Simplified Debris Index Research Articles

Oral health status and oral habits: A study on 33 rare diseases

Objectives: To analyze the patient profile and characterize the oral health status, oral habits, and daily oral hygiene difficulties of individuals with rare diseases. Methods: Data were collected from records of the clinic for people with disabilities at the Faculdade de Medicina Dentária da Universidade de Lisboa, using the Decayed, Missing, and Filled Teeth index, the simplified debris index, and the bleeding index. Results: The sample comprised 64 individuals with 33 different rare diseases, with a mean age of 31.5(±10.29) years, predominantly male (54.7%). Most could move without difficulty (51.6%), required assistance in activities of daily living (60.9%), and were cooperative in oral hygiene (54.7%). Also, 40.6% could not communicate. Half of the sample brushed their teeth twice a day, with 18.8% being independent in this activity, and the most common toothbrushing difficulty was not being able to rinse (53.1%). The Decayed, Missing, and Filled Teeth index was 8.81 (±7.54), with a higher number of filled teeth (4.47; ±5.35). The bleeding index had a mean of 1.23 (±0.56), and the simplified debris index had a mean value of 1.62 (±0.78). Conclusions: The population studied expresses care for oral health and treatment.

Reliability of smartphone images to assess plaque score among preschool children: a pilot study.

This study assessed the reliability of smartphone images of plaque-disclosed anterior teeth for evaluating plaque scores among preschool children. Additionally, the reliability of plaque scores recorded from smartphone images of anterior teeth in representing the overall clinical plaque score was also assessed. Fifteen preschool children were recruited for this pilot study. The Simplified Debris Index (DI-S), the debris component of the Simplified Oral Hygiene Index, was used to record the plaque score. A plaque-disclosing tablet was used to disclose the plaque before the plaque score recording. Following that, the image of the anterior teeth (canine to canine) of both the upper and lower arch was captured using the smartphone. Each child had three different DI-S recorded. For the first recording of the overall clinical DI-S, the plaque score was recorded clinically from index teeth 55 (buccal), 51 (labial), 65 (buccal), 71 (labial), 75 (lingual) and 85 (lingual). For the second recording, anterior clinical DI-S, the plaque score was recorded clinically from the labial surfaces of six anterior teeth only (53, 51, 63, 73, 71 and 83). Two weeks later, anterior photographic DI-S (third recording) was done using the smartphone images of the same index teeth used for the second recording. The intra-class correlation coefficient (ICC) was calculated to evaluate the reliability of smartphone images in assessing plaque scores. The results showed high reliability (ICC = 0.987) between anterior clinical and anterior photographic examinations, indicating that smartphone images are highly reliable for evaluating plaque scores. Similarly, high reliability (ICC = 0.981) was also found for comparison between overall clinical DI-S and anterior photographic DI-S, indicating plaque scores recorded from smartphone images of anterior teeth alone can represent the overall clinical plaque score. This study suggests that smartphone images can be a valuable tool for remote screening and monitoring of oral hygiene in preschool children, contributing to better oral health outcomes.

Differences in Periodontal Parameters, Serum Vitamin D, Calcium, Phosphorus, Alkaline Phosphatase and C-Reactive Protein Between Perimenopausal and Postmenopausal Women with Periodontitis

