Effect of laser corticotomy on canine retraction rate: a split-mouth randomized clinical trial

BACKGROUND

This study assessed the effect of corticotomy with Er: YAG (erbium-doped yttrium aluminium garnet) laser on the rate of canine retraction.

METHODS

This randomized split-mouth controlled clinical trial was conducted on 12 patients undergoing orthodontic treatment with extraction of maxillary first premolars. Following initial leveling and alignment, an alginate impression was made from the maxillary arch, and Er: YAG laser corticotomy was performed in one of the maxillary quadrants of each patient. Canine retraction was started immediately after corticotomy by placement of nickel-titanium (NiTi) closed coil springs at both sides. At the end of each month, alginate records were repeated for 4 months. Study models were scanned, and the anteroposterior movement of canine was quantified bilaterally. Pain was also measured by a visual analog scale (VAS). Probing depth (PPD) of canines and two adjacent teeth was also evaluated and pulp vitality was assessed by performing the cold test. Data were analyzed by paired and independent t-test and one-way ANOVA (alpha = 0.05).

RESULTS

The rate of canine retraction was significantly greater in the laser-assisted corticotomy quadrant than the control (P < 0.05). No significant difference existed in posterior anchorage loss, canine rotation angle, PPD, pulp vitality, or pain score between two groups (P > 0.05).

CONCLUSIONS

Flapless Er: YAG laser corticotomy significantly enhanced canine retraction rate with no adverse effect on other parameters.

Assessment of suturing and scaling skills of periodontology and oral medicine residents by OSATS method: a pilot study

INTRODUCTION

Updating the method for evaluating suturing and scaling skills in dental education has attracted relatively little attention and there is no consensus to what should be assessed and how. The purpose of this study was to investigate the applicability of the Objective Structured Assessment of Technical Skill (OSATS) method for these two basic skills, the possible association between the scores and demographic factors, and the level of satisfaction of residents with this method.

METHODS

All six periodontics and three oral medicine residents were recruited by census method and video-recorded while performing a simple interrupted suture, a figure eight suture and scaling on a model. Then, the videos were evaluated independently via a checklist and a global rating scale (GRS) by two expert raters. Agreement between raters and residents' satisfaction were evaluated. Correlation between demographic factors of participants and scores was also assessed. T-test and linear regression analysis were used.

RESULTS

There was no significant difference between the scores based on the views of the two raters for each of the checklist (ICC = 0.99, CI = 0.96-0.99, P < 0.001) and GRS (ICC = 0.97, CI = 0.86-0.99, P < 0.001). Linear regression showed no correlation between gender and scores but periodontics major and higher year of education showed correlation with higher scores.

CONCLUSION

Considering the excellent agreement between raters in using both the checklist and GRS components of OSATS, and satisfaction of 88% the residents with this method, it seems to be able to provide a reliable assessment.

Oral Health Status and Salivary Properties among Children before and after Tonsillectomy

Objectives: Enlarged adenoids can lead to obstruction of the nasopharyngeal airway and subsequent oral respiration. Oral breathing can cause dry mouth, dehydration in gingival tissue, and resistance to plaque accumulation. This study aimed to evaluate the impact of tonsillectomy on oral health status, salivary pH and flow rate, and common complications caused by tonsillar hypertrophy in children. Materials and Methods: An analytical before-and-after study was conducted on 60 children aged 5-12 years who required tonsillectomy. We gathered data through a questionnaire and collected unstimulated saliva using the spitting method for five minutes. Salivary pH was measured by a pH meter and its volume was determined with a calibrated test tube. The plaque index, bleeding index and modified gingival index were determined using a disclosing tablet, Williams' probe and observational examination, respectively. All measurements were repeated one month after tonsillectomy. Paired t-test was used for data analysis. Results: We found a significant increase in mean pH and salivary flow rate after tonsillectomy and observed a decrease in oral health indices among the children one month after surgery. Over half of the children who reported complications such as dry mouth, itchy nose and throat, snoring, night sweats, and sleep disturbances experienced complete recovery after tonsillectomy. Conclusion: Based on the results obtained in the present study, children with enlarged adenoids showed significant improvements in salivary pH, salivary flow rate, and oral health indices, one month after tonsillectomy.

