Oral Hygiene Instruction Research Articles

Development and validation of a printed educational material for patients undergoing periodontal treatment

OBJECTIVE: Develop and validate a Printed Educational Material (PEM), based on scientific evidence, to be used as an adjunct agent in the oral hygiene instruction process, during periodontal treatment. METHODS: In this qualitative study, the instrument was developed according to the methods proposed by theoretical references, to be used during periodontal treatment. The evaluation was carried out with dental surgeons and specialists in Periodontics, through questionnaires; and with patients, through semi-structured interviews. RESULTS: The PEM exceeded the minimum rate of 80% agreement between professionals and patient evaluators. A professional in the linguistic area also evaluated the developed material, concluding that the instrument is understandable by people who studied up to the fifth year of elementary school. The format and layout of the texts and figures were considered pleasant by the interviewed patients. CONCLUSION: The PEM was developed and validated with adequate information, from the professional point of view and according to the needs of the patients, and it can constitute a useful auxiliary tool for patients during periodontal treatment.

A novel biofilm removal approach (Guided Biofilm Therapy) utilizing erythritol air-polishing and ultrasonic piezo instrumentation: A randomized controlled trial.

To evaluate the effectiveness of biofilm removal of a treatment protocol combining an air-abrasive device using erythritol powder (AIRFLOW®) and an ultrasonic piezon instrumentation (Guided Biofilm Therapy/GBT) compared with the conventional mechanical approach (Scaling and Root Planing/SRP) during supportive periodontal treatment (SPT). Fifty patients, scheduled for supportive periodontal treatment at the Department of Preventive Dentistry, Periodontology and Implant Biology of the Aristotle University of Thessaloniki were randomly assigned to either a GBT (group A: 24 participants) or a SRP (Group B: 26 participants) treatment protocol. Therapeutic interventions and clinical measurements were performed at baseline and repeated at 6weeks. Oral hygiene instructions were reinforced at each visit. A questionnaire was handed to the participants for evaluation of patient perception of both utilized approaches. At 6weeks, the two groups showed statistically significant reduction in plaque score and in gingival bleeding index compared with baseline. GBT required approximately 15% less chair-time than SRP with a mean difference of 5.1min, which was statically significant (p=0.049). Patient perception was more favourable for GBT than SRP. Biofilm removal using erythritol AIRFLOW® and ultrasonic piezo-electric instruments (GBT) can be considered equally efficient compared with the conventional SRP. Moreover, GBT seemed to require shorter treatment time and to exhibit a more favourable patient perception than the conventional approach.

Oral Hygiene Instructions and Methods: A Comparative Survey of European General Dentists, Periodontists and Dental Hygienists.

To study the practices of general dentists, periodontists and dental hygienists who are members of the European Federation of Periodontology, regarding oral hygiene education, plaque control assessment, recommended dental and interdental hygiene tools, and antimicrobial agents. A web-based survey was sent to 13,622 members of the European Federation of Periodontology (EFP) through its 29 national member societies. It targeted general dentists (GD), specialists in periodontology (DSP) and dental hygienists (DH). Data were collected between 24 April and 17 May 2015. A data-driven statistical analysis was conducted and differences between professions were explored. A total of 2076 answers were collected. Only the 2009 answers originating from GD, DSP and DH were analysed (67 answers originated from other professions and were excluded). Among those 2009 respondents, 43.2% were DSP and 37.2% were GD. Overall, DH, DSP and GD reported spending 17.1 minutes for the initial teaching of OH, with differences between professions (p < 0.0001). DH, GD and DSP exhibited differences in the type of toothbrushes they recommend (p < 0.0001). DSP recommended electric and manual toothbrushes (TB) equally. DH predominantly recommended electric TB (56.8%). Overall, 95% of DH, DSP and GD recommended interdental brushes, with no statistically significant differences between professions. Low concentration chlorhexidine was considered the most relevant antimicrobial agent for daily oral care of periodontitis patients. Half of GD prescribed antimicrobial mouthrinses for long-term use in 70%-100% of their patients with periodontitis. EFP-affiliated practitioners allocate a significant amount of time to educating patients on oral health. Their practices are mostly in line with the current scientific evidence. Some discrepancies were found between the different professions. Similar surveys could be conducted over time to monitor the evolution of practices.

