A tangible prospect for the treatment of gingivitis using a potentially probiotic strain Lactobacillus plantarum MK06 isolated from traditional dairy products: a triple blind randomized clinical trial

BACKGROUND

Frequent bacterial plaque buildup at the gingival margin and crevice can provoke an inflammatory reaction in gingival tissues which manifests as gingivitis. Probiotics could serve as a beneficial complementary therapy for treating gingival inflammation. The main aim of this research was to investigate the effect of the Lactobacillus plantarum MK06 probiotic strain on the treatment of gingivitis.

METHODS

Patients with gingivitis, who were referred to a private clinic and were systematically healthy, were included in this randomized, triple-blind, placebo-controlled trial. They were instructed to use either placebo or Lactobacillus plantarum suspensions for one minute two times a day after tooth-brushing for four weeks. Then, the clinical parameters of gingivitis, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), and oral hygiene index (OHI-s), were measured in the first, second, and fourth weeks. A total of forty-two patients were randomly assigned to the experimental (n = 21) and control (n = 21) groups. The mean age of the experimental and control groups was 29.10 and 28.48, respectively.

RESULTS

The mean scores of BOP, GI, PI, and OHI-s reduced over time in both the control and test groups. However, according to the Mann-Whitney test, the difference between the two groups was not significant at the same time intervals (P ≥ 0.05) and only GI showed a significant difference in the fourth week (GI-3, P = 0.006). Nevertheless, the experimental group experienced a higher overall reduction rate than the control group. The BOP, GI, PI, and OHI-s scores decreased by 0.081, 0.204, 0.186, and 0.172 times in the second week, respectively, resulting from the interaction of time and the intervention, which considerably diminished these indices.

CONCLUSION

This study shows the potential of the probiotic Lactobacillus plantarum MK06 suspension as a promoting therapeutic adjuvant in the treatment of gingivitis.

Clustering of children's oral diseases in families and villages in a rural setting in Egypt

BACKGROUND

This study assessed the clustering of children' caries experience, plaque accumulation and gingival inflammation in families and villages in Northwestern Egypt and the factors related to the severity of these conditions.

METHODS

This was a secondary analysis of a 2019 household survey of children in villages around Alexandria, Egypt. Clinical examination assessed primary and permanent teeth caries experience (dmft/ DMFT using the World Health Organization criteria), plaque accumulation (Plaque Index (PlI)) and gingival inflammation (Gingival Index (GI)). A child questionnaire assessed child's age, sex, the frequency of toothbrushing (at least twice daily versus less) and frequency of consuming eight types of sugary products (daily sugar consumption score, sum of sugary products consumed daily). Mothers' questionnaire assessed the number of children in the family, mother's education (at least high school versus less), at least twice daily toothbrushing and daily sugar consumption similar to the child. Multilevel regression analyses assessed clustering, calculated by the intraclass correlation coefficient (ICC) of the three conditions in families and villages. Regression estimates (B) and 95% confidence intervals (CIs) of individual and family factors were calculated.

RESULTS

Complete data were available for 450 children (246 families, seven villages], mean = 9.9 years-old and 56% females. The mean caries experience score = 3.6, mean plaque index = 1.5 and mean gingival index = 1.2. Caries experience, plaque accumulation and gingival inflammation were not clustered in villages (ICC < 0.01) but clustered in families (ICC = 0.10, 0.44 and 0.29). Child factors significantly improved model fit for caries experience and gingivitis (p < 0.001) but not plaque accumulation (p = 0.90). Family factors did not improve any model fit (p > 0.05). Child's age was significantly associated with caries experience (B= -0.48, p < 0.001) and gingival inflammation (B = 0.032, p < 0.001). Children who brushed their teeth twice daily had significantly more caries experience (B = 1.04, p = 0.01).

CONCLUSION

The three oral conditions were not clustered in villages but clustered in families. Plaque accumulation showed the greatest within-family clustering. Family factors were not associated with the three conditions and individual factors indicated the need for interventions to promote preventive behaviors and identify families at risk of oral conditions.

Oral health status of patients infected with human immunodeficiency virus and related factors, Iran: a cross-sectional study

Background

Human immunodeficiency virus (HIV) continues to be a major global issue. HIV-infected patients commonly experience oral health problems. This study aimed to assess oral health status of the patients and its related factors in Shiraz, Iran.

Methods

In this cross-sectional study, by using simple random sampling, 250 HIV-infected patients were selected from Shiraz Voluntary Counseling and Testing Center in 2019. Patients' decayed, missing, and filled tooth (DMFT) index, plaque index (PI), and community periodontal index (CPI) were determined. Associations between patients' characteristics and the above-mentioned indices were examined by using Pearson correlation, one-way ANOVA, chi-square, and independent sample T test. The effect of possible confounding factors was controlled by using multiple linear regression and logistic models.

