Strict Plaque Control Research Articles

Use of an electric toothbrush in patients affected by autoimmune desquamative gingivitis: evaluation of biological parameters

Event Abstract Back to Event Use of an electric toothbrush in patients affected by autoimmune desquamative gingivitis: evaluation of biological parameters Giuli Antonucci1, Alessio Gambino1*, Paola Carcieri1, Marco Cabras1, Roberto Broccoletti1 and Paolo Giacomo Arduino1 1 University of Turin, Department of Surgical Sciences, Italy Aim. According to the current classification of periodontal diseases (classification of periodontal and peri-implant diseases and conditions 2017), desquamative gingivitis is included in "gingival disorders not induced by dental biofilm". The gums are usually erythematous, very sore, sometimes bleeding, with areas of atrophy, ulceration and / or presence of vesiculo-bullous lesions. It appears to be the gingival manifestation of different systemic conditions, such as oral disimmune diseases, but also as consequence of drug-induced injuries or allergic reactions to chemicals and food. Oral lichen planus (OLP), pemphigus vulgaris (PV), and mucous membranes pemphigoid (PMM) account for between 88 and 98% of total cases. The desquamative gingivitis treatment’s goal is to control the progression of the lesions and to reduce symptoms perceived, although a complete recovery may be quite difficult. The pharmacological treatment should be accompanied by a strict plaque control with home and professional proper oral hygiene procedures. This study aims to evaluate the effectiveness of the Oral-B Smart 4 electric toothbrush in association with the "Sensitive Clean" head and the "Sensitive Teeth" mode for home oral hygiene in patients with desquamative gingivitis. The study was carried out through the estimation of periodontal biological parameters, concerning the development of the pathology and parameters related to the comfort perceived by the patient, comparing their previous use of a manual toothbrush. Materials and Methods. The propose protocol consisted of 5 appointments. In the initial appointment (T0), clinical parameters were recorded such as pocket depth, recessions, plaque index (FMPS) and bleeding index (FMBS) through the compilation of a periodontal charting; a complete photographic status was also performed, and the severity of the clinical signs evaluated with the use of the Desquamative Gingivitis Clinical Score (DGCS), the severity of pain with the use of the VAS scale, and the comfort with the use of the Oral Health Impact Profile. In the next appointment (T1), a week apart, the plaque index (PI) was recorded with the help of the Tri Plaque ID Gel plaque detector; in the meantime, a frontal photo was acquired and a professional oral hygiene session were performed. In this session, the patients were instructed to use the electric toothbrush. The two following appointments (T2 and T3), one month after T1, repeated the same steps of instruction and motivation of the T1. In the last two appointments (T4 and T5), two months after T2 and T3, the same indices evaluated during the first session were examined again. Results. Fourteen patients were recruited, with an average age of 65.85 years and with an average of 25 dental elements. In the sample, 7 patients had OLP, 4 had PMM and 3 had PV. The plaque and bleeding index showed a statistically significant reduction (p<0.05) between the first and last appointments, unlike the DGCS. Discussion. According to literature data, the electric toothbrush evaluated appeared to be a valid substitute for the manual toothbrush. Our work revealed statistically significant differences in terms of plaque reduction and bleeding, thus being in line with previous studies establishing a correlation between desquamative gingivitis and plaque-induced gingivitis. The DGCS index showed a susceptibility from T0 to T5 in almost all patients, with a worsening of clinical signs detected in patients with OLP, instead of those with PMM and PV. This result may be partly explained due to the sporadic usage of immunosuppressants in patients with symptomatic OLP, being instead a steady, although low-dosage, treatment among individuals with bullous disease. The main limitation of the present protocol is represented by the small size of the sample. However, such limit must be put in perspective, considering that the limited number of patients recruited is an inevitable consequence of the sample inclusion criteria, which had to be so strictly arranged in order to minimize the weight of a steady high-dosage corticosteroid therapy as confounding factor. Further studies will be needed to increase as much as possible the size of the sample, aiming to obtain the most applicable results for the population. Plaque and tartar control through a protocol that provides professional oral hygiene sessions and oral home health motivation plays a key role in the clinical management of these patients. Oral hygiene in patients with desquamative gingivitis for autoimmune diseases are able to provide long-term benefits from their gingival health, if the same patients have previously been through a drug therapy.

