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To investigate the existence of any association between new putative periodontal pathogens and periodontitis. Two independent reviewers conducted electronic literature searches in the MEDLINE (PubMed), EMBASE, DOSS and Google Scholar databases as well as a manual search to identify eligible clinical studies prior to November 2022. Studies comparing the prevalence of microorganisms other than the already-known periodontal pathogens in subgingival plaque and/or saliva samples between subjects with periodontitis and subject with periodontal health were included. Meta-analyses were performed on data provided by the included studies. Fifty studies including a total of 2739 periodontitis subjects and 1747 subjects with periodontal health were included. The Archaea domain and 25 bacterial species (Anaeroglobus geminatus, Bacteroidales [G-2] bacterium HMT 274, Desulfobulbus sp. HMT 041, Dialister invisus, Dialister pneumosintes, Eubacterium brachy, Enterococcus faecalis, Eubacterium nodatum, Eubacterium saphenum, Filifactor alocis, Fretibacterium sp. HMT 360, Fretibacterium sp. HMT 362, Mogibacterium timidum, Peptoniphilaceae sp. HMT 113, Peptostreptococcus stomatis, Porphyromonas endodontalis, Slackia exigua, Streptococcus gordonii, Selenomonas sputigena, Treponema amylovorum, Treponema lecithinolyticum, Treponema maltophilum, Treponema medium, Treponema parvum and Treponema socranskii) were found to be statistically significantly associated with periodontitis. Network studies should be conducted to investigate the role of these newly identified periodontitis-associated microorganisms through interspecies interaction and host-microbe crosstalk analyses., (© 2023 Aix-Marseille Université. Journal of Periodontal Research published by John Wiley & Sons Ltd.)

Background and Objective: Weak direct current (DC) exerts killing effect and synergistic killing effect with antibiotics in some specific bacteria biofilms. However, the potential of weak DC alone or combined with periodontal antibiotics in controlling periodontal pathogens and plaque biofilms remains unclear. The objective of this study was to investigate whether weak DC could exert the anti-biofilm effect or enhance the killing effect of metronidazole (MTZ) and/or amoxicillin-clavulanate potassium (AMC) on subgingival plaque biofilms, by constructing an in vitro subgingival plaque biofilm model., Methods: The pooled subgingival plaque and saliva of patients with periodontitis (n = 10) were collected and cultured anaerobically on hydroxyapatite disks in vitro for 48 h to construct the subgingival plaque biofilm model. Then such models were stimulated with 0 μA DC alone (20 min/12 h), 1000 μA DC alone (20 min/12 h), 16 μg/ml MTZ, 16 μg/ml AMC or their combination, respectively. Through viable bacteria counting, metabolic activity assay, quantitative real-time PCR absolute quantification and 16S rDNA sequencing analysis, the anti-biofilm effect of 1000 μA DC and enhanced killing effects of 1000 μA DC combined with antibiotics (MTZ, AMC or MTZ+AMC) were explored., Results: The old subgingival plaque model (48 h) had no significant difference in total bacterial loads from subgingival plaque in situ, which achieved a similarity of 80%. The 1000 μA DC plus MTZ or AMC for 12 h showed a stronger synergistic killing effect than the same combination for 20 min. The metabolic activity was reduced to the lowest by DC plus MTZ+AMC, as 37.4% of that in the control group, while average synergistic killing effect reached 1.06 log units and average total bacterial loads decreased to 0.87 log units. Furthermore, the relative abundance of the genera Porphyromonas, Prevotella, Treponema_2, and Tannerella were decreased significantly., Conclusion: The presence of weak DC (1000 μA) improved the killing effect of antibiotics on subgingival plaque biofilms, which might provide a novel strategy to reduce their antibiotic resistance., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Periodontitis is a major cause of tooth loss in adults that initially results from dental plaque. Subgingival plaque pathogenesis is affected by both community composition and plaque structures, although limited data are available concerning the latter. To bridge this knowledge gap, subgingival plaques were obtained using filter paper (the fourth layer) and curette (the first‐third layers) sequentially and the phylogenetic differences between the first–third layers and the fourth layer were characterized by sequencing the V3–V4 regions of 16S rRNA. A total of 11 phyla, 148 genera, and 308 species were obtained by bioinformatic analysis, and no significant differences between the operational taxonomic unit numbers were observed for these groups. In both groups, the most abundant species were Porphyromonas gingivalis and Fusobacterium nucleatum. Actinomyces naeslundii, Streptococcus intermedius, and Prevotella intermedia possessed relatively high proportions in the first–third layers; while in the fourth layer, both traditional pathogens (Treponema denticola and Campylobacter rectus) and novel pathobionts (Eubacterium saphenum, Filifactor alocis, Treponema sp. HOT238) were prominent. Network analysis showed that either of them exhibited a scale‐free property and was constructed by two negatively correlated components (the pathogen component and the nonpathogen component), while the synergy in the nonpathogen component was lower in the first–third layers than that in the fourth layer. After merging these two parts into a whole plaque group, the negative/positive correlation ratio increased. With potential connections, the first–third layers and the fourth layer showed characteristic key nodes in bacterial networks. [ABSTRACT FROM AUTHOR]

Aim: This systematic review investigates the impact of specific interventions aiming at promoting behavioural changes to improve oral hygiene (OH) in patients with periodontal diseases., Methods: A literature search was performed on different databases up to March 2019. Randomized and non-randomized controlled trials evaluating the effects of behavioural interventions on plaque and bleeding scores in patients with gingivitis or periodontitis were considered. Pooled data analysis was conducted by estimating standardized mean difference between groups., Results: Of 288 articles screened, 14 were included as follows: 4 studies evaluated the effect of motivational interviewing (MI) associated with OH instructions, 7 the impact of oral health educational programmes based on cognitive behavioural therapies, and 3 the use of self-inspections/videotapes. Studies were heterogeneous and reported contrasting results. Meta-analyses for psychological interventions showed no significant group difference for both plaque and bleeding scores. No effect was observed in studies applying self-inspection/videotapes., Conclusions: Within the limitations of the current evidence, OH may be reinforced in patients with periodontal diseases by psychological interventions based on cognitive constructs and MI principles provided by oral health professionals. However, no conclusion can be drawn on their specific clinical efficacy as measured by reduction of plaque and bleeding scores over time., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The collection of subgingival plaque samples with paper points is time-consuming and accident-sensitive. However, the collection of saliva is simple and contains pathogens of all intraoral surfaces. The aim of this study is to investigate whether a sampling strategy with mouthrinse (mouthrinse sample [MSP]; test) leads to results comparable with standard sampling method (multiple site test from the deepest pocket of each quadrant [MT4]; control).Methods: In 50 patients with periodontitis, subgingival plaque was sampled from the deepest pocket of each quadrant by using paper points and by gaining saliva with saline mouthrinse. Analysis was performed using a commercially available polymerase chain reaction test for 11 periodontal pathogens.Results: Detection frequency of Aggregatibacter actinomycetemcomitans (MT4/MSP: 42%/36%), Porphyromonas gingivalis (78%/66%), Tannerella forsythia (98%/84%), Treponema denticola (94%/74%), Parvimonas micra (86%/62%), Campylobacter rectus (90%/76%), Eubacterium nodatum (64%/30%), Prevotella intermedia (58%/54%), and Eikenella corrodens (90%/82%) was higher with MT4 than MSP. For Fusobacterium nucleatum (100%/100%), there was no difference between test and control. Only detection frequency of Capnocytophaga species (68%/74%) was higher with MSP than MT4. Differences were significant for P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum.Conclusions: There is no significant difference between MT4 and MSP for detection frequency of key pathogen A. actinomycetemcomitans. Key pathogens P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum show statistically higher detection frequencies with MT4. [ABSTRACT FROM AUTHOR]