Results

Of the 222 participants, 111 (50%) had 15 or more missing teeth and 79 (35.6%) were edentulous. Their mean (SD) DMFT and PI were 20.71 (10.74) and 1.11 (0.79), respectively. About 40% of them had healthy gingiva. DMFT (p < 0.001), PI (p < 0.001), and CPI (p = 0.002) were significantly worse in men than women. The patients' DMFT and edentulous status were significantly associated with their age (both p < 0.001) and duration of disease (p = 0.001 and p = 0.008, respectively). Unemployed patients had the worst DMFT, PI, and CPI (all p < 0.001) and the highest percentage of edentulous individuals (p = 0.003). All examined indices were significantly worse in cigarette smokers, alcoholics, addicts, and patients with a previous history of imprisonment (all p < 0.001). The odds ratio of being edentulous was 5.74 times in addicted patients than in non-addicted ones (p < 0.001). The odds increased 0.11 with every year that the patients' age increased (p < 0.001). Multiple linear regression models also showed that the addicted patients had significantly more scores in DMFT index, PI, and CPI (all p < 0.001).

Conclusions

Overall, oral health status of the HIV-infected patients was unsatisfactory. Therefore, effective interventional programs are needed for prevention and early treatment of dental problems among this population, especially for more vulnerable groups such as older men with low socioeconomic status, and those with high-risk behaviors.

Randomised methodology development study to investigate plaque removal efficacy of manual toothbrushes

OBJECTIVES

This study aimed to evaluate plaque removal efficacy of toothbrushes to guide clinical model development.

METHODS

This single-centre, randomised, controlled, examiner-blind, method development study included 80 healthy participants. Over 28 days, participants brushed twice-daily using a fluoride toothpaste and one of four marketed toothbrushes: Toothbrushes A (compact head) and B (regular head): medium-hard; flat trim; end-rounded bristles; Toothbrush C: medium-hard; end-rounded bristles; silky, tapered filaments; compact head; Toothbrush D: soft; tapered filaments; compact head. Supra-gingival plaque removal was evaluated immediately after single brushing events (Days 0, 7, 28, at study centre) and following 7- and 28-days' home use via Rustogi modified Navy Plaque Index (RPI) and Turesky modified Quigley Hein Plaque Index (TPI).

RESULTS

All toothbrushes provided significant plaque removal after single-brushing events with change from Day 0 pre-brushing scores on RPI ranging from -0.10 to -0.16 (p<.0001) and on TPI ranging from -0.61 to -0.89 (p<.0001). Toothbrushes A and B showed significant (p<.05) pre-brushing RPI/TPI plaque reductions after 7- (-0.04/-0.06, respectively for RPI; -0.16/-0.20, respectively for TPI) and 28-days (-0.04/-0.03, respectively for RPI; -0.20/-0.11, respectively for TPI) use versus Day 0 pre-brushing (except Toothbrush B, Day 28, non-significant TPI). There were no significant differences with Toothbrush C. Toothbrush D TPI was significantly lower at both timepoints versus Day 0 pre-brushing (p<.05). Study toothbrushes were generally well-tolerated.

CONCLUSION

The observations from this study showed how various aspects of a study design could impact toothbrushes performance. These data will inform the design of future clinical studies of plaque removal efficacy using manual toothbrushes.

CLINICAL SIGNIFICANCE STATEMENT

Regular effective oral hygiene can help prevent and treat gingivitis, principally via twice-daily mechanical cleaning with a toothbrush. Data generated from this methodology development study will help to identify the key aspects which impact toothbrushes' performance and understand which one would be more suitable to answer questions of scientific interest. This study provides useful information for the design of future clinical trials to assess plaque removal efficacy of manual toothbrushes and generate results to inform clinical recommendations.

The association between diabetic retinopathy and periodontal disease

PURPOSE:

The purpose of the study was to study the association between diabetic retinopathy (DR) and periodontal disease (PD) in a South Indian cohort.

METHODS:

This was a cross-sectional, observational, interdisciplinary hospital-based study wherein patients with diabetes mellitus visiting the ophthalmology department of a university teaching hospital in coastal Karnataka, south India, during the study period, were screened independently for retinopathy by an ophthalmologist and PD by a periodontal surgeon. All the patients were above 18 years of age and did not have juvenile or gestational diabetes. A total of 213 patients consented to participate in the study. The data were analyzed for association using the Chi-square test.

