Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances

Prophylaxis during multibracket appliance treatment - a survey among general dentists in Germany

BACKGROUND

Accomplishing good oral hygiene represents a major challenge during multibracket appliance (MBA) treatment. In Germany, children, and adolescents between 6 and 18 years of age can attend an individual prophylaxis (IP) program free of charge twice a year. As part of this, they undergo training and receive recommendations to enhance oral hygiene. However, it remains unclear whether the general dentist feels responsible for prophylaxis during MBA treatment and how they adapt the IP sessions compared to patients without fixed appliances.

AIM

To assess how general dentists manage IP in children and adolescents undergoing MBA treatment.

METHOD

A questionnaire was sent to 2744 general dental practices in the region of Hesse, Germany. Dentists were asked regarding their opinion on the responsibility for prophylaxis during MBA treatment, the oral hygiene recommendations given to those patients and how they adapt the prophylaxis sessions to special MBA needs.

RESULTS

The response rate was 37.0% (n = 1014). While only 8% of the respondents consider the orthodontist as primarily responsible for IP in MBA patients, the majority considers the general dentist (46%) or both, the general dentist and the orthodontist (46%) to be responsible for IP in MBA patients. The vast majority of respondents answered that compared to patients without fixed appliances, MBA patients receive different oral hygiene recommendations during IP sessions. These recommendations are mostly related to 1. a longer toothbrushing duration (> 3 min) and 2. the use of additional tools for mechanical plaque removal (interdental brushes).

CONCLUSION

The majority of respondents perceive the general dentist as having primary or shared responsibility for IP during MBA treatment and adapt oral hygiene recommendations to the special requirements. However, the large proportion of perceived shared responsibility also suggests considerable room for improvement. Furthermore, analysis showed a large range regarding oral hygiene recommendations, indicating the need for standardized clinical guidelines.

Orthodontic YouTube™ videos made by patients for patients: What are they about and are they accurate?

OBJECTIVES

To evaluate the characteristics and content of YouTube™ videos created by patients undergoing orthodontic fixed appliance treatment and to assess the content accuracy of these videos.

DESIGN

A mixed-methods quantitative and qualitative study.

DATA SOURCE

YouTube™ webpage.

METHODS

The term 'braces' was used to search for relevant videos on the YouTube™ webpage between 18 August and 30 August 2020, with no limits imposed regarding how long the video had been available on YouTube™. Videos were included if they were made by patients and were predominantly about patients' experiences during treatment with labial fixed appliances. The main themes/subthemes of the included videos were identified. A checklist was then developed to assess accuracy of the video content for two of the main themes and the videos were assessed against the checklist.

RESULTS

The video search identified 350 videos, of which 64 were selected as potentially eligible; 41 were subsequently excluded as they related primarily to the bond up/debond experience or had minimal information about orthodontics. This meant that 23 videos were ultimately included for analysis. Six main themes were identified in the videos: problems with fixed appliances, effects of fixed appliances, oral hygiene maintenance, dietary advice, treatment duration/appointment frequency and auxiliaries used with fixed appliances. From the 23 videos, 20 were assessed against the checklist for content accuracy related to two selected themes: oral hygiene maintenance and dietary advice. The majority of videos had low content accuracy scores, indicating that important and relevant content was generally missing.

CONCLUSION

Several included videos focused on oral hygiene maintenance and dietary advice associated with fixed appliances; however, the content was incomplete and not always accurate. This is concerning to the profession, and it is therefore recommended that clinicians consider collaborating with patients to produce videos that are patient-centred and that also contain accurate information.

Alleviation of Plaque and Gingivitis with Dental Water Jet in Regular and Orthodontic Patients: A Systematic Review and Meta-Analysis

Objectives: This review aimed to compare the effectiveness of using a dental water jet (WJ) to manual tooth brushing (MTB) alone or when combined with flossing (MTB + F) in improving plaque index (PI), bleeding index (BI), and gingival index (GI) in regular and orthodontic patients. Materials and Method: This review was registered with the PROSPERO registry (CRD42022296752). Three reviewers conducted a comprehensive search of MEDLINE, the Cochrane Library, and Google Scholar for studies published between 1990 and July 2022. Eligible studies were randomized clinical trials, excluding those involving peri-implantitis, patients with impaired manual dexterity, or powered brushes. The outcomes of interest (PI, BI, and GI) were measured across short-, intermediate-, and long-term periods. Results: Eighteen RCTs were included in this review. PI: in regular patients, use of a WJ showed no additional improvement over flossing, and the results were inconsistent when compared to MTB alone. For orthodontic patients, use of a WJ provided a slight improvement over flossing in the short term and MTB alone in the intermediate term. BI: use of a WJ demonstrated a slight improvement over flossing and MTB alone in both patient groups at different time points. GI: use of a WJ was comparable to flossing but showed slight benefits over MTB alone in the short term for regular patients and in the intermediate term for orthodontic patients. Conclusions: use of a WJ may provide slight benefits in BI and GI compared to flossing or MTB alone, especially for orthodontic patients. Clinical relevance: incorporating a WJ into the daily oral hygiene routine is recommended due to its potential benefits over brushing alone and its user-friendly alternative to flossing.

Efficacy of a water flosser compared to an interdental brush on gingival bleeding and gingival abrasion: A 4 week randomized controlled trial

AIM

To determine the efficacy of a water flosser (WF) compared to an interdental brush (IDB) in reducing gingival inflammation. Additionally, the products were compared on the incidence of gingival abrasion.

METHODS

Young adults with moderate gingivitis and ≥4 accessible interdental spaces by IDB in each quadrant were selected for this study. Participants were randomly assigned a WF or an IDB as an adjunct to manual toothbrushing. Clinical signs of inflammation were measured in two randomly assigned contralateral quadrants by bleeding on pocket probing (BOPP) or bleeding on marginal probing (BOMP). Gingival Abrasion Score (GAS) was assessed per quadrant. Data was recorded at the baseline, 2 weeks and 4 weeks.

