Stabilized stannous fluoride dentifrice in relation to dental caries, dental erosion and dentin hypersensitivity: A systematic review

PURPOSE

To review the scientific evidence for the efficacy of stabilized stannous fluoride (SnF₂) dentifrice in relation to dental caries, dental erosion and dentin hypersensitivity.

METHODS

Medline OVID, Embase.com, and the Cochrane Library were searched until January 2018. Two researchers independently selected studies according to inclusion and exclusion criteria, data were extracted, the risk of bias in eligible studies was assessed and a meta-analysis was performed wherever feasible.

RESULTS

Three studies on dental caries, eight studies on dental erosion and 11 on dentin hypersensitivity were included. Risk of bias was judged as high for most of the caries and erosion studies and low or medium for the hypersensitivity studies. A similar or slightly higher anti-caries activity compared with non-stannous fluoride dentifrices was observed. Stannous fluoride showed a greater anti-erosive potential in seven of the eight studies. A mean difference score in favor of stannous fluoride dentifrices compared with controls was found in a meta-analysis including six 8-week hypersensitivity studies.

CLINICAL SIGNIFICANCE

The use of stabilized stannous fluoride dentifrices to relieve dentin hypersensitivity and to prevent the initiation of dental erosion speaks in favor of this treatment strategy.

Effects of stabilized stannous fluoride dentifrice on dental calculus, dental plaque, gingivitis, halitosis and stain: A systematic review

Objectives

The aim of the present systematic review was to examine the scientific evidence for the efficacy of stabilized stannous fluoride (SnF₂) dentifrice in relation to dental calculus, dental plaque, gingivitis, halitosis and staining.

Data and sources

Medline OVID, Embase.com, and the Cochrane Library were searched from database inception until June 2017. Six researchers independently selected studies, extracted data, and assessed methodological quality. A meta-analysis of the 6-month gingivitis studies was done. Risk of bias was estimated using a checklist from the Swedish Agency for Health Technology Assessment (SBU, 2018).

Study selection

Two studies on dental calculus, 21 on dental plaque and gingivitis, 4 on halitosis, and 5 on stain met the inclusion criteria. Risk of bias was high for the studies on dental calculus, halitosis, and stain, and varied for the dental plaque and gingivitis studies. Significant reductions in dental calculus and in halitosis were reported for the SnF₂ dentifrice; no differences in stain reduction were noted. A meta-analysis on gingivitis found better results for the SnF₂ dentifrice compared to other dentifrices, though the results of the individual trials in the meta-analyses showed a substantial heterogeneity.

Conclusions

The present review found that stabilized SnF₂ toothpaste had a positive effect on the reduction of dental calculus build-up, dental plaque, gingivitis, stain and halitosis. A tendency towards a more pronounced effect than using toothpastes not containing SnF2 was found. However, a new generation of well conducted randomized trials are needed to further support these findings.

Clinical relevance

Adding a SnF₂ toothpaste to the daily oral care routine is an easy strategy that may have multiple oral health benefits.

Polyhexamethylene guanidine phosphate irrigation as an adjunctive to scaling and root planing in the treatment of chronic periodontitis

OBJECTIVE

To evaluate the efficacy of adjunctive polyhexamethylene guanidine (PHMG) phosphate irrigation in periodontal treatment.

MATERIALS AND METHODS

The subjects comprised 59 patients with severe chronic periodontitis. Plaque index, bleeding on probing (BOP) and pocket probing depths (PPD) were recorded. The subjects were randomly allocated to one of three groups for scaling and root planning, with different adjunctive irrigants: 1% PHMG phosphate (19 subjects), 0.2% chlorhexidine (21 subjects) and distilled water (19 subjects). Patients were recalled after two weeks, one month and then after 4, 6 and 12 months.

RESULTS

In all groups, treatment resulted in considerable improvement of the observed clinical parameters. There were no intergroup differences in plaque index and BOP at any time point, but significant differences in PPD at one, four and six months. By the end of the study no intergroup differences in PPDs persisted. While post study surgical treatment needs decreased in all three groups, no intergroup differences were observed in the number of deep periodontal pockets.

CONCLUSIONS

Irrigation with PHMG phosphate significantly reduces PPDs in the short-term, but has no significant long-term effect on the mean pocket depth.

Prevalence of halitosis in elderly living in nursing homes

OBJECTIVES

Halitosis is a concern for many people, but has sparsely been studied in elderly living in nursing homes. The aim of this investigation was to study the prevalence of halitosis in this particular group and factors that could be associated with this condition.

METHOD AND MATERIALS

One hundred and twenty-four residents at three different nursing homes were included in the study. The level of halitosis was assessed using an organoleptic method based on a 6-graded scale. Oral status, including registrations of plaque, gingivitis and assessment of hyposalivation, was performed by two investigators who both examined all patients. Medical history, that is medication, neurological conditions, diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD)/asthma, dementia and mental illness, was obtained from the patient files. Registrations of the use of oral hygiene aids, ADL (Activity of Daily Life) and the frequency of contact with dental services were included in the clinical examination.

