Correlation between dental plaque accumulation and gingival health in periodontal maintenance patients using short or extended personal oral hygiene intervals

Effectiveness of dental floss in the management of gingival health: A 6-month follow-up of a randomized controlled clinical trial

OBJECTIVES

To evaluate, (i) if subjects submitted to a structured oral hygiene training program (OHt) maintain adopted habits over 180 days without professional guidance; and (ii) in perspective whether flossing provides additional benefits to toothbrushing on gingival health.

MATERIALS AND METHODS

Seventy-five adult subjects showing approximately 40% proximal gingival bleeding were randomized to receive OHt (1 session weekly over 8 weeks) using toothbrush and dental floss or toothbrush alone. The subjects were then followed over 180 days without professional guidance. Primary outcomes were mean interproximal Gingival Index (GI) and GI = 2 (gingival bleeding). Mixed linear models were used for the comparison between groups (p < 0.05).

RESULTS

68 subjects received OHt, 48 subjects completed the 180-day follow-up. Subjects maintained adequate oral hygiene routines. Besides a reduction in gingival inflammation, no alterations in gingival status were observed among groups, subjects additionally instructed to use dental floss showing a mean interproximal GI = 2 of 12.8 ± 2.5 compared with 19.8 ± 2.2 for subjects limited to tooth brushing alone.

CONCLUSIONS

OHt intensive training promotes gingival health and maintenance lasting at least 6 months without professional supervision reinforcing important principles: (i) dental health professionals should dedicate time training and motivating their patients to reach adequate self-performed plaque control; and (ii) the adjunctive use of dental floss appears essential to reduce interproximal gingival inflammation in subjects with intact interdental papillae.

CLINICAL RELEVANCE

Dentists need to invest time in training/motivating/engage their patients to achieve adequate OH; adjunct flossing in subjects with papilla filling the interdental space appears essential to reach and maintain gingival health.

CLINICALTRIALS

GOV : (53831716.5.0000.5346).

TRIAL REGISTRATION

The protocol registration was filed May 9, 2018 (# 538,311,716.5.0000.5346) on ClinicalTrials.gov. An NCT number (NCT04909840) was generated upon completed registration.

Efficacy of laser biostimulation for mandibular narrow ridges treated with one-stage ridge splitting and two-implant overdentures: A one-year preliminary study

STATEMENT OF PROBLEM

The management of patients with narrow-mandibular ridges who seek prosthetic rehabilitation is challenging.

PURPOSE

The purpose of this one-year preliminary clinical study was to compare the effects of laser biostimulation and a placebo on peri-implant tissues for a 2-implant-retained mandibular polyetheretherketone (PEEK) overdenture on expanded narrow mandibular ridges.

MATERIAL AND METHODS

Eighteen completely edentulous participants were enrolled for mandibular ridge splitting in the canine regions, followed by expansion, the placement of implants, and the application of a bone graft. In the test group, laser therapy was applied labially and lingually at the surgical sites, while a placebo laser was used in the control group. PEEK overdentures retained by LOCATOR attachments were provided after 6 months. Clinical evaluations were performed using probing depth, plaque, bleeding, and gingival indices at insertion and 3, 6, and 12 months after insertion. Vertical bone loss (VBL) was evaluated with periapical radiograph at insertion and 6 and 12 months later. The Mann-Whitney test was used to test the difference between the 2 different groups at each evaluation time (α=.05). The Friedman-test was used, followed by Wilcoxon signed rank test, to test the change over time in the same group, and the Bonferroni adjusted significance level was used for multiple comparisons.

RESULTS

Some clinical and radiographic parameters significantly increased with time in both groups (P<.001). Significant differences between the 2 groups were revealed in bleeding scores at 3 months (P=.006) and 6 months (P=.018). Also, significant differences between the 2 groups were observed in gingival scores at 3 months (P=.002), 6 months (P=.015), and 12 months (P=.019) after overdenture insertion in favor of the laser group. Peri-implant VBL was significantly higher in the non-laser group at 6 months (P=.015), and 12 months (P=.001).

CONCLUSIONS

Within the limitations of this clinical study, respecting the small sample size and the short follow-up period, laser bio-stimulation after 1-stage ridge splitting in narrow mandibular ridges enhanced the soft and hard peri implant tissues when used with LOCATOR attachments and PEEK overdentures.

Effect of blood lead levels on periodontitis in American adults: a cross-sectional analysis from the national health and nutrition examination survey

BACKGROUND

The primary objective of this study was to assess the impact of blood lead levels on the development and progression of periodontitis.

METHODS

This study included 8600 participants from the National Nutrition and Health Examination Survey conducted the United States between 2009 and 2014. The exposure variable was the blood lead level, while the outcome variable was periodontitis. To evaluate the relationship between the blood lead level and periodontitis, a multivariate logistic regression model was used.

