Reduction Of Gingival Inflammation Research Articles

A prospective study on oral adverse effects in head and neck cancer patients submitted to a preventive oral care protocol.

To evaluate the occurrence and severity of oral complications, number of radiotherapy (RT) interruptions and quality of life (QoL) in a population of head and neck cancer patients receiving a preventive oral care program (POCP) and photobiomodulation therapy (PBMT). Prospective cohort of 61 head and neck cancer patients undergoing radiochemotherapy were monitored and submitted to a POCP that included oral hygiene and plaque control, removal of infection foci, dental restorations, periodontal therapy, fluorotherapy, oral hydration, and denture removal at night, combined with daily PBMT. Outcomes included occurrence of adverse effects such as severity of oral mucositis (OM) and oral symptoms (pain, solid and fluid dysphagia, odynophagia, dysgeusia), quality of life impacts, and interruptions of radiotherapy (RT) due to symptoms. Disease-free and overall survival rates were evaluated. There was a significant improvement in oral health conditions between initial assessment and the two longitudinal assessments (p < 0.05), which indicates that the POCP was effective for plaque control and reduction of gingival inflammation. All participants were free of OM at the beginning of the RT regimen and only 45.9% after the 7th session, and few patients ranked the highest score of OM. For all symptoms related to OM, there was a progressive increase of severity until the 14th RT session, which remained stable until the completion of the RT regimen. The same effect was observed for the quality of life measures. Discontinued RT due to OM occurred in only three patients (5%), and the maximum duration was 10days. The overall survival rate was 77% and disease-free survival was 73.8%. Lower survival time was observed for patients with no response to RT (p < 0.01). The findings of this study suggest a positive effect of an oral preventive care program for head and neck cancer patients submitted to RT. The PBMT associated with a rigorous POCP resulted in satisfactory control of oral adverse effects, reduction of quality of life impacts, and interruption of RT regimen due to severe OM.

A randomized, double-blind, placebo-controlled multicenter study for evaluating the effects of fixed-dose combinations of vitamin C, vitamin E, lysozyme, and carbazochrome on gingival inflammation in chronic periodontitis patients

BackgroundTo evaluate gingival inflammation from fixed-dose combinations of vitamin C, vitamin E, lysozyme and carbazochrome (CELC) in the treatment of chronic periodontitis following scaling and root planing.MethodsOne hundred patients were randomly assigned to receive CELC (test) or placebo (control) for the first 4 weeks at a 1:1 ratio, and both groups received CELC for the remaining 4 weeks. Primary outcome was the mean change in the gingival index (GI) after 4 weeks. Secondary outcomes included mean change in GI after 8 weeks and plaque index, probing depth, clinical attachment level, and VAS at 4 weeks and 8 weeks.ResultsNinety-three patients completed the study. The GI in the test group significantly decreased after 4 weeks (p < 0.001) and 8 weeks (p < 0.001). The mean change from baseline in GI significantly decreased in the test group compared to the control group after 4 weeks (p = 0.015). In the GEE model adjusting for age, gender and visits, the test group showed 2.5 times GI improvement compared to the control group (p = 0.022).ConclusionsWithin the study, CELC showed a significant reduction in gingival inflammation compared with a placebo. Other parameters, however, were similar between groups.Trial registrationKCT0001366 (Clinical Research Information Service, Republic of Korea) and 29 Jan 2015, retrospectively registered.

Effect of stannous fluoride and zinc phosphate dentifrice on dental plaque and gingivitis: A randomized clinical trial with 6-month follow-up

