Period Of Oral Hygiene Research Articles

Comparative professional plaque removal study using 8 branded toothbrushes

Considerable interest has been shown in the plaque removal properties of modern toothbrush designs. The primary aim of the study was to compare the plaque removal properties of 8 relatively recent designs of manual toothbrush using a professional tooth brusher and within a commonly used time frame. A secondary aim was established to utilise the data to observationally appraise plaque accumulation together with the patterns of removal as a consequence of using the timed professional tooth brusher. The method was an 8-period, single-examiner, randomized, blind cross-over study involving 24 healthy volunteers, balanced for residual effects. Subjects accumulated plaque over a 4 day no oral hygiene period. On day 4, the accumulated plaque was scored by plaque index at the mesial, mid and distal sites of each of the buccal and lingual surfaces of the assessed teeth. Subjects were then removed from the assessment area where they received a professional brushing timed to last 48 s. Brushing was completed according to pre-study training without toothpaste and was followed by a re-scoring of the remaining plaque. A washout period of 3 days was then allowed prior to the next period during which normal oral hygiene was resumed. Similar quantities of plaque accumulated in each arch, although the difference between the buccal and lingual surfaces was of the order of 30%. The professional toothbrusher removed approximately 40% of the accumulated plaque in the 48 s allocated. The buccal surfaces were most effectively cleaned (approximately 45%) compared with the lingual (approximately 25%), with the plaque removal in the mesial and mid sections approaching 40% and 60% respectively. The difference in performance between the test brushes corresponded to 5% of the residual plaque values with none being significantly more efficient overall. Pair wise site comparisons did produce differences of the order of 10% (p=0.004) at the mesio-buccal, and 8% (p=0.030) at the mid-buccal sites respectively in favour of 2 brushes compared to one other brush. These data derived from a standardized brushing method support the contention of many researchers that there is no one superior design of manual toothbrush. The minor and few site differences in favour of some brushes are unlikely to be of clinical significance to gingival health. This leaves uncontested the conclusion that the user is by far the most significant variable. Perhaps methods such as used in the present study could be more gainly employed to set a minimum standard of toothbrush efficacy.

Supragingival and subgingival microbiota of adult patients with Down's syndrome. Changes after periodontal treatment.

In this longitudinal study, five adult Down's syndrome patients with periodontitis were placed on a frequent recall visit schedule (every 6 weeks) after treatment, in order to investigate: 1) the microbiological status, both supragingivally and subgingivally, and the changes that occurred after treatment and 2) the effect of frequent professional supragingival plaque control on the subgingival microbiota and clinical variables in these patients. The clinical variables recorded were probing pocket depth, probing attachment level, bleeding on probing and presence of plaque (full mouth, six surfaces per tooth). Microbiological examination was performed separately for supragingival and subgingival samples from the same site for 14 species, using whole genomic DNA probes and the "checkerboard" DNA-DNA hybridization technique. The findings indicate that, although a reduction of periodontal indices was noticed, plaque levels remained high (60%) even at the end of the experimental period. Periodontal pathogens including Porphyromonas gingivalis, Bacteroides forsythus and Actinobacillus actinomycetemcomitans were frequently detected both supragingivally and subgingivally (>30%). The presence of a species supragingivally and the presence at the same time points subgingivally were correlated. This finding suggested that supragingival plaque acts as a reservoir for reinfection of treated sites. A reduction of the percentages of detection of these species was noticed 1 month after an oral hygiene period as well as at 3 and 6 months after treatment. Inadequate oral hygiene as performed by these patients probably affected supragingival, and consequently subgingival, plaque composition.

Predominant cultivable supragingival plaque in Chinese "rapid" and "slow" plaque formers.

The aim of this study was to compare the predominant cultivable bacterial flora in supragingival plaque samples of Chinese "rapid" and "slow" plaque formers, using the experimental gingivitis model. 11 Chinese subjects (5 "rapid" and 6 "slow" plaque formers) were selected from 49 healthy young adults. The selection was based on the plaque index on the buccal surfaces of all the canines, premolars and 1st molars after 3-days without plaque control. The 11 subjects began a 14-day on oral hygiene period after prophylaxis. Plaque samples were collected on day 1, day 3, day 7 and day 14 from the buccal surface of upper right canine, 2nd premolar, 1st premolar and 1st molar, respectively. The samples were then dispensed into a tryptic soy broth, and cultured anaerobically to obtain pure isolates which were then identified by conventional means. Results showed similar trends in plaque development in the two groups; gram-positive bacteria were the predominant cultivable species ("rapid": 71-37%; "slow": 53-63%) and gram-negative species increased in proportion to the plaque age ("rapid": 9-47%, "slow": 13-28%). "Rapid" plaque formers showed a statistically significant higher percentage of gram-negative rods (38%) than the "slow" group (17%) in the 14-day samples. The difference in the proportions of other groups of bacteria between the "rapid" and "slow" plaque formers were also found to be statistically significant using the MANOVA test (p = 0.0162). Most of the cultivable gram-negative rods belonged to Fusobacterium and Capnocytophaga species. Besides the quantitative difference observed clinically, there seems to be a qualitative difference in the cultivable flora between subjects with different rates of plaque formation.

Serum immunoglobulin G antibodies to Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and Streptococcus sanguis during experimental gingivitis in young adults.