To appraise the literature on the prevalence of the JP2 clone of Aggregatibacter actinomycetemcomitans (A.a.) and on its association with presence and progression of periodontitis in different populations. A systematic search of the literature was conducted in Medline, Embase and Cochrane Library for studies reporting data on detection of the JP2 clone of A.a. A total of 56 papers were included in the review, from an initial search of 685 titles. Studies were carried out in populations with a mean age of 26.34 years (range 6.24–53.85 years). Just over 16% of the overall population assessed (n = 13 751) had the JP2 clone detected. Meta‐analyses included 16 studies and 1775 patients, and revealed an association between detection of the JP2 clone and diagnosis of periodontitis (RR = 1.86, 95% 1.43–2.42) from saliva and plaque, with high heterogeneity (I2 = 85%, p <.00001). Meta‐analyses included 5 studies and 616 patients, and revealed an association between baseline detection of the JP2 clone and onset of periodontitis over 2 to 5 years (RR = 4.12, 95% 2.42–7.00), with high heterogeneity (I2 = 81%, p <.0003). From the overall risk of bias score, 29 papers were judged as low risk of bias, whilst the remaining papers were judged to have an overall medium or high risk of bias. Detection of the JP2 clone of A.a. in subgingival plaque and saliva samples is associated with increased odds of diagnosis of periodontitis and may be able to predict onset of periodontitis. This systematic review provides clear evidence that in certain populations, the JP2 clone of A.a. is associated with early‐onset periodontitis. Furthermore, detection of this bacterium seems to be predictive of disease onset. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review was to evaluate the change of oral microbiome based on next‐generation sequencing (NGS)‐metagenomic analysis following periodontal interventions among systematically healthy subjects. Materials and Methods: A structured search strategy consisting of "metagenomics" and "oral diseases" was applied to PubMed, EMBASE, and Web of Science to identify effective papers. The included studies were original studies published in English, using metagenomic approach to analyze the effectiveness of periodontal intervention on oral microbiome among systematically healthy human subjects with periodontitis. Results: A total of 12 papers were included in this review. Due to the heterogeneity of selected study, quantitative analysis was not performed. The findings as to how alpha diversity changed after interventions were not consistent across studies. Six studies illustrated clear separation of microbial composition between dental plaque samples collected before and after intervention using principal coordinates/component analysis. The most commonly detected genera before intervention were Porphyromonas, Treponema, Tannerella, and Prevotella, while Streptococcus and Actinomyces usually increased and became the dominant genera after intervention. Correlation network analysis revealed that after intervention, the topology of network was different compared to the corresponding pre‐interventional samples. Conclusion: Existing evidence of metagenomic studies depicts a complex change in oral microbiome after periodontal intervention. [ABSTRACT FROM AUTHOR]

The aim of this study was to conduct a review of the literature to assess the relationship between quantity and pattern of sucrose use and dental caries. Using hand and electronic methods (MEDLINE, EMBASE) the literature was searched for epidemiological papers concerning any relationship of sugars and dental caries published since 1856. Superficial hand searching was carried out between 1856 and 1940, detailed hand searching 1940–1966 and electronic 1966–2007. Selection criteria were set based on, but not confined to, Cochran style standards. Investigations were categorized as A, fulfilling all criteria; B1, relevant fulfilling 19 of 23 criteria; B2, relevant but fulfilling only between 12 and 18 of the selection criteria; and C, all other papers. There were 95 papers meeting most (more than 12) or all of the selected criteria. Only 1 paper was graded A; 31 as B1. There were in addition some 65 as B2 and all the rest as C, which were discarded. There were a wide variety of study designs and those graded A or B1 comprised 23 ecological cross-sectional, 7 cohort and 2 case control studies. Summary results showed that 6 papers found a positive, significant relationship of sugar quantity to dental caries, 19 of 31 studies reported a significant relationship of sugar frequency of use to dental caries. The balance of studies does not demonstrate a relationship between sugar quantity, but a moderately significant relationship of sugar frequency to dental caries. [ABSTRACT FROM AUTHOR]

Although the first toothbrush is thought to have been used in about 1000 ad, tooth brushing in America did not gain popularity until after 1945. The introduction of the powered toothbrush in 1960 has led to a large number of studies comparing the safety and efficacy of powered toothbrushes to manual toothbrushes. There is a general agreement that powered toothbrushes are as safe as manual toothbrushes; however, studies show significantly differing conclusions regarding the efficacy of power toothbrushes for the removal of plaque. The recent amendment of the Cochrane report on this subject concluded that the only type of powered toothbrush that removes more plaque than a manual toothbrush is one with rotational oscillation movement. Their conclusion was based on the review of 29 published studies, conducted between 1964 and 2001, with a total of 2547 participants. All these studies used similar research design criteria. The Cochrane conclusion is in agreement with a 1996 study carried out in the Netherlands. Many of the conflicting study conclusions, to date, on powered toothbrushes, are the result of using differing study design criteria. While the dental profession desires evidence-based research, it is clear that dental schools will need to increase the level of attention in their curriculum to address disciplined techniques for research design in order to reconcile the large variances in reported research results. [ABSTRACT FROM AUTHOR]

To appraise the literature on the prevalence of the JP2 clone of Aggregatibacter actinomycetemcomitans (A.a.) and on its association with presence and progression of periodontitis in different populations. A systematic search of the literature was conducted in Medline, Embase and Cochrane Library for studies reporting data on detection of the JP2 clone of A.a. A total of 56 papers were included in the review, from an initial search of 685 titles. Studies were carried out in populations with a mean age of 26.34 years (range 6.24-53.85 years). Just over 16% of the overall population assessed (n = 13 751) had the JP2 clone detected. Meta-analyses included 16 studies and 1775 patients, and revealed an association between detection of the JP2 clone and diagnosis of periodontitis (RR = 1.86, 95% 1.43-2.42) from saliva and plaque, with high heterogeneity (I 2  = 85%, p < .00001). Meta-analyses included 5 studies and 616 patients, and revealed an association between baseline detection of the JP2 clone and onset of periodontitis over 2 to 5 years (RR = 4.12, 95% 2.42-7.00), with high heterogeneity (I 2  = 81%, p < .0003). From the overall risk of bias score, 29 papers were judged as low risk of bias, whilst the remaining papers were judged to have an overall medium or high risk of bias. Detection of the JP2 clone of A.a. in subgingival plaque and saliva samples is associated with increased odds of diagnosis of periodontitis and may be able to predict onset of periodontitis. This systematic review provides clear evidence that in certain populations, the JP2 clone of A.a. is associated with early-onset periodontitis. Furthermore, detection of this bacterium seems to be predictive of disease onset., (© 2023 The Authors. Journal of Periodontal Research published by John Wiley & Sons Ltd.)

Objectives: To investigate whether chlorhexidine mouthwash (CHX‐MW), with an anti‐discoloration system(ADS), is effective in preventing extrinsic tooth surface discoloration. Additionally, this paper seeks to evaluate whether CHX combined with an ADS maintains its efficacy with respect to reducing plaque and gingivitis scores. Material and methods: MEDLINE‐PubMed and Cochrane‐Central were searched up to October 2018 to identify eligible studies. Papers evaluating the effect of CHX‐MW+ADS compared to CHX without an ADS were included. A descriptive analysis and when feasible a meta‐analysis was performed. Results: Screening resulted in 13 eligible publications, presenting 16 comparisons. Six of these evaluated the MW in a non‐brushing model and ten as an adjunct to toothbrushing. A descriptive analysis demonstrated that the majority showed no differences in bleeding, gingivitis and plaque scores. This was confirmed by the meta‐analysis. In non‐brushing experiments, the difference‐of‐means (DiffM) for plaque scores was 0.10 (P = 0.45, 95%CI: [−0.15; 0.34]) and for the gingival index 0.04 (P = 0.15,95%CI: [−0.02; 0.11]). The DiffM in brushing studies for plaque scores was 0.01 (P = 0.29, 95%CI: [−0.01; 0.02]) and for the gingival index 0.00 (P = 0.87,95%CI: [−0.05; 0.06]). With respect to staining scores, the meta‐analysis revealed that in non‐brushing studies, the standardized mean difference was 3.19 (P = 0.0005,95%CI: [−3.98; −1.41]) while in brushing studies, the DiffM was 0.12 (P = 0.95,95%CI: [−3.32; 3.55]). Conclusion: There is moderate quality evidence from non‐brushing studies that the addition of an ADS to CHX‐MW reduces tooth surface discoloration and does not appear to affect its properties with respect to gingival inflammation and plaque scores. In brushing studies, there is also moderate quality evidence that ADS does not affect the anti‐plaque and anti‐gingivitis efficacy of CHX. The majority of comparisons and the meta‐analysis including these indicate no significant effect of ADS on tooth staining in situations where the mouthwash is used in addition to toothbrushing. [ABSTRACT FROM AUTHOR]