Objective: The study aimed to evaluate and compare the differences in periodontal and biochemical parameters between perimenopausal and postmenopausal women with periodontitis. 
 Methods: A cross-sectional study was conducted on 100 women with chronic periodontitis, aged 40-60 years, divided into 50 perimenopausal and 50 postmenopausal groups. Periodontal parameters (plaque index PI, gingival index GI, gingival bleeding index GBI, simplified debris index DI-S, simplified calculus index CI-S, simplified oral hygiene index OHI-S, clinical attachment loss CAL, and pocket depth PD) and blood samples were collected to estimate vitamin D, calcium Ca, phosphorous P, alkaline phosphatase ALP and C-reactive protein CRP. 
 Results: The mean values of clinical periodontal parameters were significantly higher in the postmenopausal group as compared to the perimenopausal group (P<0.05), except for CI-S (P>0.05). For the biochemical parameters, the mean serum level of AlP, Ca, and P were within the normal reference ranges, with non-significant differences reported between both groups regarding ALP and P (P>0.05). While serum Vit.D level was more significantly reduced in the postmenopausal group (P<0.05), and CRP levels were increased in both groups, but with non-significant differences (P>0.05). 
 Conclusions: Postmenopause could more significantly affect the progression & severity of periodontal disease and vitamin D deficiency than peri menopause due to reducing circulating estrogen level.

Designing and Evaluation of an Elective Oral Health Course for Fifth-Year Medical Students of Tehran University of Medical Sciences.

Objectives: This study aimed to evaluate the effect of an educational intervention on oral health-related knowledge, attitude, and practice of medical students. Materials and Methods: This study was performed on the fifth-year medical students attending an elective oral health course at the Faculty of Dentistry of Tehran University (intervention group) and 25 other students attending another elective course (control group) in 2018. A 2-week internship program including 6 sessions of a workshop program plus 2 days of school field and 2 days of attending dental departments was designed for the intervention group. Before and after the intervention, students completed a questionnaire and their simplified debris index was calculated. Statistical analysis was performed using SPSS version 24 by paired-sample t-test and general linear regression. Results: The mean age of the participants was 24.84±1.31 years in the intervention group and 23.64±1.28 years in the control group. There were 14 (56%) males in the intervention group and 16 (64%) males in the control group. At baseline, the mean knowledge, attitude and practice scores of the control and intervention groups were 26.28, 14.20 and 10.88, and 27.84, 15.80, and 9.36, respectively. After the intervention, the knowledge, attitude, debris index and willingness to adhere to oral health measures significantly improved (P<0.05). Conclusion: Oral health-related knowledge, attitude and practice of medical students were not desirable at baseline. The present study showed that even a short-term intervention in this field was effective to improve the oral health concepts in this group.

Oral Health Status of Middle School Students in Jeddah

Objective: Outreach activities are one of the essential components of dental education that would help the students understand the community's oral health needs. The study aimed to engage dental undergraduate students in measuring their oral health status using four dental indices among middle school students. Subjects and Methods: The study was conducted as a part of an oral health education program in two public schools in Jeddah. Consent was obtained from both school students and parents. Two calibrated examiners measured the dental status using Ramfjord's calculus index, decayed, missing, and filled teeth (DMFT) index, simplified debris index, and modified gingival index. An independent statistician did data analysis using SPSS ver 23. Results: Male students showed statistically significant higher scores for debris index, calculus index, and gingival index compared to female students (P &lt; 0.001). The mean D and M component DMFT indices were significantly higher in female students (P &lt; 0.001). Conclusions: The variations in oral health status between students can be attributed to differences in oral hygiene practices and other sociodemographic factors, including ethnicity and socioeconomic status. This study showed a positive learning experience for dental students in assessing the oral health status of schoolchildren.

Evolution of oral status in adults with intellectual and developmental disabilities: a longitudinal study

This longitudinal retrospective study aimed to assess oral status of people with intellectual and developmental disabilities and analyse the influence of attendance to oral hygiene appointments on oral status over a 10-year period. Clinical oral assessment at first and last visit used the Decayed, Missing and Filled Permanent Teeth Index, the Simplified Debris Index, and the Gingival Index. The sample included 58 participants that visited for at least 10-year period a dental school clinic in Lisbon, with intellectual disability (55.2%), cerebral palsy (31.0%) and trisomy 21 (13.8%). During the study period the Decayed Teeth Index increased from 5.72 (±5.63) to 8.91 (±6.72) (p < 0.001), 59.3% of the participants lost at least one tooth, with a mean tooth loss of 1.78 (±2.15), which was not different between disabilities. The number of annual visits had a positive impact on Gingival Index (p = 0.002). Coming less than one annual visit resulted in 1.21 (CI = 0.52–2.44; p = 0.802) times greater risk of losing at least one tooth. Regular oral hygiene visits had a positive impact on improving and maintaining oral health.

