Epidemiology of plaque-induced gingivitis among 12-15-year-old Chinese schoolchildren: A study based on the 2018 case definition

AIM

To explore the epidemiology of plaque-induced gingivitis and related factors among Chinese adolescents.

MATERIALS AND METHODS

This cross-sectional survey comprised 118,601 schoolchildren in the 12-15-year age group. Data came from the National Oral Health Survey in mainland China. The field investigation was conducted according to the World Health Organization guidelines. The new 2018 case definition for plaque-induced gingivitis was used. Participants underwent clinical examinations and completed a structured questionnaire. Bleeding on probing (BOP) was performed on all teeth. Multinomial logistic regression was used to explore the factors related to the extent of gingivitis.

RESULTS

Nearly half of the study population (47.3%) had plaque-induced gingivitis; 23.9% and 23.3% presented with localised and generalised gingivitis, respectively. The first molars were the most affected by BOP. Well-established factors, such as demographic characteristics, socioeconomic status, local factors and smoking habits, were significantly associated with the extent of gingivitis. Odds ratios for localised and generalised gingivitis increased with the decrease in frequency of toothbrushing with a fluoride dentifrice.

CONCLUSIONS

The study population had high plaque-induced gingivitis prevalence. The extent of gingivitis appeared to have a dose-response relationship with the frequency of toothbrushing with a fluoride dentifrice.

Influence of keratinized mucosa width on the resolution of peri-implant mucositis: A prospective cohort study

BACKGROUND

The prevalence of peri-implant diseases, driven by biofilm accumulation and influenced by factors such as the width of keratinized mucosa (KM), underscores the need for understanding their etiology and management.

PURPOSE

To evaluate the association between the KM width and the clinical resolution of peri-implant mucositis after mechanical therapy.

MATERIALS AND METHODS

Patients with an implant diagnosed with peri-implant mucositis were allocated to two groups: wide band of KM (WKM ≥ 2 mm) and narrow/no band of KM (NKM < 2 mm). Data and submucosa biofilm were collected at baseline and at 8, 12, and 24 weeks after nonsurgical therapy. A Brunner-Langer model was estimated for longitudinal data to evaluate and compare changes in any clinical parameter throughout follow-up between both groups. Furthermore, the microbial profiles were evaluated by 16S rRNA gene sequencing.

RESULTS

A total of 38 implants were analyzed. At 24 weeks, bleeding on probing was substantially reduced in both groups, reaching statistical significance (p < 0.001). Treatment resulted in 23.9% less effective in achieving success for NKM. As such, NKM reduced the odds of disease resolution by 80% compared to WKM. The rest of the explored clinical parameters yielded more favorable outcomes for WKM versus NKM. Neither the alpha nor the beta diversity of the microbial profiles were significantly modulated by KM.

CONCLUSIONS

KM width influences the clinical resolution of peri-implant mucositis after mechanical therapy (https://clinicaltrials.gov/study/NCT04874467?cond=keratinized%20mucosa&rank=8, NCT04874467, 04/30/2021).

Comparing the Effectiveness of Different Techniques for the Management of Dental Implant Peri-Implant Mucositis: A Randomized Controlled Trial

Background

Dental implant peri-implant mucositis is a prevalent complication that can lead to implant failure if left untreated. Various management techniques have been proposed, but their comparative effectiveness remains unclear of dental implant peri-implant mucositis.

Materials and Methods

A total of 120 patients with peri-implant mucositis were randomly assigned to one of four treatment groups: Group A received mechanical debridement alone, Group B received mechanical debridement with adjunctive antiseptic mouthwash, Group C underwent laser therapy, and Group D received a combination of mechanical debridement and systemic antibiotics. Clinical parameters, including bleeding on probing (BOP), probing pocket depth (PPD), and plaque index (PI), were recorded at baseline and after a three-month follow-up period.

Results

At the three-month follow-up, significant improvements were observed in all treatment groups. However, Group D, which received a combination of mechanical debridement and systemic antibiotics, showed the most substantial reduction in BOP (mean reduction of 78.2%), PPD (mean reduction of 2.5 mm), and PI (mean reduction of 1.7). Group C, treated with laser therapy, demonstrated the second-best outcomes with a mean reduction of 65.4% in BOP, 2.0 mm in PPD, and 1.3 in PI. Groups A and B showed moderate improvements, with no statistically significant differences between them.

Conclusion

This randomized controlled trial (RCT) suggests that a combination of mechanical debridement and systemic antibiotics (Group D) is the most effective treatment for managing dental implant peri-implant mucositis, yielding superior clinical outcomes compared to other techniques.

The Effect of Dental Flossing Instructions and Technique on Interproximal Bleeding: A randomized control trial

Purpose Dental floss has been promoted reduce the effects from interdental microbial biofilm, however its efficacy has been questioned in the literature. The purpose of this study was to compare daily flossing instructions using an adapted horizontal vertical flossing technique (AHVFT) and routine oral hygiene on gingival inflammation as indicated by bleeding on probing (BoP).Methods This randomized single-blinded controlled clinical trial was conducted with non-smoking adults presenting with gingivitis and no other systemic diseases. Eligible participants were recruited from a dental school patient population and were randomly assigned to one of two groups. Group A (experimental group) was instructed in how to use the AHVFT once daily and Group B (control group) was asked to continue with their regular oral hygiene practices. Clinical evaluations (interproximal BoP measurements) were performed by blinded, calibrated examiners at two, four, and eight-week intervals; the percentage of sites with interproximal BoP was recorded. Descriptive and inferential statistics were used to analyze the data.Results A total of 36 eligible participants were enrolled in the study: Group A (n=18), Group B (n=18). The mean (±SD) percentage of interproximal sites with BoP was 26.3 (±4.7), 8.6 (±7.3), 7.2 (±5.2), and 7.9 (±5.8) for Group A at baseline, two weeks, four weeks, and eight weeks, respectively. The corresponding values for Group B were 25.8 (±9.9), 15.6 (±12.4), 12.3 (±12.2), and 18.0 (±13.1), respectively. The percentage of sites with BoP was significantly lower for Group A than for Group B (p=.015 at two weeks, p=.009 at four weeks, and p<.001 at eight weeks). Within each group, the percentage of sites with BoP was significantly lower when compared with baseline (p<.008). At the final visit, the percent reduction in BoP for Group A was 70% and 30% for Group B compared with baseline. Most (88.2%) of Group A participants demonstrated mastery of the AHVFT at eight weeks.Conclusion Participants who received Instruction with the daily use of the AHVFT were shown to have reductions in interproximal BoP as compared to participants who had not received instructions in the AHVFT. Positive gingival health outcomes with dental flossing may be technique sensitive.

Comparison of the Efficacy of Different Oral Hygiene Aids in Maintaining Periodontal Health in Patients With Gingivitis

Background Gingivitis is a common oral health condition characterized by inflammation of the gingiva, which, if left untreated, can progress to more severe forms of periodontal disease. Effective oral hygiene practices play a crucial role in managing gingivitis, but the comparative efficacy of different oral hygiene aids remains unclear. This study aimed to evaluate and compare the efficacy of various oral hygiene aids in maintaining periodontal health in patients with gingivitis, considering gender and the degree of gingivitis as potential influencing factors. Methods A total of 120 participants with gingivitis were enrolled in this study. The participants were randomly assigned to one of four groups, each utilizing a different oral hygiene aid: Group A (toothbrush), Group B (electric toothbrush), Group C (brushing along with the use of an interdental brush), and Group D (brushing along with the use of a water flosser). All participants received toothpaste for use with their respective oral hygiene aids. Periodontal health parameters, including plaque index (PI), gingival index (GI), and bleeding on probing (BOP) score, were assessed at baseline and after a specified duration of oral hygiene intervention. Also, the microbial count for Streptococcus, Actinomyces, Porphyromonas, Fusobacterium, and Veillonella species was evaluated. Results No significant differences in periodontal health outcomes were observed between males and females in any of the oral hygiene aid groups. Similarly, no significant differences were found among the mild, moderate, and severe gingivitis groups within each oral hygiene aid group. The microbial count also has no statistical significance except for streptococcus species. These findings indicate that the efficacy of the tested oral hygiene aids was comparable across genders and different degrees of gingivitis. Conclusion The findings of this study suggest that the tested oral hygiene aids were effective in maintaining periodontal health in patients with gingivitis, irrespective of gender and the degree of gingivitis. These results have implications for oral healthcare professionals in their recommendations to patients regarding oral hygiene practices. However, it is important to consider the limitations of this study, including the relatively small sample size and the specific oral hygiene aids tested.

A Systematic Review and Meta-Analysis of Systemic and Local Antibiotic Therapy in the Surgical Treatment of Peri-Implantitis

(1) Background: Given the existing controversy regarding the use of antibiotics in the treatment of peri-implantitis, this systematic review and meta-analysis aim to ascertain how beneficial the role of systemic and local antibiotics is in peri-implant surgical therapy, considering the harmful effects that they represent and the abuse of antibiotics in terms of global health. (2) Methods: To determine the therapeutic efficacy of the administration of antibiotics in the surgical treatment of peri-implantitis in terms of probing pocket depth (PPD) and bleeding on probing (BoP), electronic and manual bibliographic searches were carried out in the Embase and PubMed databases, collecting data that related to before and after treatment. (3) Results: The adjunctive use of local antibiotics provides significant improvements in PPD (MD = 1.29; 95% CI: 0.56 to 2.02; p ≤ 0.0006; I² = 0%) when compared with surgical treatment alone. No significant differences were found in the other subgroup; that is, the use of systemic antibiotics did not significantly improve PPD changes in the surgical treatment of peri-implantitis (MD = 0.40; 95% CI: -0.15 to 0.95; p = 0.15; I² = 0). (4) Conclusions: The use of local antibiotics in the surgical treatment of peri-implantitis seems to offer treatment improvements in terms of PPD and BoP, unlike that observed with the use of systemic antibiotics. However, these results should be taken with caution as they also depend on the type of surgical technique used, whether regenerative or resective. More research is needed on this topic to understand the role of local and systemic antibiotics in the treatment of peri-implantitis.