RESULTS

A positive association was observed between blood lead levels and the risk of periodontitis in Model 1 (OR = 7.04, 95% CI = 5.95-8.31). After adjusting for age (continuous), sex, ethnicity, and BMI (continuous) in Model 2, the significant association between blood lead levels and periodontitis risk remained evident (OR = 3.06, 95% CI: 2.54-3.70). Consequently, even after comprehensive adjustment for potential confounding factors in Model 3, the robust association between blood lead levels and periodontitis risk persisted (OR = 2.08, 95% CI = 1.67-2.60). When considering the serum lead concentration as a categorical variable and after adjusting for potential confounders in Model 3, we observed that the odds ratios (ORs) of periodontitis in the T2 (0.94 µg/dL-1.60 µg/dL) and T3 (lead ≥ 1.60 µg/dL) groups increased from 1.27 (OR = 1.27, 95% CI: 1.11-1.44) to 1.57 (OR = 1.57, 95% CI: 1.36-1.81) compared to T1 group. Subgroup analysis revealed no effect modifiers.

CONCLUSIONS

Our main findings suggest that there is no safe range of blood lead levels regarding periodontitis risk and that increasing blood lead levels can significantly increase the prevalence of periodontitis.

The association of work physical activity and recreational physical activity with periodontitis in the NHANES (2009-2014)

BACKGROUND

The aim of this study was to investigate the association between different types and intensity of physical activities (PA) and periodontitis in a nationally representative sample of adults in the United States.

METHODS

The data of periodontal condition and PA of 10,714 individuals were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014 and the Global Physical Activity Questionnaire (GPAQ). The association between the prevalence of periodontitis and two PAs (work PA and recreational PA) was respectively analyzed and adjusted by uni- and multi-variable logistic regression models. The odd ratios (ORs), adjusted odd ratios (ORad ), and 95% confidence interval (95% CI) were calculated as the main outcome indicators.

RESULTS

After adjusted by age, sex, race, poverty-income ratio (PIR), diabetes, smoking status, alcohol use, and floss frequency, moderate and vigorous work PAs were significantly correlated with higher odds of periodontitis (ORad  = 1.22, 95% CI = 1.02-1.46; ORad  = 1.40, 95% CI = 1.04-1.89, respectively) while moderate and vigorous recreational PAs were correlated with lower odds of periodontitis (ORad  = 0.81, 95% CI = 0.69-0.95; ORad  = 0.55, 95% CI = 0.43-0.71, respectively).

CONCLUSIONS

Work PAs and recreational PAs have opposite associations on the prevalence of developing periodontitis and their aggravating or protective associations enhance with the increase of intensity.

Association between child's behaviour during first dental appointment and effectiveness of dental plaque removal by caregivers

OBJECTIVE

To evaluate the association between the behaviour of children aged 1 to 4 years during their dental appointment and the effectiveness of dental plaque removal by caregivers.

METHODS

This longitudinal study with intervention had the participation of 146 children (mean age = 34.89 months), 75 of whom (51.4%) showed positive behaviour (+ and ++) and 71 (48.6%), negative behaviour (- and - -). The children were evaluated at the first dental appointment, according to the Frankl scale. They were subjected to an assessment of oral conditions, and their plaque level was recorded (Quigley-Hein Index modified by Turesky) using the Evince® device. Caregivers received oral hygiene guidance. The dental plaque assessment was performed before giving the oral hygiene guidance and 14 days later. The statistical analysis included a descriptive assessment and the Wilcoxon test (p < 0.05).

RESULTS

Mean dental plaque levels dropped significantly from the first to the second assessment (p < 0.001). The sample was divided according to the child's behaviour, observing that only the group of children with positive behaviour showed significantly less dental plaque in the second assessment (p < 0.001).

CONCLUSION

The positive behaviour of children aged 1 to 4 years during the first dental appointments is associated with more effective dental plaque removal by caregivers.

How to Measure Adherence to a Mediterranean Diet in Dental Studies: Is a Short Adherence Screener Enough? A Comparative Analysis

This study aimed to evaluate the Mediterranean Diet Adherence Screener (MEDAS) in a study investigating the anti-inflammatory effect of a 6-week Mediterranean diet intervention on periodontal parameters. Data from a randomized clinical trial were analyzed for correlations between the MEDAS score and oral inflammatory parameters (bleeding on probing (BOP), gingival index (GI), and periodontal inflamed surface area (PISA)) and select nutrient intakes estimated by a food frequency questionnaire (FFQ) and a 24-h dietary recall (24dr). A mixed model, calculations of Spearman ρ, Lin’s Concordance Coefficient (CC), and Mann–Whitney U test were used for the statistical analyses. The MEDAS score was significantly negatively correlated with periodontal inflammation (BOP: CoE −0.391, p < 0.001; GI −0.407, p < 0.001; PISA −0.348, p = 0.001) and positively correlated with poly unsaturated fatty acids/total fat, vitamin C, and fiber intake estimates obtained from the FFQ and 24dr (ρ 0.38–0.77). The FFQ and 24dr produced heterogeneously comparable intake results for most nutrients (CC 0–0.79, Spearman ρ 0.16–0.65). Within the limitations of this study, the MEDAS was able to indicate nutritional habits associated with different levels of periodontal inflammation. Accordingly, the MEDAS can be a sufficient and useful diet screener in dental studies. Due to its correlation with oral inflammatory parameters, the MEDAS might also be useful in dental practice.