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«Guided Biofilm Therapy» (GBT) represents a systematic, risk and demand-oriented prophylaxis and treatment concept. A significant difference to conventional methods is - above all - the reduced, tissue-friendly and targeted use of ultrasound and hand instruments. The biofilm is consistently shown with suitable color solutions, the oral hygiene instruction and professional tooth cleaning is optimized. The use of suitable powders guarantees a tissue-conserving and targeted removal of biofilm. While individual treatments, techniques and materials have already been well investigated and described, little data is available on patient acceptance. The aim of the present study was to gain an impression of the acceptance of this method in comparison to the conservative-classical recall care mainly based on hand and ultrasound devices in a survey of 100 consecutive patients from the clinic's internal recall system. The overall results were very positive. The powder jet device showed the best acceptance. The aspect fear before/during the recall session was also interesting: At a low level (10%), an additional reduction to 4% occurred, since hand instruments were probably used much less and only very specifically. mConclusion: The use of plaque elevators makes the work in the recall session more efficient, more effective and guarantees ma higher quality control, which is also highly appreciated by patients.

Studies on interdental cleaning have shown an advantage of interdental brushes (IDB) over other interdental care products. Sticks (STK) made of rubber are often recommended as an alternative, as they are considered user-friendly, gentle but nevertheless effective. This laboratory study aimed to compare the cleaning efficiency with the same application force between IDB and STK. Brushes with different geometries and diameters were tested. Two conical STK from two manufacturers of the sizes "XS/S" (0.7-2.6 mm) and "L" (0.9-3.4 mm) were tested. For the IDB, one conical (2.7-3.4 mm), two cylindrical (1.9 and 2.5 mm) and one waisted brush (4-2-4 mm) were assessed. A geometric model with parallel-walled metal blocks (black and coated with titanium oxide) was used. The brushes were tested with one and five cleaning cycles each in horizontal direction. The test surfaces were measured planimetrically for cleaning efficiency by calculating the areas freed from titanium oxide in relation to the maximum cleanable total area. The maximum cleaning efficiency of the IDB was 45% at 1 mm distance with one cleaning cycle and 95% with five cycles. For the sticks, the cleaning efficiency with one cleaning cycle was 30% and 67% with five cycles. At a distance of 2 mm, the maximum cleaning efficiency was 50% with one cleaning cycle and 87% with five cycles for the IDBs and only 10% for the STKs. Taking into account the limitations of this study, the IDBs showed an overall better cleaning efficiency with the same application force, compared to STKs, with the waisted IDB achieving better cleaning efficiency than the conical IDB. In conclusion, STKs can be used in narrow interdental spaces where app opriate, but overall IDBs are more preferable in narrow and wider contact point conditions.

Dental calculus has a secondary effect on the pathogenesis of periodontal diseases by harboring bacterial biofilm on its rough surfaces. Consequently, professional removal of both calculus and biofilm is a crucial part of the therapy and prevention of gingivitis and periodontitis. Today, crystal growth inhibitors such as zinc ions in the form of zinc chloride or zinc citrate, and pyrophosphates alone or in combination with copolymer are added to toothpastes to prevent the mineralization of the dental biofilm. In addition, triclosan is used as an antimicrobial agent in combination with copolymer as an additive in toothpastes to reduce the amount of plaque and thus the substrate for calculus formation. In clinical trials, chemical additives have demonstrated an inhibiting impact on calculus formation. However, it must be clarified that in addition to home-based oral hygiene, the formation of dental calculus depends on other factors such as access to professional dental care, diet, age, ethnicity, time since last professional tooth cleaning, systemic diseases or medications. However, since chemical additives in toothpastes do not reach the deeper sites of periodontal pockets, they are recommended for the inhibition of supragingival calculus formation, thus assisting the primary prevention of gingivitis as well as the secondary prevention of periodontal disease.

Die Schule eignet sich als ein geeigneter Ansatzpunkt zur Schaffung gesundheitlicher Chancengleichheit. Mundgesundheitsfördernde Interventionen können dabei ihren Beitrag zur allgemeinen Körpergesundheit leisten. Bedauernswerterweise werden nur selten Zahnprophylaxeprogramme an weiterführenden Schulen angeboten. Insbesondere in der Pubertät nimmt die Neigung zu gesundheitsgefährdenden Verhaltensweisen zu, so dass es besonders in dieser Altersgruppe wichtig erscheint, gesundheitsförderndes Verhalten zu unterstützen. Daher stellt sich die Frage, inwiefern sich ein mehrwöchiges Zahnprophylaxeprogramm mit naturwissenschaftlichen Ansatz, auf das Zahnpflegeverhalten von Jugendlichen an weiterführenden Schulen auswirkt. Neben der Wirksamkeit der Intervention als zentraler Gesichtspunkt wurde auch die Beeinflussung des Selbstbildes, der Lebenszufriedenheit sowie der emotionalen Kontrolle der Probanden analysiert. Es nahmen 59 Schülerinnen und Schüler zwischen zehn und 15 Jahren am Zahnprophylaxeprogramm teil. Die Durchführung erfolgte an zwei weiterführenden Schulen mit je einer Interventions- und einer Wartekontrollgruppe. Die Studienteilnehmer durchliefen eine mehrwöchige, mundgesundheitsfördernde Intervention mit fünf Unterrichtseinheiten rund um die Themen Mundhygiene, Kariesentstehung sowie zahngesunde Ernährung. Während der gesamten Studiendauer wurde der Zahnstatus der Studienteilnehmer, die Selbsteinschätzung ihrer exekutiven Funktionen und der Bildungsstand der Eltern erhoben. Zudem wurde zu fünf Messzeitpunkten der Mundhygienestatus , das Mundgesundheitsverhalten sowie das Selbstbild und die Lebenszufriedenheit der Probanden dokumentiert. Es wurde eine Verbesserung der Mundhygiene der Kinder und Jugendlichen bezüglich des Plaque-Index sowie eine Zunahme der Zahnputzfrequenz konstatiert. Das Prophylaxeprogramm zeigte eine sehr positive Wirkung, sodass eine flächendeckende Mundgesundheitsförderung von Kindern und Jugendlichen im Rahmen schulbasierter Prophylaxeprogramme an weiterführenden Schulen wünschenswert wäre.