ObjectiveThe objective of this study was to compare a stabilized stannous fluoride (SnF2) dentifrice with zinc phosphate (Colgate TotalSF) with SnF2 with zinc lactate and control fluoride dentifrices for gingivitis and plaque control over a 6-month period. MethodsA total of 135 adult participants were enrolled in this study. After randomization and blinding of examiners and patients, enrolled participants were provided instructions for use of assigned dentifrice. At 3 visits (0, 3, and 6 months), various gingival and plaque indexes were collected to determine the clinical efficacy of a stabilized SnF2 dentifrice. These results were compared with a SnF2 with zinc lactate dentifrice and with a control fluoride dentifrice. ResultsA total of 135 participants completed the study. All groups reported statistically significant reductions in gingival inflammation and improvement in plaque control at 3- and 6-month follow-up. Both SnF2 dentifrices showed statistically significant reductions in all indexes compared with the control dentifrice (P < .001). However, the test dentifrice showed higher but nonsignificant improvements in plaque and gingival indexes compared with the other SnF2 dentifrice. ConclusionsThis study reports similar efficacy of a test dentifrice to a commercial SnF2-containing dentifrice for plaque control and reduction in gingival inflammation and provides supporting evidence that the test dentifrice maintains its clinical efficacy with change of formulation. Practical ImplicationsThis newly formulated SnF2 stabilized with zinc phosphate dentifrice may be of benefit to patients in controlling plaque biofilm and gingivitis.

Evaluation of a stabilized stannous fluoride dentifrice on dental plaque and gingivitis in a randomized controlled trial with 6-month follow-up

BackgroundThe objective of this study was to compare a stannous fluoride (SnF2) dentifrice (Colgate TotalSF) stabilized with zinc phosphate with a sodium fluoride control dentifrice for gingivitis and plaque control over a 6-month period. MethodsOne hundred adult participants were enrolled in this study conducted in Chengdu, China. After random assignment and blinding of examiners and patients, enrolled participants received instructions for use of the assigned dentifrice. At 3 visits (baseline and 3 and 6 months), the authors measured various gingival and plaque indexes to determine the clinical efficacy of the stabilized SnF2 dentifrice compared with those of the control fluoride dentifrice (2 groups). ResultsNinety-eight participants completed the study. Both groups (test and control) had statistically significant reductions in gingival inflammation and improvement in plaque control at the 3- and 6-month follow-ups. In addition, the test dentifrice showed statistically significant reductions in all indexes compared with the control dentifrice (P < .001). ConclusionsThis study’s results show statistically significantly improved clinical outcomes for reduction of gingival inflammation and improvement in biofilm control over a 6-month period through the use of a SnF2 dentifrice stabilized with zinc phosphate when compared with results with a fluoride control dentifrice. Practical ImplicationsThis newly formulated dentifrice improves gingival health and plaque control and thereby may aid patients in attaining improved oral health.

The Effect of the Bass Intrasulcular Toothbrushing Technique on the Reduction of Gingival Inflammation: A Randomized Clinical Trial

ObjectivesThe primary objective of this randomized controlled clinical trial was to investigate the effect of the Bass Intrasulcular Technique (BIT) on reducing gingival inflammation at 4 and 12 weeks compared with the toothbrushing techniques commonly used. Methods and MaterialsAfter receiving ethical approval from the Tufts Health Sciences Institutional Review Board, 55 subjects were invited to participate in the study. Only the subjects who presented with bleeding on probing (BoP) were enrolled. The test group (BT) was instructed on how to use the BIT, and the control group (NI) received no brushing technique instructions. Clinical measurements (probing depth, plaque score, BoP) of each tooth were recorded at 4 and 12 weeks. The toothbrushes of all participants were photographed and assessed by two blinded examiners using the ImageJ software. The statistical significance between the cohorts' BoP and their plaque score results was assessed via hierarchical logistic regression. The analyses were performed using the SAS software (version 9.4; SAS Institute, Cary, NC). ResultsForty-eight participants were eligible to participate and were randomly assigned to one of the two groups (N = 24). The BT group showed significantly smaller percentages of BoP than the NI group at 4 (BT = 12.4% and NI = 31.4%) and 12 (BT = 11.6% and NI = 43.8%) weeks. The difference in plaque scores at 12 weeks was statistically significant (P = .0003) between the two groups. At 12 weeks, the Mann-Whitney U Test indicated that the difference between the groups in terms of toothbrush area was statistically significant (P = .043). ConclusionsWithin the limitations of this randomized controlled clinical trial, the BIT used by participants in the BT group was significantly more effective in reducing gingival inflammation as determined by BoP than the techniques used by participants who had no instructions on brushing techniques; at 12 weeks, the BT group experienced less toothbrush deformation than the control group. Clinical RelevanceBIT should be recommended particularly to patients exhibiting BoP and periodontal diseases.