RESULTS

Both groups WF (n = 40) and IDB (n = 38) showed a significant reduction (p = 0.000) in BOMP and BOPP from the baseline to 4 weeks for all sites and the interdental sites only. At 4 weeks the WF group compared to the IDB group showed significantly lower BOPP (p = 0.030) and BOMP scores (p = 0.003) for all sites. For the interdental sites WF showed compared to IDB for BOMP significant (p = 0.019) lower values but not for BOPP (p = 0.219). There were no differences between the groups for GAS at any time point.

CONCLUSION

In patients with moderate gingivitis, after 4 weeks use the WF is more effective than the IDB in obtaining marginal gingival health.

The effectiveness of oral irrigators on periodontal health status and oral hygiene of orthodontic patients: a systematic review and meta-analysis

BACKGROUND

An Oral irrigator, known as a dental waterjet (DWJ), is an adjunctive oral hygiene tool to remove dental plaque. The aim of this study was to systematically evaluate the effectiveness of oral irrigators on orthodontic patients' oral hygiene and periodontal status.

METHODS

A comprehensive search was undertaken in five electronic databases (PubMed, EMBASE, Web of Science, Scopus, and Cochrane) up to 1 May 2024. Clinical trials comparing DWJ with other adjunctive tools or no adjunctive in healthy orthodontic patients were included. The outcome was periodontal health condition measured by periodontal indexes. The risk of bias of the included studies was assessed using the Cochrane risk of bias tool. Random- effects meta- analyses of mean differences (MD) with their 95% confidence intervals (CI) were conducted and the overall quality of evidence was evaluated by GRADE approach.

RESULTS

Seven trials were included in the meta-analysis (Two with low, and others with unclear risk of bias). There was no statistically significant difference between automatic toothbrush (ATB) with DWJ and ATB alone in the gingival index (GI) (MD = 0.00; 95% CI -0.17- 0.18) (low quality of evidence). No statistically significant differences were found between (ATB + DWJ) and manual toothbrush (MTB) alone in the GI (MD= -0.11; 95% CI -0.31- 0.09) (very low quality of evidence). Also, no significant difference was detected between the two groups in the Plaque index (PI) (MD= -0.12; 95% CI -0.36- 0.11) (very low quality of evidence). There was no statistically significant difference between (MTB + DWJ) and MTB alone in the GI (MD= -0.06; 95% CI -0.16- 0.03) (very low quality of evidence). No statistically significant differences were revealed between the two groups in the PI (MD= -0.33; 95% CI -0.97- 0.32) (very low quality of evidence). No statistically significant improvements were found between these two groups in bleeding index (BI) (MD= -0.05; 95% CI - 0.12 - 0.01) (low quality of evidence).

CONCLUSIONS

Adding DWJ to either manual or automatic toothbrushes did not significantly enhance oral health of orthodontic patients. Orthodontists could recommend their patients to use either of these toothbrushes with or without DWJ. Further clinical trials are needed.

TRIAL REGISTRATION NUMBER

The protocol of this study was registered on PROSPERO with the ID # CRD42023465849.

An Evaluation of a New Ultrasonic Water Irrigator in the Management of Gingival Health: A Randomised Study

INTRODUCTION

This randomised, single-blind, controlled study aimed to compare daily adjunctive use of an ultrasonic water irrigation device to dental floss in controlling plaque and gingival inflammation in patients with gingivitis.

METHODS

Participants were randomly allocated to either daily use of an ultrasonic water irrigator or dental floss as an adjunct to manual toothbrushing for 4 weeks, with periodontal assessment repeated at 1 and 4 weeks after baseline (Rustogi Modified Navy Plaque Index [PI], Loe and Silness Gingival Index [GI] and bleeding on marginal probing [BOMP]).

RESULTS

Sixty-two participants completed the investigation. Statistically significant reductions in total and marginal PI at Weeks 1 and 4 were noted in both groups compared to baseline (p < 0.05) with no significant differences between groups. BOMP and GI scores were likewise significantly reduced in both groups at Weeks 1 and 4 compared to baseline (p < 0.01). However, at Week 4, those using the ultrasonic water irrigator showed a significantly greater reduction in GI scores when compared to the floss group (-0.35 ± 0.26 vs. -0.16 ± 0.25, respectively, p < 0.01) and a significantly greater reduction in BOMP scores when compared to floss (-0.26 ± 0.12 vs. -0.15 ± 0.15, respectively, p < 0.01). Those using the ultrasonic water irrigator also reported easier usage scores (p < 0.05) when compared to the floss group.

CONCLUSION

Daily use of the ultrasonic water irrigator resulted in significantly greater reductions in gingival inflammation (gingival index and BOMP) than dental floss after 4 weeks, whereas plaque removal was similarly effective using the irrigator or floss.

Cleansing efficacy of an oral irrigator with microburst technology in adolescent orthodontic patients. A randomized-controlled crossover study

OBJECTIVES

Simplifying interdental space cleaning is a constantly discussed topic. The present study aimed to compare the cleansing efficacy of an oral irrigator with that of dental flossing in adolescent patients with fixed braces after four weeks of home-use.

MATERIALS AND METHODS

The study design is a randomized, single-blinded cross-over study. Following a twenty-eight-day period of product utilization in a home setting, a comparative analysis was conducted on hygiene indices, the Rustogi Modified Navy Plaque Index (RMNPI) and the Gingival Bleeding Index (GBI), between the test group (oral irrigator) and the control group (dental floss).

RESULTS

Seventeen adolescent individuals completed the study. After 28 days of cleaning with the oral irrigator, RMNPI was 58.81% (55.31-66.47) compared to 59.46% (52.68-68.67) with dental floss (p = 0.070). Subgroup analyses did not indicate the superiority of either method. GBI after the test phase with the oral irrigator was 28.93% (23.21-33.97) and insignificantly higher compared to 26.40% (21.01-31.41) achieved with dental floss (p = 0.1585).

CONCLUSIONS

Neither of the two products demonstrated statistically significant superiority in terms of cleaning efficacy. Therefore, no recommendation can be made in favor of one over the other. It was found that the high initial hygiene indices for fixed orthodontic appliances could be improved through increased awareness and precise instruction.

CLINICAL RELEVANCE

For adolescent patients who struggle to use interdental brushes an oral irrigator may be suggested as a simple alternative in hard-to-reach areas, such as those around a fixed dental appliance.

