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Objective: This clinical investigation evaluated oral health improvements after the use of a novel zinc toothpaste in comparison to a control after 3 weeks and 6 weeks of use. Clinical assessments of gingivitis, bleeding and dental plaque evaluated oral health. Methods: Healthy adults meeting the study criteria (plaque index scores ≥ 1.5 and gingival index scores ≥ 1.0) were randomized into a treatment group with 74 participants assigned to the test and 73 participants assigned to the control groups. With the assigned toothpaste, subjects were instructed to brush at home twice a day for one minute. Subjects were evaluated clinically for gingivitis, plaque and bleeding at the baseline, employing 3-week and 6-week examinations. Results: All one hundred and forty-seven (147) subjects completed the 6-week study with no significant differences between groups at baseline (p > 0.05). The test demonstrated progressive improvements at the 3-week and 6-week evaluations as compared to the control (p < 0.001). In comparison to the control, the test demonstrated reductions of 13.4%, 17.0% and 55.3% for gingivitis, dental plaque and gingival bleeding, respectively, at the final visit (p < 0.001). Conclusions: Clinical improvements in gingivitis, dental plaque and gingival bleeding were registered in the group assigned the test toothpaste as compared to the control. The test toothpaste demonstrated statistically significant and progressively improving gingivitis, dental plaque and gingival bleeding scores that were all statistically significant versus the control at each post-treatment assessment. [ABSTRACT FROM AUTHOR]

Objective: This clinical investigation evaluated oral health improvements after the use of a novel zinc toothpaste in comparison to a control after 3 weeks and 6 weeks of use. Clinical assessments of gingivitis, bleeding and dental plaque evaluated oral health. Methods: Healthy adults meeting the study criteria (plaque index scores ≥ 1.5 and gingival index scores ≥ 1.0) were randomized into a treatment group with 74 participants assigned to the test and 73 participants assigned to the control groups. With the assigned toothpaste, subjects were instructed to brush at home twice a day for one minute. Subjects were evaluated clinically for gingivitis, plaque and bleeding at the baseline, employing 3-week and 6-week examinations. Results: All one hundred and forty-seven (147) subjects completed the 6-week study with no significant differences between groups at baseline (p > 0.05). The test demonstrated progressive improvements at the 3-week and 6-week evaluations as compared to the control (p < 0.001). In comparison to the control, the test demonstrated reductions of 13.4%, 17.0% and 55.3% for gingivitis, dental plaque and gingival bleeding, respectively, at the final visit (p < 0.001). Conclusions: Clinical improvements in gingivitis, dental plaque and gingival bleeding were registered in the group assigned the test toothpaste as compared to the control. The test toothpaste demonstrated statistically significant and progressively improving gingivitis, dental plaque and gingival bleeding scores that were all statistically significant versus the control at each post-treatment assessment.

Aim of the study. The aim of the study was to evaluate the Romanian children’s perception regarding 2 of the most common oral pathologies, dental caries and gingivitis in correlation with oral health behaviours. Methods. This was a cross-sectional study. The answers to 2 questionnaires distributed to children 12-15 years old from 2 schools in Bucharest, Romania were analyzed. One questionnaire included questions related to oral pathology, and the other to oral health maintenance behaviour. In our dental research study we made use of descriptive statistics in order to summarize continuous and categorical variables. The test used to examine relationship between children’s perceptions and their behaviours was Roa-Scott chi-square test Results. All 137 children who participated in the study completed both questionnaires. Among them, 62% considered that a broken tooth is not a form of disease, but still 94.8% of them would go to the dentist. Regarding gingival bleeding, even if its presence as a sign of illness was not conclusive, most children (78.8%) considered that this sign requires medical attention. The frequency of sugar consumption in our study was low in 80.3% of children, and the frequency of brushing was more than once a day for 77.4% of subjects. Conclusions. Although most children perceived dental cavity as a disease and, gingival bleeding as not a sign of illness., there was a consensus regarding both conditions, that is, the necessity of dental treatment. Awareness of the need for dental treatment in case of signs for these two diseases is very important for promoting preventive dental programs for children.

The behavior of periodontal clinical indicators in metabolic syndrome (MetS) and fatty liver disease (NAFLD) are not clearly defined. It's even considered that high-risk cases for NAFLD are currently underreported or not identified in a timely manner. The aim of the study is to elucidate the interaction of periodontal clinical indicators in MetS and NAFLD. Materials and methods : 336 patients were eligible because they met the diagnostic criteria for metabolic syn -drome and nonalcoholic fatty liver disease. Those selected were randomly selected for a cross-sectional study. Metabolic status and non-alcoholic fatty liver disease were measured using the MetS Metabolic Syndrome Diagnostic Criteria (NCEP/ATP-III) and laboratory tests, respectively. In addition, periodontal clinical indicators were evaluated: probing depth, clinical attachment, plaque index and gingival bleeding. The association for NAFLD and probing depth was p = 0.736. The association for MetS and probing depth was p = 0.598. For NAFLD and clinical attachment loss, the association was p = 0.751. For MetS and clinical attachment loss, the association was p = 0.435. The plaque index for MetS was p = 0.238. The plaque index for NAFLD was p = 0.269. The gingival bleeding association for NAFLD was p = 0.673 and for MetS was p = 0.522. Periodontal clinical indicators of metabolic syndrome were as-sociated with elevated serum levels of low-density lipoproteins (LDL), HDL-cholesterol, and triglycerides. However, when comparing the values in NAFLD and MetS, a greater significance is evident in the first study group. [ABSTRACT FROM AUTHOR]

Objectives: Smoking is a significant risk factor for gingivitis and has detrimental effects on both oral health and the cardiovascular system. This study aimed to evaluate the association between cardiovascular biomarkers and gingival bleeding among smokers. Materials and Methods: This cross-sectional study comprising 60 smokers (mean age, 59.9±13.7 years) was conducted at an outpatient smoking cessation clinic. The smokers were divided into two groups based on the presence or absence of gingival bleeding, which was assessed by probing. α1-antitrypsin low-density lipoprotein complex (AT-LDL), an oxidatively modified LDL complex, causes progressive atherosclerosis. The clinical characteristics and blood markers including AT-LDL levels were measured in these patients. Results: Significantly higher (p=0.03) levels of AT-LDL, an oxidized LDL complex that promotes atherosclerosis, were observed among smokers with no gingival bleeding on probing when compared to that among smokers with gingival bleeding. The pocket depths in smokers without gingival bleeding were significantly (p=0.04) lower than those among smokers with gingival bleeding. Conclusion: The absence of gingival bleeding among smokers was associated with higher levels of AT-LDL. These findings could indicate reduced blood flow due to atherosclerosis among smokers with no gingival bleeding.

The search for hereditary bleeding disorders (HBD) prior to invasive procedures in children is primarily based on personal and family bleeding history. Although several scores are available, they have only been evaluated in specific situations or in adults. Our monocentric retrospective study aimed to analyze the association between clinical history and four scores (HEMSTOP, PBQ, ISTH-BAT, TOSETTO) and the diagnosis of MHC in children referred to the University Hospital of Montpellier for hemostasis investigations. A total of 117 children were retrospectively included in the study. Of these, 57 (49%) were diagnosed with HBD, with 30 having primary bleeding disorders and 27 having coagulation disorders. The diagnosis of HBD was significantly associated with gingival bleeding, which was present in 30% of HBD patients. In our population, only the HEMSTOP score showed an association with the diagnosis of HBD, but it was positive in only 48% of patients. By including gingival bleeding as a factor, we modified the HEMSTOP score, which increased its sensitivity from 0.45 to 0.53. When examining primary bleeding disorders, the modified HEMSTOP score, with the inclusion of gingival bleeding, enables us to diagnose 63% of patients (see Fig. 1). Conclusion: Therefore, gingival bleeding should be considered a useful factor in bleeding history for HBD diagnosis. Adding this symptom to a screening score such as HEMSTOP improves its sensitivity. To confirm our findings, a prospective study is required. Trial registration: Study registration number: NCT05214300. What is Known: • Screening for hereditary bleeding disorder diseases is a necessity and a challenge in children. • Minor disorders of primary hemostasis are the most common, but often escape standard coagulation tests. What is New: • Gingival bleeding is a frequent symptom that is easy to investigate and may point to a primary hemostasis disorder. • Adding the gingival bleeding item to a routine screening score such as HEMSTOP improves sensitivity. [ABSTRACT FROM AUTHOR]

This article discusses a study conducted on Romanian children's perceptions and behaviors related to dental cavities and gingival bleeding. The study found that most children recognized dental cavities as a disease and understood the need for dental treatment. However, their perception of gingival bleeding as a sign of illness was not clear. The study emphasizes the importance of promoting preventive dental programs and raising awareness about the need for dental treatment among children. The article also includes a list of references that cover various aspects of oral health, providing valuable information for further research. [Extracted from the article]

