Search

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]

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]

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]

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]

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]

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]

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. [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]

Objectives: The purpose of this review was to describe systematically the effects of hydrogen peroxide mouthwashes as an adjunct to daily oral hygiene or as a mono-therapy in the prevention of plaque accumulation and gingival inflammation. Materials and methods: PubMed-MEDLINE and the Cochrane-CENTRAL were searched up to December 2009 to identify appropriate papers. The primary outcome measures included plaque accumulation and parameters of gingivitis. Results: Independent screening of titles and abstracts of 229 articles resulted in 10 publications that met the criteria for eligibility. Descriptive comparisons are presented for hydrogen peroxide mouthwash as compared with control mouthwashes or no oral hygiene. Mean values and standard deviations were obtained by data extraction. Based on a quality assessment, three studies, of which one evaluated H2O2 over a period of 6 months, were considered to represent a low risk of bias. This 6-month study showed a positive effect of the use of H2O2 on the modified gingival index. Conclusions: The results of the studies included in this review showed that H2O2 mouthwashes do not consistently prevent plaque accumulation when used as a short-term mono-therapy. When used as a long-term adjunct to daily oral hygiene, the results of one study indicate that oxygenating mouthwashes reduce gingival redness. [ABSTRACT FROM AUTHOR]

Aim To report the evidence on the effect of mechanical and/or chemical plaque control in the simultaneous management of gingivitis and caries. Material and Methods A protocol was designed to identify randomized ( RCTs) and controlled ( CCTs) clinical trials, cohort studies and prospective case series ( PCS), with at least 6 months of follow-up, reporting on plaque, gingivitis and caries. Relevant information was extracted from full papers, including quality and risk of bias. Meta-analyses were performed whenever possible. Results After the screening of 1,373 titles, 15 RCTs, 10 CCTs and 2 PCS were included. Low to moderate evidence support that combined professional and self-performed mechanical plaque control significantly reduces standardized plaque index [ n = 4; weighted mean difference ( WMD) = 1.294; 95% CI (0.445; 2.144); p = 0.003] and gingivitis scores [ n = 4; WMD = 1.728; 95% CI (0.631; 2.825); p = 0.002]. The addition of fluoride to mechanical plaque control is relevant for caries management [ n = 5; WMD = 1.159; 95% CI (0.145; 2.172); p = 0.025] while chlorhexidine rinses are relevant for gingivitis. Conclusion Mechanical plaque control procedures are effective in reducing plaque and gingivitis. The addition of fluoride to mechanical plaque control is significant for caries management. Chlorhexidine rinse has a positive effect on gingivitis and inconclusive role in caries. [ABSTRACT FROM AUTHOR]

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Aim Based on the existing scientific literature, the effect of chlorhexidine ( CHX) dentifrice/gel as compared to a regular or placebo dentifrice/gel is established in healthy adults on the primary outcome parameters of plaque and gingivitis scores. As secondary parameter, tooth surface discoloration was evaluated as a side effect. Materials and methods MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched up to July 2013 to identify eligible studies. Included were (randomized) controlled clinical trials, regarding self-performed brushing by adults without periodontitis with a minimum duration of 4 weeks. Results Independent screening of 389 unique titles and abstracts resulted in 16 comparisons. Of these, nine evaluated CHX dentifrice (0.4-1.0%) and 7 CHX gel (0.2-2.0%). It was not possible to perform a meta-analysis; therefore, a descriptive analysis was carried out. Regarding plaque score reduction, the majority of the experiments using a CHX dentifrice provided a significant positive effect. All studies assessing gingival bleeding as parameter for gingivitis observed a significant reduction in favour of CHX dentifrice over placebo dentifrice. Tooth surface discoloration was more pronounced with CHX dentifrice. The combined data concerning parameters of interest for CHX gel compared with a placebo did not show a trend towards a beneficial effect on plaque and bleeding scores. Conclusions Within the limitations of this analysis, it may be concluded that toothbrushing with a CHX gel does not provide conclusive evidence. Brushing with a CHX dentifrice can be effective with regard to the control of plaque and gingivitis. Tooth surface discoloration was observed as side effect, which potentially can have a negative impact on patients' compliance. [ABSTRACT FROM AUTHOR]

Berchier CE, Slot DE, Van der Weijden GA. The efficacy of 0.12% chlorhexidine mouthrinse compared with 0.2% on plaque accumulation and periodontal parameters: a systematic review. J Clin Periodontol 2010; 37: 829–839. doi: 10.1111/j.1600-051X.2010.01575.x. Objectives: The aim of this systematic review was to evaluate the effects of 0.12% chlorhexidine (CHX) mouthrinse compared with 0.2% on plaque and periodontal parameters. Materials and methods: MEDLINE-PubMed and the Cochrane Central Register of Controlled Trials were searched for (randomized) clinical trials and cohort studies. Plaque scores, parameters of periodontal inflammation and periodontal attachment loss were selected as primary outcome parameters. Results: Screening of 409 titles and abstracts identified eight eligible publications. A meta-analysis of seven studies using the same plaque index showed a significant difference between 0.2% and 0.12% CHX ( p=0.008). The Weighted Mean Difference for plaque based on the Quigley & Hein Plaque Index (1968) was 0.10 (95%CI [0.03–0.17]) (heterogeneity I2=0%, p=0.87). Three studies that compared 0.12% and 0.2% CHX mouthrinse products provided data on gingival inflammation. No difference in the effect of gingivitis between the two concentrations was found in these studies. No studies could be found that compared the two CHX concentrations and evaluated the probing pocket depth and/or the periodontal attachment level. Conclusions: In comparing 0.12% and 0.2% CHX, information concerning the effect on gingival inflammation was sparse and no studies could be found that compared the two CHX concentrations and evaluated the probing pocket depth and/or the periodontal attachment level. With respect to plaque inhibition, the results showed a small but significant difference in favour of the 0.2% CHX concentration. However, the clinical relevance of this difference is probably negligible. [ABSTRACT FROM AUTHOR]

The article discusses the treatment of dental plaque-induced gingivitis, chronic periodontitis and other conditions. The treatment of people suffering from chronic gingivitis is initially administered in order to reduce oral bacteria and associated calcified and noncalcified deposits. Using topical antibacterial drugs in order to lessen bacterial plaque may be advantageous for the prevention and treatment of gingivitis. Scaling and root planing mixed with personal plaque control is beneficial for treating chronic periodontitis.