The effectiveness of water jet flossing and interdental flossing for oral hygiene in orthodontic patients with fixed appliances: a randomized clinical trial

BACKGROUND

Orthodontic treatment presents challenges with plaque accumulation around brackets, archwires, and elastics, leading to retained plaque and gingival inflammation. Conventional toothbrushing may not be enough, requiring additional oral hygiene aids like interproximal brushes, dental flosses, and water flossers. Limited research exists on comparing water flossing and interdental flossing in orthodontic patients. Therefore, this study aims to assess their effectiveness in maintaining oral hygiene during active orthodontic treatment.

METHODS

A single-blind, randomized, parallel clinical study recruited orthodontic patients with full-mouth brackets and archwires. Thirty participants were randomly assigned to either water jet flossing or interdental flossing groups. All participants were instructed to brush twice daily with a provided toothbrush and toothpaste and use the assigned intervention once daily at night. Clinical measures, including the Gingival Bleeding Index (BI), Plaque Index (PI), and Gingival Index (GI), were recorded at baseline and day 14. Descriptive statistics and statistical tests were performed using SPSS software.

RESULTS

The water jet flossing group demonstrated a slightly higher, albeit non-significant, benefit in plaque removal (median difference of 6.79%%, P = 0.279) and bleeding reduction (median difference of 5.21%%, P = 0.172) compared to the interdental flossing group after two weeks. Both groups showed significant reductions in gingival bleeding index and plaque index from baseline to the 2-week follow-up. The interdental flossing group had median mean percentage differences of 16.13%% (plaque index) and 23.57% (gingival bleeding index), while the water jet flossing group had median percentage differences of 21.87% (plaque index) and 32.29% (gingival bleeding index). No significant changes in gingival index grades were observed in either group.

CONCLUSION

Both water jet flossing and interdental flossing were effective in reducing plaque accumulation and gingival bleeding among orthodontic patients. While no significant differences were found between the two methods, water jet flossing showed a potential advantage. Further research is needed to validate its effectiveness, assess long-term impact, and understand its benefits for orthodontic patients.

The effectiveness of dental water jet in reducing dental plaque and gingival bleeding in orthodontic patients: A systematic review and meta-analysis of randomized clinical trials

INTRODUCTION

This systematic review and meta-analysis tests the effectiveness of dental water jet (DWJ) with manual toothbrushes (MTB) compared to MTB alone in oral health maintenance in orthodontic patients.

METHODS

Four databases were systematically searched: PubMed, Scopus, Web of Science (WoS) and Cochrane Library until 6 January 2022 using a combination of medical subject heading (MeSH) terms and keywords. Randomized clinical trials (RCTs) were only included and critically appraised using the Cochrane Risk of Bias (ROB) tool. The mean difference (MD) effect measure was calculated using the Mantel-Haenszel statistical test (95% confidence interval [CI]) to compare both study groups (p-value < 0.05).

RESULTS

After reviewing 5881 studies from a systematic search, six were selected for inclusion, with four involved in the quantitative analysis. The risk of bias was low in two studies, moderate in two studies and high in the remaining two studies. The meta-analysis showed a significant improvement in plaque index and bleeding scores in DWJ + MTB group compared MTB alone group in orthodontic patients with generalized gingivitis (MD = -0.75, 95% CI [-1.29, -0.22], p = 0.006) and (MD = -0.17, 95% CI [-0.27, -0.08], p = 0.0003), respectively. However, no significant improvement was detected between both groups in the gingival index.

CONCLUSIONS

The use of DWJ as an adjunctive device in addition to MTB can be an effective strategy for maintaining oral hygiene in orthodontic patients with gingivitis. However, more high-quality RCTs are needed to confirm the findings.

Comparison of the Impact of Two Interdental Cleaning Devices on the Reduction of Bleeding Around Implants

Objective

Purpose: To evaluate the efficacy of water flossing to traditional flossing in lowering the bleeding on probing (BOP) index around dental implants.

Methods and Materials

This single-center, examiner-masked research enrolled patients with implants and randomly allocated them to one of two groups. The research analyzed the effectiveness of manual toothbrushes when used with either string floss or a water flosser.

Results

After 30 days, the main result was a decrease in BOP occurrence. At the outset, neither group had noticeably higher rates of bleeding than the other. While only six of 20 implants in the floss group demonstrated a decrease in BOP after 30 days, 18 of 20 implants in the water flosser group did.

Conclusions

These results demonstrate that the use of water flossers was associated with much less bleeding than that of string floss. The researchers think that water flossing might be a useful addition to the maintenance of dental implants.

Effectiveness of Waterpik® for oral hygiene maintenance in orthodontic fixed appliance patients: A randomised controlled trial

OBJECTIVE

To establish whether the use of a WaterPik® alongside a manual toothbrush (WaterPik® + MTB) is more effective for maintaining oral hygiene compared to the use of a manual toothbrush alone (MTB) in patients wearing fixed orthodontic appliances.

DESIGN

A single-centre, two-arm, parallel-group, single-blind, randomised controlled clinical trial with a 1:1 allocation ratio.

SETTING

Orthodontic department at York Hospital, York Teaching Hospitals NHS Foundation Trust, UK.

PARTICIPANTS

A total of 40 fit and well participants, aged 10-20 years, being treated with upper and lower fixed orthodontic appliances.

METHODS

Participants were randomly allocated, using stratified block randomisation, to the control group (MTB) or intervention group '(Waterpik® + MTB)'. Plaque, gingival and interdental bleeding indices were recorded at baseline, 8 weeks, 32 weeks and 56 weeks. A generalised linear mixed model was used to assess differences between groups.

RESULTS

An interim analysis of results was performed with 40 patients recruited and 85% of data collected. The overall mean differences between the groups were as follows: plaque index = 0.199 (P = 0.88, 95% confidence interval [CI] -0.24 to 0.27); gingival index = -0.008 (P = 0.94, 95% CI -0.22 to 0.20); and interdental bleeding index = 5.60 (P = 0.563, 95% CI -13.22 to 24.42). No statistical difference between the two groups was found for any variable. The trial was stopped at this point.

