Effective professional intraoral tooth brushing instruction using the modified plaque score: a randomized clinical trial

Manual toothbrushes, self-toothbrushing, and replacement duration to remove dental plaque and improve gingival health: A scoping review from recent research

OBJECTIVE

To investigate characteristics of manual toothbrushes, self-toothbrushing methods, and replacement duration of manual toothbrushes that effectively remove dental plaque, reduce gingivitis, and promote gingival health.

STUDY DATA AND SOURCES

PubMed-MEDLINE, Scopus and Central Register Cochrane of Controlled trials (CENTRAL) were searched for randomized control trials (RCTs) from 01 January 2018 to 12 December 2023. Articles were subjected for including participants aged six years and older with a study duration of at least four weeks to investigate the efficacy of manual toothbrushes used self-toothbrushing. To investigate the appropriate time to replace manual toothbrushes, this study was focused on the physical properties of the bristles and changes in the microorganisms present in the bristles over time.

STUDY SELECTION

Of 1520 retrieved articles, 26 studies were included after screening. The total number of manual toothbrushes was 40 and 5 kinds of self-toothbrushing techniques were selected in the review. 4 studies investigated the changes the physical properties bristles of manual toothbrushes.

CONCLUSIONS

Among manual toothbrushes, the cross-angle and indicator bristles were found to significantly improve dental plaque index and gingival condition. Most toothbrushes with soft bristles had a trend of superior dental plaque removal and gingivitis improvement efficacy. Toothbrush with end-round shape bristles tip has tended to reduce the dental plaque and gingival index scores. Studies reported that brushing twice a day for at least two minutes using the Bass method had a positive effect on the dental plaque and gingival index. Further research is required to investigate the relationships between property physical bristle and clinical intraoral indices to clarify the replacement duration of manual toothbrushes.

CLINICAL SIGNIFICANCE

The findings of this study could guide people's daily self-brushing habits, thereby aiding the prevention of periodontal disease. Moreover, our findings suggest the need for strategic clinical trial designs to verify the ideal timing to replace manual toothbrushes.

Effectiveness of novel oral hygiene instruction avoiding inattentional blindness using an application for unique plaque control record calculation: A randomized clinical trial

OBJECTIVE

This study was performed to estimate the effectiveness of novel oral hygiene instruction (OHI) focusing on areas with deep periodontal pockets for reduction of periodontal inflammation.

BACKGROUND DATA DISCUSSING THE PRESENT STATUS OF THE FIELD

Because stained areas on the plaque chart do not always correspond to the areas with deep periodontal pockets, conventional OHI based on O'Leary's plaque control record (PCR) often provides guidance inconsistent with the target area.

METHODS

This randomized clinical trial involved two groups: (1) OHI based on the PCR limited in deep pocket sites (novel OHI group) and (2) OHI based on O'Leary's PCR (conventional OHI group). The unique PCR (aggressive target for PCR [agPCR]; only counting the plaque-stained areas with PD at ≥4 mm sites) for the novel OHI was calculate by dedicated expression program. The probing depth (PD), bleeding on probing (BOP), and periodontal inflamed surface area (PISA) were obtained at the baseline and 5 to 6 months later.

RESULTS

The approximation curve with PISA before and after instruction indicated that the PISA converged to a lower value after instruction in the novel OHI group. The approximation curve with the improvement rate of the PISA and agPCR showed a positive correlation in the novel OHI group but no correlation in the conventional OHI group.

CONCLUSION

Control of inflammation was more effective in the novel OHI group. These results suggest that this novel OHI technique using our developed application could be used as a strategy to improve the effectiveness of brushing instruction.

Effectiveness of mobile augmented reality-integrated oral health education for community-dwelling older adults: A randomized controlled trial

BACKGROUND & PURPOSE

Oral health education helps older adults optimize their oral health. However, traditional lecture-based oral health education has limitations, exacerbated by the COVID-19 pandemic. Mobile augmented reality (MAR) has emerged as an alternative educational method. This study compared the effectiveness of MAR-integrated oral health education with that of lecture-based education and no education.

