally induced gingivitis was accompanied by quantitative alterations in the cultivable microbiota in both groups. Changes were most prominent in the transition from gingival health to experimental gingivitis and were found in dental plaque for Actinomyces species, C. rectus, F. nucleatum, and P. intermedia. Within the group of non-smokers, a distinction was made between subjects with a 'weak' or 'strong' inflammatory response. No relationship with a single bacterial species could be established which would likely explain the differences in levels of inflammation. It is concluded that differences in response to experimental gingivitis are not caused by major differences in the composition of the oral microbiota.

The effect of a single scaling with or without oral hygiene instruction on gingival bleeding and calculus formation

136 students of both sexes aged 14-18 years who were deprived of regular dental care participated in a 22-month longitudinal study. All students underwent scaling of the assigned teeth in 2 quadrants according to a randomised split-mouth design on contralateral quadrants. 2 groups of students were formed, one group received oral hygiene instruction (OHI). Follow-up examinations on gingival bleeding and calculus were carried out 6, 12, and 22 months after the scaling session. The prevalence of calculus on assigned teeth at baseline was high with a mean score of 1.10. At the end of the study, new calculus formation on scaled teeth reached a mean score of 0.58. Formation of calculus still continued on non-scaled teeth, but at a lower rate than on scaled teeth. Scaling resulted in an approximately 20% reduction of the gingival bleeding score which remained during the 22 months follow-up period. OHI had no significant effect on the calculus and bleeding scores. Since the effect of scaling alone on the gingival condition was small and the effect of a single OHI negligible, the practice of occasional scaling without repeated OHI, which is commonly employed in developing countries, should be considered as clinically irrelevant and of little use in improving the standard of periodontal health.

Oral microbiota in subjects with a weak or strong response in experimental gingivitis

The purpose of the present study was to examine the composition of the oral microbiota in subjects who had previously demonstrated to develop either a weak or strong response to experimental gingivitis. For this study, subjects were selected from a pool of 25 individuals who had participated twice in an experimental gingivitis trial. Out of these 25 panellists, 6 subjects were selected who had developed 2X a weak gingival inflammatory response and 7 subjects who had developed 2X a strong gingival inflammatory response. Approximately 9 months after the 2nd experimental gingivitis trial, we evaluated the clinical condition and the prevalence of a panel of selected oral micro-organisms in these subjects. The subjects were clinically examined for the presence of plaque, bleeding, pocket depth and loss of attachment. For the microbiological evaluation, samples were taken from the mucous membranes, subgingival sites and saliva. Samples were analyzed for the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Peptostreptococcus micros, Actinomyces spp., Fusobacterium nucleatum, Campylobacter rectus, spirochaetes and motile rods. Clinical evaluation showed that most subjects had a relatively healthy periodontal condition. No clinically significant differences could be detected between the weak and strong responding groups. The microbial evaluation showed absence of A. actinomycetemcomitans, P. gingivalis and P. micros in all subjects in either group. Analysis of the microbial data for the weak and strong responding group showed no differences between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)