CONCLUSIONS

In terms of oral hygiene, our study did not find evidence to support the claim of benefit of using a Waterpik® in addition to a manual toothbrush for patients wearing fixed orthodontic appliances.

A Comparative Review of Water Flossers in Periodontal Therapy

This study investigated the efficacy of water flossers (WFs), devices used to irrigate the interdental and subgingival areas, compared to other interdental care methods, in the management of periodontal disease. A computerized PubMed search was conducted by the author, encompassing the years 1962 to 2023. The year 1962 was selected due to it being the introduction of the first WF. Keywords included "oral irrigator", "efficacy," and "water flossers." The review provided a broad comparative assessment of WFs, rather than an exhaustive detailed article review. We discussed the history and evolution of commercially available WFs and introduced a novel classification system. The research also evaluated the performance of WFs in comparison to traditional and novel interdental care methods, focusing on crucial clinical parameters such as plaque removal efficiency and reduction in gingival inflammation. The results of the study reveal that WFs appear to be superior in the management of periodontal disease and have demonstrated effectiveness in a variety of indices. However, it's worth noting that the author did not statistically analyze any of the data. We identified gaps in the literature and found opportunities for further clinical studies. These findings hold implications for optimal periodontal disease prevention and management, addressing the evolving landscape of oral care practices.

Efficacy of water flossing on clinical parameters of inflammation and plaque: A 4-week randomized controlled trial

BACKGROUND

The primary prevention of periodontitis is controlling gingivitis daily. The study objective was to compare the efficacy of a pulsating water flosser to a pulsating water flosser infused with air microbubbles on clinical signs of inflammation and plaque.

METHODS

One hundred and five participants were enrolled in this single-blind, single-centre, parallel, 4-week, IRB/IEC-approved clinical trial. Participants were randomly assigned to one of three groups: water flosser (WF) plus manual toothbrush, water flosser infused with microbubbles of air (MBWF) plus manual toothbrush, or dental floss (DF) plus manual toothbrush. Bleeding on probing (BOP), Modified Gingival Index (MGI) and Rustogi Modification Navy Plaque Index (RMNPI) scores were recorded at baseline, 2 and 4 weeks.

RESULTS

All participants completed the study (n = 105). All groups showed a statistically significant reduction for BOP, MGI and RMNPI at 4 weeks (p < 0.05, except DF marginal RMNPI). The WF group showed a statistically significant greater reduction in whole mouth BOP (0.41) compared to MBWF (0.32) and DF (0.19). This was also true for MGI (0.37, 0.30 and 0.20, respectively) and RMNPI (0.13, 0.11 and 0.06, respectively; p < 0.05 for all comparisons). No adverse events were reported.

CONCLUSION

This study demonstrates that a manual toothbrush and water flosser, with or without microbubbles, is an effective oral care regimen for controlling gingivitis over 4 weeks.

The efficacy of the dental Water Jet, orthodontic, and conventional toothbrushes in plaque removal around orthodontic braces in adolescents: A randomized controlled trial

OBJECTIVES

Orthodontic treatment improves both masticatory function and the aspects of facial esthetics through the correct alignment of the teeth. If oral hygiene is neglected during fixed orthodontic treatment, it may lead to plaque accumulation and gingivitis. The aim of this randomized controlled trial was to evaluate the effectiveness of the dental Water Jet (DWJ), and orthodontic toothbrush (O-TH) in removing dental plaque around the orthodontic braces compared to conventional toothbrush (C-TH) in adolescents.

MATERIALS AND METHODS

This was a three-arm, double-blind, and parallel-group randomized active-controlled trial. Forty-five patients were randomly allocated into three groups: DWJ, the O-TH, and the C-TH (control group). The primary outcome measure was dental plaque accumulation change from the baseline (t0 ) to post-cleaning (t1 ), and plaque scores were recorded using the Orthodontic Plaque Index (OPI). The current clinical trial was registered and approved by Australian New Zealand Clinical Trials Registry (ACTRN12623000524695).

RESULTS

A statistically significant difference was noted in the OPI scores between different time points in the DWJ group, the O-TH group, and the C-TH group (p < .05). However, no significant difference was noted between the groups after the cleaning procedure (p > .05).

CONCLUSION

The level of oral hygiene was not satisfactory in patients undergoing fixed orthodontic treatment. In addition, the efficacy of the DWJ was not superior to O-TH nor to C-TH in plaque removal.

Effect of a multichannel oral irrigator on periodontal health and the oral microbiome

Oral biofilms or dental plaques are one of the major etiological factors for diverse oral diseases. We aimed to evaluate the effect of a multichannel oral irrigator (MCOI) on periodontal health in 29 participants randomly divided into two groups: the MCOI group and the control group. To evaluate the effect of the MCOI on periodontal health, the modified Quigley Hein Plaque Index (PI), Mühlemann-Son Sulcus Bleeding Index (SBI), bleeding on probing (BOP), and swelling were evaluated and compared before and after MCOI use for 3 days. Although PI and SBI showed statistically significant increases in the control group, the MCOI group showed no significant changes in either parameter. Moreover, the percentage of BOP was significantly lower in the MCOI group. Saliva samples were analyzed by 16s rRNA amplicon sequencing to investigate changes in the oral microbiome. Sequencing results showed that Porphyromonas spp. were significantly increased in the control group, whereas no significant change was detected in the MCOI group. Using the MCOI, enriched populations and functional pathways were detected in pioneer species comprising non-mutans streptococci. These findings provide evidence of the effectiveness of the MCOI in maintaining periodontal health and a healthy microbial ecology in the oral cavity.

Cleansing efficacy of an oral irrigator with microburst technology in orthodontic patients-a randomized-controlled crossover study

OBJECTIVES

Orthodontic patients struggle with interdental cleaning calling for simpler mechanical devices to reduce the high plaque levels. The present study aimed to compare the cleansing efficacy of an oral irrigator with that of dental flossing in patients with fixed braces after 4 weeks of home-use.

MATERIALS AND METHODS

The study design is a randomized and single-blinded cross-over study. After 28 days using the products at home, hygiene indices (Rustogi Modified Navy Plaque Index (RMNPI); gingival bleeding index (GBI)) were compared between test (oral irrigator) and control product (dental floss).