Comparative Analysis of Various Forms of Local Drug Delivery Systems on a Class 2 Furcation - A Systematic Review

Class II mandibular furcation defect is a periodontal condition characterized by a cul-de-sac lesion, a definite parallel constituent with only a portion of alveolar bone remaining intact. There may be involvement of vertical bone loss. Local drug deliveries such as Boric acid, alendronate gel, and other drugs exhibited anti-inflammatory, antibacterial & osteoblastic differentiation activity. The present systematic review compares the drugs based on their outcomes and pharmacological action. To analzse & compare various forms of local drug delivery systems on a class II furcation. A search was conducted using PubMed, Google scholar, science direct, and Pub Med central using MeSH terms - local drug delivery in periodontics, boric acid in the management of class II mandibular furcation, simvastatin in the treatment of furcation. A total of 560 articles were screened; 58 out of 560 were full-text articles accessed for eligibility, and five articles were included in the systematic review. PRISMA guidelines were used for reporting this review. In addition, five randomized controlled trials were enclosed and used in this systematic review. The various local drugs used in treating class II mandibular furcation defects are effective in the prevention of bleeding on probing, bone resorption, gingival bleeding index and increase in the bone fill, and microbial deposit removal. The managing of class II mandibular furcation defect with the drugs mentioned in this review can be effective by reducing several clinical parameters such as bleeding on probing, gingival indices, osteoblastic differentiation, bone fill, etc., Considering the results of the studies, it can be concluded that it can be used as a therapeutic therapy against class II furcation defects with positive outcomes.

Periodontitis Severity Grading Scale and C-Reactive Protein: A Possible Relation

Background C-reactive protein (CRP) is the first acute-phase protein and is an exceptional investigative marker for local and systemic inflammation. The periodontitis severity grading scale (PSGS) indicates the extent of periodontal inflammation. Therefore, the aim of the study was to explore the correlation between the markers of systemic and periodontal inflammation as assessed by CRP and the PSGS in participants with periodontitis. Materials and methods The present study enrolled 85 systemically healthy participants with periodontitis. PSGS and CRP levels were measured in each participant. Descriptive and inferential statistics were applied for analysis. Results The PSGS scores ranged from 24 to 213, and the CRP levels ranged from 0.5 to 3.23 mg/l. This shows a positive correlation between the periodontal scale and CRP. A nonsignificant (p-value > 0.05) correlation exists between age and CRP score, and a significant association was seen between gender and severity of periodontitis with p-value < 0.02. A highly significant association between gender and CRP score was found with p-value < 0.001. Conclusion The level of serum CRP dramatically increased with the severity of periodontitis. The results of this study point to a highly significant correlation between markers of systemic and periodontal inflammation, as well as a strength of association between the two markers.

Resolution of peri-implant mucositis at tissue- and bone-level implants: A 6-month prospective controlled clinical trial

OBJECTIVE

The objective of the study was to compare resolution of inflammation of naturally occurring peri-implant mucositis (PM) at tissue-level (TL) and bone-level (BL) implants after non-surgical mechanical debridement.

MATERIALS AND METHODS

Fifty-four patients with 74 Implants with PM were allocated in two groups (39 TL and 35 BL implants) and treated by means of subgingival debridement using a sonic scaler with a plastic tip without adjunctive measures. At baseline and at 1, 3, 6 months, the full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), bleeding on probing (BOP), and modified plaque index (mPlI) were recorded. The primary outcome was BOP change.

RESULTS

After 6 months, the FMPS, FMBS, PD, and number of implants with plaque decreased statistically significantly in each group (p < .05); however, no statistically significant differences were found between TL and BL implants (p > .05). After 6 months, 17 (43.6%) TL and 14 (40%) BL implants showed a BOP change in (17.9%) and (11.4%), respectively. No statistical difference was recorded between groups.

CONCLUSIONS

Within the limitations of present study, the findings showed no statistically significant differences in terms of changes in clinical parameters following non-surgical mechanical treatment of PM at TL and BL implants. A complete resolution of PM (i.e., no BOP at all implant sites) was not achieved in both groups.

Utility of a haemoglobin test of gingival crevicular fluid: A multicentre, observational study

OBJECTIVE

The purpose of this study was to verify the accuracy and utility of clinical parameters (plaque index, gingival crevicular fluid volume, probing depth, clinical attachment level, bleeding on probing and gingival index) and biochemical parameters (aspartate aminotransferase, protein and haemoglobin) in a longitudinal analysis during the supportive periodontal therapy period.

SUBJECTS AND METHODS

A total of 279 test sites of 128 patients were investigated clinically and biochemically. After the first examination of clinical and biochemical parameters, periodontal support treatments were administered immediately and performed once every three months up to the second examination.

RESULTS

All of the clinical and biochemical parameters were significantly lower at the second examination than at the first, except for the plaque index and bleeding on probing. Of these parameters, in particular, aspartate aminotransferase and haemoglobin in the gingival crevicular fluid were significantly reduced compared to those of the first examination in both the ≤4 and ≥5 mm probing depth groups, and they clearly suggested that periodontitis tended to recover.

CONCLUSION

Adding the haemoglobin test to the bleeding on probing test strongly improves the accuracy of measurement of clinical parameters after periodontal treatment.

Efficacy of adjunctive measures in peri-implant mucositis. A systematic review and meta-analysis

AIM

To answer the following PICO question: In systemically healthy humans with peri-implant mucositis, what is the efficacy of patient-performed or administered (by prescription) measures used adjunctively to submarginal instrumentation, as compared to submarginal instrumentation alone or combined with a negative control, in terms of reducing bleeding on probing (BOP), in randomized controlled clinical trials (RCTs) with at least 3 months of follow-up?

MATERIALS AND METHODS

Three databases were searched until April 2022. Weighted mean differences (WMDs) with 95% confidence intervals (CIs) and predictive intervals were calculated.

RESULTS

Sixteen parallel RCTs corresponding to 14 studies with low/moderate risk of bias were included. Test groups showed greater reductions in BOP (%) than control groups (n_studies  = 16; n_patients  = 650; WMD = 14.25%; 95% CI [9.06-19.45]; p < .001; I²  = 98.7%). The greatest WMD in BOP reductions (%) were obtained by antiseptics (n_s  = 5; n_p  = 229; WMD = 22.72%; 95% CI [19.40-26.04]; p < 0.001; I²  = 94.8%), followed by probiotics (n_s  = 6; n_p  = 260; WMD = 12.11%; 95% CI [3.20-21.03]; p = .008; I²  = 93.3%) and systemic antibiotics (n_s  = 3; n_p  = 101; WMD = 5.97%; 95% CI [1.34-10.59]; p = .012; I²  = 58.1%). Disease resolution was scarcely reported (n = 6).

CONCLUSIONS

Significant clinical improvements can be obtained when professional submarginal instrumentation is combined with patient-performed or administered (by prescription) adjunctive measures, although a complete disease resolution may not be achieved.

Effect of Interdental Enamel Reduction on Clinical Attachment Loss, Bleeding on Probing, and Incidence of Caries in Treating Class I Malocclusion Cases: A Retrospective Cohort Study

Introduction Interdental Enamel Reduction (IER) is a clinical procedure that reduces the mesiodistal size of permanent teeth by enamel removal and anatomical re-contouring. The aim of this study was to investigate the effect of IER on patients' gingival health status, including clinical attachment loss (CAL) and bleeding on probing (BOP). Furthermore, in this study, the incidence of caries after IER with or without fluoride therapy was evaluated. Methods In this retrospective cohort study, 90 patients who had started and completed their orthodontic treatment within the past two years were divided into three groups as follows: In group 1, patients had received interproximal stripping on their anterior mandibular teeth. Patients in group 2 had also received interproximal stripping on their mandibular anterior teeth and topical fluoride had been applied after IER. Patients in group 3 had only received orthodontic treatment without any interproximal stripping. Then, patients were examined for CAL, BOP, and incidence of caries. Results CAL for patients in the IER and control groups were 2.06±0.18 and 2.08±0.16, respectively. Also, BOP for patients in the IER and control groups were 3.01±0.14 and 3.05±0.19, respectively. Incidences of caries, BOP, and CAL were not significantly different between the group of patients who received IER and the control group (P>0.05). Moreover, the incidence of caries was not significantly different between the patients who received topical fluoride after IER and those who did not receive fluoride (P=0.999). Conclusion Interproximal stripping of mandibular anterior teeth before orthodontic treatment does not significantly increase the incidence of caries, BOP, and CAL. Moreover, the application of topical fluoride after IER has no significant effect on the incidence of caries.