The effective cleaning of interdental spaces using toothbrushes is a challenge. The aim of the present in vitro study was to evaluate on the one hand the interdental cleaning efficiency and on the other hand the gingival injury potential of an electric single-headed sonic toothbrush (Water-pik) and two single-tufted manual toothbrushes (Curaprox 1009; Lactona Interdental Brush). Brushes were evaluated using a brushing device. Test dental casts (maxillary sextants) consisting of black teeth coated with white paint were brushed using standardized horizontal movements. Thereafter, black (i.e. cleaned) areas were measured planimetrically. The soft tissue injury potential was evaluated using front segments of porcine mandibles. In the same brushing device, test brushes were moved over the gingiva. Before and after each treatment, the porcine mucosa was stained with a plaque disclosing agent to visualize injured areas, which could then be measured planimetrically as well. These evaluations were each made after 15, 30, 60, and 120 seconds of brushing. The statistical analysis was performed using non-parametric Mann-Whitney tests, and the level of significance was set at 5%. The best cleaning performance of 46% across all interdental spaces assessed was found with the electric sonic toothbrush (Waterpik), while the performances of the manual brushes from Lactona and Curaprox were 14.8% and 5%, respectively. At each point of evaluation, the gingiva was injured most markedly by the powered sonic toothbrush (Waterpik), followed by the manual Curaprox brush. The smallest damage of the porcine gingiva was produced by the manual Lactona brush. When comparing the manual toothbrushes, the Lactona product revealed a better cleaning performance combined with a smaller injury potential than the Curaprox brush. Thus, the prophylactic goal to achieve high degrees of cleaning while producing minimal damage is important and should have priority when evaluating and selecting toothbrushes.