RESULTS

Seventeen adult individuals finalized the study. After 28 days of cleaning with the oral irrigator, RMNPI was 54.96% (46.91-66.05) compared to 52.98% (42.75-65.60) with dental floss (p = 0.029). Subgroup analysis revealed that the higher cleansing efficacy of the dental floss is attributable to buccal and marginal areas. GBI after the test phase with the oral irrigator was 12.96% (7.14-24.31) and statistically significantly higher compared to 8.33% (5.84-15.33) with dental floss (p = 0.030) which could be seen in all subgroups.

CONCLUSIONS

Oral irrigators do not remove plaque and reduce gingival bleeding as efficiently as dental floss in easily accessible regions. However, in posterior regions, where the patients struggled with the application of dental floss, the oral irrigator showed similar results.

CLINICAL RELEVANCE

Oral irrigators should only be recommended to orthodontic patients who cannot use interdental brushes and are not compliant with dental flossing.

Efficacy of power-driven interdental cleaning tools: A systematic review and meta-analysis

OBJECTIVES

To summarize the available evidence on the efficacy of power-driven interdental cleaning tools (PDICTs) as an adjunct to tooth brushing compared to tooth brushing alone or tooth brushing combined with any other non-PDICT in terms of interproximal plaque and gingival bleeding reduction in gingivitis patients.

MATERIAL AND METHODS

A systematic literature search was performed in three databases until March 20, 2022 with the following main eligibility criteria: (1) randomized controlled clinical trials (RCTs) with (2) at least 28 days of follow-up in (3) gingivitis patients. Interproximal plaque and bleeding values were defined as the primary outcome variables and used for pair-wise meta-analyses.

RESULTS

Sixteen RCTs were identified including data from 1258 participants at the final evaluation. Eight studies each investigated the effect of either a liquid-based or mechanical PDICT; one of these studies tested additionally a combined liquid-based and mechanical PDICT. Tooth brushing combined with a liquid-based PDICT compared to tooth brushing alone did not result in better interproximal plaque values but in significantly lower interproximal bleeding values. Tooth brushing combined with either a liquid-based PDICT or with a mechanical PDICT compared to tooth brushing and flossing achieved comparable interproximal plaque and bleeding values. The majority of studies reporting on patient compliance/preference favored the use of a PDICT, and except for a single study, which was reporting soft tissue trauma in two subjects from improper use of a mechanical PDICT, none of the studies reported adverse events.

CONCLUSIONS

Daily use of PDICT as an adjunct to tooth brushing significantly reduces interproximal bleeding. This effect appears comparable to that of flossing, while PDICT may achieve higher patient acceptance/compliance.

Effectiveness of Super Floss and Water Flosser in Plaque Removal for Patients Undergoing Orthodontic Treatment: A Randomized Controlled Trial

Objectives

This study aimed to compare the effectiveness of super floss and water flosser in plaque removal for patients undergoing orthodontic treatment.

Methods

A single-blind, randomized, controlled, parallel clinical trial with a split-mouth protocol was conducted on young adult orthodontic patients who were recruited from Riyadh Specialized Dental Center in Riyadh, Saudi Arabia. The type of floss used was randomly assigned to each side of the oral cavity; Super-Floss® (Oral-B) was used on one side, while the Waterpik® water flosser was used on the other. Patients' plaque level was assessed using Rustogi et al. modified navy plaque index (RMNPI) at baseline and immediately after cleaning.

Results

A total of 62 subjects were screened; however, only 34 subjects were enrolled in the study with an equal number of males and females. Overall, the plaque score was significantly reduced from 0.56 ± 0.35 to 0.13 ± 0.26 in the super floss group and from 0.61 ± 0.35 to 0.13 ± 0.28 in the water flosser group. There was no significant difference between the mean difference of super floss and water flosser (p=0.951). On the other hand, there was no significant difference between both groups in terms of the preintervention plaque score (p=0.379). The water flosser had a greater effect size on plaque removal compared to super floss on distal interproximal surface of the molar tooth with a mean difference of (−0.21, 95% CI: 00.37 to −0.04, p=0.033).

Conclusions

The use of super floss or water flosser as interproximal aids for plaque removal in patients undergoing orthodontic treatment are both effective. Trial registration. ISRCTN, ISRCTN83875016. Registered 12 September 2021-retrospectively registered, https://www.isrctn.com/ISRCTN83875016.

A Randomized Controlled Trial for Evaluation of the Effectiveness of Oral Irrigator and Interdental Floss for Plaque Control in Children with Visual Impairment

Aim

To evaluate the effectiveness of oral irrigator and interdental floss as adjuncts to manual tooth brushing in 8-16 years old children with visual impairment.

Materials and methods

A three-arm, parallel-group randomized controlled trial with blinded outcome assessment was carried out with the inclusion of 90 institutionalized children with visual impairment of age 8-16 years. They were equally allocated to three groups: group I: tooth brushing along with interdental flossing, group II: brushing along with a powered oral irrigator, and group III: brushing alone (control). Baseline oral hygiene index-simplified (OHI-S), gingival index (GI), and plaque index (PI) scores were recorded for all the samples and compared with post-intervention scores at 14 and 28 days intervals. Repeated measures of analysis of variance (ANOVA), one-way ANOVA, and post hoc Tukey tests were used for statistical analysis.

Results

At 28 days interval, children in group II showed a highly statistically significant reduction in OHI-S (0.46; p = 0.0001), PI (0.16; p = 0.0001), and GI (0.24; p = 0.0001) scores compared to control group. They also showed a significant reduction in OHI-S (0.25; p = 0.018), PI (0.15; p = 0.011), and GI (0.15; p = 0.0001) scores compared to group I. There is no significant reduction in the scores of children of group I compared to control group except for the GI score (0.08; p = 0.02).

Conclusion

Oral hygiene maintenance using oral irrigator along with brushing was found to be more effective in visually challenged children. Interdental flossing, along with brushing and brushing alone was found to be less effective.