Association of periodontal disease with oral lichen planus: A systematic review and meta analysis

Background

Gingival lesions in oral lichen planus can indirectly increase the risk of plaque-induced periodontal disease when symptoms associated with such lesions hamper the proper oral hygiene maintenance by the patients and can increase the risk of periodontal tissue destruction. This systematic review analyses the existing evidence on the association between oral lichen planus and periodontal disease.

Aim

This systematic review of case-control studies aimed to analyse the association between periodontal disease and oral lichen planus.

Material and Methods

An electronic database search for randomised controlled trials, experimental studies, case-control studies, and cohort studies published in peer-reviewed Journals in the English language was conducted from the following databases: PubMed, EBSCOHost, Science Open, EMBASE, and Google Scholar.

Results

A total of 12,507 were identified on an electronic database search. Only eight studies fulfilled the eligibility criteria and were included for quantitative analysis. A data extraction sheet was prepared, and studies were analysed.

Conclusion

Bleeding on Probing and Probing depth were seen to be significantly associated with Oral Lichen Planus. The symptoms in Oral Lichen Planus impede efficient oral hygiene maintenance by a patient and predispose them to the occurrence of long-term Periodontal Disease.

Impact of a Specific Collagen Peptide Food Supplement on Periodontal Inflammation in Aftercare Patients-A Randomised Controlled Trial

Background: This controlled clinical trial evaluated the impact of a specific collagen peptide food supplement on parameters of periodontal inflammation in aftercare patients. Methods: A total of 39 study patients were enrolled. At baseline, bleeding on probing (BoP; primary outcome), gingival index (GI), plaque control record (PCR), recession (REC) and probing pocket depth (PPD) for the calculation of the periodontal inflamed surface area (PISA) were documented. After subsequent professional mechanical plaque removal (PMPR), participants were randomly provided with a supply of sachets containing either a specific collagen peptide preparation (test group; n = 20) or a placebo (placebo group; n = 19) to be consumed dissolved in liquid once daily until reevaluation at day 90. Results: PMPR supplemented with the consumption of the specific collagen peptides resulted in a significantly lower mean percentage of persisting BoP-positive sites than PMPR plus placebo (test: 10.4% baseline vs. 3.0% reevaluation; placebo: 14.2% baseline vs. 9.4% reevaluation; effect size: 0.86). Mean PISA and GI values were also reduced compared to baseline, with a significant difference in favor of the test group (PISA test: 170.6 mm2 baseline vs. 53.7 mm2 reevaluation; PISA placebo: 229.4 mm2 baseline vs. 184.3 mm2 reevaluation; GI test: 0.5 baseline vs. 0.1 reevaluation; GI placebo: 0.4 baseline vs. 0.3 reevaluation). PCR was also significantly decreased in both experimental groups at revaluation, but the difference between the groups did not reach the level of significance. Conclusions: The supplementary intake of specific collagen peptides may further enhance the anti-inflammatory effect of PMPR in periodontal recall patients.

Effects of an Ozonated Water Irrigator on the Plaque Index and Bleeding Index of Pregnant Women

Pregnancy causes physiological changes in the woman’s body, which can also affect oral health. Therefore, pregnant women may manifest gingival inflammation that is favored by their hormonal increase. This clinical trial (ClinicalTrials.gov Identifier: NCT04140643) evaluated the variation in the plaque index (PI) or bleeding index (BOP) in pregnant women after daily use of an ozonated water irrigator and proper home oral hygiene, compared to a control group who only performed home oral hygiene. The inclusion criteria were the gestation period from the 14th week to the 30th week, a diagnosis of gingivitis, and a minimum number of teeth equal to 20. The PI and BOP index were evaluated at T0, fifteen days after T0 (T1), and two months after T1 (T2). The PI values systematically decreased over time (F (1.19) = 41.82) in both groups, with a systematic difference in PI values between the two groups (F (1.19) = 6.28, p = 0.021). A statistically significant difference was assessed in the BOP index at T2 between the two groups, with the control group suffering a higher BOP index. The results show that the patients in the study group showed a decrease in the BOP index over the three time points, in contrast to the control group, due to the beneficial properties of ozonated water.

A Systematic Review and Meta-Analysis of Systemic Antibiotic Therapy in the Treatment of Peri-Implantitis

Research has been conducted into the advantages of the systemic administration of antibiotics. The aim of this systematic review and meta-analysis was to assess the efficacy of systemic antibiotic administration in the treatment of peri-implantitis in terms of bleeding on probing (BoP) and probing pocket depth (PPD). Literature searches were performed across PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials and observational clinical studies. After peri-implantitis treatment, PPD was reduced by 0.1 mm (p = 0.58; IC 95% [-0.24, 0.47]), indicating a non-significant effect of antibiotic administration on PPD. The BoP odds ratio value was 1.15 (p = 0.5; IC 95% [0.75, 1.75]), indicating that the likelihood of bleeding is almost similar between the test and control groups. Secondary outcomes were found, such as reduced clinical attachment level, lower suppuration and recession, less bone loss, and a reduction in total bacterial counts. In the treatment of peri-implantitis, the systemic antibiotic application reduces neither PPD nor BoP. Therefore, the systemic administration of antibiotics, in the case of peri-implantitis, should be rethought in light of the present results, contributing to address the problem of increasing antibiotic resistance.

Impact of an Oral Hygiene Intervention in People with and without Dementia on Oral Health Parameters-Results from the Oral Health, Bite Force, and Dementia (OrBiD) Pilot Study

This study aimed to assess the influence of an oral hygiene intervention on oral health, depending on the degree of dementia. A clinical evaluation of oral health parameters (index of decayed, missing, and filled teeth (DMFT-index), periodontal screening index (PSI), oral hygiene index (OHI), and bleeding on probing (BOP)) was performed in 120 subjects assigned to five groups, based on the mini mental state examination (MMSE) at baseline and after 12 months. Each MMSE group (no dementia (noDem, MMSE 28–30), mild cognitive impairment (mCI, MMSE 25–27), mild dementia (mDem, MMSE 18–24), moderate dementia (modDem, MMSE 10–17), and severe dementia (sDem, MMSE ≤ 9)) was split into control (no intervention) and experimental groups (intervention on oral hygiene: increased frequency, daily usage of high-fluoride toothpaste). In total, 99 out of 120 subjects were included in the analysis. The dropout rate was high in subjects with modDem and sDem due to death. In subjects with noDem, mCI, and mDem, no changes in the DMFT were found, but improvements in the OHI, BOP, and PSI were observed. Subjects with modDem or sDem demonstrated a deterioration in DMFT; however, in these patients, OHI improved in all control and experimental groups, BOP improved in the experimental group only, and PSI did not improve at all. The scope of improving oral health parameters by increasing the recall frequency and by continuously using high fluoride toothpaste is at its limits in people with severe dementia. Multidimensional approaches should be sought to improve the oral health of vulnerable older patients.

Impacts of the Triple bristles three-sided sonic powered toothbrush on tooth shade, plaque control and gingival health

OBJECTIVES

To evaluate the efficacy of the Triple bristles three-sided sonic powered toothbrush in plaque removal and its impact on tooth shade and gingival health, and to compare this with a conventional manual toothbrush.

METHODS

Fifty two participants (26 males and 26 females; mean age [SD] = 22.48 [1.52], SE = 0.210, 95% CI = 22.06-22.90) were recruited into this controlled within-subject, randomized, two-treatment, 1-month crossover and examiner-blinded observational study between October 2020 and January 2021 in the School of Dentistry, University of Jordan. Within each participant, the upper and lower jaws were randomized to receive a brushing protocol either with the Triple bristles three-sided sonic brush or with a soft manual standard toothbrush with flat trimmed bristles. Tooth shades were recorded for upper and lower anterior and premolar teeth. The Turesky-Modified Quigley-Hein Plaque Index (TMQHPI) and bleeding on probing (BOP) were evaluated at study baseline, 1 week and 1 month after applying the brushing protocol.

RESULTS

Both tested brushes were associated with significant reduction in plaque scores and BOP (p < 0.05). The Triple bristles brush was more effective in reduction in plaque and BOP in the lower jaw and among females than the manual brush (p < 0.05).

CONCLUSIONS

The Triple bristles brush was more superior for reduction in plaque and probing on bleeding in the lower jaw and among females.

Impact of interproximal composite restorations on periodontal tissue health: Clinical and cytokine profiles from a pre-post quasi-experimental study

BACKGROUND

The aim of this study is to clinically and molecularly evaluate the effect of an interproximal iuxta/subgingival direct composite restoration on periodontal tissue healing.

METHODS

Individuals in need of a posterior iuxta/subgingival interproximal restoration were consecutively enrolled. After enrollment, a test (site with tooth decay) and a control site (intact contralateral tooth) were identified. After a periodontal examination (probing depth [PD], clinical attachment level, recession, plaque, and bleeding on probing [BOP]) and a sampling of gingival crevicular fluid, the composite restoration was performed (T₀ ). Clinical and molecular assessments were repeated at 3 (T₃ ), 6 (T₆ ), and 12 (T₁₂ ) months after the restoration. Intragroup pre-post comparisons for quantitative variables were performed either through one-way ANOVA or Kruskal-Wallis test. A multivariate linear regression analysis was then modeled. With α = 0.05, a power of 80% will be reached with the inclusion of 41 individuals.

