Supragingival Plaque Removal Research Articles

Preventive oral healthcare for children: towards appropriate care

In recent decades, oral healthcare has shifted from curation to prevention. Preventive oral healthcare for children consists mainly of oral health education to improve health behaviors and clinical prevention such as fissure sealants, application of fluoride varnish, removal of supragingival plaque and dental polishing. In addition, the periodic clinical examination is an important preventive instrument. These 5 preventive interventions for children up to 12 years of age can be discussed using the principles of 'appropriate care'. Appropriate care is an approach of the Dutch government to ensure the accessibility, quality and affordability of care in the Netherlands. Central to the approach are the effectiveness, efficiency and patient-centeredness of care. This article describes to what extent preventive oral healthcare meets these principles based on literature, care consumption data and recommendations from the clinical guidelines 'Oral care for children: prevention and treatment of dental caries' and the 'Advice on Caries Prevention' by the Ivory Cross, a Dutch scientific association for oral health. Appropriate oral healthcare is best served by care that is tailored to both the individual oral disease burden of the patient and their risk of disease as well as to the wishes of the patient.

The use of an ultrasonic device in periodontal practice in elderly and senile people

The majority of periodontal visits in dental care to the population are made up of patients in the elderly age group (according to the WHO classification, these include persons 60–74 years old). Features of periodontal treatment of elderly people require a new approach to standard treatment regimens. In recent years, treatment with the «Vector» device (Dürr Dental, Germany) has found widespread use in periodontal consultations. The purpose of the study is to determine the volume of periodontal care for the elderly population in the State Medical Institution of the RO «SP» in Rostov-on-Don in dynamics from 2020 to 2022 using the «Vector» device. Results of the study: periodontal doctors performed ultrasonic removal of supragingival and subgingival dental plaque in the area of one tooth (using the Vector apparatus) in 2020, 1825 services, and in 2022 2562, which is 737 services more than in 2020, At the same time, 1241 services were performed for elderly people in 2020, and in 2022 there were 552 more services.Conclusion: the use of the «Vector» device in addition to traditional treatment regimens for chronic generalized periodontitis in elderly patients accelerates periodontal recovery time.

Randomised methodology development study to investigate plaque removal efficacy of manual toothbrushes

ObjectivesThis study aimed to evaluate plaque removal efficacy of toothbrushes to guide clinical model development. MethodsThis single-centre, randomised, controlled, examiner-blind, method development study included 80 healthy participants. Over 28 days, participants brushed twice-daily using a fluoride toothpaste and one of four marketed toothbrushes: Toothbrushes A (compact head) and B (regular head): medium-hard; flat trim; end-rounded bristles; Toothbrush C: medium-hard; end-rounded bristles; silky, tapered filaments; compact head; Toothbrush D: soft; tapered filaments; compact head. Supra-gingival plaque removal was evaluated immediately after single brushing events (Days 0, 7, 28, at study centre) and following 7- and 28-days’ home use via Rustogi modified Navy Plaque Index (RPI) and Turesky modified Quigley Hein Plaque Index (TPI). ResultsAll toothbrushes provided significant plaque removal after single-brushing events with change from Day 0 pre-brushing scores on RPI ranging from -0.10 to -0.16 (p<.0001) and on TPI ranging from -0.61 to -0.89 (p<.0001). Toothbrushes A and B showed significant (p<.05) pre-brushing RPI/TPI plaque reductions after 7- (-0.04/-0.06, respectively for RPI; -0.16/-0.20, respectively for TPI) and 28-days (-0.04/-0.03, respectively for RPI; -0.20/-0.11, respectively for TPI) use versus Day 0 pre-brushing (except Toothbrush B, Day 28, non-significant TPI). There were no significant differences with Toothbrush C. Toothbrush D TPI was significantly lower at both timepoints versus Day 0 pre-brushing (p<.05). Study toothbrushes were generally well-tolerated. ConclusionThe observations from this study showed how various aspects of a study design could impact toothbrushes performance. These data will inform the design of future clinical studies of plaque removal efficacy using manual toothbrushes. Clinical Significance StatementRegular effective oral hygiene can help prevent and treat gingivitis, principally via twice-daily mechanical cleaning with a toothbrush. Data generated from this methodology development study will help to identify the key aspects which impact toothbrushes’ performance and understand which one would be more suitable to answer questions of scientific interest. This study provides useful information for the design of future clinical trials to assess plaque removal efficacy of manual toothbrushes and generate results to inform clinical recommendations.