RESULTS:

There was a statistically significant association between the presence of DR and PD (P = 0.02). The increasing severity of DR was associated with an increase in the components of PD including plaque index (P < 0.001) and gingival index (P < 0.001).

CONCLUSION:

There is a significant association between DR and PD. The awareness of this association can aid in the screening of potentially sight-threatening retinopathy in diabetics presenting to the dental clinic with PD.

The effects of using phase-contrast microscopy on oral hygiene training of patients receiving orthodontic treatment: A randomized controlled study

Objective

To investigate of effects of using phase-contrast video technique on education in oral hygiene training. This one blind, parallel randomized controlled trial was conducted in a tertiary clinic. Fifty-three patients who presented to the orthodontics department aged 12-20 years were divided into two groups randomly by computer-generated assigned codes to receive oral hygiene education. The participants were blinded to type of education method. Before orthodontic therapy, the control group was trained only by the conventional method, while the test group was trained by phase-contrast video microscopy method in addition to conventional method. Some images and videos of moving microorganisms in dental plaque were shown to the patients in test group on a computer monitor.

Subjects and Methods

The bacterial count, plaque index, and gingival index scores were compared. Measurements were obtained in baseline and follow-ups which were repeated with 1-month intervals after the training.

Results

The plaque index scores (1.05 ± 0.1 vs. 1.43 ± 0.2; P < 0.001) and gingival index scores (0.90 ± 0.1 vs. 1.14 ± 0.2; P < 0.001) in test group was statistically lower than those in control group at the end of the study. The gingival index scores reduced by 39% in test group vs. 14% in control group. The number of bacteria significantly decreased in the group trained with phase-contrast video microscope technique (8,059,133 ± 3016 vs. 10,830,600 ± 4919; 0.018).

Conclusions

The training with phase-contrast microscopy has a more positive effect than the traditional method in oral hygiene education.

Effect of interdental brush design on plaque during nonsurgical periodontal therapy

OBJECTIVE

The aim of this randomized controlled trial was to evaluate the interproximal cleaning efficacy of waist-shaped compared with straight soft interdental brushes in patients undergoing nonsurgical periodontal therapy.

MATERIALS AND METHODS

Ten patients diagnosed with periodontitis stage II or III were scheduled for nonsurgical periodontal therapy. Baseline plaque control record (PCR), modified approximal plaque index (API), papillary bleeding index (PBI), probing pocket depth (PPD), and bleeding on probing (BOP) were evaluated. Four interdental spaces of equal sizes were determined, and baseline plaque indices (PI) were assessed on eight surfaces of the respective adjacent teeth, resulting in 640 measuring positions. Interdental brushes with a straight or waist-shaped design were randomly allocated to the right or left side, and patients received oral hygiene instructions. Follow-up measurements including PCR, API, PBI, and site-specific PI were performed during initial nonsurgical periodontal therapy sessions and reevaluation which was undertaken 8 weeks afterwards.

RESULTS

PCR, API, and PBI decreased significantly compared with baseline at each time point (p < 0.001). PPD (waist-shaped, baseline 4 mm (range, 2-9 mm) vs. reevaluation 3 mm (range, 1-6 mm); p < 0.001; straight, baseline 4 mm (range, 2-10) vs. reevaluation 3 mm (range, 1-6) mm; p < 0.001) and BOP (p = 0.008) showed significant reduction in both groups. Sub-analysis of site-specific areas including line angles and interproximal areas revealed no significant reduction of plaque during the observation period between both brush designs. No difference between straight and waist-shaped brushes regarding PPD or BOP decrease was found.

CONCLUSION

The efficacy of both interdental brush designs concerning plaque control in patients undergoing nonsurgical periodontal therapy was similar.

CLINICAL RELEVANCE

The use of interdental brushes is essential for biofilm removal in patients during initial periodontal therapy, regardless of brush design.

CLINICAL TRIAL REGISTRATION

ISRCTNregistry (#ISRCTN24498365), http://www.isrctn.com/ISRCTN24498365.

Comparative Evaluation of Plaque Removal Effectiveness of Manual and Chewable Toothbrushes in Children: A Randomized Clinical Trial

Objective

In children, manual dexterity poses a problem with the use of manual tooth brushes (MB), resulting in inefficient plaque removal. Recently, novel chewable brushes (CB) have been introduced which could overcome this problem but are less researched in children. The objective of this study is to assess and compare the plaque removal effectiveness of CB with that of MB.