Abstract Background Plaque-induced gingivitis is a chronic inflammatory condition characterized by complete reversibility of tissue damage once the periodontal biofilm has been disorganised. The aim of this study was to evaluate the efficacy of two commercially available mouthwashes (MWs) versus a chlorhexidine (CHX) 0.12% MW in reducing gingival bleeding (GB) in adults with plaque-induced gingivitis. Methods The present study was a double-blind, parallel, randomized controlled trial involving 6492 gingival sites (i.e. 39 subjects × 28 teeth × 6 sites/tooth) aged 18–75 years. During a 2-week period, subjects were randomized to receive MWs: a control CHX 0.12% MW (group C, 1818 sites); a MW test containing CHX 0.09% + Citrox®/P complex (group CX, 2628 sites); a MW test based on natural compounds (group P, 2016 sites). GB was assessed at the inclusion visit (T0) and after 2 weeks of MW use (T1). Analyses of GB were compared between groups and then restricted to subjects with bleeding sites between 10 and 30% (moderate gingivitis) or ≥ 30% (severe gingivitis) at T0. Pairwise comparisons were made between groups and logistic regression was used to identify correlates of GB (T1). Results For total bleeding site analysis, GB reduction between T0 and T1 ranged from 23% (C), 26% (CX) and 36% (P), respectively (all p

ABSTRACT Purpose: The presented study was aimed to investigate the level of interest in gingival bleeding among internet users and its relationship with. demographic. economic and temporal variables. Materials and Methods: In this study. the relative search volume of the term "gum bleeding" both quarterly and annually from the data provided by Google Trends for 2017-2021 was analysed. The provincial level of interest in this term was analyzed along with the gross domestic product. population. data on illiteracy and data on dental visit obtained from the Turkish Statistical Institute and the Ministry of Health of the Republic of Turkey. Statistical significance was set at p0.05). Analysis of quarter-based data showed a lower volume for the term in the third quarters each of 2021. 2020. and 2018 compared to the other quarters (p=0.012. p=0.035. p 0.05). Conclusion: The outcomes revealed that gingival bleeding. an early sign of periodontal disease. exhibits seasonal variations. with a decrease during the summer months. No direct relationship was observed between provincial interest level and any variables. Google Trends data provides valuable insights into user interest in gingival bleeding. contributing to the understanding of public awareness of periodontal diseases.

Background: To investigate the effects of combinations of mechanical (brushing and flossing) and chemotherapeutic regimens which included essential oils (EO) non-alcohol and alcohol-containing mouthrinses compared to brushing only in the prevention and reduction of plaque, gingivitis, and gingival bleeding. Methods: This was a randomized, virtually supervised, examiner blind, controlled clinical trial. Following informed consent and screening, subjects (N = 270) with gingivitis were randomly assigned to one of the following regimens: (1) Brush Only (B, n = 54); (2) Brush/Rinse (EO alcohol-containing mouthrinse) (BA, n = 54); (3) Brush/Rinse (EO non-alcohol containing mouthrinse) (BZ, n = 54); (4) Brush/Floss (BF, n = 54); (5) Brush/Floss/Rinse (EO non-alcohol containing mouthrinse) (BFZ, n = 54). Unflavored waxed dental floss (REACH unflavored waxed dental floss), and fluoridated toothpaste (Colgate Cavity Protection) were used. Examinations included oral hard and soft tissue, plaque, gingivitis, gingival bleeding, probing depth and bleeding on probing. Results: After 12 weeks, both BA and BZ and the BFZ group were superior in reducing interproximal plaque (30.8%, 18.2%, 16.0%, respectively), gingivitis (39.0%, 36.9%, 36.1%, respectively), and bleeding (67.8%, 73.6%, 79.8%, respectively) compared to B. The BF group did not provide significant reductions in interproximal plaque but did reduce interproximal gingivitis (5.1%, p = 0.041) at Week 4 and bleeding at Weeks 4 and 12 (34.6%, 31.4%, p < 0.001 respectively) compared to B. The BFZ group did not significantly reduce interproximal plaque, gingivitis or bleeding compared to BZ. Conclusions: This study demonstrated that the addition of EO non-alcohol containing mouthrinse to the manual toothbrushing and flossing regimen further reduces plaque, gingivitis and bleeding showing that addition of EO mouthrinses (alcohol or non-alcohol containing) to the oral hygiene regimen provides sustained reductions in plaque to help maintain gingival health after a dental prophylaxis. Dental professional recommendation of the addition of an EO non-alcohol containing mouthrinse to daily oral hygiene routines of brushing or brushing and flossing should be considered to aid supragingival plaque control and improve gingivitis prevention. Study registry number: NCT05600231. [ABSTRACT FROM AUTHOR]

Introduction: This systematic review and meta‐analysis tests the effectiveness of dental water jet (DWJ) with manual toothbrushes (MTB) compared to MTB alone in oral health maintenance in orthodontic patients. Methods: Four databases were systematically searched: PubMed, Scopus, Web of Science (WoS) and Cochrane Library until 6 January 2022 using a combination of medical subject heading (MeSH) terms and keywords. Randomized clinical trials (RCTs) were only included and critically appraised using the Cochrane Risk of Bias (ROB) tool. The mean difference (MD) effect measure was calculated using the Mantel‐Haenszel statistical test (95% confidence interval [CI]) to compare both study groups (p‐value < 0.05). Results: After reviewing 5881 studies from a systematic search, six were selected for inclusion, with four involved in the quantitative analysis. The risk of bias was low in two studies, moderate in two studies and high in the remaining two studies. The meta‐analysis showed a significant improvement in plaque index and bleeding scores in DWJ + MTB group compared MTB alone group in orthodontic patients with generalized gingivitis (MD = −0.75, 95% CI [−1.29, −0.22], p = 0.006) and (MD = −0.17, 95% CI [−0.27, −0.08], p = 0.0003), respectively. However, no significant improvement was detected between both groups in the gingival index. Conclusions: The use of DWJ as an adjunctive device in addition to MTB can be an effective strategy for maintaining oral hygiene in orthodontic patients with gingivitis. However, more high‐quality RCTs are needed to confirm the findings. [ABSTRACT FROM AUTHOR]

Introduction: Periodontal disease (PD) presents a substantial global health challenge, encompassing conditions from reversible gingivitis to irreversible periodontitis, often culminating in tooth loss. The gut-oral axis has recently emerged as a focal point, with potential gut microbiota dysbiosis exacerbating PD. Methods: In this study, we employed a double-sample bidirectional Mendelian randomized (MR) approach to investigate the causal relationship between specific gut microbiota and periodontal disease (PD) and bleeding gum (BG) development, while exploring the interplay between periodontal health and the gut microenvironment. We performed genome-wide association studies (GWAS) with two cohorts, totalling 346,731 (PD and control) and 461,113 (BG and control) participants, along with data from 14,306 participants’ intestinal flora GWAS, encompassing 148 traits (31 families and 117 genera). Three MR methods were used to assess causality, with the in-verse-variance-weighted (IVW) measure as the primary outcome. Cochrane’s Q test, MR-Egger, and MR-PRESSO global tests were used to detect heterogeneity and pleiotropy. The leave-one-out method was used to test the stability of the MR results. An F-statistic greater than 10 was accepted for instrument exposure association. Results and conclusion: Specifically, Eubacterium xylanophilum and Lachnoclostridium were associated with reduced gum bleeding risk, whereas Anaerotruncus, Eisenbergiella, and Phascolarctobacterium were linked to reduced PD risk. Conversely, Fusicatenibacter was associated with an elevated risk of PD. No significant heterogeneity or pleiotropy was detected. In conclusion, our MR analysis pinpointed specific gut flora with causal connections to PD, offering potential avenues for oral health interventions. [ABSTRACT FROM AUTHOR]

Background: Plaque-induced gingivitis is a chronic inflammatory condition characterized by complete reversibility of tissue damage once the periodontal biofilm has been disorganised. The aim of this study was to evaluate the efficacy of two commercially available mouthwashes (MWs) versus a chlorhexidine (CHX) 0.12% MW in reducing gingival bleeding (GB) in adults with plaque-induced gingivitis. Methods: The present study was a double-blind, parallel, randomized controlled trial involving 6492 gingival sites (i.e. 39 subjects × 28 teeth × 6 sites/tooth) aged 18–75 years. During a 2-week period, subjects were randomized to receive MWs: a control CHX 0.12% MW (group C, 1818 sites); a MW test containing CHX 0.09% + Citrox®/P complex (group CX, 2628 sites); a MW test based on natural compounds (group P, 2016 sites). GB was assessed at the inclusion visit (T0) and after 2 weeks of MW use (T1). Analyses of GB were compared between groups and then restricted to subjects with bleeding sites between 10 and 30% (moderate gingivitis) or ≥ 30% (severe gingivitis) at T0. Pairwise comparisons were made between groups and logistic regression was used to identify correlates of GB (T1). Results: For total bleeding site analysis, GB reduction between T0 and T1 ranged from 23% (C), 26% (CX) and 36% (P), respectively (all p < 0.05). Multiple comparison between groups showed that group C was significantly less effective (p < 0.05) than groups CX and P. Splitting the analysis, in patients with severe gingivitis (≥ 30% bleeding sites at T0), all MWs had a positive effect on GB with a reduction at T1 of 36% (C), 33% (CX) and 42% (P), respectively. While GB reduction between T0 and T1, was significant for all groups, the comparison among groups showed no significant difference between group C and CX, whereas the improvement was significant for group P. On the other hand, in adults with moderate gingivitis (< 30% bleeding sites at T0), only CX and P had a positive effect on GB reduction at T1(9% in CX and 2% in P, respectively), although the differences between the three groups were not significant. Conclusion: The daily use of MWs with natural components (groups P and CX) for 2 weeks should be considered positively as an adjunct to individual oral prophylaxis to reduce GB compared to the control MW containing CHX 0.12% (group C) in healthy adults with plaque-induced gingivitis. For subjects with severe gingivitis, it is advisable to first use natural MW (P) and then MW based on CHX 0.09% with natural components (CX), compared to MW with CHX 0.12% (C). For adults with moderate gingivitis, P and CX can be advisable, even if no definitive recommendations can be drawn. Trial Registration: ACTRN12622000215729, 07/02/2022. [ABSTRACT FROM AUTHOR]