Role of probiotics in the treatment and prevention of oral malodor/halitosis: A systematic review

Oral malodor is a condition which impedes people's social life and self-esteem. With more widespread acceptance of the potential for probiotic intervention providing health benefits for nonintestinal body sites, application of it on alternative target tissues has increased, to obtain more specific and enduring benefits. From the periodontal perspective, several studies have revealed the role of probiotic in the reduction of gingival inflammation. However, the studies of stronger evidence pertaining to the role of probiotics in the treatment and prevention of halitosis is limited. The aim of this study was to determine the role of probiotic strains in the treatment and prevention of oral malodor. Records were searched from various databases such as PubMed/Medline, Cochrane, and EMBASE. Articles published over the past 11 years were identified using the key search terms. A total of 178 records were identified by title/abstracts/full-text articles and were retrieved. After thorough assessment, 11 manuscripts were included in qualitative synthesis in this systematic review. Analysis of studies revealed 666 participants, aged 4–76 years, and about 20 probiotic strains were assigned to the test groups and control groups with a varying follow-up period. The effect size for randomized control trials ranged from 0.08 to 0.7 which suggests low-to-moderate practical significance. The results of this systematic review confirm that more studies are necessary to evaluate the efficacy of probiotics with correct methodological design, in broader population samples, and over longer periods.

Periodontal reconstruction by heparan sulfate mimetic-based matrix therapy in Porphyromonas gingivalis-infected mice

BackgroundPeriodontitis is a set of chronic inflammatory diseases affecting the supporting structures of the teeth, during which a persistent release of lytic enzymes and inflammatory mediators causes a self-perpetuating vicious cycle of tissue destruction and repair. A matrix-based therapy using a heparan sulfate (HS) analogue called ReGeneraTing Agent (RGTA) replaces destroyed HS by binding to available heparin-binding sites of structural molecules, leading to restoration of tissue homeostasis in several inflammatory tissue injuries, including a hamster periodontitis model. MethodsThe ability of RGTA to restore the periodontium was tested in a model of Porphyromonas gingivalis-infected Balb/cByJ mice. After 12 weeks of disease induction, mice were treated weekly with saline or RGTA (1.5 mg/kg) for 8 weeks. Data were analyzed by histomorphometry. ResultsRGTA treatment restored macroscopic bone loss. This was related to (1) a significant reduction in gingival inflammation assessed by a decrease in infiltrated connective tissue, particularly in cells expressing interleukin 1ß, an inflammatory mediator selected as a marker of inflammation; (2) a normalization of bone resorption parameters, i.e. number, activation and activity of osteoclasts, and number of preosteoclasts; (3) a powerful bone formation reaction. The Sharpey's fibers of the periodontal ligament recovered their alkaline phosphatase coating. This was obtained while P. gingivalis infection was maintained throughout the treatment period. ConclusionsRGTA treatment was able to control the chronic inflammation characteristic of periodontitis and blocked destruction of periodontal structures. It ensured tissue regeneration with recovery of the periodontium's anatomy.

Evaluation of the clinical effect of a probiotic mouthwash in the treatment of generalized marginal chronic gingivitis. Randomized pilot study