Objectives: In adult participants, what is, following a single brushing exercise, the efficacy of a powered toothbrush (PTB) as compared to a manual toothbrush (MTB) on plaque removal? Methods: MEDLINE‐PubMed and Cochrane‐CENTRAL were searched from inception to February 2019. The inclusion criteria were (randomized) controlled clinical trials conducted in human subjects ≥18 years of age, in good general health and without periodontitis, orthodontic treatment, implants and/or removable prosthesis. Papers evaluating a PTB compared with a MTB in a single brushing exercise were included. When plaque scores were assessed according to the Quigley‐Hein plaque index (Q&HPI) or the Rustogi modified Navy plaque index (RMNPI). From the eligible studies, data were extracted. A meta‐analysis and subanalysis for brands and mode of action being oscillating‐rotating (OR) and side‐to‐side (SS) were performed when feasible. Results: Independent screening of 3450 unique papers resulted in 17 eligible publications presenting 36 comparisons. In total, 28 comparisons assessed toothbrushing efficacy according to the Q&HPI and eight comparisons used the RMNPI. Results showed a significant effect in favour of the PTB. The difference of Means (DiffM) was −0.14 (P < 0.001; 95%CI [−0.19; −0.09]) for the Q&HPI and −0.10 (P < 0.001; 95%CI [−0.14; −0.06]) for the RMNPI, respectively. The subanalysis on the OR mode of action showed a DiffM −0.16 (P < 0.001; 95%CI [−0.22, −0.10]) for the Q&HPI. For the SS mode of action using RMNPI, the DiffM showed −0.10 (P < 0.001; 95%CI [−0.15; −0.05]). The subanalysis for brands showed for the P&G OR PTB using the Q&HPI a DiffM of −0.15 (P < 0.001; 95%CI [−0.22; −0.08]) and the Colgate SS for RMNPI showed a DiffM of −0.15 (P < 0.001; 95%CI [−0.18; −0.12]). Conclusion: There is moderate certainty that the PTB was more effective than the MTB with respect to plaque removal following a single brushing exercise independent of the plaque index scale that was used. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This systematic review was performed to establish the effect of a manual toothbrush with tapered toothbrush filaments (TFTBs) compared to a manual toothbrush with end‐rounded toothbrush filaments (ERTB) on clinical parameters of dental plaque, gingivitis and gingival abrasion. Materials and methods: MEDLINE‐PubMed and Cochrane‐CENTRAL databases were searched. The inclusion criteria were (randomized) controlled clinical trials, participants ≥18 years and papers evaluating the effect of a TFTB compared to an ERTB. Data were extracted for dental plaque index (PI), bleeding scores (BS), gingival index scores (GI) and gingival abrasion scores (GA). A descriptive analysis and a meta‐analysis were performed when appropriate. Results: An independent screening of 33 unique papers resulted in seven eligible publications, which included eight comparisons. Meta‐analysis did not show a significant difference between TFTB and ERTB with respect to PI scores. The meta‐analysis of the GI scores showed a significant mean difference in favour of the TFTB (DiffM=−0.12 [95% CI: −0.17; −0.07]). Of the three comparisons evaluating GA, no differences were found. Conclusion: With respect to plaque removal, evidence that supports the recommendation for usage of a TFTB over an ERTB is lacking. Regarding GI, there is minimal evidence favouring a TFTB over an ERTB and the clinical relevance of this difference is probably negligible. Therefore, based on the collective evidence emerging from this systematic review, the strength and direction of the recommendation, there appears to be no firm evidence for a dental healthcare professional to advise the use of a TFTB over the use of an ERTB. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to establish the efficacy of sodium hypochlorite mouthwash (NaOCl‐MW) compared with a control mouthwash on plaque and clinical parameters of periodontal disease. Methods: MEDLINE‐PubMed, Embase and Cochrane‐CENTRAL databases were searched for clinical trials on patients with gingivitis or periodontitis that assessed the effect of NaOCl‐MW in comparison with a negative or positive control on plaque index (PI), gingival index (GI), and bleeding index (BI) scores and probing pocket depth (PPD). Data were extracted from the eligible studies. Results: Seven eligible papers were retrieved, which together represented six clinical trials. The studies showed considerable heterogeneity regarding methodological and clinical aspects that did not permit a meta‐analysis. Two of the three studies in which NaOCl‐MW was compared with a negative control showed that NaOCl‐MW significantly reduced PI, GI and BI, and no effect was found on PPD. In three studies, NaOCl‐MW was assessed using chlorhexidine mouthwash (CHX‐MW) as a positive control; no difference was found for GI and BI. One of the three comparisons showed a statistically significant PI score favouring NaOCl‐MW. One study measured PPD and found it to be significant in favour of NaOCl‐MW. Conclusions: Studies with a negative control group provided very weak quality evidence for a very small beneficial effect of NaOCl‐MW on PI, GI and BI scores. Studies with a positive control group provided very weak quality evidence that NaOCl‐MW had a similar effect as CHX‐MW on PI, GI and BI scores. The outcome for PPD was inconclusive. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to establish the efficacy of a rubber bristles interdental cleaner (RBIC) as an adjunct to toothbrushing (TB) compared to that of the adjuvant use of other interdental cleaning devices and TB alone on plaque and gingivitis parameters. Additionally, the safety aspects and panellists' appreciation were evaluated. Materials and Methods: Databases were searched for randomized controlled clinical trials (RCTs) evaluating plaque (PI), bleeding (BS), and gingival index (GI) scores, safety assessments, and participants' appreciation. Extracted data were summarized in a descriptive and, if possible, a meta‐analysis. Results: The search retrieved 142 unique papers; six studies with 10 comparisons were included in a descriptive analysis. Five RCTs compared RBICs with interdental brushes (IDBs), four with dental floss (DF) and one with manual TB only. No comparisons to wood sticks were retrieved. Using an RBIC resulted in no difference in plaque scores compared to DF and IDBs. For overall bleeding scores, no difference was found. Two studies analysing the accessible sites separately found RBICs to be more favourable than DF and IDBs. Conversely, one study evaluating the efficacy of RBICs compared to IDBs, according to the GI scores, showed that IDBs achieved significantly greater reduction. Moreover, RBICs caused fewer gingival abrasions and were preferred by the study participants. Conclusion: Based on a descriptive and a meta‐analysis of the available literature, it is synthesized that in gingivitis patients, a weak to very weak certainty exists that a RBIC is indicated for gingivitis and plaque reduction. The evidence supports user safety and participants' preferences. [ABSTRACT FROM AUTHOR]

Focus question: What is the efficacy of a chlorhexidine (CHX) mouthwash (MW) containing sodium fluoride (NaF) compared to a CHX − MW alone on the parameters of plaque, gingivitis and discoloration? Material and Methods: MEDLINE‐PubMed, Cochrane‐CENTRAL, and EMBASE were searched for papers from inception to December 2017. The inclusion criteria were (randomized) controlled clinical trials conducted in human subjects with good general health and without removable prosthesis. Papers evaluating the effect of a MW containing CHX + NaF compared to a CHX alone were included. From the eligible studies, data were extracted, a descriptive analysis was performed and a meta‐analysis when feasible. Results: Independent screening of 412 unique papers resulted in 9 eligible publications presenting 10 clinical trials comparing the effect of CHX + NaF to CHX − MW and provided 13 comparisons. Five evaluated the MW as an adjunct to brushing and 8 were non‐brushing comparisons of which 4 used an experimental gingivitis model. No significant difference was observed for plaque score reduction in the brushing studies the end scores (diffM; −0.04, P = .36; 95%CI: [−0.13, 0.05]) nor the differences (diffM; 0.11, P = .33; 95%CI: [−0.12, 0.24]). In the descriptive analysis, none of the experiments demonstrated a statistical significant difference regarding Gingival Index (GI), Bleeding Score and Discoloration Scores. For the GI, a meta‐analysis of the difference of Means was not significant when included experimental gingivitis model studies end scores (0.01, P = .78; 95%CI: [−0.08, 0.11]) and the difference (0.01, P = .81; 9 5%CI: [−0.08, 0.10]) either for the end scores of brushing studies (diffM; −0.01, P = .82; 95%CI: [−0.10, 0.08]). Conclusion: From this study, it can be concluded that NaF and CHX may be present in the same MW without reducing CHX efficacy with respect to plaque and gingivitis scores. Moreover, no difference in the development of tooth discoloration was observed. [ABSTRACT FROM AUTHOR]

This paper focuses on plaque control and the management of gingivitis in adults and summarizes the evidence of commercially available dentifrices as gathered from existing systematic reviews. Three internet sources were used to search for appropriate papers (up to and including February 2017). The search strategy was designed to include any systematic review published on dentifrices that also included an evaluation of plaque and gingivitis scores. Characteristics of the individual reviews, such as methodological aspects, quantitative data and conclusions, were extracted. The potential risk of bias was estimated and the acquired evidence was graded. Independent screening of 205 unique reviews resulted in 10 published and eligible systematic reviews. One publication evaluated the mechanical contribution of dentifrice to plaque removal. Eight papers were identified that evaluated the efficacy of a proposed single active ingredients, of which two reviewed more than one potentially active ingredient. One study compared two active ingredients. This meta-review appraised the current state of evidence and found that toothbrushing with a standard fluoride dentifrice does not provide an added effect for the mechanical removal of dental plaque. Evidence suggests that compared with a standard dentifrice, those containing triclosan or stannous fluoride have benefits with respect to gingival health and control of dental plaque. [ABSTRACT FROM AUTHOR]