Introduction: Good oral hygiene is vital for overall health, and interdental floss is a key tool for maintaining a healthy mouth by removing plaque and food particles from between teeth. However, the success of floss depends on patient compliance, which is crucial for its effectiveness. The aim of this study was to assess the clinical efficacy and patient compliance after dental health education of interdental floss when used alongside toothbrushing for dental plaque control. Materials and Methods: A prospective observational comparative study was conducted, involving 52 participants randomly divided into toothbrush and dental floss (TB + DF) and toothbrush (TB) groups. The participants underwent professional prophylaxis, and interdental floss education was provided to the TB + DF group. Results: Results showed significant differences between the groups at 7 days and 1 month, favoring the floss group in terms of approximal plaque index. However, the toothbrush group exhibited better outcomes for interdental bleeding at 7 days. Patients' perceptions of cleaning capacity, comfort, and Visual Analog Scale scores were also evaluated. While no significant difference was observed in cleaning capacity perception at 7 days, the floss group showed significantly better results at 1 month. Comfort favored the floss group at both time points. Conclusion: This study highlights the importance of dental health education in improving compliance and underscores the efficacy of interdental floss in conjunction with toothbrushing for comprehensive plaque control. [ABSTRACT FROM AUTHOR]

Objectives: Smoking is a significant risk factor for gingivitis and has detrimental effects on both oral health and the cardiovascular system. This study aimed to evaluate the association between cardiovascular biomarkers and gingival bleeding among smokers. Materials and Methods: This cross-sectional study comprising 60 smokers (mean age, 59.9±13.7 years) was conducted at an outpatient smoking cessation clinic. The smokers were divided into two groups based on the presence or absence of gingival bleeding, which was assessed by probing. α1-antitrypsin low-density lipoprotein complex (AT-LDL), an oxidatively modified LDL complex, causes progressive atherosclerosis. The clinical characteristics and blood markers including AT-LDL levels were measured in these patients. Results: Significantly higher (p=0.03) levels of AT-LDL, an oxidized LDL complex that promotes atherosclerosis, were observed among smokers with no gingival bleeding on probing when compared to that among smokers with gingival bleeding. The pocket depths in smokers without gingival bleeding were significantly (p=0.04) lower than those among smokers with gingival bleeding. Conclusion: The absence of gingival bleeding among smokers was associated with higher levels of AT-LDL. These findings could indicate reduced blood flow due to atherosclerosis among smokers with no gingival bleeding. [ABSTRACT FROM AUTHOR]

Gingival bleeding is a common complaint and symptom in patients with periodontitis. In clinics, gingival bleeding is regarded as an important sign of gingival inflammation, which is also of great significance in predicting the activity of periodontitis. Existing research has indicated that periodontitis has an impact on distant sites, such as the kidney. Hematuria is the principal feature of glomerular disease, which can reflect the degree and condition of glomerular inflammation. Previous studies have revealed an association between periodontal diseases with renal diseases, so a study is necessary to discuss their representative signs of them. For the moment, there are no reports that are concerned about the correlation between gingival bleeding with hematuria. The main point of this text is to review the potential association between gingival bleeding with hematuria, reveal their underlying mechanisms, and provide instructions for the therapy of periodontitis and glomerular diseases. [ABSTRACT FROM AUTHOR]

Purpose: The presented study was aimed to investigate the level of interest in gingival bleeding among internet users and its relationship with demographic, economic and temporal variables. Materials and Methods: In this study, the relative search volume of the term "gum bleeding" both quarterly and annually from the data provided by Google Trends for 2017-2021 was analyzed. The provincial level of interest in this term was analyzed along with the gross domestic product, population, data on illiteracy and data on dental visit obtained from the Turkish Statistical Institute and the Ministry of Health of the Republic of Türkiye. Statistical significance was set at p<0.05. Results: The study showed lower relative search volume for the term "gum bleeding" in 2017 than in other years (p<0.001). The highest volume was observed in 2021, although no difference was revealed among the remained years (p>0.05). Analysis of quarter-based data showed a lower volume for the term in the third quarters each of 2021, 2020 and 2018 compared to the other quarters (p=0.012, p=0.035, p<0.001, respectively). However, no correlation was found between the interest level in the term "gum bleeding" and any other variables (p >0.05). Conclusions: The outcomes revealed that gingival bleeding, an early sign of periodontal disease, exhibits seasonal variations with a decrease during the summer months. No relationship was observed between provincial interest level and any variables. Google Trends data provides valuable insights into user interest in gingival bleeding, contributing to the understanding of public awareness of periodontal diseases. [ABSTRACT FROM AUTHOR]

Background: Evidence is limited regarding the relationship among physical activity, anxiety, and oral health in Chinese university students. This cross-sectional investigation aimed to assess the potential relationship between physical activity, anxiety, and oral health conditions among university students in China. Methods: An online questionnaire measuring physical activity, anxiety status, and oral health condition was completed by 1604 university students. The International Physical Activity Questionnaire Short Form (IPAQ-SF) and Generalized Anxiety Disorder-7 (GAD-7) were selected to evaluate physical activity and anxiety, respectively. Oral health condition was assessed through several self-reported variables, including self-reported toothache, gingival bleeding, frequency of tooth brushing, and use of dental floss. Multivariate logistic regression was performed to analyze the underlying relationship between outcome variables. The control variables included age, height, weight, gender, whether only one-child, education level, parental education level, smoking status, drinking habits, and length of sleep. Path analysis was conducted to disentangle the association between physical activity, anxiety, and oral health conditions. Results: Among 1604 university students, 666 (41.5 %) were males and 938 (58.5 %) were females, with an average of 21.9 ± 2.8 years. Only 833 (51.9 %) reported sufficient physical activity, while 684 (42.6 %) of the subjects displayed varying degrees of anxiety. Self-reported gingival bleeding was associated with insufficient physical activity (OR = 1.25; 95%CI: 1.02–1.55), anxiety (OR = 0.45; 95%CI: 0.27–0.74), frequency of tooth brushing (OR = 0.75; 95%CI: 0.60–0.95) and use of dental floss (OR = 0.75; 95%CI: 0.59–0.96), while toothache was not directly influenced by the physical activity and anxiety among university students. Anxiety markedly mediated the relationship between physical activity and oral health conditions. Conclusions: Anxiety was considered a factor associated with the level of physical activity, tooth brushing habits, and self-reported gingival bleeding among university students. Further investigations are required to elucidate whether oral health conditions could be enhanced through the improvement of anxiety and physical activity.

Objectives: To compare the prevalence of gingivitis estimated by the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification with the other case definitions and assess the ability of this classification system in discriminating sociodemographic and clinical factors associated with the presence of gingivitis in a cohort study. Materials and methods: A multistage random sample of 1134 12-year-old adolescents was submitted to a full-mouth examination according to the Community Periodontal Index. Socioeconomic and clinical variables were collected at baseline. Gingivitis was considered according to the following criteria: (a) ≥ 10% of bleeding sites (the 2018 EFP/AAP criteria); (b) ≥ 15% of bleeding sites; and (c) the mean full-mouth bleeding sites. Adjusted multilevel Poisson regression assessed the association between independent variables at baseline and each definition of gingivitis at 2-year follow-up. Results: Seven hundred forty-two 14-year-old adolescents were re-revaluated at follow-up. The prevalence of gingivitis was 28.7% according to 10% of bleeding threshold. The 2018 EFP/AAP criteria and other definitions showed higher prevalence and mean of gingivitis for low-household income adolescents and for those with higher levels of dental plaque and untreated dental caries. Nonetheless, the highest strengths of association were observed for the threshold of ≥ 15% of bleeding sites. Conclusion: The 2018 EFP/AAP case definition of gingivitis showed a similar discriminant validity compared to the 15% threshold and the mean full-mouth bleeding sites. Clinical relevance: The 2018 EFP/AAP classification allows the discrimination of important risk factors and should be used for the establishment of priorities for large-scale therapeutic programs. [ABSTRACT FROM AUTHOR]