Effects of omega-3 supplementation as an adjunct to non-surgical periodontal therapy on periodontal parameters in periodontitis patients: a randomized clinical trial

Objectives

This study aimed to assess the effects of omega-3 fatty acid supplementation as an adjunct to non-surgical periodontal therapy in patients with periodontitis.

Materials and methods

This randomized clinical trial was conducted on 30 patients with periodontitis. All patients received standard non-surgical periodontal therapy, and were randomly divided into two groups of intervention and control by a table of random numbers (n = 15). The intervention group consumed 1000 mg natural fish oil soft-gels daily (300 mg Omega-3 marine triglycerides, 180 mg Eicosapentaenoic acid and 120 mg Docosahexaenoic acid) while the control group used soft-gels contained only some soybean oil for 3 months. Clinical attachment loss (CAL), probing depth (PD), and bleeding index (BI) were recorded at baseline (before the intervention) and after 3 months. The two groups were compared regarding the clinical parameters by t-test (alpha = 0.05).

Results

All three clinical parameters decreased in both groups at 3 months compared with baseline (P = 0.001). The improvement in PD and CAL in the intervention group was significantly greater than that in the control group (P = 0.001); however, the difference in BI was not significant between the two groups (P = 0.283).

Conclusion

Omega-3 supplementation as an adjunct to non-surgical periodontal therapy significantly improved the clinical parameters in periodontitis patients compared to soybean oil supplements.

Evaluation of root surface roughness produced by hand instruments and ultrasonic scalers: An in vivo study

Background. The aim of periodontal treatment is to remove bacterial plaque and dental calculus by hand and power-driven instruments. However, the comparison of the effectiveness of these instruments has always been controversial. Therefore, this in vivo study investigated and compared the effects of hand and ultrasonic piezoelectric instruments on the roughness of dental surfaces under an atomic force microscope (AFM). Methods. In this study, 35 periodontally hopeless teeth were selected and randomly divided into four groups (n=7). The control group consisted of teeth that had to be extracted for orthodontic or prosthetic treatment (n=7). In group one, scaling and root planing were performed using hand instruments. In other groups, scaling and root planing were performed using piezoelectric ultrasonic instruments with low to high power, respectively. Then the scaled teeth were extracted for analysis under an atomic force microscope. Results. This study showed that root roughness significantly differed between different experimental groups (P<0.027). The root roughness (Rq) in the SRP2 group significantly differed from the control group (P<0.05), while no significant differences were observed between the other groups. Furthermore, the least roughness was observed in the SRP3 group, with the highest roughness in the SRP2 group. Conclusion. Within the limitation of this study, there were no significant differences in surface roughness between different powers of the ultrasonic device.

The Effect of Aqueous Extract of Crocus sativus L. (Saffron) on Periodontal Indices of Patients with Generalized Periodontitis

Many therapeutic properties have been reported for saffron (Crocus sativus L.), including anti-inflammatory effects due to its strong antioxidant properties and the ability to accumulate oxygen free radicals by components such as crocin and crocetin. The aim of this study was to evaluate the anti-inflammatory effect of saffron on the treatment of patients with periodontitis. 40 patients with moderate to severe generalized periodontitis were selected and divided randomly into the intervention and control groups. The intervention group was instructed to use a mouthwash containing aqueous saffron extract twice a day for 2 weeks; while the control group members were asked to apply chlorhexidine as the gold standard mouthwash. The participants’ gingival probing depth index, modified gingival index, and gingival bleeding index were measured before and one month after the intervention. The patients’ level of satisfaction on the taste of mouthwash was also measured. T-test and Mann-Whitney test were run for statistical analysis. A significant difference was observed in terms of the gingival indices before and four weeks after using both saffron and chlorhexidine mouthwashes (p value: 0.001). However, no statistically significant difference was found between two groups. Patients reported higher levels of taste satisfaction after using saffron aqueous extract mouthwash than the chlorhexidine mouthwash (p value: 0.021). Saffron mouthwash showed comparable therapeutic effect to the gold standard mouthwash, chlorhexidine, and may be helpful as an adjunct treatment for management of periodontitis.

