Dental Plaque Accumulation Research Articles

The effect of fluoride varnish and chlorhexidine gel on white spots and gingival and plaque indices in fixed orthodontic patients: A placebo-controlled study

Difficulties to maintain good oral hygiene during orthodontic treatment can cause prolonged accumulation of dental plaque, thereby increasing the risk of developing gingival inflammation and periodontal disease as well as enamel demineralization and caries. The purpose of this study was to determine the effect of chlorhexidine (CHX) gel and fluoride varnish versus placebo and control groups on plaque and gingival indices as well as their influence on enamel demineralization prevention in orthodontic patients with fixed appliances. In this clinical trial, forty patients with fixed orthodontic appliances were participated and were divided into control, CHX gel (0.2%), fluoride varnish (5%), and placebo groups. The parameters evaluated in this research were dental plaque index (DPI), index of gingival inflammation, and white spot lesion (WSL) index. For all the patients, each index was scored at the beginning of orthodontic treatment, then 3 months, 6 months, and 9 months afterward. Data were analyzed using Kruskal-Wallis and Mann-Whitney tests. The level of significance was set at 0.05. All the scores showed statistically significant differences (P < 0.05) between the four groups for each of the three time points. A statistically significant decrease of DPI, WSL index, and gingival index was observed 9 months after treatment in fluoride and CHX groups. Adding CHX gel and fluoride varnish to the patients' oral hygiene regimen can reduce the development of plaque and gingivitis and decrease WSLs in orthodontic patients.

Evaluation of periodontal status and detection of Dialister pneumosintes in cerebral palsy individuals: A Case-Control study.

The worldwide prevalence of cerebral palsy among live births is estimated to be between 1.9 and 3.6/1000. The presence of periodontal disease in cerebral palsy children typically is due to bacterial plaque accumulation caused by their inability to correctly clean their own teeth, difficulties in chewing and swallowing food, and improper movements of masticatory muscles and tongue muscles. The objective of this study is to estimate the periodontal status in cerebral palsy individuals and evaluate the presence of Dialister pneumosintes. Thirty cerebral palsy children from the Spastics Society of Tamilnadu with signs of periodontitis were compared with the same number of age- and gender-matched controls for oral hygiene and periodontal parameters. Subgingival plaque samples were screened for the presence of respiratory pathogen D. pneumosintes by polymerase chain reaction (PCR). A variation was noted between types of cerebral palsy individuals with a mean probing pocket depth value of 6 in spastic type, 4.86 in the ataxic, and 4.3 in the dyskinetic. Clinical attachment level varied from 6.71 in spastic to 5.43 in ataxic and 3.50 in dyskinetic. Oral hygiene index-simplified ranged from 2.764 in spastic to 2.25 in ataxic and 1.41 in dyskinetic. PCR results indicated 25% and 21.7% positivity for D. pneumosintes among cerebral palsy and control group, respectively. The odds ratio calculated to estimate the risk of periodontitis due to D. pneumosintes was 0.765. It was concluded that oral hygiene status and severity of periodontitis worsens as the rigidity and muscle tone limiting limb movement increases in cerebral palsy individuals.

Prevalence of fimA genotypes of Porphyromonas gingivalis in adolescent orthodontic patients.

BackgroundThe placement of fixed orthodontic appliances may alter the composition of oral microbiota and has the potential risk of periodontal complication. Porphyromonas gingivalis fimbriae play a critical role in colonization of P. gingivalis in subgingival regions. In this study, we investigated the association between the prevalence of P. gingivalis-specific fimA genotypes and periodontal health status in adolescent orthodontic patients, to identify the pathogencity of P. gingivalis during orthodontic therapy.MethodsSixty-one adolescent orthodontic patients were enrolled in the case group, while the control group consisted of 56 periodontally healthy adolescents. At baseline (T0), clinical parameter (gingival index) was tested, and subgingival plaque samples were obtained from the lower incisors. The incidences of P. gingivalis and fimA genotypes were detected by polymerase chain reaction. All parameters were reassessed after 1 month (T1), 2 months (T2), 3 months (T3), and 6 months (T4) in the case group and then compared with those of the controls.ResultsBoth microbiological and clinical parameters from orthodontic patients started to increase after placement of fixed appliances. Maximum values were reached at 3 months after placement and followed by their decreases at six months. However, the microbiological and clinical parameters in the case group were significantly higher than those of the control group. The GI of fimA II, IV-positive samples was significantly higher than that of negative samples.ConclusionP. gingivalis carrying fimA II or IV was closely related to orthodontic gingivitis. In addition, proper oral hygiene control could lead to little increase in dental plaque accumulation, and exert a beneficial effect to periodontal tissues.

