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Purpose: To compare clinical outcomes and oral fluid biomarkers in gingivitis subjects using an electric toothbrush/irrigator combination (test) or a manual toothbrush alone (control) over 8 weeks., Materials and Methods: Subjects were randomly assigned to two groups of n = 30. In both groups, toothbrushing was performed twice daily at home and no additional interdental cleaning aids were allowed. Plaque Index (PLI), Gingival Index (GI), whole saliva (WS), and gingival crevicular fluid (GCF) samples were collected at weeks 2, 4, and 8., Results: Subjects' mean age was 23 years and 52% were female. Overall baseline means were 1.31 for PLI, 1.07 for GI, and 34.9 for number of bleeding sites. At every follow-up visit, both groups differed statistically significantly (p < 0.001) from baseline for all clinical parameters. The test group demonstrated statistically significantly (p < 0.001) greater reductions in GI vs the control group by 18% at week 2, 17% at week 4 and 24% at week 8. The test group also demonstrated statistically significantly (p < 0.002) greater reductions in the number of bleeding sites vs the control group by 33% at week 2, 34% at week 4 and 43% at week 8. Between-group comparisons for both WS and GCF revealed numerical trends for decreased levels of interleukin (IL)-1β in GCF after 4 and 8 weeks, but these were not statistically significant., Conclusion: In subjects using the electric toothbrush/irrigator combination, increased clinical improvements may be found accompanied by similarly improved trends for oral fluid biomarkers such as IL-1β.

Purpose: The aim of the present study was to test the effects of interdental cleansing with dental floss on supragingival biofilm removal in natural dentition during a 3-week period of experimental biofilm accumulation., Materials and Methods: The present study was performed as a single-blind, parallel, randomised, controlled clinical trial using the experimental gingivitis model (Löe et al, 1965). Thirty-two students were recruited and assigned to one of the following experimental or control groups: Group A used a fluoride-containing dentifrice (NaF dentifrice) on a toothbrush for 60 s twice a day, Group B used an unwaxed dental floss twice a day, Group C used a waxed dental floss twice a day in every interproximal space and Group D rinsed twice a day for 60 s with drinking water (control)., Results: During 21 days of abolished oral hygiene, the groups developed various amounts of plaque and gingivitis. Neither of the cleansing protocols alone allowed the prevention of gingivitis development. Toothbrushing alone yielded better outcomes than did any of the flossing protocols. Interdental cleansing with a waxed floss had better biofilm removal effects than with unwaxed floss., Conclusions: Toothbrushing without interdental cleansing using dental floss and interdental cleansing alone cannot prevent the development of gingivitis.

Purpose: The aim of the present study was to report the radiographical prevalence of overhanging fillings in a group of Swiss Army recruits in 2006 and to relate the dimensions of the overhangs to clinical parameters., Materials and Methods: A total of 626 Swiss Army recruits were examined for their periodontal conditions, prevalence of caries, and stomatological and functional aspects of the masticatory system and halitosis. In particular, the present report deals with the presence or the absence of fillings, the presence or the absence of overhangs and their relation to clinical and radiographic parameters., Results: A total of 16,198 interdental sites were evaluated on bitewing radiographs. Of these sites, 15,516 (95.8%) were sound and 682 (4.2%) were filled. Amalgam restorations were found in 94.1% and resin composite fillings in 5.9% of the sites. Of these 682 sites, 96 (14.1%) yielded overhanging margins of various sizes. This low prevalence of fillings represents not only a substantial reduction when compared with a similar Swiss Army study (Lang et al, 1988), but also an improvement in the quality of dental care delivery to young Swiss males. Plaque Index and Gingival Index increased statistically significantly with the presence of fillings, when compared with healthy non-filled sites. Clinical parameters that were significantly associated with the presence of overhangs included clinical attachment loss. Moreover, between 1985 and 2006 the prevalence of fillings was significantly reduced from 20.0% to 4.2% of all surfaces. Furthermore, the marginal fit of the fillings improved from 33.0% with overhangs to 14.1%., Conclusions: A significant improvement was observed in the periodontal and dental conditions of young Swiss males that was shown to have taken place within the previous two decades. From 1985 to 2006, the prevalence of fillings was reduced fourfold and that of overhanging margins twofold, documenting an improvement in the quality of restorative dentistry.