Effect of periodontal treatment on serum inflammatory parameters and disease activity in patients with systemic lupus erythematosus: A randomized controlled trial

Background

Several descriptive studies have shown an association between periodontitis and systemic lupus erythematosus (SLE), but clinical trials evaluating the effect of periodontal treatment on serological inflammatory parameters or disease activity in SLE patients are very limited. The aim of this study was to see how periodontal treatment affects the status of SLE patients.

Materials and Methods

Ninety patients with active SLE and periodontitis were randomly assigned to one of two groups: case (oral hygiene instructions + scaling and root planning) or control (oral hygiene instructions only). Periodontal parameters, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) and SLE Disease Activity Index (SLEDAI) levels were monitored at baseline and 3 months later.

Results

Periodontal parameters in the case group were significantly reduced both statistically and clinically after 3 months. However, in the control group, these indices decreased statistically (P < 0.05) but not clinically. The score of SLEDAI in both the groups showed a significant downward trend (P < 0.05) from the start of the study, but the differences in this index between the two groups were not statistically significant (P = 0.894). Although there was a significant decrease in CRP and ESR (P = 0.001) after 3 months in the case group, indicating a positive effect of periodontal treatment on inflammation reduction, there was no significant decrease in CRP and ESR in the control group.

Conclusion

According to our findings, it appears to be no statistically significant association between periodontal treatment and SLEDAI level. However, this treatment seems to be effective in reducing acute phase biomarkers such as CRP and ESR.

Bacterial composition of subgingival plaque in crowded and noncrowded teeth

INTRODUCTION

Patients with dental crowding, even with good oral hygiene, may show increased bacterial presence in the crowded area. This study aimed to determine the microbial composition of subgingival plaque in crowded and noncrowded dental regions.

METHODS

Forty dental students with anterior dental crowding, who were aware of correct brushing techniques and oral hygiene, were enrolled in this study. After orthodontic records were taken and the periodontal examination was performed, subgingival plaque samples were collected from the crowded (experimental) and noncrowded regions (control) of each patient. Colony counting was performed for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and streptococcus species.

RESULTS

The mean amount of Aa and Pg colonies was significantly higher in crowded areas (P <0.0001), but there was no significant difference between streptococcus species colonization and crowding. Aa and Pg colonization had a significant direct relation with the amount of crowding. (P <0.0001).

CONCLUSIONS

Crowded dental areas, even with good oral hygiene, are more suitable environments for Aa and Pg colonization.

Nurses' educational needs in the oral health of inpatients at Yazd Province in Iran: a Delphi study

Background

Oral hygiene is an integral part of general health of a person. Nurses qualified about oral care can play an important role in improving the quality of oral health in hospitalized patients. This study investigated the educational needs of nurses in the field of oral health of hospitalized patients.

Methods

The study used the modified Delphi method in three rounds. Fifty faculty members of the School of Dentistry and Nursing were selected via purposive sampling. The data collection tool was a demographic form and an open-ended questionnaire in the first round and a structured questionnaire in the next rounds. The analysis was performed using both content and descriptive analysis techniques.

Results

The top ten oral health education priorities for nurses were greater than 75% with a consensus level: oral anatomy and physiology, learning the signs and symptoms of common oral diseases, learning of oral medications and administration, learning the drugs that cause damage to the mouth and teeth, training in managing dental emergencies, patient education for tooth brushing and taking care of the mouth, especially in the elderly patient, providing oral and dental care, training for unconscious and fasting patients, undergoing chemotherapy and radiotherapy, and hospitalization in intensive care unit.

