Dental plaque control strategies for the elderly population: A scoping review

Evaluation of the effect of dental caries, oral hygiene, and treatment need on oral health-related quality of life among Turkish orphan children and adolescents

BACKGROUND

The oral and dental health and related quality of life of orphan children and adolescents-who are considered a vulnerable population-are critical for both individual and public health.

OBJECTIVES

This study aimed to investigate the status of the dental caries, oral hygiene, and dental treatment needs among a group of Turkish male orphan children and adolescents, as well as their impact on oral health-related quality of life.

METHODS

A total of 112 orphan children and adolescents aged between 9 and 17 years living in a residential care facility in Istanbul, Türkiye, were involved in this cross-sectional study. A comprehensive examination was conducted on each individual, encompassing the assessment of dental caries using the decayed, missing, and filled teeth (DMFT/dft) index, oral hygiene using the debris (DI-S), calculus (CI-S), and simplified oral hygiene (OHI-S) indices, and dental treatment need using the treatment need index (TNI). Oral health-related quality of life was evaluated using the validated Turkish version of the Child Oral Health Impact Profile-Short Form (COHIP-SF-19). The relationship between oral health-related quality of life and explanatory variables was evaluated using a multivariable linear regression model.

RESULTS

The mean age of the participants was 12 ± 1.79 years. The mean DMFT score was 4.57 ± 3.42, and the mean OHI-S score was 1.4 ± 0.52. Participants had a mean COHIP-SF-19 score of 57.79 ± 14.11, with 25% requiring at least one tooth to undergo radical treatment. Multivariable linear regression analysis indicated that the DMFT score (p = 0.009) and the need for radical treatment (TNI code 6) (p < 0.001) had a statistically significant impact on oral health-related quality of life among orphan children and adolescents aged 13-17.

CONCLUSIONS

This study underscores that dental caries and the need for radical treatment significantly impact the oral health-related quality of life of orphan children and adolescents.

Manual toothbrushes, self-toothbrushing, and replacement duration to remove dental plaque and improve gingival health: A scoping review from recent research

OBJECTIVE

To investigate characteristics of manual toothbrushes, self-toothbrushing methods, and replacement duration of manual toothbrushes that effectively remove dental plaque, reduce gingivitis, and promote gingival health.

STUDY DATA AND SOURCES

PubMed-MEDLINE, Scopus and Central Register Cochrane of Controlled trials (CENTRAL) were searched for randomized control trials (RCTs) from 01 January 2018 to 12 December 2023. Articles were subjected for including participants aged six years and older with a study duration of at least four weeks to investigate the efficacy of manual toothbrushes used self-toothbrushing. To investigate the appropriate time to replace manual toothbrushes, this study was focused on the physical properties of the bristles and changes in the microorganisms present in the bristles over time.

STUDY SELECTION

Of 1520 retrieved articles, 26 studies were included after screening. The total number of manual toothbrushes was 40 and 5 kinds of self-toothbrushing techniques were selected in the review. 4 studies investigated the changes the physical properties bristles of manual toothbrushes.

CONCLUSIONS

Among manual toothbrushes, the cross-angle and indicator bristles were found to significantly improve dental plaque index and gingival condition. Most toothbrushes with soft bristles had a trend of superior dental plaque removal and gingivitis improvement efficacy. Toothbrush with end-round shape bristles tip has tended to reduce the dental plaque and gingival index scores. Studies reported that brushing twice a day for at least two minutes using the Bass method had a positive effect on the dental plaque and gingival index. Further research is required to investigate the relationships between property physical bristle and clinical intraoral indices to clarify the replacement duration of manual toothbrushes.

CLINICAL SIGNIFICANCE

The findings of this study could guide people's daily self-brushing habits, thereby aiding the prevention of periodontal disease. Moreover, our findings suggest the need for strategic clinical trial designs to verify the ideal timing to replace manual toothbrushes.