Twenty-eight young, healthy adults completed an experimental gingivitis study in which blood and clinical recordings were obtained at baseline; after a 4-week period of thorough oral hygiene; after a subsequent 3-week period of plaque accumulation; and after another 2 weeks of thorough oral hygiene. Serum immunoglobulin G antibodies against whole cells of Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and Streptococcus sanguis were determined using enzyme-linked immunosorbent assay. Mean serum immunoglobulin G antibody levels to P. intermedia, F. nucleatum and S. sanguis remained essentially constant during the experiment, whereas the immunoglobulin G antibodies to P. gingivalis declined during the initial period of oral hygiene and the subsequent period of plaque accumulation to an average of 84.5% of the baseline value. This reduction could be attributed to the people who developed marked gingival inflammation during the period of plaque accumulation, indicating that the systemic host response may be associated with local tissue responses to variations in oral hygiene. These people were, however, also characterized by higher initial serum immunoglobulin G responses to P. gingivalis than people who developed less pronounced gingival inflammation during the experiment. The variability and individuality noted in the host response to potential pathogens have important implications for attempts to use such measures for establishing a diagnosis or prognosis for the individual patient.

Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment

A sanguinaria-containing toothpaste and oral rinse regimen was evaluated during a 6-month period to determine its effectiveness in controlling plaque, gingival inflammation, and sulcular bleeding. Oral hygiene instructions and a 1-month prestudy brushing period failed to produce a significant improvement in health among the 24 subjects as determined by the three evaluation parameters. After the oral hygiene period, the subjects were randomly assigned to the active treatment (marketed Viadent toothpaste and oral rinse) or the placebo treatment (same base formulas without sanguinaria). Treatments were evaluated using the Löe and Silness gingival index, the Silness and Löe plaque index, and the Mühlemann and Son sulcular bleeding index at baseline and monthly through 6 months. The sanguinaria regimen reduced plaque by 57%, gingival inflammation by 60%, and sulcular bleeding by 45% from baseline compared with placebo group reductions of 27% (plaque) and 21% (gingival inflammation), and an increase of 30% in bleeding index. Repeated-measures analysis of covariance with baseline scores used as covariates showed statistically significant differences at 6 months for plaque (active 0.39; placebo 0.68, p < 0.01), gingival inflammation (active 0.32; placebo 0.76, p < 0.001), and sulcular bleeding (active 0.34; placebo 0.70, p < 0.002). Results of this study demonstrated that the combined use of the sanguinaria-containing toothpaste and oral rinse controls and reduces plaque and gingival inflammation in an orthodontic population.

Effects of oral hygiene measures on clinical and microbiological parameters of periodontal disease

The effects of a 12-week period of oral hygiene alone on gingival conditions and subgingival microflora in 15 patients with severe periodontitis were investigated. Clinical measurements and plaque samples from selected sites were taken at week 0 (baseline), week 6, and week 12. Plaque samples were also taken at week 13, that is, 1 week following debridement. At week 0, the patients were instructed in supragingival plaque control and at week 6, the hygiene regimen was supplemented with the subgingival use of a toothpick device. At week 12, the patients received a full mouth supra- and subgingival debridement under local anesthesia. In those patients who complied with oral hygiene instructions (subgroup A), the gingival condition improved moderately while no improvement was found in less compliant patients (subgroup B). No significant changes were noted in the subgingival microflora in either subgroups A or B throughout the 12-week period of oral hygiene alone. However, significant reductions for all microbial parameters were found 1 week after debridement. Therefore, while moderate clinical improvements followed oral hygiene alone, no measurable changes in the subgingival microflora were observed concomitantly.

Experimental gingivitis in humans. A histochemical and immunological characterization of the lymphoid cell subpopulations.

Cell types in a human experimental gingivitis model were analyzed sequentially on days 0, 4, 8, and 21 of a no oral hygiene period. The cells were characterized using enzyme and surface antigen markers. In all but two of the day 0 specimens a small inflammatory infiltrate was localized immediately beneath the junctional epithelium. These, essentially lymphocytic lesions, consisted of over 70% T‐cells as suggested by the phenotype T‐enzyme +ve/T‐cell surface antigen +ve/B‐cell surface antigen −ve/HLA‐DR −ve/B‐cell subset antigen −ve. At days 4, 8, and 21, although the size of the infiltrate increased, its essential nature did not change. At all times the majority of lymphocytes (over 70%) had the characteristic T‐cell phenotype. These results show that in the developing gingival lesion in humans a T‐cell dominated lesion occurs and persists at least for the 3 week experimental period used in the present study.

Plaque growth while chewing sorbitol and xylitol simultaneously with sucrose flavored gum

In a recent study, sorbitol flavored chewing gum was found neither to increase nor decrease the normal rate of plaque formation, whereas high plaque scores were obtained with sucrose gum during 4 days of no mechanical tooth cleaning. The aim of the present study was to see if chewing sorbitol or xylitol flavored gum together with sucrose gum would affect the growth rate of plaque and whether chewing of xylitol flavored gum could reduce the amount of already formed plaque. Twenty-seven dental students refrained from mechanical oral hygiene measures from Monday to Friday morning for 3 weeks. The students were randomly divided into three groups. A three time crossed-over double-blind approach was used. During each test period one group chewed a combination of one piece sorbitol and one piece sucrose flavored gum five times per day, the second group correspondingly chewed xylitol and sucrose flavored gum, while the third group served as a no hygiene control group. After each test period the students in the control group chewed one piece of xylitol gum every 15 minutes for 2.5 hours. The participants started out each week with clean teeth and were at the end of each test period scored for visible plaque on the facial, mesial and lingual surfaces of their teeth. There was somewhat more plaque after 4 days of chewing sucrose-sorbitol and sucrose-xylitol gum combinations than after no oral hygiene alone. There was no difference between the two test treatments. The 2.5-hour chewing of xylitol flavored gum after the no oral hygiene period did not result in a reduction of the 4-day-old plaque.