Electric toothbrush for biofilm control in individuals with Down syndrome: a crossover randomized clinical trial

Evaluation of the effectiveness of novel oral hygiene aids in the prevention of gingival diseases in children and adolescents with special healthcare needs - A systematic review and meta-analysis

Background

Due to a lack of manual dexterity, impaired cognitive and general development, and awareness of caregivers, special children are not able to maintain good oral health. This leads to the development of dental plaque, gingival inflammation, and further periodontal diseases. It is, thus, necessary for dentists and caregivers to understand which of oral hygiene aids can be best suited for a child with special healthcare needs. The aim of this review is to evaluate the most efficacious oral healthcare aids in children and adolescents with special healthcare needs.

Materials and Methods

Systematic search was conducted in databases: PubMed, Cochrane, Google Scholar, Scopus, and ProQuest for studies published from January 1, 2000, till December 31, 2023. Randomized trials conducted among children and adolescents with special healthcare needs below 18 years using oral hygiene aids to reduce plaque were included in this review.

Results

A total of 23 articles satisfying eligibility criteria were included in the systematic review and 11 articles for meta-analysis. Meta-analysis was divided into two parts. Novel toothbrushes were more effective than manual toothbrushes with P = 0.01 (SMD: Standard Mean Difference) 95% confidence interval: -4.23 (-7.62, -0.85), I 2 = 99.63%). In chemical oral hygiene aids, chlorhexidine (CHX) spray at concentration of 0.12% was found to be more effective than placebo to control plaque and was not statistically significant.

Conclusion

Current evidence suggests that novel mechanical oral hygiene aids used with CHX spray as an adjunct can be best suited for children and adolescents with special healthcare needs to control plaque.

Periodontal diseases in Down syndrome during childhood: a scoping review

BACKGROUND

Down syndrome (DS) is a genetic condition that involves the deregulation of immune function and is characterized by a proinflammatory phenotype leading to an impaired response to infections. Periodontitis is a highly prevalent chronic inflammatory disease. It has been shown that adults and teenagers with DS are more susceptible to this disease, but a similar correlation in DS children remains elusive. This systematic scoping review aims to address this knowledge gap by examining periodontitis in DS children, with a secondary objective of elucidating the underlying mechanisms involved.

METHODS

Our primary search was conducted via the PubMed/MEDLINE database and Google Scholar, covering the period from 1951-July 1st, 2024. Primary studies written in English or French were included. The excluded articles were reviews, in vitro or animal studies, studies on teenagers or adults, and studies involving patients with disabilities other than DS. The quality of evidence was assessed via the Newcastle‒Ottawa scale for observational studies and a published tool for evaluating the quality of case reports and case series.

RESULTS

The initial electronic database search yielded a total of 2431 articles. 58 full-text articles, comprising seven cross-sectional studies, 36 case‒control studies, seven cohort studies, and eight case reports and case series, were included in the review. Compared with healthy children or children with disabilities, DS children appear to have more severe periodontal inflammation. However, the evidence is inconclusive regarding the presence of bone loss, with studies divided on this issue. Local risk and etiopathogenetic factors do not seem to play a significant role in increased inflammation. Instead, this difference could be attributed to the general proinflammatory phenotype of children with DS.

CONCLUSIONS

DS children seem to have higher periodontal inflammation than other children, but no periodontal bone loss. Investigating periodontal inflammation in DS children could provide valuable insights into the deregulation of immune function in these patients.

Comparison of Oral Hygiene and Gingival Outcomes in Children With Special Care Needs Using Powered or Manual Toothbrushes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

AIM

This systematic review and meta-analysis (SRMA) compares oral hygiene and gingival outcomes in children with special care needs (CSCNs) using powered or manual toothbrushes.

MATERIAL AND METHODS

Two authors searched articles using PubMed and Cochrane library; the search was extended to other databases to include publications until July 2024. RCTs available in English were included. Oral hygiene and gingival outcomes in CSCNs, using powered or manual toothbrushes were: plaque index (PI), Quigley Hein plaque index (QHPI), gingival index (GI), and oral hygiene index simplified (OHI-S). ROB and publication bias was assessed using Cochrane tool and funnel plots, respectively. Meta-analyses were performed using forest plots. GRADE was used for the quality.

RESULTS

Twelve studies were included in SR and 11 studies in MA. In relation to GI and in the subgroup analysis of QHPI, powered toothbrushing was superior to manual toothbrushing with SMD -0.681 [95% CI (-0.911 to -0.451)] and SMD -0.85 [95% CI (-1.166 to -0.53)], respectively using REM. Comparisons with other indices exhibited no significant differences. The ROB and publication bias were moderate, quality of evidence was low to moderate GRADE.

CONCLUSION

Powered toothbrushes had favorable outcomes in a few but not all parameters. The overall quality of evidence is low.

PROSPERO REGISTRATION ID

CRD42024579260.

Efficacy of periodontal treatment modalities in Down syndrome patients: a systematic review and meta-analysis

OBJECTIVE

The systematic review aimed to review the existing evidence, to identify and appraise the effectiveness of periodontal prevention and treatment modalities in individuals diagnosed with Down syndrome (DS) and to determine the estimates of the effects of implemented periodontal prevention and treatment strategies compared to chromosomally normal (CN) individuals.

METHODOLOGY

The systematic review was conducted and reported in conformity with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The study protocol was registered in the Open Science Framework. Electronic and manual searches, in accordance with PICO framework and delineated inclusion/exclusion criteria, were conducted in multiple databases.

