Use of an electric toothbrush in patients affected by autoimmune desquamative gingivitis: evaluation of biological parameters

Abstract

Event Abstract Back to Event Use of an electric toothbrush in patients affected by autoimmune desquamative gingivitis: evaluation of biological parameters Giuli Antonucci1, Alessio Gambino1*, Paola Carcieri1, Marco Cabras1, Roberto Broccoletti1 and Paolo Giacomo Arduino1 1 University of Turin, Department of Surgical Sciences, Italy Aim. According to the current classification of periodontal diseases (classification of periodontal and peri-implant diseases and conditions 2017), desquamative gingivitis is included in "gingival disorders not induced by dental biofilm". The gums are usually erythematous, very sore, sometimes bleeding, with areas of atrophy, ulceration and / or presence of vesiculo-bullous lesions. It appears to be the gingival manifestation of different systemic conditions, such as oral disimmune diseases, but also as consequence of drug-induced injuries or allergic reactions to chemicals and food. Oral lichen planus (OLP), pemphigus vulgaris (PV), and mucous membranes pemphigoid (PMM) account for between 88 and 98% of total cases. The desquamative gingivitis treatment’s goal is to control the progression of the lesions and to reduce symptoms perceived, although a complete recovery may be quite difficult. The pharmacological treatment should be accompanied by a strict plaque control with home and professional proper oral hygiene procedures. This study aims to evaluate the effectiveness of the Oral-B Smart 4 electric toothbrush in association with the "Sensitive Clean" head and the "Sensitive Teeth" mode for home oral hygiene in patients with desquamative gingivitis. The study was carried out through the estimation of periodontal biological parameters, concerning the development of the pathology and parameters related to the comfort perceived by the patient, comparing their previous use of a manual toothbrush. Materials and Methods. The propose protocol consisted of 5 appointments. In the initial appointment (T0), clinical parameters were recorded such as pocket depth, recessions, plaque index (FMPS) and bleeding index (FMBS) through the compilation of a periodontal charting; a complete photographic status was also performed, and the severity of the clinical signs evaluated with the use of the Desquamative Gingivitis Clinical Score (DGCS), the severity of pain with the use of the VAS scale, and the comfort with the use of the Oral Health Impact Profile. In the next appointment (T1), a week apart, the plaque index (PI) was recorded with the help of the Tri Plaque ID Gel plaque detector; in the meantime, a frontal photo was acquired and a professional oral hygiene session were performed. In this session, the patients were instructed to use the electric toothbrush. The two following appointments (T2 and T3), one month after T1, repeated the same steps of instruction and motivation of the T1. In the last two appointments (T4 and T5), two months after T2 and T3, the same indices evaluated during the first session were examined again. Results. Fourteen patients were recruited, with an average age of 65.85 years and with an average of 25 dental elements. In the sample, 7 patients had OLP, 4 had PMM and 3 had PV. The plaque and bleeding index showed a statistically significant reduction (p<0.05) between the first and last appointments, unlike the DGCS. Discussion. According to literature data, the electric toothbrush evaluated appeared to be a valid substitute for the manual toothbrush. Our work revealed statistically significant differences in terms of plaque reduction and bleeding, thus being in line with previous studies establishing a correlation between desquamative gingivitis and plaque-induced gingivitis. The DGCS index showed a susceptibility from T0 to T5 in almost all patients, with a worsening of clinical signs detected in patients with OLP, instead of those with PMM and PV. This result may be partly explained due to the sporadic usage of immunosuppressants in patients with symptomatic OLP, being instead a steady, although low-dosage, treatment among individuals with bullous disease. The main limitation of the present protocol is represented by the small size of the sample. However, such limit must be put in perspective, considering that the limited number of patients recruited is an inevitable consequence of the sample inclusion criteria, which had to be so strictly arranged in order to minimize the weight of a steady high-dosage corticosteroid therapy as confounding factor. Further studies will be needed to increase as much as possible the size of the sample, aiming to obtain the most applicable results for the population. Plaque and tartar control through a protocol that provides professional oral hygiene sessions and oral home health motivation plays a key role in the clinical management of these patients. Oral hygiene in patients with desquamative gingivitis for autoimmune diseases are able to provide long-term benefits from their gingival health, if the same patients have previously been through a drug therapy.