Oral Hygiene Reinforcement Research Articles

Locally Delivered Doxycycline During Supportive Periodontal Therapy: A 3‐Year Study

Adjunctive locally delivered antibiotics during maintenance may favor the control of periodontal infections. This study evaluated the long-term clinical and microbiologic effects of yearly locally delivered controlled-release doxycycline as an adjunct to mechanical debridement. A total of 128 periodontal maintenance patients having at least four teeth with probing depth (PD) > or =5 mm were randomly assigned to local application of doxycycline gel at baseline and 1 and 2 years as an adjunct to mechanical debridement (test) or mechanical debridement only (control). Supportive periodontal therapy (mechanical debridement, polishing, and oral hygiene reinforcement) was provided every 6 months. Plaque, bleeding on probing (BOP), PD, and relative attachment level (RAL) were scored at baseline; 3 months; and 1, 2, and 3 years. Subgingival plaque samples were taken at each examination and analyzed for their content of 40 bacterial species. Data analyses were performed on an intention-to-treat basis with the subject as the statistical unit. Significant reductions in BOP, PD, RAL, and the mean counts of a number of target species between baseline and 3 years were documented for both treatment groups, whereas plaque scores remained unchanged. A statistically significant difference in favor of the adjunctive doxycycline therapy was found between the two groups only at the 3-month examination for BOP, PD, and RAL and for a minority of bacterial species at 2 years. Although short-term effects on clinical parameters were found with the adjunctive use of locally delivered doxycycline, repeated applications annually had no clinical or microbiologic effects beyond those observed with mechanical debridement alone in maintenance patients.

Bacteria and salivary profile of adolescents with and without cleft lip and/or palate undergoing orthodontic treatment

Patients with cleft lip and/or palate (CL&/P) experience a higher caries prevalence. This study aimed to determine if patients with CL&/P, undergoing and not undergoing orthodontic treatment, have a different salivary biochemical profile and different salivary levels of Mutans Streptococci (MS) and Lactobacilli (LB) compared to patients undergoing and not undergoing orthodontic treatment without CL&/P. One hundred and ten subjects aged between 12 and 17 years were recruited into one of four different groups comprising two control groups and two treatment groups. The control groups comprised of subjects with and without CL&/P who were not undergoing orthodontic treatment. The treatment groups comprised of subjects with and without CL&/P undergoing orthodontic treatment. Regular reinforcement of oral hygiene instructions, dietary counselling and debridement, when necessary, were offered to subjects in the treatment groups following their orthodontic adjustment appointments. The salivary secretion time, pH of resting and stimulated saliva, salivary flow rate, buffering capacity, quantity of salivary MS and LB were measured. Subjects with CL&/P undergoing orthodontic treatment at the Children's Oral Health Service tended to present with microbiological and salivary profiles that were less favourable for caries development. There was a significant difference in the percentage of subjects with > or = 10(5) colony forming units (CFU)/mL of MS between the cleft treatment and non-cleft treatment groups. Subjects in the non-cleft treatment group had the highest percentage of subjects (86.7 per cent) with > or = 10(5) CFU/mL of MS whereas subjects in the cleft treatment group had the lowest percentage of subjects (60 per cent) with > or = 10(5) CFU/mL of MS. For LB, there were significantly higher percentages of subjects with > or =10(5) CFU/mL of LB in the non-cleft treatment (76.7 per cent) and cleft treatment (73.3 per cent) groups compared to the non-cleft control (46.7 per cent) and cleft control (40.0 per cent) groups. Regular oral hygiene reinforcement and dental health education appears to have a positive effect in reducing the percentage of subjects with > or = 10(5) CFU/mL of MS.

Rare lesions of the oral cavity: case report of an actinomycotic lesion limited to the gingiva

Actinomycosis is an infectious disease that frequently has chronic granulomatous and suppurative lesions caused by saprophytic Actinomyces species. Although cervicofacial actinomycosis is known to be the most common type, intraorally and periodontally types occur rarely in a localized fashion. The present case reports on an adult periodontitis patient with a diffuse and atypic actinomycotic lesion which was limited to the gingiva and had an abscess formation, a large desquamation and subsequent exposure of the alveolar bone in the involved region. Diagnosis was based on histopathological examination, the history of the case and clinical nature of the lesion. The patient responded to daily administration of 100 g doxcycycline (first day-bid) for 3 weeks and 0.2% chlorhexidine gluconate irrigation (following tooth brushing) performed with oral hygiene reinforcement and periodontal debridement procedures. Complete improvement of the lesion was observed after 5 weeks. Due to the opportunistic characteristics of the actinomycotic infection, early and adequate differential diagnosis of actinomycosis prior to therapeutic attempts, as well as management steps, are of great importance in the oral cavity to prevent the spread of the disease.