In der vorliegenden Arbeit sollte geklärt werden, ob und welche Schäden durch eine Ansäuerung des Tränkwassers mit Salzsäure auf pH2, welche als hygienische Maßnahme zum Erhalt der Wasserqualität angewandt wird, an den Zähnen von konventionellen und keimfreien Laboratoriumsmäusen auftreten. Vier Versuchsgruppen zu je 10 Tieren wurden eingesetzt. Gruppe 1 : Konventionelle Tiere (Leitungswassertränke) Gruppe 2 : Konventionelle Tiere (Leitungswassertränke, angesäuert) Gruppe 3 : Keimfreie Tiere (Leitungswassertränke, autoklaviert) Gruppe 4 : Keimfreie Tiere (Leitungswassertränke, autoklaviert, angesäuert) Die Tränke mit angesäuertem Wasser erfolgte über einen Zeitraum von 7 – 9 Wochen. Als Untersuchungsparameter wurden gewählt: 1\. Bestimmung von Zahnbelag (Plaque- Index nach Silness und Löe (1964)) 2\. Zahnhartsubstanzdefekte (Severity-Index nach Radike und Muhler (1953)) 3\. Bestimmung von Erosionen und Abrieb (Sorvari et al. 1988) 4\. Fissurentiefe nach Karle et al. (1980) und 5\. Raster-Elektronenmikroskopie der (Unterkiefer)-Molaren und Incisivi. Zahnbelag wurde in allen Gruppen beobachtet. Konventionelle mit Leitungswasser getränkte Tiere hatten einen mittleren Plaque-Index von 8,4, Tränke mit angesäuertem Wasser bewirkte einen durchschnittlichen Plaque-Index von 4,0. Bei keimfreien Tieren getränkt mit Leitungswasser wurde ein Plaque-Index von 5,0, bei angesäuertem Tränkwasser von 3,6 ermittelt. Zahnhartsubstanzdefekte wurden bei konventionellen Tieren mit Leitungswassertränke mit einem Severity-Index von 3,3 beurteilt. Angesäuertes Tränkewasser ergab einen Index von 7,9. Auch bei keimfreien Tieren erhöhte Tränke mit angesäuertem Wasser den Severity-Index auf 6,9, gegenüber Tränke mit Leitungswasser (Index 2,3). Erosionen stellten sich besonders als Abnahme intakten Schmelzes dar. Auffällig ist ein bei Tränke mit angesäuertem Wasser zu beobachtender höherer Abrieb von 12,67 (konventionell) bzw. 15,49 % (keimfrei) gegenüber der Kontrollgruppe (Gruppe 1, konventionell, Leitungswasser-Tränke). Rasterelektronenmikroskopische Aufnahmen zeigten, dass bei Tränke mit angesäuertem Wasser (Gruppe 2 und Gruppe 4) an den palatinalen Höckerseiten der Molaren deutliche Ätzspuren am Schmelz und Spaltbildung an der Schmelz-Dentin-Grenze an den Höckerspitzen auftreten. An den Schneidezähnen sind an der Schneidefläche im Schmelz flächig freiliegende Prismen sichtbar, die deutlich Demineralisation zeigen., The aim of this investigation was to determine the effects of hydrochloric acid used as hygienic measure in drinking water (pH2) on teeth of conventional and germfree laboratory mice. Four groups of 10 animals each were used. Group 1 : Conventional animals (tap water) Group 2 : Conventional animals (tap water, acidified ) Group 3 : Germfree animals (tap water, sterilized ) Group 4 : Germfree animals (tap water , acidified, sterilized ) The application of acidified drinking water was applied for a period of 7 to 9 weeks. The following parameters were used to describe the effects on dental hard tissues. 1\. Plaque and dental calculus (plaque-index , Silness and Löe 1964) 2\. Defects on enamel and dentin (Severity-index, Radike and Muhler 1953) 3\. Erosions and wear (Sorvari et al. 1988) 4\. Depth of fissures (Karle et al. 1980) and 5\. Scanning-electronmicroscopy of lower jaw molars and incisivi. Dental plaque was found in animals of all groups. Conventional animals having received tap water revealed a Plaque-index of 8,4. The same phenomenon was observes for germfree animals (Plaque-index of 5,o and 3,6 respectively). Estimation of defects of enamel and dentin by the Severity-index resulted in 3,3 for the conventional tap water group, 7,9 for the conventional acidified water group. In germfree animals acidified water also elevated the index to 6,9 compared to the tap water group with an index of 2,3. In both conventional and germfree animals a significantly higher degree of tooth defects and erosions were detected. Conventional animals showed 12,7% and germfree animals showed 15,5% less intact enamel when being exposed to acidified drinking water. The analysis of scanning electronmicroscopic pictures showed clearly visible etching pattern in group 2 and 4 – mainly on palatinal surfaces of molar cusps. Additionally, Gaps at the enamel-dentine interface and denuded enamel rods on incisors could be observed. In conclusion, acidified drinking water (pH2) used as hygienic measure leads to severe tooth defects in conventional and germfree laboratory mice.

The development of the white spot demineralization associated with fixed appliance orthodontic treatment is a significant clinical problem. Several studies have reported a significant increase in the prevalence and severity of demineralization after orthodontic therapy. Orthodontists should be proactive and take active responsibility to prevent the development of WSL by educating their patients about the importance of maintaining an excellent dietary compliance and oral hygiene regime. In front of the appearance of the white spots, several preserving palliative treatments can be suggested.

Dental care of pregnant patients is a demanding task. On one hand, clinicians are facing patients with an altered physiology that may cause a greater need for treatment. On the other hand, pregnancy in itself as well as the unborn child involves potential contraindications to dental interventions. It is therefore essential that dentists be knowledgeable of the ramifications pregnancy has on medical findings and therapy. Also, clinicians must be able to conduct their treatment based on well-grounded data to avoid any harm to the pregnant woman and her unborn child. This article focuses on facts specifically relevant to clinicians. Based on most current scientific data, we aim to answer the following ten questions: 1. What are the physiological changes during pregnancy? 2. What is the adequate lying position for a pregnant patient? 3. Is there a pregnancy-related gingivitis? 4. What is the association between periodontitis, pregnancy and preterm birth? 5. Are there oral manifestations of pregnancy-related therapies? 6. Are caries and erosions inevitable during pregnancy? 7. Should the intake of fluoride be advocated? 8. Is it permissible to x-ray pregnant patients? 9. Is orthodontics contraindicated during pregnancy and 10. Which medication should be administered with caution?

Helicobacter pylori (HP) infection usually occurs in childhood. While there are various studies on the prevalence of HP in dental plaque, ours is the first to analyze its prevalence during orthodontic therapy and its interaction with competitive bacteria in adolescents. The prevalence of HP was examined before and during the first 12 weeks of orthodontic therapy with fixed appliances in 11 patients with a mean age of 12.7 years. A total of 93 plaque samples were analyzed using PCR. The data acquired at every consultation were the following: PCR analysis of dental plaque and 13C urea breath tests for HP, quantitative analyses of saliva for Lactobacilli and Streptococcus mutans, the interproximal plaque index (API), and sulcus bleeding index (SBI). The prevalence of HP in plaque was 82% before orthodontic therapy, dropping to 54% during therapy (t test, p≤0.05). In contrast to HP’s prevalence, the Lactobacilli count rose (p≤0.05). The number of Streptococcus mutans bacteria in saliva decreased during orthodontic therapy (p≤0.05). The prevalence of HP in dental plaque amounted to 82%. Orthodontic treatment did not reduce its prevalence. The prevalence of Lactobacilli was inversely proportional to that of HP.

