Interproximal Tooth Surfaces Research Articles

Awareness Regarding Usage of Interdental Aids and their Role in Oral Hygiene among Medical Undergraduates in District Sheikhupura, Pakistan-A Questionnaire-Based Study

Aim: The contemplations and actions of medical undergraduates concerning their oral well-being mirror their perception of the significance of interdental cleaning aids in the maintenance of oral hygiene. The current study aimed to evaluate understanding and discernment of the practice of interdental aids as well as their role in the maintenance of oral hygiene among medical undergraduates in the district of Sheikhupura, Pakistan. Methods: A questionnaire-based cross-sectional analysis was performed from June 2021 to December 2021 at Amna Inayat Medical College in the district of Sheikhupura, Pakistan on a total of 220 medical undergraduates who were enrolled by convenient sampling method. Data were assembled using a standardized questionnaire that was circulated amongst students of 1st Year MBBS to Final Year MBBS. Associations between awareness regarding interdental cleaning and oral hygiene practice among both genders and all the years of study were assessed through the Pearson Chi-Square test. Results: The study comprised 123 females and 97 males with an average age range of 18 - 25 years. Most of the students i.e. 47.3% knew that the interproximal tooth surface is the most difficult to clean and cannot be effectively cleansed with a toothbrush only. Significant differences were seen in gender regarding the cleaning of teeth (P ≤ 0.001), the challenging surface of the tooth to clean (P ≤ 0.01), reasons for bad breath (P ≤ 0.003), knowledge of gum disease (P ≤ 0.000) and information regarding interdental cleaning (P ≤ 0.000). Practical Implication: Imparting knowledge regarding the maintenance of oral hygiene is crucial due to the connection between the oral cavity and the rest of the body. In a developing country like Pakistan, awareness, and understanding of oral hygiene is not up to the mark even in the medical population. Hence, improvement in oral hygiene can be brought about by creating public awareness regarding interdental aids in addition to brushing alone. Conclusions: Outcomes of the existing research propose that the overall understanding and awareness amongst medical undergraduates related to interdental aids was satisfactory. Established on these conclusions, additional communal-focused oral health promotions are requisite to piloting the degree of the dwelling of medical undergraduates. Keywords: Awareness, Dental, Dentist, Interdental area, Gingivitis, Knowledge, Medical Undergraduates, Oral Health, Periodontitis, Plaque.

Success of resin infiltration treatment on interproximal tooth surfaces in young adults-A practice-based follow-up study.

ObjectivesArresting active initial caries lesions is part of the modern caries controlling system. Resin infiltration (RI) system has been found a promising method in arresting interproximal initial lesions. The aim was to investigate whether RI arrests progression of active caries lesions.Materials and methodsParticipants (n = 20) of the retrospective study were patients in the Dental Teaching Unit, City of Oulu, Finland, mean age 26 years (SD5.2). Indication for RI was radiographically diagnosed progressing (ICDAS 1–3) interproximal lesions (n = 54). RI treatments were performed in 2015–2017. Controls were initial lesions in the same bitewing radiographs without RI or other treatment (n = 24). For analyzes teeth were categorized as lower and upper premolars and molars. The change in lesions during the follow‐up period was recorded surface wise as follows: deterioration / improvement from ICDAS score 3/improvement from ICDAS score 2/improvement per se/at follow‐up, lesion was less diffuse/no change. The changes in each tooth surface were analyzed between RI intervention and control teeth by using Chi‐square test. Proportions of successful and failed surfaces were given.ResultsThe mean length of follow‐up period was 17.4 m (SD7.2). Arresting of caries lesions (ICDAS scores 2 and 3) was distinctly better in RI group (63.0%) compared with the controls (29.1%). The situation progressed among 29.2% of the controls whereas the respective proportion among the intervention group was 14.8%. Progression of lesions was more distinct in all tooth groups in the control group. Outcome was successful despite the lesion depth.ConclusionsResin infiltration seems effective in arresting progression of initial caries lesions with monitoring period of 1.5 years.