Dental paleopathology in fossil rhinoceroses: etiology and implications

AbstractThe identification and interpretation of paleopathological findings in the dentition of mammals have the potential to shed light on disturbed development and stress conditions. In combination with knowledge about the timing of dental development, dental pathologies can provide a unique opportunity to reconstruct specific phases in the life history of fossil taxa, as well as animal‐environment interactions. The dental ontogeny of the extinct rhinoceros Prosantorhinus germanicus from the Miocene is well‐known from an exceptionally preserved sample of juvenile dentaries. Two of the represented juvenile individuals each revealed a dental anomaly, which were analyzed macroscopically and via X‐ray tomography in this study. One specimen documents decreased dental wear of deciduous cheek teeth, mandibular bone resorption as well as abnormal cemental deposition. At an early age, the extinct juvenile rhinoceros probably was affected by a gingival infection resulting from an accumulation of bacterial plaque. This led to a chronic gingivitis and eventually may have caused periodontitis. Furthermore, it suffered from inflammation‐induced hypercementosis. Another specimen revealed an abnormal reduction in thickness of enamel in the deciduous cheek tooth. The enamel hypoplasia indicates stress experienced during the prenatal period. During a phase of environmental stress (e.g. increased fluoride exposure) or physiological stress (e.g. malnutrition) the function of the secretory ameloblasts was disrupted in the developing embryo. The present work shows that the analysis of dental paleopathologies is a useful means for retrospective assessment of specific phases in the life history of extinct animals. This adds to the picture of the living conditions of the extinct rhinoceros P. germanicus.

The Development And Evaluation Of Water Irrigator For Plaque Removal

Introduction: Patient undergoes orthodontic treatment with fixed appliances have more plaque retentive area compare to normal person. Therefore, this patient requires higher standard of oral hygiene care. One of adjunctive cleaning device for oral hygiene care is water irrigator. There are several types of water irrigator available in the market such as syringe type, electricity and battery operated. However, the problem is the available water irrigators are expensive. Materials and Methods: A prototype of water irrigator was designed and constructed in USIM. The water irrigator is faucet powered so that the pressure can be easily controlled by adjusting the tap. Four dental arches with orthodontics brackets were prepared using sets of natural teeth mounted on plaster of paris. Artificial plaque was prepared and grown on the dental arches. Plaque score was recorded based on Rustogi modification of navy plaque index (RMNPI) before and after irrigation with water irrigator. The procedure was repeated using toothbrush which act as control group. All the data were collected and analysed using SPSS version 22. Results: The initial mean plaque score for water irrigator was 6.34 and 2.54 after cleaning. While the initial mean plaque score for toothbrush was 6.04 and 3.71 after cleaning. This showed that there were significantly reduction of 60% and 39% plaque score after using water irrigator and tooth brushing respectively. Conclusion(s): In conclusion, both tooth brushing and the new water irrigator can significantly remove dental plaque accumulation on the tooth surface. However, water irrigator showed better results in removal of dental plaque accumulation.

A Polymethyl Methacrylate-Based Acrylic Dental Resin Surface Bound with a Photoreactive Polymer Inhibits Accumulation of Bacterial Plaque.