After completion of comprehensive periodontal therapy, the main objective is to maintain gingival tissues in a clinically healthy state. Traditional methods like curettes and ultrasonic devices used during maintenance are responsible of irreversible hard tissue damages ensuing from repeated mechanical scraping of tooth surfaces. A new approach to clean root surfaces without inducing these damages may be the air-polishing technology. Original air-polishing systems are highly abrasive to root cementum and dentin and cannot be used safely in the subgingival area (risk of inducing hard and soft tissue lesions and emphysema). New low abrasive powders and nozzles were designed in order to allow access to root surfaces and to permit the use of the air-polishing devices safely. Recent clinical studies have shown the short-term clinical efficacy of such devices in residual pockets and their safety when used on root surfaces. The new subgingival air-polishing devices are perceived more acceptable by the patients and are more time efficient than scaling and root planning during maintenance. Long-term studies are still lacking to prove their clinical and microbiological efficacy.

The aim of the study was to evaluate the efficacy of Parodontax® (GlaxoSmith-Kline, Bühl, Germany) on the signs gingival inflammation and the enzyme activity of matrix metalloproteinase-8 (aMMP-8) in the gingival crevicular fluid. After approval by the ethics commission, a total of 50 volunteers participated in the study; group 1 (n = 25, age: 43 ± 12 years) with moderate gingivitis (BOP +) and group 2 (n = 25, age: 29 ± 11 years) with clinically healthy gingival conditions (BOP -). After obtaining anamnestic data, the dental examination included assessment of oral hygiene (QuigleyHein 1962), gingival inflammation (SaxerMühlemann 1975), probing pocket depth and clinical attachment level. Gingival crevicular fluid was collected from both groups. A quantitative assessment of aMMP-8 in the gingival crevicular fluid samples was performed (DentoAnalyzer, Dentognostics GmbH, Jena, Germany). Study participants were instructed to use only Parodontax®. After three weeks, all parameters were measured again. The aMMP-8 values of group 1 were significantly reduced after the use of Parodontax® toothpaste and mouthwash (p0.001; baseline median 41.25 ± 38.16 ng/ml, final post-treatment median 7.73 ± 7.58 ng/ml aMMP-8 eluate; group 2: baseline median 3.75 ± 3.16 ng/ml, final post-treatment median 3.73 ± 1.54 ng/ml aMMP-8 eluate). Gingival inflammation and plaque accumulation were reduced. It was shown that Parodontax® was effective in reducing the enzymatic activity of inflammation.

The aim of this study was to use the Zurich polyspecies biofilm model to compare the antimicrobial effects of chlorhexidine mouth rinses available on the Swiss market. As positive and negative controls, aqueous 0.15% CHX solution and water were used, respectively. In addition, Listerine® without CHX was tested. Biofilms in batch culture were grown in 24- well polystyrene tissue culture plates on hydroxyapatite discs in 70% mixed (1:1 diluted) unstimulated saliva and 30% complex culture medium. During the 64.5-hour culturing period, the biofilms were exposed to the test solutions for 1 minute twice a day on two subsequent days. Thereafter, the biofilms were dip-washed 3 times in physiological NaCl. Following the last exposure, the incubation of biofilms was continued for another 16 h. They were then harvested at 64.5 h. The dispersed biofilms were plated on 2 agar media. After incubation, colonies (CFU) were counted. All solutions containing CHX as well as Listerine ® significantly reduced the number of microorganisms in biofilms. According to their efficacy, the mouth rinses were classified into 2 groups. The two Curasept ADS solutions, Parodentosan, and the Listerine® mouth rinse reduced the number of total CFU by 3 log10 steps. This seems sufficient for a long-lasting prophylactic application. The two PlakOut® mouth rinses and the CHX control fell into the other group, where the number of CFU was reduced by 7 log10 steps. These mouth rinses are predestined for short-term therapeutic use. However, reversible side effects must be taken into account. It has thus far not been possible to formulate CHX products with effective ADS (Anti Discoloration System) additives without reducing antimicrobial activity.

In 16 rural communities of the Canton of Zurich, school-children of all age groups participated in dental examinations conducted at intervals of 4 years since 1963/64. The same standardised method was used throughout the entire period. This study documents the caries experience over a period of 45 years. From 1964 to 2009, the DM*FT per 14-year-old child fell from 12.50 to 1.31, corresponding to a caries reduction of 90%. The caries experience in 8-, 10- and 12-year-olds decreased by 90% to 92%. From 1964 to 2009, the "Significant Caries Index" (the mean DM*FT in the third of 12-year-olds with the highest DM*FT values) fell from 13.09 to 2.20, corresponding to a caries reduction of 83%. The observed caries decline was unexpectedly high. The effect of fluorides may explain a caries reduction of roughly 50%. A large part of the decline, however, remains unexplained. Possible causes are discussed in this paper.