Conclusion

The findings of the study emphasized the need for interdisciplinary cooperation between nursing and dental professionals for the development of an oral health curriculum for nurses to promote and improve oral health and prevent dental diseases in hospitalized patients and the community.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-020-00517-8.

Assessment of dental residents' professionalism through Professionalism Mini-Evaluation Exercise (P-MEX)

PURPOSE/OBJECTIVES

The aim of the study was to assess the professional behavior of dental residents through Professionalism Mini-Evaluation Exercise (P-MEX).

METHODS

This was a descriptive-analytical study. Content validity of P-MEX form was investigated for use in the context of dentistry. A total of 24-item version of P-MEX consisted of doctor-patient relationship skills (n = 7), reflective skills (n = 5), time management (n = 3), and interprofessional relationship skills (n = 9) was used in the present study. Residents in different dental specialties (n = 56) were evaluated by trained raters (448 times). Data were analyzed by descriptive (mean, SD) and analytical tests (Pearson, ANOVA, and post hoc test (Bonferroni)).

RESULTS

Validity of P-MEX was approved in the field of dentistry. The mean score of professional behavior in residents were reported 2.79 ± 0.24, with minimum and maximum scores of 2.17 and 3.62, respectively. The residents' professional behavior in the domain of reflective skills and doctor-patient relationship skills were lower than the other domains.

CONCLUSION(S)

The results showed that the scores of professional behavior among dental residents were classified in the below expectation level and their scores have followed a downward trend from the second year. Therefore, planning for training and continuous assessment of professional behavior among residents in the faculty of dentistry should be considered.

Characteristic Factors Affecting Oral Pigmentation in Passive Smoker Children

Statement of the Problem:

Smoking affects not only smokers themselves, but also the people around them. 700 million children are exposed to second hand tobacco worldwide. One of the adverse effects of being a passive smoker is oral pigmentation.

Purpose:

This study was conducted to evaluate the association between smoking of a parent at home and oral pigmentation in children, and the characteristic factors affecting that.

Materials and Method:

In this retrospective cohort study, 140 healthy children aged 4 to 10 (mean age= 6.68±1.60), 70 with smoker parent and 70 without smoker parents, were examined for oral pigmentation. Environmental factors were evaluated by asking the parents to fill a questionnaire. Data were analyzed using Chi-square test, Fisher's exact test, Logistic regression, and Spearman scale.

Results:

There was a meaningful relationship between having a smoker parent and oral pigmentation (p= 0.0001). Spearman’s correlation showed parents' duration of cigarette smoking and the number of cigarettes per day could meaningfully affect the severity of oral pigmentation (R=0.329). The study did not find a statistical relationship between oral pigmentation in passive smoking and gender or house area.

Conclusion:

Children exposed to secondhand tobacco are at more risk for oral pigmentation. Its severity depends on duration of cigarette smoking and the number of cigarettes per day.

Awareness of the effect of fluctuations in female sex hormone levels on periodontal health among obstetricians

Background

Changes in women’s hormonal levels in different periods of their lives, such as puberty, menses, pregnancy, menopause and oral contraceptive use, affect periodontal health. Periodontal status has been associated with adverse pregnancy outcomes. Subsequently, it is important for obstetricians to be aware of the effects of hormones on women's oral health. The current study assessed obstetricians’ awareness about the effect of female sex hormones on periodontium in Yazd in 2016.

Methods

A cross-sectional study was conducted using a self-administered, structured questionnaire. Prior to the study, a questionnaire was pre-tested and validated (ICC=0.89). The questionnaire was randomly distributed among 40 obstetricians in Yazd. Data were analyzed with chi-squared test, t-test and ANOVA and Spearman's correlation coefficient, using SPSS 18.

Results

There were no significant relationships between awareness level and the age (P=-0.252), years of practice and experience (P=-0.030) or practicing in public medical centers (P=0.121).