Objective To systematically review and evaluate the available scientific evidence on the effectiveness of chlorhexidine dentifrice or gel (CHX DF/gel) compared to chlorhexidine mouthwash (CHX MW) on plaque, bleeding, gingival inflammation and tooth discoloration scores. Material and methods PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched to identify appropriate studies. Results Independent screening of the 2256 unique titles and abstracts resulted in five publications that met the eligibility criteria. Considerable heterogeneity was found between the studies. Three of the five studies showed a positive effect on plaque scores in favour of the CHX MW. With respect to gingival index and bleeding scores, no significant differences were found. Chlorhexidine mouthwash, however, showed a significantly more tooth discoloration than the CHX DF/gel. A meta-analysis of the effect on ' de novo' plaque formation of CHX DF/gel versus CHX MW resulted in a difference in means of 0.27 [95% CI: 0.14; 0.39] ( P < 0.0001). Conclusion Chlorhexidine gel can be successfully formulated and will inhibit plaque growth to some degree, but not to the same extent, as a CHX MW. When CHX DF/gel is used in a non-brushing model, it is significantly less effective in plaque inhibition compared to CHX MW. Based on one study when CHX gel was applied with a finger after brushing, it is significantly more effective on plaque scores and the gingival index. The only brushing study also with a long follow-up showed that there is no significant difference between CHX DF and CHX MW. However, as a corollary, significantly more tooth discoloration was observed with the CHX MW. Altogether, the data show that when daily oral hygiene cannot be performed, CHX MW is the first product of choice. [ABSTRACT FROM AUTHOR]

Objective This study aimed to systematically review the present literature to establish the clinical effect of medicated, sugar-free chewing gum on plaque indices and parameters of gingival inflammation. Materials and methods MEDLINE-PubMed, Cochrane CENTRAL and EMBASE databases were searched up to April 2012 to identify appropriate studies. Included studies used an intervention of medicated, sugar-free chewing gum containing antimicrobial agents or herbal extracts compared with a control gum. Plaque and gingivitis scores were selected as outcome variables. Results Independent screening of 594 unique titles and abstracts identified 10 non-brushing and four brushing studies that met the eligibility criteria. Means and standard deviations were extracted. A sufficient number of studies evaluated chlorhexidine gum to perform a meta-analysis. Although this review provides evidence for the comparative effectiveness of chewing gums containing various ingredients, the results must be weighed carefully against the methods that were used to assess their outcomes. Conclusion Most of the chewing gums with antimicrobial agents or herbal extracts were shown to have a positive effect with respect to plaque and gingivitis scores. The most compelling evidence was provided for chewing gum containing chlorhexidine. Meta-analysis and individual results indicate a beneficial effect of chlorhexidine on plaque inhibition. However, GRADE evidence profile shows that the recommendation to use CHX-gum to reduce plaque scores in the absence of brushing is considered to be 'weak'. Other ingredients with positive outcomes on plaque scores are eucalyptus, acacia, funoran, Pycnogenol and mastic. Limited data with respect to gingivitis scores were available, and the following agents showed a positive effect: magnolia, eucalyptus and CHX. [ABSTRACT FROM AUTHOR]

Objectives: To compare 3 mouthwashes: 0.20% chlorhexidine (CHX) with Anti‐Discoloration System (ADS), 0.20% CHX and 0.12% CHX with 0.05% cetylpyridinium chloride (CPC), in terms of reduction of plaque and gingival bleeding and side effects. Methods: Mild gingivitis patients were randomly divided into three Groups: they underwent professional oral hygiene and received instructions: oral rinse with 10 mL for 1', twice a day, 30' after tooth brushing, for 14 days. Primary outcomes were plaque and gingival bleeding, assessed with Plaque Control Record and Gingival Bleeding Index. Feedback questionnaire and spectrophotometer evaluated secondary outcomes: adverse events. Timing of the study was T0 (baseline), T1 (professional oral hygiene) and T2 (14th day after mouthwash use). Results: Sixty‐six patients were recruited, two patients dropped out, and 64 patients completed the study. PCR T1‐T2 mean variation was 30.67 (SD = 15.22; 95% CI 23.55 to 37.80; P = 0.000), 19.93 (SD = 11.03; 95% CI 14.90 to 24.95; P = 0.000) and 16.24 (SD = 15.35; 95% CI 9.60 to 22.88; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. GBI mean variation (T0‐T2) was −9.82 (SD = 9.27; 95% CI −5.48 to 14.16; P = 0.000), −19.31 (SD = 11.33; 95% CI −14.15 to −24.47; P = 0.000) and −21.13 (SD = 12.56; 95% CI −15.70 to −26.56; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. Statistical significance was found in lower efficacy of 0.2% CHX + ADS Group. Patients tolerated 0.12% CHX + CPC mouthwash better in bleeding perception (95.5%; P = 0.046), burning sensation (13.6%; P = 0.006), and mouthwash taste (100%; P = 0.000). Results on staining were no statistically significant (P = 0.106). Conclusions: Addition of CPC allows reduction of CHX percentage in mouthwash formulation while keeping equal efficacy and less side effects. ADS addition decreases CHX efficacy in reducing plaque and bleeding, while resulting more tolerated than CHX. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of this systematic review was to evaluate the effect of external tooth‐bleaching products on plaque indices and to compare it to a placebo or a negative control. Methods: A protocol was developed aimed to answer the next focused question: What is the effect of tooth bleaching compared to no treatment or a placebo, in subjects without periodontitis aged ≥18 years in the levels of plaque and gingivitis? Two electronic databases were used as sources in the search for studies satisfying the inclusion criteria: (a) The National Library of Medicine (MEDLINE via PubMed); (b) Cochrane Central Register of Controlled Trials. Results: Only randomized controlled trials were included. The initial search found 382 potential publications. Seven of them were finally included, and six were used in the meta‐analyses. The use of bleaching products showed higher reductions in plaque (n = 6; standardized mean difference [SMD] = 0.47; 95% confidence interval [CI] = 0.06, 0.88; P < 0.001) and gingivitis indices (n = 4; SMD = 0.47; 95% CI = 0.22, 0.73; P < 0.001), when compared to a control group (no treatment or placebo). Conclusions: External tooth bleaching is associated with statistically significant short‐term reductions in plaque and gingivitis indices. However, no data were available to evaluate long‐term effects. [ABSTRACT FROM AUTHOR]