Investigation of the Presence of SARS-CoV-2 in Aerosol After Dental Treatment

AimsThe objective of the present study was to investigate the presence of SARS-CoV-2 in aerosol and COVID-19 contamination distance asssociated with ultrasonic scaling and tooth preparation.MethodsTwenty-four patients with COVID-19 were included in this study. Removal of supragingival plaque with ultrasonic instruments for 10 minutes and high-speed air-turbine using for the simulation of cutting the maxillary right canine tooth with a round diamond bur for 5 minutes were performed. Patients were randomly assigned to 2 groups: In group A, medium-volume suction was used during treatment. In group B, high-volume suction with an aerosol cannula was added to medium-volume suction. Prior to treatment, 5 glass petri dishes containing viral transport medium were placed in the operating room. After treatment, petri dishes were immediately delivered to a microbiology laboratory for real-time polymerase chain reaction (RT-PCR) analysis.ResultsRT-PCR test results were negative for all specimens in group B. However, 5 positive test results for COVID-19 were detected in group A specimens.ConclusionsSuction with an aerosol cannula is very important to prevent COVID-19 viral contamination via aerosol. In addition, a high-volume suction capacity (air volume) of 150 mm Hg or 325 L/min is sufficient for elimination of viral contamination. Thus, high-volume suction should be used during dental treatments in COVID-19 patients.

Can Porphyromonas gingivalis Contribute to Alzheimer's Disease Already at the Stage of Gingivitis?

Alzheimer’s disease (AD) has been associated with periodontitis, which starts as gingivitis. Similar to periodontitis, gingivitis bacteria, bacterial products, and inflammatory mediators can travel to the brain via the blood stream and promote brain inflammation. Periodontal pathogens such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, both associated with AD, have been found in dental plaque of children already at the age of 3. It is suggested that these bacteria during long-term exposure may drive microglia (brain resident macrophage cells) into a pro-inflammatory M1 phase where they contribute to AD rather than protect against it. This notion comes from studies in mice showing that microglia actually can “remember” previous inflammatory challenge and become “trained” or “tolerant” to toxins like lipopolysaccharide. If gingivitis has an impact on AD, which should be verified, AD prophylaxis should start already at this pre-periodontitis stage with removal of supragingival plaque.

Comparative Efficacy of Regular and Musical Toothbrush in Supragingival Plaque Removal in Children - A Randomized Clinical Trial

Comparative Efficacy of Regular and Musical Toothbrush in Supragingival Plaque Removal in Children - A Randomized Clinical Trial

Efficacy of two soft-bristle toothbrushes in plaque removal. A randomized controlled trial

The aim of the present examiner-blind randomized controlled clinical study was to compare the efficacy two soft-bristle toothbrushes in terms of plaque removal. Seventy volunteers were randomly allocated to Group A (tapered-tip toothbrush) or Group B (end-rounded toothbrush). At baseline appointment (Day 0), volunteers underwent plaque examination using the Improved Plaque Identification Index. Under supervision, they brushed their teeth for 1 minute with their assigned toothbrushes and the plaque examination was repeated. Volunteers continued the oral hygiene regimen (assigned toothbrush and a regular dentifrice provided by the researchers) for 7 days. The experimental procedures of Day 0 were then repeated. Separate statistical analyses were performed for mean percent reduction of plaque in the whole-mouth, interproximal and gumline scores at both times, using Mann-Whitney test, p0.05). In conclusion, on Day 0, Group A presented higher efficacy in supragingival plaque removal than Group B, as reflected by whole-mouth, gumline and interproximal plaque scores.