Focused question What is the effectiveness of a chlorhexidine ( CHX) mouthwash used in combination with a sodium lauryl sulphate ( SLS) dentifrice on the parameters of plaque and gingivitis? Material and methods MEDLINE- Pub Med, Cochrane- CENTRAL, EMBASE and other electronic databases were searched up to July 2014. The inclusion criteria were (randomized) controlled clinical trials, subjects ≥18 years of age with good general health. Papers evaluating the effect of CHX mouthwash used in combination with SLS dentifrice or a dentifrice slurry compared with CHX mouthwash as a single oral hygiene intervention or in combination with an SLS-free dentifrice were included. From the eligible studies, data were extracted, and a meta-analysis was performed when feasible. Results Independent screening of 83 unique papers resulted in four eligible publications, with nine comparisons. The meta-analysis showed that when an SLS dentifrice was used as a slurry rinse, the interference on the plaque-inhibiting effect of a CHX mouthwash was significantly decreased ( MD 0.33; P ≤ 0.00001; 95% CI: <0.24; 0.42>). No significant difference was observed when SLS dentifrice was applied as a paste in combination with CHX mouthwash ( MD 0.08; P = 0.42; 95% CI: <−0.26; 0.11>). Descriptive and subgroup analyses support these findings. Moreover, the observed effect for the dentifrice paste occurred regardless of the order of use. Conclusion This review demonstrates that when CHX mouthwash is recommended, it can be used in combination with an SLS dentifrice without any interference regarding its inhibiting effect on dental plaque, regardless of the order of use. Consequently, the collective evidence indicates that the combined use of dentifrice and CHX mouthwash is not contraindicated. However, this recommendation has been graded as moderate taking into account a potential publication bias because three of the four included studies emerged from the same research group. [ABSTRACT FROM AUTHOR]

Aim: The aim of this review was to systematically review the literature on the adjunctive effect of oral irrigation in addition to toothbrushing on plaque and clinical parameters of periodontal inflammation. Material and Methods: Papers in the MEDLINE-PubMed and Cochrane Central register of Controlled Trials (CENTRAL) databases up to January 2008 were searched to identify appropriate studies. Clinical parameters of periodontal inflammation such as plaque, bleeding, gingivitis and pocket depth, were selected as outcome variables. Results: Independent screening of the titles and abstracts of 809 PubMed and 105 Cochrane papers resulted in seven publications that met the eligibility criteria. Mean values and standard deviations were collected by data extraction. Descriptive comparisons with brushing alone or regular oral hygiene are presented. Conclusion: As an adjunct to brushing, the oral irrigator does not have a beneficial effect in reducing visible plaque. However, there is a positive trend in favour of oral irrigation improving gingivial health over regular oral hygiene or toothbrushing only. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the results of microbiological RNA-probe analysis after subgingival plaque sampling applying two different strategies. Methods: in 220 patients, clinical examinations were obtained prior to commencement of therapy for aggressive or generalized severe chronic periodontitis (n = 113), after combined mechanical and antibiotic anti-infective periodontal therapy (n = 43), or because of periodontal pockets despite adequate therapy (n = 64). Subgingival plaque samples were obtained from the three pockets with the deepest probing depths. Two sterile paper points were inserted simultaneously into the periodontal pockets. One paper point from each pocket was put into a separate transport vial; the second paper point was pooled (multiple site test [MT3]) with paper points from each of the two other sampling sites from the respective patient into a transport vial. The content of each vial was analyzed separately for Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, and Treponema denticola (Td) with a commercially available RNA-probe test. Results: For all tested pathogens, log-transformed numbers of bacteria were higher in pooled samples compared to the mean values for the separate samples (P≤0.01). However, for Td only, statistically significant differences in frequency were seen between the separate samples and MT3. These findings were observed over all samples as well as after evaluation of subgroups separately. Conclusions: Pooling of plaque samples increased the bacterial counts per analysis compared to separate samples and thus may increase the probability of detecting existing pathogens. However, this observation only was statistically significant for the frequency of Td. [ABSTRACT FROM AUTHOR]

Aim To introduce dental hygienists ( DHs) in the UK to the principles of research through a practice-based product evaluation programme. Methods The programme consisted of an initial training and orientation day with presentations on evidence-based practice, research methods and the structure of research papers. The programme and its aims were explained in detail, and participants were briefed on the methods to be used. Participants then recruited seven to ten patients from their practices (offices), carried out a baseline assessment of: plaque, gingival health, calculus and staining at anterior teeth, and gave the patients a questionnaire asking about their teeth and then provided a 3-month supply of a test toothpaste. About 10 weeks later, a follow-up assessment of the same variables was performed and the questionnaire was repeated. A second training day followed during which the DHs provided feedback of their experiences and received training in literature searching and critical appraisal of literature including interpretation of results. Results Sixty-five DHs attended the first training day; 31 were able to recruit sufficient patients and attend the second training day. The DHs recruited 168 patients who received baseline and follow-up assessments. All the variables improved overall. Feedback from the DHs was very positive, and patients expressed delight with the care they had received. Conclusions Qualitative feedback for participating DHs suggests the programme met its aim and could be used in the future as a mechanism for helping DHs who want to increase their understanding of research methodology. [ABSTRACT FROM AUTHOR]

Summary: Due to its speed, accuracy and cost‐effectiveness, microscopy has become an integral part of clinical examination for disease diagnosis. However, modern microscopes are very costly and require skilled personnel for their operation and maintenance, and specimen processing and analysis is labour‐intensive. Further, lack of such expensive diagnostic tools in remote areas is a serious concern. Affordable point‐of‐care diagnostic tools are the most useful for timely disease diagnosis and management. The Foldscope is an affordable origami‐based microscopy device composed of a series of paper clippings, which, upon assembly, can hold a specimen slide for observation, and this specimen can be viewed via a mobile phone camera attached to it. The present study evaluated the use of the Foldscope in the clinical diagnosis of oral and urinary tract infections and evaluated its efficacy as a motivational tool for improving oral health among school children in India. We qualitatively compared the Foldscope to a clinical microscope by examining five different types of clinical samples. Of the different types of clinical samples, the Foldscope was effective in detecting infection in dental plaque samples and urine samples. Thus, we further analysed 31 dental plaque samples of patients aged 3–13 years and 25 urine samples of patients aged 11–62 years. We also evaluated the use of the Foldscope as an educational tool for motivating oral hygiene among 80 school children aged 12 years and found that students in the Foldscope intervention group had better measures of oral hygiene than did students in the nonintervention group. In summary, our study indicated that the Foldscope is useful in detecting urinary tract infections and kidney stones in urine samples and is a useful motivational tool for oral health education among school‐aged children. Furthermore, it may also be useful in oral health monitoring in resource poor settings. Lay Description: Poor and remote population often suffers due to lack of capacity to buy products or avail services which are expensive. In such a society people are not able to afford even the basic detection of diseases. Foldscope may come to rescue here! Foldscope is a paper‐based, use‐and‐throw, affordable microscope. This study explores the use of Foldscope in clinics and diseases diagnosis using patient samples. Preliminary detection of disease associated symptoms in dental and urinary infections and digital record keeping via storage in mobile phone memory and hospital OPD records for monitoring patient's health are some of the advantages of Foldscope for clinical use in resource poor settings. It identifies that Foldscope not only can be used by students or teachers for educational purposes but it can also pave a path for promotion of dental hygiene among young children. The study also suggests that further improvement in design or resolution of Foldscope will broaden the scope of its application, in future. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this systematic review was to establish the adjuvant clinical effect of brushing with a dentifrice containing purported active ingredients as compared to a regular sodium fluoride dentifrice with respect to the inhibition of overnight dental plaque regrowth from studies with human participants. Methods: MEDLINE‐PubMed, EMBASE and Cochrane CENTRAL were searched, up to June 2019. The inclusion criteria were controlled clinical trials with participants aged ≥ 18 years in good general health. Studies were included that evaluated the effect of toothbrushing with a dentifrice on the inhibition of overnight dental plaque regrowth when an active ingredient was added to the dentifrice as compared to a common sodium fluoride product. Data were extracted from the eligible studies, the risk of bias was assessed, and a meta‐analysis was performed where feasible. Result: Independent screening of 213 unique papers resulted in 10 eligible publications that provided 14 comparisons. Stannous fluoride and triclosan dentifrices were found as the active ingredients. The descriptive analysis indicated that all, but two comparisons demonstrated an additional effect on the active‐ingredient dentifrice. The meta‐analysis supported and strengthened these findings. It showed that when plaque was scored digitally, a DiffM was −3.15(95% CI [−4.61:‐1.69], P <.001, prediction interval [−5.07;‐1.24]). When plaque was scored clinically, the difference of means (DiffM) was −0.33(95% CI [−0.49:‐0.16], P <.001, prediction interval [−0.87; 0.21]). Conclusion: The results of this review demonstrate moderate‐quality evidence that brushing with an active‐ingredient dentifrice with stannous fluoride or triclosan does provide an added clinically relevant effect concerning plaque inhibition capabilities that surpass the effect of a regular sodium fluoride dentifrice. [ABSTRACT FROM AUTHOR]