Background: The anatomical and morphological alterations associated with cleft lip and palate (CLP) favour the buildup of dental plaque. Aim: To assess the efficacy of a new add‐on to regular toothbrush—the Cleft Toothbrush, in removing the dental plaque of CLP patients, compared to a regular toothbrush. Design: Forty‐five children with CLP were randomly organized into two groups: A (n = 26, 2‐6 years old) and B (n = 19, 7‐12 years old). They were evaluated at days 0, 15, 30, and 60. After brushing their teeth with a regular toothbrush or with the Cleft Toothbrush, the dental plaque was recorded using an adapted Plaque Index (aPI). Data analyses were performed in IBM SPSS(c), and all statistic inference comparisons were made using non‐parametric tests. Results: In the first 15 days, children used a new regular toothbrush and aPI‐C (teeth adjacent to the cleft) was recorded. The Cleft Toothbrush, used by all children from day 15 to day 30, showed high efficacy in removing dental plaque in the cleft area, evidenced by significantly lower aPI‐C values, compared to those observed with the regular toothbrush (P < 0.001). When given free option of brushing technique, from day 30 to day 60, most of the children (38 out of 45) chose the Cleft Toothbrush. Conclusions: The Cleft Toothbrush showed high efficacy in removing dental plaque in the cleft area, and presented high level of acceptance by parents and children, compared to a regular toothbrush. This is expected to improve the health status of the local adjacent tissues, a requirement for their rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: The aim of the current study was to assess the association between 3 different calcium channel blockers (CCBs) (nifedipine, amlodipine and felodipine) and gingival overgrowth in patients with a diagnosis of severe refractory hypertension. Methods: One hundred and sixty‐two patients with severe refractory hypertension, taking CCBs, were selected. Gingival overgrowth was graded and periodontal measurements were recorded (probing pocket depth, clinical attachment level, plaque index and bleeding on probing). Unconditional multivariable binary logistic regression analyses were performed to assess the association between CCB intake and gingival overgrowth after adjusting for potential confounders. Results: Of the 162 patients, 26 (16.0%) were current smokers and 101 (62.3%) were females. The mean age (SD) was 54.1 (8.5) years and the median age (range) 52.5 (39‐78) years. Gingival overgrowth was observed in 55 patients (34.0%). Nifedipine was the most common medication (35.2%; 57 of 162). The results of multiple binary logistic regression showed statistically significant associations between CCB intake (exposure) and gingival overgrowth (outcome) after adjusting for the variables treatment time with antihypertensive and plaque index. Patients with gingival overgrowth were 2.5 (odds ratio = 2.46; 95% confidence interval: 1.04‐5.82) and 4.0 (odds ratio = 3.90; 95% confidence interval: 1.47‐10.35) times more likely to be taking nifedipine and amlodipine, respectively, than patients without gingival overgrowth. On the other hand, this significant association was not observed for felodipine. Conclusion: Nifedipine and amlodipine, but not felodipine, were associated with gingival overgrowth in patients with severe refractory hypertension. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To study the effect of guava and synthetic vitamin C on the development of gingival inflammation during experimental gingivitis. Material and methods: Participants were randomly assigned to three groups supplemented daily with either 200 g guava, 200 mg synthetic vitamin C or water. The study included a 14 days pre‐experimental period with oral hygiene instructions, scaling, prophylaxis and supplementation. Thereafter, experiment gingivitis was initiated, while continuing supplementation. At baseline, Day 7 and Day 14 of experimental gingivitis, Plaque Index (PlI) and Gingival Index (GI) were assessed. During the entire study, dietary fruit/vegetables intake was minimal. Results: PlI increased in guava, vitamin C and control group (ΔPlI: 1.30, 1.61 and 1.79, respectively). However, the guava group developed significantly less plaque compared to the control group. The GI increase in both guava and vitamin C group was significantly less than the increase in the control group (ΔGI: 0.10, 0.24 and 0.87, respectively). Conclusion: In a population of young nonsmoking adults, consumption of either 200 g guava/day or 200 mg synthetic vitamin C/day, prior to and during the oral hygiene abstention period, has a preventive effect on the development of experimental gingivitis as compared to the control group that developed the usual amount of experimental gingivitis. [ABSTRACT FROM AUTHOR]

Background and Objective: To the best of our knowledge, the healing time for toothbrush‐induced gingival abrasions in humans has not yet been explored. The aim of this study was to evaluate the time needed to heal for toothbrush‐induced abrasions of the keratinized mucosa of the palate. Material and Methods: In patients without, with mild periodontitis or with periodontitis, gingival abrasion lesions were induced at the keratinized mucosa of the palate by brushing up to 2 minutes. Healing as observed clinically was followed via calibrated digital photographs of the lesion after staining, every 24 hours until the lesion had resolved. In patients without or with only mild periodontitis, the healing time of lesions caused by 30 seconds and 1 minute of brushing was also recorded. Results: Thirty‐one participants (11 without or with mild periodontitis, 20 with periodontitis) met the inclusion criteria. In patients without or with mild periodontitis, the lesions induced by brushing for 2 minutes diminished by 48.7% of their original surface area within 24 hours. In patients with periodontitis the respective outcome was 45.4% (P = .87). Abrasions caused by 2 minutes of brushing needed more than 24 hours to heal completely. When decreasing the time exposed to trauma, fewer lesions were visible at baseline and the time needed to heal decreased. The subgroup of smokers was too small to evaluate any effect. Conclusion: The longer the exposure time of the keratinized mucosa of the palate to trauma, the more lesions were visible, the larger the abrasions were and the more time they needed to heal completely. More studies are needed to investigate the role of smoking, gingival biotype and to link these findings with gingival recessions. [ABSTRACT FROM AUTHOR]