Effect of Cancer Treatment on the Worsening of Periodontal Disease and Dental Caries: A Preliminary, Retrospective Study.

To investigate the effect of cancer treatment on the worsening of dental caries and periodontal disease. Fifty-three adult cancer patients who underwent panoramic radiography before cancer treatment and 1-2 years later were enrolled in this study. They received professional oral care, including oral hygiene instruction, scaling and root planing, professional mechanical tooth cleaning, and dental treatment or extraction of any tooth with the source of infection. Age, sex, smoking habit, probing pocket depth, alveolar bone loss, oral hygiene, number of teeth, leukocytes, haemoglobin, and albumin counts, cancer treatment, the administration of immunosuppressants, worsening of dental caries, and alveolar bone loss after 1-2 years were examined. Factors related to the worsening of dental caries and alveolar bone loss were analysed using logistic regression analysis. Dental caries and periodontal disease worsened in 20.8% of the patients. Smoking habit and chemotherapy were independent risk factors for the worsening of dental caries, while alveolar bone loss greater than 1/3 and chemotherapy were independent risk factors related to worsening periodontal disease. Anticancer drug treatment is an exacerbating factor for dental caries and periodontal disease.

C – reactive protein in saliva of non-smoking patients with periodontitis (a pilot study)

Introduction: C-reactive Protein (CRP) as an inflammatory biomarker can be easily determined in saliva, but the values of salivary CRP in periodontitis are not well-studied. The aim of this study was to analyze and determine the values of salivary CRP in non-smokers with periodontitis stage 3 or 4 before and after supragingival and subgingival full-mouth periodontal therapy.Methods: Standard periodontal parameters and saliva samples were collected in 12 non-smoking patients. Patients in the test group (n = 6) underwent supragingival and subgingival full-mouth periodontal therapy, and the control group (n = 6) received only supragingival full-mouth therapy. Both groups received the same oral hygiene instructions in addition to therapy. After 3 months, re-registration of periodontal parameters and re-sampling of saliva for analysis of salivary CRP were done for both groups.Results: Statistical analysis revealed large differences in the values of clinical periodontal parameters and CRP levels in the test group after therapy. Values of salivary CRP in the test and control groups were lower 3 months the therapy; however, the results were not statistically significant. The correlation of clinical periodontal parameters and salivary CRP varied in both groups.Conclusion: Our pilot study reveals decreased concentrations of salivary C-reactive protein in non-smoking patients following non-surgical periodontal therapy. Further studies are needed to prove the reliability of salivary CRP as a biomarker for periodontitis.

Online Oral Hygiene Instructions for Orthodontic Patients in Malaysian Population

Fixed orthodontic appliances causes plaque accumulation, which leads to the formation of dental caries and gingivitis. Therefore, concise oral hygiene instructions (OHI) is necessary to avoid the occurrence of these diseases. Massive Open Online Course (MOOC) ensures interactive learning to improve knowledge retention. MOOC transfers the responsibility of learning OHI to the patients with remote guidance from the clinician, thus reduces clinical time. This research aimed to develop the MOOC learning content on OHI in orthodontic practice. The secondary aim was to assess the overall analytics data among learners enrolled for the completion rate and time taken to complete the MOOC. The ADDIE principles which were, "Analyse, Design, Develop, Implement and Evaluate", were used to develop the MOOC. The contents were based on a published pamphlet of OHI from the Ministry of Health, Malaysia. The MOOC was pre-tested, and content was improved based on the feedback from users and experts. The MOOC named “Penjagaan Kebersihan Pendakap Gigi” utilises the Bahasa Melayu language to educate learners regarding oral care with orthodontic appliances. Sixty-two learners joined the MOOC, with 77.4% achieving a high rate of completion of the MOOC learning content. There were forty-six female learners (74.2%), while male learners comprised sixteen (25.8%). The median (interquartile range) time taken to complete MOOC learning content were 31.50 minutes, (13.00 minutes to 55.50 minutes). This shows that MOOC could be an alternative platform to instruct patients on OHI with fixed appliances. MOOC can potentially reduce clinical time to teach OHI to patients.