Purpose: To assess the impact of oral health related quality-of-life (OHQoL) on patients presenting at the Department of Periodontology and Fixed Prosthodontics using a German version (the OHQoL-GE) of the oral health-related quality-of-life in the UK (OHQoL-UK) questionnaire., Materials and Methods: A total of 251 patients were invited to fill out the OHQoL-GE. In addition, patients were given a checklist of dental-related items over the past year including 'tooth ache', 'dental treatment', 'bleeding gums', 'swollen gums' and 'problems with dental prosthesis'. Prior to being seen by a dental professional, the patients completed the questionnaires. During the new patient clinic visit, medical and dental history, age, gender, number of teeth present and presence or absence and type of dental prosthesis were recorded. In addition, a basic periodontal examination (BPE) was performed., Results: Two hundred and fifteen OHQoL-GE questionnaires were completed. OHQoL-GE scores were significantly associated with patients' self-reported symptoms and problems in the past year: experiences of 'tooth ache' (P < 0.05), 'swollen gums' (P < 0.001) and 'problems with dental prosthesis' (P < 0.05) with the exception of 'bleeding gums' (P = 0.102) and 'dental treatment' (P = 0.739). In addition, OHQoL-GE scores were directly correlated with the BPE (r(s) = -0.295, P < 0.01), the number of teeth present (r(s) = 0.190, P < 0.01) and inversely correlated with age (r(s) = 0.152, P < 0.05). Patients with removable partial dentures had the lowest median score of 43 (interquartile range, IQR 23), patients without dental prosthesis had a median score of 46 (IQR 18) and patients with fixed dental prosthesis (FDP) had the highest score of 54 (IQR 26). The differences were statistically significant between patients without dentures and patients with FDP (P < 0.05), and between removable denture wearers and patients with FDP (P < 0.05)., Conclusions: The issues were periodontal and prosthetic status, number of teeth present and age impact on quality-of-life. This has implications in understanding the consequences of dental health and in the use of patient-centred outcomes in dental research. The OHQoL-GE demonstrates discriminative validity in a population seeking dental advice and/or treatment.

Aim: To evaluate the outcomes of short (15 minutes) oral hygiene vs. hand hygiene education for preschool children 4 weeks after these interventions., Materials and Methods: Sixty-one preschool children (age range 4-6 years) attending four kindergarten classes participated in a 15-minute health education programme on the importance of body cleanliness for general health. In addition, specific instructions on oral hygiene were provided for two randomly selected classes (30 children), while the remaining two classes (31 children) were given instruction of hand and nail cleaning. The oral hygiene status was assessed usingthe plaque control record (PCR). The cleanliness of the hands and fingernails was determined using a hand hygiene index (HHI) and a nail hygiene index (NHI). All three parameters were assessed before the intervention as well as 4 weeks thereafter., Results: Four weeks after education, the PCR had improved for all children from 79.95% to 72.35% (p < 0.001). The NHI had improved from 74.91% to 61.71% (p < 0.001). In addition, the mean PCR of the children given oral hygiene instruction decreased from 83.67% to 72.40%, while the mean PCR of the children given hand and nail cleaning instruction decreased from 76.23% to 72.29% (interaction effect 'time x type of instruction': p = 0.044). Girls' PCR improved significantly more than boys' PCR (Girls, 80.98 vs. 69.71; boys, 78.33 vs. 75.31; p = 0.021)., Conclusions: The results of the study show that even a short, school-based educational intervention at an early age may affect children's oral health promotion significantly. Teachers should, therefore, be encouraged to educate children from an early age about oral hygiene promotion.