Objective. To evaluate the clinical effect of a probiotic mouthwash in reducing generalized marginal chronic gingivitis using positive and negative control groups. Methodology. Four-week study conducted in San Luis Potosí, Mexico, from January to March 2017. Participants were healthy, non-smokers with generalized marginal chronic gingivitis; age range 18-45 years. Subjects were randomized and divided into three groups: Group A: mouthwash based on 0.05% cetylpyridinium chloride (CPC) (positive control); Group B: mouthwash based on probiotics (experimental); Group C: placebo mouthwash (negative control). No oral hygiene practices or routines were modified; subjects were followed for 4 weeks. The primary outcome variable of interest was the Löe and Silness gingival index, and the secondary one, the Quigley Heinn plaque index modified by Turesky. Results. Of the 45 patients included, 19 (42.2%) were men and 26 (57.7%) women, mean age was 22.8±2.07. Each group consisted of 15 subjects; all subjects completed the study. There was no statistically significant reduction in gingival inflammation when comparing the 3 treatment groups (p=0.540) with respect to the gingival index. A comparison was made before and after the treatment and in the 3 groups there was no reduction of the gingival inflammation. Plaque reduction was not statistically significant when comparing the 3 groups (p=0.278). However, when doing intra-group comparison, it was found that the patients in group A had a reduction in plaque index (p&lt;0.005), which was not observed in groups B (p=0.1103) and C (p=0.1508). Conclusions. The use of a probiotic mouth mouthwash did not reduce gingival inflammation or the accumulation of dentobacterial plaque in a period of 4 weeks. There were no statistically significant differences between the study groups.

Effects of Adjunctive Daily Blue Light Toothbrushing on Dental Plaque and Gingival Inflammation—A Randomized Controlled Study

Phototherapy with blue light emitting diodes (LEDs) is gaining interest because of the efficient antimicrobial benefits reported in several studies in the last decade. The aim in this study was to investigate if a toothbrush with incorporated blue light used in daily oral care can reduce dental plaque and gingival inflammation. An 8-week single-blinded randomized controlled clinical study including 48 subjects compared effects of toothbrushes with/without 450 nm blue LED light emission, on clinical parameters (plaque index, gingival index, bleeding on probing), and on inflammatory markers in saliva and gingival crevicular fluid. Significant reductions in dental plaque and gingival inflammation (p β and interleukin (IL)-8, were detected within both groups from baseline to follow-up. For all subjects dental plaque was reduced with 57%, and a reduction in gingival inflammation was demonstrated by a decrease in gingival index (GI) with 46% and in bleeding on probing (BOP) with a decrease of 15%. No significant differences were found between the groups at a level of p = 0.05. However, the amount of plaque was reduced by 62% in the blue light group and 51% in the control group, a difference established at a level of p = 0.058. A toothbrush with a 450 nm LED did not show any statistical significant adjunctive effect of toothbrushing regarding reduction in measurements of dental plaque and gingival inflammation.

A Prospective Study to Evaluate the Efficacy of Supersaturated Calcium Phosphate Oral Rinse in Patients with Xerostomia

Background and Objective: Xerostomia exhibits symptoms of variable severity that are commonly attributed to medication use, chronic disease and medical treatment, such as radiotherapy to the head and neck region. Chronic xerostomia significantly increases the risk of experiencing dental caries, periodontal disease, and other oral diseases that may negatively affect the quality of life. This study was aimed to evaluate the beneficial effects of a Supersaturated Calcium Phosphate Rinse (SSCPR) in patients diagnosed with xerostomia. Material and Methods: 38 subjects with xerostomia and high Streptococcus mutans levels were divided blindly under the control and test group. The control group received standard customary treatment while subjects under the test group were further advised to rinse with SSCPR 4 times per day for 3 months. Clinical, microbiological, and biochemical oral health parameters were evaluated after 3 months. The results were subjected to statistical analysis. Results: Subjects under the test group i.e., using SSCPR had a 19% reduction in gingival inflammation, a 16% reduction in plaque level and a 29% improvement in oral hygiene as compared to the control group. There was a 39% improvement in salivary flow and a more neutral pH in the oral cavity compared to the control group. The S. mutans load in the test group was markedly less than as compared to the control group. All outcomes demonstrated a statistically significant difference (p<0.05). Conclusion: Standard preventive and customary treatment when supplemented with SSCPR or SalivaMAX gave a statistically significant improvement in oral health for all outcomes measured (inflammation, plaque, oral hygiene, salivary flow, oral pH, and S. mutans) when used regularly for a 3 month time period. SSCRP shows promise as a daily oral rinse and should be further evaluated for additional health benefits