Association between occupational exposure to domestic solid waste and dental caries: a cross-sectional study.

Studies have shown that domestic waste collectors are exposed to toxicants including infectious pathogens, which may be linked to their oral health conditions. This cross-sectional study evaluated the dental caries and its associated factors among domestic waste collectors. A total of 301 adult men who worked for a waste collection corporation were included; 171 men worked in direct contact with domestic solid waste and 130 did not. Sociodemographic data, working, and medical history were assessed. The decayed, missing, and filled permanent teeth (DMFT) index was examined. Logistic regression analysis was used to identify factors associated with dental status with a significance level of 5%. The overall mean DMFT score was 8.36±5.64. The mean DMFT, missing teeth (MT), and filled teeth (FT) were significantly higher in workers who did not have any direct contact with waste (p≤0.04). In the logistic analysis, DMFT ≥8 was only associated with older age (OR=8.41 [95% confidence interval (95%CI), 5.01–14.12], p<0.001). Decayed teeth (DT) ≥2 was associated with no previous oral hygiene instruction (OR=2.70 [1.50–4.81], p=0.001) and no daily dental flossing (OR=4.26 [1.92–9.43], p<0.001). MT ≥9 was associated with lower education level (OR=3.33 [1.57–7.10], p= 0.002). FT≥3 had a negative association with low income (OR= 0.42 [0.25–0.70], p<0.001) and no daily flossing (OR=0.42 [0.23–0.76], p=0.004). In conclusion, occupational exposure to domestic solid waste was not associated with poor dental status. Instead, age, education, income level, and oral hygiene were associated with dental health status. Missing teeth constituted the major component of the DMFT index. Therefore, prevention and oral rehabilitation programs are necessary to improve dental health.

Comparative evaluation of efficacy and patient-reported outcome measures of oral hygiene instruction methods for calibrated interdental brush.

To compare the efficacy and patient-reported outcome measures of oral hygiene instruction methods for calibrated interdental brush. A total of 60 participants, with 30 each in control and test group, participated in the study. Clinical examination included gingival index, full mouth bleeding scores and approximal plaque index. Supragingival scaling was performed. Interdental access probe was used to assess the size of interdental brush and corresponding interdental brush were given to the participants. For the control group, oral hygiene instructions were given through demonstration with model and video. For the test group, oral hygiene instructions were given through 'Touch-to-Teach' method. At 4-week follow-up, oral hygiene instructions were repeated to respective groups. After 3months, clinical examination was done and exit survey on patient-reported outcome measures was administered. Statistical analysis was done. Intergroup comparison of gingival index, full mouth bleeding index and approximal plaque index showed statistically significant difference between test and control group. 'Touch-to-Teach' method of oral hygiene instruction was found to be 'Good'. Acceptance of interdental brush was regarded to be 'Good'. Within limitations of the study, Touch-to-Teach method of oral hygiene instruction method was found to be effective and more acceptable and participants used the interdental brush regularly.

Oral health-related quality of life during supportive periodontal therapy: results from a randomized clinical trial.