METHODS

This parallel, randomized controlled, open-label trial enrolled 75 older adults from six activity centers. The participants were randomly assigned, by a random number table technique, to the lecture-based, MAR, or control group. Data on oral healthcare-related knowledge, self-efficacy, and oral health status were collected through questionnaires and oral examinations at baseline, immediately after the intervention, and at a 2-week follow-up. The MAR system's usability was assessed. Statistical analyses, comprising descriptive statistics and inferential tests, were performed.

RESULTS

Data from 61 participants were analyzed, 22 in the lecture-based group, 20 in the MAR group, and 19 in the control group. Both lectures and MAR education significantly improved oral health status. However, changes in knowledge and self-efficacy scores were significantly different only for the MAR versus control group (p = .002 and .001, respectively). The MAR group demonstrated better knowledge and self-efficacy retention than did the lecture-based group, without significant difference. Usability assessment revealed potential for improvement in the MAR system.

CONCLUSIONS

MAR-integrated oral health education enhanced the knowledge, self-efficacy, and oral health status of community-dwelling older adults. However, addressing technology adoption and usability challenges is vital. Longer-term evaluations and broader geographical studies are recommended.

Dental anxiety and oral health-related quality of life before and after non-surgical periodontal treatment

OBJECTIVES

To (1) investigate dental anxiety (DA) and oral health-related quality of life (OHRQOL) before and after non-surgical periodontal treatment (NSPT) and (2) determine correlations between these patient-reported measures.

MATERIALS AND METHODS

Demographics, smoking habits, dental pain, Modified Corah's Dental Anxiety Scale (MDAS), and Oral Health Impact Profile (OHIP-14) were assessed in eighty-two participants.

RESULTS

Mean age was 48.3 years ± 11.5. At baseline, 8.5% reported being active smokers. Of non-smokers, 11% reported being an ex-smoker. After NSPT, 11.0% reported smoking. Patients' maximal pain in the last month decreased after therapy. Before treatment, participants reported higher DA. Extreme DA was observed in 8.5% of participants before therapy. Afterwards, 2.4% of participants reported extreme DA. Fear of having a foreign object in the mouth decreased after NSPT. All OHIP-14 scores, except functional limitation, improved post-treatment. Higher DA was associated with worse OHRQoL before treatment. After treatment, total MDAS score was associated with OHIP-14 global score, physical pain, psychological disability, and social disability. Worse MDAS sub-scores were associated with a higher OHIP-14 global score. Individuals with "normal/slight anxiety" had a significant improvement in OHRQoL, whereas people in the "moderate and extreme anxiety" group did not report a significant improvement. Patients diagnosed with generalized periodontitis (GP) stage III grade B and GP stage IV grade B reported less anxiety after NSPT.

CONCLUSIONS

Associations of MDAS subcategories with OHIP-14 domain scores were found before and after therapy. DA decreases and OHRQoL enhances after NSPT in patients with "normal/slight" anxiety to dental treatment. Dental practitioners should plan strategies to cope with anxiety to dental treatment and prevent decreases in OHRQoL.

CLINICAL RELEVANCE

Within the limitations of this study, DA and OHRQoL were positively correlated in patients with periodontitis, before and after NSPT, using the MDAS and OHIP-14 questionnaires. The results of our study suggest that treatment is effective in terms of alleviating DA and improving oral health, along with quality of life, in patients that report "normal/slight" anxiety to dental treatment. Nonetheless, results must be interpreted with caution since patients are generally anxious before any type of dental treatment. DA may not just be confined to NSPT per se. According to our results, evaluation of both outcomes should be an integral part of routine periodontal clinical evaluation and periodontal reevaluation of initial therapy. It is important that clinicians learn to identify patients that suffer from anxiety and take time to explain the treatment procedures to the patient, to strive for patient's emotional well-being before, during, and after dental care services. The use of specific questionnaires for both DA and OHRQoL may be more appropriate to demonstrate the psychological and quality of life differences due to periodontal disease and NSPT.