The pathogenesis of hereditary gingival fibromatosis (HGF) is largely unknown; however, the removal of excess tissue may often be necessary as it often causes aesthetic and functional problems. Gingivectomy is usually a treatment option that can be performed using a scalpel, cryotherapy, electrosurgery, or laser. This paper aims to evaluate the results of HGF treatments using a diode laser of five people from the same family. Three members of a family of five (two females and three males; 9–36 years old) underwent gingivectomy with a 3 W 300‐micron fiber‐tipped diode laser (Doctor Smile, Vicenza, Italy) at 810 nm wavelength. While all teeth of one member were extracted, the other member refused treatment. Relapse occurred in three members due to poor oral hygiene. The diode laser was reapplied and oral hygiene instructions were repeated. Patients were followed during the postoperative period for up to two years. HGF is a rare condition that clinicians should pay attention to in the diagnosis, treatment, and follow‐ups. Since recurrences are due to dental plaque, oral hygiene instructions are essential and compliance is mandatory. Although there are many treatment approaches, the diode laser is the most indicated method due to many advantages such as providing a bloodless and more sterile operation field, performing an atraumatic surgery, ensuring earlier and ideal recovery, and minimizing postoperative pain. [ABSTRACT FROM AUTHOR]

Objectives: To review the effectiveness of antiseptic oral sprays on oral health. Methods and materials: Three electronic databases (PubMed, Cochrane Library and Web of Science) were systematically searched to identify relevant studies. Only randomized controlled trials (RCTs) comparing the effect of oral sprays to placebo/control spray or mouthrinse on dental plaque and gingival inflammation were included. Results: Among a total of 996 papers, 20 effective studies fulfilled the selection criteria, and 8 studies were suitable for inclusion in meta‐analyses. A meta‐analysis of three studies using a 0.2% chlorhexidine (CHX) spray intervention, without prophylaxis at baseline, showed reductions in Plaque Index (PI) (Silness and Löe) and Gingival Index (GI) (Silness and Löe) scores of 0.74 (95% CI: −1.03 to −0.45) and 0.22 (95% CI: −0.38 to −0.06), respectively. Five studies provided a prophylaxis for subjects before study initiation. Three of these five studies used 0.2% CHX spray. A meta‐analysis demonstrated an increase of 0.18 (95% CI: −0.01 to 0.37) in PI (Silness and Löe) scores. Two RCTs compared 0.12% and 0.2% CHX spray, and a meta‐analysis showed increases of 1.71 (95% CI: 1.27 to 2.14) and 1.58 (95% CI: 1.23 to 1.93), respectively, in PI (Quigley and Hein) scores. Of the RCTs not amenable to meta‐analysis, eight studies reported significant improvements in PI and GI scores. Conclusions: Available evidence suggests that oral sprays are an acceptable delivery method for antiseptic agents. Further high‐quality studies are warranted to determine the effectiveness of alternative chemotherapeutic agents delivered via oral sprays on oral health. [ABSTRACT FROM AUTHOR]

Objective: This review searched for a relationship between susceptibility to periodontitis and peri-implantitis, with implant outcome as the primary outcome variable and supportive periodontal therapy (SPT) and implant surface roughness as confounding factors. Material and Methods: It is based on a MEDLINE search up to June 2006. Only 16 fulfilled the selection criteria. The heterogeneity of the studies (e.g. periodontal status, SPT, prosthetic design, ...) rendered a meta-analysis impossible. The impact of a history of periodontitis on early implant loss was negligible. Only five papers reported sub-data for patients with different degrees of periodontitis. Four out of five papers indicate a higher incidence of late implant loss and/or marginal bone loss in patients with a history of periodontitis. This difference was most obvious for very rough implants (three papers), and/or when SPT was not organized (one paper). Other confounding factors were often neglected. Another 10 papers only reported the outcome of implants in patients with a history of periodontitis. In case of SPT and when avoiding roughened surfaces, late implant loss remained below 3%, and marginal bone loss remained low. Conclusions: These results seem to indicate that periodontally compromised patients can be successfully treated with minimally/moderately rough implants, in the presence of SPT. [ABSTRACT FROM AUTHOR]

Abstract Aim: A study was undertaken to examine cytokine markers in gingival crevicular fluid (GCF) during the early stages of plaque accumulation. Methods: A panel of five subjects with good oral hygiene went without brushing for 1 or 3 days, after which GCF samples were taken by placing paper strips into the gingival margins of the maxillary premolars and first molar for 30 s. GCF flow rates were determined with a Periotron® instrument (Oraflow, Inc., Plainview, New York), and neutrophils (polymorphonuclear leukocytes) were determined as myeloperoxidase activity. Interleukin-1b (IL-1b) and IL-8 were eluted from the paper strips and assayed with enzyme-linked immunosorbent assay (ELISA) systems. Results: The plaque index rose to 2.7 ± 0.2 (mean ± SE) after 3 days without brushing, and the GCF flow rate increased to 146.8% of baseline. PMN and IL-8 concentrations fell but, when corrected for dilution as a result of increased GCF flow, were not statistically different from baseline. IL-1b was slightly elevated after 1 day, and increased to 223.8 ± 54.3% (from 6.8 ± 1.7 to 13.8 ± 3.6 pg/30 s; p = 0.04) after 3 days of plaque accumulation. Resumption of tooth brushing led to a return of IL-1b to baseline (109.1% after 2 days of brushing). When subjects rinsed with 0.12% chlorhexidine during the 3-day no-brushing period, the increases in plaque index, GCF flow rates and IL-1b release rates did not occur. Conclusions: The results indicate that IL-1b release rates increase in the GCF after 3 days of plaque accumulation, before any clinical signs of inflammation appear. [ABSTRACT FROM AUTHOR]

Focused question Based on evidence as presented in systematic reviews what is the efficacy and safety of available homecare toothbrush regimens for mechanical plaque removal on plaque and gingivitis in adults? Material & Methods Three Internet sources were used (up to and including August 2014) to search for appropriate papers that satisfied the study purpose. Plaque scores and gingivitis scores were considered to be the primary parameter of interest. Safety was considered an important facet in relation to efficacy. Data and conclusions as presented in the selected papers were extracted. The potential risk of bias was estimated and the emerging evidence was graded. Results Independent screening of 176 unique reviews resulted in 10 published and eligible systematic reviews. They were categorized into one review evaluating the effect of an oral hygiene instruction with a toothbrush on plaque and gingivitis scores, five evaluating the efficacy of manual and power toothbrushes and three reviews evaluating toothbrush safety and one evaluating toothbrush contamination. Conclusion Tooth brushing is effective in reducing levels of dental plaque. With respect to gingivitis power toothbrushes have a benefit over manual toothbrushes. The greatest body of evidence was available for oscillating-rotating brushes. Tooth brushing generally can be considered safe for the teeth and their investing tissues. [ABSTRACT FROM AUTHOR]