Assessment of Oral Health Impact Profile (OHIP-14) during a randomized controlled trial of supportive periodontal therapy (SPT) consisting of oral prophylaxis with oral hygiene instructions only (test) or in conjunction with subgingival instrumentation (control). OHIP-14 was assessed at baseline, 6, 12, 18 and 24months. Data from 62 participants (50.97±9.26years, 24 smokers) were analysed by GEE and Logistic regression. OHIP-14 means, effect size, floor and ceiling effect and minimal important difference were calculated. Sum of OHIP-14 (severity), numbers of responses (extent) "fairly often" (FO) or "very often" (VO) and percentage of people (prevalence) reporting FO or VO were computed. At baseline, low scores of OHIP-14 were observed for test (7.67±9.27) and control (6.51±7.47) with a decreasing trend during SPT, without differences between or intra-groups over time. At 6months, a difference was observed in the OHIP-14 prevalence (p=.03), without differences in severity and extent. Smoking status and plaque >15% (moderate oral hygiene) at 24months were associated with higher OHIP-14 prevalence scores at that point of time (p=.038 and p=.034, respectively). Patients submitted to two different modalities of SPT maintained low OHIP-14 scores over 2years of care.

Periodontal health education session can improve oral hygiene in patients with gingivitis: A masked randomized controlled clinical study.

The aim of this clinical trial was to evaluate the effect of a periodontal health education session (PHES), which included education on the pathogenesis and consequences of periodontal diseases on oral hygiene motivation in patients with gingivitis. A randomized controlled clinical trial was conducted on 50 (26 females and 24 males) patients with gingivitis who underwent periodontal treatment. Subjects were randomly allocated into the PHES group (experimental group) and standard oral hygiene education group (control group). The Rustogi Modified Navy Plaque Index (RMNPI) and Papillary Bleeding Index (PBI) were used to evaluate oral hygiene at baseline and were repeated after 1, 3, and 6 months. Knowledge about periodontal disease was measured and the participants' motivation was determined using the Oral Hygiene Motivation Scale. Although baseline knowledge levels and motivation scores were not different between the groups, following the educational motivational interviewing (MI) session, levels were higher in the experimental compared with the control group. The subjects' RMNPI and PBI scores at the 1-, 3-, and 6- month re-examinations were statistically higher in the control group than the experimental group. Furthermore, the level of knowledge and intrinsic and total motivation scores were moderately positively correlated with a reduction in clinical indices at 6 months compared with baseline. The results of this study indicated that increased knowledge and awareness about periodontal diseases and its consequences, including systemic effects, via educational MI session increased intrinsic motivation and improved oral hygiene of patients with gingivitis, especially regarding interproximal surfaces.

Knowledge, Awareness and Practice oral health survey among parents of children with Congenital Heart Diseases

AIM : To investigate the oral health of pediatric cardiac patients and the parental knowledge and attitude about the importance of oral health and infective endocarditis.&#x0D; MATERIAL AND METHOD:- Descriptive cross-sectional survey with total 100 CHD patients, ages 2-12 years (48 girls and 52 boys) performed with the application of a questionnaire. For each patient, demographic data, oral hygiene habits, knowledge and awareness of dental and general health, and attitudes toward professional dental care. oral hygiene and caries experience of these patients were recorded.&#x0D; STATISTICAL ANALYSIS:-Pearson’s Chi Square test was used to observe the relation between categorical study and outcome variables&#x0D; RESULT:- In the present study 43 % parents were aware of the importance of maintaining good oral hygiene in patients with CHD. Around 56% of parents were unaware of antibiotic prophylaxis for the dental procedure and 67 % of parents were unaware about the term IE. Oral hygiene of these patients is good while caries experience is higher and deft/DMFT Score, It was lower among the &lt;5 years age group than 6 years and above and it was statistically significant.&#x0D; CONCLUSION :- Parental knowledge was limited and fragmented and their attitude towards a specialized dental treatment or maintaining good oral health status was very minimal. the primary focus should be on oral hygiene instructions, dietary counseling, instructions on fluoride use and the awareness of infective endocarditis. Closer cooperation between Pediatric Dentists, Pediatric Cardiologists and Pediatrician could help improve dental care for these children.