Are social stories beneficial for oral health promotion in preschool children with special healthcare needs?

Design A 24-month randomised, two-armed, double-blinded, parallel controlled trial.Methods Participants were recruited from educational centres for children with special healthcare needs (SHCN) aged 2-6 years. Out of the 37 special needs schools in Hong Kong, 19 were randomly selected, of which 16 met the inclusion criteria. Further exclusions occurred if the child was absent, no consent was signed or if they did not meet the inclusion criteria. All participants received standardised tooth brushing instructions. The test group were given validated social stories, while the control group utilised standard leaflets issued by the Department of Health. The resources were used both in education centre sessions in three phases and at home by parents. The oral health-related behaviours were assessed before and after interventions as well as dmft index. Caries was assessed via dmft at baseline and phase 3 (at 24 months). The severity of existing caries was assessed using the International Caries Detection and Assessment System. If existing carious lesions progressed from one stage to a more advanced stage, it was defined as progression. At baseline and each of the three follow-up visits, oral hygiene and gingival health were assessed using the modified gingival index and simplified debris index. Oral health behaviours assessed included tooth brushing performance (assessed by number of tooth brushing steps and duration/frequency), between-meal snacking (assessed by frequency) and dental visit experience (assessed as favourable if the child attended at least annual visits). It was then determined if these behaviours had improved. Data analysis utilised generalised estimating equations, negative binomial regression and binary logistic regression. Kappa statistics were used to test intra-examiner reliability on 10% of randomly selected participants.Results There was no significant difference in caries experience between the two groups after 24 months. The results suggest children in the test group displayed improved tooth brushing performance, better oral hygiene and more frequent dentist visits. Children from higher socioeconomic backgrounds also showed better oral hygiene compared to those from lower socioeconomic backgrounds.Conclusions Social stories may be useful resources to improve oral health-related behaviours in children with SHCN.

Oral hygiene and periodontal condition of 12- and 15-year-old Greek adolescents. Socio-behavioural risk indicators, self- rated oral health and changes in 10 years.

To investigate oral hygiene and periodontal status of 12- and 15-year-old Greek adolescents in relation to socio- demographic and behavioural indicators and identify national trends. In a stratified cluster sample of 2,478 participants, the Simplified Debris Index (DI-S) and the Community Periodontal Index (CPI) were calculated. Socio- demographic/behavioural data were collected through structured questionnaires. Multivariate ordinary regression examined the effect of socio-behavioural indicators on oral hygiene and periodontal conditions. 51.7% of the 12-year-olds and 56.9% of the 15- year-olds had fair and good oral hygiene, respectively. Approximately 30% of the adolescents had healthy periodontium. Bleeding on probing was detected in 23.6% and 21.6% of the 12- and the 15-year-olds, accordingly. Calculus was found in 46.2% and 44.3% of the 12- and the 15-year-old groups, correspondingly. The prevalence of periodontal pockets ?4mm was 3.2%. Significantly higher DI-S scores were found among 12-year-olds who were males, had lower educated mothers or did not use dental floss and among adolescents who brushed their teeth <twice/day. Inferior periodontal status was found among 15-year-olds who were males, 12-year- olds with lower educated mothers, who did not brush or brushed infrequently, and among subjects who did not floss. Poor self-rated oral health was significantly related to adverse oral hygiene and periodontal health outcomes. Oral hygiene and periodontal status of Greek adolescents improved moderately in ten years. Periodontal health promotion strategies should target vulnerable sub- groups of adolescents to reduce future periodontal burden. Self-rated oral health may be useful for identifying unmet periodontal treatment needs.