Objectives: To assess the effects of an experimental 0.454% stannous fluoride (SnF2) dentifrice on the oral sulcular microbiota in patients with various stages of oral diseases using checkerboard DNA-DNA hybridization., Material and Methods: In the present one-month, single center, single product, prospective cohort trial, 37 adults (mean age 37.6) were assigned to one of four oral health condition cohorts with seven to 10 subjects each: 1. mild gingivitis, 2. marked generalized gingivitis to moderate periodontitis, 3. caries-prone and 4. treated moderate to advanced chronic periodontitis in supportive periodontal care. All four groups were asked to use the test dentifrice and a power toothbrush twice a day for one minute during a four-week test period. Before and after the trial period, Plaque Indices (PII, Silness and Löe, 1964) and Gingival Indices (GI, Löe and Silness, 1963) were recorded. Subgingival plaque samples were collected from all patients at Baseline, as well as after two and four weeks. These samples were analyzed for content of 40 bacterial species using checkerboard DNA-DNA hybridization., Results: As a result of the only one minute brushing with the stannous fluoride dentifrice, the mean PII at Baseline was significantly lower (p < 0.05) from the mean PII at four weeks. No statistically significant differences were found between premolar and molar mean values. Moreover, no statistically significant differences were found between the mean GI at Baseline and at four weeks. The microbiological analysis showed that at baseline subjects in groups 2 and 4 had significantly higher bacterial loads of bacteria than groups 1, and 3 (i.e. A. actinomyctemcomitans P. gingivalis, T. forsythia, and T. denticola. Over the study period, the total bacterial load did not change in groups 2, 3 and 4. In groups 1 and 3, however, an increase in the loads of Streptococci spp. were noticed (p < 0.05) including S. mitis, S. intermedius, and S. sanguis (p < 0.01) suggesting an increase in the presence of early colonizing and health associated bacteria., Conclusion: One minute brushing with a 0.454% stannous fluoride dentifrice did--after four weeks--not affect the subgingival microbial profiles in patients with moderate periodontitis and treated moderate to advanced periodontitis. However, the sulcular microbial profiles of mild gingivitis and caries-prone patients were affected, indicating a shift towards a gingival health associated microbiota in the sulcular region of patients not affected by attachment loss. RUNNING HEAD: Effect of stannous fluoride on sulcular microbiota.

Purpose: The purpose of this retrospective cohort study was to evaluate the effect of smoking habits and patient compliance on the outcomes of supportive periodontal therapy (SPT) (tooth loss and residual pockets defined by probing depth of > or = 5 mm) in a private practice situation., Materials and Methods: Eighty-seven patients, who completed active periodontal treatment and then followed an SPT program for at least 5 years, were recruited from the patient pool of a private dental practice. After active periodontal therapy and at the follow-up examination 5-11 years later, pocket probing depths (PPD) and tooth loss were assessed, and the patients were divided into 4 subgroups based on their smoking history: non-smokers (NS); occasional smokers (OS); moderate smokers (S); and heavy smokers (HS). The patient cohort was also divided into 4 subgroups based on patient compliance (mean delay from the scheduled recall sessions): fully compliant (< 1 week); compliant within 1-3 weeks; compliant within 3-6 weeks; and not compliant (> 6 weeks)., Results: The mean tooth loss per patient and year ranged from 0.11 - 0.18 in the various subgroups with no significant differences between them. After a mean observation period of 7.3+/-1.5 years, the incidence of new sites with residual probing depth of > or =5 mm varied between 1.2% for the NS and 13.8% for the HS (p < 0.05,), and between 3.2% for the compliant and 5.8% for the non-compliant patients., Conclusion: Smoking habits significantly influenced the treatment outcomes of SPT, while compliance was less influential regarding the incidence of new residual pockets during 7.3 years of SPT.

Aim: To epidemiologically assess the periodontal conditions of the adult population in Switzerland., Material and Methods: During a ten-year period, a total of 1318 subjects were randomly selected on the basis of a process involving the community rosters in seven regions (Cantons) of Switzerland: (Canton of Berne; Canton of Zurich; Western cantons (GE,VD,NE); Eastern cantons (SG,AI,AR,TG,SH); Southern cantons (VS,GR,TI); Central cantons (LU,GL,ZG,UR,SZ,OW,NW) and Northern cantons (JU,FR,SO,AG,BL)) and encompassing all adult age groups (20-89 years). The subjects were examined in dental offices randomly distributed throughout the country. The number of teeth present, the mean Plaque and Gingival as well as Retention Indices were assessed. Furthermore, pocket probing depths and loss of periodontal attachment were determined on all teeth., Results: Ninety-four (7.1%) of the subjects were completely edentulous leaving 1224 dentate individuals with an average of 21.65 teeth for analysis. In the youngest cohort (20-29 years) 27.03 teeth were present. During the fourth to the seventh decade of life, tooth loss appeared to follow a linear pattern leaving 17.63 teeth in the age group of 60-69 years. The oldest age group of the 80-89 years old yielded 11.08 teeth. The mean scores of all clinical parameters increased significantly with increasing age. Mean PII in the youngest age group was PII: 0.72 (SD: 0.38) and reached PII: 1.55 (SD: 0.68) in the oldest. The corresponding mean GI were 1.17 (SD: 0.31) and GI: 1.64 (SD: 0.50), respectively. The mean RI increased from 0.24 (SD: 0.29) to RI: 1.34 (SD: 0.70) in the oldest. Mean probing depth increased slightly from 20 to approximately 49 years. Thereafter, mean PPD remained around 3.0 mm. The loss of periodontal attachment increased dramatically after the age of 50., Conclusions: Periodontitis manifests itself after the age of 50. The pronounced progressive attachment loss in the age cohorts over fifty years explained the marked loss of teeth in some individuals. From a public health point of view, it is indicated to make a major effort for periodontal prevention in the population approaching the second third of life.