English

BACKGROUND Oral hygiene maintenance is a crucial factor for successful orthodontic therapy. Oral hygiene compliance is a must to maintain better oral hygiene and plaque control in orthodontic patients. To get good oral hygiene compliance the information has to reach the patients in a proper way. The purpose of this study was to determine whether audio - visual aids help in improving oral hygiene status in orthodontic patients. METHODS A prospective randomized control trial study was done on 30 subjects, who underwent fixed orthodontic appliances selected from the out-patient department of Department of Orthodontics and Dentofacial Orthopaedics, Saveetha Dental College and Hospitals, (SIMATs), Chennai. They were divided randomly into two groups based on a computer - generated randomization chart: group 1 – experimental group (audio - visual aids group), group 2 – control group (verbal instruction) respectively. Group 1 subjects received oral hygiene instruction through videotape instructions and group 2 received verbal and written instructions. RESULTS The results were assessed with respect to plaque index scores of both groups. A parametric intragroup comparison (paired ‘t’ test) was done to compare the before and after plaque score of each group and student independent sample ‘t’ test to compare both groups. The plaque score for the verbal group was found to be 0.666 + / - 0.417 and for the audio - visual group it was 1.211 + / - 0.261. A statistically significant P - value (&lt; 0.05) was found between the groups. CONCLUSIONS Patients who were given instructions through audio - visual aids had better improvement in plaque scores than patients who were given instructions verbally. KEY WORDS Audio - Visual Aids, Dental Plaque Index, Oral Hygiene, Oral Hygiene Index, Orthodontic Appliance

Effectiveness of orthodontic toothbrush versus conventional toothbrush on plaque and gingival index reduction: A systematic review and meta‐analysis

In orthodontic patients submitted to oral hygiene instruction, what is the efficacy of orthodontic toothbrush (O-TB) versus conventional toothbrush (C-TB) on plaque and gingival index reduction in randomized and non-randomized controlled clinical trials? Electronic database search was performed on PubMed, ClinicalTrials.gov, Cochrane Library and Google Scholar. Database research, study selection, data extraction and ROBINS-I and Risk of Bias Tool 2.0 analysis were conducted by two independently examiners in duplicate. Two different meta-analyses were performed for plaque index and gingival index, followed by the analysis of overall quality of the evidence using GRADE. A total of 158studies were identified for screening; six articles were included in qualitative synthesis, and of those, three were subjected to a quantitative synthesis (meta-analysis). Three non-randomized studies presented an overall 'low', 'moderate' and 'high' risk of bias for each one of the articles, and the three randomized clinical trials presented 'low risk' for two articles and 'some concerns' quality for the other one. The overall strength of evidence was ranked 'very low' quality for plaque index and gingival index subgroups. Gingival bleeding is not modified by orthodontic design toothbrush, but there is circumstantial scientific evidence for recommending the use of an O-TB instead a C-TB based on the analysis of plaque index control. Although major plaque removal of the O-TB was validated by meta-analysis, this improvement is not completely clarified which calls for further clinical studies to assess the effects of using an O-TB compared with a C-TB.

Effect of ultrasonic scaling with adjunctive photodynamic therapy on the treatment of gingival inflammation among diabetic patients undergoing fixed orthodontic treatment