RESULTS

Biometric parameters demonstrated an increased mean PD (ΔPDT₀ -T₁₂ = -0.83 mm; P = 0.001) and loss of attachment (AL) (ΔCALT₀ -T₁₂ = -0.91 mm; P = 0.005) in the test site at 12 months. Accordingly, in the final multivariate regression model the radiographic distance between the bone crest and the restorative margin at baseline accounted for the dependent variable "attachment loss (AL)" (ΔCALT₀ -T₁₂ ) (P <0.05).

CONCLUSIONS

Iuxta/subgingival interproximal restorative margins jeopardized clinically and molecularly the periodontal tissue healing at least up to 1 year of follow-up.

Patients' opinion on the use of 2 generations of power-driven water flossers and their impact on gingival inflammation

Objectives

To assess patients' opinion on the use of 2 generations of power‐driven water flossers and their impact on gingival inflammation.

Material & Methods

In the present prospective cohort study 24 periodontitis patients under regular supportive periodontal therapy used daily 2 generations of a power‐driven water flosser (Sonicare AirFloss [SAF] and Sonicare AirFloss Ultra [SAFU]) for 12 weeks each. Patients were instructed to position the nozzle interproximally from the buccal aspect at each interproximal space. Patients' opinion was assessed by a questionnaire and interproximal bleeding on probing (BoP) was recorded.

Results

Overall satisfaction with SAF/SAFU was rated high, by about 80% of the patients. About 66% of the patients preferred SAF/SAFU compared to their previous interdental cleaning device and indicated that they would continue using SAF/SAFU after the study; none of the patients reported any discomfort or pain. Compared to only tooth brushing, daily use of SAF/SAFU caused a significant reduction of interproximal BoP values, which were well maintained over 6 months; that is, BoP at interproximal buccal and oral sites (pooled), as well as at interproximal buccal and oral sites separately, was proportionately reduced by 29.1%, 41.2%, and 24.8%, respectively (pooled: p = 0.027; buccal sites: p = 0.030; oral sites: p = 0.030).

Conclusion

Patients were very fond of the power‐driven water flossers tested herein, and daily use of the devices for 6 months (i.e., each device was used for 3 months) resulted in a significant reduction of gingival inflammation interproximally.

Success of supportive periodontal therapy in periodontitis patients - A retrospective analysis

Objective

The aim of this retrospective analysis was to evaluate, in adult patients treated for periodontitis, the periodontal stability during supportive periodontal therapy (SPT).

Methods

Data were collected and analyzed retrospectively for periodontitis patients aged ≥36 years who underwent active periodontal therapy (APT) and were following an SPT programme. The stability of the APT success, defined as a probing pocket depth (PPD) of ≤5 mm, was the main outcome parameter. Analyses were performed in which PPD, tooth loss (TL), bleeding on probing (BOP), periodontal epithelium surface area (PESA), and the effects of age, gender, smoking status, and the number of years in SPT were evaluated. The annual TL and BOP of <10% in addition to a PPD of ≤5 mm were considered to be secondary outcome variables.

Results

In total, 993 patients were included, in 36% of whom a PPD ≤5 mm was found at the evaluation of APT. If the outcome was defined as a BOP of <10% in addition to a PPD of ≤5 mm, this was present in only 16% of the patients. During SPT, a small overall increase in clinical parameters for the total population and an annual average TL of 0.15 per patient was observed. Patients of male gender and smokers negatively affected the success of SPT.

Conclusion

The periodontal clinical status remained ‘fairly’ stable during SPT in chronic periodontitis patients aged ≥36 years. Smoking negatively affects the outcome of APT and periodontal stability during SPT.

Effects of Lingual and Palatal Site Toothbrushing on Periodontal Disease in the Elderly: A Cross-Sectional Study

(1) Background: To analyze the association between periodontal health status and daily oral health activities including lingual and palatal site toothbrushing. (2) Methods: One hundred and fifty Korean elderly people aged >65 years participated in the study. Clinical examination regarding oral health status, including periodontal health status, was evaluated, and data on the oral health activities, socio-demographic factors, and systemic health-related factors were obtained using a questionnaire. Statistical analyses assessed the differences of periodontal health status according to daily oral health activities, including lingual and palatal site toothbrushing. (3) Results: Oral health activities including lingual and palatal site toothbrushing, frequency of toothbrushing, use of an interdental toothbrush, dietary patterns, and activity dependence correlated with bleeding on probing (BOP) and periodontitis. After adjusting for covariates, the prevalence of periodontitis was lower in the group where the inner surfaces of the teeth were partially or wholly cleaned than in the group without such cleaning. High BOP was significantly associated with the brushing of the inner surfaces of teeth. (4) Conclusions: Lingual and palatal site toothbrushing was associated with good periodontal health status in the elderly; the importance of brushing the inner surfaces of teeth should be emphasized for them and their caregivers.

Cortisol levels in the peri-implant sulcular fluid among patients with and without peri-implantitis

BACKGROUND AND OBJECTIVE

Cortisol levels remain uninvestigated in peri-implant sulcular fluid (PISF) of patients with and without peri-implantitis. The present investigation investigated levels of cortisol in PISF among controls (individuals without peri-implantitis) and patients with peri-implantitis.

METHODS

The patient population comprised of participants with and without peri-implantitis (groups 1 and 2, respectively). Demographic information and data related to implant characteristics was recorded. Peri-implant radiographic (crestal bone loss [CBL]) and clinical (modified plaque and bleeding on probing indices [PI and BOP], and probing depth [PD]) and parameters were assessed. In all patients, levels of cortisol were measured in the PISF, which was collected using standard methods. Data normality and group comparisons were assessed, and multiple logistic regression was performed. Probability values less than 0.01 were nominated as being significant.

RESULTS

Eighty-eight individuals (44 and 44 in groups 1 and 2, correspondingly) were included. In group 1, 24 and 20 participants were males and females, and there were 22 and 22 males and females in group 2. Mean ages were analogous in both groups. Peri-implant BOP (p < .001); CBL (p < .001); PI (p < .001); and PD (p < .001) were higher among patients in group 1 compared with group 2. The volume of PISF (p < .001) collected and its concentrations of cortisol (p < .001) were significantly higher among patients in group 1 compared with group 2. Regression analysis showed that CBL and PD directly correlated with increased PISF levels of cortisol among participants with peri-implantitis.

CONCLUSION

Within the limits of the present study, it remains debatable whether or not PISF cortisol levels vary among patients with and without peri-implantitis. Further studies are needed to evaluate the role of PISF levels of cortisol in the diagnosis of peri-implantitis.

Prolonged multimodal fasting modulates periodontal inflammation in female patients with metabolic syndrome: A prospective cohort study

AIM

To determine the potential anti-inflammatory effect of a multimodal periodic fasting programme on surrogate parameters of periodontal inflammation in hospitalized patients diagnosed for metabolic syndrome (MetS).

MATERIAL AND METHODS

A total of 47 patients were recruited and hospitalized in an integrative ward for an intensified two-week multimodal fasting, diet and lifestyle programme. Patients were periodontally examined at baseline (t1), after the 2-week fasting protocol (t2) and, subsequently, 4 months after fasting (t3). The following parameters were determined: periodontal screening index (PSI), bleeding on probing (BOP), gingival crevicular fluid volume (GCF), plaque index (PI), C-reactive protein (CRP), blood pressure (BP), waist circumference (WC), fasting glucose (FGLU), triglycerides (TRG), high-density lipoprotein (HDL) and HbA1c.

RESULTS

A total of 28 female and 8 male patients fulfilled the defined criteria for MetS and were analysed separately by gender. At t2, BOP and GCF were reduced when compared to t1 (median: t2 = 39; t1 = 33.1%; p < .001 and t2 = 73.9; t1 = 59.3 Periotron units p = .02, respectively). BOP reduction correlated to FGLU (R = .37, p = .049) and weight reduction (R = .4, p = .04).

CONCLUSION

This study showed for the first time that clinically supervised periodic fasting in female patients with MetS may facilitate the reduction of periodontal inflammation.

Effect of Age on Bleeding on Probing (BOP) as an Indicator of Periodontal Inflammation in Patients Enrolled in Supportive Periodontal Therapy

PURPOSE

To assess the effect of age on the mean percentage of bleeding on probing (BOP) during supportive periodontal therapy (SPT) in patients enrolled in SPT for at least 5 years. Materials and Methods: This study was performed as a retrospective analysis of data collected from SPT patients initially diagnosed with gingivitis or mild to severe periodontitis. Two groups of patients were selected: in group A, younger adults (age ≤ 35 years) were included while group B consisted of older SPT patients (age ≥ 65 years). BOP in the two groups was compared according to both disease severity and % compliance with SPT visits. Results: BOP in all patients (n = 236) was 19.2% (± 12.4). Group A (n = 110) presented mean BOP levels of 19.7% (± 11.8), while lower BOP levels of 18.7% (± 13.0) were found in group B (n = 126; p = 0.5272). Older patients demonstrating high % compliance had lower mean BOP levels (14.2% ± 9.5) than younger patients (18.0% ±  11.7; p = 0.0841). Similarly, BOP was lower in older patients with moderate (group B: 18.4% ± 12.1, group A: 19.3% ± 14.6, p = 0.0541) or severe periodontitis (group B: 22.4% ± 11.4, group A: 23.2% ±  14.0; p = 0.3440). In patients with moderate or severe periodontitis and higher % compliance with SPT, the mean BOP was statistically significantly lower in older patients than in younger patients (moderate: 14.4% ± 11.9 vs 19.4% ± 15.1, p < 0.0001; severe: 13.2% ± 11.1 vs 18.3% ± 17.5, p = 0.0170). Conclusion: Older patients enrolled in SPT may present lower levels of BOP. This finding should be considered when determining SPT intervals with elderly patients.