Background: The primary prevention of periodontitis is controlling gingivitis daily. The study objective was to compare the efficacy of a pulsating water flosser to a pulsating water flosser infused with air microbubbles on clinical signs of inflammation and plaque. Methods: One hundred and five participants were enrolled in this single‐blind, single‐centre, parallel, 4‐week, IRB/IEC‐approved clinical trial. Participants were randomly assigned to one of three groups: water flosser (WF) plus manual toothbrush, water flosser infused with microbubbles of air (MBWF) plus manual toothbrush, or dental floss (DF) plus manual toothbrush. Bleeding on probing (BOP), Modified Gingival Index (MGI) and Rustogi Modification Navy Plaque Index (RMNPI) scores were recorded at baseline, 2 and 4 weeks. Results: All participants completed the study (n = 105). All groups showed a statistically significant reduction for BOP, MGI and RMNPI at 4 weeks (p < 0.05, except DF marginal RMNPI). The WF group showed a statistically significant greater reduction in whole mouth BOP (0.41) compared to MBWF (0.32) and DF (0.19). This was also true for MGI (0.37, 0.30 and 0.20, respectively) and RMNPI (0.13, 0.11 and 0.06, respectively; p < 0.05 for all comparisons). No adverse events were reported. Conclusion: This study demonstrates that a manual toothbrush and water flosser, with or without microbubbles, is an effective oral care regimen for controlling gingivitis over 4 weeks. [ABSTRACT FROM AUTHOR]

Purpose The primary prevention of periodontitis is controlling gingivitis daily. The study objective was to compare the efficacy of a pulsating water flosser to a pulsating water flosser infused with air microbubbles on clinical signs of inflammation and plaque. Methods One hundred and five participants were enrolled in this single-blind, single-center, parallel, four-week, IRB/IEC-approved clinical trial. Participants were randomly assigned to one of three groups: water flosser (WF) plus manual toothbrush, water flosser infused with microbubbles of air (MBWF) plus manual toothbrush, or dental floss (DF) plus manual toothbrush. Bleeding on probing (BOP), Modified Gingival Index (MGI), and Rustogi Modification Navy Plaque Index (RMNPI) scores were recorded at baseline, 2-weeks, and 4-weeks. Results All participants completed the study (n=105). All groups showed a statistically significant reduction for BOP, MGI, and RMNPI at 4-weeks (p<0.05, except DF marginal RMNPI). The WF group showed a statistically significant greater reduction in whole mouth BOP (0.41) compared to MBWF (0.32) and DF (0.19). This was also true for MGI (0.37, 0.30, and 0.20, respectively) and RMNPI (0.13, 0.11, and 0.06, respectively) (p<0.05 for all comparisons). No adverse events were reported. Conclusion This study demonstrates that a manual toothbrush and water flosser, with or without microbubbles, is an effective oral care regimen for controlling gingivitis over four weeks. [ABSTRACT FROM AUTHOR]

The study aimed to assess self-reported symptoms of periodontal disease (gingival bleeding, tooth mobility and halitosis) among diabetic and non-diabetic patients from Transylvania, Romania. Using statistical analysis methods, correlation between the aforementioned symptoms and diet, oral hygiene habits, stress, physical activity, and BMI (body mass index) were researched. Another secondary objective was to assess the impact of self-reported oral health, aesthetics, and halitosis on their life. Patients' willingness to use a mobile app for generating awareness of oro-dental complications, improving their knowledge of oro-dental health, and reminding them to visit the dentist based on an awareness-raising function, was also assessed. Methods: The study was based on an original self-administered questionnaire, applied to 182 subjects, in an unselected, randomized manner. A total of 110 questionnaires were applied in two dental offices and 72 questionnaires were applied in a public clinic for diabetic patients from Cluj-Napoca, Romania. Results: Warning signs and symptoms relevant to periodontal disease were identified by respondents, having statistically significant associations with the declared oral health-care habits, including interdental aids, vicious habits (nail biting, bruxism), etc. Some of these periodontal signs could be correlated with a certain lifestyle, such as the perceived stress, smoking status, practicing maintenance sports, and alcohol consumption. A total of 66% of the non-diabetics and 68% of the diabetics of the surveyed subjects consider a software application for generating awareness of oro-dental complications useful, and are willing to pay around EUR 6 for it. Conclusions: Having a medical condition such as diabetes makes patients pay more attention to dental health compared with non-diabetic patients. Patients expressed their desire to use a software application to help them to be aware of their condition and for improving their self-report capabilities, including their oral-health-related status. [ABSTRACT FROM AUTHOR]

Background and Objectives: Dental caries and periodontal disease are the most common oral diseases. Thus, the aim of this study was to examine the oral health status of adults aged 18 years and above visiting the various outreach camps in the Ghaziabad District. Materials and Methods: A cross-sectional study was conducted among 336 participants of Ghaziabad District. Dental caries in form of DMFT and periodontal status was recorded based World Health Organization (WHO) criteria-2013. The Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) software. Results: In total, 336 respondents completed the survey among which 216 (64.3%) were males and 120 (35.7%) were females. Majority of the study subjects belonged to low socioeconomic background. The prevalence of dental caries was found to be 44.34 % and periodontal disease was 81.8% respectively. Individuals belonging to lower socioeconomic status has significantly higher caries prevalence when compared to upper and middle class individuals. (p = 0.05) Conclusion: Mounting evidence has demonstrated the essential role of oral health in a long and healthy life. The oral health status of the participants indicates low awareness in majority of the population of Ghaziabad District and only a small number of participants made routine dental visits. The findings can aid planning strategies for oral health care among the population. [ABSTRACT FROM AUTHOR]

Objective: To investigate the dental caries status and periodontal status of disabled children and adolescents aged 0 to 18 years in China and provide suggestions for future policies. Methods: The cross-sectional survey included disabled children and adolescents aged 0 to 18 years in welfare institutions across 10 provinces in eastern, central and western regions in China, between November 2013 and May 2015. Oral health examination included dental caries status and periodontal status. The mean score for decayed, missing and filled teeth (dmft/DMFT) due to caries in primary/permanent dentition, gingival bleeding rate and calculus rate were recorded and statistically evaluated. Data analysis was performed using SPSS 24.0 software (IBM, Armonk, NY, USA), and the level of statistical significance was P < 0.05. Results: The mean dmft/DMFT values of for groups aged 0 to 5, 6 to 12 and 13 to 18 years were 1.48 ± 3.00, 2.19 ± 2.94 and 1.78 ± 2.93, respectively. The mean scores for the groups aged 0 to 5 (P < 0.05) and 13 to 18 years (P < 0.01) showed a significant difference among different disability types. A significant difference between sexes was found only in the group aged 0 to 5 years (P < 0.05). Gingival bleeding rates were 13.70% for the group aged 0 to 5 years, 24.81% for the group aged 6 to 12 years and 42.06% for the group aged 13 to 18 years, and calculus rates were 5.48%, 22.41% and 47.62% for the three age groups, respectively. The gingival bleeding rate for all three age groups showed a significant difference between different disability types (P < 0.01), whereas calculus rates a showed significant difference only in the groups aged 6 to 12 and 13 to 18 years (P < 0.01). Conclusion: The prevalence of dental caries, gingival bleeding and calculus in disabled children and adolescents in China is high. Disability type was strongly associated with oral health status. Specially designed oral health education and training are necessary for clinical professionals and caregivers. [ABSTRACT FROM AUTHOR]

Introduction: Periodontal diseases (gingivitis and periodontitis) are chronic non-communicable inflammatory diseases. The risk of developing gingivitis and periodontitis increases during pregnancy. Also, periodontitis increases the risk of developing adverse pregnancy outcomes such as preterm birth and preeclampsia. Early diagnosis of adverse pregnancy outcomes is essential and periodontitis could be an early sign to take into consideration. Material and methods: We conducted a longitudinal observational study (PERISCOPE study: CNIL, no. 1 967 084 v 0; CER, no. 01-0416) on 121 pregnant women in the first trimester to determine their oral and periodontal health status. We explored the relations between oral and periodontal health status and sociodemographic and behavior characteristics, as well as their course and outcome of pregnancy. Results: A total of 47.1% of the women had periodontitis, of which only 66.7% presented clinical manifestations associated with the disease such as gingival bleeding. These women had a poorer oral and periodontal health, and a higher body mass index, and more of them developed gestational diabetes during the course of pregnancy. The remaining 33.3% showed only discreet and isolated inflammatory signs and, unless thoroughly examined, would have gone undiagnosed for periodontitis. Interestingly these women were more often primiparous, still active professionally and had had a recent oral examination. Conclusions: The PERISCOPE study is one of the few studies that reports the oral and periodontal health status of pregnant women in the first trimester. Furthermore, the results highlight the need for early oral and periodontal assessment and treatment, even in the absence of exterior clinical signs, in order to prevent periodontal disease aggravation and also, by reducing low grade systemic inflammation, possibly adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objective To investigate the incidence of dental anxiety in pregnant women and its influencing factors. Methods A total of 2 638 pregnant women in Shanghai were included in this study. Data on demographic and social factors, oral health behaviors and the number of teeth were collected. Participants completed the modified dental anxiety scale (MDAS), and an MDAS score greater than 12 was defined as a dental anxiety disorder. An electronic data capture system (EDC) was used to establish a database, and SPSS 22.0 was used to analyze the degree of anxiety and its influencing factors. Results A total of 2 638 valid questionnaires were received. The incidence of dental anxiety in pregnant women was 34.9%. The results of a univariate analysis showed that the prevalence of dental anxiety in pregnant women (P1).The results of a negative binomial regression analysis of MDAS showed that the frequency of dental cleaning and the number of teeth were significantly associated with dental anxiety. The frequency of dental cleaning "semiannually or annually" (P1) for dental anxiety in pregnant women. Conclusion Educational level, teeth cleaning frequency, teeth brushing frequency, gingival bleeding, and the number of teeth influence dental anxiety in pregnant women. To effectively reduce the prevalence of dental anxiety, dentists should attach great importance to it in clinical practice and enhance pregnant women's awareness of oral hygiene maintenance by disseminating relevant health care knowledge.