Background: Peri-implant diseases are prevalent, with numerous therapies studied in an attempt to combat this condition. The present review aims to systematically evaluate the effectiveness of laser therapy with non-surgical or surgical therapy in managing peri-implant mucositis and peri-implantitis.Methods: An electronic search of three databases and a hand search of peer-reviewed journals for relevant articles published (in English) from January 1980 to June 2016 were performed. Human clinical trials of ≥ 10 patients with peri-implant diseases, treated with surgical or non-surgical approaches and laser therapy, and a follow-up period of ≥ 6 months, were included. Random-effects meta-analyses were performed to analyze weighted mean difference (WMD) and confidence interval for the recorded variables according to PRISMA guidelines. Risk of bias assessment was also performed for randomized controlled trials included.Results: From 22 articles selected, 11 were included in the meta-analyses. The outcomes of using lasers as a monotherapy could not be evaluated since no controlled studies were identified. Therefore, all reported results were the outcomes of applying lasers as an adjunct to surgical/non-surgical treatment. For the non-surgical approach, WMD of probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI), marginal bone level (MBL) and recession (REC) was 0.15 mm (P = 0.50), -0.10 mm (P = 0.32), 21.08% (P = 0.02), -0.07 (P = 0.002), -0.22 mm (P = 0.04) and -0.11 mm (P = 0.34), respectively. For the surgical approach with a long-term follow up, WMD of PD, CAL, BOP, and PI was 0.45 mm (P = 0.11), 0.22 mm (P = 0.56), 7.26% (P = 0.76) and -0.09 (P = 0.84), respectively.Conclusions: Current evidence shows laser therapy in combination with surgical/non-surgical therapy provided minimal benefit in PD reduction, CAL gain, amount of REC improvement, and PI reduction in the treatment of peri-implant diseases. Lasers when used as an adjunct to non-surgical therapy might result in more BOP reduction in the short term. However, current evidence allowed for analysis of only Er:YAG, CO2 , and diode lasers. Studies on others failed to have controlled evidence supporting their evaluation. [ABSTRACT FROM AUTHOR]

Background: Mechanical plaque control methods such as brushing and flossing are highly recommended to remove dental plaque. The aim of this study is to evaluate the efficacy of the sequence of brushing and flossing on reducing interdental plaque and increasing fluoride retention in that area.Methods: This randomized controlled crossover trial was conducted on 25 dental students. After prophylaxis, they were asked to discontinue all forms of oral hygiene for 48 hours. The study was performed in two phases with two-week washout intervals. In one phase, they first brushed, then flossed (sequence 1: brush-floss group). In the other phase they initially used dental floss then brushed (sequence 2: floss-brush group). At each phase, dental plaque (using the Rustogi Modified Navy Plaque Index) and fluoride concentrations (using a fluoride ion specific electrode) were measured before and after flossing and brushing, and the dental plaque reduction and fluoride increase were compared between the two groups using the mixed model test. A significance level of 5% was selected.Results: In the floss-brush group interdental and whole plaque was reduced significantly more than the brush-floss group (p = 0.001, p = 0.009 respectively). However, marginal plaque did not show any statistically significant difference between the two groups (p = 0.2). Fluoride concentrations in interdental plaque were significantly higher in the floss-brush group than the other group (p = 0.027).Conclusion: The results showed that flossing followed by brushing is preferred to brushing then flossing in order to reduce interdental plaque and increase fluoride concentration in interdental plaque. [ABSTRACT FROM AUTHOR]

Background and Objective: Glycine powder air‐polishing (GPAP) is an alternative approach to removing subgingival plaque biofilms for effective periodontal therapy. This study aimed to investigate the effect of subgingival GPAP as an additional approach to nonsurgical periodontal treatment in subjects with chronic periodontitis. Material and Methods: Twenty‐seven nonsmoking subjects were recruited. Two quadrants in each subject were randomly assigned, according to a split‐mouth design, to receive scaling and root planing (SRP) and GPAP (Test group) or SRP and air flushing with water (Control group) at sites with probing depth ≥5 mm. Clinical parameters, gingival crevicular fluid volumes and the concentrations of interleukin‐1β and interleukin‐1ra in gingival crevicular fluid were measured at baseline and 1, 3 and 6 months after the treatments. Results: At baseline, no statistically significant difference in periodontal and gingival crevicular fluid parameters was found between the Test and Control groups. Overall, the periodontal conditions of all subjects showed significant improvement after the treatments. Notably, the Test group showed greater reduction in gingival crevicular fluid volume (0.37 ± 0.26 μL) than the Control group (0.23 ± 0.30 μL) at 3 months (P < .05). The gingival crevicular fluid levels of interleukin‐1β and interleukin‐1ra showed a significant decrease in both groups at 6 months, and no significant difference was found between the groups. Conclusion: These preliminary results suggest that GPAP, as an additional approach to nonsurgical periodontal treatment, may be beneficial for the short‐term improvement of subclinical inflammation when measured by gingival crevicular fluid volume. Further longitudinal studies with larger sample sizes are required to clarify the exact benefits of GPAP treatment for controlling inflammation and maintaining long‐term periodontal health. [ABSTRACT FROM AUTHOR]