Focused question What is the effect of mechanical inter-dental plaque removal in addition to toothbrushing, on managing gingivitis using various formats of inter-dental self-care in adults based on evidence gathered from existing systematic reviews? Material & Methods Three Internet sources were searched by a strategy designed to include systematic reviews on inter-dental cleaning devices. Plaque and gingivitis scores were the primary parameters of interest. Characteristics of selected papers were extracted. The potential risk of bias was estimated and the acquired evidence was graded. Results Screening of 395 papers resulted in six systematic reviews. Two papers evaluated the efficacy of dental floss, two of inter-dental brushes ( IDB), one of woodsticks and one of the oral irrigator. Weak evidence of unclear or small magnitude was retrieved that supported dental floss, woodsticks and the oral irrigator to reduce gingivitis in addition to toothbrushing. No concomitant evidence for an effect on plaque emerged. There is moderate evidence that IDBs in combination with toothbrushing reduce both plaque and gingivitis. Conclusion Evidence suggests that inter-dental cleaning with IDBs is the most effective method for inter-dental plaque removal. The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal. All investigated devices for inter-dental self-care seem to support the management of gingivitis, however, to a varying extend. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this systematic review was to establish the effectiveness of brushing with a triple‐headed manual toothbrush compared to a single‐headed manual toothbrush on plaque removal. Materials and methods: The MEDLINE‐PubMed and Cochrane‐CENTRAL databases were searched. The inclusion criteria were clinical trials conducted with humans without fixed orthodontic appliances who were not dental care professionals. Papers that evaluated the effect of toothbrushing with a triple‐headed manual toothbrush compared to a single‐headed manual toothbrush on plaque removal were included. Data were extracted from the eligible studies, and a descriptive analysis was performed. Result: The search retrieved 15 eligible publications including 18 relevant comparisons. Heterogeneity was most obvious with respect to the person who performed the brushing, either the participants themselves or a caregiver responsible for daily oral hygiene. Additionally, participant characteristics such as age and individual disabilities varied. A lack of appropriate data and a variation in the indices used allowed only a descriptive analysis. Of the 14 comparisons with self‐performed brushing by the participants, the majority showed no difference between triple‐headed and single‐headed toothbrushes, with a few favouring the triple‐headed. In the comparisons in which a caregiver performed the brushing, three of the four showed that the triple‐headed toothbrush performed significantly better on the reduction in plaque scores. Conclusion: From this review emerges the recommendation that the use of a triple‐headed manual toothbrush instead of a single‐headed manual toothbrush might be favorable with respect to plaque removal in case a care‐dependent individual is brushed by a caregiver. [ABSTRACT FROM AUTHOR]

To evaluate the effect of herbal mouthrinses as an adjuvant to oral hygiene on dental plaque and gingival inflammation in subjects with gingivitis. Searches were conducted in the PubMed/MEDLINE, Cochrane—CENTRAL, EMBASE, Web of Science, LILACS/BIREME, Clinical Trials Registry and grey literature for Randomised Clinical Trials (RCTs) published up to April 2018 without language restrictions. From 4,013 paper found, 20 studies met the eligibility criteria and were included. The herbal mouthrinses achieved significant reductions in dental plaque and gingival inflammation compared to placebo rinses. Five herbal products (Camelia sinensis, Azadirachta indica, Anacardium occidentale Linn, Schinus terebinthifolius and Curcuma longa) showed better results than chlorhexidine in dental plaque and gingival inflammation reductions. However, the unclear risk of bias of most included RCTs precludes definitive conclusions. Therefore, it is necessary to improve the design of future RCT in other reduced potential bias that may affect the degree of precision of treatment outcomes in order to evaluate the effect size and clinical relevance of herbal mouthrinses. [ABSTRACT FROM AUTHOR]

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Objective The purpose of this review was to systematically evaluate the effects of an alcohol vehicle solution ( V- Sol) compared with an essential-oils mouthwash ( EOMW) and if available with a water-based control ( WC) on plaque, gingival inflammation parameters and extrinsic tooth staining. Materials and Methods The Pub Med- MEDLINE, Cochrane- CENTRAL and EMBASE databases were searched. Where appropriate, a meta-analysis was performed, and difference of means ( DIFFM) as calculated. Results In total, 971 unique papers were found of which five met the eligibility criteria. The DIFFM of the meta-analysis of four 6-month studies showed that the EOMW provided significantly better plaque control ( DIFFM = 0.39, P < 0.00001) and gingival inflammation reduction as measured by the Löe and Silness Index ( DIFFM = 0.36, P = 0.00001) as compared to the V- Sol. Regarding extrinsic tooth staining, a small but significant difference ( DIFFM = −0.08, P = 0.03) was observed. Conclusion Limited data, but with a low risk of bias, were available to assess the potential benefit of the alcohol-containing V- Sol. 'High'- and 'moderate'-quality data were available for the analysis of plaque and gingivitis, respectively. Within these limitations, EOMW appears to provide a significant oral health benefit during the 6 months of use. The data retrieved for this review suggest that the essential oils produce an effect on plaque and gingivitis that extends beyond the V- Sol. Furthermore, the V- Sol proved to be no different from a WC. [ABSTRACT FROM AUTHOR]

Peri-implant diseases are prevalent with a weighted mean prevalence rate of 43% across Europe and 22% across South and North America. Although the main etiologic agent is bacterial biofilm, a myriad of factors influence the initiation and progression of the disease. Unfortunately, the treatment of peri-implant diseases is at best favorable in the short term with a high rate of persistent inflammation and recurrence. Therefore, it is sensible to consider and control all potential factors that may predispose an implant to peri-implant tissue inflammation in an attempt to avoid the disease. This paper reviews recent evidence on factors that may predispose implants to peri-implantitis and measures that can be taken to prevent it. [ABSTRACT FROM AUTHOR]

Aim: The aim of this network meta-analysis (NMA) was to compare the efficacy of different oral hygiene products for chemical biofilm control, in 6-month home-use, randomized clinical trials (RCTs), in terms of changes in gingival index (GI)., Material and Methods: Six-month RCTs assessing GI were identified and screened for inclusion. Relevant information was extracted, and quality and potential risk of bias were estimated. Mean differences between baseline and end were calculated to obtain standardized mean differences (SMDs). NMA protocols were applied to assess direct and indirect comparisons among products using Löe & Silness GI, modified GI and gingival severity index., Results: Fifty-three papers were included, 19 studies for mouth rinses, 32 for dentifrices, comprising data from 5,775 and 2,682 subjects, respectively. When ranking treatments, similar results were observed for all tested dentifrices, with the lowest effect observed for sanguinarine and baking soda. For mouth rinses, essential oils, triclosan-copolymer, chlorhexidine (at concentrations ≥ 0.10%) and cetylpyridinium chloride (>0.05%) demonstrated the greatest effect., Conclusion: Although NMA revealed significant differences when comparing placebo versus some active agents, when comparing among active agents, no differences were found for dentifrices, while mouth rinses containing essential oils showed the greatest effect on GI scores., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To determine the efficacy of manual tooth brushing with respect to toothbrush design and brushing duration. Material and Methods: The PubMed--MEDLINE and Cochrane CENTRAL were searched through October 2010 to identify appropriate studies. The outcome measurement was dental plaque removal following subject brushing. Results: The search yielded 2119 titles and abstracts. Ultimately, 59 papers with 212 brushing exercises as separate legs of the experiments and meeting the eligibility criteria were selected. Overall, a brushing exercise provides a 42% (21) plaque score reduction (95% CI: 41.23; 42.03). Of the brushing studies providing data as assessed according to the Quigley and Hein plaque index, the weighted mean reduction from baseline in plaque scores was 30% (95% CI: 26.79; 33.21). A weighted mean plaque score reduction of 53% (95% CI: 49.51; 56.49) was observed in the experiments using the Navy plaque index. Subanalysis between the different bristle tuft configurations illustrated variation in plaque removal ability (24-61%). The angled bristle design numerically showed the highest mean plaque reduction with either index. A subanalysis of brushing duration revealed after 1 min, a mean reduction of 27% and after 2 min, 41%. Conclusion: The efficacy in plaque removal following a brushing exercise is a reduction from baseline plaque scores of 42% on average, with a variation of 30-53% dependent on the plaque index used. The available evidence indicates that bristle tuft arrangement (flat trim, multilevel, angled) and brushing duration are factors that contribute to the variation in observed efficacy. [ABSTRACT FROM AUTHOR]

Background: Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation after endotracheal intubation. The role of chlorhexidine and tooth-brushing has been considered as a clinical intervention to reduce infection rates, however, evidence to inform this needs appraising. Aim: This paper presents a critical review on the effect of chlorhexidine gluconate (CHX) and tooth-brushing in decreasing rates of VAP in mechanically ventilated adult patients cared for in intensive care settings. Methods: A literature search was conducted using a number of bibliographic databases ( n = 6). A number of parameters were used to exclude irrelevant papers. A total n = 17 papers were located and accessed, which were directly related to the field. Eight studies that met the criteria and addressed the study aims were reviewed. Findings: CHX was successful in reducing the rate of VAP and using a combination of CHX and colistine resulted in better oropharyngeal decontamination which reduced and delayed VAP. Chlorhexidine was also effective in reducing dental plaque in patients cared for in intensive care and had the potential to reduce nosocomial infections. Results of studies investigating the use of tooth-brushing in reducing VAP incidence proved inconsistent, although all recommend tooth-brushing as important in maintaining good oral hygiene. Conclusions: The use of chlorhexidine has been proven to be of some value in reducing VAP, although may be more effective when used with a solution which targets gram-negative bacteria. Tooth-brushing is recommended in providing a higher standard of oral care to mechanically ventilated patients and reducing VAP when used with chlorhexidine. However, limitations in study design and inconsistency in results suggest that further research is required into the effects of tooth-brushing. [ABSTRACT FROM AUTHOR]