Abstract Background Periodontitis has been associated with inflammatory processes in arterial walls such as impairment in endothelial function and thickening of intima media. As inflammation plays a role also in arterial stiffening, an association between periodontal inflammation and arterial stiffness can be expected. So far, conflicting results of the association between periodontal disease and arterial stiffness have been reported. Many of the earlier studies were conducted in specific populations and heterogeneous measures of both arterial stiffness and periodontal status were used. In this population-based study we aimed to investigate whether periodontal pocketing and gingival bleeding are associated with ultrasound-based measures of arterial stiffness. Methods In this cross-sectional study, two sets of data based on the national Health 2000 Survey in Finland were formed. Data set I comprised never-smoking 45–64-year-old dentate (≥ 10 natural teeth), non-diabetic, non-rheumatic, non-obese (BMI ≤ 30 kg/m2), non-hypertensive subjects with no coronary artery disease or ongoing lipid-lowering medications (n = 157). Data set II was formed of an unrestricted 45–74-year-old dentate population (n = 536). Four arterial stiffness measures (carotid artery compliance, Peterson’s elastic modulus, Young’s elastic modulus and beta stiffness index) based on an ultrasound examination of the common carotid artery were used. Periodontal parameters included the number of teeth with ≥ 4 mm deep periodontal pockets and the number of sextants with gingival bleeding. β-estimates, confidence intervals, and p-values were obtained from linear regression models. Results In Data set I, the adjusted β-estimates for the association between the number of teeth with ≥ 4 mm deep periodontal pockets and Peterson’s elastic modulus and Young’s elastic modulus were 15.80 (p = 0.12) and 61.02 (p = 0.22), respectively. The respective β-estimates were 31.06 (p = 0.17) and 121.16 (p = 0.28) for the association between the number of bleeding sextants and these two stiffness measures. The results in Data set II were in line with the results in Data set I, with the exception that the adjusted β-estimates for the associations between Peterson’s elastic modulus and Young’s elastic modulus and periodontal parameters were closer to null. Conclusions This population-based study did not provide evidence of an association between periodontal condition and arterial stiffness.

Purpose: To assess caries prevalence and periodontal condition in adolescents in Poland and investigate the factors related to oral health.Materials and Methods: A national survey was carried out among 615 15-year-olds of both sexes living in urban and rural areas. Subjects were selected via cluster sampling. The mean DMFT and its components, the tooth distribution pattern of caries and percentage of subjects with gingival bleeding and gingival pockets were analysed. The information regarding sociodemographic, oral hygiene and nutritional variables was collected via questionnaire to evaluate their relationships with caries and periodontal parameters. The t-test, bivariate and multivariate logistic analyses were conducted to evaluate the differences and dependent variables of caries prevalence and gingivitis.Results: Caries prevalence was 94.0%, and DMFT was 5.75 ± 3.74. Higher DMFT, DT and MT values were found in rural areas. 50% of the subjects carried about 75% of the total caries burden. Severe caries (DMFT ≥7) was associated with toothbrushing less than twice a day, not using a fluoridated dentifrice, frequent consumption of snacks and absence of pit-and-fissure sealants. The prevalence of gingival bleeding was 37.4% and shallow pockets 2.8%, which were higher in males and rural areas. Gingival bleeding was associated with toothbrushing less than a twice a day, not using dental floss and consumption of fresh fruits and vegetables less than once a week.Conclusion: The prevalence of oral diseases in Poland is very high. Additional strategies must be implemented to promote oral health early on to improve oral hygiene practices and nutritional habits. [ABSTRACT FROM AUTHOR]

Background: Gingival bleeding is uncommon in disseminated intravascular coagulation (DIC), rarely caused by prostate cancer (PC). Case presentation: A 69-year-old man complained of uncontrollable gingival bleeding. A low platelet count and prolonged bleeding and prothrombin times were observed. Elevated levels of fibrin degradation products, D-dimer, thrombinantithrombin- complex, plasmin-α2-plasmin inhibitor-complex, and prostate-specific antigen suggested PC-associated DIC with hyperfibrinolysis. Computed tomography revealed prostate tumor with metastasis to the regional lymph nodes and vertebrae. By treatment with heparin, anti-androgenic agents, and tranexamic acid, gingival bleeding resolved. Conclusion: Oral and maxillofacial surgeons should be aware that gingival bleeding may be a sign of PC-associated DIC. [ABSTRACT FROM AUTHOR]

Pazopanib is a potent multi-kinase inhibitor that hinders angiogenesis and blocks tumor growth. It has been approved for the treatment of metastatic renal cell carcinoma (mRCC) and advanced soft tissue sarcoma. There is emerging evidence that bleeding is a common adverse effect of pazopanib and other targeted therapies in patients with mRCC. In addition, jaw osteonecrosis related to pazopanib was recently described in the literature. We report three cases of patients with mRCC who developed adverse oral events related to pazopanib. The first patient, treated with pazopanib as monotherapy, presented with gingival bleeding and oral burning sensation. The other two patients receiving pazopanib as monotherapy and pazopanib followed by sunitinib, respectively, presented complaining about mandibular pain; a diagnosis of medication-related osteonecrosis of the jaw (MRONJ) was rendered in both cases. Gingival bleeding and MRONJ may develop as oral side effects of pazopanib use. The cases presented here aim to alert and inform health care professionals about the risk of adverse oral events in patients with mRCC receiving the antiangiogenic agent pazopanib. [ABSTRACT FROM AUTHOR]

Pendahuluan: Pansitopenia merupakan suatu keadaan yang ditandai oleh adanya anemia, leukopenia serta trombositopenia akibat gangguan pada sumsum tulang yang menyebabkan proses produksi sel hematopoietik menjadi tidak normal. Salah satu manifestasi rongga mulut pada pansitopenia adalah pendarahan gingiva. Perawatan pendarahan gingiva telah banyak dilakukan dengan pemberian obat kumur feracrylum 1%, atau dengan cara mengompres lokasi pendarahan menggunakan kain kasa yang ditetes dengan lidokain. Laporan kasus ini bertujuan untuk memaparkan manajemen perawatan pendarahan gingiva pada pasien pansitopenia dengan suspek anemia aplastik. Laporan kasus: Seorang pria berusia 50 tahun dengan keluhan lemah badan, demam, melena dan gingiva berdarah sejak dua tahun yang lalu, tidak disertai rasa sakit pada gingiva dan area lainnya dalam rongga mulut. Pasien ini dirawat bersama oleh bagian Ilmu Penyakit Dalam dan Ilmu Penyakit Mulut. Pemeriksaan rongga mulut menunjukkan adanya pendarahan pada gingiva regio rahang atas kiri dan bawah kiri. Hasil pemeriksaan penunjang menunjukkan hemoglobin: 7,1g/dL, hematokrit: 18%, eritrosit 1,46x104/μL, leukosit 2,5x103/μL, trombosit 7,2x104/μL. Hasil pemeriksaan sumsum tulang yang pertama sulit dinilai. Transfusi darah diberikan dua labu perhari selama enam hari, area pendarahan pada gingiva dilakukan kompres menggunakan asam traneksamat selama satu sampai tiga menit kemudian dilanjutkan kumur asam traneksamat selama satu menit. Hasil setelah terapi selama 6 hari, tidak ditemukan lagi pendarahan pada gingiva. Simpulan: Terapi lokal kompres dan kumur asam traneksamat dapat menjadi pilihan perawatan yang sangat efektif untuk menghentikan pendarahan gingiva pada pasien pansitopenia, selain terapi transfusi darah tetap dilakukan untuk mengembalikan kadar normal komponen dalam darah. Kata kunci: anemia aplastik; asam traneksamat; pansitopenia; pendarahan gingiva ABSTRACT Introduction: Pancytopenia is a condition characterised by anaemia, leukopenia and thrombocytopenia due to disorders of the bone marrow that cause the production process of hematopoietic cells to become abnormal. One of the oral manifestations of pancytopenia is gingival bleeding. Gingival bleeding treatment has been mainly carried out by administering 1% Feracrylum mouthwash or compressing the bleeding site using gauze dripped with lidocaine. This case report aimed to describe the management of pancytopenia gingival bleeding in patients with suspected aplastic anaemia. Case report: A 50-year-old male with the chief complaint of weakness, fever, melena, and gingival bleeding two years prior, without gingival pain and other oral cavity areas. This patient was treated simultaneously by the Department of Internal Medicine and Oral Medicine. Examination of the oral cavity revealed bleeding in the left maxillary and left mandibular gingiva. Investigation results showed haemoglobin level was 7.1g/dL, hematocrit 18%, erythrocytes 1.46x104/μL, leukocytes 2.5x103/μL, and platelets 7.2x10⁴/μL. However, the first bone marrow examination result was still challenging to assess. Therefore, two flasks of blood transfusions were given per day for six days. The bleeding gingival area was compressed using tranexamic acid for one to three minutes, followed by tranexamic acid gargling for one minute. After six days of therapy, no more gingival bleeding was detected. Conclusion: Local compress therapy and tranexamic acid gargling can be effective treatment options to stop gingival bleeding in pancytopenia patients; blood transfusion therapy needs to remain carried out to restore normal levels of blood components. Keywords: aplastic anaemia; tranexamic acid; pancytopenia; gingival bleeding