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

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

Effectiveness of Mouthwash-Containing Silver Nanoparticles on Cariogenic Microorganisms, Plaque Index, and Salivary pH in A Group of Saudi Children

Objectives:

To compare the effectiveness of Silver nanoparticles (AgNPs) and Chlorhexidine (CHX) mouthwash on Streptococcus mutans (S. mutans), Lactobacillus spp., and Candida albicans (C. albicans) counts O’Leary plaque index (O’Leary PI) scores, and salivary pH levels among children.

Materials and Methods:

The study sample consisted of 117 eligible participants aged 12–18 years. They were divided into control, CHX, and AgNPs groups, with 39 subjects per group. The log10 salivary microbial counts, O’Leary PI, and salivary pH values were recorded and statistically analyzed at baseline and the 28th day. Descriptive statistics were presented as the mean ± standard deviation. In addition, the analyses of variance (ANOVA) and Tukey posthoc test were implemented. The p-value ≤ 0.05 denotes a significant difference between the two points.

Results:

AgNPs and CHX mouthwash were found to have significantly reduced salivary microbial counts and O’Leary PI scores. The salivary pH levels notably increased on the 28th day (p-value < 0.001). All measured outcomes demonstrated notable effects, with the greatest observed for the CHX group, followed by the AgNPs group, and finally, the control group.

Conclusion:

Chlorhexidine and AgNPs mouthwash effectively reduced the cariogenic microbial count and dental plaque and improved the salivary pH values. AgNPs mouthwash may be used as an adjunctive measure to prevent dental caries.

Evaluation of the isosceles-configured SUN TeethTMtoothbrush in dental plaque removal and gingival health

Objective

To evaluate the clinical efficacy and safety profile of a novel-designed isosceles-configured (SUN Teeth™) toothbrush in comparison to a standard reference toothbrush with end-rounded bristles (approved by the American Dental Association [ADA]).

Methods

The sample size was determined using the G-Power-software, version 3.1.2 and, accordingly, 104 subjects (ages 19 years to 25 years) were recruited and randomized into either the test group (n = 54) or the control group (n = 50). Prior to study commencement, scaling was performed followed by abstinence from oral hygiene for 24 hours. Baseline pre-brushing gingivitis scores (Lobene) and plaque scores (Turesky modification of Quigley Hein) were recorded. Brushing was performed for 3 minutes and post-brushing scores were recorded on days 1, 14, and 28 without refraining from regular brushing. Data were analysed with Statistical Package for Social Sciences (IBM-SPSS, v.25.0).

Results

Post-brushing plaque scores showed significant reduction in both groups at all time intervals. However, no significant differences between the test and control brush groups were achieved at any time points.

Conclusion

The isosceles-configured SUN TeethTMtoothbrush is equivalent in plaque removal to the conventional flat-bristled ADA reference brush.

Clinical factors affecting the longevity of fixed retainers and the influence of fixed retainers on periodontal health in periodontitis patients: a retrospective study

PURPOSE

The aim of this study was to evaluate clinical factors affecting the longevity of fixed retainers and the influence of fixed retainers on periodontal health in periodontitis patients.

METHODS

In total, 52 patients with at least 2 years of follow-up after periodontal and orthodontic treatment were included in this study. After scaling and root planing, orthodontic treatment with fixed appliances or clear aligners was performed. Fixed retainers with twist-flex stainless steel wires were bonded to the palatal or lingual sides of anterior teeth. Changes in clinical parameters, including the plaque index, gingival index, calculus index (CI), probing pocket depth, and radiographic bone levels, were evaluated before bonding of fixed retainers and at a 12-month follow-up. Cumulative survival rates (CSRs) for retainer failure were evaluated according to sex, site, CI, stage of periodontitis, and the severity of the irregularity with the log-rank test and hazard ratios (HRs).