RESULTS

The initial search identified 11,704 studies. After removing duplicates, 9,048 remained. Title and abstract screening narrowed these to 281 for full-text review. Ultimately, 16 studies met the inclusion criteria, with 4 eligible for quantitative data synthesis. Results of the meta-analysis indicated that professional tooth cleaning in combination with oral hygiene reinforcement was less effective in the reduction of PPD in patients with DS compared to those without DS (Mean difference (MD): 0.23; 95% Confidence Interval (CI): 0.14 to 0.32; p < 0.001).

DISCUSSION

These findings suggest that conventional periodontal treatment is less effective in managing periodontitis in patients with DS. Thus, tailored periodontal care strategies that address the specific needs of individuals with DS should be implemented to improve treatment outcomes for this population The presence of moderate to high risk of bias in the included studies underscores the need for rigorously designed research that minimizes bias through effective blinding, randomization, control of confounding factors, and inclusion of diverse treatment outcomes to further investigate these associations.

CONCLUSION

Based on the best available evidence, professional tooth cleaning combined with oral hygiene instructions appears to be less effective in reducing pocket depths in individuals with DS compared to those without DS. https://doi.org/10.17605/OSF.IO/UXTCG.

Oral hygiene changes & compliance with telemonitoring device in individuals with intellectual/developmental disabilities: a randomized controlled crossover trial

OBJECTIVE

Advances in mobile technology are helping with health management practices, and smart toothbrushes provide proper dental care by collecting and analyzing users' toothbrushing data. The purpose of this study is to assess the effect of a telemonitoring device on oral hygiene management in individuals with intellectual or developmental disabilities and its role in promoting oral health.

MATERIALS AND METHODS

Participants were split into two groups: one initially using the telemonitoring device (telemonitoring device/manual toothbrush) and the other using it later (manual toothbrush/telemonitoring device), with a one-month washout period. The study compared plaque index, halitosis, changes in oral microbiota, and guardian questionnaire responses between the groups.

RESULTS

In period 1, the QHI index score significantly decreased from 1.93 to 0.83 in the group using the remote monitoring device, compared to an increase from 1.75 to 2.01 in the manual toothbrush group. Additionally, toothbrushing frequency, time, and cooperation increased by 0.82 ± 0.60, 0.82 ± 1.16, and 1.09 ± 0.94, respectively, with initial telemonitoring device use. However, these measures decreased by -1.45 ± 0.68, -1.09 ± 0.70, and - 1.00 ± 1.00 after switching to a manual toothbrush, and decreased by -0.64 ± 0.67, -0.27 ± 1.19, and 0.09 ± 0.94 overall, respectively. However, there were no significant differences in oral microbiota between the groups at these different time points.

CONCLUSIONS

The study shows that telemonitoring devices effectively reduce plaque index and improve toothbrushing frequency, time, and cooperation. However, these benefits decrease after switching to a manual toothbrush. Follow-up is needed to assess satisfaction and compliance with telemonitoring device use.

CLINICAL RELEVANCE

Using telemonitoring devices in the oral health management of individuals with intellectual and developmental disabilities can improve their oral health quality.

Periodontal Management in Periodontally Healthy Orthodontic Patients with Fixed Appliances: An Umbrella Review of Self-Care Instructions and Evidence-Based Recommendations

The present umbrella review aimed to characterize periodontal self-care instructions, prescriptions, and motivational methods; evaluate the associated periodontal outcomes; and provide integrated, evidence-based recommendations for periodontal self-care in periodontally healthy orthodontic patients with fixed appliances. The presently applied study protocol was developed in advance, compliant with the PRISMA statement, and registered on PROSPERO (CRD42022367204). Systematic reviews published in English without date restrictions were electronically searched until 21 November 2022 across the PROSPERO Register and Cochrane Library, Web of Science (Core Collection), Scopus, and MED-LINE/PubMed databases. The study quality assessment was conducted through the AMSTAR 2 tool. Seventeen systematic reviews were included. Powered and manual toothbrushes showed no significant differences in biofilm accumulation, although some evidence revealed significant improvements in inflammatory, bleeding, and periodontal pocket depth values in the short term with powered toothbrushes. Chlorhexidine mouthwashes, but no gels, varnishes, or pastes, controlled better biofilm accumulation and gingival inflammation as adjuncts to toothbrushing, although only for a limited period. Organic products, such as aloe vera and chamomile, proved their antimicrobial properties, and herbal-based mouthwashes seemed comparable to CHX without its side effects. Motivational methods also showed beneficial effects on periodontal biofilm control and inflammation, while no evidence supported probiotics administration.

Powered Toothbrushes: An Opportunity for Biofilm and Gingival Inflammation Control

The present review aimed at a broad investigation on the potential of powered as compared to manual toothbrushes in different aspects of clinical dentistry. Studies evaluating plaque and gingival inflammatory parameters were included, as well as those that investigated adverse effects. Emphasis was given separately to adults, youngsters, special-needs patients, and those under fixed orthodontic therapy. In general, comparisons favored powered toothbrushes. In summary, approximately 68% of the included studies, in terms of plaque/gingival inflammation in adults, presented better results for powered toothbrushes. In children and special-needs populations, approximately 40% of the included studies favored powered toothbrushes for plaque/gingival inflammation, and none favored manual ones. In orthodontic individuals, 50% of the studies also demonstrated a better effect of powered toothbrushes on plaque and gingival inflammation. All included studies that assessed adverse events did not demonstrate a difference in these effects when comparing manual vs. powered toothbrushes. It is concluded that the use of powered toothbrushes is an opportunity to enhance patterns of plaque control and associated gingival inflammation.