Oral Hygiene Program Research Articles

The effect of controlled ascorbic acid depletion and supplementation on periodontal health.

To determine if systemic levels of vitamin C influence periodontal health, changes in plaque accumulation, gingival health and periodontal probing depth were measured in healthy subjects housed for 3 months in a nutrition suite that provided controlled periods of ascorbic acid depletion and supplementation. Eleven healthy, nonsmoking men, aged 19 to 28 years, ate a rotating 7-day diet adequate in all nutrients except ascorbic acid. This basal diet, which contained less than 5 mg/day ascorbic acid, was supplemented with 60 mg/day ascorbic acid for 2 weeks, 0 mg/day ascorbic acid for 4 weeks, 600 mg/day ascorbic acid for 3 weeks and 0 mg/day ascorbic acid for 4 weeks. Plasma, urine and leukocyte ascorbate levels, Plaque Index, Gingival Index, Bleeding Index and probing depths were monitored throughout the study. A uniform oral hygiene program was maintained in which oral hygiene instructions were reinforced bi-weekly. Ascorbate concentrations in body fluids and leukocytes responded rapidly to changes in ascorbic acid intake. No mucosal pathoses or changes in plaque accumulation or probing depths were noted during any of the periods of depletion or supplementation. However, measures of gingival inflammation were directly related to the ascorbic acid status. The results suggest that ascorbic acid may influence early stages of gingivitis, particularly crevicular bleeding.

The effect on the composition of subgingival plaque of a simplified oral hygiene system including pulsating jet subgingival irrigation.

The aim of this study was to investigate the effect on subgingival plaque of a simplified oral hygiene regime consisting of instruction in Bass brushing without stress on interdental cleaning, scaling and root planing, in combination with subgingival pulsated jet irrigation with dilute solutions of chlorhexidine, metronidazole or placebos. Twenty‐five patients, 14 women and 11 men, each with periodontal pockets ≥ 4 mm, participated in a randomized, double‐blind, placebo‐controlled study. The patients were assigned to 4 groups: 2 test groups (0.02% chlorhexidine and 0.05% metronidazole) and 2 placebo groups (0.01% quinine sulphate and 0.09% sodium chloride). Subgingival plaque samples were obtained from at least 4 sites in each subject on days 0 (prior to scaling and root planing), 7, 28, 56 and 84. Subgingival irrigation was terminated on d 28. Darkfield microscopy was used to assess the effects of treatment on the subgingival microflora by observing 4 morphologic groups: cocci, motile organisms, spirochetes and others (i.e. non‐motile rods and filaments). All the groups showed marked beneficial changes at the end of the 28‐d irrigation period, with increases in cocci and decreases in motile forms and spirochetes to less than baseline values. These beneficial effects were maintained for at least 8 weeks after irrigation was stopped. Metronidazole was more effective in reducing motile forms, but the reduction was not significant at d 84. It was concluded that pulsating monojet subgingival irrigation as part of a simplified oral hygiene program, with or without an active antimicrobial agent at low concentration, is effective in reducing the motile and spirochete portions of the subgingival microflora. These effects might be enhanced and prolonged if suitable antimicrobial solutions of higher concentration were used.

Evaluation of a television‐tape demonstration for the reinforcement of oral hygiene instruction

The effect of using a television-tape demonstration in order to reinforce the advice given in a self-teaching oral hygiene program was evaluated in the present study. The teeth of 24 periodontal patients were scaled and 2 weeks later oral hygiene instruction was given by handling out a self-teaching manual. The patients were divided into 2 groups, matched with regard to the initial status of oral cleanliness. An experimental group (TV) comprising 12 patients who, 1 week after the instruction, were shown a demonstration of proper oral hygiene technique on closed circuit television and a control group of 12 patients who did not receive this reinforcement. The presence or absence of dento-gingival plaque and gingival bleeding by gentle probing was recorded initially and after 8 weeks on 4 surfaces of all teeth. In addition, plaque scores were recorded at 2 and 3 weeks to assess the effect of the oral hygiene self-instruction. At the final examination after 8 weeks, the patients with plaque on more than 20% of the tooth surfaces were subjected to a tooth cleaning test including a subsequent scoring of remaining plaque. The patients in the experimental group (TV) were asked their opinion regarding the television-tape demonstration. Although the patients in the experimental group expressed a positive opinion about viewing the television-tape demonstration, the improvement in the plaque and gingival bleeding scores recorded at the 8-week examination showed no difference between the 2 groups of patients. Similarly, the scoring of plaque after the tooth cleaning test showed no difference between the 2 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral findings in irradiated edentulous patients