The aim of this study was to examine the ability of a poly(2-methacryloyloxyethyl phosphorylcholine-co-n-butylmethacrylate-co-2-methacryloyloxyethyloxy-p-azidobenzoate) (PMBPAz) coating on polymethyl methacrylate (PMMA)-based dental resin to inhibit bacterial plaque formation, as well as the polymer's durability against water soaking and chemical exposure. Successful application of PMBPAz on PMMA surfaces was confirmed by x-ray photoelectron spectroscopy (XPS) and measuring the static air contact angle in water. The anti-adhesive effects to bacterial plaque were evaluated using Streptococcus mutans biofilm formation assay. The mechanical and chemical durabilities of the PMBPAz coating on the PMMA surfaces were examined using soaking and immersion tests, respectively. XPS signals for phosphorus and nitrogen atoms and hydrophilic status on PMMA surfaces treated with PMBPAz were observed, indicating the presence of the polymer on the substrates. The treated PMMA surfaces showed significant inhibition of S mutans biofilm formation compared to untreated surfaces. The PMBPAz coating was preserved after water soaking and chemical exposure. In addition, water soaking did not decrease the ability of treated PMMA to inhibit biofilm formation compared to treated PMMA specimens not subjected to water soaking. This study suggests that PMBPAz coating may represent a useful modification to PMMA surfaces for inhibiting denture plaque accumulation.

In vitro assessment of stainless steel orthodontic brackets coated with titanium oxide mixed Ag for anti-adherent and antibacterial properties against Streptococcus mutans and Porphyromonas gingivalis

Orthodontic brackets made from stainless steel were introduced in dentistry, though they have less ability in reducing enamel demineralization and are not successful in preventing microbial as well as biofilm growth. In this study, we evaluated the significant role of different brackets in reducing enamel demineralization indirectly. Results from different tests indicate the significant reduction in adhesion, biofilm formation and slow growth of tested bacterial species on brackets coated with Ag + TiO2 and found to be statistically significant lower than control. There was no loss in cell viability in all brackets indicating that the cells are biocompatible with different bracket materials. Scanning electron microscopy showed less bacteria attached with the surface coated with Ag + TiO2 indicated that bacteria were losing adherent nature on coated surface. In conclusion, TiO2+Ag coating on stainless steel brackets possessed anti-adherent properties and also have demonstrable antibacterial properties therefore helps in preventing dental caries and plaque accumulation indirectly. The cell compatibility of TiO2+Ag coated brackets is superior to the uncoated samples therefore can be used in orthodontics as it not only provide suitable antimicrobial activity and resistance to biofilm formation but also sustained the cell viability of human gingival fibroblast (HGF) cell lines.

The Effect of Photodynamic Therapy in the Treatment of Chronic Periodontitis: A Review of Literature.

Introduction: Chronic periodontitis is the most common periodontal disease which is related to the chronic accumulation of bacterial plaque. Since mechanical methods are not sufficient in the treatment of this disease, administration of local/systemic antibiotic is recommended following mechanical debridement. However, side effects of antibiotics such as microbial resistance and patient allergy led to development of alternative methods. One of these suggested methods is the antimicrobial photodynamic therapy (aPDT). PDT is a local noninvasive treatment modality without the side effects caused by antibiotics. The aim of this study was to review the articles related to the application of PDT with laser in the treatment of chronic periodontitis. Review of literature: In the present review of literature, the authors used key words such as chronic periodontitis, laser and photodynamic therapy, and conducted a literature search via Google Scholar and PubMed for the period of 1990 to 2015. A total of 47 articles in English were found. The articles that were not associated with the topic of research and review articles were deleted and only clinical trials were evaluated. After reviewing 23 articles' abstracts, the full texts of 16 articles were analyzed. Conclusion: Considering the safety, the lack of side effects and general advantages like more patient compliance, the PDT treatment with scaling and root planing (SRP) is recommended as an efficient adjunctive modality for the treatment of localized chronic periodontitis especially during the maintenance phase in non-surgical treatment.

Intensywność próchnicy i stan higieny jamy ustnej warszawskich dzieci w wieku przedszkolnym obciążonych dużym ryzykiem wystąpienia próchnicy