Outcome of peri-implant maintenance care in patients with an implant-supported lower denture-A 3.5-year retrospective analysis

Background

Implant‐supported overdentures represent a successful treatment for edentulous patients. As early diagnosis, detection and supportive care are considered key factors for the prevention of peri‐implant diseases, consistent maintenance of these implants is becoming increasingly relevant.

Purpose

This retrospective analysis evaluated a cohort of edentulous patients with a mandibular implant‐supported overdenture over a period of 3.5 years during which the peri‐implant tissues were assessed.

Materials and Methods

A total of 108 patients that had consistently adhered to the annual maintenance appointments was selected. The clinical peri‐implant pocket probing depth (PiPPD) and peri‐implant bleeding on probing score (PiBOP) were investigated. Data from the 3.5‐year follow‐up were compared to data from the baseline assessment.

Results

A 100% implant survival was reported after 3.5 years. The mean PiBOP showed a significant decrease over time (P = .028). The mean PiPPD was found significantly deeper for male patients both at baseline (P = .004) and 3.5‐year follow‐up (P < .001). Besides, the PiPPD for locator anchorages was found significantly deeper compared to ball anchorages at the 3.5‐year follow‐up (P = .026).

Conclusion

In those patients that adhered to the annual maintenance visits during the 3.5 years after implant surgery a stable peri‐implant condition was observed. As future consideration, the comparison of the clinical outcomes of patients participating in the maintenance program with those that did not would make this observation even more meaningful.

Optimal Examination Sites for Periodontal Disease Evaluation: Applying the Item Response Theory Graded Response Model

Periodontal examination data have a complex structure. For epidemiological studies, mass screenings, and public health use, a simple index that represents the periodontal condition is necessary. Periodontal indices for partial examination of selected teeth have been developed. However, the selected teeth vary between indices, and a justification for the selection of examination teeth has not been presented. We applied a graded response model based on the item response theory to select optimal examination teeth and sites that represent periodontal conditions. Data were obtained from 254 patients who participated in a multicenter follow-up study. Baseline data were obtained from initial follow-up. Optimal examination sites were selected using item information calculated by graded response modeling. Twelve sites—maxillary 2nd premolar (palatal-medial), 1st premolar (palatal-distal), canine (palatal-medial), lateral incisor (palatal-central), central incisor (palatal-distal) and mandibular 1st premolar (lingual, medial)—were selected. Mean values for clinical attachment level, probing pocket depth, and bleeding on probing by full mouth examinations were used for objective variables. Measuring the clinical parameters of these sites can predict the results of full mouth examination. For calculating the periodontal index by partial oral examination, a justification for the selection of examination sites is essential. This study presents an evidence-based partial examination methodology and its modeling.

Effect of Reinforced Oral Hygiene on Periodontally Healthy Dental Students: A Four-year Follow-up Clinical Trial

PURPOSE

In periodontally healthy individuals, mean crevicular depth ranges from 1 to 3 mm. This depth threshold has been used as an indicator to differentiate a physiological dentoalveolar sulcus from a periodontal pocket needing further treatment. Because many studies have shown the important contribution of oral hygiene status to periodontal health, the purpose of this study was to explore the clinical effect of reinforced oral hygiene on the periodontal status of periodontitis-free dental students.

MATERIALS AND METHODS

In our longitudinal observational clinical study, we assessed the periodontal status of healthy individuals attending the dental school by measuring the periodontal pocket depth, bleeding on probing, and plaque index. The follow-up reassessment was carried out four years later at the end of the dental curriculum.

RESULTS

The study showed that oral hygiene improvement led to a slight but significant reduction in the mean sulcus depth (-0.049 mm; p<0.0001).

CONCLUSIONS

Reinforcement of oral hygiene contributes to the reduction of probing depth even in periodontally healthy patients.

Effect of Periodontal Disease on Diabetic Retinopathy in Type 2 Diabetic Patients: A Cross-sectional Pilot Study

Both periodontal disease and diabetes are common chronic inflammatory diseases. One of the major problems with type 2 diabetes is that unregulated blood glucose levels damage the vascular endothelium and cause complications. A bidirectional relationship between periodontal disease and diabetic complications has been reported previously. However, whether periodontal disease affects the presence of diabetic complications has not been clarified. Therefore, we examined the effect of the periodontal disease status on diabetic complications in patients with type 2 diabetes. Periodontal doctors examined the periodontal disease status of 104 type 2 diabetic patients who visited a private diabetes medical clinic once a month between 2016 and 2018. The subject’s diabetic status was obtained from their medical records. Bayesian network analysis showed that bleeding on probing directly influenced the presence of diabetic retinopathy in type 2 diabetes patients. In addition, bleeding on probing was higher in the diabetic retinopathy group (n = 36) than in the group without diabetic retinopathy (n = 68, p = 0.006, Welch’s t-test). Bleeding on probing represents gingival inflammation, which might affect the presence of diabetic retinopathy in type 2 diabetes patients who regularly visit diabetic clinics.

Comparison of an Herbal- and a 0.12% Chlorhexidine-based Oral Rinse as Adjuncts to Nonsurgical Mechanical Debridement in the Management of Peri-implant Mucositis: A Randomised Controlled Trial

PURPOSE

In the present randomised controlled trial (RCT), the authors hypothesise that herbal-based oral rinses are as effective as 0.12% chlorhexidine when used as adjuncts to non-surgical mechanical debridement (MD) in the management of peri-implant mucositis. The aim of the present RCT was to compare the efficacy of an herbal oral rinse with a 0.12% chlorhexidine-based oral rinse when used as adjuncts to non-surgical MD in the treatment of peri-implant mucositis.

MATERIALS AND METHODS

Adult patients with peri-implant mucositis were included. Participants were randomly allocated into 3 groups. In group 1, patients only underwent non-surgical MD. In groups 2 and 3, patients underwent non-surgical MD with adjunct rinsing with an herbal- and 0.12% CHX-based oral rinse, respectively. Peri-implant plaque index (PI) and bleeding-on-probing (BOP) and probing-depth (PD) were assessed at baseline and at 3, 6, and 12 weeks. Group comparisons were done and p < 0.01 was considered statistically significant.

RESULTS

Forty-eight patients with peri-implant mucositis (16, 16, and 16 in groups 1, 2 and 3, respectively) were included. At baseline, there was no difference in PI, PD, BOP in all groups. In group 1, there was no statistically significant difference in PI and BOP at 6, and 12 weeks of follow-up compared with baseline. In groups 2 and 3, PI (p < 0.01) and BOP (p < 0.01) were statistically significantly higher at baseline than 3, 6, and 12 weeks of follow-up. In group 1, there was no statistically significant difference in PD at all time intervals. In groups 2 and 3, PD was statistically significantly higher at baseline than 3, 6, and 12 weeks of follow-up. In groups 2 and 3, there was no statistically significant difference in PI, BOP and PD at all intervals.

CONCLUSION

Herbal- and 0.12% CHX-based oral rinses are useful adjuncts to MD for the treatment of peri-implant mucositis.

Self-reported bleeding on brushing as a predictor of bleeding on probing: Early observations from the deployment of an internet of things network of intelligent power-driven toothbrushes in a supportive periodontal care population

BACKGROUND

Bleeding on brushing (BoB) is an important sign of gingival inflammation. Recently, the use of intelligent toothbrushes and oral health Apps has shown potential to improve oral and periodontal health. In the context of the introduction of an Internet of things network of intelligent power-driven toothbrushes in a supportive periodontal care programme, the aim of this study was (a) to audit the adoption and retention of this new technology; and (b) to preliminarily assess the feasibility to gather data on BoB and associate them with clinical periodontal parameters.

METHODS

100 subjects with different periodontal case diagnoses participating in supportive periodontal care (SPC) were provided with and instructed on the use of an intelligent power-driven toothbrush connected with an App (I-Brush). Brushing sessions and occurrence of BoB were recorded through the App and stored in a data protection compliant backend. Subject retention was audited over time. BoB recorded in the two weeks before the SPC appointment was associated with clinical parameters observed by the clinician blind to App data.

RESULTS

75% of subjects provided data from using the power toothbrush and the App for a minimum of 10 brushing sessions over an average period of 362 days. Compared with baseline, subjects' oral hygiene, bleeding on probing and prevalence of residual pockets improved gradually while using the I-Brush. The number of BoB episodes in the two weeks leading to the SPC appointment and the number of residual pockets predicted BOP (p < .001) detected during the examination. App use in the previous two weeks was associated with lower plaque scores at SPC.

CONCLUSIONS

These preliminary observations indicate good adoption and retention of a mobile health system built around an intelligent power toothbrush in a SPC population. The App was able to gather clinically relevant information predicting the observed degree of gingival inflammation. Deployment of mHealth systems seems feasible in dental practice and may bring significant oral health benefits. More investigations are needed in this area.