Geriatric oral health neglect: calculus on the attached gingiva: a case report

Introduction and importance

Aging exerts various effects on and causes changes to the oral tissues. It is often difficult to distinguish between what is caused by the physiological process of aging itself and what is caused by the individual's lifestyle or diseases. The elderly face peculiar health challenges and require special dental care. It is therefore vital that greater attention be given to the oral health needs of this rapidly population. In this article, the authors present the case of an elderly female patient with a rare case of calculus on the attached gingiva.

Case presentation

A 90-year-old retired teacher with a history of hypertension, presented with a small, painless, grayish-brown growth on her attached gingiva, noticed by her daughter-in-law. Examination revealed signs of gingivitis and significant dental issues including missing teeth, fractures, and calculus buildup. Diagnosis of chronic generalized marginal gingivitis and calculus deposition was made, and scaling and polishing were performed. Perforation of the attached gingiva was observed during scaling thus exposing the root, which facilitated the calculus accumulation. Post-procedure care included medication and oral hygiene instructions. Follow-up after 1 week showed satisfactory healing, but subsequent assessment at 3 months revealed plaque accumulation, with the patient declining further treatment.

Clinical discussion

The patient shows relative neglect in oral healthcare given the subpar oral health features she exhibited and decline of further treatment options presented to her. This is common in the population as some abnormal oral presentations and features are perceived as normal in the population, which can be attributed to poor knowledge of oral health practices, which affects the illness seeking behaviour of individual.

Conclusion

Calculus deposition in the oral cavity requires a hard surface for formation, and proper oral hygiene practices are essential to mitigate its adverse effects, particularly among the elderly who may require additional attention due to their unique physiological changes.

Effect of oral health interventions for dependent older people-A systematic review

BACKGROUND

There is an increasing proportion of older people in the population worldwide, with a large group being dependent on the care of others. Dependent older people are more vulnerable to oral diseases, which can heavily impact their quality of life (OHRQoL) and general health.

OBJECTIVE

The purpose of this systematic review was to comprehensively assess interventions to improve oral health or guarantee access and adherence to dental treatment of dependent older people.

METHODS

We searched MEDLINE, EMBASE, CENTRAL and clinical trial registries. Two reviewers performed the selection, data extraction, risk of bias evaluation using the Cochrane Risk of Bias tool and assessment of certainty of the evidence. When possible, we conducted a meta-analysis to calculate effect estimates and their 95%CIs. Primary outcomes were OHRQoL, oral/dental health, and use of the oral care system.

RESULTS

We included a total of 30 randomised clinical trials assessing educational and non-educational interventions for community-dwelling older people (n = 2) and those residing in long-term care facilities (n = 28). Most studies assessed oral hygiene and showed that interventions may result in a reduction in dental plaque in the short term (with low certainty of evidence), but there is limited evidence for long-term effectiveness. Only one study assessed OHRQoL, and none evaluated changes in the use of the oral health care system.

CONCLUSION

Our findings do not provide strong conclusions in favour of any specific intervention, mainly due to study quality and imprecision. There is limited information about the long-term effect of interventions, and further research is needed, especially targeting community-dwelling older people.

PROSPERO ID

CRD42021231721.

Different Polymers for the Base of Removable Dentures? Part II: A Narrative Review of the Dynamics of Microbial Plaque Formation on Dentures