Abstract: Background and Objective: Oral probiotics appear to improve the treatment of periodontal diseases but there is limited evidence on their efficacy in the treatment of peri‐implant diseases. The objective of the present study was to evaluate, clinically and microbiologically, the effect of the oral probiotic, Lactobacillus reuteri Prodentis, as adjuvant to non‐surgical mechanical therapy in implants with mucositis or peri‐implantitis, placed in patients with a history of periodontal disease. Material and Methods: A randomized, controlled, parallel‐design, triple‐blind prospective clinical study was designed. Patients included in the study were partially edentulous and had implants with mucositis or peri‐implantitis. Implants with radiographic bone loss of ≥5 mm and/or ≥50% of the implant length were excluded, and only one implant per patient was included. After non‐surgical mechanical therapy, subjects were randomly assigned to take either 1 probiotic lozenge or 1 placebo lozenge every day for 30 days. Clinical measurements were taken in the whole mouth (general plaque index and general bleeding on probing) and at the implant site (probing pocket depth, plaque index and bleeding on probing) at baseline and 30 and 90 days Microbiological examination (to identify Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Peptostreptococcus micros, Fusobacterium nucleatum, Campylobacter rectus and Eikenella corrodens) was performed at the same study time points that clinical measurements were made. Results: A total of 44 patients – 22 with mucositis and 22 with peri‐implantitis – randomly received treatment with either probiotic or placebo. The probiotic L. reuteri, together with mechanical therapy, produced an additional improvement over treatment with mechanical therapy alone, both in the general clinical parameters of patients with mucositis (bleeding on probing) and at the level of implants with mucositis (probing pocket depth) or peri‐implantitis (bleeding on probing and probing pocket depth). However, L. reuteri had a very limited effect on the peri‐implant microbiota because the only parameter in which a significant decrease was found was the bacterial load of P. gingivalis in implants with mucositis (P = .031). Conclusion: The administration of a daily lozenge of L. reuteri for 30 days, together with mechanical debridement of the whole mouth, improved the clinical parameters of implants with mucositis or peri‐implantitis over a period of at least 90 days, but the microbiological effect was much more limited. Probiotics provide an alternative therapeutic approach to consider in the prevention and treatment of peri‐implant diseases, but further long‐term prospective studies with standardized variables are needed. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the influence of a triclosan-containing toothpaste in the profile of osteo-immunoinflammatory mediators in peri-implant crevicular fluid (PICF) and in clinical parameters during progression of peri-implant mucositis.Methods: Twenty-two clinically healthy patients with an implant-supported single-unit crown were enrolled in this double-blind, randomized, crossover study carried out in two phases of 21 days each. During an experimental 3-week period of undisturbed plaque accumulation in the implants, patients were randomly assigned to use three times/day: triclosan (n = 11), triclosan/copolymer/fluoride toothpaste; or placebo (n = 11), fluoride toothpaste. After a professional prophylaxis, a washout period of 30 days was established. Clinical parameters and 15 osteo-immunoinflammatory mediators in the PICF were evaluated at baseline and at 3, 7, 14, and 21 days.Results: Both groups showed increase in plaque index at implant sites from the 3rd until the 21st day (P < 0.05). Only triclosan treatment was able to avoid an increase in bleeding on probing (BOP) throughout the follow-ups (P > 0.05), whereas a significant intensification in BOP was observed from the 14th day in the placebo-treated sites (P < 0.05). Lower interleukin (IL)-10 concentrations were detected in the placebo group at the 21st day when compared with triclosan-treated implant sites (P < 0.05). IL-10 levels were reduced and IL-1β concentrations were increased at 21 days when compared with baseline only in placebo-treated sites (P < 0.05). Osteoprotegerin levels significantly increased from the 14th until the 21st day only in triclosan-treated sites (P < 0.05).Conclusion: Triclosan-containing toothpaste controls clinical inflammation and interferes positively in the profile of osteo-immunoinflammatory mediators during progression of experimental peri-implant mucositis. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to evaluate the long-term results of the surgical treatment of single peri-implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen ( DBBMC). Material and Methods The original population consisted of 26 patients with one crater-like defect, around either sandblasted and acid-etched ( SLA) or titanium plasma-sprayed ( TPS) dental implants, with a probing depth ( PD) ≥6 mm and no implant mobility ( Roccuzzo et al. J Clin Periodontol. 2011; 38: 738). Implants were mechanically debrided and treated using EDTA gel and chlorhexidine gel. The bone defects were filled with DBBMC, and the flap was sutured around the non-submerged implant. Patients were placed on an individually tailored supportive periodontal therapy ( SPT). Results Two patients were lost to follow-up. During SPT, additional antibiotic and/or surgical therapy was necessary in eight implants, and four of these were removed for biologic complications. At 7-year, the survival rate was 83.3% for SLA implants and 71.4% for TPS. PD was significantly reduced from 6.6 ± 1.3 to 3.2 ± 0.7 mm in SLA and 7.2 ± 1.5 to 3.4 ± 0.6 mm in TPS. Bleeding on probing decreased from 75.0 ± 31.2% to 7.5 ± 12.1% ( SLA) and from 90.0 ± 12.9% to 30.0 ± 19.7% ( TPS). When successful therapy was defined as PD ≤5 mm, absence of bleeding/suppuration on probing, and no further bone loss, treatment success was obtained in 2 of 14 (14.3%) of the TPS and in 7 of 12 (58.3%) of the SLA implants. Conclusions Seven years after surgical treatment with DBBMC, patients, in an adequate SPT, maintained sufficient peri-implant conditions in many cases, particularly around SLA implants. Nevertheless, some patients required further treatment and some lost implants. The clinical decision on whether implants should be treated or removed should be based on several factors, including implant surface characteristics. [ABSTRACT FROM AUTHOR]

Objectives To assess long-term attachment and periodontitis-related tooth loss (PTL) in untreated periodontal disease over 40 years. Material and Methods Data originated from the natural history of periodontitis study in Sri Lankan tea labourers first examined in 1970. In 2010, 75 subjects (15.6%) of the original cohort were re-examined. Results PTL over 40 years varied between 0 and 28 teeth (mean 13.1). Four subjects presented with no PTL, while 12 were edentulous. Logistic regression revealed attachment loss as a statistically significant covariate for PTL ( p < .004). Markov chain analysis showed that smoking and calculus were associated with disease initiation and that calculus, plaque, and gingivitis were associated with loss of attachment and progression to advanced disease. Mean attachment loss <1.81 mm at the age of 30 yielded highest sensitivity and specificity (0.71) to allocate subjects into a cohort with a dentition of at least 20 teeth at 60 years of age. Conclusions These results highlight the importance of treating early periodontitis along with smoking cessation, in those under 30 years of age. They further show that calculus removal, plaque control, and the control of gingivitis are essential in preventing disease progression, further loss of attachment and ultimately tooth loss. [ABSTRACT FROM AUTHOR]

Background: Previous studies have provided substantial evidence of the association of Aggregatibacter actinomycetemcomitans, and its highly leukotoxic JP2 genotype, with localized aggressive periodontitis (LAgP). The present study aims to evaluate presence of JP2 in individuals with LAgP after periodontal treatment.Methods: Sixty African-American patients with LAgP, aged 5 to 25 years, were examined. At baseline, probing depth (PD), clinical attachment level (CAL), bleeding on probing, and plaque index were measured, and subgingival plaque was collected from LAgP diseased and healthy sites for each participant. Patients received whole-mouth ultrasonic debridement, scaling and root planing, and a 7-day prescription of amoxicillin and metronidazole. Participants were reevaluated and resampled and received regular maintenance therapy at 3, 6, and 12 months after treatment. Polymerase chain reaction was used to detect presence of the JP2 genotype before and after treatment.Results: At baseline, the JP2 sequence was identified in 75% of LAgP diseased sites and in 56.67% of healthy sites. At 3, 6, and 12 months after treatment, the number of patients was 40, 31, and 31, respectively, and JP2 detection decreased to 17.5%, 6.45%, and 3.23%, respectively, in diseased sites (P <0.001) and to 2.5%, 3.23%, and 0%, respectively, in healthy sites (P <0.001). Clinical parameters of disease were also significantly reduced after therapy (P <0.001). Additionally, significant correlations were observed between JP2 presence and mean PD (P <0.002) and CAL (P <0.001), after therapy.Conclusion: Periodontal therapy was successful in reducing clinical parameters of LAgP and subgingival presence of JP2 in diseased and healthy sites. [ABSTRACT FROM AUTHOR]