11 edentulous patients (mean age 71.2 years) with oral or oropharyngeal malignancies were examined clinically and microbiologi-cally before, during, and after receiving tumoricidal radiation doses (26.4–74 Gy) towards the head and neck regions. The effect of a supervised oral hygiene program and a saliva substitute (Va-OraLube) was studied. The 9 patients who survived the observation period, showed increased xerostomia and mucositis related to increased radiation. Radionecrosis or oral infections were not observed. The patients wore their dentures throughout the observation period and preferred to use the saliva substitute. The initial number of acidophilic bacteria was high, Candida albicans were present in low numbers and enteric bacteria occurred more frequently than normally. There was a reduction of micro-organisms after introduction of the hygiene program. It is concluded that careful planning of the radiotherapy, preradiation oral examination, denture control and instruction and an effective oral hygiene program are essential for the reduction of oral complications in edentulous patients receiving tumoricidal radiotherapy to the head and neck regions.

A Study of Chlorhexidine Gel Treatment in an Oral Hygiene Program for Elderly Patients in Long Term Care1

An investigation was made to measure the effectiveness of one of the newer agents used in promotion of oral hygiene, i.e., Chlorhexidine gel. The study was designed with elderly people in long term care.

Effect of variation in dietary sucrose intake on plaque removal by mechanical means.

The influence of dietary sucrose on the rate of plaque formation was investigated for 22 dental personnel. The subjects were instructed to continue their normal oral hygiene procedures throughout the study period. It was found that an increase in the frequency of sucrose intake resulted in an enhancement of plaque deposition and an increase in gingival inflammation. The restriction of dietary sucrose for this group of subjects had a minimal effect on either plaque retention or levels of gingival inflammation; this result might have been caused by the habitual diet of these particular subjects being relatively low in sugar. The results of this study would suggest that an assessment of sucrose intake of patients might be appropriate when planning an oral hygiene programme, consideration being given to modifying the diet as an aid to plaque removal for individuals having a relatively high intake.

Denture plaque: Quiet destroyer

S ince the 1960s the work of L6e and others’-5 established a relationship between dental plaque accumulation on natural teeth and gingival tissue disease levels. These early studies, which confirmed the pathogenicity of plaque, showed the need to control plaque accumulations to promote gingival tissue health and preserve the supporting structures of the teeth. Professional involvement in proper home care oral hygiene programs has made the public more aware of the necessity of daily removal of plaque. The relationship between oral tissue disease and the presence on the denture surface of a developing or mature plaque mass has not been widely recognized by the dental profession nor well publicized to individuals who wear dentures. This is unfortunate, all the more since the probable effects of denture cleanliness on oral health have been explored for more than 30 years. As early as 1952 Fisher’ proposed that poor denture hygiene might dispose to denture stomatitis. However, in 1953 Nyquist7 found no such relationship. Love et al.* in 1967 and McKendrick’ in 1968 reported relationships between lack of denture cleanliness and denture stomatitis. In 1970 BudtzJorgensen and BertramI also showed a relationship between unclean dentures and denture stomatitis. Most recently Abelson” pointed out in 1981 that of the most commonly cited triad associated with soft tissue changes in denture wearers (ill fit, trauma, and unclean dentures), the plaque that forms on the tissue-fitted surfaces probably is of the greatest clinical significance. However, none of these workers has provided quantitative objective evidence of the relationship between denture plaque levels and the health of the oral tissues. In the first phase of this study we report a quantita-

The good toothbrushing game: a school-based dental hygiene program for increasing the toothbrushing effectiveness of children.