This study examined how halitosis, oral dryness and general oral health were impacted during treatment with the Invisalign(®) system. Furthermore, the effect of a lowdose chlorhexidine solution (CHX) was evaluated.Thirtyone patients with good periodontal health participated in this crossover study and were divided into two groups (group 1: CHX/no CHX, group 2: no CHX/CHX). The following parameters were recorded during the first 8 months of Invisalign(®) treatment: stimulated saliva flow rate, organoleptic index, tongue coating index, measurement of the oral volatile sulfur compound level (ppb), modified gingival and plaque index and bleeding on probing index. Professional oral cleaning was performed at the beginning of each period lasting 3 months. The patients received a questionnaire at the first, third, fourth, sixth and eighth control visits.The very low volatile sulfur compound level was significantly decreased by CHX (0.06%) during the first examination period (p = 0.02), i.e. for the first group of patients only. Neither halitosis, nor oral dryness, nor high plaque or gingival index measurements were observed. Oral health-related quality of life was hardly influenced by wearing aligners and oral hygiene habits were very good.This study provides evidence that Invisalign(®) treatment is characterized by only minimal impairment of overall oral health and the associated quality of life. Consequently, it appears unnecessary to recommend the general adjunctive use of a low-dose chlorhexidine mouthwash during treatment with Invisalign(®).

The aim of this study was to assess the biocompatibility of orthodontic bands following exposure to the human oral environment. Cell adherence and cell morphology of gingival fibroblasts grown on 32 orthodontic bands were tested. The bands were in place intraorally for 6 to 37 months. We observed cell adherence in 76% of the previously plaque-free surfaces. Cell morphology was 50% spherical and 50% elongated. The surfaces that had had plaque attached demonstrated cell adherence in 84% of the given areas; those cells were spherical in 42% and elongated in 58%. We conclude that individual oral hygiene habits during orthodontic treatment seem to have no effect on the biocompatibility of orthodontic bands, as we failed to discern a difference in either cell adherence or cell morphology in areas with and without prior plaque attachment.

Oral jewelry is popular. One of the most widely spread types are so-called tooth diamonds made of composite materials which are applied to the teeth with an adhesive. Note that parents are required to sign a release form for under-aged patients in Switzerland. Tooth cap grills and gold teeth are considered status symbols within the Hip-Hop fashion scene. However, tooth ornaments favour the accumulation of plaque and can diminish the ability to articulate. With respect to jewelry in oral soft tissue especially tongue and lip piercings are of significance to dentists. Besides the systemic complications, which are mostly caused by a lack of hygiene or the failure of noting medical contraindications by the piercer, local complications occur frequently. After surgery, pain, swelling, infections as well as hemorrhages or hematomas can be observed. Long-term effects can be problematic: gingival recession can be discernes mainly in the case of lip piercings the loss of hard tooth substance in the case of tongue piercings. Because of that, conservation therapies can become indespensable. Patients wearing dental jewelry have to be aware of risks of tooth damage, and they regularly have to undergo dental check-ups. Information campaigns--for dentists as well as patients--are necessary.

Inflammatory disorders of the periodontium are often associated with chronic systemic diseases, which can demonstrate a reciprocal influence. Within the adult population at present, 74% of younger adults and 88% of older individuals require periodontal treatment. Due to inflammatory processes, patients with rheumatoid arthritis or other chronic polyarthritides frequently suffer from pain in the temporomandibular joint and, since finger mobility is often limited, their ability to perform oral hygiene measures is impeded. However, diligent and constant oral hygiene is of crucial importance both for maintaining a healthy periodontium and to prevent the development of caries. For their daily dental care, these patients should favor the use of electric toothbrushes, products for interdental cleaning and mouth rinses. The dentist should be informed immediately about increased and constant gingival bleeding, gingival hyperplasia, loosening or migration of teeth associated with gingival recession or other irritations in the oral cavity. Professional dental cleaning should be routinely performed at 3- to 6-month intervals in order to prevent an increase in the risk for periodontal disease.

The aim of the study was to report on oral, dental and prosthetic conditions as well as therapeutic measures for temporarily institutionalized geriatric patients. The patients were referred to the dentist since dental problems were observed by the physicians or reported by the patients themselves. This resulted in a selection among the geriatric patients; but they are considered to be representative for this segment of patients exhibiting typical signs of undertreatment. The main problem was the poor retention of the prosthesis, which was associated to insufficient masticatory function and poor nutrition status. Forty-seven percent of the patients were edentulous or had maximally two radicular rests out of function. Altogether 70% of the maxillary and 51% of the mandibular jaws exhibited no more teeth. Eighty-nine percent of the patients had a removable denture, and it was observed that maxillary dentures were regularly worn in contrast to mandibular dentures. The partially edentate patients had a mean number of ten teeth, significantly more in the manidublar than maxillary jaw. Treatment consisted mainly in the adaptation and repair of dentures, tooth extractions and fillings. Only few appointments (mostly two) were necessary to improve the dental conditions, resulting in low costs. Patients without dentures or no need for denture repair generated the lowest costs. Slightly more visits were necessary for patients with dementia and musculoskeletal problems. The present findings show that regular maintenance care of institutionalized geriatric patients would limit costs in a long-term perspective, improve the oral situation and reduce the need for invasive treatment.