Background: Effects of conventional ultrasonic scaler versus an erbium:yttrium-aluminum-garnet (Er:YAG) laser on titanium surfaces contaminated with subgingival plaque from patients with peri-implantitis are evaluated in terms of: 1) plaque and biocorroded titanium oxide coating removal; 2) surface change induction; and 3) residual biocompatibility toward osteoblasts.Methods: Subgingival plaque-coated titanium disks with a moderately rough surface were fixed with ethanol and treated with an ultrasonic scaler (metal tip) or Er:YAG laser (20.3 or 38.2 J/cm2) in non-contact mode. Fluorescent detection of residual plaque was performed. Disk surface morphology was evaluated by scanning electron microscopy. Viability, attachment, proliferation, and differentiation of Saos-2 osteoblasts on new and treated disks were assayed by propidium iodide/DNA stain assay and confocal microscopic analysis of cytoskeleton, Ki67, expression of osteopontin and alkaline phosphatase, and formation of mineralized nodules.Results: Both methods resulted in effective debridement of treated surfaces, the plaque area being reduced to 11.7% with the ultrasonic scaler and ≤0.03% with the Er:YAG laser (38.2 J/cm2). Ultrasound-treated disks showed marked surface changes, incomplete removal of the titanium dioxide (TiO2) layer, and scanty plaque aggregates, whereas the Er:YAG laser (38.2 J/cm2) completely stripped away the plaque and TiO2 layer, leaving a micropitted surface. Both treatments maintained a good biocompatibility of surfaces to Saos-2 osteoblasts. Air-water cooling kept disk temperature below the critical threshold of 47°C.Conclusion: This study shows that an ultrasonic scaler with metal tip is less efficient than high-energy Er:YAG irradiation to remove the plaque and TiO2 layer on anodized disks, although both procedures appear capable of restoring an adequate osseoconductivity of treated surfaces. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in the use of probiotics in periodontal therapy; however, until now, most research has focused on lactobacilli probiotics. The aim of this study is to evaluate the effect of 4-week use of yogurt supplemented with Bifidobacterium animalis subsp. lactis DN-173010 versus a placebo yogurt, followed by a 5-day non-brushing period.Methods: Individuals were included in this single-mask, randomized, controlled study if probing depth (PD) was ≤3 mm and attachment loss was ≤2 mm. After professional prophylaxis, they were randomized into two groups receiving yogurt containing either placebo or B. animalis for 28 days, followed by a 5-day non-brushing period. Outcome measures were plaque index (PI), gingival index (GI), bleeding on probing (BOP), PD, gingival crevicular fluid (GCF) volume, and total amount and concentration of interleukin (IL)-1β in GCF. These were measured at baseline, after 28 days of study product use, and subsequently after 5 days of plaque accumulation.Results: Fifty-one patients were analyzed. No intergroup differences could be detected before and after intake of study products. However, after plaque accumulation, significantly better results for all parameters were seen in the probiotic group compared with the control group (P <0.001): lower PI and GI, less BOP, less increase in GCF volume, and lower IL-1β total amount/concentration.Conclusion: The use of a probiotic yogurt supplemented with B. animalis can have a positive effect on plaque accumulation and gingival inflammatory parameters after refraining from oral hygiene practices. [ABSTRACT FROM AUTHOR]

Background Clinical investigations of plaque removal efficacy of power toothbrushes in children are limited. Aim To compare plaque removal of a power versus manual toothbrush in a paediatric population. Design This was a randomised, replicate-use, single-brushing, examiner-blinded, two-treatment, four-period crossover clinical trial in children 8-11 years of age. Subjects were randomly assigned to a treatment sequence involving an oscillating-rotating power toothbrush and a manual toothbrush control. Subjects brushed under supervision with a NaF dentifrice. Plaque was assessed pre- (baseline) and post-brushing using the Turesky Modification of the Quigley-Hein Plaque Index by two examiners. Plaque scores were averaged for mixed and permanent dentition on a per-subject basis and analysed using a mixed-model ancova for a crossover design. Results Forty-one subjects (mean 9.0 years) were randomised and completed the trial. Both the power brush and manual brush provided statistically significant mean plaque reductions versus baseline in all analyses ( P < 0.001). For both examiners, plaque removal was significantly ( P < 0.001) larger for the power brush in permanent and mixed dentitions. The interexaminer correlations for the permanent dentition were strong ( ICC = 0.68-0.88) for pre-brushing plaque across all periods. Conclusions An oscillating-rotating power toothbrush provided superior plaque reduction versus a manual toothbrush in children. [ABSTRACT FROM AUTHOR]

Background and Objective Lactobacillus spp. and bifidobacteria are the most frequently used probiotics in oral health research. However, although probiotic effects have been suggested for other genera, such as bacilli, no trials are available to describe the effect of bacilli probiotics on gingivitis in humans. The aim of the present study was to evaluate the clinical effects of a bacilli-containing toothpaste, a mouthrinse and a toothbrush cleaner versus a placebo in patients with generalized gingivitis. Material and Methods In this double-blind placebo-controlled randomized clinical trial, nonsmoking, systemically healthy patients with generalized gingivitis were included. They used a placebo or an experimental probiotic Bacillus subtilis-, Bacillus megaterium- and Bacillus pumulus-containing toothpaste, mouthrinse and toothbrush cleaner for 8 wk. Primary outcome measures of interest were plaque and gingivitis index, and the secondary outcome measures were pocket probing depth and bleeding on probing. Results Twenty male and 20 female patients were randomized over the two groups. All participants could be included in the final analysis. Although plaque and gingivitis indices were significantly reduced after 8 wk, no intergroup differences could be found at any time point. Also, for the secondary outcome measure, intragroup but no intergroup differences could be detected. No harm or unintended effects were reported by the patients after using the study products. Conclusions This study did not show any statistically significant differences between a placebo and a bacilli-containing toothpaste, mouthrinse and toothbrush cleaner on gingivitis parameters. [ABSTRACT FROM AUTHOR]