Materials and methods

A total of 60 patients aged 8 to 10 years were enrolled in a single-blinded randomized clinical trial. At baseline, disclosing solution was applied and the Turesky modification of the Quigley–Hein index (TQHI) plaque index and Loe and Silness gingival index were recorded. The subjects were randomly divided into two groups as group I (MB) and group II (CB) and they were instructed to use their respective brushes for a period of 1 week. For statistical comparison, the difference (prebrushing minus postbrushing) in average scores was calculated. Data were evaluated by the independent t test and paired t test, with p < 0.05.

Results

The overall plaque scores reduced from 1.71 ± 0.4 to 0.79 ± 0.24 when using CB and from 1.64 ± 0.64 to 1.13 ± 0.47 when using MBs. On lingual tooth surfaces, CB showed a plaque reduction of 38.70 ± 11.04 to 12.60 ± 4.79 compared to less reduction from 37.43 ± 14.26 to 28.73 ± 11.37 for MB. The overall gingival scores were also reduced from 0.33 ± 0.51 to 0.09 ± 0.07 when using CB and from 0.30 ± 0.33 to 0.19 ± 0.23 when using MB. Differences in scores between the two brushes were statistically significant (p = 0.0001).

Conclusion

It was concluded that the experimental CB was able to remove a significant amount of plaque, particularly on the lingual surfaces, and reduced gingival index scores, thereby improving oral hygiene and gingival health status.

How to cite this article

Kayalvizhi G, Radha S, et al. Comparative Evaluation of Plaque Removal Effectiveness of Manual and Chewable Toothbrushes in Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2019;12(2):107–110.

Prevalence and caries-related risk factors in schoolchildren of 12- and 15-year-old: a cross-sectional study

Background

To assess the prevalence and severity of caries in 12- and 15-year-old schoolchildren, and to analyse the related risk factors.

Methods

We conducted a cross-sectional study on a random sample of 1843 schoolchildren aged 12 and 15 from Galicia (northwest of Spain). Self-administered questionnaire and dental clinical examination were performed to obtain information about oral health habits, dental caries and oral hygiene. A logistic regression model including dental-caries-related variables was generated for each age group.

Results

The respective findings for 12- and 15-years-old were as follows: decayed, missing, filled teeth index both for permanent and temporary dentition (DMFT/dmft) of 0.89 (95% CI, 0.87–0.91) and 1.38 (95% CI, 1.33–1.43), respectively; caries prevalence 39.6% (95% CI, 36.3–42.9) and 51.7% (95% CI, 48.0–55.4), respectively. In the 12-year-old group, individuals who occasionally, never or hardly ever brushed their teeth had higher values of caries (OR = 1.83, 95% CI 1.07–3.15, and OR = 9.14, 95% CI1.63–51.17, respectively). Also, the presence of plaque on more than 1/3 gingival was statistically associated with an increase of caries (OR = 2.03; 95% CI, 1.11–3.70), and living in a rural environment was a risk factor (OR = 1.3; 95% CI,1.02–1.80). In the 15-year-old group, higher caries risk was found when brushing was performed once a day (OR = 1.61; 95% CI,1.03–2.50), and among individuals who visited private clinics (OR = 1.77; 95% CI, 1.17–2.66), while electric toothbrush was associated with a lower caries risk (OR = 0.50; 95% CI, 0.29–0.86).

Conclusions

This study revealed that risk factors of dental caries showed differences in schoolchildren of 12- and 15-year-old. Strongest evidence related to caries in 12-year-old group were found in frequency of toothbrushing and dental plaque. In 15-year old group, electric toothbrush, time since the last visit to the dentist and type of dental care (public/private) had a stronger association with dental caries. Caries prevalence and mean DMFT/dmft increased from 12- to 15-year-old, in spite of improvement in oral hygiene at the age of 15.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0806-5) contains supplementary material, which is available to authorized users.

Impact of cigarette smoking and vaping on the outcome of full-mouth ultrasonic scaling among patients with gingival inflammation: a prospective study

OBJECTIVES

There are no studies that have assessed the oral soft tissue response to full-mouth ultrasonic scaling (FMUS) among cigarette-smokers (CS) (group 1), individuals vaping electronic-cigarettes (E-cigs) (group 2), and never-smokers (NS) (group 3). The aim was to assess the impact of cigarette smoking and vaping on periodontal tissues following FMUS.

MATERIALS AND METHODS

In a clinical prospective study, 89 male individuals were divided into three groups: CS (group 1), E-cig users (group 2), and NS (group 3). A questionnaire was used to gather demographic data and information regarding duration and daily frequency of CS and vaping. Full-mouth plaque index (PI), bleeding on probing (BOP), clinical attachment loss (AL), and probing depth (PD) were measured at baseline and 3 and 6 months after FMUS (without root surface debridement). Numbers of missing teeth (MT) were also recorded.