Clinical significance

This study underlines the fact that comprehensive oral hygiene care should include interdental cleaning aids for effective plaque control to prevent dental diseases in children with visual impairment. Since these children have less manual dexterity to perform good oral hygiene practices, electrically driven interdental cleaning aids like oral irrigator may help them to overcome the problem.

How to cite this article

Deepika V, Chandrasekhar R, Uloopi KS, et al. A Randomized Controlled Trial for Evaluation of the Effectiveness of Oral Irrigator and Interdental Floss for Plaque Control in Children with Visual Impairment. Int J Clin Pediatr Dent 2022;15(4):389-393.

Applicability of neutral electrolyzed water for cleaning contaminated fixed orthodontic appliances

INTRODUCTION

We investigated whether water jet washing with neutral electrolyzed water (NW) can be an easy and safe self-performed cleaning method for oral environments of fixed orthodontic appliance-wearing patients. In line with this, we examined the bactericidal effects and dissolution behaviors of metal elements released from appliances.

METHODS

A metal or resin bracket ligated with a metal wire and metal bracket adhered to an apatite-pellet were used as specimens. The bacteria and plaque removal effects of the 30 seconds of NW (30, 100 ppm) jet washing for contaminated specimens were examined via an agar-plate method and the observation of the residual plaque, comparing with other treatments (brushing and flow washing), those treatments with tap water (TW), and flow washings with commercial mouthwashes, Listerine Total Care + (LS) and ConCool F (CC). The amounts of metal released from metal specimens during the 1-week immersion in NW were analyzed and compared with those in TW, LS, and CC.

RESULTS

NW jet washing produced larger decreases of surviving bacteria than the treatments with TW and CC (P <0.05) and equal or larger decreases than the treatment with LS (P <0.05). NW jet washing yielded the highest plaque removal level. The amounts of nickel and chromium released from metal specimens after the 1-week immersion in NW (30 ppm) were less than or equal to those with LS.

CONCLUSIONS

NW jet washing could be applicable for cleaning fixed orthodontic appliances because of its higher bactericidal effects than the treatments with commercial mouthwashes, inducing no or a slight metal release in actual usage time.

Formation, Development, and Cross-Species Interactions in Biofilms

Biofilms, which are essential vectors of bacterial survival, protect microbes from antibiotics and host immune attack and are one of the leading causes that maintain drug-resistant chronic infections. In nature, compared with monomicrobial biofilms, polymicrobial biofilms composed of multispecies bacteria predominate, which means that it is significant to explore the interactions between microorganisms from different kingdoms, species, and strains. Cross-microbial interactions exist during biofilm development, either synergistically or antagonistically. Although research into cross-species biofilms remains at an early stage, in this review, the important mechanisms that are involved in biofilm formation are delineated. Then, recent studies that investigated cross-species cooperation or synergy, competition or antagonism in biofilms, and various components that mediate those interactions will be elaborated. To determine approaches that minimize the harmful effects of biofilms, it is important to understand the interactions between microbial species. The knowledge gained from these investigations has the potential to guide studies into microbial sociality in natural settings and to help in the design of new medicines and therapies to treat bacterial infections.

Efficacy of herbal versus chlorhexidine-based mouthwashes towards oral hygiene maintenance in patients undergoing fixed orthodontic therapy: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

The review aims to fill the gap in literature by comparing the efficacy of herbal and chlorhexidine-based mouthwashes towards oral hygiene maintenance (OHM) in patients undergoing fixed orthodontic treatment (OT).

METHODS

Indexed databases were searched electronically to include randomized controlled trials (RCTs) for data gathering. The protocol was registered in PROSPERO (CRD42020182497). Risk of bias assessment, quality of evidence investigation, and meta-analysis were performed to evaluate reported OHM related parameters at time points before and after the use of chlorhexidine (control group) and herbal mouthwashes (intervention group). With 95% confidence intervals, mean difference (MD) or standardized mean difference (SMD) were used to estimate effect size.

RESULTS

Out of eight RCTs, results from one RCT favored chlorhexidine and the results from a second RCT favored herbal mouthwashes. Results from three RCTs showed comparable effects for the respective investigated OHM related parameters. Chlorhexidine demonstrated higher antimicrobial efficacy against Streptococcus mutans (S.mutans) in two studies, and one RCT found comparable antimicrobial efficacies. Risk of bias was low in 4 studies, and moderate and high in two studies each. Quality of evidence was very low to moderate for the respective investigated parameters. Sub-group analysis for parameters colony forming units (CFU) {SMD (0.40) [95% CI (-0.22, 1.03)], gingival index (GI) {MD (0.06) [95% CI (-0.08, 0.20)]}, plaque index (PI) {SMD 0.22 [95% CI (-0.23, 0.67)]} before the use of chlorhexidine and herbal mouthwashes remained inconclusive.

CONCLUSION

The comparison between efficacy of herbal and chlorhexidine towards OHM in patients undergoing fixed OT remains debatable.

Punica granatum peel extract as adjunct irrigation to nonsurgical treatment of chronic gingivitis

Pomegranate is one of the most universally studied medicinal plants for its ethnomedical history, with several studies presenting the positive outcome of its use or its extracts in managing inflammation. The objective of the present trial was to investigate the efficiency of the traditionally used 5% of pomegranate peel extract in treating gingival inflammation. Herein, 34 chronic gingivitis patients were randomized in a 1:1 ratio for four weeks in a controlled, double-blind clinical trial to evaluate the effect of the adjunctive use of a pulsating jet irrigator containing 5% pomegranate peel extract solution to nonsurgical periodontal therapy against a placebo in managing these patients' condition. No adverse reactions had been reported, and within the limits of this study, it may be concluded that pomegranate peel extract can serve as a promising alternative in managing chronic gingivitis. This trial is registered on the German clinical trials register (DRKS-ID: DRKS00010602).