This review focuses on the current disparities and gaps in research on the characteristics of the oral ecosystem of denture wearers, making a unique contribution to the literature on this topic. We aimed to synthesize the literature on the state of current knowledge concerning the biological behavior of the different polymers used in prosthetics. Whichever polymer is used in the composition of the prosthetic base (poly methyl methacrylate acrylic (PMMA), polyamide (PA), or polyether ether ketone (PEEK)), the simple presence of a removable prosthesis in the oral cavity can disturb the balance of the oral microbiota. This phenomenon is aggravated by poor oral hygiene, resulting in an increased microbial load coupled with the reduced salivation that is associated with older patients. In 15-70% of patients, this imbalance leads to the appearance of inflammation under the prosthesis (denture stomatitis, DS). DS is dependent on the equilibrium-as well as on the reciprocal, fragile, and constantly dynamic conditions-between the host and the microbiome in the oral cavity. Several local and general parameters contribute to this balance. Locally, the formation of microbial plaque on dentures (DMP) depends on the phenomena of adhesion, aggregation, and accumulation of microorganisms. To limit DMP, apart from oral and lifestyle hygiene, the prosthesis must be polished and regularly immersed in a disinfectant bath. It can also be covered with an insulating coating. In the long term, relining and maintenance of the prosthesis must also be established to control microbial proliferation. On the other hand, several general conditions specific to the host (aging; heredity; allergies; diseases such as diabetes mellitus or cardiovascular, respiratory, or digestive diseases; and immunodeficiencies) can make the management of DS difficult. Thus, the second part of this review addresses the complexity of the management of DMP depending on the polymer used. The methodology followed in this review comprised the formulation of a search strategy, definition of the inclusion and exclusion criteria, and selection of studies for analysis. The PubMed database was searched independently for pertinent studies. A total of 213 titles were retrieved from the electronic databases, and after applying the exclusion criteria, we selected 84 articles on the possible microbial interactions between the prosthesis and the oral environment, with a particular emphasis on Candida albicans.

Evaluation of the relationship between GOHAI, MNA and the dental hygiene of using denture wearers for older patients

BACKGROUND

The use of removable dentures increase due to tooth loss that occurs with ageing. The relationship between age, use of removable dentures and nutrition is important.

OBJECTIVE

To evaluate the effectiveness of the GOHAI, the MNA, and the dental hygiene of older patients using dental prostheses.

METHODS

This was a cross-sectional study of people over 65 who used removable prostheses in at least one jaw (partial or complete denture) for a minimum of 6 months (n = 120). The data were collected using questionnaires of a qualified examiner and oral clinical tests with interviewers in person. The subjects' nutritional status was assessed by a Turkish version of the mini nutritional assessment (MNA). GOHAI questionnaire was used to evaluate those aspects considered to have an impact on the quality of life of the older population, such as functional limitation, aesthetic dissatisfaction, chewing discomfort, avoidance of particular food, out-of-social contacts and self-medication administered for dental pain.

RESULTS

There was no statistically significant correlation between the GOHAI score and sociodemographic and intraoral data (p > .050). A negative correlation was found between age and MNA. A statistically significant difference was found between the MNA score's median values according to the participant's education level, type of prosthesis, and marital status (p < .050). Good was determined as the highest GOHAI category with 54%.

CONCLUSION

There is a negative correlation between age and MNA. The risk of malnutrition increases with age. Since the oral condition also affects the patient's systemic condition, the team caring for geriatric patients must bring these people to the maximum level of life in a multidisciplinary manner.