Forms of a localized erythema can be observed occasionally as an expression of inflamed gingiva. It is characterized by a localized sharply demarcated and painless swelling of the gingiva with considerable redness. The differential diagnosis is not unequivocal and appropriate diagnosis and therapy are a challenge. In the present case presentation we report on three cases, which showed good disease remission after simple antiseptic prophylactic measures. Based on the available literature possible etiologic factors are reviewed and a pragmatic treatment strategy is discussed.

Periodontitis is caused by an opportunistic infection with pathogenic microorganisms of the oral biofilm. In this paper, we discuss the usefulness of microbial diagnostics with respect to the differential diagnosis or the treatment approaches of periodontal diseases. Several diagnostic techniques, based on morphological, enzymatic, cultural, genetic or antigenetic properties have been established to analyze the microbial flora. Among the bacterial species some virulent genotypes of P. gingivalis play an important role in the etiology of periodontitis. Expression of fimbriae or different proteases have been identified as potential virulence factors of this gram negative anaerobic rod. To date a characterization of virulence of specific strains or a correlation between expression of different virulence factors and distinct periodontal conditions, however, is missing. Therefore, the importance of a routine identification of P. gingivalis still needs further evaluation.

Toothbrushing is still the most effective method to maintain healthy conditions for teeth and gingiva. Over the last decades various manual and electric toothbrushes were developed to simplify oral hygiene and to shorten the duration of plaque removal. The aim of this study was to compare the effectiveness of two conventional toothbrushes and a three-headed toothbrush. Over a period of eight months 47 schoolchildren, aged between five and nine years, used different toothbrushes (one conventional medium-hard "Pingu", one conventional soft "CuraKid" and the three-headed toothbrush "Superbrush"). The study had a balanced, single blinded cross-over design. The children were assigned to one of two groups balanced with respect to the O'Leary Plaque Index. Following instructions, one group used a conventional brush during two months, the other group the"Superbrush". After two months they changed the brushes. After eight months the children had used all three brushes. The children were instructed to keep their usual oral hygiene habits. At the start and the end of each experimental period, the presence of plaque and gingival inflammation were recorded. A significant improvement of plaque removal and reduction of the gingival inflammation over eight months were noticed for all three brushes (P0.05). There were no significant differences in the cleaning efficiency between the three toothbrushes (P0.05). Significant improvements in plaque removal in children can be achieved following good brushing instructions regardless of the toothbrush design used.

In addition to conventional treatment modalities (mechanical and chemical), the use of different lasers has been increasingly proposed for the treatment of peri-implantitis. Results from both controlled clinical and basic studies have pointed to the high potential of an Er:YAG-laser. Its excellent ability to effectively ablate dental calculus without producing major thermal side-effects to adjacent tissue has been demonstrated in numerous studies. Recently, a new ultrasonic device has been used for the treatment of periodontal and peri-implantitis infections. Preliminary clinical data indicate that treatment with both treatment procedures may positively influence peri-implant healing. The aim of the present review paper is to evaluate, based on the available evidence, the use of an Er:YAG-laser and a newly introduced ultrasonic device for treatment of peri-implantitis in comparison to a conventional treatment approach.

The tea tree oil (melaleuca alternifolia) has antiseptic, fungicide and bactericide effects. The efficiency against oral bacteria was also evident. Xylitol is known for counterattacking the cariogenic effect caused by the streptococcus mutans. Less plaque was developed during the time of the study.

Fusobacterium nucleatum is one of the most frequently cultured bacteria from subgingival plaque. It can be isolated from active periodontal lesions as well as from healthy sites. Currently, F. nucleatum has been divided into five subspecies. An early hypothesis suggested an association between certain subspecies and periodontal disease or health. On the other hand, a broad heterogeneity between F. nucleatum isolates has been suggested, so that the subspeciation scheme and therefore the proposed association may not be valid. The purpose of the present study was to analyze if clonal differences exist between human F. nucleatum isolates from either periodontally healthy or diseased individuals. 23 F. nucleatum isolates from periodontally healthy and 17 isolates from periodontally diseased individuals were analysed by ribotyping. A broad genetic heterogeneity was present, although some of the isolates from periodontally healthy individuals were genotypically identical. However, no clonal differences between isolates from periodontally healthy or diseased individuals was detected.

The aim of the present study was to investigate changes in the subgingival flora in adults with chronic periodontitis undergoing orthodontic fixed appliance therapy.In seven adult patients who had undergone nonantibiotic periodontal pretreatment, the subgingival bacteria were subjected to microbiological examination and the number of periodontopathogenic organisms was determined before (T1: prior to treatment being started), during (T2: 6 weeks after orthodontic treatment was started) and after the end of orthodontic treatment (T3: 6 weeks after removal of the fixed appliances).During the fixed appliance therapy (metal brackets, NiTi archwires, stainless steel archwires), a marked reduction was observed in the total bacteria count from the subgingival pocket despite the clinical periodontal parameters remaining almost unchanged. However, the total count of some highly pathogenic bacteria rose again slightly after the end of treatment. We attribute the marked improvement in the periodontopathogenic bacteria spectrum under fixed appliance therapy with metal brackets, NiTi archwires and stainless steel archwires to metal corrosion entailing the release of primarily nickel ions, which have a toxic effect on bacteria and thus enable the regeneration of the physiological bacterial flora. In none of the patients was a deterioration of the periodontal status observed during and after fixed appliance therapy.