Repeated delivery of chlorhexidine chips for the treatment of peri‐implantitis: A multicenter, randomized, comparative clinical trial

Peri-implantitis is a challenging condition to manage and is frequently treated using non-surgical debridement. The local delivery of antimicrobial agents has demonstrated benefit in mild to moderate cases of peri-implantitis. This study compared the safety and efficacy of chlorhexidine gluconate 2.5mg chip (CHX chips) as an adjunctive treatment to subgingival debridement in patients afflicted with peri-implantitis. A multicenter, randomized, single-blind, two-arm, parallel Phase-3 study was conducted. Peri-implantitis patients with implant pocket depths (IPD) of 5-8mm underwent subgingival implant surface debridement followed by repeated bi-weekly supragingival plaque removal and chlorhexidine chips application (ChxC group) for 12weeks, or similar therapy but without application of ChxC (control group). All patients were followed for 24weeks. Plaque and gingival indices were measured at every visit whereas IPD, recession, and bleeding on probing were assessed at 8, 12, 16, 24week. A total of 290 patients were included: 146 in the ChxC group and 144 in the control. At 24weeks, a significant reduction in IPD (P=0.01) was measured in the ChxC group (1.76 ± 1.13mm) compared with the control group (1.54 ± 1.13mm). IPD reduction of ≥2mm was found in 59% and 47.2% of the implants in the ChxC and control groups, respectively (P=0.03). Changes in gingival recession (0.29 ± 0.68mm versus 0.15 ± 0.55mm, P=0.015) and relative attachment gain (1.47 ± 1.32mm and 1.39 ± 1.27mm, P=0.0017) were significantly larger in the ChxC group. Patients in the ChxC group that were<65 years exhibited significantly better responses (P<0.02); likewise, non-smokers had similarly better response (P<0.02). Both protocols were well tolerated, and no severe treatment-related adverse events were recorded throughout the study. Patients with peri-implantitis that were treated with an intensive treatment protocol of bi-weekly supragingival plaque removal and local application of chlorhexidine chips had greater mean IPD reduction and greater percentile of sites with IPD reduction of ≥2mm as compared with bi-weekly supra-gingival plaque removal.

CBD-supplemented Polishing Powder Enhances Tooth Polishing by Inhibiting Dental Plaque Bacteria.

ABSTRACTObjective:Air polishing is a safe tooth polishing technique used by dental professionals for stain and plaque removal and as a preventive procedure for dental health. We previously reported the antibacterial properties of cannabinoids against dental plaque bacteria. The objective of this study was to analyze the possibilities to improvise the existing air-polishing technique by supplementing cannabinoid powder into the classic polishing powder for effective removal of supragingival and subgingival plaque and for inhibition of plaque-forming bacteria.Materials and Methods:The cannabidiol (CBD) powder was added to the tooth polishing powder (AIR-N-GO, classic) at a 1% (wt/wt) ratio. The study was conducted on 12 patients, of whom six received regular polishing treatment and six received CBD-supplemented polishing treatment. The dental plaque samples were collected before and after each treatment and subjected to in vitro microbiological analysis, and the colony forming units (CFU) were analyzed by using an automated colony counter.Results:Based on in vitro microbiological analysis, the average CFU of interdental space samples collected from post-CBD-supplemented polishing treatment was significantly reduced (linear fold change between 3.9 and 18.4) compared with that of postregular polishing (linear fold change between 1.0 and 2.6) treatment.Conclusions:The CBD-supplemented polishing powder can help in effective removal and killing of dental plaque bacteria during the polishing treatment; it can also be added as an enhancing supplement to the existing polishing powders.

Distinct signatures of dental plaque metabolic byproducts dictated by periodontal inflammatory status

Onset of chronic periodontitis is associated with an aberrant polymicrobial community, termed dysbiosis. Findings regarding its etiology obtained using high-throughput sequencing technique suggested that dysbiosis holds a conserved metabolic signature as an emergent property. The purpose of this study was to identify robust biomarkers for periodontal inflammation severity. Furthermore, we investigated disease-associated metabolic signatures of periodontal microbiota using a salivary metabolomics approach. Whole saliva samples were obtained from adult subjects before and after removal of supragingival plaque (debridement). Periodontal inflamed surface area (PISA) was employed as an indicator of periodontal inflammatory status. Based on multivariate analyses using pre-debridement salivary metabolomics data, we found that metabolites associated with higher PISA included cadaverine and hydrocinnamate, while uric acid and ethanolamine were associated with lower PISA. Next, we focused on dental plaque metabolic byproducts by selecting salivary metabolites significantly decreased following debridement. Metabolite set enrichment analysis revealed that polyamine metabolism, arginine and proline metabolism, butyric acid metabolism, and lysine degradation were distinctive metabolic signatures of dental plaque in the high PISA group, which may be related to the metabolic signatures of disease-associated communities. Collectively, our findings identified potential biomarkers of periodontal inflammatory status and also provide insight into metabolic signatures of dysbiotic communities.