Background. Fast progression of caries in primary teeth may lead to pulpitis or even to premature tooth loss. Poor oral hygiene is a risk factor for caries, although it is not considered to be an important one.Objectives. The objective of this study was to assess the correlation between dental caries and oral hygiene in Warsaw preschool children at high risk for caries.Material and Methods. One hundred and eighty preschool children (average age 50.27 ±11.27 months) at risk for caries were eligible to participate in the study. Oral hygiene, carious lesions, fillings and missing teeth were evalnated. White spot lesions, dmft, dmfs, d1-2dmft, d1-2dmfs, and their components were calculated. The study was conducted by 3 calibrated examiners.Results. Dmft was 7.20 ±5.33, dmfs 15.65 ±15.82, d1-2dmft 10.81 ±5.63, d1-2dmfs 20.84 ±16.56, including d1-2t and d1-2s dp – 3.59 ±2.86 and 5.14 ±4.51 respectively for 19.04 ±1.99 examined primary teeth. The main component of the indicators was the average number of teeth/tooth surfaces with caries (4.71 ±4.54/8.72 ±10.77 respectively). The average number of teeth/surface fillings amounted to 1.73 ±1.99 and 3.58 ±5.01; those lost due to the caries of 0.79 ±1.74 and 3.39 ±7.56. Treatment index amounted to 0.27 and DI-S to 1.1 ±0.57. There was a statistically significant positive correlation between dmft and dmfs, dt and ds, and the DI-S.Conclusion. Poor oral hygiene caused severe caries. Massive accumulation of dental plaque was accompanied by a greater number of teeth and tooth surfaces with caries.

Randomized controlled trial on mouth rinse and flossing efficacy on interproximal gingivitis and dental plaque.

The objective of this study was to compare the efficacy of an essential oils mouth rinse and dental floss on dental plaque accumulation and gingivitis in interproximal areas. With informed consent, a parallel randomized controlled clinical trial was developed with 60 third-year dental hygiene students, randomly divided into two non-blind groups of 30 individuals each. For a period of 2weeks, one group used an essential oils mouth rinse, according to manufacturer's instructions, and the other group flossed twice a day. Both groups received a toothbrush and fluoridated toothpaste for home dental hygiene care. A baseline dental hygiene appointment consisted of tooth scaling, prophylaxis and collection of the study data, using the Lobene modified gingival index; Saxton & Ouderaa gingival bleeding index and the Quigley & Hein modified by Turesky dental plaque index. At baseline, there was no significant difference between the groups for interproximal gingival inflammation (P=.214), gingival bleeding (P=.829) and dental plaque accumulation (P=.860). After 2weeks of treatment, no significant differences were found between the essential oils mouth rinse and dental flossing for reduction of interproximal gingival inflammation (P=.938) and bleeding (P=.307). Essential oils mouth rinse showed to be significantly better than dental flossing in reducing interproximal dental plaque accumulation (P=.006). The use of an essential oils mouth rinse may be advised, as a complement, for patients unable to floss effectively, as it is more effective in reducing interproximal dental plaque accumulation than dental floss.

Efectiveness of 0,05% sodium hypochlorite rinse against gingival inflammation

Objectives: To compare the effectiveness of a mouth rinse of sodium hypochlorite 0.05% and 0.12% chlorhexidine against supragingival plaque and gingivitis development. Materials and Methods : A comparative randomized, double blind parallel group trial was performed with 38 young men who form part of the Ecuadorian Military Service. Subjects were divided into two groups according to their hygiene methods and each group receives a type of blinded rinse, after a professional cleaning. The rinses were indicated twice a day with rinses of Sodium Hypochlorite administered to Group 1 and 0,12% Chlorhexidine administered to Group 2, using 15 ml of the substances twice a day during 60 seconds for 21 days. Plaque index (QHPI), Loe and Silness Gingival Index, and Percentage of bleeding sites on probing were recorded on Day 0 and Day 21. Adverse effects were evaluated with questionnaires and pictures were taken in order to register any staining. Results : Values between groups showed no statistically significant differences. On day 21, the plaque indexes decreased in both groups. The CLX group, the average QHPI values decreased 0.38, in the NaOCl group the average values decreased 0.12. The average value in the CLX IG group decreased 0.42 and 0.38 in the NaOCl group. The percentage of sites that bled on probing decreased 3.84% in average in the CLX group and 7.07% in the NaOCl group. Conclusions: Clorhexidine has evidence of Gold Standard Agent in terms of antiplaque and antigingivitis, but mouth rinses with 0.05% NaOCl were effective compared to chlorhexidine in terms of antimicrobial action, which could be an effective method to treat inflammation gingival and the accumulation of bacterial plaque at a lower cost.