Predominant cultivable microflora of supragingival dental plaque in Chinese individuals

The aim of this study was to determine the predominant supragingival cultivable bacterial flora in Chinese individuals, using the experimental gingivitis model. A total of 11 healthy dental students, mean age 22.5 years (range 20–25) were recruited. All were provided with once-a-week dental prophylaxis and oral hygiene reinforcement for 3 weeks to ensure gingival health. In the fourth week, after prophylaxis, the participants entered a 14-day period without any plaque control. A plaque sample was collected at days 1, 3, 7 and 14 from the buccal surface of the upper right canine, second premolar, first premolar and first molar, respectively. Each sample was then dispensed in tryptic soy-broth transport medium and grown anaerobically to obtain pure cultures, which were subsequently identified. Results whowed that Gram-positive cocci and rods were the predominent cultivatable species (51–61%) in the samples throughout the 14-day period; with time there was a decreasing percentage of cocci and an increasing percentage of rods. Gram-negative cocci and rods increased in proportion with the plaque age (11–37%). Streptococcus spp. were the predominant Gram-positive cocci while Actinomyces were the predominant Gram-positive rods isolated. Fusobacterium and Capnocytophaga spp. were the two most frequent Gram-negative anaerobic rods cultured. The results compared with those from other analogous studies from the West suggest the possibility of interracial differences in supragingival plaque flora.

Long‐Term Stability of Class II Furcation Defects Treated With Barrier Membranes

The present longitudinal study was designed to explore the long-term efficacy of guided tissue regeneration (GTR) in Class II furcation defects and establish the factors that might be responsible for modifying this response. Subjects with two or more mandibular molars, one of which had Class II furcation defects, received the hygienic phase of therapy followed by baseline clinical measurements and subgingival plaque sampling. GTR procedure was performed in furcation defect sites using expanded polytetrafluoroethylene (ePTFE) membranes, while the other non-furcated molars received only scaling and root planning. Twenty-eight subjects (13 females, 15 males) aged 27 to 66 were included in this longitudinal analysis. Post-surgical treatment included routine home care supplemented with daily chlohexidine rinse and systemic tetracycline. Membranes were retrieved 4 to 6 weeks after surgery. During the first year, patients were initially seen bi-weekly and subsequently monthly for professional prophylaxis. At the end of this year, clinical measurements and samples were obtained. For the next 2 years, patients were seen bi-annually for maintenance visits. Clinical measurements and microbiological samples were then repeated. Next, a tighter maintenance protocol was established and patients were seen quarterly for scaling and oral hygiene reinforcement. Final measurements and samples were taken again 1 year later (4 years postoperative). Significant probing reduction (3.00 mm) and gain in horizontal attachment (2.59 mm) were obtained 1 year postsurgery for the GTR sites. These changes were maintained over 4 years with a slight decline at the end of year 3. Changes in probing depth (PD) from year 1 to 4 served to dichotomize the sites into stable (delta PD < or = 0.9 mm), and unstable (PD increase > or = 1 mm). Of the 54 sites available for this analysis only 5 (9.3%) were unstable while 49 (90.7%) were stable or even further improved. Sites which exhibited minimal or no plaque (plaque index [PI] < or = 1) over the tight maintenance period had a further decrease in mean probing depth (0.43 mm) compared with a slight increase (-0.06 mm) in mean probing depth in sites with PI > or = 2 mm (P = 0.0235). The same phenomenon was observed for changes in relative attachment level (RAL): mean gain in RAL was 0.61 mm compared to 0.25 mm for the 2 groups, respectively (P = 0.07). Actinobacillus actinomycetemcomitans was only isolated from 2 sites at year 3, and none at year 4, compared to 21.45% of the sites at baseline. Porphyromonas gingivalis positive sites showed a continual decline over the years: 14.28% at baseline, 10.71% at year 1, and 5.1% at year 4. On the contrary, Prevotella intermedia (Pi) and Bacteroides forsythus (Bf) infected sites remained at approximately the same rate throughout the 4 years of the study (40% to 50% and 30% to 40% for Pi and Bf, respectively). Of these, Pi-infected sites exhibited less favorable clinical results compared to sites which were not infected with this microorganism. In summary, furcation defects treated with membrane barriers can be maintained in health for at least 4 years; however, good oral hygiene and frequent recall visits as part of a complete anti-infective therapy are essential. Finally, once treated, these teeth are comparable to similar molar teeth with no previous history of furcation pathosis.