EXPRESSION OF MMP-1 AND MMP-9 IN LOCALIZED AGGRESSIVE PERIODONTITIS PATIENTS BEFORE AND AFTER TREATMENT: A CLINICAL AND IMMUNOHISTOCHEMICAL STUDY

Aim: This study aimed to clinically investigate the efficacy of β-glucan supplementation to non-surgical periodontal therapy in localized aggressive periodontitis (LAP) patients. In parallel, immunohistochemical detection of matrix metalloproteinase-1 (MMP-1) and MMP-9 expression levels has undergone to determine the subcellular changes behind the clinical status and reliability of each antibody in predicting the periodontal condition.Method: 40 subjects suffering from LAP were randomly and equally assigned to receive scaling and root planning (SRP); either with placebo pills (Group I) or β-glucan (100 mg/ once a day) (Group II), for 40 days. Subjects were clinically monitored on day 0 and day 91. Gingival samples were harvested from hopeless teeth sites to be investigated histologically and immunohistochemically using matrix metalloproteinase (MMP)-1 and 9 antibodies form each participating patient; at the same time intervals.Results: The experimental intervention showed a greater mean of probing pocket depth reduction (p=0.1128), with significant gain in clinical attachment (p=0.0180) and reduction of gingival inflammation (p=0.0207) compared to the control group at the end of the study. Furthermore, the experimental protocol was able to achieve better modulating effects on the levels of MMP-1 and MMP-9 compared to control therapy, along with enhancing protective healing patterns. MMP-9 was more sensitive indicator of the periodontal condition compared to MMP-1.Conclusions: The curre nt study demonstrated that the non-surgical treatment of LAP is markedly improved clinically by the adjunctive use of β-glucan, accompanied by a trend for modulation of the cytokine profile in gingival tissue samples with better healing events. The results also suggest that the expression of MMP-9 may be a precise indicator of periodontal disease activity.

Effect of Antimicrobial Photodynamic Therapy as an Adjunct to Nonsurgical Treatment of Deep Periodontal Pockets: A Clinical Study.

Introduction: Deep periodontal pockets pose a great challenge for nonsurgical periodontal treatment. Scaling and root planing (SRP) alone may not suffice in cases where surgical therapy cannot be undertaken. Various recent studies have suggested the use of antimicrobial Photodynamic Therapy (aPDT) for the management of periodontal infections. The aim of this study was to evaluate the effects of using aPDT along with SRP, compared to SRP alone for the management of deep periodontal pockets. Methods: Thirty patients with chronic periodontitis, who met the criteria of having periodontal pockets with depth ≥ 6 mm and bleeding on probing (BOP) in at least 2 different quadrants were included. After SRP, one quadrant was randomly selected for aPDT (test), while another served as control. Clinical parameters i.e. plaque index (PI), modified sulcular bleeding index (mSBI), probing depth (PD) and clinical attachment level (CAL) were measured at baseline, 1 month and 3 months post-treatment intervals. Results: All clinical parameters significantly improved in both groups after 1 and 3 months. At 1-month interval, inter-group difference in mean change was statistically significant (P < 0.05) in terms of mSBI (0.85 ± 0.41in test vs 0.54 ± 0.47 in control group) and PD (1.77±0.86 in test vs 1.3 ± 0.95 in control group). At 3 months interval, no statistically significant difference was observed between test and control groups except in terms of mSBI (0.97 ± 0.45 in test vs 0.73 ± 0.42 in control group). Conclusion: aPDT appears to play an additional role in reduction of gingival inflammation when used along with nonsurgical mechanical debridement of deep periodontal pockets.

Effect of TNF-α Blockade in Gingival Crevicular Fluid on Periodontal Condition of Patients with Rheumatoid Arthritis.