Reason for tooth material loss among FMR patients - A retrospective study

Tooth wear is a general term describing the loss of dental hard tissues, from the surface of the teeth caused by factors other than dental caries, trauma and developmental disorders. Attrition, Abrasion and erosion usually cause alterations of the tooth surfaces and manifest as tooth wear. Tooth surface loss may be considered physiological or pathological. Physiological tooth surface loss occurs as a result of mastication and adjustment, which is required for the teeth to function correctly. Physiological tooth surface loss may also occur at interproximal tooth surfaces due to friction between the adjacent teeth. Inversely, pathological tooth surface loss represents unacceptable levels of dental hard tissue loss. It is characterized by abnormal destruction, which may require treatment. The aim was to assess the reason for tooth material loss among FMR diagnosis patients. A retrospective study sample of 65 cases was collected from DIAS(Dental Information Archiving Software). The data was converted into an excel sheet for tabulation and further statistical analysis were done in SPSS. The p-value was insignificant and the current study proves that the reason for tooth material loss is predominantly caused by attrition. Within the limits of the study, the reason for tooth material loss is due to attrition.

Effect of orthodontic treatment and comorbidity risk factors on interdental alveolar crest level: A radiographic evaluation.

Alveolar bone loss is regarded as a potential adverse event during orthodontic treatment, especially in adults. The purposes of this study were to evaluate the prevalence and severity of interdental alveolar crest height loss in adult orthodontic patients compared with an untreated control group and to identify comorbidity risk factors for such bone loss (high BMI score, high blood pressure, high cholesterol levels, and smoking). Standardized bitewing radiographs of patients' buccal segments were taken before and after treatment of 34 consecutive adults treated in an orthodontic clinic. The control group included 29 patients from the operative dental clinic matched according to age and sex. Mean ages of the participants before treatment were 35.7±6.7 and 35.6±7.3years for the control and treatment groups, respectively. Before orthodontic treatment, the patients were evaluated, treated as needed, and approved by a periodontist. They were periodontically healthy before treatment. Interdental alveolar crest height loss was calculated by subtracting the distance on a bitewing x-ray from the cementoenamel junction to the interdental alveolar crest at each interproximal tooth surface from the mesial aspect of the first premolar to the distal aspect of the secondmolar (8 sites per quadrant). Changes in interdental alveolar crest height were calculated by subtracting the cementoenamel junction-interdental alveolar crest distance before treatment from the corresponding distance after treatment. The mean individual bone losses of all interproximal surfaces were 0.130±0.192 and 0.072±0.280mm in the treatment and control groups, respectively. These differences did not reach statistical significance (P=0.353). Twenty-two patients (65%) from the treatment group and 10 patients (34%) from the control group had an increase in the cementoenamel junction-interdental alveolar crest distance of more than 1mm in at least 1 site, with borderline significance between the groups (P=0.079). Notably, no association was observed between bone loss with any comorbidity factor. The results of this study correspond to the conventional understanding in the orthodontic and periodontal literature that orthodontic tooth movement per se does not cause attachment loss. However, orthodontists should always be aware of the possibility of periodontal deterioration during orthodontic treatment. Therefore, comprehensive periodontal examination is necessary during orthodontic treatment, especially in adults.

Digital Imaging Capability for Caries Detection: A Meta-analysis.