Objective: To review the literature concerning hexetidinecontaining mouthwash as a monotherapy or as an adjunct to oral hygiene in the prevention of plaque accumulation and gingival inflammation. Materials and methods: PubMed-MEDLINE and the Cochrane-CENTRAL were searched through January 2010 to identify appropriate studies. The primary outcome measurements were plaque accumulation and gingivitis parameters. Results: Independent screening of titles and abstracts of 168 papers resulted in six publications that met the eligibility criteria. Mean values and standard deviations were obtained by data extraction. Descriptive comparisons are presented for hexetidine mouthwash and control mouthwashes (chlorhexidine and placebo). Conclusions: Considering the potential benefits in the light of the observed side effects, hexetidine appears to be a poor alternative to chlorhexidine. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this paper is to present Gingival Index (GI) and Plaque Scores (PS) of older and disabled adults living in low-income senior housing and their association with sociodemographic, health status and oral health behaviours.Methods: Participants were recruited from six low-income senior housing residences in Connecticut. Primary outcome measures were Gingival Index (GI) and Plaque Scores (PS). Surveys assessed sociodemographic characteristic, beliefs and behaviours. Logistic regression analysis was used to model the binary outcomes of probability of unfavourable GI status (>=0.34) and unfavourable PS (>=74%) against variables including demographic characteristics, oral hygiene behaviours and health status.Results: 331 participants volunteered for the study. Mean baseline GI was 0.38 (SD: 0.3), and mean PS was 71.7% (SD: 18%). Logistic regression showed that males were more likely to have higher GI and plaque scores than females. Those with less formal education were more likely to have worse GI scores and high PS compared to those with college educations. Those with lower incomes and those who rated their oral health poor/fair were more likely to have higher PS.Conclusion: Participants had remarkably good gingival health regardless of relatively high PS. Males and less educated individuals should receive special attention when implementing oral hygiene interventions because of their relatively poor oral hygiene status. [ABSTRACT FROM AUTHOR]

Aim: To evaluate oral environmental changes in cannabis users. Material and Methods: The MEDLINE and Cochrane Central register of controlled trails (CENTRAL) were searched up to April 2007 to identify appropriate studies. Results: Independent screening of 982 titles and abstracts (MEDLINE-Pubmed) and (Cochrane) papers resulted in seven eligible publications. Conclusion: Based on the limited data, it seems justified to conclude that with increasing prevalence of cannabis use, oral health care providers should be aware of cannabis-associated oral side effects, such as xerostemia, leukoedema and an increased prevalence and density of Candida albicans. [ABSTRACT FROM AUTHOR]

Objective: To review the literature on whether a hand-held triangular woodstick, as compared with no adjunct or other interdental cleaning device in addition to daily toothbrushing, can improve clinical parameters of gingival inflammation. Material and Methods: MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched through February 2008 to identify appropriate studies. Plaque and gingivitis were selected as outcome variables. Results: Independent screening of the titles and abstracts of 181 MEDLINE and 65 CENTRAL papers yielded seven publications with eight clinical experiments that met the eligibility criteria. The improvement in gingival health, as observed in seven studies, represents a significant incremental benefit realized by the use of triangular woodsticks. None of the studies that scored plaque demonstrated any significant advantage to the use of woodsticks, as opposed to alternative methods, in gingivitis patients. Conclusion: Evidence from controlled trials, most of which were also randomized, shows that woodsticks do not have an additional effect on visible interdental plaque or gingival index, but do, however, provide an improvement in interdental gingival inflammation by reducing the bleeding tendency. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to asses the effect of the use of interdental brushes (IDB) in patients as an adjunct to toothbrushing compared with toothbrushing alone or other interdental oral hygiene devices on plaque and the clinical parameters of periodontal inflammation. Material and methods: MEDLINE–PubMed and the Cochrane Central register of controlled trials (CENTRAL) were searched through November 2007 to identify appropriate studies. Clinical parameters of periodontal inflammation such as plaque, gingivitis, bleeding and pockets were selected as outcome variables. Results: Independent screening of the titles and abstracts of 218 MEDLINE–PubMed and 116 Cochrane papers resulted in nine publications that met the eligibility criteria. Mean values and standard deviations were collected by data extraction. Descriptive comparisons are presented for brushing alone or brushing and woodsticks; meta-analyses were also performed for the floss comparison. Conclusion: As an adjunct to brushing, the IDB removes more dental plaque than brushing alone. Studies showed a positive significant difference using IDB with respect to the plaque scores, bleeding scores and probing pocket depth. The majority of the studies presented a positive significant difference in the plaque index when using the IDB compared with floss. [ABSTRACT FROM AUTHOR]

Objective: To compare the subgingival microbiota of aggressive and chronic periodontitis (ChP) using single-site and pooled plaque samples. Methods: In 60 patients with aggressive or ChP, subgingival plaque was sampled from the four deepest pockets using two sterile paper points simultaneously. One paper point from each pocket was put in a separate transport vial, the second was pooled with the three other paper points of a respective patient. The content of each vial was analysed for Aggregatibacter actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, and Treponema denticola. Results: Pooled plaque samples detected higher numbers for all tested pathogens than single-site samples. Detection frequencies were similar for both strategies. Using single-site samples, A. actinomycetemcomitans detection rate was statistically significantly a higher in aggressive than in ChP ( p=0.01). A. actinomycetemcomitans was found in higher numbers, the other pathogens in lower numbers in aggressive than in ChP. Neither presence nor absence of one of the tested bacteria had sufficient positive or negative predictive value for aggressive periodontitis. Conclusion: A. actinomycetemcomitans was detected in higher numbers and frequency in aggressive than in ChP. Its detection may confirm the clinical diagnosis and influence therapy. As a diagnostic test, its sensitivity and predictive value was low. [ABSTRACT FROM AUTHOR]

Objectives: Self‐performed oral hygiene is essential for preventing dental caries, periodontal, and peri‐implant diseases. Oral irrigators are adjunctive oral home care aids that may benefit oral health. However, the effects of oral irrigation on oral health, its role in oral home care, and its mechanism of action are not fully understood. A comprehensive search of the literature revealed no existing broad scoping reviews on oral irrigators. Therefore, this study aimed to provide a comprehensive systematic review of the literature on oral irrigation devices and identify evidence gaps. Methods: The Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews guidelines were utilized to prepare the review. Four databases and eight gray literature sources were searched for English publications across any geographical location or setting. Results: Two hundred and seventy‐five sources were included, predominantly from scientific journals and academic settings. Most studies originated from North America. Research primarily involved adults, with limited studies in children and adolescents. Oral irrigation was safe and well‐accepted when used appropriately. It reduced periodontal inflammation, potentially by modulating the oral microbiota, but further research needs to clarify its mechanism of action. Promising results were reported in populations with dental implants and special needs. Patient acceptance appeared high, but standardized patient‐reported outcome measures were rarely used. Anti‐inflammatory benefits occurred consistently across populations and irrigant solutions. Plaque reduction findings were mixed, potentially reflecting differences in study designs and devices. Conclusions: Oral irrigators reduce periodontal inflammation, but their impact on plaque removal remains unclear. Well‐designed, sufficiently powered trials of appropriate duration need to assess the clinical, microbiological, and inflammatory responses of the periodontium to oral irrigation, particularly those with periodontitis, dental implants, and special needs. Patient‐reported outcome measures, costs, caries prevention, and environmental impact of oral irrigation need to be compared to other oral hygiene aids. [ABSTRACT FROM AUTHOR]