Effectiveness of Brushing Associated With Oral Irrigation in Maintenance of Peri-Implant Tissues and Overdentures: Clinical Parameters and Patient Satisfaction

Hygiene of implant-supported prostheses and the health of peri-implant tissues are considered to be predictive factors of successful prosthetic rehabilitation. Therefore, the purpose of this study was to evaluate the effectiveness of brushing associated with oral irrigation measured as biofilm-removing capacity, maintenance of healthy oral tissues, and patient satisfaction. A randomized, crossover clinical trial was conducted with 38 patients who wore conventional maxillary complete dentures and mandibular overdentures retained by the O-ring system. The patients were instructed to use the following hygiene methods for 14 days: mechanical brushing (MB; brush and dentifrice, control) and MB with oral irrigation (Waterpik [WP], experimental). Biofilm-removing capacity and maintenance of healthy oral tissues were evaluated by the modified plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing index (BP) recorded at baseline and after each method. In parallel, patients answered a specific questionnaire using a visual analog scale after each hygiene method. Data were analyzed by Friedman and Wilcoxon tests (α = .05). The results showed significantly lower PI, GI, PD, and BP after application of the hygiene methods (P < .001) than those observed at baseline. However, no significant difference was found between MB and WP. The responses to the satisfaction questionnaire for both methods showed high mean values for all questions, with no statistically significant difference found between the answers given after the use of MB and WP (P > .05). The findings suggest that WP was effective in reducing PI, GI, PD, and BP indices and provided a high level of patient satisfaction.

Biofilm dispersion: The key to biofilm eradication or opening Pandora's box?

Biofilms are extremely difficult to eradicate due to their decreased antibiotic susceptibility. Inducing biofilm dispersion could be a potential strategy to help combat biofilm-related infections. Mechanisms of biofilm dispersion can basically be divided into two groups, i.e. active and passive dispersion. Active dispersion depends on a decrease in the intracellular c-di-GMP levels, leading to the production of enzymes that degrade the biofilm matrix and promote dispersion. In contrast, passive dispersion relies on triggers that directly release cells from the biofilm. In the present review, several active and passive dispersion strategies are discussed. In addition, the disadvantages and possible consequences of using dispersion as a treatment approach for biofilm-related infections are also reviewed.

A visual evaluation of oral plaque removal utilizing an adjunct enzyme pre-rinse in orthodontic subjects

OBJECTIVE

To determine if an adjunct proteolytic pre-rinse along with contemporary methods of dental cleaning may more effectively remove visual plaque in subjects with fixed orthodontic appliances.

MATERIALS AND METHODS

Forty-three orthodontic subjects, ages 10 to 25, completed this single site, double-blind, crossover clinical trial. Subjects randomly received bromelain enzyme or a powdered-sugar placebo pre-rinse, followed by manual tooth brushing and use of a Waterpik. Subjects received the alternate pre-rinse during the subsequent visit. Baseline and residual plaque accumulation were recorded via disclosing tablet and digital photography. A single, blinded examiner scored visual plaque scores from randomized photographs. Treatment effects on composite plaque score were evaluated using repeated-measures analysis of variance. A 5% significance level was used for all tests.

RESULTS

No significant differences in plaque scores were noted at baseline or post-rinse between the enzyme and placebo. The changes from baseline to post-rinse (P = .190), post-brushing (P = .764), and post-Waterpik (P = .882) were not significantly different between interventions. Significant reduction in plaque scores were observed in both arms of the study after brushing (P < .01) and waterjet use (P < .01). Neither age (P = .220) nor gender (P = .449) impacted plaque scores.

CONCLUSIONS

Use of a bromelain enzyme pre-rinse alone did not significantly enhance plaque removal. A significant reduction in retained plaque was observed with the application of brushing and or Waterpik.

Brushing associated with oral irrigation in maintaining implants and overdentures hygiene - a randomized clinical trial

Evaluate, through a randomized clinical trial, the efficacy of brushing associated with oral irrigation in maintaining implant and overdenture hygiene. Thirty-eight participants, who had a clinically acceptable conventional maxillary complete denture and mandibular overdenture retained by either implants or mini-implants using an O-ring-retained system, were enrolled to participate in the study. They were instructed to use two different hygiene methods, in a random sequence for a period of 14 days, with a 7-day wash-out interposed period: (I) mechanical brushing (MB); (II) association of mechanical brushing with oral irrigation (WP). Biofilms from both subgingival sulci and overdentures were collected and processed by Checkerboard DNA-DNA hybridization method at baseline and after using the proposed hygiene protocols. Comparisons were performed using Wilcoxon test and Friedman test with Benjamini-Hochberg false discovery rate, followed by Conover post-hoc test (α = 0.05). In the subgingival sulci-related biofilm, a lower number of microbial cells were detected, after WP compared to the MB method (P < 0.001). The findings of overdenture-related biofilm suggest that both methods were similar (P = 0.607) being the identified microbiota qualitatively coincident after each method. Despite the number of microbial counts, it was concluded that the association of mechanical brushing with oral irrigation was more effective in reducing microorganisms in the subgingival sulci biofilm; however, the same outcome was not observed in the overdentures.

Dental water jet efficacy in the plaque control of orthodontic patients wearing fixed appliance: A randomized controlled trial

Background

Different studies assess the role of fixed orthodontic appliances in supragingival plaque accumulation. In patients wearing fixed orthodontic appliances a good management of oral hygiene is required in order to prevent complication like as decay, enamel demineralization, gingivitis, gingival hyperplasia and periodontitis. The aim of this Randomized Controlled Trial (RCT) is to evaluate the efficacy of the use of a DWJ in patients under orthodontic treatment with fixed multibracket appliance.

Material and Methods

The study design was single-blinded RCT with a split mouth protocol. Each patient followed a personal cleaning protocol using a DWJ in addition to traditional brushing only on one side while just brushing on the control side. The side on which was decided to use the DWJ was chosen randomly and the dental hygienist who took the measurements was blind. Plaque and gingival indexes were evaluated at baseline and at one, three and six-months follow-up.

Results

It did not emerge any difference in the plaque and gingival indexes trend between the two groups. Patients initially reported an worsening of the indexes at one month evaluation, then they set at baseline levels at three and six months.

Conclusions

The dental water jet does not improve significantly the efficacy of home oral hygiene in orthodontic patients wearing a multi-bracket fixed appliance. Patients did not show the traditional worsening during the whole orthodontic therapy.

Key words:Dental water jet, fixed orthodontics, plaque index, gingival index.