RESULTS

In groups 1, 2, and 3, 30, 28, and 31 individuals, respectively were included. In group 1, there was no statistically significant difference in mean PI and PD and numbers of sites with PD ≥ 4 mm at 6 months' follow-up compared with baseline and 3 months' follow-up. In groups 2 and 3, there was no significant difference in PI, BOP, and PD at 3 months' (P > 0.05) and 6-months' (P > 0.05) follow-up. There were no pockets with PD ≥ 4 mm at 3 and 6 months' follow-up in groups 2 and 3. There was no difference in the numbers of MT and none of the individuals exhibited clinical AL in all groups.

CONCLUSION

Following FMUS, gingival inflammation is worse in CS compared with individuals vaping E-cigs and NS.

CLINICAL RELEVANCE

Periodontal inflammatory parameters are worse in cigarette-smokers than individuals vaping electronic cigarettes and never-smokers following FMUS. However, these findings should be interpreted with extreme caution as a number of factors may have influenced the present results.

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

Purpose

The purpose of this study was to evaluate the efficacy of the modified plaque score (MPS) for assessing the oral hygiene status of periodontitis patients.

Methods

A total of 116 patients were included in this study. After evaluation of the Löe and Silness gingival index (GI), Silness and Löe plaque index (PlI), O'Leary plaque control record (PCR), and MPS, patients were randomly assigned to either a conventional tooth brushing instruction (C-TBI) group (n=56) or a professional intraoral tooth brushing instruction (P-TBI) group (n=60). The MPS and clinical parameters were re-evaluated after scaling and a series of root planing. The convergent validity of MPS with the PlI and PCR was assessed. The measurement time for MPS and PCR was compared according to the proficiency of the examiner.

Results

After root planing, the GI, PlI, PCR, and MPS improved from their respective baseline values in both groups. Three different plaque indices including the MPS, showed significant differences between the C-TBI group and the P-TBI group after root planing. The MPS showed significant concurrence with the PCR and PlI. The mean time for PCR measurement was 2.76±0.71 times longer than that for MPS measurement after 2 weeks of training.

Conclusions

MPS seems to be a practical plaque scoring system compared with the PlI and PCR. These findings suggest that repetitive plaque control combined with an easily applicable plaque index (MPS) may facilitate more effective oral hygiene education and improved periodontal health.

Knowledge, Attitudes and Habits Regarding Oral Health in First- and Final-Year Dental Students

The purpose of the research was to compare oral health behavior and plaque indices between Croatian first-year and final-year dental students. Therefore, 46.9% of first-year and 47% of final-year dental students were surveyed using the Hiroshima University Dental Behavior Inventory (HU-DBI) questionnaire and had their plaque indices determined. Descriptive statistics analysis, nonparametric tests, and correlation analysis were performed (p<0.05). Sixth-year students had a significantly better mean HU-DBI score (8.06) than first-year students (6.45). Significantly more first-year students thought that they could not help having false teeth at their old age (p=0.007), had never been taught professionally how to brush (p=0.019), and used a toothbrush with hard bristles (p=0.001). Significantly more final-year students brushed each of their teeth carefully (p=0.008), thought they could clean their teeth well without using tooth paste (p=0.000), used a dye to see how clean their teeth were (p=0.002), and had their dentist telling them they brushed very well (p=0.028). Plaque index values were significantly lower (p<0.05) among first-year (7.94±0.72) than among final-year (9.13±0.77) students. With advancement in dental training, oral health attitudes improved, but the level of dental students' oral hygiene decreased.

The antiplaque and bleeding control effects of a cetylpyridinium chloride and tranexamic acid mouth rinse in patients with gingivitis

Purpose

This study aimed to evaluate the effects of a cetylpyridinium chloride (CPC) and tranexamic acid (TXA) mouth rinse on patients with gingivitis.

Methods

This randomized, placebo-controlled, double-blind, parallel-group, clinical trial included 45 healthy adults with gingivitis, who were randomized into 2 groups. The experimental group used a 0.05% CPC and 0.05% TXA mouth rinse, and the control group used a placebo mouth rinse. The following clinical indices were assessed at baseline, at 3 weeks, and at 6 weeks: the Turesky-Quigley-Hein plaque index (QHI), the Löe-Silness gingival index (GI), and bleeding on marginal probing (BOMP). The subjects used the mouth rinse during the experimental period for 20 seconds, 4–5 times daily (10 mL each time).

Results

There were no significant differences in the clinical indices between the groups at baseline. In the experimental group (CPC+TXA), a statistically significant improvement was evident in the QHI, GI, and BOMP at 3 and 6 weeks. These results were similar to those observed in the control group at 3 and 6 weeks, although the change in BOMP was not statistically significant in that group. At 6 weeks, the experimental group had a significantly lower mean score for the QHI than the control group.