The objective of this study was to identify the diagnostic capability of photostimulable phosphor plates (PSPs) and direct digital sensors (DDSs) in the detection of interproximal caries. Studies were identified that evaluated the diagnostic capability of PSPs and DDSs in detecting interproximal caries in human teeth, in both dentin and enamel. Histologic sections were the gold standard. This systematic review searched several electronic databases. In addition, Google Scholar and reference lists of the finally included studies were screened. QUADAS-2 was applied to evaluate the risk of bias among included studies. Six studies were finally included; 4 of which were considered homogeneous enough to conduct a meta-analysis. The meta-analysis evaluated 668 interproximal human tooth surfaces. All studies used extracted human teeth ranging from no caries present to caries into dentin. Each tooth was radiographed by both PSP and DDS technologies and then submitted for histologic analysis as the gold standard. Meta-analysis showed that intraoral digital imaging is of high specificity but low sensitivity in the detection of interproximal caries. The sensitivity and specificity for different studies with PSPs varied substantially from 15% to 54% and from 84% to 100%, respectively. Direct sensor analysis sensitivity and specificity ranged from 16% to 56% and from 90% to 100%, respectively. Newer PSP and DDS technologies had statistically significant higher sensitivities, yet the differences in diagnostic capabilities between the older and newer technologies were clinically insignificant. Both digital systems were excellent in identifying surfaces without caries (specificity) but were not sensitive enough to reliably identify interproximal surfaces with caries. Clinicians must therefore remain vigilant in performing a careful clinical examination and other diagnostic tests rather than relying solely on radiographic imaging to diagnose interproximal caries. Knowledge Transfer Statement: This study will help clinicians make an evidence-based decision when deciding which digital radiography system to use when evaluating interproximal caries. Time, patient radiation safety, cost, and image quality are factors to be considered. The performance of the different available digital imaging systems was compared with the current gold standard-a histologic analysis-via meta-analysis.

Tooth brushing for oral prophylaxis

Control of plaque and debris is essential for the prevention of inflammatory periodontal diseases and dental caries, because plaque is the primary etiological factor in the introduction and development of both of these infection-oriented diseases. Plaque removal with a toothbrush is the most frequently used method of oral hygiene. Powered toothbrushes were developed beginning in the 1960s and are now widely used in developed countries. The bristles of a toothbrush should be able to reach and clean efficiently most areas of the mouth, and recently the design of both manual and powered toothbrushes has focused on the ability to reach and clean interproximal tooth surfaces. An individual's tooth brushing behavior, including force, duration, motivation and motion, are also critical to tooth brushing efficacy. Dental floss and the type of toothpaste play additional important roles as auxiliary tools for oral prophylaxis. Dental professionals should help their care-receivers’ meet the requirements of oral hygiene to maintain their QOL. This article reviews these topics.

Effect of fluorides from various restorative materials on remineralization of adjacent tooth: An in vitro study

The aim of the study was to evaluate the extent of surface zone remineralization and the effect of fluoride at the inter-proximal adjacent tooth surface, using restorative materials FusionAlloy, Ketac-Fil and Heliomolar. Ninety extracted molar teeth were used of which 45 were placed in artificial caries for 10 weeks. The remaining 45 teeth were filled with the respective restorative materials, mounted with the artificial carious teeth in proximal contact with plaster and placed in artificial saliva for a period of 28 days. Finally, sectioning of artificially carious teeth was done mesio-distally and observed under the optical microscope and scanning electron microscope. Comparison among the groups was done by one-way analysis of variance [ANOVA] and Fischer's F test. Intercomparison between the groups was done by using Dunnett's t-test. Results obtained from transmitted electron microscopic and scanning electron microscopic observations were almost similar with the Ketac-Fil and Heliomolar showing better results in surface zone remineralization compared to FusionAlloy. Also, Ketac-Fil is a good material in releasing fluoride to remineralize enamel when compared to Heliomolar and FusionAlloy. Thus, it can be used mainly in class II cavity restorations of primary and permanent dentitions due to the potential ability of fluoride containing glass ionomer cements and composite resins to remineralize incipient carious lesions on adjacent teeth.

Comparison of different toothbrushing protocols in poor-toothbrushing orthodontic patients

The aim of this study was to determine, using a computerized image analysing system, whether the use of a curved-bristle toothbrush (CBT) alone is more effective than two other toothbrushing protocols on dental plaque elimination in poor-toothbrushing orthodontic patients. The labial surfaces of the maxillary canine-to-canine anterior teeth of 30 patients (12 males and 18 females) were individually photographed following dental plaque staining before and 4 weeks after each toothbrushing protocol, with a 1-month washout interval. The toothbrushes used were (1) a CBT, (2) an orthodontic toothbrush (OT), and (3) an OT in combination with interproximal toothbrush (IT) (OT + IT). Total labial surfaces of the anterior teeth and stained plaque areas were measured and gingival indices (GIs) were also recorded. Repeated measures analysis of variance and Tukey's Honestly Significant Difference multiple range tests showed that the OT + IT produced a statistically significant decrease in the mean plaque percentage both for the total labial (7.2%) and interproximal (17.7%) tooth surfaces, when compared with the other toothbrushing protocols (P < 0.05). No statistically significant differences were found between the CBT and OT for the amount of bacterial plaque and GI scores (P > 0.05). Neither the CBT nor the OT alone was able to remove plaque under the archwires in poor-toothbrushing patients. Therefore, the use of ITs should be mandatory for effective plaque removal in these patients.