Knowledge, attitudes and behaviours of patients regarding interdental deplaquing devices: A mixed-methods study

OBJECTIVES

This mixed-methods study assessed patients' oral health literacy, motivation level and barriers regarding interdental plaque control.

METHODS

Participants (n = 49) from a study comparing the use of Glide® Pro-Health Floss Original (F) or GUM® Curved Soft-Picks® Advance (SP) completed daily diaries and questionnaires regarding motivation, tiredness, confidence and satisfaction for their deplaquing method. The Mantel-Haenszel chi-square test was utilized. Data were also collected from 19 participants who attended focus group discussions regarding their oral health habits, knowledge, motivators and barriers with interdental plaque control. Discussions were digitally recorded, transcribed and imported into ATLAS.ti 7.5.15 to identify themes.

RESULTS

There were no statistically significant differences between the two groups in relation to age, sex or ethnicity. F users reported statistically significant higher agreement about ability to remove food/debris (P = 0.01), cleaning thoroughly (P = 0.02) and clean feeling of the mouth (P = 0.01). SP users reported higher ease/efficiency of use (P = 0.01), convenience (P = 0.003), easy to hold (P = 0.0001) and easy use away from home (P = 0.008). Daily diaries revealed higher motivation and compliance/ease of use (SP). During the focus groups, some reported that they did not feel clean unless they deplaqued interdentally; however, most reported that they lacked motivation due to constraints on time, no desire due to lack of immediate or tangible rewards, and lack of knowledge on proper use of interdental devices or the benefits of using them.

CONCLUSION

This study showed that the lack of compliance may be due to poor literacy and lack of motivation in patients due to gaps in patient education.

Consequences of orthodontic treatment in malocclusion patients: clinical and microbial effects in adults and children

BACKGROUND

Malocclusion is a common disease of oral and maxillofacial region. The study was aimed to investigate levels changes of periodontal pathogens in malocclusion patients before, during and after orthodontic treatments, and to confirm the difference between adults and children.

METHOD

One hundred and eight malocclusion patients (46 adults and 62 children at the school-age) were randomly selected and received orthodontic treatment with fixed orthodontic appliances. Subgingival plaques were Porphyromonas gingivalis (P.gingivalis), Fusobacterium nucleatum (F. nucleatum), Prevotella intermedia (P. intermedia) and Tannerella forsythensis (T. forsythensis) collected from the observed regions before and after treatment. Clinical indexes, including plaque index (PLI), gingival index (GI), sulcus bleeding index (SBI), probing depth (PD) and attachment loss (AL) of observed teeth were examined.

RESULTS

The detection rates of P.gingivalis, F. nucleatum, P. intermedia and T. forsythensis increased from baseline to the third month without significant difference, and then returned to pretreatment levels 12 month after applying fixed orthodontic appliances. Adults' percentage contents of P.gingivalis, F. nucleatum, P. intermedia and T. forsythensis were significantly higher than those of children at baseline and the first month, but not obvious at the third month. PLI and SBI were increased from baseline to the first and to the third month both in adults and children groups. Besides, PD were increased from baseline to first month, followed by a downward trend in the third month; however, all patients were failed to detect with AL.

CONCLUSIONS

Periodontal and microbiological statuses of malocclusion patients may be influenced by fixed orthodontic appliances in both adults and children, more significant in children than in adults. Some microbiological indexes have synchronous trend with the clinical indexes. Long-term efficacy of fixed orthodontic appliances for malocclusion should be confirmed by future researches.

Quantifying plaque during orthodontic treatment:

OBJECTIVE

To evaluate the literature on different methods of scoring plaque in patients with fixed orthodontic appliances.

MATERIALS AND METHODS

A systematic electronic and hand search using MEDLINE and PubMed was conducted.

RESULTS

Most orthodontic trials have used the original Silness and Löe plaque index. Indices vary in several potentially important aspects. Only two papers have reported reproducibility of methods of plaque scoring in orthodontic patients.

CONCLUSION

Some plaque indices are inappropriate for orthodontic patients. Newer digital planimetric methods are promising if more complex. There is a need to further assess the reproducibility and practicability of the advocated methods.

Plaque levels of patients with fixed orthodontic appliances measured by digital plaque image analysis

INTRODUCTION

A digital plaque image analysis system was developed to objectively assess dental plaque formation and coverage in patients treated with fixed orthodontic appliances.

METHODS

The technique was used to assess plaque levels of 52 patients undergoing treatment with fixed appliances in the Department of Orthodontics at Johannes Gutenberg University in Mainz, Germany.

RESULTS

Plaque levels ranged from 5.1% to 85.3% of the analyzed tooth areas. About 37% of the patients had plaque levels over 50% of the dentition, but only 10% exhibited plaque levels below 15% of tooth coverage. The mean plaque coverage was 41.9% ± 18.8%. Plaque was mostly present along the gum line and around the orthodontic brackets and wires.

CONCLUSIONS

The digital plaque image analysis system might provide a convenient quantitative technique to assess oral hygiene in orthodontic patients with multi-bracket appliances. Plaque coverage in orthodontic patients is extremely high and is 2 to 3 times higher than levels observed in high plaque-forming adults without appliances participating in clinical studies of the digital plaque image analysis system. Improved hygiene, chemotherapeutic regimens, and compliance are necessary in these patients.

[Plaque control, a key element of successful orthodontics]

It is mainly because of periodontal tissues and, more particularly, the periodontal ligament that the orthodontist is able to move teeth. According the ratio cost/benefit/security, the orthodontist needs to prevent and/or to avoid the deleterious effects of its treatments on periodontal tissues. Gingival inflammation with a high hyperplasia compound, periodontal attachment loss, bone loss and root resorption may result, in absolute value, in a reduction of periodontal support. The key to prevent these problems is plaque control, phase too often neglected. The challenge before any orthodontic treatment, both in children or in adults, is to change the behavior of the patient concerning the mouth and the dental plaque. The aim of this paper is to explore the evidence based literature (systematic revues, meta-analysis), to provide thought elements and concrete proposals to definitely resolve this critical phase of orthodontic treatment that is the motivation, phase that can also be achieved by "dental auxiliaries".