There has been a serious lack of experimentally verified, effective dental hygiene programs in the schools. In and of themselves, the instruction-alone programs which comprise children's dental education do not produce proper toothbrushing skills. In the present study, a school-based contingency dental hygiene program designed to increase the effectiveness of children's toothbrushing skills at home was implemented with grade one and two classes. Each class was divided into teams and participated in the "Good Toothbrushing Game." Each day four children fron each team had the cleanliness of their teeth assessed according to the Simplified Oral Hygiene Index (Greene & Vermillion, 1964). The team with the lowest mean oral hygiene score was declared the daily winner. Winning teams received stickers and had their names posted. A multiple baseline across classrooms single-subject group design. (Hersen & Barlow, 1976, pp. 228-229) established that the good toothbrushing game greatly increased the effectiveness of children's oral hygiene skills. the treatment terminal levels for the grade one scores was 2.0 as compared to a baseline terminal level of 5.0 and for the grade two's was 2.3 compared to 5.7 at the end of baseline. A 9-mo follow-up indicated that these results were maintained. The data strongly suggest that proper implementation of behavioral principles is essential to the success of oral hygiene programs.

Longitudinal study of periodontal condition associated with orthodontic treatment in adolescents

Periodontal condition, plaque situation, and gingival status were studied longitudinally on five different occasions before, during, and after a full period of routine edgewise treatment in thirty-eight adolescents, 11 to 12 years old at the start. Extraction of permanent teeth was part of therapy in all cases. Thirty-nine matching persons who had not had any orthodontic treatment served as a reference group and were examined in an identical way. Loss of attachment was recorded with a periodontal probe on the mesial, distal, and facial surfaces of all permanent maxillary teeth except the second molars. A particular oral hygiene program was followed carefully by all orthodontic patients. The response of the preventive program was reflected in good or excellent oral hygiene and gingival condition throughout treatment. While no differences were registered during active therapy, after removal of the fixed appliances the orthodontic patients had significantly lower plaque scores and less gingivitis than the untreated persons. With regard to loss of attachment, there were no statistically significant differences between the two categories of patients at any of the five examinations. In fact, periodontal condition was excellent in both groups and the average loss of attachment was less than 0.1 mm. per surface. Although it was not possible with the methods used to demonstrate any statistically significant difference in periodontal condition between the treated and untreated adolescents shortly after band removal, the need for extended long-term studies is evident, as discussed. Such follow-ups are planned for both categories of patients in this study.

Developing an effective oral hygiene program for the orthodontic patient: Review, rationale, and recommendations

This article demonstrates the importance of good oral hygiene during and after orthodontic treatment. The attitude of all parties involved toward oral hygiene contributes to the dentition's future. Several means of assisting the patient to maintain good oral hygiene are discussed. It has been emphasized throughout the article that correcting malocclusions is important, but if the result of this effort is lost in a few years because of periodontal disease or caries the patient has not been helped. However, if the patient learns to practice effective plaque control, he may keep his teeth for a lifetime. 2

Effectiveness of community preventive programs on improving oral health.

Although sizable community efforts in the United States have been made to educate children and adults about periodontal disease and its control, valid inferences regarding their effectiveness cannot be made because, for the most part, invalid methods of evaluation have been used. Confusion about these methods may exist because there has been little conviction that the available methods of control will stop the progress of periodontal pathology. Many recommended oral hygiene practices are probably applicable only to certain motivated individuals. An effective, comprehensive community-program for the prevention of periodontal disease remains to be developed. It is unlikely that sufficient sums of money and personnel could be diverted from the budgets of lesser-developed countries to initiate mass oral hygiene programs. Therefore, it appears that, organized community efforts appear to be promising only for the control of dental caries. However, it must be remembered that community fluoridation may not be applicable in many countries. Therefore, new strategies and vehicles to bring fluorides to all segments of the world's population are needed.