Aim: The present study was carried out to examine the association between periodontitis and glycated hemoglobin (HbA1c) in Type 2 diabetes mellitus adults. The objective of the study was to assess the effect of nonsurgical periodontal therapy on serum levels of HbA1c in patients with Type 2 diabetes mellitus and moderate-to-severe periodontitis. Material and Methods: The study population consisted of 78 Type 2 diabetes mellitus patients aged 30–70 years suffering from chronic generalized periodontitis. The patients were selected randomly from among the patients reporting at medicine outpatient department from July 2018 to August 2019. They were assessed for the presence or absence of gingival bleeding, presence or absence of periodontal pockets, and loss of attachment using the Community Periodontal Index (World Health Organization, 2013). Data were analyzed using the statistical package SPSS (version 21.0) and paired t-test at P < 0.05. Results: The mean reduction in haemoglobin levels of patients with moderate to severe periodontitis were significantly reduced by 1.19 in Group I, 0.51 in Group II, and 0.09 in Group III respectively after 3 months of nonsurgical periodontal therapy. This periodontal therapy was clinically effective and had a significant effect on the participant's glycemic control. Conclusion: This periodontal therapy was clinically effective and had a significant effect on the participant's glycemic control.

Background: Oral health is an integral part of general health. In certain populations, especially among intellectually and physically disabled individuals, oral health is neglected. People with disabilities deserve the same opportunities for oral health and hygiene as those who are abled, but sadly dental care is the most common unmet health care need of the disabled people. Aim: The purpose of the study is to assess the oral health status and dental care utilization of people above 15 years with intellectual and physical disability in Chennai. Methodology: A descriptive cross-sectional study was carried out to assess the dental caries experience, gingival status, prevalence of fluorosis and lesion, and dental service utilization among 132 intellectually and physically disabled people in Chennai. After obtaining the caregivers consent of the participants, oral health was assessed using the World Health Organization (WHO) proforma, 2013. Statistical analysis was done using Statistical Package for the Social Sciences Version 23. Results: When DMFT indexes were examined with regard to sex, the mean DMFT was found to be higher for males with 1.453 ± 1.847 whereas females have 1.403 ± 1.73, and mean DMFT was found to be more for the 26–35 years age group with 2.3 ± 2.01. 81.8% of the population had no gingival bleeding whereas only 18.18% had gingival bleeding. Conclusion: With the obtained results, people with physical disability have a high mean DMFT compared with intellectual disability. The present study showed dental negligence among mentally disabled population where the parents, caretakers, and dentists are responsible.

Background: Periodontitis has been associated with inflammatory processes in arterial walls such as impairment in endothelial function and thickening of intima media. As inflammation plays a role also in arterial stiffening, an association between periodontal inflammation and arterial stiffness can be expected. So far, conflicting results of the association between periodontal disease and arterial stiffness have been reported. Many of the earlier studies were conducted in specific populations and heterogeneous measures of both arterial stiffness and periodontal status were used. In this population-based study we aimed to investigate whether periodontal pocketing and gingival bleeding are associated with ultrasound-based measures of arterial stiffness. Methods: In this cross-sectional study, two sets of data based on the national Health 2000 Survey in Finland were formed. Data set I comprised never-smoking 45–64-year-old dentate (≥ 10 natural teeth), non-diabetic, non-rheumatic, non-obese (BMI ≤ 30 kg/m2), non-hypertensive subjects with no coronary artery disease or ongoing lipid-lowering medications (n = 157). Data set II was formed of an unrestricted 45–74-year-old dentate population (n = 536). Four arterial stiffness measures (carotid artery compliance, Peterson's elastic modulus, Young's elastic modulus and beta stiffness index) based on an ultrasound examination of the common carotid artery were used. Periodontal parameters included the number of teeth with ≥ 4 mm deep periodontal pockets and the number of sextants with gingival bleeding. β-estimates, confidence intervals, and p-values were obtained from linear regression models. Results: In Data set I, the adjusted β-estimates for the association between the number of teeth with ≥ 4 mm deep periodontal pockets and Peterson's elastic modulus and Young's elastic modulus were 15.80 (p = 0.12) and 61.02 (p = 0.22), respectively. The respective β-estimates were 31.06 (p = 0.17) and 121.16 (p = 0.28) for the association between the number of bleeding sextants and these two stiffness measures. The results in Data set II were in line with the results in Data set I, with the exception that the adjusted β-estimates for the associations between Peterson's elastic modulus and Young's elastic modulus and periodontal parameters were closer to null. Conclusions: This population-based study did not provide evidence of an association between periodontal condition and arterial stiffness. [ABSTRACT FROM AUTHOR]

Aims: This qualitative study aimed to assess people with congenital bleeding disorders (CBDs) perspectives on why their dentists refused to treat them. Methods: Using validated and reliable questions, people with CBDs were asked about their attitude toward dental visit and teeth brushing, perceived thought about dentists' knowledge and skill in treating them, perceived dental anxiety, and perceived barriers toward receiving dental services. Free text responses were added to report reasons of why people with CBDs could not brush their teeth sometimes and why the dentists refused to treat them. An open card sorting method was used to analyze participants free text reports. Results: A total of 30 participants were recruited for the purpose of this qualitative study (70% adults and 30% children). Hemophilia A affected the majority of both groups. The majority of participants (n = 20, 67%) reported that they have been refused to be treated by their dentists (71% of adults versus 56% of children, as reported by their parents, p‐value = 0.398). Adult participants reported that they have been refused to be treated by dentists due to fear of dentists from uncontrolled gingival bleeding, their dentists' beliefs that no dental treatment required for them, their thoughts that their dentists will refuse to treat them and difficulty of accommodating the dental visit with other medical appointments. Parents of children reported other reasons such as parents did not ask for dental treatments, difficulty of dental treatment to dentists, young age of patient, and poor accessibility to dental services due to long waiting list. Fear of adult participants from uncontrolled gingival bleeding (n = 4, 57%) and poor compliance of children toward teeth brushing (n = 2, 29%) were the reasons behind why they could not brush their teeth sometimes. Conclusions: Among several reported reasons, fear of dentists from uncontrolled gingival bleeding was the most reported reason of why dentists refused to treat adults with CBDs. While other reasons were reported by parents of children with CBDs such as parents did not ask for dental treatment to their children, difficulty of dental treatment to dentists, young age of patients, and poor accessibility due to long waiting list. [ABSTRACT FROM AUTHOR]

Abstract Background To investigate the related risk factors of periodontal health status among Chinese middle school students. Methods This study is a part of the Fourth National Oral Health Epidemiological Survey, which is by far the largest oral epidemiological survey in China, including all provinces, municipalities and autonomous regions in mainland China. A multi-stage stratified sampling method was used to select middle school students aged 12–15 from the sampled middle school for investigation. The survey consisted of two parts: oral examination and questionnaire survey. The oral examination included gingival bleeding and calculus. The questionnaire included sociodemographic information, oral health knowledge, attitudes and behaviors. Logistic regression and generalized linear mixed model were used to investigate the risk factors of gingival bleeding and calculus. Results A total of 118,514 middle-school students has been examined. Less gingival bleeding (OR = 0.746, CI 0.718–0.774) and calculus (OR = 0.550, CI 0.529–0.527) were found in 12-year-old group compared to 15-year-old group. The periodontal health status of males was worse than that of females (gingival bleeding OR = 1.102, CI 1.074–1.132, calculus OR = 1.258, CI 1.223–1.295). Besides age and gender, region, living place, ethnic groups, family structure, parent’s education level, oral health knowledge and behavior were also related to gingival bleeding and calculus. Conclusions Gingival bleeding and calculus occurred most of 12–15 years old adolescents in China. Several related factors, such as gender, age, ethnicity, father’s education level, oral health knowledge and behavior, were found in multi-factorial models. The impact of province should arouse people’s attention.