Poor metabolic control of diabetes mellitus has often been associated with the severity of periodontal disease. This case report describes the diagnosis, therapeutic concept, treatment steps, and long-term monitoring of a 22-year-old female with generalized aggressive periodontitis who had a history of type 1 brittle diabetes mellitus. The main objective was to treat the patient with periodontal surgery despite the difficult baseline situation to avoid tooth loss that would have been accompanied by a need for prosthodontic treatment. The mean of glycosylated hemoglobin [figure: see text] measurement (HbA1c) was used to indicate the long-term control of diabetes mellitus. This report proves the efficiency of periodontal therapy in the prevention of future periodontal breakdown and improvement of the HbA1c level in a systemically compromised patient.

The prevention of caries and gingivitis is mainly based upon modalities aiming to reduce supra- and subgingival dental plaque. Certain antibacterial agents may compensate for non-adequately self-performed mechanical plaque removal. While such prophylactic agents exhibit an antibacterial effect against oral microorganisms, the new agent delmopinol possesses the property of inhibiting the adhesion of oral microorganisms to the tooth surface. In numerous studies, delmopinol showed a plaque inhibitory potential. However, due to the lower efficacy and side effects similar to those of chlorhexidine, at present, delmopinol cannot be considered as an alternative to chlorhexidine. A long-term utilization of delmopinol in addition to the regular mechanical plaque control might be possible. For the time being there is a lack of studies comparing the efficacy of delmopinol to that of other antibacterial substances such as amine fluoride/stannous fluoride, triclosan/copolymer or cetylpyridinium chloride.

(I) Introducing an intraoral camera system with a special positioner to allow computer-based analysis of reproducible images on lingual tooth surfaces and (II) comparing plaque removal by three manual toothbrushes with different brushhead designs (convex, multilevel and flat trimmed) on lingual mandibular tooth surfaces.In a clinical single-blind, crossover, 24-h plaque-regrowth study on 25 subjects, a computer-based index (PPI) was used to evaluate pre- and postbrushing plaque on lingual surfaces of mandibular premolars and molars. Subjects brushed their teeth under standardized conditions at three visits, each time with a different, randomly assigned toothbrush.The intraoral camera system allowed a reproducible and relatively convenient access to the lingual surfaces of the mandibular teeth and provided an increase in objectivity. Overall, each brush achieved statistically significant plaque removal, however, none reached clinical relevance. The multilevel brush was superior at specific sites, but failed to show statistically significant superiority in terms of overall plaque reduction. Without regard of the toothbrush used, the right handed subjects were less efficient in removing plaque from the right side compared to the left.The method is able to detect even small differences in plaque reduction. None of the different brushhead designs was able to compensate an insufficient brushing techniques.

The periodontal region is a source of gram-negative bacterial infection. The pathogens involved have recently also been demonstrated in atheromatous plaques. They may increase the risk of myocardial infarction. In this study a strategy for eradicating periodontal bacteria and thus healing in patients with periodontal pockets and advanced destruction of alveolar bone was examined.Initial periodontal status was documented in 36 patients with periodontitis (24 women, 12 men) who were then randomly assigned to one of three groups. Those in two of the groups were given either metronidazole or doxycycline orally as adjuvant treatment, while the third group received no antibiotics. Patients in all groups were treated according to a two-step procedure. In step 1, extensive supra- and subgingival plaques and concrements were removed. In step 2, root debridement and/or closed curettage of all pockets was undertaken in one visit, and the antibiotic given to the patients in groups 1 and 2. Results were assessed 3 weeks after the first step and 6 months, 2 and 4 years after step 2.The initial examination at 3 weeks revealed significant changes in all three groups with regard to the incidence of plaque and sulcus bleeding, but not regarding probing depth and attachment level. However, there were significant changes in probing depth and attachment level in all groups after step 2. Periodontal attachment was significantly improved at 2 and 4 years in the patients on metronidazole, but not those on doxycycline or no antibiotics. The greatest decrease in bleeding tendency was recorded in the metronidazole group. This group also had the greatest gain of new alveolar bone compared with the other two groups. Complete eradication of Porphyromonas gingivalis and Actinobacillus (Hemophilus) actinomycetemcomitans, important pathogenic bacteria that may have an atherogenic action, was obtained only in patients on metronidazole.The tissue-sparing two-step procedure brought about good clinical and radiological results, which can be significantly bettered by the addition of metronidazole, achieving eradication of pathogens involved in periodontal disease.