Prediction of Periodontal Inflammation via Metabolic Profiling of Saliva

Periodontal disease is characterized by chronic inflammation in subgingival areas, where a vast array of inflammation-associated metabolites are likely produced from tissue breakdown, increased vascular permeability, and microbial metabolism and then eventually show a steady flow into saliva. Thus, prolonged periodontal inflammation is a key feature of disease activity. Although salivary metabolomics has drawn attention for its potential use in diagnosis of periodontal disease, few authors have used that to investigate periodontal inflammation detection. In this pilot study, the authors explored the use of salivary metabolites to reflect periodontal inflammation severity with a recently proposed parameter—periodontal inflamed surface area (PISA)—used to quantify the periodontal inflammatory burden of individual patients with high accuracy. Following PISA determination, whole saliva samples were collected from 19 subjects before and after removal of supragingival plaque and calculus (debridement) with an ultrasonic scaler to assess the influence of the procedure on salivary metabolic profiles. Metabolic profiling of saliva was performed with gas chromatography coupled to time-of-flight mass spectrometry, followed by multivariate regression analysis with orthogonal projections to latent structures (OPLS) to investigate the relationship between PISA and salivary metabolic profiles. Sixty-three metabolites were identified. OPLS analysis showed that postdebridement saliva provided a more refined model for prediction of PISA than did predebridement samples, which indicated that debridement may improve detection of metabolites eluted from subgingival areas in saliva, thus more accurately reflecting the pathophysiology of periodontitis. Based on the variable importance in the projection values obtained via OPLS, 8 metabolites were identified as potential indicators of periodontal inflammation, of which the combination of cadaverine, 5-oxoproline, and histidine yielded satisfactory accuracy (area under the curve = 0.881) for diagnosis of periodontitis. The authors’ findings identified potential biomarkers that may be useful for reflecting the severity of periodontal inflammation as part of monitoring disease activity in periodontitis patients.

A comparative evaluation of plaque-removing efficacy of air polishing and rubber-cup, bristle brush with paste polishing on oral hygiene status: A clinical study.

Objectives:Over the years, professional dental prophylaxis has involved the use of rubber-cup, bristle brush, and abrasive paste for coronal polishing. Although air polishing is an excellent alternative for removal of tooth stain and dental plaque, very few studies have compared their efficacy in vivo. The present study attempts to evaluate and compare the efficacy of air polishing (test) alone versus rubber-cup polishing (control).Materials and Methods:A total of 35 individuals having generalized mild to moderate gingivitis were enrolled as the study population after obtaining their informed consent. Before commencement of the study, all subjects underwent scaling to remove calculus deposits (if any), following which the ipsilateral quadrant of the patient's mouth was randomly assigned as the test side and the contralateral quadrant of the same arch was assigned as the control side for polishing procedures. Time employed for both methods of polishing was held constant at 5 min for each technique. Subjects were assessed before and immediately after polishing and again after 15 days following treatment, for plaque and gingival status along with gingival bleeding.Results:Overall, the results of the intra-group comparison of both the polishing procedure sites indicated similar but significant plaque and gingival status changes, whereas the inter-group comparison showed no significant difference between the efficacies of both the groups.Conclusions:Air polishing and the rubber-cup, bristle brush with paste polishing demonstrated equivalent efficacy regarding removal of supragingival plaque and in reducing gingival inflammation.

Efficacy versus health risks: An in vitro evaluation of power-driven scalers.