Fracture, roughness and phase transformation in CAD/CAM milling and subsequent surface treatments of lithium metasilicate/disilicate glass-ceramics

This paper studied surface fracture, roughness and morphology, phase transformations, and material removal mechanisms of lithium metasilicate/disilicate glass ceramics (LMGC/LDGC) in CAD/CAM-milling and subsequent surface treatments. LMGC (IPS e.max CAD) blocks were milled using a chairside dental CAD/CAM milling unit and then treated in sintering, polishing and glazing processes. X-ray diffraction was performed on all processed surfaces. Scanning electron microscopy (SEM) was applied to analyse surface fracture and morphology. Surface roughness was quantitatively characterized by the arithmetic average surface roughness Ra and the maximum roughness Rz using desktop SEM-assisted morphology analytical software. The CAD/CAM milling induced extensive brittle cracks and crystal pulverization on LMGC surfaces, which indicate that the dominant removal mechanism was the fracture mode. Polishing and sintering of the milled LMGC lowered the surface roughness (ANOVA, p < 0.05), respectively, while sintering also fully transformed the weak LMGC to the strong LDGC. However, polishing and glazing of LDGC did not significantly improve the roughness (ANOVA, p > 0.05). In comparison of all applied fabrication process routes, it is found that CAD/CAM milling followed by polishing and sintering produced the smoothest surface with Ra = 0.12 ± 0.08µm and Rz = 0.89 ± 0.26µm. Thus, it is proposed as the optimized process route for LMGC/LDGC in dental restorations. This route enables to manufacture LMGC/LDGC restorations with cost effectiveness, time efficiency, and improved surface quality for better occlusal functions and reduced bacterial plaque accumulation.

Effectiveness of siwak salvadora persica extract to aggregatibacter actinomycetemcomitans as one of pathogenic bacteria causing periodontal disease

Objective : Periodontal disease is one of oral and dental diseases which most commonly found in humans caused by several factors, one of them due to the accumulation of bacterial plaque. Aggregatibacter actinomycetemcomitans is a bacterial pathogen that frequently causes periodontal disease.Material and Methods : To inhibit the growth of these bacteria can be done by using natural ingredients that contain anti-bacterial agent. One of the natural ingredients that contain antibacterial substances is Siwak. To determine the effect of siwak extract against bacteria Aggregatibacter actinobaciluscomnitans as one of the pathogenic bacteria causing periodontal diseases. The study was laboratory experimental with posttest only control group design.Results : This study used sample of Aggregatibacter actinomycetemcomitans colonies in MHA medium. Twenty four samples were divided into six treatment groups, they were 5 groups given the extract siwak with concentration of 3.125%, 6:25%, 12.5%, 25%, 50% and 1 group treated with control DMSO 5%. Inhibition zone was measured after 48 hours incubation at 37°C and measured using caliper. Data analysis was performed using Kruskal Wallis test. The mean diameter of inhibition zone at concentrations of 3.125%, 6:25%, 12.5%, 25%, and 50% were 6.4 mm, 7.0 mm, 7.2 mm, 7.9 mm and 8.6 mm.Conclusion : Siwak extract can inhibit the growth of Aggregatibacter actinomycetemcomitans as one of the pathogenic bacteria causing periodontal diseases with the largest concentration is a concentration of 50% and the smallest concentration that is 3.125%.

Rinsing effect of 60% bay leaf (Syzygium polyanthum wight) aqueous decoction in inhibiting the accumulation of dental plaque during fixed orthodontic treatment

Background: Fixed orthodontic appliance patients have a high risk to increasing plaque accumulation in tooth surface due to the presence of fixed appliance components. Using mouthwash with antibacterial agent from herbal material can control dental plaque accumulation. Bay leaf (BL) contains active compounds such as essential oil, tannin and flavonoid that have been known as an antibacterial agent. Purpose: The purpose of this study was to determine the effect of rinsing with 60% of BL aqueous decoction to the accumulation of dental plaque in fixed orthodontic appliance patients. Method: This research was an experimental clinical research with pretest and post-test control group design conducted on 20 subjects with age ranged between 18-25 years old. All subjects were undergoing the last stage (finishing) of fixed active orthodontic treatment. The subjects were instructed to rinse with 60% of BL aqueous decoction and 0.2% chlorhexidine as a control. Wash out period that needed between rinsing with 60% of BL aqueous decoction and rinsing with 0.2% chlorhexidine was 7 days. Each mouthwash used routinely for 7 days with same duration and intensity. Plaque scoring was measured before and after each treatment using Orthodontic Plaque Index (OPI). Result: One-way Anova test showed that there was a significant difference in the plaque index before and after treatment between the group of rinsing with 60% of BL aqueous decoction and group of rinsing with chlorhexidine (p&lt;0.05). Conclusion: Rinsing with 60% BL aqueous decoction can decrease the accumulation of dental plaque in fixed orthodontic appliance patients.