Bacterial morphotypes of 3-day old plaque in Chinese. A pilot study.

The aim of the this study was to estimate the % distribution of bacterial morphotypes of supragingival plaque in Chinese subjects after 3 days of no oral hygiene. 36 dental students, hygienists or dental surgery assistants (mean age: 24.3 years) were recruited. Prophylaxis and oral hygiene reinforcement were given 1 x a week for 3 weeks to obtain gingival health and a 3-day period without any plaque control started afterwards. At the end of the 3-day period, the plaque along the gingival margin of the upper right central incisor was removed and direct Gram stained smears were prepared for light microscopy. Bacteria were classified as gram-positive or gram-negative cocci, rods, filaments, fusiform organisms, spirilla or spirochetes. A differential count of 200 organisms from 3-6 microscopic fields was performed and the results expressed as a % of the organisms counted. Results from the 36 direct smears showed approximately 83% (range: 52%-96%) of the organisms to be gram-negative while gram-positive bacteria comprised only a minority of about 12% (range: 0.7%-43%). This result is remarkably different from previous reports from the West where gram-positive bacteria were the predominant bacterial types noted in early supragingival plaque. Further longitudinal studies involving both microscopy and bacteriological culture will be necessary to confirm this finding.

Restorative dental care of children participating in a school based plaque control programme in London.

The effect of a school based plaque control programme on restorative dental treatment was investigated over a 4-yr period. The programme consisted of fortnightly visits to a hygienist during term time for oral hygiene reinforcement and prophylaxis during the first 3 yr. The subjects were girls aged 11-12 yr at baseline and all attended the same school; the present study was concerned with the subjects in both the experimental and control groups who attended the dentist based in the school for restorative care (n = 147 for the first year falling to 108 for the 4-yr period). During the first year, the subjects treated from the experimental group received significantly fewer restorations than the subjects treated from the control group. This significant difference was not seen in the subsequent 3 yr and the mean number of restorations provided over the 4-yr period in the experimental and control groups respectively was 5.45 and 6.67. The corresponding 4 yr DFS increments for these groups were 5.56 and 5.52. The anomalous first finding appeared to have been due more to decayed surfaces being present in the control group at baseline. The results for restorative care generally confirmed the ineffectiveness of the programme in preventing caries and the relatively low caries increments reflect the reductions in caries experience occurring in similar communities during the period of the study.

Prevention of Phenytoin Associated Gingival Enlargement—A 15‐Month Longitudinal Study

The purpose of the present study was to investigate on a longitudinal basis, the effectiveness of a specific preventive dental program for outpatients who were taking phenytoin for seizure control. Plasma, mixed and parotid saliva were also monitored in relation to each other and gingival enlargement. The results confirmed that a preventive dental program consisting of frequent prophylaxis and oral hygiene reinforcement was effective in minimizing gingival enlargement associated with phenytoin therapy. However, a small but statistically significant increase in anterior gingival enlargement occurred within the first 6 months of phenytoin therapy. No further enlargement developed during the subsequent 9 months. Control subjects not receiving phenytoin demonstrated no change in the coronal position of the free gingival margin about anterior segments of the dentition. In the posterior segments, the control group exhibited statistically significant gingival recession which became evident at 12 months. Individuals taking phenytoin did not demonstrate any change in the coronal position of the free gingival margin within the posterior segments of the dentition. Combined with the dental prophylaxis, improvement in plaque control appeared to be consistent with the prevention of clinically significant gingival enlargement. Parotid and mixed salivary levels of phenytoin were approximately 10% that of plasma values. Both salivary levels rose when plasma levels increased as reflected by the relatively high coefficient of correlation between these parameters. Furthermore, neither plasma, mixed or parotid levels of phenytoin were correlated to the minimal degree of gingival enlargement which occurred in the anterior segments of individuals taking phenytoin.

The role of visual feedback by a disclosing agent in plaque control.

The common prescription of disclosing agents for home use assumes a relationship between visual feedback from stained plaque and subsequent oral hygiene behaviour. A study of double crossover design showed that there was no significant difference in the improvement in plaque control between the group which received only individual oral hygiene education and another group which had the same oral hygiene education supplemented by the home use of a disclosing agent for 2 weeks. On receiving oral hygiene reinforcement and discontinuing use of the disclosing agent, there was a further significant improvement in plaque control after another 2 weeks. This again suggests that visual feedback from the disclosing agent did not play a critical role in patient motivation. It appears that oral hygiene education is still fundamental to the whole concept of prevention. The prescription of a disclosing agent for home use should not be considered mandatory. Thorough and repeated oral hygiene education seems to be the most important feature in patient motivation.