In a prospective plaque regrowth study focusing on oral hygiene during fixed appliance therapy 12 adolescent patients (mean age 14.1 +/- 1.5 years) were evaluated twice over 2-day test periods. In the randomized, double-blind study the influences of a 0.2% chlorhexidine mouthrinse (Corsodyl, CHX) and a commercially available dentifrice supplementing fluoride (Odol-med-3) were compared intra- and interindividually in a crossover design with regard to the bacteriological parameters. The bacteriological parameters of vital fluorescence, bacteriological counts (BC), colony forming units (CFU), plating efficiency (PE) and mutans streptococci (MS) were related to the clinically assessed indices of plaque and gingivitis. All parameters analyzed demonstrated significant differences between the control and the test (chlorhexidine) group. Where-as the values of BC, CFU, and PE progressively increased in the control group from T0 to T2, these parameters distinctly decreased in the chlorhexidine group. All values of vital flora (VF) scored around 75% in the control group compared to values of 30% in the test group. BC, CFU und PE correlated significantly. The score of mutans streptococci persisted or increased in the controls whereas mutans streptococci approached 0 in the chlorhexidine group. Until the 5th day of washout a clear-cut carry over of the chlorhexidine rinse on mutans streptococci as well as on the gingival index was evident. Since dead microorganisms remain on the tooth surface and in order to maintain oral health, chlorhexidine application might advisedly be supplemented by mechanical plaque control.

In a prospective plaque regrowth study focusing on oral hygiene during fixed appliance therapy 12 adolescent patients (mean age 14.1 +/- 1.5 years) were evaluated twice over 2-day test periods. In the randomized, double-blind study the influence of a 0.2% chlorhexidine (CHX) mouthrinse (Corsodyl) and a commercially available dentifrice supplementing fluoride (Odol-med-3) were compared intra- and interindividually in a crossover design with regard to plaque and gingivitis. Before starting the first test phase there was a 14-day preliminary phase for upgrading the oral hygiene. Between the 2 test phases was a 5-day "washout". On the last day of the second test phase the patients were asked to fill in a questionnaire concerning their experiences during the study. The 0.2% Corsodyl reduced the plaque index scores significantly (p0.001). The gingival index revealed a similar reduction (2nd day of test: p = 0.03). Until the 5th day of washout a clear-cut carryover effect of the chlorhexidine rinse on the gingival index was observed. Both the lower mean values of the 2 clinical parameters at the beginning of the test phases as compared with those at the beginning of the preliminary phase and the evaluation of the questionnaires indicated a possible Hawthorne effect. 0.2% Corsodyl may be employed as an adjunct to other preventive measures such as professional care and patient-oriented instruction on an intermittent basis in order to reduce the plaque-induced iatrogenic side effects and to enhance the efficacy of oral hygiene measures in connection with orthodontic therapy with fixed appliances.

There are several discrepancies with respect to the composition of subgingival plaque in gingivitis and in inactive adult periodontitis (AP). In this study we compared subgingival plaque samples taken from gingivitis sites to those from inactive periodontitis sites of the same patients. Of 44 patients plaque samples from 86 gingivitis sites and 92 periodontitis sites were analysed. Darkfield microscopy showed a higher proportion of spirochetes and mobile rods in the periodontitis sites. Analysis of cultures revealed a higher and statistically significant number of anaerobes in the periodontitis sites (1.7 x 10(7) vs 3 x 10(6), p = 0.006). The following bacterial species were isolated more frequently from periodontitis sites than from gingivitis sites: Actinobacillus actinomycetemcomitans (18% vs 10%), as well as the black-pigmented Prevotella intermedia (68% vs 48%) and Porphyromonas gingivalis (48% vs 28%). On the one hand, these small differences in the bacteriological parameters can be explained by the fact that both gingivitis and periodontitis plaque samples were taken from the same periodontitis patients. An infection of the gingivitis sites from the parodontitis sites within the same patient could not be excluded. On the other hand, the mean probing depth of the gingivitis sites was relatively high, 3.6 mm (measuring point interdental plus pseudo-pocket) which may favor the growth of anaerobic bacteria.

In view of the possibility of reinfection after successful treatment and the pitfalls in eradicating Helicobacter pylori (H. pylori) from gastric mucosa, it is of great interest to identify natural reservoirs for this organism, other than the stomach. This review discusses the results of investigations as to whether H. pylori can be harboured in the microaerobic environment of dental plaques in saliva. Only few data are available on the prevalence of H. pylori in the mouth. Data from conventional microbiological technique studies are contradictory, with the prevalence varying from 3.4% to 100%. Different diagnostic procedures were used to identify H. pylori, but only a few seem to be reliable enough to detect H. pylori in clinical samples taken from the mouth. Moreover, insufficient information is provided on the role of hygienic conditions in the investigated oral cavity and the existence of gingival or periodontal disease. The mechanisms of oral colonisation with H. pylori are still unknown. Human periodontal disease is associated with a complex microflora in which more than 350 microbial species can be encountered. The periodontal pocket may be important as a natural reservoir for H. pylori, because it can provide microaerobic conditions. Recently reported molecular techniques such as the highly sensitive and specific polymerase chain reaction (PCR) may help to clarify the prevalence of oral carriage of H. pylori in future.