Interdisciplinary care of the periodontally compromised elderly patient

Aim: Patients with a compromised periodontal condition, multiple missing teeth and pathological migration of tooth may require an interdisciplinarymanagement. To demonstrate that combined periodontic-surgical-restorative-prosthodontic-orthodontic treatment can achieve an improved periodontal condition, masticatory function, esthetics, and occlusion. Materials and Methods: This report describes the case of a 55-year-old woman with severely compromised periodontal tissues, multiple missing teeth, and malocclusion. An interdisciplinary, periodontic-surgicalrestorative- prosthodontic-orthodontic approach with strict plaque control during treatment was carried out.Results: Clinical examination revealeda well-functioning dentition, natural inappearance and in a harmonious occlusion and periodontalstate of health.The treatment outcomes, includingthe periodontal condition and the orthodontic treatment, were stable at the age of 60 years.Conclusion: Successful functional and esthetic results were achieved by an interdisciplinary management.Bangladesh Journal of Medical Science Vol.17(1) 2018 p.161-168

Comments about the paper “Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial”

Comments about the paper “Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial”

Response to a letter to the Editor addressing the publication “Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial”

Response to a letter to the Editor addressing the publication “Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial”

Laser-Assisted Periodontal Management of Drug-Induced Gingival Overgrowth under General Anesthesia: A Viable Option

Gingival overgrowth/hyperplasia can be attributed to several causes, but drug-induced gingival overgrowth/hyperplasia arises secondarily to prolonged use of antihypertensive drugs, anticonvulsants and immunosuppressants. The management is complex in nature considering the multitude of factors involved such as substitution of drug strict plaque control along with excision of the tissue to be performed under local anesthesia as outpatient. In the recent times, the patient's psychological fear of the treatment with the use of surgical blade and multiple visits has developed the concept of single visit treatment under general anesthesia incorporating a laser as viable option. The present case highlights the new method of management of gingival overgrowth.

Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial

This randomized controlled clinical trial was carried out to assess the effect of comprehensive nonsurgical periodontal treatment and strict plaque control performed during pregnancy on the reduction of preterm and/or low birth weight rates (PTLBW). Three hundred and three women were randomly allocated to receive periodontal treatment either during pregnancy (n = 147, test group) or after delivery (n = 156, control group). During pregnancy, the control group received only one session of supragingival scaling and oral hygiene instruction. In contrast, the test group received comprehensive periodontal treatment including multiple sessions of scaling and root planing, oral hygiene instructions, and frequent maintenance visits. At baseline, periodontal inflammation was observed in approximately 50% of sites and attachment loss affected <15% of sites. Compared to controls, women in the test group had significant reductions in the percentage of sites with plaque (48.5% vs. 10.3%, p < 0.001), gingival bleeding (23.3% vs. 2.5%, p < 0.001), calculus (21.3% vs. 4.1%, p < 0.001), bleeding on probing (38.1% vs. 2.6%, p < 0.001) and probing depth ≥3 mm (19.97% vs. −2.45%, p < 0.001). No significant differences were observed between the groups in the occurrence of PT (11.7% vs. 9.1%, p = 0.57), LBW (5.6 % vs. 4.1%, p = 0.59), and PTLBW (4.15% vs. 2.60%, p = 0.53). Comprehensive periodontal treatment and strict plaque control significantly improved periodontal health; however, no reduction of PTLBW rates was observed. Thus, remaining periodontal inflammation posttreatment cannot explain the lack of effect of periodontal treatment on PTLBW. Clinical relevance This study demonstrated that periodontal diseases may be successfully treated during pregnancy. Our results do not support a potential beneficial effect of periodontal treatment on PTLBW.

Ortho-perio integrated approach in periodontally compromised patients

It is an undisputed fact that sound and strong periodontal health is a must in patients seeking orthodontic treatment. Does this mean that we are going to deny orthodontic treatment for those adults whose number is rising, more often secondary to periodontal deterioration and pathological migration of teeth resulting in aesthetic and functional problems? Need of the hour is to have an integrated approach where in periodontal treatment precedes orthodontic treatment to restore periodontal health. Orthodontic treatment should be performed under strict plaque control measures to place the teeth in a structurally balanced and functionally efficient position. Aim of this article is to familiarize the practicing clinicians both in the field of orthodontics and periodontics with current thoughts and successful clinical techniques used in the field of periodontology to regenerate lost periodontal structures. Furthermore, it aims to integrate such techniques into the orthodontic treatment of patients with severe bone loss.