Conclusions

This study demonstrated that a CPC and TXA mouth rinse exhibited significant antiplaque and anti-gingivitis efficacy, and had a positive effect on bleeding control when used daily for 6 weeks.

Comparison of Periodontal Parameters and Self-Perceived Oral Symptoms Among Cigarette Smokers, Individuals Vaping Electronic Cigarettes, and Never-Smokers

BACKGROUND

To the authors' knowledge, there are no studies that have compared periodontal parameters and self-perceived oral symptoms (OSs) among cigarette smokers (CSs) (group 1), individuals exclusively vaping electronic cigarettes (group 2), and never-smokers (NSs) (group 3). The aim of this study is to assess periodontal parameters and self-perceived OSs among vaping individuals, CSs, and NSs.

METHODS

Ninety-four male participants (groups 1, 2, and 3: 33, 31, and 30 individuals, respectively) were included. Demographic data, self-perceived OSs, and duration and daily frequency of vaping and smoking were gathered using a questionnaire. Full-mouth plaque index (PI), bleeding on probing (BOP), probing depth (PD) ≥4 mm, and clinical attachment loss (AL) were measured; marginal bone loss (MBL) around all teeth was measured on digital radiographs. Numbers of missing teeth (MT) were also recorded. Odds ratios were calculated for OSs, and periodontal parameters were assessed using analysis of variance and Bonferroni post hoc tests. P <0.05 was considered statistically significant.

RESULTS

PI (P <0.01) and PD ≥4 mm (P <0.01) were significantly higher in groups 1 and 2 than in group 3. BOP was significantly higher in group 3 than in groups 1 (P <0.01) and 2 (P <0.01). There was no difference in number of MT, clinical AL, and MBL among all groups. Gingival pain was more often reported by individuals in group 1 than by individuals in groups 2 (P <0.01) and 3 (P <0.01).

CONCLUSION

Periodontal inflammation and self-perceived OSs were poorer among CSs than among vaping individuals and NSs.

Validation of the Visible Occlusal Plaque Index (VOPI) in estimating caries lesion activity

OBJECTIVE

The present study appraises the construct validity of the Visible Occlusal Plaque Index (VOPI) along with its sub-types, convergent and discriminant validity.

METHODS

618 10-15year old Brazilian adolescents were included. The VOPI has a four-point ordinal scale ranging from no plaque to heavy plaque. VOPI scores and caries status on permanent molars were mapped and recorded at individual anatomical sites of the groove-fossa-system and at surface level. Outcomes were presence of sound site/surface and site/surface with active or inactive caries lesions (non-cavitated or cavitated).

RESULTS

Construct validity was assumed based on qualitative assessment as no plaque (score 0) and thin plaque (score 1) reflected the theoretical knowledge that a regular disorganization of the dental biofilm either maintains the caries process at sub-clinical levels or inactivate it clinically. The VOPI also showed convergent validity since the likelihood that anatomical sites with no or thin plaque had inactive lesions simultaneously with sites with thick plaque (score 2) or heavy plaque (score 3) having active lesions were overall significant (RR=1.0-7.8). At surface level, discriminant validity of the VOPI was evidenced with multivariable analysis (GEE), by its ability to discriminate between the groups of adolescents with different oral hygiene status; negative association between adolescents with thick and heavy plaque and those with sound occlusal surfaces was found (OR=0.3, p<0.001).

CONCLUSION

The VOPI has construct as well as convergent and discriminant validity and is therefore recommended as an additional clinical tool to estimate caries lesions activity and support treatment decisions.

CLINICAL SIGNIFICANCE

The Visible Occlusal Plaque Index is an additional clinical tool to the assessment of oral hygiene and caries lesion activity. The VOPI is recommended to standardize and categorize information on the occlusal biofilm, thus being suitable for direct application in research and clinical settings.

Comparison of Three types of Tooth Brushes on Plaque and Gingival Indices: A Randomized Clinical Trial

OBJECTIVE

To compare clinical results of three types of manual tooth brushes on plaque removal efficacy and gingivitis.

METHOD

This study is a single blind randomized trial with crossover design which involved 30 periodontaly healthy individuals. Professional plaque removal and oral hygiene instruction were performed for all the participants in the first step of our study followed by asking them to avoid brushing for 2 days. Thereafter plaque and gingivitis scores were measured using plaque and gingival indices (PI and GI). Then subjects were instructed to use Pulsar tooth brush for a two-week period and then, GI and PI indices were assessed again. After passing one-week period for wash out, subjects didn't brush for 2 days and indices were recorded again. The same procedure was done for CrossAction, and Butler 411 tooth brushes respectively and at the end of the study these variables were analyzed using SPSS software ver.16. Repeated measurement ANOVA test was used to compare the scores between different brushes.