Background:Power-driven instrumentation of root surfaces during supportive periodontal therapy is an alternative to hand instrumentation. The purpose of this pilot in vitro study was to investigate the efficacy of sub- and supragingival plaque removal with a sonic (AIR: Synea, W and H, Bürmoos, Austria) and two ultrasonic devices (TIG: Tigon+, W and H, Bürmoos, Austria; VEC: Vector, Dürr, Bietigheim-Bissingen, Germany) as well as the health-risk for dental professionals during treatment.Materials and Methods:The power-driven devices were utilized to remove plaque from model teeth in dummy heads. The percentage of residual artificial plaque after 2 min of supra- or subgingival instrumentation was calculated by means of image-processing techniques at four sites (n = 576) of each tooth. The Health-Risk-Index (HRI: spatter/residual plaque quotient) with the different power-driven devices was assessed during treatment.Results:The smallest amounts of residual plaque were found for the sonic device AIR (8.89% ± 10.92%) and the ultrasonic scaler TIG (8.72% ± 12.02%) (P = 0.707). Significantly more plaque was remained after the use of the ultrasonic scaler VEC (18.76% ± 18.07%) (P < 0.001). Irrespectively of the scaler, efficacy was similar sub- (10.7% ± 11.6%) and supragingivally (13.5% ± 17.2%) (P = 0.901). AIR/TIG demonstrated equal residual amounts of plaque sub- (P = 0.831) as well as supragingivally (P = 0.510). However, AIR/VEC and TIG/VEC were significantly in favor of AIR and TIG (P < 0.001). In contrast, the lowest HRI was found after using VEC (0.0043) and differed considerably for AIR (0.2812) and TIG (0.0287).Conclusion:Sonic devices are as effective as ultrasonic devices in the removal of biofilm but bear a higher risk to the dental professional's health concerning the formation of spatter.

Routine Prophylaxes Every 3 Months Improves Chronic Periodontitis Status in Type 2 Diabetes

Periodontitis and type 2 diabetes mellitus (T2DM) are major health problems, especially in low-income populations with little access to dental care. Low-cost models for treatment of periodontal disease have not been tested in controlled studies in low-income populations. Dental prophylaxis, which includes removal of supragingival calculus and plaque, has been shown to arrest the progression of periodontitis. A controlled clinical trial was conducted to determine the effect of dental prophylaxis on periodontitis in T2DM. Twenty-six patients with T2DM and chronic periodontitis (CP) and 26 without T2DM with CP were selected. Periodontal probing depth (PD), gingival bleeding on probing (BOP), clinical attachment level (CAL), and surfaces with plaque were recorded at baseline and 3, 6, and 9 months after initial treatment. All the participants received instructions on oral hygiene and one session of dental prophylaxis at baseline and every 3 months. Glycated hemoglobin (HbA1c) levels were measured at baseline and every 3 months in patients with T2DM. A significant improvement of PD, BOP, and sites with plaque was observed 3 months after treatment in patients with T2DM (P = 0.001). In controls, mean PD significantly improved after 6 months compared with baseline (P = 0.001). No significant improvement of CAL occurred in either group. No significant differences in periodontal parameters between the groups were detected, and no participant showed progression of CP during the 9-month study period. Dental prophylaxis did not influence HbA1c levels, and no association among HbA1c concentration, pretreatment metabolic status, and severity of CP was found. Routine prophylaxes every 3 months significantly improve periodontal health and prevent progression of CP in both poorly controlled and well-controlled patients with T2DM.

Periodontal Vaccine—A Boon In Periodontics

Periodontal disease though is multifactorial it is thought to be caused by group of gram negative anaerobic bacteria resulting in destruction of periodontal ligament and alveolar bone. The current treatment of periodontitis is non specific and is centered on removal of supragingival and subgingival plaque by mechanical debridement and surgical procedures. Due to its high prevalence rate this disease has created an innovative interest to find a solution in the form of vaccine. The search for periodontal vaccine revolves around the antigenic factors of the periodontal pathogens. The objective of periodontal vaccine is to identify the antigens involved in the destructive process of periodontitis against which antibodies would be evoked to exert protection. It also aims to induce mucosal antibody response with little or moderate doses of vaccine. Till date no preventive modality exists for periodontal disease and treatment rendered is palliative. Thus availability of periodontal vaccine would not only prevent and modulate periodontal disease but also enhance the quality of life for whom periodontal treatment cannot be easily obtained.