The study aimed to assess self-reported symptoms of periodontal disease (gingival bleeding, tooth mobility and halitosis) among diabetic and non-diabetic patients from Transylvania, Romania. Using statistical analysis methods, correlation between the aforementioned symptoms and diet, oral hygiene habits, stress, physical activity, and BMI (body mass index) were researched. Another secondary objective was to assess the impact of self-reported oral health, aesthetics, and halitosis on their life. Patients’ willingness to use a mobile app for generating awareness of oro-dental complications, improving their knowledge of oro-dental health, and reminding them to visit the dentist based on an awareness-raising function, was also assessed. Methods: The study was based on an original self-administered questionnaire, applied to 182 subjects, in an unselected, randomized manner. A total of 110 questionnaires were applied in two dental offices and 72 questionnaires were applied in a public clinic for diabetic patients from Cluj-Napoca, Romania. Results: Warning signs and symptoms relevant to periodontal disease were identified by respondents, having statistically significant associations with the declared oral health-care habits, including interdental aids, vicious habits (nail biting, bruxism), etc. Some of these periodontal signs could be correlated with a certain lifestyle, such as the perceived stress, smoking status, practicing maintenance sports, and alcohol consumption. A total of 66% of the non-diabetics and 68% of the diabetics of the surveyed subjects consider a software application for generating awareness of oro-dental complications useful, and are willing to pay around EUR 6 for it. Conclusions: Having a medical condition such as diabetes makes patients pay more attention to dental health compared with non-diabetic patients. Patients expressed their desire to use a software application to help them to be aware of their condition and for improving their self-report capabilities, including their oral-health-related status.

Objectives: Plaque control by improved domestic oral hygiene is essential in periodontal treatment. However, changing treatment providers may interfere with building a dentist-patient relationship and in turn affect treatment success. The aim of this randomized, controlled, prospective short-term study was to determine the influence of either one or four different pre-graduate practitioners on patients' oral hygiene parameters during active periodontal therapy. Material and Methods: A total of 55 patients with periodontitis were allocated to two groups. Within the group "continuous treatment" (CT, n = 27), each patient was treated by one individual practitioner over the treatment period. For patients of the group "discontinuous treatment" (DT, n = 28), treatment in each session was performed by a different practitioner. Periodontal parameters (BOP, PBI, and PCR) were assessed at two timepoints: T1 (baseline) and T2 (end of active therapy). Results: With CT, the PBI improved in 93% of the patients, compared to 71% with DT (p = 0.048). T1-T2 intragroup analysis showed a statistically significant improvement of all observed clinical parameters with no differences in ∆PBI, ∆BOP, and ∆PCR. Spearman's correlation analysis revealed a weak correlation between PCR and BOP of CT only. Conclusions: In the present study, improvement of all parameters was comparable between the groups. PBI, as a parameter displaying patient's domestic plaque control compliance, improved in more patients from CT than DT. This is possibly indicating an advantage of continuous treatment by one single practitioner. Clinical relevance: Treatment by either a single practitioner or by multiple, constantly changing practitioners might influence patients' compliance to modify their behaviour when medically necessary. [ABSTRACT FROM AUTHOR]

Introduction: Peri-implantitis is a significant factor affecting the success rate of oral reconstruction. Hence, it is vital to prevent it. To control peri-implant disease, non surgical treatment is the first line of defense. While peri-implant mucositis can be entirely treated, there are unforeseen repercussions for the treatment of peri-implantitis, according to many studies using non invasive approaches. Aim: To investigate the clinical effects of the tetracycline group of medications in the treatment of non surgical peri-implantitis. Materials and Methods: Electronic bibliographic databases PubMed (MEDLINE), EBSCO, Cochrane database, Clinical trial registry, DOAJ, Google Scholar, and Manual reference searches were performed for articles published January 2010 to August 2021. Total five Randomised Controlled Trials (RCTs) were selected. Three reviewers independently performed the data extraction using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting. The risk of bias was assessed with the ROB-2 tool and the quality of evidence was determined with the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. A quantitative meta-analysis was performed to compare the reduction in Bleeding On Probing (BOP), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). Results: In the overall analysis, BOP and PPD, was statistically reduced in the tetracycline drugs compared to the tetracycline groups. When comparing experimental and control groups, the mean reduction in BOP was -9.71 mm, (95% CI: -11.74 to -7.68), The random-effects model showed a statistically significant difference Z=9.40 (p-value <0.00001). The mean PPD was reduced by -1.18 mm in the experimental groups compared to the control groups (95% CI: -2.35 to -0.02). The CAL gain was -0.98 mm from 3.23 to 1.28 mm in the experimental group which was statistically non significant. The minocycline revealed statistically significant mean difference in BOP (mean difference was -0.72 (95% CI: -6.84, -3.24 mm but non significant difference reduction in PPD (p-value >0.05). High heterogenicity was reported in all analyses. Conclusion: The non surgical treatment with the tetracycline medication group resulted in a significant clinical reduction in BOP and PPD without a significant change in CAL when compared to other non surgical therapies. The minocycline has resulted in clinical decreases in BOP except PPD. Long-term randomised controlled trials are needed to assess the efficacy of treatments that do not prevent further bone loss, implant survival rates and oral health-related quality of life standards. [ABSTRACT FROM AUTHOR]

Aim: To describe associations of gingival bacterial composition and diversity with self‐reported gingival bleeding and oral hygiene habits in a Norwegian regional‐based population. Materials and Methods: We examined the microbiome composition of the gingival fluid (16S amplicon sequencing) in 484 adult participants (47% females; median age 28 years) in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) study in Bergen, Norway. We explored bacterial diversity and abundance differences by the community periodontal index score, self‐reported frequency of gingival bleeding, and oral hygiene habits. Results: Gingival bacterial diversity increased with increasing frequency of self‐reported gingival bleeding, with higher Shannon diversity index for "always" β = 0.51 and "often" β = 0.75 (p <.001) compared to "never" gingival bleeding. Frequent gingival bleeding was associated with higher abundance of several bacteria such as Porphyromonas endodontalis, Treponema denticola, and Fretibacterium spp., but lower abundance of bacteria within the gram‐positive phyla Firmicutes and Actinobacteria. Flossing and rinsing with mouthwash twice daily were associated with higher total abundance of bacteria in the Proteobacteria phylum but with lower bacterial diversity compared to those who never flossed or never used mouthwash. Conclusions: A high frequency of self‐reported gingival bleeding was associated with higher bacterial diversity than found in participants reporting no gingival bleeding and with higher total abundance of known periodontal pathogens such as Porphyromonas spp., Treponema spp., and Bacteroides spp. [ABSTRACT FROM AUTHOR]

Aim: The present study was carried out to examine the association between periodontitis and glycated hemoglobin (HbA1c) in Type 2 diabetes mellitus adults. The objective of the study was to assess the effect of nonsurgical periodontal therapy on serum levels of HbA1c in patients with Type 2 diabetes mellitus and moderate-to-severe periodontitis. Material and Methods: The study population consisted of 78 Type 2 diabetes mellitus patients aged 30–70 years suffering from chronic generalized periodontitis. The patients were selected randomly from among the patients reporting at medicine outpatient department from July 2018 to August 2019. They were assessed for the presence or absence of gingival bleeding, presence or absence of periodontal pockets, and loss of attachment using the Community Periodontal Index (World Health Organization, 2013). Data were analyzed using the statistical package SPSS (version 21.0) and paired t-test at P < 0.05. Results: The mean reduction in haemoglobin levels of patients with moderate to severe periodontitis were significantly reduced by 1.19 in Group I, 0.51 in Group II, and 0.09 in Group III respectively after 3 months of nonsurgical periodontal therapy. This periodontal therapy was clinically effective and had a significant effect on the participant's glycemic control. Conclusion: This periodontal therapy was clinically effective and had a significant effect on the participant's glycemic control. [ABSTRACT FROM AUTHOR]

Introduction. The oral health conditions of migrants coming from middle- and low-income countries to developed countries have been shown to be poorer than those of the host population. Since the phenomenon of migration has continued to grow over the past five decades, the oral health status of migrant populations should be an issue of great concern. Objectives. The objective of our observational study was to analyse the periodontal health status and the prevalence of dental caries and lesions of the oral mucosa in a migrant cohort resident in Italy, assessing the association between the oral health status and the educational level of the included patients. Materials and Methods. Our research was conducted at the dental department of Policlinico Tor Vergata (Rome, Italy). A sample of 200 migrants coming from middle- and low-income countries, aged between 3 and 37, was included in our study. Each patient underwent a physical examination of the oral cavity, recording the DMFT/dmft index, Community Periodontal Index of Treatment Needs (CPI), and lesions of the oral mucosa. The one-way ANOVA test was used to establish the correlation between the oral health status and the educational level of the participants. Results. Many participants (62.5%) showed a DMFT/dmft Index ≥ 4; only 27% of the migrants had a DMFT/dmft Index lower than 4, and only 21 of them (10.5%) were recorded at 0. A CPI equal to 0 or 1 was observed in 131 patients (65.5%), while only 30 participants presented a CPI equal to or higher than 4 (15%), and 19.5% (39 patients) were assigned to code 2 and 3. Significant statistical differences were found in the CPI after adjusting data for the educational level of the included participants (p-value < 0.01). Conclusions. The data obtained in our research highlighted poor oral conditions among the analysed migrant population, recording a high prevalence of dental caries and inadequate oral hygiene habits. [ABSTRACT FROM AUTHOR]