Periodontitis and rheumatoid arthritis (RA) share a number of clinical and pathologic features, one of which is the presence of the tumor necrosis factor alpha (TNF-α)-induced bone resorption that is involved in the pathogenesis of both. To investigate the effect of TNF-α blockade on periodontal conditions in patients with active RA. The periodontal statuses of 36 patients (26 females, 10 males) diagnosed with active RA were evaluated both before and after anti-TNF-α therapy. Gingival index, bleeding on probing (BOP), probing pocket depth (PPD), oral hygiene index (OHI), and levels of TNF-α in gingival crevicular fluid (GCF) were measured at the baseline and 6 weeks after the treatment. Wilcoxon signed ranked test was used for statistical analyses. Based on OHI (p=0.860), the level of plaque control did not change during the study period, but there was a significant reduction in gingival inflammation based on the mean BOP (p=0.049) and GI (p=0.036) before and after 6 weeks of anti-TNF-α therapy. The mean PPD index did not significantly differ at the baseline and 6 weeks after treatment (p=0.126). Anti-TNF-α therapy might have a desirable effect on periodontal conditions and might reduce TNF-α level in GCF of patients with RA.

Efficacy of an aluminium triformate mouthrinse during the maintenance phase in periodontal patients: a pilot double blind randomized placebo-controlled clinical trial.

BackgroundThe aim of this prospective placebo-controlled pilot study was to evaluate short-term effects of a mouthrinse containing aluminium triformate (ATF) on gingival inflammation and plaque formation in periodontal patients who are in the maintenance phase. ATF has styptic (astringent) and anti-inflammatory effects.MethodsForty non-smoking periodontal patients with modified sulcus bleeding index (MSBI) ≥40 % were randomly divided into two groups. The participants received a masked mouthrinse (ATF or placebo) and were instructed with the rinsing protocol of 3 daily rinses during 30 s for 7 days. One blinded investigator (CE) performed all clinical examinations. The primary outcome was reduction in gingival inflammation as measured by MSBI. The secondary outcomes were reduction of the amount of plaque as measured by plaque index (PI) and approximal plaque index (API) and the occurrence of side effects. The patients were evaluated at the start and the end of the rinsing period, including the compliance of the patients.ResultsMSBI was reduced in both groups compared to baseline, but the ATF group showed significantly more reduction in MSBI compared to the placebo group (ATF: 17.6 %, placebo: 7.6 %, p = 0.035). ATF and placebo had no effects on dental plaque. Patients reported ATF mouthrinse not to have side effects other than oral sensation, whereas compliance of the patients was good. Almost all patients in the ATF group reported reduction of gum bleeding after 1 week of rinsing with ATF.ConclusionsThis short-term pilot clinical trial is a firm basis to design a long-term controlled clinical trial to show whether ATF helps to inhibit further periodontal breakdown in maintenance patients with high MSBI.Trial registrationThis trial was registered in the WHO International Clinical Trials Registry Platform as DRKS00007672, date of registration: 21/01/2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-016-0214-z) contains supplementary material, which is available to authorized users.

Improving periodontal outcomes: merging clinical and behavioral science.

New data indicate that periodontal diseases are much more prevalent than previously thought, which means that there are large numbers of patients who will need to be diagnosed and treated for periodontal disease in a general dental practice. Oral hygiene procedures performed by patients between office visits are important for gingival health. No particular type of toothbrush has consistently been shown to have superior plaque-removal ability over another. Although studies on powered brushes have shown evidence for efficacy of biofilm removal and increased patient compliance, they are of short duration, making evaluation of long-term effects difficult to achieve. Interdental cleaning with dental floss can be effective but it is technique-sensitive. Interdental brushes have been shown to be superior to floss in plaque index scores, but not in gingival inflammation reduction. A systematic review of oral irrigation reported a beneficial adjunctive effect on bleeding and gingival indices and pocket depth. Antimicrobials in mouthrinses and toothpastes have shown significant reductions in plaque and gingivitis when used correctly. Even though it is considered essential for patients to utilize biofilm-removal techniques on a frequent basis, studies on adherence show that approximately 30-60% of health information is forgotten within 1h, and 50% of health recommendations are not followed. Incorporating psychosocial aspects of behavioral change, including well-established counseling strategies, such as motivational interviewing, may elicit improved patient outcomes.