Original Research. Surface Roughness Changes of Different Restoration Materials after Tooth Brushing Simulation Using Different Toothpastes

Abstract Background: The need for the whitening effects of toothpastes became primary for most users. Changes in the surface roughness of restoration materials after tooth brushing are inevitable, and the abrasion is known to increase the possibility of dental plaque accumulation. Aim of the study: To evaluate in vitro surface roughness changes of different dental restorative materials after tooth brushing simulation. Material and methods: Fifty specimens of two composite materials (Evicrol, Super-Cor), two glass ionomer materials (Glassfill, Kavitan Cem) and a silicate cement (Fritex) were prepared according to the manufacturer’s instructions. Each group of specimens was divided in three subgroups for tooth brushing simulation: using two different types of toothpaste and without toothpaste. Before and after 153 hours of tooth brushing simulation with a custom-made device, the surface roughness was measured with a surface roughness tester. Statistical analysis was performed after collecting the data. Results: All materials exhibited changes in surface roughness after the use of both toothpastes. The self-curing composite showed the less change and glass ionomer materials showed the greatest changes in surface roughness. Conclusions: The surface changes of dental materials depended on their composition and the cleaning procedure. Although self-curing composite was the most resistant to surface changes, its surface roughness values were high. Light-curing composite presented the lowest surface roughness values, even after brushing with toothpastes. The “medium” labeled toothbrush caused significant changes without toothpaste on the surface of light-curing composite, glass ionomer and silicate cement materials.

Oral health status, salivary pH status, and Streptococcus mutans counts in dental plaques and saliva of children with acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL), accounting for 23% of all malignancies in children, is the most prevalent pediatric malignancy. This study compared dental caries, oral hygiene status, salivary pH, and Streptococcus mutans counts in dental plaques and saliva of children with leukemia with those of healthy controls. This case-control cross-sectional study assessed 32 children with ALL and 32 healthy children (4-9-year-old) for gingival bleeding index (GBI), decayed, missing, and filled/decayed, missing, and filled surfaces (DMF/dmfs), and plaque index (PI). Sampling was performed to determine salivary pH and S. mutans counts of the participants. The two groups matched in terms of age, gender, and socioeconomic status. The groups were compared using independent t-test, Mann-Whitney test, Chi-square test, and Spearman's and Pearson's correlation analyses. The mean DMF/dmfs and GBI were significantly higher in the ALL group (PDMF/dmfs= 0.03; PGBI= 0.04). However, the two groups were not significantly different in the mean PI values (P = 0.47). The mean S. mutans counts in dental plaques and saliva of the children with leukemia were significantly lower than the healthy controls (P < 0.01). Moreover, the mean salivary pH was significantly lower in the ALL group compared to the control group (P < 0.01). Higher caries and gingival bleeding rates, higher dental plaque accumulation in children with ALL, decreased salivary pH, and cumulative effects of other risk factors highlight the significance of oral hygiene training programs (for the parents of these children) and regular dental examinations for these children.

Oral Hygiene in the Elderly with Different Degrees of Cognitive Impairment and Dementia.

The control of bacterial dental plaque through daily oral hygiene is essential to prevent oral diseases such as caries or periodontal disease, especially in at-risk populations, including the elderly with mild cognitive impairment and dementia. The aim of this study was to determine the association between different levels of cognitive impairment and dementia in an elderly population and their capacity to maintain adequate oral hygiene. A case-control study (elderly with versus without mild cognitive impairment or dementia) was performed in Granada, Spain. Outcome variables were tooth/prosthesis-brushing frequency/day, bacterial plaque index, and gingival bleeding index. Statistical models were adjusted by age, sex, educational level, and tobacco and alcohol habits. The study included 240 cases and 324 controls. The final model, adjusted by age, sex, educational level, and tobacco and alcohol consumption, showed a significant association between degree of cognitive impairment and daily oral hygiene, accumulation of bacterial plaque, and gingival bleeding. In summary, deficient daily oral hygiene, evidenced by greater bacterial dental plaque accumulation and gingival inflammation, is independently associated with cognitive impairment, even at its earliest stage.