Introduction: Peri-implantitis is a significant factor affecting the success rate of oral reconstruction. Hence, it is vital to prevent it. To control peri-implant disease, non surgical treatment is the first line of defense. While peri-implant mucositis can be entirely treated, there are unforeseen repercussions for the treatment of peri-implantitis, according to many studies using non invasive approaches. Aim: To investigate the clinical effects of the tetracycline group of medications in the treatment of non surgical peri-implantitis. Materials and Methods: Electronic bibliographic databases PubMed (MEDLINE), EBSCO, Cochrane database, Clinical trial registry, DOAJ, Google Scholar, and Manual reference searches were performed for articles published January 2010 to August 2021. Total five Randomised Controlled Trials (RCTs) were selected. Three reviewers independently performed the data extraction using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting. The risk of bias was assessed with the ROB-2 tool and the quality of evidence was determined with the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. A quantitative meta-analysis was performed to compare the reduction in Bleeding On Probing (BOP), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). Results: In the overall analysis, BOP and PPD, was statistically reduced in the tetracycline drugs compared to the tetracycline groups. When comparing experimental and control groups, the mean reduction in BOP was -9.71 mm, (95% CI: -11.74 to -7.68), The random-effects model showed a statistically significant difference Z=9.40 (p-value 0.05). High heterogenicity was reported in all analyses. Conclusion: The non surgical treatment with the tetracycline medication group resulted in a significant clinical reduction in BOP and PPD without a significant change in CAL when compared to other non surgical therapies. The minocycline has resulted in clinical decreases in BOP except PPD. Long-term randomised controlled trials are needed to assess the efficacy of treatments that do not prevent further bone loss, implant survival rates and oral health-related quality of life standards.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that can affect all aspects of life, including nutrition. This case reports a patient with ASD in which gingival bleeding was the key finding that led to a diagnosis of scurvy. The literature review discusses behavioral food aversions in patients with ASD that lead to significant nutritional deficiencies, such as scurvy. Through this case report, the objective is to raise clinical awareness to consider relatively rare diseases in patients with ASD who have atypical feeding patterns. [ABSTRACT FROM AUTHOR]

Objective: There are no studies that have (a) compared self-perceived oral symptoms and clinical and radiographic periodontal parameters (plaque index [PI], bleeding on probing [BoP], clinical attachment loss [CAL], and marginal bone loss [MBL]) among shamma-chewers (SC) and gutka-chewers (GC); and (b) assessed periodontal parameters among SC. The aim of the present study was to compare the self-perceived oral symptoms and periodontal parameters among SC, GC, and controls. Method and Materials: Information regarding demographic characteristics and self-perceived oral symptoms was gathered using a structured questionnaire. Odds ratios were computed for self-perceived oral symptoms and periodontal parameters and compared between the groups. For multiple comparisons, the Bonferroni post-hoc test was used. Level of significance was set at P < .05. Results: Forty-seven SC, 45 GC, and 41 control individuals were included. Group comparisons for pain in teeth, pain on chewing, bleeding gums, and burning sensation in the mouth showed no statistically significant difference among SC and GC. These symptoms were significantly higher in SC (P < .01) and GC (P < .01) than controls. PI, BoP, PD (4-6 mm and > 6 mm), and CAL were significantly higher in SC (P < .05) and GC (P < .05) than controls. There was no statistically significant difference in PI, BoP, PD (4-6 mm and > 6 mm), and CAL among SC and GC. There was no statistically significant influence of daily frequency of smokeless tobacco consumption and duration of placement in the mouth on the severity of periodontal parameters. Conclusion: Self-perceived oral symptoms and periodontal parameters were worse among SC and GC than controls, with no statistically significant difference when comparing these findings between SC and GC. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the frequency of gingival bleeding (GB) and associated drug-withdrawal in atrial fibrillation (AF) patients using oral anti-coagulants (OAC). Materials and Methods: 457 patients with AF receiving OAC were screened. The periodontal parameters and OAC drug-withdrawal of 32 patients with spontaneous GB were compared with 32 patients without bleeding who were matched for age, sex and OAC treatment protocol. Results: GB was detected in 32 patients (7.0%) and 13 of these patients (40.6%) had OAC drug-withdrawal due to bleeding. The plaque index (PI), gingival index (GI) and probing pocket depths (PPD) were significantly higher in patients with GB. The GI scores independently determined the risk of OAC drug-withdrawal. Conclusion: AF patients under OAC treatment may have significant rates of GB and subsequent OAC withdrawal due to pre-existing periodontal disease. The GI scores and GB can predict the risk of OAC drug-withdrawal. The periodontal examination and/or treatment of these patients should be performed before OAC treatment.

Smoking is associated with the deteriorating health of the gingiva and periodontium. The long-term beneficial effects of smoking cessation on oral health are well known. However, the effects of short-term smoking cessation on gingival bleeding and periodontal pocket depth are unknown. The purpose of the present study was to determine the effects of short-term smoking cessation on gingival bleeding and periodontal pocket depth. Dentate smokers with a mean age of 56.9 ± 14.4 years at an outpatient smoking cessation clinic participated in this study. A professional dentist checked the periodontal pocket depth and gingival bleeding. Patients visited the smoking cessation clinic on their first visit and 2, 4, 8, and 12 weeks (three months). The gingival assessment was re-performed in those who succeeded in smoking cessation 3 months after the baseline. The baseline data of 83 patients showed that an increase in pocket depth was associated with increasing age and the amount of smoking. A significant increase in gingival bleeding (p =.031) and increase in pocket depth (p =.046) were observed 3 months after the baseline in patients who successfully quit smoking (n = 14). Short-term smoking cessation increased periodontal pocket depth and gingival bleeding. These findings may reflect healing processes that occur in the healthy gingiva. Study findings will be useful to advise patients during smoking cessation programs. Dentists can inform patients that an initial increase in gingival bleeding and pocket depth could be associated with smoking cessation. Such advice will prevent patients from any apprehension that may cause them to recommence smoking. [ABSTRACT FROM AUTHOR]

Context: Adolescents experience many types of gingival and periodontal diseases, including gingivitis, localized or generalized aggressive periodontitis, and periodontal complications of various systemic diseases. The occurrence of periodontal diseases is not only related to biotic factors but may also be affected by nonbiotic factors such as oral health behaviors and practices. Various factors that influence an individual's health-related behaviors include a psychosocial construct named sense of coherence (SOC). Aim: The aim of this study is to investigate the association of SOC with oral health behaviors and gingival bleeding. Settings and Design: This was a cross-sectional, analytical study that was done in the school setting. Materials and Methods: A random sample of 850 adolescents was selected from nine schools of the Faridabad block of Faridabad district (Haryana) through the multistage cluster sampling technique. Methods of data collection included a combination of questionnaire administration and clinical examination. The questionnaire comprised sociodemographic variables, questions related to oral health behaviors, and Antonovsky's SOC scale. The questionnaire was interviewer administered. Statistical Analysis: Unadjusted and adjusted rate ratios of gingival units having bleeding on probing were estimated by Poisson regression multilevel analysis in Statistical Package for the Social Sciences (SPSS) software for Microsoft Office. Results: Adolescents whose mothers had studied 1 (RR 2.765; 95% CI 2.12–3.25) presented with the higher number of gingival units having bleeding. Conclusion: SOC is associated with gingival bleeding through oral health behaviors.

Abstract Gingival bleeding, which was not previously present, may be a preceding symptom associated with COVID‐19 infections, preceding or coincidental with fever, other clinical signs, and positive testing.

Cytopenia’s are frequently seen haematological disorders encountered in daily clinical practice. Bicytopenia is defined as a decrease in any of the two cell lines of the blood i.e., Red Blood Cells (RBC), White Blood Cells (WBC), or platelets. Though bleeding gums is a common complaint in dental practice, bleeding of gums as a result of systemic diseases is rare. The author presents a case of a 65-year-old male patient who reported spontaneous bleeding of the gums. The patient was diagnosed with gingival bleeding secondary to bicytopenia. Gingival bleeding was treated with local styptic agents and systemic platelet infusion as recommended by a haematologist. The patient was also prescribed antifibrinolytics and antibiotics for further dental management. This case reports highlights the concerns about the oral manifestations and the dentist’s responsibility to be familiar with the recognition and customised management of patients with Bicytopenia by analysing the clinical and haematological profiles of patients.