Factors Affecting Future Caries Occurrence Among Preschoolers in Northern Guangdong: A Longitudinal Study.

PurposeThis study aimed to investigate the new development of caries among preschoolers in northern Guangdong and to assess caries-related factors to distinguish groups with different caries risk levels.MethodsBaseline data were recorded for participants from September to November 2019, and participants were reexamined from September to November 2020. A longitudinal observation of 11,973 preschoolers was conducted. The simplified debris index (DI-S) and decayed-missing-filled tooth (dmft) index values were obtained for each participant.ResultsFactors associated with whether caries would occur in the future and one-year increase in dmft (Δdmft) included baseline dmft, baseline DI-S, and baseline age. The risk ratio (RR) of caries occurrence and the number of teeth with new-onset caries were 4.482 (95% confidence interval, 4.056–4.957) and 2.945 (2.742–3.165) in the participants with baseline dmft ≥3, which were higher than those with baseline dmft =1 or 2. In the baseline caries-free group, whether caries would occur in the future was related to the baseline DI-S (95% confidence interval, 0.022–0.062). The caries incidence of maxillary central incisors (27.9%) was the highest among teeth of preschoolers without caries at baseline, whereas the caries incidence of mandibular first deciduous molars (42.7%) was the highest among teeth of preschoolers with caries at baseline.ConclusionBaseline dmft is a good predictor of future caries. Children with baseline caries-free status, baseline dmft >0, and baseline dmft ≥3 should be treated with preventive interventions of different intensities and frequencies. The occurrence of future caries in baseline caries-free participants is related to oral hygiene status. Measures to prevent caries on smooth surfaces, such as topical fluoridation, should be applied to all preschoolers. Preschoolers with caries at baseline may be given priority for pit and fissure sealing.

Oral Health Status among Adult Employees in Kuwait.

To determine the oral health status among adult employees in Kuwait. This cross-sectional study was performed on a convenience sample (n = 1294) of adult employees. Their ages ranged from 19 to 77 years (mean 36.2). Six trained and calibrated dentists examined them using a mouth mirror and a WHO ball-tip probe. Caries was scored using WHO diagnostic criteria. The debris index simplified (DI-S) score was used to assess oral hygiene status. Overall, the mean DMFT in the adults was 10.3. The DMFT increased from 7.8 for the age group 19-24 years to 10.7 at 35-44 years and 18.9 at 65-77 years (p < 0.001). Females had slightly higher caries experience (DMFT) (11.0) than did males (10.1) (p = 0.021), and Kuwaitis (11.1) more than non-Kuwaitis (8.9) (p < 0.001). The proportion of caries-free adults was 28%. In multivariate analysis, adults with poor oral hygiene (OR=1.5; 95% CI=1.2-2.1), those with an intermediate-school (grades 6 to 9) or lower level of education (OR=2.6; 95% CI=1.4-4.7), Kuwaitis (OR=1.3; 95% CI=1.0-1.7), those with oral pain (OR=1.4; 95% CI=1.0-1.8), and those needing urgent dental care (OR=4.6; 95% CI=2.6-8.0) were statistically significantly associated with caries risk. About 19.6% of these adults had good, 36.1% fair and 44.4% had poor oral hygiene. Nearly one-third (32.9%) of adults had perceived oral pain at the time of examination. Implementing oral health programs is needed and efforts should be made to promote oral hygiene practices in workplaces among adults in Kuwait.