Dental restorations: a risk factor for periodontal attachment loss?

Dental caries and restorations in proximal tooth surfaces often impinge upon the periodontal biological width. This study examines whether these factors may contribute to risk for periodontal attachment loss at these sites. The study is based upon data from the Dunedin Multidisciplinary Health and Development Study, a long-standing cohort study. Approximal tooth surfaces of 884 study members were evaluated for restorations and caries at age 26 and again at 32 years, and probing depth and gingival recession were recorded in millimetres at age 32. Attachment loss was computed as the sum of pocket depth and gingival recession. Data were analysed using generalized estimating equations. Where a caries/restorative event had occurred on an inter-proximal tooth surface before age 26, the age-32 attachment loss at the corresponding periodontal site was approximately twice more likely to be >or=3 mm than if the adjacent tooth surface had remained sound to age 32. This was also true where a caries/restorative event had occurred subsequent to age 26. The association remained after controlling for potential confounders, including smoking. Site-specific periodontal attachment loss due to dental caries or restorative events occurs in adults in their third and fourth decades of life.

Alveolar bone loss of maxillary anterior teeth in adult orthodontic patients

The purpose of this study was to evaluate prevalence and severity of alveolar bone loss in adult orthodontic patients, and to identify risk factors for such bone loss. Standardized periapical radiographs of maxillary anterior teeth and cephalograms made before (T-1) and after (T-2) treatment and treatment charts of 343 adults aged 20.0 to 70.1 years (mean 34.5, SD 9.0) before treatment, representing groups of consecutively treated patients from four orthodontic practices, were examined. Alveolar bone loss was calculated by subtracting the distance from the cementoenamel junction (CEJ) to the alveolar crest (AC) at each interproximal tooth surface from the mesial of one maxillary canine to the mesial of the other. Changes in bone level were calculated by subtracting the distance CEJ-AC at T-1 from the corresponding distance at T-2. Tooth movement was calculated from measurements of superimposed tracings of pretreatment and posttreatment cephalograms. Hygiene level was scored subjectively as adequate or inadequate on the basis of gingival appearance on posttreatment intraoral color slides. Sample means of averaged bone loss of all six anterior teeth and of the surface with the most severe bone loss per patient were 0.54 mm (SD 0.62) and 1.82 mm (SD 1.01), respectively. Only 2.5% of the patients had averaged bone loss of > or = 2 mm, whereas 36% of the patients had one or more surfaces with bone loss of > or = 2 mm. Multiple linear regression analyses revealed a positive relationship between age and bone loss, and a negative relationship between initial bone level and subsequent bone loss. No association was found between bone loss and length of treatment, posttreatment gingival appearance, amount of horizontal or vertical tooth movement, or treatment with maxillary osteotomy.

キャビテーション効果を用いたプラーク除去に関する研究 ＩＶ 歯肉が退縮した歯間隣接面での人工プラークの除去効果について

歯肉が退縮した歯間隣接面でのキャビテーション効果による人工プラークの除去効果について検討を行った。歯冠部のみが露出した場合と歯根面まで露出した場合の, 歯間部歯肉の退縮程度の異なる2種類の顎模型を作製し, それぞれの1,4の近心隣接面, 6の遠心隣接面の歯冠部分と歯根部分を被験面とし, 水中でプラーク除去用チップの超音波振動により発生されるキャビテーションを頬側・口蓋側のいずれか一方向から照射した場合と両側から照射した場合の被験面の人工プラークの経時的な除去率を測定した。さらに, それぞれの歯肉退縮モデルにおける歯間空隙の形態についても測定を行い, 人工プラークの除去効果との関係について検討を加えた。その結果, 歯冠部のみが露出されたモデルでは, 頬側・口蓋側のいずれの方向から照射した場合も, チップと被験面の距離および照射方向から影となる程度が小さい1の被験面において最も高い除去率が得られた。また, 歯根部が露出されたモデルでも同様に1で最も高い除去率が認められた。さらに, 他の被験面についても, 人工プラークの除去率はチップと被験面の距離や歯間空隙の形態学的要因が関与することが示唆された。また, 両側より照射するといずれの被験面においても片側より照射した場合と比較し, 短時間でより劾率的に人工プラークが除去されることが確認された。