Clinical and microbiological benefits of strict supragingival plaque control as part of the active phase of periodontal therapy

To compare the clinical and microbiological effects of scaling and root planing (SRP) alone or combined with mechanical [professional plaque control (PPC)] or chemical [chlorhexidine rinsing (CHX)] control of supragingival plaque in the treatment of chronic periodontitis. Sixty subjects were randomly assigned to receive SRP alone or combined with PPC (twice a week) or with CHX rinsing (twice a day). The adjunctive treatments began with SRP and were continued for 42 days. Clinical and microbiological examinations were performed at baseline, 2 and 6 months post-therapy. Subgingival plaque samples were analysed for 38 bacterial species by checkerboard DNA-DNA hybridization. The two test treatments were more effective in improving probing depth and clinical attachment level (CAL) than SRP alone, even in intermediate and deep sites. CAL gain was better maintained in the CHX group. The most beneficial microbiological changes were observed in CHX-treated subjects, who showed a significant reduction in the proportions of red and orange complexes, as well as an increase in the proportions of the host-compatible bacterial species. Strict plaque control performed during and after SRP improves periodontal treatment outcomes. The greatest microbiological and clinical benefits were observed with the use of CHX rinsing.

Non‐surgical periodontal treatment of cyclosporin A‐induced gingival overgrowth: immunohistochemical results

The present study was planned to analyze the effects of a 12-month non-surgical periodontal treatment on histologic and immunohistochemical features of cyclosporin A (CsA)-induced gingival overgrowth (GO). Gingival samples were collected from 21 liver transplant subjects exhibiting CsA-induced GO prior to, and 12 months after non-surgical periodontal therapy including oral hygiene instructions, scaling and 2-month recall appointments, and also from 18 healthy control subjects. Gingival biopsy specimens were stained with hematoxylin-eosin and monoclonal antibodies for vimentin, CD3 (T-lymphocytes), CD20 (B-lymphocytes), CD34 (endothelium) and Ki-67 (fibroblasts proliferation rate), using a streptavidin-biotin-peroxidase complex method. Total inflammatory cells, gingival vessels and fibroblast proliferation rate demonstrated significant reduction after non-surgical periodontal treatment (P < 0.0001) in overgrown gingiva, while B- and T-lymphocytes remained nearly unchanged (P = 0.61 and 0.33, respectively). At the 12-month evaluation no significant differences were found when comparing the gingival biopsies from CsA-treated patients and those from healthy controls (P > 0.05). Control of clinical inflammation by means of non-surgical periodontal treatment results both in lowering of inflammatory infiltrate and in changes in connective tissue composition. Thus, plaque-induced inflammation would seem to modulate the drug-gingival tissue interaction. A strict plaque control program play a pivotal role in the management of transplant patients exhibiting cyclosporin A-GO.

はたして歯周病患者にはどのような補綴方法が有効か？―Ｐａｒｔ ２：歯周病患者に対するＲＰＤ・ＦＰＤ治療の文献Ｒｅｖｉｅｗと臨床的示唆（ＲＰＤ ｖｓ．ＦＰＤ ｖｓ．Ｉｍｐｌａｎｔ）―

To review the clinical literature on fixed partial denture (FPD) and removable partial denture (RPD)treatment for periodontally compromised patients with partial dentate. In addition, prosthodontic management in periodontitis-susceptible subjects was evaluated from the results of Part 1 and Part 2. Clinical studies that documented survival rates of FPD in periodontally compromised patients were selected and reviewed. There was no RPD study that fulfilled the criteria of this review paper. On the other hand, 8 reports that were reviewed in this study showed good survival rate of FPD in long-term clinical results. Since the number of reports on RPD is very few, it was difficult to evaluate the RPD treatment for periodontally compromised patients. From the results of some long-term follow-up retrospective studies, however, it was suggested that FPD of high-risk design showed excellent results. Regarding management in periodontits- susceptible subjects, it should be discussed whether positive prosthodontic treatment is necessary. Strict plaque control by both doctors and patients before/after treatment is indispensable for prosthodontic management in periodontally compromised patients.