Halitosis and Associated Risk Factors in Children: A Cross-sectional Study

To investigate risk factors associated with halitosis in children using OralChroma™. Sixty-seven children between the ages of 3 and 8 who attended a pre-general anesthesia assessment at the Dental University Hospital at King Saud University, Riyadh, Saudi Arabia, were enrolled in this study after satisfying the inclusion criteria. Demographic data, medical history, and oral hygiene practices were obtained by a standardized questionnaire completed by the parents of each child. Clinical dental examination was conducted to record the following: caries index (dmft/DMFT), simplified debris index (DI-S), modified gingival index (MGI), and Winkel tongue coating index (WTCI). Clinical halitosis was assessed using the OralChroma™ device that measures the concentration of volatile sulfur compounds (VSCs) including hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and dimethyl sulfide (CH3SCH3). Statistics were completed using Spearman's correlation coefficient and Mann-Whitney U-test to assess the association with the VSC scores with continuous and binary variables, respectively. Then, multivariate linear regression analysis was performed to detect the degree of association. High VSC measures were detected in 58 children (87%). The dmft/DMFT was significantly associated with H2S level (β = 26.84, p = 0.034) and CH3SH level (β = 19.96, p = 0.016) after controlling possible confounders. There was no significant association of DI-S, MGI, and WTCI with the VSC measures. The result suggested that dmft/DMFT score (children's caries experience) is associated significantly with high levels of H2S and CH3SH in the sample studied. Caries experience in children is a significant risk factor for halitosis and should be considered during the management of halitosis.

Evaluation of periodontal indices in young adults submitted to chlorhexidine 0.12% mouthwash: a randomized clinical trial

Abstract Introduction Gingivitis is a gingival inflammation which can often be treated with oral hygiene such as brushing, flossing, and an antiseptic mouthwash. Objective The aim of this randomized clinical trial was to clinically evaluate the effectiveness of 0.12% chlorhexidine (CHX) solution as an anti-inflammatory agent and for reducing the presence of plaque and inflammation in young adults. Material and method Thirty patients with gingivitis aged 18 to 30 years with a probing depth ≤ 3 mm and a minimum of 20 teeth in the whole mouth were selected and evaluated at baseline and 30 days after treatment. Periodontal clinical parameters were verified: plaque index (PI), gingival index (GI), Simplified Oral Hygiene Index (OHI-S), Simplified Debris Index (DI-S), and Simplified Calculus Index (CI-S) Patients were then randomly allocated into two groups: CHX Group, received chlorhexidine 0.12% labeled as solution 1, and Placebo Group, received saline solution labeled as solution 2. Both groups were included in a hygiene program and received mouthwash. Result Statistically significant differences between CHX and Placebo groups were observed for the variables PI, GI, DI-S, CI-S, and OHI-S (p&lt;0.05 - Paired T Test) after 30 days. The CHX group presented improved GI compared to Placebo at 30 days. Chlorhexidine 0.12% was efficient in the control of periodontium inflammation. Conclusion It can be concluded that chlorhexidine as a mouthwash is efficient in improving periodontal indices in young adults, but it is still controversial whether age can influence GI and OHI-S.

Poor oral hygiene and dental caries predict high mortality rate in hemodialysis: a 3-year cohort study

The aim of this study was to investigate the impact of oral hygiene, periodontal diseases, and dental caries on all-cause mortality in hemodialysis. This prospective cohort study included 266 patients with end-stage renal disease who were undergoing hemodialysis. Medical interviews, blood biochemical tests, and comprehensive dental examinations including periodontal pocket examination on all teeth and dental plaque accumulation by debris index-simplified (DI-S), were performed. Survival rates were assessed at a 3-year follow-up. Overall, 207 patients were included in the longitudinal analysis, and 38 subjects died during the follow-up period. Cox proportional hazards analysis of the multivariate model demonstrated that the highest tertile of DI-S had a significantly higher risk of all-cause mortality than the lowest two tertiles after adjustment for age, sex, smoking habit, body mass index, diabetes, prior cardiovascular disease, hemodialysis vintage, high sensitivity C-reactive protein, albumin, and number of remaining teeth (hazard ratio, 3.04; 95% confidence interval, 1.50–6.17; p = 0.002). Moreover, the number of decayed teeth significantly increased the hazard ratio to 1.21 (95% confidence interval, 1.06.1.37; p = 0.003). This study suggests that accumulated dental plaque and untreated decay, but not periodontal disease, may be independently associated with all-cause mortality in patients undergoing hemodialysis.