BackgroundThe aim of the present clinical trial was to evaluate the effect of methylene blue-mediated antimicrobial photodynamic therapy (aPDT) on the gingival and immunological parameters in diabetic adolescent patients undergoing fixed orthodontic treatment. MethodsThe selected 40 participants were randomized equally into two groups; Group I (ultrasonic scaling + oral hygiene instructions) and Group II (ultrasonic scaling/oral hygiene instructions + aPDT). Serum HbA1c levels was assessed for all the participants at chairside. Plaque index (Pi), and bleeding on probing (BOP) were analyzed. Moreover, the assessment of crevicular fluid matrix metalloproteinase 8 (MMP-8) and macrophage inflammatory protein 1 alpha (MIP-1α) was performed using enzyme-linked immunosorbent assay technique. All measurements were recorded at baseline, 6 weeks, and 12 weeks follow-up periods, respectively. Intergroup comparisons for p-value were computed using Mann-Whitney test and Wilcoxon singed ranks test to compute p-value for intra-group comparisons. Stepwise logistic regression analysis was used to identify explanatory variables for reduction in plaque scores and bleeding on probing, after controlling for the effects of other covariates. Odds ratios and 95% confidence intervals were used to assess the direction and strength for associations. Significance level was set at 5% for all analyses. ResultsAll 40 individuals completed the clinical trial. There was a statistically significant reduction in Pi and BOP in both Group I and Group II from baseline to 12 weeks of follow up (P<0.05). However, there was slight reduction in the plaque scores in Group-II as compared to Group-I at 12 weeks visit (P<0.05). There was also a statistically significant difference for BOP when Group-I was compared with Group-II on 12 weeks follow up assessment (P<0.05). HbA1c assessment indicated no statistically significant difference either within or between groups at any time point (P>0.05). Both MMP-8 and MIP-1α reported a significant decrease for both Groups I and II at 6 weeks and 12 weeks follow-up periods in comparison to baseline (P<0.05). Inter-group comparison indicated a statistically significant difference noted at both 6 weeks follow up that was maintained at 12 weeks follow up (P<0.05). The logistic regression analysis revealed that even after controlling the mean BMI as a predictor, the change of biomarker levels along with the improvement in plaque scores and bleeding on probing was not significant (p> 0.05). ConclusionaPDT significantly improved bleeding on probing and proinflammatory biomarkers among diabetic adolescent patients undergoing fixed orthodontic therapy.

A Report of Incontinentia Pigmenti in an 11-year-old Girl

Introduction: Incontinentia pigmenti (IP) is a rarely diagnosed x-linked dominant disease affecting tissues of ectodermal and mesodermal origin such as cutaneous tissues, teeth, eyes, hair, and the central nervous system. Dermatologic manifestations are often the first signs observed in patients diagnosed with IP and are present in nearly all the subjects, but they are less harmful and do not require treatment. Oral manifestations in patients diagnosed with IP might affect both the deciduous and permanent teeth, with tooth shape anomalies and hypodontia, delayed tooth eruption, cleft palate, and high arched palate. These oral abnormalities influence feeding, quality of life (QoL), and self-esteem of the patient but can be successfully corrected by oral rehabilitation. Case Presentation: Here, we report the case of a female patient, aged 11 years, presenting with dental manifestations such as hypodontia, conical teeth, delayed tooth eruption, narrow and atrophic dental ridge, and also some non-dental findings of IP. Her dental ‎management included oral hygiene instructions, extraction of all unrestorable primary molars, and composite filling of all primary canines. Conclusions: A removable space maintainer was constructed for the patient, which resulted in favorable esthetic outcomes, proper re-establishment of mastication, and improved self-esteem.

Clinical efficacy of scaling and root planing with and without metronidazole on glycemic control: three-arm randomized controlled trial