Purpose: A double blind, controlled, parallel group trial utilizing the experimental gingivitis model was performed on thirty young adults to evaluate the clinical effects of a 0.45% stannous fluoride dentifrice used as a slurry on dental biofilm formation and the development of gingivitis., Material and Methods: Following a thorough examination and oral prophylaxis procedures, subjects were randomly assigned to apply one of the following dentifrices twice daily over a three-week period: A) dentifrice slurry without active ingredients; B) 0.45% stannous fluoride gel; and C) Colgate Total dentifrice slurry (0.30% triclosan, 0.24% sodium fluoride, 2% copolymer)., Results: After three weeks, the stannous fluoride dentifrice significantly (p < 0.05) reduced gingivitis compared with the Colgate Total group by 39.7%. Gingival bleeding was also reduced relative to the Colgate Total group. This difference was statistically significant (P < 0.05). During the experimental period, the mean PII scores increased almost linearly in all three groups without yielding any statistically significant differences., Conclusions: The results of this clinical trial demonstrated that, over a three-week period, the application of a 0.45% SnF2 gel significantly inhibited the onset of gingivitis compared to Triclosan/sodium fluoride/copolymer (Colgate Total). However, neither stannous fluoride nor Triclosan/sodium fluoride/ copolymer (Colgate Total) possessed sufficient antimicrobial activity to suppress biofilm formation in the absence of regular oral hygiene practices.

The subject risk assessment may estimate the risk for susceptibility for progression of periodontal disease. It consists of an assessment of the level of infection (full mouth bleeding scores), the prevalence of residual periodontal pockets, tooth loss, an estimation of the loss of periodontal support in relation to the patient's age, an evaluation of the systemic conditions of the patient and finally, an evaluation of environmental and behavioral factors such as smoking. All these factors should be contemplated and evaluated together. A functional diagram may help the clinician in determining the risk for disease progression on the subject level. This may be useful in customizing the frequency and content of SPT visits.

Background: Multi-factorial risk models have been proposed to enhance the ability to predict risk for the progression of treated chronic periodontitis., Aims: to study if the outcomes of supportive periodontal therapy (SPT) based on a multi-factorial periodontal risk assessment are influenced by IL-1 gene polymorphism (IP) status., Material and Methods: Information about the IP and smoking status, clinical periodontal conditions and age related bone level measurements were used to calculate a peridontal risk assessment model (PRA). The surface area of this diagram was calculated for 224 subjects who had participated in an SPT program over four years. Baseline and 4-year follow-up data were studied in relation to the IP status., Results: Positive IP tests were obtained for 80/224 (35.7%) of the subjects. At baseline the mean PRA for the IP positive group was 79.9 units, which at year four had increased to 81.3 units (mean diff: 1.4 units, S.D.+/-16.5, p<0.45, 95% CI: 2.3 to 5.1). At baseline and year four the mean PRA for the IP negative group was 44.2 and 38.6 units, respectively. This difference was statistically significant (mean diff: 5.6, S.D.+/-16.1, p<0.001, 95% CI: 3.0 to 8.3). Independent t-tests confirmed that the IP status was significantly associated with a less favorable change in PRA over the four-year period (PRA difference: 7.04, t=3.01, p<0.003, 95% CI: 2.4 to 11.65). Bleeding on probing, and probing depth values alone did not differ between positive and negative IP status. Regression analysis demonstrated that the best-fit model for change in PRA included bleeding on probing at baseline, IP status, proportional alveolar bone loss in relation to the age, and gender., Conclusion: The PRA allowed the assessment of the outcomes of SPT therapy. Subjects with positive IP did not respond to individualized SPT as favorably as did IP negative subjects.