Efficiency of traditional chewing sticks in oral hygiene programs among Ethiopian schoolchildren

The effect of oral hygiene programs was studied in 248 children from five schoolclasses in Asella, Ethiopia. All children received professional toothcleaning after an initial clinical examination, and were again examined after a trial period of 3 months. The classes were assigned to the following procedures: one class received information and instruction in the use of the toothbrush, and a second class in the use of the mefaka, a wooden chewing stick traditionally used for oral cleaning. The children were advised to clean their teeth daily. Two other classes received similar information and instruction with regard to the toothbrush and the mefaka. Oral cleaning was then performed daily under direction and supervision, in one class with the toothbrush and in the other class with the mefaka. The fifth class was used as control. Instruction only was found to have no effect on the amount of oral deposits. Supervised oral cleaning, on the other hand, improved the oral hygiene of the schoolchildren significantly. The mefaka was found to be as effective as the toothbrush in removing oral deposits. It was concluded that the mefaka should be recommended for use in preventive dental programs in Ethiopia since it is effective, inexpensive, and familiar to the population.

Oral Hygiene and Educational Programs for Caries Prevention

Oral Hygiene and Educational Programs for Caries Prevention

A practical, behavior-based oral hygiene program for elementary school children

A three-year study was made of the effectiveness of a behavior-based program of oral hygiene for schoolchildresn. The primary focus of the program was a daily "brush-in," managed by teachers and parent volunteers. Emphasis was placed on plaque removal in lieu of conceptual-informational content, and the role of consultants was to maintain the behavior of participants through occasional visitation and evaluation. Analysis suggested that the program was economical and effective when judged on the basis of typical oral hygiene measures. Findings are discussed in terms of the relationship between knowledge and behavior, and efficient use of professional time.

Oral Hygiene in a Group of Supervised Patients with Fixed Prostheses

The oral hygiene, the gingival condition, pocket depth, and the incidence of caries on crowned teeth were studied during a period of 5 years in a group of patients (114) who had been treated with fixed dental prostheses. Prior to the prosthetic treatment, the patients received periodontal treatment. During the study, the subjects participated in an oral hygiene program. Crown margins were located sub-gingivally, at the gingiva and supra-gingivally. When the crown margins were located sub-gingivally, there was an increase in Gingival Index scores 2, and in pocket depth, compared to supra-gingival placement. An improvement of gingival health was recorded where the crown margins were located supra-gingivally. Caries lesions developed on 3.5% of the tooth surfaces which had recieved crowns.

WHO'S accent on prevention

It is widely recognized that oral health has its major obstacles in the form of dental caries and periodontal diseases and that in many populations each of these disease areas attacks nearly 100% of the population during the normal life span. Furthermore, there are clear signs of sharp increases in the dental caries problem in populations which previously benefited by a near absence or low prevalence of the disease. For highly developed countries dental caries and periodontal disease are responsible for an ever increasing economic burden which could easily become intolerable for even the richest of economies. In developing countries where dental caries prevalence is increasing the extreme lack of manpower resources is the first barrier, any response to which will encounter the second and associated economic constraint. It is essential for both situations that greater emphasis be given to prevention of oral diseases both by methods already proven, such as fluoridation of water supplies and other uses of fluorides, by oral hygiene programs, and by coordinated research to develop complementary or other methods. The WHO program in oral health has now developed a priority activity to promote and guide such endeavors.