Plaque Removal and Gingival Health after Use of a Novel Dental Gel: A Clinical Study.

BackgroundGoal of this in vivo prospective, randomized, controlled, double-blinded, cross over study was to compare the level of plaque control and gingivitis after use of a novel dental gel (test) vs. A Triclosan/copolymer dentifrice (control).MethodsAfter coronal polishing, 22 subjects with moderate gingivitis were randomly assigned to brush twice daily with test or control dentifrice for the first study Arm. Plaque, gingival and sulcus bleeding indices were recorded at baseline, week 2 and week 4. Professional coronal polishing was repeated, and then subjects brushed with the second dentifrice for 4 weeks. Clinical indices were again recorded at Baseline, week 2 and week 4. The effects of each dentifrice on clinical indices were compared using Student’s t-test.ResultsBrushing with the test gel produced significantly greater levels of plaque reduction versus the Triclosan/copolymer control dentifrice at each time point. 45% less plaque was measured after 4 weeks of test agent use than after control agent use (p<0.000000005). A significant reduction in gingival inflammation from test vs control agent over w\\4 weeks was also observed (p=0.000342).ConclusionsAn activated edathamil dental gel formulation provides effective plaque control and reduced gingival inflammation compared to a Triclosan/Co-polymer dental gel. Practical Implications: A novel dental gel formulation that does not contain abrasives, detergents or antimicrobials may provide effective plaque control and support gingival health.

Probiotics in the treatment of periodontal disease: A systematic review.

Over the years, probiotics have been used in the treatment of a variety of diseases. The use of probiotics in the treatment of periodontal disease has caught on over the last decade or so. This review was performed to determine whether administration of probiotics produced a lasting clinical benefit in the treatment of periodontal disease. A MEDLINE, Cochrane database and a hand search was performed on human randomized placebo controlled trials using probiotics in the treatment of periodontal disease. A total of thirteen papers which addressed the question of the use of probiotics in the treatment of periodontal disease were retrieved. Most of the studies reviewed showed only a short term benefit with regards to reduction in gingival inflammation and probing depth reduction. Lasting clinical benefits were not seen in any of the studies. At least four different combinations and strains of probiotics have been used in the studies. There also existed significant heterogeneity in the methodology of the studies reviewed. It was concluded that current regimens of probiotics in the treatment of periodontal disease produce only short-term clinical and microbiologic benefits.

Effectiveness of a miswak extract‐containing toothpaste on gingival inflammation: a randomized clinical trial

In this study, the efficacy of a miswak extract-containing toothpaste (Salvadora persica) on gingival inflammation was compared with that of a herbal and a conventional toothpaste. Non-smoking outpatients with sulcus bleeding index (SBI) ≥25% and with periodontal pocket depths ≤3 mm were randomly selected and divided into three groups: M-group, miswak extract-containing toothpaste; P-group, herbal toothpaste; and C-group, conventional toothpaste. After instructing the patients to brush their teeth twice a day for 3 weeks with the assigned toothpaste using a flat-trimmed manual toothbrush, a thorough oral examination was performed by a calibrated examiner (EH). The primary outcome was the SBI after 21 days. Furthermore, the amount of plaque was measured by approximal plaque index (API). Sixty-six patients with a mean age of 57.8 ± 10.2 years were recruited and enrolled. After 3 weeks of brushing, all three patient groups showed a significant reduction in SBI. The P-group (SBI reduction: 17.1% ± 9.1) and the M-group (14.5% ± 8.1) showed the strongest effect followed by the C-group (9.4% ± 7.8). All three groups showed a significant reduction in API without significant differences between the groups. The use of each of the three tested toothpastes caused a significant reduction in gingival inflammation and amount of plaque. The miswak extract-containing toothpaste showed a similar effect as the herbal toothpaste and can be safely used for domestic oral hygiene in patients with gingivitis.

Primary prevention of periodontitis: managing gingivitis.