Comparison of 0.2% chlorhexidine mouthwash with and without anti-discoloration system in patients with chronic periodontitis: A randomized controlled clinical trial

BACKGROUND

Chemical plaque control, an adjunct to mechanical approaches, could improve the maintenance of patients with different types of periodontitis. Chlorhexidine, the gold standard in chemical plaque control, might have some side effects; the most determining one is tooth discoloration. Anti-discoloration systems (ADS) have been added to minimize brownish tooth discoloration. This study aimed to evaluate the staining potential and clinical efficacy of chlorhexidine with and without ADS in patients with chronic periodontitis.

METHODS

In this randomized controlled trial, 46 patients with chronic periodontitis were randomly allocated to two groups. Each patient used 10 mL of mouthwash A (CHX without ADS) or B (CHX with ADS, including sodium metabisulfite and ascorbic acid) twice a day for two weeks. After a two-week interval, they used the second mouthwash. At the beginning and the end of each two-week cycle, plaque index (PI), bleeding on probing (BoP), and staining index were recorded.

RESULTS

There was no significant difference between mouthwash A and B in the reduction of BoP and PI. The staining index was significantly lower after rinsing with mouthwash B compared to mouthwash A.

CONCLUSION

CHX mouthwash containing ADS has similar efficacy in microbial plaque control and reduction of BOP as CHX without ADS, with the advantage of lower stain formation on tooth surfaces in patients with chronic periodontitis.

Peri-implant soft tissue inflammatory parameters and crestal bone loss among waterpipe (narghile) smokers and never-smokers with and without type 2 diabetes mellitus

BACKGROUND

Peri-implant soft tissue inflammatory parameters and crestal bone loss (CBL) among waterpipe smokers (WS) with and without type 2 diabetes mellitus (T2DM) remains uninvestigated. The aim of the present study was to assess peri-implant soft tissue inflammatory parameters and CBL among WS and never smokers (NS) with and without T2DM.

METHODS

Demographic data and information regarding duration of implants in function, daily frequency of smoking, duration and treatment of T2DM, and daily toothbrushing was collected using a questionnaire. Peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD) ≥4 mm, CBL, and hemoglobin A1c (HbA1c) levels were assessed in all individuals. Level of significance was set at 5%.

RESULTS

Seventy-nine male individuals (39 patients with T2DM [20 WS and 19 NS] and 40 systemically healthy individuals [21 WS smokers and 19 NS]) were included. The mean age was comparable among individuals in all groups. The mean HbA1c levels were significantly higher among patients with T2DM compared to controls (P < 0.01). Peri-implant PI, BOP, PD, and CBL were comparable among WS and NS with T2DM. Among patients without T2DM, PI (P < 0.05), PD ≥4 mm (P < 0.05) and mesial and distal CBL (P < 0.05) were significantly higher in WS than NS. Among individuals without T2DM, BOP was significantly higher among NS (P < 0.05) than WS. In patients with T2DM, BOP was comparable among WS and NS.

CONCLUSIONS

Peri-implant soft tissue inflammatory parameters and CBL were comparable among WS and NS with T2DM. Among individuals without T2DM, these parameters were worse among WS than NS.

Distribution of Periodontal Pockets Among Smokers and Nonsmokers in Patients with Chronic Periodontitis: A Cross-sectional Study

Context

Cigarette smoking is a well-established risk factor for periodontitis and carries an increased risk for loss of periodontal attachment as well as bone loss.

Aims

The purpose of the present study was to investigate whether disease severity differs between smokers and nonsmokers in a group of chronic periodontitis patients by assessing the periodontal probing depth (PPD) and bleeding on probing (BOP).

Materials and methods

The study included 150 individuals, 75 smokers and 75 nonsmokers, in the age group of 35-60 years. Subjects with chronic periodontitis were selected and included in the study. Periodontal evaluation, including periodontal probing pocket depths and bleeding on probing, was performed on all four quadrants and at six sites per tooth using the Williams periodontal probe. The data were pooled from the anterior sextant and the posterior sextant as well as from the facial and lingual surfaces.

Statistical analysis

Comparisons were made between smokers and nonsmokers using the z-test (two-tailed test). Probing pocket depth categories 0-3 mm, 4-5 mm, 6-7 mm, and ≥8 mm and the proportion of sites having a pocket depth of ≥5 mm were used in the analysis.

Results

The mean percentage of sites that bleed upon probing was higher for nonsmokers as compared with smokers. Smokers had less shallow pockets (0-3 mm) than nonsmokers and more pockets of 4-7 mm (categories 4-5 mm, 6-7 mm). No significant differences were detected in the prevalence of pockets ≥8 mm. In the anterior, premolar, and molar regions, pockets of 6-7 mm were significantly more prevalent in smokers. The buccal and lingual sides also showed that smokers had more sites with deep probing depths ≥5 mm than nonsmokers. The data also showed that in the upper jaw, in the anterior and premolar teeth, the largest differences were found between smokers and nonsmokers.

Conclusions

From the results, it can be concluded that cigarette smoking results in periodontal tissue destruction in the different areas of the oral cavity, with the maximum periodontal destruction in the maxillary anterior and premolar region.

Success of non-surgical periodontal therapy in adult periodontitis patients: A retrospective analysis

Objective

To evaluate the results of active non‐surgical treatment in patients diagnosed with adult periodontitis treated in a specialized clinic for periodontology.

Material & Methods

In total, 1182 patients with adult periodontitis received active non‐surgical therapy, which involved professional oral hygiene instruction, scaling and root planing, supragingival polishing and elective systemic antimicrobial medication. The results of this therapy were based on a full‐mouth periodontal chart as assessed at the time of evaluation. Successful treatment as periodontal pocket depth (PPD) ≤5 mm was the main outcome parameter with bleeding on pocket probing as secondary outcome. Patient‐related factors such as smoking and severity of periodontitis at baseline and site‐related factors such as tooth type, furcation involvement and endodontic treatment were analysed. Possible relations with assessed parameters and the success of active periodontal therapy were evaluated.

Results

Overall 39% of the patients reached the successful treatment objective and a mean bleeding on pocket probing tendency of 14%. Treatment success appeared to be dependent on tooth type where the results at single‐rooted front teeth (85%) and premolar teeth (78%) were more successful than at molar teeth (47%). Analysis revealed that in 55% of the cases furcation involvement at molars was associated with the absence of success. Endodontic treatment was associated with absence of success in 8%‐11% of the cases. Smoking negatively influences successful treatment outcome (P < 0.001).

Conclusion

Active non‐surgical periodontal therapy in patients with adult periodontitis resulted in approximately one third of the cases in the success endpoint of PPD ≤ 5mm. Sub‐analysis showed that the outcome appeared to be dependent on tooth type, furcation involvement, severity of periodontal disease at intake and smoking status.

Biological aspects: Summary and consensus statements of group 2. The 5th EAO Consensus Conference 2018

OBJECTIVES

This publication reports the EAO Workshop group-2 discussions and consensus statements which provided the scientific evidence on the influence of biological parameters on implant-related clinical outcomes.

MATERIAL AND METHODS

The first publication was a systematic review on the biological effects of abutment material on the stability of peri-implant marginal bone levels and the second, a critical narrative review on how peri-implant diagnostic parameters correspond with long-term implant survival and success. The group evaluated the content of both publications, made corrections and recommendations to the authors and agreed on the consensus statements, clinical recommendations and recommendations for future research, which are described in this consensus report.

RESULTS

Tested abutment materials can be considered appropriate for clinical use according to the observation period studied (mean 3.5 years). Mean peri-implant bone loss and mean probing pocket depths are not adequate outcomes to study the prevalence of peri-implantitis, while the reporting of frequency distributions is considered more appropriate.

CONCLUSIONS

Titanium is currently considered the standard of care as abutment material, although other materials may be more suitable for aesthetic locations. Peri-implantitis should be diagnosed through composite evaluations of peri-implant tissue inflammation and assessment of marginal bone loss with different thresholds.

Effect of waterpipe smoking on peri-implant health: A systematic review and meta-analysis

The aim of the present review was to evaluate the effect of waterpipe smoking (WS) on clinical peri-implant inflammatory parameters compared to non-smokers (NS) with dental implants. Literature searches were performed using bibliographic databases up to May 2018. Primary outcomes included peri-implant bone loss (PIBL), while secondary outcomes were probing depth (PD), plaque index, and bleeding on probing. Relative risk (RR) and 95% confidence intervals (CI) for each PIBL and PD were estimated by a random-effect model. Four retrospective case-control studies were included in the qualitative and quantitative syntheses. All of the included studies showed statistically-significantly worse peri-implant outcomes in WS compared to NS. Considering the effects of WS on peri-implant parameters, significant heterogeneity for PIBL (Q-value = 34.21, P < 0.0001, I²  = 94.16%) and PD (Q-value = 51.97, P < 0.0001, I²  = 96.15%) was observed between both groups. The overall RR for PIBL (RR = 3.32, 95% CI = 1.01-3.97, P = 0.001) and PD (RR = 3.40, 95% CI = 1.91-7.17, P = 0.001) were significant between WS and NS groups. WS has detrimental effect on peri-implant health. Clinicians should instruct and advise patients about poor prognosis and peri-implant diseases caused by WS.

Evaluation of the Addition of a Water Flosser to Manual Brushing on Gingival Health

OBJECTIVES

The purpose of this clinical trial was to compare the use of a manual toothbrush plus water flosser to a manual toothbrush alone on clinical signs of inflammation.