A combined approach to preventing dental caries in schoolchildren: caries reductions after one year

A prototype school-based dental program is being conducted in a low-middle-income, urban area, as a demonstration project to test the combined effect on dental caries of several preventive measures. Procedures include ingestion of fluoridated water (1.0 ppm), topical application of acidulated phosphate fluoride, application of a pit and fissure sealant, early detection of caries and restoration of affected teeth, and dental health education (oral hygiene and dietary counseling program). The four-year project began in early 1973. A group of 1,200 children in the first and sixth grades was randomly separated into a treatment and a comparison group. All children participate in a dental health education program and consume fluoridated water. Dental care is provided on site at 18 schools, with the use of two mobile vans, saving time and expense in school hours lost and transportation costs. A hygienist coordinates the oral hygiene and dietary programs in classrooms with the help of teachers trained in workshops. Supervised toothbrushing, flossing, and use of disclosing agents are carried on in the classrooms. First-year caries increment data in permanent teeth indicate a high degree of success. Occlusal surfaces of permanent teeth in children in the treatment group, contrasted to those in children in the comparison group, showed an average reduction in caries of 84%. The encouraging results obtained at the end of one year indicate that a school-based preventive dentistry program may have great potential for preventing and controlling dental caries in schoolchildren.

Periodontal conditions in patients 5 years following insertion of fixed prostheses. Pocket depth and loss of attachment.

The oral hygiene, gingival condition, pocket depth and loss of attachment were studied during a period of 5 years in a group of patients (114) who had been treated with fixed dental protheses. Eighty-four per cent of the subjects had received periodontal therapy prior to the prosthetic treatment. During the study the subjects participated in an oral hygiene programme. Crown margins were located sub-gingivally, at the gingiva, and supra-gingivally. Initially 65% of the crown margins were sub-gingival compared to 41% 5 years later. When the crown margins were located sub-gingivally there was an increase in Gingival Index scores 2 and 3, in pocket depth, and in loss of attachment compared to a supragingival placement. However, most of the alterations were small.

Oral hygiene for orthodontic patients: Current concepts and practical advice

A survey of current knowledge about oral hygiene has been carried out, with emphasis on practical measures of proven value for orthodontic patients. The review covers various aspects of toothbrushing, complementary aids (dental floss, single-tufted brushes, toothpicks, water irrigators, disclosing agents, salivary stimulation, tooth positioners) and chemical cleaning (urea peroxide, chlorhexidine). Some advice is presented to facilitate teaching the patients to understand, master, and practice good oral hygiene, using toothbrushing with a horizontal scrub technique as the basis of the oral hygiene program. The unique potential of the orthodontist to make his patients hygiene minded and the longrange benefits of such awareness, as shown by recent clinical and experimental findings, are stressed.

Experimental gingivitis in the monkey. Relationship of leukocyte counts in junctional epithelium, sulcus depth, and connective tissue inflammation scores.

Rhesus monkeys receiving an oral hygiene program which included brushing, interdental cleansing and topical applications of chlorhexidine gluconate demonstrated a clinically normal gingiva for periods of up to 3 months. Wide fluctuations within individual dental units were noted with respect to histological sulcus depth, degree of connective tissue infiltration with lymphocytes and plasma cells, and total leukocyte or polymorphonuclear leukocyte (PMN) counts in the Junctional epithelium, even when the plaque and gingivitis index scores were 0. Of 18 clinically normal dental units sampled, only 6 appeared free of connective tissue inflammation. However, more than half of the tissue blocks obtained from dental units with a gingivitis and plaque index of 0 also showed scores of 0 with respect to the connective tissue inflammation (CTI) score and the number of PMNs in the Junctional epithelium. Within three days following discontinuation of oral hygiene procedures, rhesus monkeys developed a clinically noticeable gingivitis which began in the interdental papillae. Increases in CTI scores and number of leukocytes in the Junctional epithelium were evident after 2 days without oral hygiene. These values tended to increase further during the experimental period. A slight, but significant increase in sulcus depth was also noted during this time period. Regardless of the clinical state of the gingiva, a positive correlation was established between CTI scores and the number of PMNs and leukocytes in the Junctional epithelium. In early gingivitis, the plasma cells did not appear to outnumber lymphocytes, as has been reported for chronic gingivitis of longer duration.