Conclusion

As women have special periodontal health care considerations due to fluctuations in the levels of their sex hormones, this study suggests that promotion of oral health awareness among obstetricians is necessary to improve women's overall health, especially during pregnancy.

Effect of non-surgical periodontal treatment on clinical signs of rheumatoid arthritis

Background

Several studies have shown the association between periodontitis and rheumatoid arthritis (RA) and some similarities in the pathogenesis of these two diseases but clinical trials which have evaluated the effect of periodontal therapy on clinical signs of active RA are scarce, particularly in Iran. The aim of this study was to evaluate the effect of non-surgical periodontal treatment on the improvement of clinical signs of patients with RA.

Methods

Fifty-six patients with active RA and generalized moderate-to-severe chronic periodontitis were selected and divided into case (periodontal treatment) and control (without periodontal treatment) groups. Periodontal parameters and RA disease activity scores (DAS28 index) were compared at 6- and 12-week intervals.

Results

In the case group, a significant reduction in all the periodontal indices was observed 6 weeks after treatment. At the 12-week evaluation, periodontal indices showed a significant reduction in comparison with baseline and a little increase in comparison with 6-week interval. Six weeks after treatment, DAS28 decreased significantly in the case group (P<0.05). DAS28 also decreased at 12-week interval but its reduction was not significant in comparison with 6-week interval. DAS28 in the case group at 12-week interval was significantly less than that in the control group (P<0.05).

Conclusion

Since periodontal care as a part of treatment protocol in RA patients can be effective in improving clinical signs, the recall intervals are better to be 3 months or shorter.

The Effect of Nonsurgical Periodontal Therapy on Trichomonas Tenax and Entamoeba Gingivalis in Patients with Chronic Periodontitis

STATEMENT OF THE PROBLEM

Trichomonas tenax and Entamoeba gingivalis are commensal protozoa which inhabit the human oral cavity. These parasites are found in patients with poor oral hygiene and might be a reason for progressive periodontal diseases.

PURPOSE

The aim of this study was to evaluate the effect of nonsurgical periodontal treatment on the frequency of these protozoa in saliva and plaque samples.

MATERIALS AND METHOD

In this clinical trial, samples of saliva and dental plaque were collected from 46 patients with moderate to severe chronic periodontitis before and after periodontal therapy. The samples were assessed for the frequency of parasites.

RESULTS

The frequency of Entamoeba gingivalis was reduced in saliva (p= 0.007) and plaque (p= 0.027) three weeks after the treatment. Likewise, the frequency of Trichomonas tenax reduced in saliva (p= 0.030); however, the decrease was not significant in plaque (p= 0.913). Trichomonas tenax frequency in dental plaque directly related to the severity of periodontitis (r= 0.565, p≤ 0.000). In contrast, the number of Entamoeba gingivalis in both saliva (r= -0.405, p≤ 0.005) and plaque (r= -0.304, p= 0.040) was inversely related with the severity of the periodontal disease.

CONCLUSION

Nonsurgical periodontal treatment could reduce the number of Trichomonas Tenax and Entamoeba gingivalis in the oral environment of patients with chronic periodontitis.

Effect of 1% Phenytoin Muco-Adhesive Paste on Improvement of Periodontal Status in Patients with Chronic Periodontitis: A Randomized Blinded Controlled Clinical Study

STATEMENT OF THE PROBLEM

Phenytoin (PHT) has been known to promote wound healing in some medical conditions owing to its proliferative as well as anti-inflammatory effects. Yet, its application in oral lesions was less investigated.

PURPOSE

The aim of this study was to evaluate changes in periodontal indices following the topical use of phenytoin in chronic periodontitis.