Oral Health and Related Behavior of Children Aged 9–12 with Attention Deficit Hyperactivity Disorder in Tron District, Thailand

Attention deficit hyperactivity disorder (ADHD) is a common biobehavioral childhood disorder that leads to significant behavioral problems that affect everyday life. Objective: This study aimed to compare oral health and oral health behaviors among children with and without ADHD. Methods: The study included 105 children aged 9–12 years with ADHD and 105 age-, gender-, and family income-matched children without ADHD. Clinical data as caries, periodontal health, and traumatic dental injuries were recorded by calibrated examiners. All parents of the children completed questionnaires about the oral health behaviors of their children by a single interview. Data were compared using Chi-square test, McNemar test, and Paired t-test at the significance level of 0.05. Results: The children with ADHD had significantly lower tooth brushing frequency and shorter tooth brushing duration compared with the children without ADHD. The two groups had equivalent dental trauma prevalence (1.9%). Compared with the children without ADHD, the children with ADHD had significantly more decayed, missing, and filled teeth (3.24±2.14 vs. 2.25±2.23). Therefore, 11.4% of the children in the ADHD group were caries free compared with the 30.5% in the non-ADHD group. The children with ADHD had 3.9 times the odds of prevalence dental caries than the children without ADHD. The children with ADHD had significantly higher Simplified Debris Index and Simplified Calculus Index values than the children without ADHD. Conclusion: Children with ADHD exhibited a higher prevalence of caries and periodontal problems than children without ADHD.

The Adverse Impact of Thalassemia Major on Adolescents' Oral Health-related Quality of Life.

Adolescents with beta-thalassemia major (βTM) had unfavorable quality of life (QOL). To assess oral health status of adolescents with βTM and its impact on their oral health-related QOL (OHRQoL). Forty adolescents with βTM were recruited and compared with 40 age-matched and sex-matched healthy adolescents. Intraoral examination including dental caries assessment, oral hygiene index simplified (OHI-S), and Angle classification were performed. OHRQoL questionnaires were filled-out using child perception questionnaire-short form16. Although the majority of adolescents with βTM had dental problems and convinced by their need for dental treatment, nearly half of them never brushed their teeth nor visited dental office. Patients showed higher frequency of class II malocclusion (P=0.017) and higher percentage of poor simplified debris index (DI-S) and OHI-S grade (P=0.008, 0.037, respectively). The median of DI-S and OHI-S were significantly higher in adolescents with βTM (P=0.009, 0.037, respectively). Adolescents with βTM had worse emotional well-being total score (P=0.049) than controls. Patients with poor oral hygiene had the worse total OHRQoL score (P=0.03). The total OHRQoL score showed significant positive correlation with oral hygiene; DI-S, calculus index-S, and OHI-S (P=0.028, 0.038, and 0.045, respectively). βTM had a negative impact on the emotional well-being aspect.

Improvement of oral function and hygiene in Parkinson's disease: A randomised controlled clinical trial.