Prevalence of interproximal periodontal intrabony defects in an adult population in Sweden. A radiographic study.

The aim of this study was to determine the prevalence and localization of interproximal periodontal intrabony defects (IPIDs) in the total adult population of a Swedish county. On each interproximal tooth surface (third molars excluded) in 733 randomly selected dentate individuals aged 20 years and over, one examiner recorded from x5-magnified periapical radiographs, the presence or absence of IPID with a width and depth of at least 5 and 10 mm, respectively, representing 1 and 2 mm unmagnified. Intra-examiner reproducibility determined from double recordings was substantial (kappa = 0.66). Recordings of IPID were compared with those performed by 24 specialist periodontists using their own diagnostic criteria. IPIDs were recorded in 32% of the 733 examined individuals; the number of defects per individual ranged from 1 to 15. The prevalence of IPID increased with increasing age and IPID occurred more frequently in men than in women. IPID was observed more frequently on mesial than on distal tooth surfaces, whereas there was no difference between maxillary and mandibular tooth surfaces. Symmetrical localizations of IPID in relation to the sagittal plane were observed.

EPIX: an interactive computer application program for cross-sectional epidemiological, periodontal investigations from X-ray films

This article introduces the interactive computer application program EPIX and the associated personal computer/digitizer system. The system is used to measure marginal alveolar bone height and to record angular alveolar bone defects, defective margins of dental restorations and dental calculus from 5 x -magnified periapical radiographs in cross-sectional epidemiological investigations. The 134-kBytes compiled BASIC program provides 17 menu options. A complete recording of interproximal tooth surfaces takes on average 20 minutes per subject. Data from 200 subjects can be stored on one 5.25″ floppy disk. EPIX transforms data files into text files to enable transfer to main-frame computer for statistical analyses. Data displays on VDU or paper are available. Routines for data location and processing, file processing and visual display of an operator's manual provide additional facilities. EPIX has been use to process an epidemiological material of 912 subjects and has proved to be useful.

A computerized system to measure interproximal alveolar bone levels in epidemiologic, radiographic investigations. II. Intra- and inter-examiner variation study.

The study was aimed at analyzing intra- and inter-examiner variations in computerized measurement and in non-measurability of alveolar bone level in a cross-sectional, epidemiologic material. At each interproximal tooth surface, alveolar bone height in percentage of root length (B/R) and tooth length (B/T) were determined twice by one examiner and once by a second examiner from x5-magnified periapical radiographs. The overall intra- and inter-examiner variations in measurement were 2.85% and 3.84% of root length and 1.97% and 2.82% of tooth length, respectively. The variations were different for different tooth groups and for different degrees of severity of marginal periodontitis. The overall proportions of non-measurable tooth surfaces varied with examiner from 32% to 39% and from 43% to 48% of the available interproximal tooth surfaces for B/R and B/T, respectively. With regard to the level of reliability, the computerized method reported is appropriate to cross-sectional, epidemiologic investigations from radiographs.

Periodontal status of teeth facing extraction sites long-term after orthodontic treatment.

The present study was undertaken to examine the long-term periodontal status of teeth orthodontically moved into extraction sites. Patients were examined 14 to 34 years after active orthodontic treatment involving extraction of four first premolars. Three groups were established: one with closed tooth contacts and parallel adjacent teeth, one with closed tooth contacts and tipped adjacent teeth, and one with open contacts between adjacent teeth. Within each group accumulation of plaque, gingival health status, probing pocket depth, and probing attachment level of interproximal tooth surfaces, facing extraction sites and adjacent control sites between canine and lateral incisor were compared. Significantly more probing attachment loss was found in extraction sites with open tooth contacts (P less than 0.01) and with parallel adjacent teeth and closed tooth contacts (P less than 0.05) than in control sites. However, the mean differences were less than 0.5 mm, which may not be considered clinically significant. Tipping of teeth into the extraction sites had no long-term detrimental effect on the probing attachment level. No differences in accumulation of plaque and in gingival health status were observed.