Periodontitis is a ubiquitous and irreversible inflammatory condition and represents a significant public health burden. Severe periodontitis affects over 11% of adults, is a major cause of tooth loss impacting negatively upon speech, nutrition, quality of life and self-esteem, and has systemic inflammatory consequences. Periodontitis is preventable and treatment leads to reduced rates of tooth loss and improved quality of life. However, successful treatment necessitates behaviour change in patients to address lifestyle risk factors (e.g. smoking) and, most importantly, to attain and sustain high standards of daily plaque removal, lifelong. While mechanical plaque removal remains the bedrock of successful periodontal disease management, in high-risk patients it appears that the critical threshold for plaque accumulation to trigger periodontitis is low, and such patients may benefit from adjunctive agents for primary prevention of periodontitis. The aims of this working group were to systematically review the evidence for primary prevention of periodontitis by preventing gingivitis via four approaches: 1) the efficacy of mechanical self-administered plaque control regimes; 2) the efficacy of self-administered inter-dental mechanical plaque control; 3) the efficacy of adjunctive chemical plaque control; and 4) anti-inflammatory (sole or adjunctive) approaches. Two meta-reviews (mechanical plaque removal) and two traditional systematic reviews (chemical plaque control/anti-inflammatory agents) formed the basis of this consensus. Data support the belief that professionally administered plaque control significantly improves gingival inflammation and lowers plaque scores, with someevidence that reinforcement of oral hygiene provides further benefit. Re-chargeable power toothbrushes provide small but statistically significant additional reductions in gingival inflammation and plaque levels. Flossing cannot be recommended other than for sites of gingival and periodontal health, where inter-dental brushes (IDBs) will not pass through the interproximal area without trauma. Otherwise, IDBs are the device of choice for interproximal plaque removal. Use of local or systemic anti-inflammatory agents in the management of gingivitis has no robust evidence base. We support the almost universal recommendations that all people should brush their teeth twice a day for at least 2min. with fluoridated dentifrice. Expert opinion is that for periodontitis patients 2min. is likely to be insufficient, especially when considering the need for additional use of inter-dental cleaning devices. In patients with gingivitis once daily inter-dental cleaning is recommended and the adjunctive use of chemical plaque control agents offers advantages in this group.

Impact of cigarette smoking on clinical outcomes of periodontal flap surgical procedures: a systematic review and meta-analysis.

Periodontal flap surgery is frequently used to remove subgingival deposits, yielding consequential reductions in gingival inflammation and probing depth (PD) with a gain in clinical attachment level (CAL) to treat advanced periodontal disease. However, clinical studies have reported diminished periodontal healing in smokers compared with non-smokers. The aim of the present systematic review and meta-analysis was to assess the impact of cigarette smoking on clinical outcomes following periodontal flap surgical procedures. A systematic electronic review of articles relevant to periodontal flap surgical procedures in smokers was conducted from 1977 to March 2014 inclusive, using predefined, optimized search strategies. Meta-analyses were done separately for changes in the two primary outcomes of PD and CAL. The initial search yielded 390 titles and abstracts. After screening, eight controlled clinical studies were finally selected. Three studies were assessed as having a low risk of bias, two as having moderate risk of bias, and three as having a high risk of bias. Qualitative assessment of the articles consistently showed an improved treatment effect among non-smokers versus smokers. The reduction in PD in smokers and non-smokers ranged from 0.76 to 2.05 mm and 1.27 to 2.40 mm, respectively. For CAL, the gain in non-smokers versus smokers ranged from 0.29 to 1.6 mm and 0.09 to 1.2 mm, respectively. Meta-analysis on eight studies reporting on 363 study participants demonstrated an increased reduction in mean (95% confidence interval) PD of 0.39 (0.33 to 0.45) mm. Similar results were found for mean gain in CAL (0.35 [0.30 to 0.40] mm, n = 4 studies). Considering the relatively homogenous information available, the authors conclude that active smokers could be candidates for periodontal flap surgical procedures. However, the magnitude of the therapeutic effect is compromised in smokers compared with non-smokers. Therefore, cigarette smokers should be: 1) encouraged to abstain from smoking; and 2) thoroughly informed preoperatively of substantial reduction in clinical outcomes compared with non-smokers.