Measurements of chlorhexidine, p-chloroaniline, and p-chloronitrobenzene in saliva after mouth wash before and after operation with 0.2% chlorhexidine digluconate in maxillofacial surgery: a randomised controlled trial

Chlorhexidine gluconate is used to prevent the accumulation of dental plaque and gingivitis, infection of the surgical site, and ventilator-associated pneumonia in maxillofacial surgery, but it is not clear whether the metabolites of chlorhexidine are detectable in the patient’s saliva at clinically relevant concentrations. Forty-three patients who had orofacial operations were randomised to use a 0.2% chlorhexidine gluconate (n=23), or an octenidine-based, chlorhexidine-free (n=20), mouthwash once preoperatively and three times daily for five postoperative days. After the first, 8.7 (23.3) mg/L chlorhexidine (0.7%-2.5% of the total amount used) was measured in saliva. The concentration increased to 15.2 (6.2) mg/L after the second rinse (first postoperative day), and peaked at 29.4 (11.2) mg/L on the fourth postoperative day. It remained detectable for up to 12hours after the last one, but was not detectable in serum or urine at any time. The potentially carcinogenic metabolite p-chloroaniline was detectable in saliva at higher concentrations in the chlorhexidine group (0.55mg/L) than the octenidine group (0.21mg/L), and p-chloronitrobenzene was detected in both groups in only minimal concentrations (0.001-0.21mg/L). Chlorhexidine gluconate mouthwashes do increase the concentration of p-chloroaniline, but a single use seems to be safe. Whether prolonged exposure over many years may have carcinogenic potential is still not clear. Based on the hitherto unknown kinetics of p-chloroaniline in saliva, the recent recommendation of the Federal Drug Administration (FDA) in the USA to limit the use of a chlorhexidine gluconate mouthwash to a maximum of six months seems to be justified.

Clinical Evaluation Of The Periodontal Condition During Fixed Orthodontic Treatment

Throughout orthodontic treatment, oral hygiene is particularly important and must be rigorously controlled throughout therapeutic act. The aim of our clinical study was to examine the periodontal status of patients before, during and after orthodontic appliances are used. 50 patients were selected, plaque index, gingival index, modified papillae bleeding index and clinical probing depth was evaluated on anchorage teeth, separately those with orthodontic bands and tubes. One of the most common findings during this kind of treatment is gingival alteration in the posterior region. Our practical observations showed a different status of these alterations at patients wearing bands on the anchorage teeth versus those with buccal tubes. Using some of the indices which describes the periodontal status at adult and adolescent patients, we found out that adolescents present a higher plaque index, and the accumulation of dental plaque is more severe when bands are used in both categories. Another finding, which is very important in everyday practice is that gingival inflammation and plaque accumulation decrease one month after debonding.

RETRACTED ARTICLE: Biological Mechanisms Relating Periodontitis and Diabetes

Diabetes mellitus is associated with a number of complications resulting from hyperglycemia. Periodontitis is among the major complications associated with diabetes and reciprocally affects the severity and control of diabetes. Increase inflammation induced by type 2 diabetes directly contributes to the increased prevalence and severity of periodontitis in these patients. Regardless of the amount of dental plaque accumulation, gingivitis is more prevalent in diabetic patients than in healthy controls suggesting an impact of diabetes on periodontal inflammatory response to the bacterial biofilm. Levels of proinflammatory cytokines in the periodontal tissue or gingival crevicular fluid are elevated in patients with poorly controlled diabetes in the absence of periodontal disease when compared to well-controlled and non-diabetic patients. This review focuses on the possible pathological mechanisms underlying the association between periodontal disease and type 2 diabetes, explores new avenues in understanding the inflammatory pathways, and discusses novel therapeutic approaches with a paradigm shift in the prevention and treatment of diabetes and periodontitis.