Objective The aim was to evaluate the effect of a chlorhexidine-containing brush-on gel when used as supplement to oral hygiene instructions and mechanical debridement, on peri-implant mucositis in adults. Materials and methods The study group consisted of 38 adults (48-87 years.) with peri-implant mucositis that were consecutively enrolled in three private clinics after informed consent. The study employed a double-blind controlled design with two parallel arms. After baseline registrations, oral hygiene reinforcement and mechanical debridement, the patients were randomly allocated to either a test group with once daily tooth brushing with an oral care brush-on gel containing 0.2% chlorhexidine digluconate (Cervitec Gel) or a control gel group. The duration of the intervention was 12 weeks. The primary outcome was bleeding on probing ( BOP) and secondary endpoints were local plaque score ( LPS) and pocket probing depth ( PPD). Results The groups were balanced at baseline. The daily use of the chlorhexidine-containing gel resulted in reduced BOP after 4 and 12 weeks compared with the control group ( P < 0.05). The PPD was significantly reduced ( P < 0.05) after 12 weeks compared to baseline in the test group, but not in the control group. No side effects or adverse events were reported. Conclusion The present findings indicated moderate but significant improvements of clinical parameters when mechanical debridement was combined with a self-applied oral care brush-on gel for the management of peri-implant mucositis. [ABSTRACT FROM AUTHOR]

Background: This study aims to reveal how air polishing behaves on a titanium surface by evaluating the size and shape of the cleaned area and the influence of different device settings, probing depths, and cleaning movements.Methods: Forty-eight titanium sandblasted large-grit acid-etched surface film-coated disks were treated with an air abrasive system using a subgingival plastic nozzle. Two subgingival models were used: open-ended (step 1) and defined-size (step 2). In step 1, the most effective parameters were investigated by 5-second static applications under different settings. In step 2, the best settings were used for dynamic application to test influence of different movements (up-down, slowly up, rotation). For both steps, powder and water consumption and total cleaned area were calculated.Results: Air pressure was the main factor with the strongest effect on cleaning. Increasing air pressure extended cleaning area. Other factors, such as nozzle depth and excessive powder flow amount, had weak influence. Cleaning effect reached deeper than the nozzle physically reached. Step 2 showed that there was no significant difference between different nozzle movements; however, cleaning efficiency decreased significantly without movement.Conclusions: For the most effective clinical use of air polishing, it should be applied with high pressure, deep insertion of nozzle, and enough water flow. Additionally, the nozzle has to be moved to get the best cleaning effect. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This study aimed to determine attitudes and practices of intensive care unit ( ICU) nurses towards provision of oral care for intubated patients. Background Oral care is as an essential nursing intervention for intubated patients to maintain patient comfort and prevent colonization of dental plaque by respiratory pathogens. Design This was a cross-sectional study. Methods Data were collected from 93 ICU nurses of a teaching hospital in the East Coast of Peninsular Malaysia using a self-administered questionnaire. Results Some nurses agreed that oral cavity of intubated patients was difficult (40·8%) and unpleasant (16·2%) to clean, but all of them realized the importance of oral care and the majority (97·9%) would like to learn more about it. Most nurses reported providing oral care at least two times daily using various methods and products such as suction toothbrush (90·4%), manual toothbrush (49·5%), cotton swab (91·5%) and foam swab (65·7%). Chlorhexidine gluconate oral rinse was the preferred mouthwash (97·8%) and swabs (93·5%) solution although few used non-optimal products such as sodium bicarbonate (14·0%), tap water (4·3%) and hydrogen peroxide (3·2%) to wash their patients' mouths. While the majority of nurses agreed that oral care supplies and equipments were available (93·6%) and suitable (88·2%), most of them also thought they need better hospital support (88·2%). Conclusions The nurses' attitudes towards oral care were generally positive and most oral care methods were appropriate. However, some methods and products used were inconsistent with the current recommendations and they have mixed views about the suitability of oral care supplies and equipment provided by the hospital. Relevance to clinical practice Recommendations were made for providing standard oral care protocols for intubated patients and oral care training programs for ICU nurses to support delivery of quality patient care. [ABSTRACT FROM AUTHOR]

Aim The aim of the present study was to explore the effects of Iranian green tea mouthwash containing 1% tannin on dental plaque and chronic gingivitis. Methods In this randomized, double-blinded, parallel, controlled clinical trial, 40 volunteer dental students with a gingival index ≥1 were enrolled. At baseline, gingival, plaque, and bleeding indices were recorded and all the participants received dental polishing. Based on random allocation, 20 participants used the test and 20 used chlorhexidine mouthwash with no change in regular toothbrushing methods. The participants were asked to use 15 mL of the respective mouthwash for 1 min, twice a day for 28 days. All indices, as well as stain index, were recorded after 1 and 4 weeks post-rinsing. Data were analyzed using repeated-measures ANOVA and Bonferroni tests. Results Significant in-group differences, but not between-group differences, were observed in all indices after 1 and 4 weeks compared to baseline. The test mouthwash resulted in significantly less tooth staining than the control. Conclusion The 1% tannin green tea mouthwash could be a safe and feasible adjunct to mechanical plaque control. The tested green tea mouthwash could be considered a good alternative for chlorhexidine in contraindicating situations. [ABSTRACT FROM AUTHOR]

Aims The aim of this systematic review was to establish the efficacy of brushing with and without a dentifrice for dental plaque removal. Materials and Methods MEDLINE-PubMed, Cochrane- CENTRAL, EMBASE and other electronic databases were searched. The inclusion criteria were randomized controlled trials and controlled clinical trials and subjects ≥18 years of age with good general health. Studies that evaluated the effect of toothbrushing with a dentifrice compared to brushing without a dentifrice were included. Data were extracted from the eligible studies, and a meta-analysis was performed where feasible. Result The search was conducted until June 2016 and retrieved 10 eligible publications that included 20 comparisons. On average, 49.2% of plaque was removed when brushing was performed with a dentifrice, and 50.3% of plaque was removed when toothbrushing was performed without a dentifrice. The descriptive analysis indicated that the majority of the comparisons did not show an additional effect of dentifrice use. Regarding the meta-analysis of post-brushing scores, no significant difference was observed between toothbrushing with and without a dentifrice (DiffM 0.00, 95% CI [−0.05: 0.05], p = 0.91). The meta-analysis of incremental data (as means or percentages) supported and strengthened these findings. Conclusion The cumulative evidence for this systematic review demonstrates that there is moderate certainty that toothbrushing with a dentifrice does not provide an added effect for the mechanical removal of dental plaque. [ABSTRACT FROM AUTHOR]