RESULT

Finding of this study reveals that using all three types of tooth brushes resulted in significant plaque and gingivitis reduction compared to baseline levels. Pulsar tooth brush was significantly more effective in diminishing PI and GI than Butler tooth brush (p=0.044 and 0.031 respectively).

CONCLUSION

According to our findings all 3 types of tooth brushes are effective in reduction of plaque and gingivitis and this reduction is significantly greater for Pulsar tooth brush compared to Butler and CrossAction tooth brushes.

Comparison of red autofluorescing plaque and disclosed plaque-a cross-sectional study

Objectives

The aim of this cross-sectional study was to assess the correlation between dental plaque scores determined by the measurement of red autofluorescence or by visualization with a two-tone solution. Clinical photographs were used for this study.

Materials and methods

Overnight plaque from the anterior teeth of 48 participants was assessed for red fluorescence on photographs (taken with a QLF-camera) using a modified Quigley & Hein (mQH) index. A two-tone disclosing solution was applied. Total disclosed plaque was clinically assessed using the mQH index. In addition, total and blue disclosed plaque was scored on clinical photographs using the mQH index.

Results

A strong correlation was observed between the total disclosed plaque scored on photographs and the clinical scores (r = 0.70 at site level; r = 0.88 at subject level). The correlation between red fluorescent plaque and total plaque, as assessed on the photographs, was moderate to strong and significant (r = 0.50 at the site level; r = 0.70 at the subject level), with the total plaque scores consistently higher than the red fluorescent plaque scores. The correlation between red fluorescent plaque and blue disclosed plaque was weak to moderate and significant (r = 0.30 at the site level; r = 0.50 at the subject level).

Conclusions

Plaque, as scored on white-light photographs, corresponds well with clinically assessed plaque. A weak to moderate correlation between red fluorescing plaque and total disclosed plaque or blue disclosed plaque was found.

Clinical relevance

What at present is considered to be matured dental plaque, which appears blue following the application of a two-tone disclosing solution, is not in agreement with red fluorescent dental plaque assessment.

Comparison of prevalence of periodontal disease in women with polycystic ovary syndrome and healthy controls

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, affecting 4-18% of them. Previous studies also showed that periodontal diseases are associated with different components of the metabolic syndrome. The aim of this study is to determine the association between PCOS and periodontal diseases.

MATERIALS AND METHODS

A total of 196 women (98 with PCOS and 98 healthy controls) were enrolled. PCOS diagnosis was confirmed by history, clinical signs, physical examination, laboratory parameters, and ultrasound studies. Both cases and controls were examined by the same periodontist. Periodontal parameters including bleeding on probing (BOP), probing depth, clinical attachment loss (CAL), plaque index, and tooth loss were investigated in all participants. Pregnant women, smokers, individuals with a history of malignancy or osteoporosis, and those taking prophylactic antibiotics for dental procedures or receiving periodontal treatment during the 6-month period before examination were excluded. Data were analyzed using t-test, Chi-square test, and linear regression. Statistical significance was set at P < 0.05.

RESULTS

CAL and sites with BOP were significantly higher in women with PCOS (P < 0.05). However, no significant difference was observed in the tooth loss rate between PCOS and non-PCOS participants (P = 0.384).

CONCLUSION

The prevalence of periodontal disease seems to be higher in women with PCOS. This may be related to the role of chronic systemic inflammation in the pathophysiology of both PCOS and periodontal diseases.

Impact of Bariatric Surgery and Diet Modification on Periodontal Status: A Six Month Cohort Study

BACKGROUND

Nutrition is an essential component of oral health and improper nutrition is an important aetiological factor in the development of obesity as well.

AIMS AND OBJECTIVES

This study aimed to evaluate effect of diet modification and oral hygiene maintenance after bariatric surgery on the periodontal status of Class III and IV obese patients.

MATERIALS AND METHODS

Two hundred and twenty four patients between the age ranges of 18 -64 years, from both sexes, were subjected to complete periodontal examination prior to bariatric surgery and 6 months post surgery. Patients were advised diet modification which included more fibrous food intake & decreased intake of soft and sugary food along with supragingival scaling & oral health care regime after bariatric surgery with a 6 month follow up. No periodontal surgical intervention was performed.

RESULTS

The patients showed a mean differences in the bleeding score, plaque and gingival index which was found to be statistically significant (p<0.001). The improvement in clinical attachment level and probing pocket depth before and after surgery were found to be statistically insignificant (p>0.05).