Oral prophylaxis and its effects on halitosis‐associated and inflammatory parameters in patients with chronic periodontitis

A controlled clinical trial was conducted to evaluate the effects of oral prophylaxis on halitosis-associated, immunological and microbiological parameters. Thirty subjects were included in this controlled clinical trial (patients with generalized chronic periodontitis and controls without clinical attachment loss; each n = 15). Before oral prophylaxis and 14 days after (including tongue cleaning) volatile sulphur compounds (VSC), organoleptic scores and a tongue coating index were evaluated. The levels of IL-1β, IL-8, IL-10 and MMP-8 were measured in GCF, and also major periodontal pathogens were detected. Data were statistically analysed using anova and paired t-test. Supragingival plaque and calculus removal with combined tongue cleaning was able to reduce significantly (P < 0.05) the VSC values in both groups (no significant differences between both groups). Two weeks after periodontal debridement, the VSC values were observed in the periodontitis group, but not in the control group, similar to the baseline values. The difference between the groups was statistically significant (P < 0.05). Only a repeated prophylaxis session in the periodontitis group was able to reduce VSC values significantly in comparison with baseline (P < 0.05). Organoleptic scores (10 and 30 cm) were significantly different (P < 0.05) between both groups before and after the treatment. Periodontal pathogens and host-derived markers were not significantly affected by a single prophylaxis session. Oral prophylaxis may result in a significant decrease in VSC values. However, in periodontal diseases, a more complex treatment seems to be necessary.

Supragingival plaque removal with and without dentifrice: a randomized controlled clinical trial

The aim of this study was to compare the efficacy of dental plaque removal by brushing with and without conventional dentifrice. Twenty-four students aged 17 to 28 years participated in this randomized controlled clinical trial. Quadrants 1-3 or 2-4 were randomly allocated to the test group (brushing without dentifrice) or control group (brushing with dentifrice). After 72 h of cessation of oral hygiene, Quigley & Hein (Turesky) plaque index was assessed before and after brushing by a calibrated and blind examiner. Overtime and intergroup comparisons were performed by Student's paired sample t-test at 5% significance level. The results showed that both groups after toothbrushing presented statistically significant reductions in plaque, with no differences between them (from 3.06 ± 0.54 to 1.27 ± 0.26 versus from 3.07 ± 0.52 to 1.31 ± 0.23). A separate analysis of the buccal and lingual aspects also showed no significant differences between groups. It may be concluded that the use of a conventional dentifrice during toothbrushing does not seem to enhance plaque removal capacity.

Periodontal treatment effects on endothelial function and cardiovascular disease biomarkers in subjects with chronic periodontitis: protocol for a randomized clinical trial

BackgroundPeriodontal disease (PD) is an infectious clinical entity characterized by the destruction of supporting tissues of the teeth as the result of a chronic inflammatory response in a susceptible host. It has been proposed that PD as subclinical infection may contribute to the etiology and to the pathogenesis of several systemic diseases including Atherosclerosis. A number of epidemiological studies link periodontal disease/edentulism as independent risk factor for acute myocardial infarction, peripheral vascular disease, and cerebrovascular disease. Moreover, new randomized controlled clinical trials have shown an improvement on cardiovascular surrogate markers (endothelial function, sICAM, hsPCR level, fibrinogen) after periodontal treatment. Nonetheless, such trials are still limited in terms of external validity, periodontal treatment strategies, CONSORT-based design and results consistency/extrapolation. The current study is designed to evaluate if periodontal treatment with scaling and root planning plus local delivered chlorhexidine improves endothelial function and other biomarkers of cardiovascular disease in subjects with moderate to severe periodontitis.Methods/DesignThis randomized, single-blind clinical trial will be performed at two health centers and will include two periodontal treatment strategies. After medical/periodontal screening, a baseline endothelium-dependent brachial artery flow-mediated dilatation (FMD) and other systemic surrogate markers will be obtained from all recruited subjects. Patients then will be randomized to receive either supragingival/subgingival plaque cleaning and calculus removal plus chlorhexidine (treatment group) or supragingival plaque removal only (control group). A second and third FMD will be obtained after 24 hours and 12 weeks in both treatment arms. Each group will consist of 49 patients (n = 98) and all patients will be followed-up for secondary outcomes and will be monitored through a coordinating center. The primary outcomes are FMD differences baseline, 24 hours and 3 months after treatment. The secondary outcomes are differences in C-reactive protein (hs-CRP), glucose serum levels, blood lipid profile, and HOMA index.DiscussionThis RCT is expected to provide more evidence on the effects of different periodontal treatment modalities on FMD values, as well as to correlate such findings with different surrogate markers of systemic inflammation with cardiovascular effects.Trial registration numberClinicalTrials.gov Identifier: NCT00681564.