Immediate effect of instrumentation on the subgingival microflora in deep inflamed pockets under strict plaque control

To investigate (1) reduction in the number of microorganisms obtained directly after subgingival instrumentation, (2) rate of bacterial re-colonization during 2 weeks, under supragingival plaque-free conditions. Effects of subgingival instrumentation were measured at one deep pocket in 22 patients (11 smokers and 11 non-smokers). Immediately after initial therapy, experimental sites, under strict plaque control, were instrumented subgingivally. Microbiological evaluation was performed at pre-instrumentation, immediate post-instrumentation and 1 and 2 weeks post-instrumentation. Mean total anaerobic colony forming units (CFUs) dropped from 3.9 x 10(6) before to 0.09 x 10(6) immediately following instrumentation. Significant reductions were found for Tannerella forsythia, Micromonas micros, Fusobacterium nucleatum and spirochetes. Significant reductions were not observed for Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Campylobacter rectus. Except for spirochetes, no reduction in prevalence of specific periodontal bacteria was found immediately after instrumentation. During follow-up, mean total CFU tended to increase. Prevalence of periodontal bacteria further reduced. No effect of smoking was found. Results indicate that subgingival mechanical cleaning in itself, has a limited effect, in actually removing bacteria. The subsequent reduction in prevalence of specific periodontal bacteria shows that it is apparently difficult for these species to survive in treated pockets.

Treatment of interproximal angular defects by guided tissue regeneration: 1 year follow‐up

SUMMARY The periodontal regeneration of interproximal bone defects of the posterior teeth produced by guided tissue regeneration (GTR), with expanded Polytetrafluoroethylene barrier membranes and conventional therapy, was clinically evaluated in 20 intrabony periodontal defects in 10 patients. The material included the presence of at least two proximal angular lesions for the same patient, probing pocket depth ≥ 6 mm, bone defect depth ≥ 3 mm, and 2‐wall defects with crestal involvement relative to the tooth circumference ranging from 90 to 270°. Healing was clinically evaluated by surgical re‐entry of GTR‐treated sites (10 sites) and debridement only sites (10 sites) 1 year after initial surgery following a strict plaque control regimen. A significant correlation was observed between probing depth reduction, attachment gain and defect depth (test sites); there was increased bone fill in GTR‐treated lesions of 2.95 ± 1.3 mm corresponding to a 69.4% improvement compared to control sites, and 1–3 ± 1.0 mm corresponding to a 32% improvement (P &lt; 0.0039). The results demonstrated that bone regeneration is highly reliable, as compared to conventional therapy, in cases of severe periodontal bone loss from posterior teeth provided that the principles of GTR are applied.

Periodontal regeneration of human infrabony defects. II. Re-entry procedures and bone measures.

This paper evaluates the osseous healing response of 40 infrabony defects treated with guided tissue regeneration. The selected sites presented with deep periodontal lesions with a 1-, 2-, and 3-wall combination infrabony component of 6.1 +/- 2.5 mm. Baseline intrasurgical clinical measurements were compared with intrasurgical clinical measurements obtained at the 1 year surgical re-entry. A significant regeneration of bone of 4.3 +/- 2.5 mm was observed, along with a 0.4 +/- 1.9 mm resorption of the alveolar bone crest, which resulted in a 4.7 mm reduction of the original infrabony defect. Almost 90% of the sites showed a bone gain of 2 mm or more, while no site lost supporting bone; 73 +/- 31.2% of the original defect was filled with bone. The 3- and 2-wall components were filled 95 +/- 6.2% and 82 +/- 18.7% of their original depth, respectively; however, the 1-wall component was filled only 39 +/- 62.4%. It is concluded that treatment of infrabony defects according to the principles of guided tissue regeneration and a strict plaque control regimen resulted in clinically significant and highly predictable bone regeneration.

Periodontal regeneration of human infrabony defects. I. Clinical measures.

A series of investigations was undertaken to evaluate the extent and predictability of periodontal regeneration with barrier membranes in deep infrabony defects. This study reports the clinical outcomes in terms of probing attachment level (PAL) gains, probing pocket depth (PPD) reduction, and recession (REC) of marginal gingiva. Forty deep 1, 2, and 3-wall combination infrabony defects treated with membranes were evaluated 1 year postoperatively following a strict plaque control regimen (mean plaque score = 6.1%, bleeding score = 4% at 1 year). A PAL gain of 6.1 +/- 2.5 mm along with a PPD reduction of 5.9 +/- 2.5 mm were observed. A PAL gain of 2 mm or more was detected in almost 90% of the treated sites. No site lost attachment. Residual PPD was 3 mm or shallower in 95% of the sites. It is concluded that treatment of deep infrabony defects according to the principles of guided tissue regeneration and a strict plaque control regimen represents an efficacious and predictable treatment alternative.