Parkinson's disease (PD) is a progressive neurodegenerative disorder. It is associated with reduced oral health and impaired oro-facial function, but besides recommendations of dental visits and drooling treatment, there are little documented odontological treatment options. To evaluate the effect of standardised home exercise jaw opening and chewing programmes, as well as home oral hygiene measures instructed and controlled by a trained dentist. Twenty-nine patients (median 65years) with moderate to advanced PD participated in the project after informed consent. They were followed at a Neurology Department, were able to cooperate, and had stable medical treatment and nine also deep brain stimulation. The interventions were individual dental hygiene instruction, training of jaw opening (JawTrainer), and lip and chewing exercises (Ulmer Oral Screen and Proxident Fluoride Gum). The study was performed as a randomised controlled study. The treatment effect was evaluated after 2 and 4months. The primary outcome was maximum unassisted jaw opening capacity, chewing time of a standardised apple slice, and the Simplified Debris Index. Results were analysed with Wilcoxon matched pairs test and Mann-Whitney U test (significance level P<.05). Jaw opening, chewing time and hygiene were significantly improved 2months from the start of the invention, respectively, 6%, 49%, and 25%, and the improvement was still significant after 4months. No significant changes were found after the 2-month control period without intervention. The simple measures had a substantial and significant clinical effect which is promising despite the progressive nature of the PD.

Do Parenting Styles Affect Children's Oral Health in Saudi Arabia?

ObjectiveThe purpose of the study is to correlate the parenting styles of parents with the oral health of their children, in Riyadh, Saudi Arabia.Study designTwo hundred and eighty healthy preschool children, who have never been to the dentist, were recruited. Parenting style was determined by the Parenting Style and Dimensions Questionnaire (PSDQ). World Health Organization (WHO) criteria and simplified debris index (DI-S) were used for the diagnosis of dental caries and oral hygiene of the children respectively.ResultsTwo parenting styles were identified among Saudi parents; authoritative (94%, n = 265) and permissive (6%, n = 17). The majority of children were brushing by themselves (n = 130, 46.1%) and once per day (n = 163, 57.8%). Significant correlations were detected between parenting style and children’s brushing times (P-value of 0.016) and the number of meals consumed by children (P-value of 0.031). The age of the child and oral hygiene score were significantly correlated to dental caries (P-value < 0.05).ConclusionTwo parenting styles were identified among Saudi parents. Parenting style influenced the child’s oral health but not significantly. Early childhood caries and fair to poor oral hygiene were commonly detected among children. Clinically interesting correlations were identified regarding factors affecting the child’s oral health status.

The impact of 0.2% chlorhexidine gel on oral health and the incidence of pneumonia amongst adults with profound complex neurodisability.

Investigate the effect of toothbrushing with 0.2% chlorhexidine gel on oral health and pneumonia amongst patients with a neurodisability who are fed via percutaneous endoscopic gastrostomy. Forty-nine patients at the Royal Hospital for Neuro-disability were recruited to an observational study. Daily toothbrushing with 0.2% chlorhexidine gel was undertaken for 12 months by trained nursing staff. Plaque and gingival health were assessed every six weeks using the Simplified Debris Index and the Basic Periodontal Examination. The annual incidence and prevalence of episodes of pneumonia experienced by patients whilst using the chlorhexidine gel were compared to rates from the previous year. Plaque levels and the proportion of patients with periodontal pocketing>3.5mm significantly reduced, P<.001, with chlorhexidine toothbrushing. Total number of pneumonia episodes (75-67), antibiotics administered (73-64), and radiographs taken (19 to 16) were lower in the year wherein chlorhexidine was employed, and hospitalisations dropped by 31% (16-11), but these reductions were not statistically significant. No adverse events were reported. Daily toothbrushing with 0.2% chlorhexidine undertaken by a trained and supported nursing staff was effective in improving oral health but did not significantly affect annual rates of pneumonia amongst patients.

Expression of matrix metalloproteinase-3 in patients with reheumatoid arthritis and its correlation with chronic periodontitis and rheumatoid arthritis