Long-term periodontal status of teeth moved into extraction sites

The present study was undertaken to assess the long-term periodontal status adjacent to teeth that had been moved move orthodontically into extraction sites. Twelve persons with a mean age of .2 ± 5.7 (SD) years, who had completed orthodontic therapy at least 10 years previously, were examined. The orthodontic treatment had included bilateral premolar extraction in only the maxilla. Interproximal tooth surfaces in the maxilla adjacent to the extraction sites (study group) were compared to corresponding tooth surfaces in the mandible (control group) with respect to (1) plaque, (2) visual inflammation, (3) bleeding after probing, (4) pocket depth, (5) gingival recession, (6) loss of connective tissue attachment, (7) radiographic bone height, and (8) root resorption. Statistical comparisons were made via analyses of variance and t tests. There were no differences between the groups for any clinical parameter except the presence of less visual inflammation in study subjects. Radiographically, there were no differences in crestal alveolar bone levels measured from the cementoenamel junction. Bone height evaluation by the Bjorn method showed less alveolar support in the study group. However, this was due to the influence of root resorption rather than an effect on crestal height. It was concluded that orthodontic movement of teeth into extraction sites had been without detrimental effect upon the adjacent periodontal status.

Rational periodontal therapy by papillectomy.

Successful periodontal therapy provided by the clinician is largely dependent on the removal of supra- and subgingival calculus and on the careful preparation of root surfaces to remove trapped endotoxin. A suitable environment for the reattachment of epithelial cells and fibroblasts results. The papillectomy technique provides good visual and instrumental access to the interproximal tooth surfaces, and allows optimal preparation of cemental surfaces without the necessity of a full surgical procedure.

Access to interproximal tooth surfaces by different bristle designs and stiffnesses of toothbrushes

An in vitro model for the purpose of testing the access to interproximal tooth surfaces by toothbrushes is described. The model was used to compare the access of different bristle designs and stiffnesses. Two standardized brushing techniques were used: a horizontal and a vertical one. The test method discriminated significantly between different bristle designs and stiffnesses. With regard to interproximal access the V-shaped bristles were superior to the straight multitufted ones and soft bristles were better than medium and stiff ones. This study also indicated that the interproximal access increased with increasing pressure within the pressure range chosen. Of the two techniques used in this study the vertical one was superior to the horizontal. The results indicated that some current opinions with regard to mechanical cleaning should be re-evaluated and clinical testing methods be further developed to enable corresponding in vivo testing.

Asymmetrical dental caries and Streptococcus mutans infection

A 27-year-old woman chewed unilaterally and had restorations and caries only on the right side of the dentition. The left side had a greater amount of soft and hard deposits and more severe periodontal disease. Plaque samples from occlusal and interproximal tooth surfaces were collected and cultured. The proportion of Streptococcus mutans of the total anaerobic count in the plaque samples from the right side was 1,000 to 10,000 times as high as from the left side. The proportion of S mutans of the total streptococcus was 6% to 20% on the right and less than 1% on the left side.

Effect of Multiple Dental Floss-SnF2 Treatment on Streptococcus mutans in Interproximal Plaque

Samples of dental plaque obtained from the interproximal tooth surfaces of seven young men showed considerable variation in the prevalence and anatomic site distribution of the potentially cariogenic microorganism S mutans. Multiple application of 10% SnF2 topical solution and saline solution delivered to interproximal test sites with dental floss were evaluated as short-term measures for eliminating S mutans from these surfaces. A greater overall reduction in the number of positive S mutans sites was observed for the SNF2-treated sites than the saline solution-treated sites. Long term studies are required to evaluate the effect of the treatments on the incidence of dental caries.