BackgroundTreating periodontitis through non-surgical periodontal therapy (NSPT) may improve glycemic control in type-2 Diabetes Mellitus (T2DM) patients. However, the evidence to maintain this improvement beyond four months is insufficient. Hence, this trial was conducted to assess clinical efficacy of NSPT on glycemic control in T2DM patients.MethodsThis three-arm randomized controlled trial recruited 150 known T2DM participants (35–65 years), suffering from moderate to severe periodontitis, having HbA1c level ≥ 6.5% at baseline. Participants were followed up at 3 and 6 months. Intervention for test group-1 included scaling and root planing (SRP) with metronidazole (MET) and oral hygiene instructions (OHI). Test group-2 was intervened with SRP + OHI and control group with OHI only. Stata v. 14 was used to observe inter and intragroup mean changes in glycemic [glycated hemoglobin (HbA1c), fasting blood glucose (FBG)] and periodontal variables [bleeding on probing (BOP), periodontal pocket depth (PPD), clinical attachment loss (CAL)] using ANOVA and RMANOVA. Proportion of change in outcome variable (HbA1c) was assessed between treatment groups using chi-square test. Change was considered significant at p-value ≤ 0.05.ResultsA significant reduction was observed in BOP, PPD, CAL, HbA1c and FBG over time [p < 0.05]. Significant reductions were observed in same variables in both test groups in comparison to control arm [p < 0.05]. No change between the two test groups was observed [p > 0.05].ConclusionScaling and root planing improves glycemic control of T2DM patients independently of the use of MET. Therefore, SRP after every 6 months may be suggested and included as a part of overall diabetes management for patients suffering from T2DM.Clinical trial registration NCT 03,343,366 [Date of Registration: 17/11/2017]

Oral manifestations of patients with systemic sclerosis: a meta-analysis for case-controlled studies

BackgroundSystemic sclerosis (SSc) is a multisystem rheumatic disease. Orofacial manifestations are commonly in SSc but maybe usually ignored and overshadowed by other systemic complications. Multiple comparative studies have been conducted to investigate the possible links between SSc and oral manifestations. The present study aimed to investigate the oral health status in patients with SSc.MethodsPubmed, Embase, Web of Science, and Scopus were searched up to July 2020. Following outcomes were evaluated: Probing depth (PD), Attachment loss (AL), Bleeding on probing (BOP), Number or percentage of Sites with PD ≥ 4 mm, Prevalence of periodontitis, Number of teeth, Decayed Teeth, Missing teeth, Filled teeth, DMFT index, and the interincisal distance. Newcastle-Ottawa Scale (NOS) were applied for quality assessment. The statistical analysis was processed using the software STATA.Results11 eligible studies were included. The maximum interincisor distance was significantly restricted in SSc patients (SMD − 1.061; 95 %CI [− 1.546, − 0.576]; Z = 4.29, P = 0.000).The prevalence of Periodontitis (OR 7.007; 95 %CI [3.529, 13.915]; Z = 5.56, P = 0.000), PD (SMD 3.101; 95 %CI [1.374, 4.829]; Z = 3.52, P = 0.000), AL(SMD 2.584; 95 %CI [0.321, 4.846]; Z = 2.24, P = 0.025), sites with PD ≥ 4mm (SMD 2.071 ; 95 %CI [0.267, 3.875]; Z = 2.25, P = 0.024) and the number of decayed teeth (SMD, 0.186; 95 %CI [0.007, 0.365]; Z = 2.04, P = 0.041) were increased significantly in SSc population in comparison with the controls.ConclusionsSSc patients have limited mouth opening, higher periodontitis prevalence, and worse periodontal status, as well as an increased number of decayed teeth. Routinely oral hygiene instruction and initial periodontal treatment is recommended for SSc patients.

The effects of topical erythropoietin on non-surgical treatment of periodontitis: a preliminary study