METHODS

Seventy-two subjects were randomized into two groups and completed this four-week, single-blind, parallel, clinical trial. Group 1 used a Waterpik®Water Flosser (WF) once daily and brushed with a manual toothbrush twice a day. Group 2 brushed twice a day with a manual toothbrush only (MT). Subjects in group 1 were provided written and verbal instructions for the water flosser and all participants used the toothpaste and manual brush provided, brushing as they normally do. Data were evaluated at baseline (BSL), two weeks (W2), and four weeks (W4) for bleeding on probing (BOP), Modified Gingival Index (MGI), and Rustogi Modification of the Navy Plaque Index (RMNPI).

RESULTS

Both groups showed a significant reduction from BSL for BOP, MGI, and RMNPI at W2 and W4, except for MT W2 facial proximal MGI (p = 0.153) and marginal RMNPI (p = 0.324). The WF was significantly more effective than the MT for reducing BOP, MGI, and RMNPI at W2 and W4 for all areas measured. The WF was 3.13 times as effective for reducing BOP, 2.69 times for MGI, and 2.44 times for RMNPI at W4 (p < 0.001) for whole mouth scores.

CONCLUSIONS

The addition of the Waterpik®Water Flosser to manual tooth brushing is significantly more effective for improving gingival health than manual tooth brushing alone.

Effects of soft tissue augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis

OBJECTIVE

To review the dental literature in terms of soft tissue augmentation procedures and their influence on peri-implant health or disease in partially and fully edentulous patients.

METHODS

A MEDLINE search from 1966 to 2016 was performed to identify controlled clinical studies comparing soft tissue grafting versus no soft tissue grafting (maintenance) or two types of soft tissue grafting procedures at implant sites. The soft tissue grafting procedures included either an increase of keratinized tissue or an increase of the thickness of the peri-implant mucosa. Studies reporting on the peri-implant tissue health, as assessed by bleeding or gingival indices, were included in the review. The search was complemented by an additional hand search of all selected full-text articles and reviews published between 2011 and 2016. The initial search yielded a total number of 2,823 studies. Eligible studies were selected based on the inclusion criteria (finally included: four studies on gain of keratinized tissue; six studies on gain of mucosal thickness) and quality assessments conducted. Meta-analyses were applied whenever possible.

RESULTS

Soft tissue grafting procedures for gain of keratinized tissue resulted in a significantly greater improvement of gingival index values compared to maintenance groups (with or without keratinized tissue) [n = 2; WMD = 0.863; 95% CI (0.658; 1.067); p < .001]. For final marginal bone levels, statistically significant differences were calculated in favor of an apically positioned flap (APF) plus autogenous grafts versus all control treatments (APF alone; APF plus a collagen matrix; maintenance without intervention [with or without residual keratinized tissue]) [n = 4; WMD = -0.175 mm; 95% CI: (-0.313; -0.037); p = .013]. Soft tissue grafting procedures for gain of mucosal thickness did not result in significant improvements in bleeding indices over time, but in significantly less marginal bone loss over time [WMD = 0.110; 95% CI: 0.067; 0.154; p < .001] and a borderline significance for marginal bone levels at the study endpoints compared to sites without grafting.

CONCLUSIONS

Within the limitations of this review, it was concluded that soft tissue grafting procedures result in more favorable peri-implant health: (i) for gain of keratinized mucosa using autogenous grafts with a greater improvement of bleeding indices and higher marginal bone levels; (ii) for gain of mucosal thickness using autogenous grafts with significantly less marginal bone loss.

[Effect of the treatment of periodontal disease on the outcome of pregnancy]

INTRODUCTION

Correlations between periodontitis and its effects on the outcome of pregnancies are actually more focused topics. Maternal motivation for a good oral hygiene and preventive dental treatment must be highlighted tasks during pregnancy care.

AIM

The authors analysed the effect of the preventive dental treatment during pregnancy and its obstetrical effects.

METHOD

In a prospective randomised study, including pregnant women observed for threatening preterm deliveries, patients with dental examination (n = 71) were compared with patients undergoing dental treatment at the same time (n = 79).

STATISTICAL ANALYSIS

Univariate comparisons for categorical variables were assessed by χ2 tests and independent Student's t-tests for continuous variables. ORs were compared with Mantel-Haenszel tests. Multivariable logistic regression was performed to evaluate the factors determining the poor periodontal parameters and gingivitis separately. The two-tailed statistical significance level was set at 5%.

RESULTS

In the dental treatment group, the neonatal birth weight was significantly higher than in the non-treated group, in case of patients with periodontitis (2990 ± 582.3 g vs 2568.1 ± 699.1 g, p = 0.005). Also the average age at delivery was significantly higher in the treated vs non-treated groups (37.3 ± 1.9 vs 36.0 ± 2.9 weeks, p = 0.027), and the treatment had a beneficial effect on the prolongation of pregnancy, with a higher level of significance in the gingivitis group vs patients with periodontitis groups (p = 0.02 vs p = 0.043).

CONCLUSIONS

Dental treatment of expecting women has a beneficial effect on the prolongation of pregnancy by decreasing the rate of prematurity and perinatal complications. Orv Hetil. 2018; 159(24): 978-984.

[Periodontal status assessment before orthodontic treatment and opportune moment selection for orthodontic treatment]

The aesthetic demands of teeth by the public have improved with the increase in the living standard. Orthodontics, which is a method of aesthetic dentistry, is becoming increasingly important. Orthodontic treatment mainly involves the application of orthodontic force to the teeth and guides the reconstruction of the periodontal tissue, thereby changing the position of the teeth at the occlusal bone. Orthodontic treatment can also improve the dental occlusion caused by dentition crowding and teeth mobility to achieve long-term stability of periodontal tissue. The number of patients with periodontal disease is high in China, and the number of patients with periodontal disease that are eager to receive orthodontic treatment is increasing. Hence, the periodontal status during the orthodontic therapy should be explored along with periodontal therapy and orthodontic treatment. This article briefly demonstrates the assessment criteria of periodontal status before orthodontic treatment, the opportune moment selection for orthodontic treatment, and the supportive periodontal therapy. This study helps dentists develop individualized treatment programs and win a balanced, stable, and aesthetic impression.

Improved General and Oral Health in Diabetic Patients by an Okinawan-Based Nordic Diet: A Pilot Study

Periodontal disease, periodontitis as well as the preceding gingivitis, has been associated with both obesity and diabetes. Studies have shown that diet changes can lead to a lower incidence of such inflammation. The aim of the present case series over four weeks was to study the effects on medical and dental conditions in patients with type 2 diabetes of the consumption of the Okinawan-based Nordic Diet (OBND^®). Medical and dental examinations were performed to estimate the general health and gingivitis/periodontitis. Serum cytokine levels were assessed using Luminex technology. Eight of ten study participants completed the study. All participants lost weight (p = 0.012). Six out of seven that were treated with insulin could reduce their insulin intake after two weeks with OBND^®. The reduction was about 16 units which corresponds to a 34% relative reduction compared to the starting point (range 15–63%). Fasting blood glucose values fell (p = 0.035). Hemoglobin A1c (HbA1c) (p = 0.01), triglycerides (p = 0.05), and low-density lipoprotein (LDL) (p = 0.05) were also reduced. Bleeding on probing changed from ~28% before any dietary changes to ~13% after two weeks with OBND^® (p = 0.01). The reduction in gingival bleeding was as substantial as might be expected from one session of professional tooth cleaning. Markers of inflammation were also reduced. The OBND^® thus showed significant promise in alleviating the impact of diabetes on dental as well as general health.

Adult periodontitis treated with a new device for subgingival lavage-a randomized controlled clinical trial using a split-mouth design

OBJECTIVES

To evaluate in patients with untreated adult periodontitis, the effect of treatment with a novel pocket irrigator/evacuator device (IED) compared to conventional subgingival debridement (CPT), both provided during the initial phase of active periodontal therapy.

METHODS

This study was an examiner-blind, randomized controlled clinical trial using a split-mouth design. Systemically healthy patients with adult periodontitis were selected. Full-mouth probing pocket depth (PPD), gingival bleeding on pocket probing scores (BOPP), gingival recession (REC) and dental plaque (PI) were assessed at baseline. All participants received oral hygiene instructions and supragingival prophylaxis including polishing. In 2 randomly assigned contra-lateral quadrants, approximal sites were irrigated with the IED, whereas in the other quadrants, CPT was provided. The CPT consisted of subgingival debridement using ultrasonic devices followed by the use of hand instruments. At 3 months post-treatment, the clinical parameters were re-assessed.

RESULTS

Twenty-five patients met the inclusion criteria and were willing to participate. At 3 months post-treatment, the PPD and BOPP had significantly improved for both treatment modalities. Pockets of ≥5 mm reduced by 0.64 mm in the IED group (P < .001), compared to a reduction of 0.82 mm for the CPT group (P < .001). With respect to the primary outcome parameter (PPD) and BI, the results with the IED were less pronounced. Between the test and control groups, no significant differences were observed for REC and PI.

CONCLUSIONS

Oral hygiene instructions, supragingival prophylaxis and subgingival lavage with the IED resulted in a significant reduction in PPD and BOPP. However, the effect does not reach the results of CPT which included the subgingival use of ultrasonic and hand instruments.

Cross-sectional associations of impaired glucose metabolism measures with bleeding on probing and periodontitis

AIM

This study assessed the associations of pre-diabetes and insulin resistance with bleeding on probing (BOP) and periodontitis among adults.