Background: An antiplaque agent with minimal side effects that can be used as an effective adjunct to mechanical plaque control is needed. The current study is designed to evaluate efficacy of triphala (TRP) mouthwash in reduction of plaque and gingivitis.Methods: Ninety individuals with chronic generalized gingivitis were randomly assigned to three groups: 1) group I, placebo mouthwash; 2) group II, TRP mouthwash; and 3) group III, chlorhexidine (CHX) mouthwash. All individuals were instructed to rinse with their respective mouthwash twice daily. 1) Plaque index (PI); 2) gingival index (GI); 3) oral hygiene index-simplified (OHI-S); and 4) microbiologic colony counts were recorded at baseline and at 7, 30, and 60 days.Results: All three groups showed gradual reduction in PI, GI, and OHI-S levels from baseline to 7, 30, and 60 days. There was also significant reduction in microbial counts in all groups at all time intervals except in group I. A significant difference was noticed with respect to reduction in PI, GI, OHI-S, and microbiologic counts in group I compared with groups II and III. However, no significant differences were found between groups II and III for any parameters at any time intervals.Conclusions: TRP mouthwash was found to decrease inflammatory parameters from baseline to follow-up intervals. Because improvement in gingivitis was comparable with that of CHX mouthwash, TRP mouthwash can be considered a potential therapeutic agent in the treatment of gingivitis. [ABSTRACT FROM AUTHOR]

New data indicate that periodontal diseases are much more prevalent than previously thought, which means that there are large numbers of patients who will need to be diagnosed and treated for periodontal disease in a general dental practice. Oral hygiene procedures performed by patients between office visits are important for gingival health. No particular type of toothbrush has consistently been shown to have superior plaque-removal ability over another. Although studies on powered brushes have shown evidence for efficacy of biofilm removal and increased patient compliance, they are of short duration, making evaluation of long-term effects difficult to achieve. Interdental cleaning with dental floss can be effective but it is technique-sensitive. Interdental brushes have been shown to be superior to floss in plaque index scores, but not in gingival inflammation reduction. A systematic review of oral irrigation reported a beneficial adjunctive effect on bleeding and gingival indices and pocket depth. Antimicrobials in mouthrinses and toothpastes have shown significant reductions in plaque and gingivitis when used correctly. Even though it is considered essential for patients to utilize biofilm-removal techniques on a frequent basis, studies on adherence show that approximately 30-60% of health information is forgotten within 1 h, and 50% of health recommendations are not followed. Incorporating psychosocial aspects of behavioral change, including well-established counseling strategies, such as motivational interviewing, may elicit improved patient outcomes. [ABSTRACT FROM AUTHOR]

The main focus of this review is polymorphonuclear neutrophilic granulocytes. Polymorphonuclear neutrophils play a pivotal role in normal host resistance to subgingival dental-plaque biofilm. Both hyper- and hypo-responsiveness of the immune system toward the microbial challenge in periodontitis have been described. We review polymorphonuclear neutrophil physiology with emphasis on the role of neutrophil functions and dysfunctions in periodontitis. Text boxes are given at the end of each subsection, which present the current knowledge on neutrophil-modulating agents as a potential therapeutic approach in periodontitis. [ABSTRACT FROM AUTHOR]

Aim To evaluate the effect of self-performed mechanical plaque control ( SPC) frequency on gingival health. Methods Thirty-nine subjects exhibiting limited gingival inflammation and minimal clinical attachment loss were enrolled in a single-blind, parallel group, randomized clinical trial. The subjects that were divided into three groups were tasked to perform SPC (using tooth brush and dental floss) at 12, 24 or 48 h intervals. Gingival index ( GI), plaque index (PlI), and gingival crevicular fluid ( GCF) volume were evaluated at baseline and 30 days follow-up. Groups were compared using anova and Tukey. Results No significant differences in mean GI change were observed between the 12 and 24 h SPC intervals from baseline to 30 days (−0.06 ± 0.13 versus 0.05 ± 0.09; p = 0.11). In contrast, the 48 h interval had significantly higher mean GI change than the 12 and 24 h intervals (0.33 ± 0.17; p = 0.001). Similarly, mean PlI change was not significantly different between the 12 and 24 h SPC intervals (0.11 versus 0.28; p = 0.15), whereas SPC at 48 h-intervals yielded a significantly increased PlI (0.39; p = 0.001). Conclusions Self-performed mechanical plaque control performed at 12 h or 24 h intervals appears sufficient to maintain gingival health in subjects with no or limited clinical attachment loss. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate efficacy in children affected by Down syndrome of "Digital Brush" in terms of Plaque Index reduction added to the daily oral hygiene procedures.Methods: A total of 56 patients with Down syndrome were recruited and randomly assigned in two groups: both control and test groups underwent standard hygiene procedures of tooth brushing twice a day followed by the intervention of Digital Brush, TNT gauze impregnated with chlorhexidine 0.12%, for the test group and by sterile gauze soaked in water for the control group. Initial plaque index was measured for all patients (T0), subsequently were instructed to use either Digital Brush or gauze soaked with water for 2 weeks. At last, patients were reevaluated (T1) and the plaque index measured.Results: Plaque index improvement from T0 to T1 in control group was 11.7%, while in test group was 24.1%. The mean differences between test and control group was statistically significant (p < 0.001).Conclusions: This study demonstrates how the Digital Brush, added to the daily oral hygiene procedures, obtains significant improvements in supragingival plaque control in children with Down syndrome. [ABSTRACT FROM AUTHOR]

Objectives: To conduct a feasibility study on investigating the effectiveness of an alcohol-free essential oil mouthwash (AF-EOMW) to reduce plaque accumulation and oral pathogen levels in institutionalised elders receiving long-term care and to obtain preliminary results.Background: Although simple, cost-effective strategies to improve oral hygiene in seniors such as the use of mouthwashes have been shown to reduce the risks of respiratory diseases, little information is available on the feasibility of implementing these measures.Methods: Twenty-five elderly participants with significant loss of autonomy were initially recruited and divided into two groups. A test group rinsed with an AF-EOMW twice a day, and a control group rinsed with tap water. Data on demographic characteristics, dental history and tobacco use were collected from a questionnaire. Problems encountered during recruitment and data collection were documented. Plaque index, denture cleanliness and salivary levels of several pathogens were measured at three time points: baseline (T0 ), day 22 (T1 ) and day 45 (T2 ).Results: Eighteen participants completed the study. Several problems were encountered during recruitment and execution of the study protocol. No significant differences in clinical or microbiological measures were found between the test group and controls at three time points (p > 0.05).Conclusion: This pilot study shows that, if sufficient logistical and financial resources are available, it is feasible to conduct randomised clinical trials in a seniors' facility. The use of an AF-EOMW to improve oral hygiene in seniors was not found to be superior to tap water. However, larger controlled clinical studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]