BackgroundThe purpose of periodontal treatments is to reduce inflammation, restore gingival health and clinical attachment level gain by controlling microbial plaque formation and other etiological factors. One of the drugs that has been tested in many areas and shown good anti-inflammatory properties is erythropoietin (EPO). We evaluated the effect of this drug on the improvement of periodontitis after the phase I treatment.MethodsThis study was conducted on 30 patients with stage III periodontitis who had at least two bilateral teeth with CAL of ≥ 5 mm and PPD ≥ 6 mm at ≥ 2 non‐adjacent teeth and bleeding on probing. After oral hygiene instruction and scaling and root planning (SRP), EPO gel containing a solution of 4000 units was applied deeply in the test group and placebo gel was deeply administered in the control pockets (5 times, every other day). The clinical parameters of the plaque index (PI), gingival index (GI), clinical attachment level (CAL), probing depth (PD) and bleeding index (BI) were measured at baseline and after three months of follow up. The P-value was set at 0.05.ResultsAll clinical variables improved after treatment in both groups. The BI and GI scores (which reflects the degree of gingival inflammation) showed statistically more reduction in test group. The CAL decreased from 5.1 ± 4.1 to 3.40 ± 2.71 mm; and 5.67 ± 4.32 to 4.33 ± 3.19 mm in test and control group, respectively (P < 0.00). After the treatment, there was a significant greater reduction in CAL and also PD values in test group (P < 0.01).ConclusionLocal application of EPO gel in adjunct to SRP can improve clinical inflammation and CAL gain in periodontitis.Trial registration: This study was registered at 2017-11-06 in IRCT. All procedures performed in this study were approved with ID number of IR.TUMS.DENTISTRY.REC.1396.3139 in Tehran University of medical science.

Evaluation of healing and anti-plaque efficacy of antioxidant mouthrinse in patients with gingival inflamation – A single blind clinical study

: To evaluate the clinical efficacy of healing as well as anti plaque activity of an antioxidant mouthrinse containing sodium hyaluronate, coenzyme Q10, tea tree oil and aloe vera as active ingredients in a subject population of established clinical gingivitis. A single blind study was conducted among 45 participants, all of whom were in the age group of 18‑60 years. The study subjects were randomly divided into three groups of 15 each. The control group where only oral hygiene instructions were given. Group B1 in which the participants underwent oral prophylaxis at baseline, day 7 and day 14. Group B2 where the participants were given the antioxidant mouthrinse to use thrice daily in addition to undergoing oral prophylaxis at baseline, day 7 and day 14. The clinical parameters assessed were the probing pocket depth, Plaque Index by Sillness and Loe (1964) and Gingival Index by Loe and Sillness (1963). These were assessed at baseline, day 7 and day 14 for all the 3 groups. The results were found to be statistically significant at 14 days interval of plaque and gingival inflammation reduction in the B2 group as compared to the other two groups, however, with regard to reduction of periodontal depth, the result was not found to be significant. This study supports the effectiveness of herbal constituents based antioxidant mouthwash in its role as an antiplaque and healing agent. It should be explored as a cost‑effective, long‑term antiplaque rinse with prophylactic and therapeutic benefits.

The effect of plaque control in the treatment of Oral Lichen Planus with gingival manifestations: a Systematic Review.

Oral lichen planus (OLP) is a chronic autoimmune disease that frequently affects the oral mucosa. Patients with OLP tend to present with plaque accumulation which may further exacerbate the lichenoid lesion, thus plaque control may improve the quality of life of patients. The aim of this review was to test the effect of plaque control on OLP with gingival manifestations. Systematic review following the PRISMA checklist. A search was conducted through Medline, Embase and the Cochrane Library Database up to March 2020 and complemented by a manual search in some relevant journals. Randomised Controlled Trials (RCTs) reporting plaque interventions and their effects in populations with gingival manifestations of OLP, with a follow-up period of at least 3 months were included. Risk of Bias was assessed using the Cochrane Collaboration Tool in Randomised Trials. The initial search generated 89 sources, resulting in final inclusion of three RCTs following full-text reading. The control groups were asked to continue their regular oral hygiene routine, while test groups received additional tailored oral hygiene advice as the intervention. Two of the included papers had sufficiently similar design to be included in meta-analysis. The oral hygiene intervention was associated with improvements in clinical disease status (Escudier index) and patient-reported outcomes (OHIP-14) from baseline compared with the control group. Differences in visual analogue scores for pain between groups were not statistically different between test and control groups. Two studies were judged to have low risk of bias, while one (not included in meta-analysis) had high risk of bias. Improvements in disease and patient-reported outcomes can occur as a result of oral hygiene instruction in patients with gingival manifestations of OLP.