Effects of ultrasonic, electric, and manual toothbrushes on subgingival plaque composition in orthodontically banded molars

Orthodontic appliances hinder mechanical plaque control. In this study, we evaluated the effect of self-performed supragingival plaque removal with ultrasonic, electric, and manual toothbrushes on subgingival plaque composition in orthodontically banded molars. Twenty-one patients wearing fixed orthodontic appliances were assigned to this single-blind crossover study. Samples of subgingival plaque were collected from banded molars, before and after each toothbrush usage period, for quantification of 22 bacterial species by the checkerboard DNA-DNA hybridization method. For each crossover, patients used a toothbrush for 30 days, followed by a washout period of 14 days. The prevalence of Tannerella forsythia decreased significantly after a month of electric brush usage. In the manual brush group, the prevalences of Selenomonas noxia, Streptococcus sanguinis, and Prevotella melaninogenica also decreased significantly. However, there were no significant differences in the prevalences and levels of bacteria after usage of the ultrasonic brush. Intergroup comparisons showed no statistical differences among the 3 brushes for the microbiologic parameters. All 3 brushes generally reduced bacterial prevalences, and, although electric and manual toothbrushes showed some isolated significant variations, we found no superiority with any toothbrush type when used three times daily for 2 minutes on microbiologic parameters in orthodontically banded molars.

Periodontal Therapy Reduces the Rate of Preterm Low Birth Weight in Women With Pregnancy-Associated Gingivitis.

One hypothesis to explain the association between periodontal disease (PD) preterm/low birth weight (PT/LBW) is that PT/LBW may be indirectly mediated through translocation of bacteria or bacterial products in the systemic circulation. Transient bacteremias occur in subjects with marginal periodontitis or with gingivitis, and it is possible that bacteria and their products may reach the placental membranes hematogenously and provide the inflammatory effect to induce preterm labor. The effect of gingivitis as a potential risk factor for PT/LBW has still not been studied. A randomized controlled trial was undertaken to determine the effect of routine plaque control and scaling on the pregnancy outcomes in women with gingivitis. Eight hundred seventy (870) pregnant women with gingivitis, aged 18 to 42, were enrolled while receiving prenatal care in Santiago, Chile. Women were randomly assigned in a two-to-one fashion to either a treatment group (N = 580), receiving periodontal treatment before 28 weeks of gestation or to a control group (N = 290), receiving periodontal treatment after delivery. Periodontal therapy consisted of plaque control, scaling, and daily rinsing with 0.12% clorhexidine. Maintenance therapy was provided every 2 to 3 weeks until delivery, and consisted of oral hygiene instruction and supragingival plaque removal by instrumentation, as needed. The primary outcomes assessed were delivery at less than 37 weeks of gestation or an infant weighing less than 2,500 g. Of the 870 women enrolled, 36 women (27 in the treatment group and nine in the control group) were excluded from the analyses for different reasons. The incidence of PT/LBW in the treatment group was 2.14% (12/560) and in the control group, 6.71% (19/283) (odds ratio [OR] 3.26; 95% confidence interval [CI] 1.56 to 6.83; P = 0.0009). Multivariate logistic regression analysis showed that, after adjusting for several known risk factors for PT/LBW, women with gingivitis were at a higher risk of PT/LBW than women who received periodontal treatment (OR 2.76; 95%CI 1.29 to 5.88; P = 0.008). Periodontal treatment significantly reduced the PT/LBW rate in this population of women with pregnancy-associated gingivitis. Within the limitions of this study, we conclude that gingivitis appears to be an independent risk factor for PT/LBW for this population.