CONCLUSION

Thus we conclude that fibrous diet along with good periodontal care can help to improve the oral hygiene status of patients undergoing bariatric surgery, even if periodontal surgical intervention is not performed resulting in freedom from periodontitis, thus improving quality of life of the patient.

Relationship of Halitosis with Gastric Helicobacter Pylori Infection

OBJECTIVES

Gastric infection with Helicobacter pylori may be one of the main causes of halitosis. This study was performed to evaluate the relationship of Helicobacter pylori infection with halitosis.

MATERIALS AND METHODS

This case control study was performed on 44 dyspeptic patients with a mean age of 34.29±13.71 years (range 17 to 76 years). The case group included 22 patients with halitosis and no signs of diabetes mellitus, renal or liver failure, upper respiratory tract infection, malignancies, deep carious teeth, severe periodontitis, coated tongue, dry mouth or poor oral hygiene. Control group included 22 patients without halitosis and the same age, sex, systemic and oral conditions as the case group. Halitosis was evaluated using organoleptic test (OLT) and Helicobacter pylori infection was evaluated by Rapid Urease Test (RUT) during endoscopy. The data were statistically analyzed using chi square, Mann Whitney and t-tests.

RESULTS

Helicobacter pylori infection was detected in 20 (91%) out of 22 halitosis patients, and 7 control subjects (32%) (P<0.001).

CONCLUSION

Helicobacter pylori gastric infection can be a cause of bad breath. Dentists should pay more attention to this infection and refer these patients to internists to prevent further gastrointestinal (GI) complications and probable malignancies.

Antiplaque and antigingivitis effects of a mouthrinse containing cetylpyridinium chloride, triclosan and dipotassium glycyrrhizinate

Purpose

The goal of this study was to evaluate the clinical anitplaque and antigingivitis effects of a mouthrinse containing cetylpyridinium chloride (CPC), triclosan and dipotassium glycyrrhizinate (DPZ) in patients with gingivitis and mild periodontitis.

Methods

Thirty-two subjects were randomized into 2 groups. The test group used a mouthrinse containing 0.05% CPC, 0.02% triclosan and 0.02% DPZ, while the control group used a placebo mouthrinse. At baseline, 2 weeks and 4 weeks, the papillary bleeding index (PBI), Turesky-Quigley-Hein plaque index (PI) and Löe-Silness gingival index (GI) were assessed. During the experimental period, the patients used the mouthrinse for 30 seconds, 4 to 5 times/day (10 mL/time) within 30 minutes after toothbrushing.

Results

No adverse effects appeared in either the experimental or the control group. Regarding PBI, PI and GI values, statistical significance was detected between values at baseline and 2 weeks for both groups (P<0.05). In the experimental group, statistically significantly lower values were detected at 4 weeks compared to at 2 weeks. However, in the control group, no statistically significant difference was detected between the values at 2 weeks and 4 weeks. Additionally, the mean value after 4 weeks for the control group was slightly higher than the mean value after 2 weeks for the control group.

Conclusions

This study for 4 weeks demonstrated that mouthrinses containing CPC, triclosan and DPZ may contribute to the reduction of supragingival plaque and gingivitis.

Effect of sugar-free gum in addition to tooth brushing on dental plaque and interdental debris

BACKGROUND

Chewing-gum may serve as an effective oral hygiene device when brushing may not be possible. The aim of the present study was to evaluate the effect of chewing sugar-free gum twice a day after meals in addition to tooth brushing on dental plaque and interdental debris.

METHODS

Twenty four (12 males and 12 females aged 20-21 years) healthy third-year dental students participated in the study. It was a prospective single blind and non-randomized before and after study. The control group followed tooth brushing habit twice a day plus water rinsing after meals at noon and night for 10 days. The study group followed tooth brushing habit twice a day plus chewing one pellet of sugar-free gum after meals at noon and night for 30 minutes for 3 weeks. Personal hygiene performance index (PHP-M) was used to assess the dental plaque and self-designed interdental debris index for interdental debris. ANOVA, Tukey and 't' tests were used for data analysis. The level of significance was fixed at α = 0.05.

RESULTS

The baseline percentages of cumulative plaque and interdental debris were 63.12% and 76.44%, respectively. There was no significant difference in the plaque scores following either water rinsing (61.73%) or gum chewing (59.44%) after meals, but a statistically significant reduction of 14.18% in interdental debris was observed among those who chewed the gum (P < 0.05).

CONCLUSION

After meal, gum chewing in addition to daily tooth brushing reduced interdental debris, but had no effect on established buccal and lingual dental plaques.