MATERIALS AND METHOD

In this doubled-blind, randomized, split-mouth controlled clinical study, 20 patients with moderate to severe chronic periodontitis referred to Periodontology Department of Shahid Sadoughi Medical University of Yazd in 2014 were selected consecutively. After initial therapy (scaling and root planning and oral hygiene instructions), periodontal indices including bleeding on probing (BOP), periodontal pocket depth (PPD) and modified gingival index (MGI) were recorded. Gingival facial surface of two posterior sextants with at least two teeth with similar conditions, were selected randomly. Then one surface received PHT paste whereas the other side had placebo as control. Patients were received the mucoadhesive pastes under strict control by an examiner, twice a day for a week. Periodontal indices were measured 3 weeks after treatment. Data was analyzed with t-test and paired t-test by using SPSS 21 software.

RESULTS

It was observed that periodontal pocket depth was significantly more decreased in phenytoin side in comparison with placebo one (p< 0.05). In addition, inflammatory indices including bleeding on probing and modified gingival index declined more in the phenytoin group (p= 0.001 and p< 0.05 respectively).

CONCLUSION

These encouraging results support the use of 1% phenytoin mucoadhesive paste as an adjunctive in periodontal treatment.

The Effect of Brushing with a Soft Toothbrush and Distilled Water on the Incidence of Ventilator-Associated Pneumonia in the Intensive Care Unit

BACKGROUND

Ventilator-associated pneumonia (VAP) is a common nosocomial infection, which results in longer hospitalization, increased treatment costs, and higher mortality rates. One major cause of VAP is colonization and microaspiration of oropharyngeal secretions following the formation of dental plaque, which is due to poor oral hygiene and failure to mechanically remove these microorganisms from the teeth. This study was conducted to determine the effect of brushing teeth with distilled water on the incidence of VAP in patients admitted to intensive care unit (ICU).

MATERIALS AND METHODS

In this randomized clinical trial, 168 intubated patients, who had at least 20 teeth were randomly assigned to two groups. In the experimental group, the patients' teeth were brushed twice a day with a children's toothbrush and distilled water in addition to the routine oral care. The clinical pulmonary infection score (CPIS) was used to diagnose VAP. The data were analyzed using SPSS version 16 software.

RESULTS

A total of 38.6% of the patients in each group developed VAP. There was a significant difference in incidence of VAP on day five between the two groups (P<0.05). The incidence of VAP had a significant relationship with smoking (P<0.001), underlying diseases (P<0.001), duration of hospitalization (P=0.002), and age (P<0.001). Enterobacter was the most common microorganism identified in both groups.

CONCLUSION

According to our results, tooth brushing twice daily with distilled water reduced the incidence of VAP in patients admitted to the ICU. Therefore, it is recommended that nurses caring for ventilator-dependent patients brush the patients' teeth with distilled water as a part of their routine oral care.

CPITN changes during pregnancy and maternal demographic factors 'impact on periodontal health

BACKGROUND

There have been speculations about the effects of hormonal changes and socio-demographic factors on periodontal health during pregnancy.

OBJECTIVE

According to the lack of sufficient epidemiologic information about the periodontal status of pregnant women in Yazd, this study was accomplished to determine the changes of Community Periodontal Index for Treatment Needs (CPITN) during pregnancy and evaluating the possible relationship between this index and demographic characteristics of the mothers.

MATERIALS AND METHODS

This was a longitudinal descriptive study. The samples included 115 pregnant women who were referred to health centers of Yazd, Iran. The mothers' data were obtained from a questionnaire consisted of 3 parts: consent paper, demographic data and CPITN records. Examination was performed with dental unit light, flat dental mirror and WHO's scaled probe.

RESULTS

In the beginning of the study, 60.1% of checked sextants had healthy gingival status. 25.9% had code1 and 14% had code 2. Code 3 and 4 were not seen in any sextants. There was a significant relationship between lower CPITN and higher maternal education, occupation and more frequencies of tooth-brushing but there was not a relationship between CPITN and mother's age and number of pregnancies. CPITN had a significant relationship with increasing of the gestational age.

CONCLUSION

There might be a relationship between increasing the month of pregnancy and more periodontal treatment needs. CPITN Increasing during pregnancy shows the importance of periodontal cares during this period.