Recent Clinical Treatment and Basic Research on the Alveolar Bone

The periodontal ligament is located between the bone (alveolar bone) and the cementum of the tooth, and it is connected by tough fibers called Sharpey’s fibers. To maintain healthy teeth, the foundation supporting the teeth must be healthy. Periodontal diseases, also known as tooth loss, cause the alveolar bone to dissolve. The alveolar bone, similar to the bones in other body parts, is repeatedly resorbed by osteoclasts and renewed by osteogenic cells. This means that an old bone is constantly being resorbed and replaced by a new bone. In periodontal diseases, the alveolar bone around the teeth is absorbed, and as the disease progresses, the alveolar bone shrinks gradually. In most cases, the resorbed alveolar bone does not return to its original form even after periodontal disease is cured. Gum covers the tooth surface so that it matches the shape of the resorbed alveolar bone, exposing more of the tooth surface than before, making the teeth look longer, leaving gaps between the teeth, and in some cases causing teeth to sting. Previously, the only treatment for periodontal diseases was to stop the disease from progressing further before the teeth fell out, and restoration to the original condition was almost impossible. However, a treatment method that can help in the regeneration of the supporting tissues of the teeth destroyed by periodontal diseases and the restoration of the teeth to their original healthy state as much as possible is introduced. Recently, with improvements in implant material properties, implant therapy has become an indispensable treatment method in dentistry and an important prosthetic option. Treatment methods and techniques, which are mainly based on experience, have gradually accumulated scientific evidence, and the number of indications for treatment has increased. The development of bone augmentation methods has contributed remarkably to the expansion of indications, and this has been made possible by various advances in materials science. The induced pluripotent stem cell (iPS) cell technology for regenerating periodontal tissues, including alveolar bone, is expected to be applied in the treatment of diseases, such as tooth loss and periodontitis. This review focuses on the alveolar bone and describes clinical practice, techniques, and the latest basic research.

The stain resistant effect of an ultraviolet curable coating material on denture base resin

This study aimed to evaluate the effects of an ultraviolet (UV) curable coating material on denture base resin. The results of the three-point bending test showed no significant difference between treated and untreated specimens, suggesting that the UV curable coating material did not compromise the physical strength of denture base resin. The surface free energy measurement and the surface analysis with atomic force microscopy revealed superhydrophilicity and a regularly arranged structure on the coating surface, improving wettability. Moreover, untreated specimens were significantly discolored in the staining test. However, specimens treated with the UV curable coating material showed no significant difference in color with slight staining, suggesting excellent antifouling ability. Therefore, the UV curable coating material used in this study could contribute to simplifying hygiene without altering the physical properties of denture base resins.

Use of the Probiotic Bifidobacterium animalis subsp. lactis HN019 in Oral Diseases

The oral cavity is one of the environments on the human body with the highest concentrations of microorganisms that coexist harmoniously and maintain homeostasis related to oral health. Several local factors can shift the microbiome to a pathogenic state of dysbiosis. Existing treatments for infections caused by changes in the oral cavity aim to control biofilm dysbiosis and restore microbial balance. Studies have used probiotics as treatments for oral diseases, due to their ability to reduce the pathogenicity of the microbiota and immunoinflammatory changes. This review investigates the role of the probiotic Bifidobacterium animalis subsp. lactis (B. lactis) HN019 in oral health, and its mechanism of action in pre-clinical and clinical studies. This probiotic strain is a lactic acid bacterium that is safe for human consumption. It mediates bacterial co-aggregation with pathogens and modulates the immune response. Studies using B. lactis HN019 in periodontitis and peri-implant mucositis have shown it to be a potential adjuvant treatment with beneficial microbiological and immunological effects. Studies evaluating its oral effects and mechanism of action show that this probiotic strain has the potential to be used in several dental applications because of its benefit to the host.

The denture microbiome in health and disease: an exploration of a unique community

The United Nations suggests the global population of denture wearers (an artificial device that acts as a replacement for teeth) is likely to rise significantly by the year 2050. Dentures become colonized by microbial biofilms, the composition of which is influenced by complex factors such as patient’s age and health, and the nature of the denture material. Since colonization (and subsequent biofilm formation) by some micro‐organisms can significantly impact the health of the denture wearer, the study of denture microbiology has long been of interest to researchers. The specific local and systemic health risks of denture plaque are different from those of dental plaque, particularly with respect to the presence of the opportunist pathogen Candida albicans and various other nonoral opportunists. Here, we reflect on advancements in our understanding of the relationship between micro‐organisms, dentures, and the host, and highlight how our growing knowledge of the microbiome, biofilms, and novel antimicrobial technologies may better inform diagnosis, treatment, and prevention of denture‐associated infections, thereby enhancing the quality and longevity of denture wearers.