Objectives: This narrative review was prepared for the 2017 World Workshop of the American Academy of Periodontology and European Federation of Periodontology to address key questions related to the clinical condition of peri-implant mucositis, including: 1) the definition of peri-implant mucositis, 2) conversion of peri-implant health to the biofilm-induced peri-implant mucositis lesion, 3) reversibility of peri-implant mucositis, 4) the long-standing peri-implant mucositis lesion, 5) similarities and differences between peri-implant mucositis at implants and gingivitis at teeth, and 6) risk indicators/factors for peri-implant mucositis., Methods: A literature search of MEDLINE (PubMed) and The Cochrane Library up to and including July 31, 2016, was carried out using the search strategy (peri-implant[All Fields] AND ("mucositis"[MeSH Terms] OR "mucositis"[All Fields])) OR (periimplant[All Fields] AND mucosits[All Fields]). Prospective, retrospective, and cross-sectional studies and review papers that focused on risk factors/indicators for peri-implant mucositis as well as experimental peri-implant mucositis studies in animals and humans were included., Findings: Peri-implant mucositis is an inflammatory lesion of the soft tissues surrounding an endosseous implant in the absence of loss of supporting bone or continuing marginal bone loss. A cause-and-effect relationship between experimental accumulation of bacterial biofilms around titanium dental implants and the development of an inflammatory response has been demonstrated. The experimental peri-implant mucositis lesion is characterized by an inflammatory cell infiltrate present within the connective tissue lateral to the barrier epithelium. In long-standing peri-implant mucositis, the inflammatory cell infiltrate is larger in size than in the early (3-week) experimental peri-implant mucositis lesion. Biofilm-induced peri-implant mucositis is reversible at the host biomarker level once biofilm control is reinstituted. Reversal of the clinical signs of inflammation may take longer than 3 weeks. Factors identified as risk indicators for peri-implant mucositis include biofilm accumulation, smoking, and radiation. Further evidence is required for potential risk factors, including diabetes, lack of keratinized mucosa, and presence of excess luting cement., Conclusions: Peri-implant mucositis is caused by biofilm accumulation which disrupts the host-microbe homeostasis at the implant-mucosa interface, resulting in an inflammatory lesion. Peri-implant mucositis is a reversible condition at the host biomarker level. Therefore, the clinical implication is that optimal biofilm removal is a prerequisite for the prevention and management of peri-implant mucositis. An understanding of peri-implant mucositis is important because it is considered a precursor for peri-implantitis., (© 2018 American Academy of Periodontology and European Federation of Periodontology.)

Objective: To test the efficacy of a dentifrice containing baking soda (BS), compared with dentifrice without BS for controlling plaque and gingivitis. Materials and methods: MEDLINE‐PubMed and Cochrane‐CENTRAL were searched. The inclusion criteria were randomized controlled clinical trials including healthy participants aged 18 years or older. Studies were selected that compared the effect of toothbrushing with a dentifrice with and without BS on the clinical parameters of plaque and gingivitis. Data were extracted from the selected studies, and a meta‐analysis was performed. Results: The search retrieved 21 eligible publications. Among these papers, 43 comparisons were provided, with 23 involving a single‐use design and 20 being evaluations with a follow‐up. Negative controls were found, or positive controls for which various active ingredients had been used. The included studies showed a moderate overall potential risk of bias and considerable heterogeneity. The meta‐analysis of plaque scores from the single‐brushing experiments showed that BS dentifrice (BS‐DF) was associated with significantly better outcomes than the negative control dentifrices (DiffM −0.20; P < 0.0001; 95% CI: [−0.27; −0.12]) or the positive control dentifrices (DiffM −0.18; P < 0.0001; 95% CI: [−0.24; −0.12]). This finding was only confirmed in studies that used a follow‐up design as compared to a negative control (DiffM −0.19; P = 0.01; 95% CI: [−0.34; −0.04]). The indices of gingival bleeding also improved when the comparison was a negative control (DiffM −0.08; P = 0.02; 95% CI: [−0.16; −0.01] and (DiffM −0.13; P < 0.001; 95% CI: [−0.18; −0.08]. However, for the gingival index scores, the meta‐analysis did not reveal any significant differences. Conclusion: BS‐DF showed promising results with respect to plaque removal in single‐use studies. However, the finding was partially substantiated in follow‐up studies. Studies that assessed bleeding scores indicated that a small reduction can be expected from BS, relative to a control product. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this systematic review was to establish in studies with human participants the effect of a regular fluoride dentifrice compared to water or saline on dental plaque inhibition. Methods: MEDLINE‐PubMed, Cochrane‐CENTRAL, EMBASE and other electronic databases were searched, up to April 2018. The inclusion criteria were controlled clinical trials among participants aged ≥18 years with good general health. Papers that evaluated the effect of dentifrice slurry compared with water or saline on plaque regrowth during a 4‐day nonbrushing period were included. Data were extracted from the eligible studies, the risk of bias was assessed, and a meta‐analysis was performed where feasible. Result: The search retrieved eight eligible publications including 25 comparisons. The estimated potential risk of bias was low for all studies. Based on three different indices, overall plaque regrowth was significantly (P < 0.01) inhibited for 0.25 or more by the use of a dentifrice slurry as compared to water. All subanalysis on specific dentifrice ingredients and the overall descriptive analysis supported these findings. Conclusion: The results of this review demonstrate moderate‐quality evidence for a weak inhibitory effect on plaque regrowth in favour of the use of a dentifrice intended for daily use. [ABSTRACT FROM AUTHOR]

Aim The aim of this systematic review was to evaluate the efficacy of anti-plaque chemical formulations for managing gingivitis, in 6-month, home-use, randomised clinical trials ( RCTs). Material and Methods A protocol was designed, including inclusion and exclusion criteria to identify RCTs assessing gingival and/or bleeding indices. Electronic and hand-searches identified relevant papers, which were screened and evaluated for inclusion. Full-papers were retrieved and relevant information was extracted (also plaque indices), including quality and risk of bias. Mean treatment effects were calculated to obtain weighted mean differences ( WMD) and 95% confidence intervals. Results After the process of screening and selection, 87 articles with 133 comparisons, were included in the review. The additional effects of the tested products were statistically significant in terms of Löe & Silness gingival index (46 comparisons, WMD −0.217), modified gingival index ( n = 23, −0.415), gingivitis severity index ( n = 26, −14.939%) or bleeding index ( n = 23, −7.626%), with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies, WMD −0.475), Silness & Löe ( n = 26, −0.109), and plaque severity ( n = 12, −23.4%) indices, with significant heterogeneity. Conclusion Within the limitations of the present study, formulations with specific agents for chemical plaque control provide statistically significant improvements in terms of gingival, bleeding and plaque indices. [ABSTRACT FROM AUTHOR]

Objective To systematically review the literature to compare the efficacy of triclosan ( Tcs) and stannous fluoride ( Sn F) dentifrices on parameters of gingivitis and plaque scores. Materials and Methods Medline, EMBASE and Cochrane Central Register of Controlled Trials were searched up to March 2013 to identify appropriate studies. Studies regarding self-performed manual brushing by adults with a minimum 4 weeks of follow-up were included. Primary outcomes were parameters of gingivitis. Secondary outcome was plaque score. Results Of 55 publications, 11 met the eligibility criteria. Additionally, four unpublished papers were added after contacting the manufacturers of the leading brands. In total, 15 studies [10 medium term and five long term (>6 months)] were processed for data analysis. There was no difference in gingival index (or its modification) between the two types of dentifrice [DiffM-0.04, 95% confidence interval CI (−0.11; 0.04); P = 0.34]. The change in the average gingival bleeding score was significantly in favour of Sn F [DiffM0.02, 95% CI (0.01; 0.02); P < 0.00001]. Plaque scores demonstrated a statistical significant difference in favour of Tcs, according to Quigley-Hein Plaque Index ( Q& H PI; DiffM-0.29, 95% CI [−0.45; −0.13]; P = 0.0004), but there was no difference according to Rustogi Modified Navy Plaque Index ( RMNPI) [DiffM-0.09, 95% CI (−0.01; 0.18); P = 0.07]. Long-term results supported these findings. Conclusions In the context of inconclusive results for the primary outcome variable of gingival health, it can be concluded that there was a minor and most likely clinically insignificant difference between Tcs- and Sn F-containing dentifrices. Meta-analysis of plaque score reduction was also inconclusive; whereas Tcs was more effective when assessed by the Q& H PI, it was not when scored with the RMNPI. [ABSTRACT FROM AUTHOR]

Today, dental caries is regarded as a preventable non‐communicable disease (NCD) that affects a majority of the population across their lifespan. As such, it shares a number of behavioural, socio‐economic, and lifestyle factors with other NCDs, such as overweight and diabetes, and should be subjected to a similar model of chronic disease management. Caries prevention has traditionally relied on fluoride exposure, diet control, thorough oral hygiene, and antibacterial measures. Prevention of caries as an NCD does certainly not disqualify these methods, but brings them into a new context. This conference paper provides a brief review on how common preventive measures can interfere with the drivers of dysbiosis and promote the growth of health‐associated clusters in the oral microbiome. Besides the established routines of regular toothbrushing with fluoride products, there is an opportunity for additional technologies, based on ecological principles, to address and modify the oral biofilm. Methods to reduce dietary sugar intake, slow down plaque metabolism, and support saliva functions should be further developed and investigated in terms of efficacy, compliance, and cost‐effectiveness. Furthermore, biofilm engineering through pre‐ and probiotics early in life to support microbial diversity seem promising in order to obtain a sustained caries‐preventive effect. [ABSTRACT FROM AUTHOR]