Objective: To detect the expression of matrix metalloproteinase-3 (MMP-3) in serum and gingival crevicular fluid in patients with rheumatoid arthritis (RA) and its correlation with chronic periodontitis (CP). Methods: From March 2017 to July 2018, 26 patients with RA and CP [CP+RA group, (54.9±6.5) years old, 4 males and 22 females], 22 patients with RA only [RA group, (49.6±11.7) years old,5 males and 17 females] in the Department of Rheumatology and Immunology, Shengjing Hospital Affiliated to China Medical University, 22 patients with simple CP in the Department of Stomatology, Shengjing Hospital Affiliated to China Medical University [CP group, (51.4±12.5) years old, 8 males and 14 females] and 18 generally healthy controls in Physical Examination Center of Shengjing Hospital Affiliated to China Medical University [group H, (49.4±9.1) years old, 8 males and 10 females] were recruited. There were no significant differences in age and sex ratio amongst 4 groups. Patient's general status, probing depth (PD) , clinical attachment loss (CAL), sulcus bleeding index (SBI), simplified calculus index (CI-S) and simplified debris index (DI-S) were recorded in 4 groups. Samples of serum and gingival crevicular fluid were collected from patients of each group, and the expression levels of MMP-3 in serum and gingival crevicular fluid samples were detected by using enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate, rheumatoid factor, anti-cyclic citrulline peptide antibody and C-reactive protein were detected in the serum of subjects in RA group and CP+RA group. Correlation analysis was conducted between MMP-3 expression level and periodontal indices amongst 4 groups. The results were statistically analyzed using the SPSS 20.0 software package. Results: The indices of CAL [(4.12±1.13) mm], SBI (2.58±0.64) and DI-S (2.65±0.69) in CP+RA group were significantly higher than indices of CAL [(3.00±0.00) mm], SBI (2.59±1.05) and DI-S, (2.36±0.49) in CP group (P<0.05); The expression levels of MMP-3 in serum samples of CP+RA group [(1 1645.6±6 903.4) μg/L] and CP group [(9 337.0±6 719.0) μg/L] were significantly higher than that of RA group [(2 389.9±1 320.3) μg/L] and H group [(1 493.5±292.1) μg/L] (P<0.05). The expression level of MMP-3 in gingival crevicular fluid samples of CP+RA group [(164.4±45.3) μg/L] was significantly higher than that of CP group [(84.6±92.5) μg/L], RA group [(49.0±18.1) μg/L] and H group [(20.4±6.3) μg/L] (P<0.05), respectively. The erythrocyte sedimentation rate, rheumatoid factor and anti-cyclic cirullinated peptide antibodies levels in the CP+RA group were significantly higher than those in the RA group (P<0.05). The expression level of MMP-3 in serum is positively correlated with PD (r=0.45, P=0.04) and the expression level of MMP-3 in gingival crevicular fluid is positively correlated with CAL (r=0.58, P<0.01). Conclusions: The levels of MMP-3 in serum and gingival crevicular fluid of patients with RA and CP were significantly increased. MMP-3 may be associated with the development of CP and RA.

Effectiveness of musical toothbrush on oral debris and gingival bleeding among 6-10-year-old children: A randomized controlled trial.

Motivation serves to be an integral part of health promotion to children at the learning phase of their life. Evaluation of the effectiveness of musical toothbrush over regular toothbrush in the debris and gingival bleeding scores among children. This was a single-blinded parallel, randomized controlled trial conducted among 6-10-year-old schoolchildren in Chennai. One hundred participants with allocation ratio of 1:1 were assigned to musical and regular toothbrush group by simple randomization. After baseline evaluation (T0) of Debris Index-Simplified (DI-S) and Gingival Bleeding Index (GBI), outcome variables were assessed for a period of 3 months (T1, T2, and T3). Friedman test and Mann-Whitney statistical test were used to compare the outcome variables within and across the two groups. Thirty-two boys and 68 girls (mean age: 8.53 years) participated in the study. Statistically significant difference was seen in DI-S score among musical toothbrush group (mean: 0.50 [T3] and GBI score: 8.18% [T3]) when compared to regular toothbrush group (mean: 1.59 [T3] and GBI score: 23.54 [T3]) at the end of the 3rd month. Although both the musical and regular toothbrushes effectively reduced the DI-S and GBI scores, former showed effective change among children when compared to the latter.