MATERIALS AND METHODS

We included 1191 Hispanic adults aged 40-65 years, free of diabetes, enrolled in San Juan Overweight Adults Longitudinal Study. Pre-diabetes was defined as impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or impaired glycated haemoglobin. Impaired one-hour plasma glucose (1hPG) was defined as levels >155 mg/dl. Insulin resistance was defined using the study population-specific 75th percentile (HOMA-IR ≥ 3.13). High BOP was defined as percentage of teeth with bleeding ≥30%. Periodontitis was defined according to the CDC/AAP definition.

RESULTS

After multivariable adjustment for age, gender, education, smoking status, alcohol consumption, physical activity, obesity, HDL-C, and plaque index, pre-diabetes with and without 1hPG, IFG, impaired 1hPG, IGT, and HOMA-IR were significantly associated with high BOP; pre-diabetes, IFG, and impaired 1hPG were significantly associated with severe periodontitis. Most of these associations remained significant when the analyses were restricted to non-smokers.

CONCLUSIONS

This study suggests associations between pre-diabetes and insulin resistance with BOP and periodontitis. Given the high prevalence of impaired glucose metabolism and periodontitis, the assessment of the temporal sequence of these associations is of utmost importance.

Comparison of Water Flosser and Interdental Brush on Reduction of Gingival Bleeding and Plaque: A Randomized Controlled Pilot Study

OBJECTIVES

The purpose of this randomized, two-week, single blind, two-group parallel pilot study was to compare the reduction in gingival bleeding and plaque in subjects using a water flosser or interdental brush, each combined with a manual toothbrush.

METHODS

Twenty-eight subjects completed the study. Subjects were randomly assigned to one of two groups: Waterpik® Water Flosser (WF) plus manual toothbrush or interdental brushes (IDBs) plus a manual toothbrush. Bleeding on probing (BOP) was measured at six sites and reported for whole mouth, lingual, facial, and interproximal areas. Plaque data were measured using the Rustogi Modification of the Navy Plaque Index (RMNPI) and were reported for whole mouth, approximal, marginal, facial, and lingual areas. Subjects received verbal and written instructions on the use of their interdental product and demonstrated proficiency prior to starting the study.

RESULTS

There were no differences between the groups for BOP or RMNPI at baseline. Both groups demonstrated a significant reduction in BOP and RMNPI for all regions and areas measured from baseline to two weeks. The WF was more effective than the IDBs for BOP whole mouth (56%), facial (44%), approximal whole mouth (53%), and approximal facial (41%). Post hoc power analysis showed that the sample size was not adequate to detect a significant difference between groups for lingual and marginal assessments for BOP or any area for RMNPI.

CONCLUSIONS

The Waterpik Water Flosser is more effective than IDBs for reducing gingival bleeding over two weeks.

The association between dental health and nutritional status in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) and periodontitis are chronic inflammatory systemic diseases with common risk factors (smoking and aging). In COPD, poor periodontal health could result in inadequate nutrition, potentially causing loss of muscle volume. The purpose of this case-control study was to examine our hypothesis that COPD patients have poorer periodontal health and poorer nutritional status than non-COPD patients. Periodontal status was assessed using bleeding on probing (BOP), pocket depth (PD), and plaque-control ratio (PCR). Nutritional status was assessed using body mass index, lean body mass, and serum albumin levels. The COPD group ( n = 60) had fewer remaining teeth, greater BOP, greater PD, and lower serum albumin levels compared with smokers without COPD ( n = 41) and nonsmokers ( n = 35; p < 0.001). COPD was an independent risk factor for poor periodontal health, demonstrated by fewer remaining teeth (relative risk (RR), 5.48; p = 0.0024), BOP (RR, 12.8; p = 0.0009), and having >30% of remaining teeth with a PD ≥ 4 mm (RR, 4.82; p = 0.011). A significant negative correlation existed between the number of teeth with a PD ≥ 4 mm and serum albumin level ( r² = 0.127; p = 0.013). We demonstrated that poor periodontal health was associated with hypoalbuminemia, suggesting poor nutritional status and inflammation in COPD.

Gingival crevicular blood for screening of blood glucose level in patients with & without diabetes: a chair-side test

OBJECTIVES

Diabetes is a pandemic disease with increasing prevalence and serious complications. Periodontitis being one of its presentation and is its sixth recognized complication. This study compares blood glucose levels in gingival crevicular blood of patients with and without diabetes elicited during routine periodontal probing and venous blood sample.

METHODS

Seventy patients with moderate gingivitis and periodontitis positive for bleeding on probing were chosen. All the subjects were divided in two groups, group I consisted of 35 diabetic and group II of 35 non-diabetic subjects. Blood from the gingiva of the most inflamed site was collected with the test strip of a glucose self-monitoring device, and the blood glucose levels were measured. At the same time, intravenous blood was collected for measurement in a laboratory glucose analyzer. Gingival index and probing pocket depth were evaluated for each subject at same time.

RESULTS

The mean GCB levels and VB derived from all samples were 156.07 ± 49.23 mg dl(-1) and 156 ± 49.89 mg dl(-1) , respectively, for diabetic group and 90.80 ± 11.07 and 93.41 ± 9.30 for non-diabetic group. In both the groups, the difference between GCB and VB glucose levels was non-significant (P > 0.005). Highly significant correlation between GCB and VB (r = 0.972 for diabetic and r = 0.721 for non-diabetic) in both the groups was found.

CONCLUSION

The data from this study show that GCB collected during diagnostic periodontal examination can be an excellent source for estimation of blood sugar or glucometric analysis. This technique is also suitable for routine screening of diabetic and early diagnosis of unknown diabetic cases.

Biofilm removal from implants supported restoration using different instruments: a 6-month comparative multicenter clinical study

OBJECTIVES

The aim of this study was to compare the efficacy of different instruments on biofilm removal from implant supported restorations.

MATERIALS AND METHODS

The study was designed as comparative multicenter clinical study including patients proceeding from the Milan, Naples, and Buenos Aires, with a peri-implant mucositis. Implants enrolled for the study were allocated in 4 groups and treated with ultrasonic scalers with plastic tips, with titanium curettes, with airflow with glycine powder, and with rubber cup and polishing paste, respectively. mPI was assessed at baseline, immediately after therapy, at 1, 3, and 6 months. mBI, PD, and REC were assessed at baseline, 1, 3, and 6 months. All parameters were recorded on six sites per implant. Kruskal-Wallis and Mann-Whitney tests were used to compare groups and centers. A generalized linear model for repeated measures was chosen for inter-group comparison. An intra-group comparison was performed with repeated measure ANOVA test to assess differences between baseline and recalls.

RESULTS

A total of 89 patients (39 males, 50 females) were enrolled in the study, and 141 implants were available for the analysis. 55 implants were enrolled in University of Buenos Aires, 32 in University of Milan, and 54 in University of Naples. There were no significant differences between the four groups in inflammatory status reduction of peri-implant mucosa.

CONCLUSIONS

Non-surgical therapy is effective in reducing peri-implant mucositis. Sonic scaler with plastic tip and rubber cup with polishing paste showed higher efficacy when compared with titanium curettes or airflow with glycine powder.

Self-perceived oral health and periodontal parameters in chronic periodontitis patients with and without rheumatoid arthritis

AIM

It is hypothesized that self-perceived oral health and periodontal status are worse in chronic periodontitis (CP) patients with rheumatoid arthritis (RA) compared to CP patients without RA. The aim of the present study was to assess self-perceived oral health and periodontal parameters in CP patients with and without RA.

METHODS

Fifty CP patients with RA and 50 CP patients without RA were included. Information regarding sociodemographic characteristics and self-perceived oral symptoms were collected using a questionnaire. Periodontal parameters (plaque index, bleeding on probing, probing depth, clinical attachment loss, number of missing teeth, and marginal bone loss) were recorded.

RESULTS

There was no significant difference in socioeconomic status, education status, self-perceived oral symptoms, and periodontal parameters among CP patients with and without RA.

CONCLUSIONS

Self-perceived oral health and periodontal parameters are mainly governed by the intensity of CP, and the role of RA in this context seems to be rather secondary.

Is gingival bleeding a symptom of patients with type 1 von Willebrand disease? A case-control study

BACKGROUND

Von Willebrand disease (VWD) is the most common inherent bleeding disorder resulting in prolonged bleeding time. Gingival bleeding is a frequently reported symptom of VWD. However, gingival bleeding is also known as a leading symptom of plaque-induced gingivitis and untreated periodontal disease. Gingival bleeding in VWD patients (VWD) may be triggered by gingival inflammation and not a genuine symptom. Thus, this study evaluated whether type 1 VWD determines an increased susceptibility to gingival bleeding in response to the oral biofilm.

METHODS

Fifty cases and 40 controls were examined haematologically (VWF antigen, VWF Ristocetin cofactor, factor VIII activity) and periodontally [Gingival Bleeding Index (GBI), bleeding on probing (BOP), Plaque Control Record (PCR), periodontal inflamed surface area (PISA), vertical probing attachment level].

RESULTS

GBI was significantly higher in controls (12.2%) than in VWD (10%). The study failed to find a significant difference regarding BOP between VWD (17%) and controls (17.2%). Multiple regressions identified PCR and PISA to be associated with GBI and BOP. VWD was negatively associated with GBI. Smoking and number of remaining teeth was negatively associated with BOP.

CONCLUSION

VWD is not associated with a more pronounced inflammatory response to the oral biofilm in terms of GBI and BOP.