RESULTS

Twelve months after bonding of fixed retainers, improvements were observed in all clinical parameters except CI and radiographic bone gain. The overall CSR of the retainers with a CI <1 at the 12-month follow-up after bonding of fixed retainers was significantly higher than that of the retainers with a CI ≥1 at the 12-month follow-up (log-rank test; P<0.001). Patients with stage III (grade B or C) periodontitis had a higher multivariate HR for retainer failure (5.4; 95% confidence interval, 1.22-23.91; P=0.026) than patients with stage I (grade A or B) periodontitis.

CONCLUSIONS

Although fixed retainers were bonded in periodontitis patients, periodontal health was well maintained if supportive periodontal treatment with repeated oral hygiene education was provided. Nonetheless, fixed retainer failure occurred more frequently in patients who had stage III (grade B or C) periodontitis or a CI ≥1 at 12-month follow-up after bonding of fixed retainers.

Association of Education and Depressive Symptoms with Tooth Loss

Previous evidence suggests the association of lower educational attainment and depressive symptoms with tooth loss. The hypothesis of this study was that these factors may exacerbate the effect on tooth loss beyond the sum of their individual effects. We aimed to clarify the independent and interactive effects of educational attainment and depressive symptoms on the number of missing teeth among community residents. Cross-sectional data of 9,647 individuals were collected from the general Japanese population. Dental examination was conducted by dentists. Educational attainment was categorized into 3 levels based on the number of educational years: ≤9, >9 to ≤12, and >12 y. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive symptoms; a total score of ≥16 and/or the use of medications for depression indicate the presence of depressive symptoms. In the multivariate analysis with adjustment for conventional risk factors, educational attainment was identified as a determinant of the number of missing teeth (>9 to ≤12 y of education: coefficient = 0.199, 95% confidence interval [CI], 0.135 to 0.263, P < 0.001; ≤9 y of education: coefficient = 0.318, 95% CI, 0.231 to 0.405, P < 0.001: reference, >12 y of education). An analysis that included interaction terms revealed that the relationship between "≤9 y of education" and the number of missing teeth differed depending on the depressive symptoms, indicating a positive interactive association (coefficient for interaction = 0.198; 95% CI, 0.033 to 0.364, P for interaction = 0.019: reference, >12 y of education). Our study suggests the presence of a significant association between educational attainment and tooth loss, as well as a partial interactive association between "≤9 y of education" and "depressive symptoms" in the general Japanese population.

To Determine the Effect of Chewing Gum Containing Xylitol and Sorbitol on Mutans Streptococci and Lactobacilli Count in Saliva, Plaque, and Gingival Health and to Compare the Efficacy of Chewing Gums

Aims and Objective:

The aim of the study is to determine the effect of chewing gum containing xylitol and sorbitol on mutans streptococci and Lactobacilli count in saliva, plaque, and gingival health and to compare the efficacy of chewing gums.

Materials and Methods:

The study was designed as a double-blinded randomized uncontrolled clinical trial with two parallel arms. A total of 80 students consented and completed the study. The test group (X) received corresponding pellets with xylitol and the control group (S) was given pellets containing sorbitol and maltitol three times daily for 30 days. Clinical scoring and saliva samples were collected at three different intervals, at baseline, 15^th, and 30^th day of the study. The outcome measure was plaque index score, gingival index score, salivary mutans streptococci, and Lactobacilli counts. Data collected were analyzed using Statistical Package for the Social Sciences (SPSS version 19.0).

Results:

There was no statistically significant difference between the mean of mutans streptococci count of test and control group at baseline and 15^th day, but there was statistically highly significant difference (P = 0.00) between the mean of mutans streptococci count in test and control group on the 30^th day. The mean of Lactobacilli count, plaque index, and gingival index score between test and control group showed no statistically significant difference at baseline, 15^th day, and 30^th day.

Conclusion:

The results suggest that only xylitol gum may interfere with the mutans streptococci composition and reduce it after continuous use of 30 days effectively as compared to sorbitol gum, but both the gums are equally effective on salivary Lactobacilli, plaque, and gingiva at different intervals.