RESULTS

Halitosis occurred in over 50% of residents living in nursing homes and was found to be associated with the presence of hyposalivation, periodontal disease, calculus, fixed prosthodontics and dementia.

CONCLUSION

Halitosis was a common finding in the elderly living in Swedish nursing homes.

A randomized controlled cross-over study of the effect of alcohol-free chlorhexidine and essential oils on interleukin-1 levels in crevicular fluid

Aim of the study was to determine the effect of an alcohol-free chlorhexidine mouth rinse and an essential oils containing mouth rinse on pro-inflammatory cytokine levels in gingival crevicularfluid in participants who continue to perform their regular mechanical oral hygiene regimes and normal dietary practice. Twenty adult volunteers (mean age: 59 years) participated in the double-blind randomised controlled cross-over study.Three mouth rinses were used during 16-day periods as an adjunctiveto regular mechanical oral hygiene: a solution with alcohol-free chlorhexidine (CHX; Paroex), a solution with essential oils (EO; Listerine), and water (negative control).The mouth rinse periods were separated by 3-month washout periods. At days o (baseline) and 17 (end) of each mouth rinse period, gingival crevicular fluid (GCF) was collected at different tooth sites and analyzed with ELISA technique for IL-1α, IL-1β and IL-ira levels. No significant correlations between clinical parameters (QHI and GI) and cytokine concentra- tions were observed, regardless of mouth rinse regimen.The generalized linear models revealed that none of the mouth rinses had a statistically significant impact on IL-1 concentrations in GCF. Large inter-individual variations were observed for the levels of IL-iα, IL-1β and IL-ira. Also the changes in concentrations between day o and day 17fo r the mouthrinses showed large intra-individual variations. It can be concluded that neither the alcohol-free chlorhexidine nor the mouth rinse contain- ing essential oils reduced the levels of IL-iα, IL1β and IL-ira in GCF.

Antimicrobial activity of polyhexamethylene guanidine phosphate in comparison to chlorhexidine using the quantitative suspension method

Background

Polyhexamethylene guanidine phosphate (PHMG-P) belongs to the polymeric guanidine family of biocides and contains a phosphate group, which may confer better solubility, a detoxifying effect and may change the kinetics and dynamics of PHMG-P interactions with microorganisms. Limited data regarding PHMG-P activity against periodontopathogenic and cariogenic microorganisms necessitates studies in this area. Aim is to evaluate polyhexamethylene guanidine phosphate antimicrobial activity in comparison to chlorhexidine.

Methods

Quantitative suspension method was used enrolling Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Candida albicans, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus mutans and Lactobacillus acidophilus.

Results

Both tested antiseptics at their clinically-used concentrations, of 0.2% (w/v) and 1% (w/v), correspondingly provided swift bactericidal effects against S. aureus, P. aeruginosa, E. coli andC. albicans, A. actinomycetemcomitans and P. gingivalis with reduction factors higher than 6.0. Diluted polyhexamethylene guanidine phosphate and chlorhexidine to 0.05% continued to display anti-bacterial activity and decreased titers of standard quality control, periopathogens to below 1.0 × 10³ colony forming units/ml, albeit requiring prolonged exposure time. To achieve a bactericidal effect against S. mutans, both antiseptics at all concentrations required a longer exposure time. We found that a clinically-used 1% of polyhexamethylene guanidine phosphate concentration did not have activity against L. acidophilus.

Conclusion

High RF of polyhexamethylene guanidine phosphate and retention of bactericidal effects, even at 0.05%, support the use of polyhexamethylene guanidine phosphate as a biocide with sufficient anti-microbial activity against periopathogens. Polyhexamethylene guanidine phosphate displayed bactericidal activity against periopathogens and S. mutans and could potentially be applied in the management of oral diseases.

Electronic supplementary material

The online version of this article (doi:10.1186/s12941-015-0097-x) contains supplementary material, which is available to authorized users.

A randomized controlled clinical study of the effect of daily intake of Ascophyllum nodosum alga on calculus, plaque, and gingivitis

OBJECTIVE

The aim of this study is to evaluate, in a randomized controlled cross-over study, the effect of daily intake of the alga Ascophyllum nodosum on supragingival calculus, plaque formation, and gingival health over a 6-month period.

MATERIAL AND METHODS

Sixty-one adults with moderate to heavy calculus formation since their last yearly recall visit participated. In a randomized order over two 6-month periods, they swallowed two capsules daily, comprising a total of 500 mg dried marine alga powder (Ascophyllum nodosum, ProDen PlaqueOff®) or two negative control tablets. During the study, the participants maintained their regular oral habits. Their teeth were professionally cleaned at the start of each period and after the 6-month registrations. A wash out period of 1 month separated the two 6-month periods. Supragingival calculus (Volpe Manhold), gingivitis (Löe and Silness), gingival bleeding (Ainamo and Bay), and plaque (Quigley-Hein) were registered at screening and at the end of the two periods. Differences in oral health between the test and control periods were analyzed using a paired t test and Wilcoxon signed rank test.

RESULTS

Fifty-five participants completed the study. After the alga intake, the mean calculus reduction was 52% compared to the control (p < 0.0001). Fifty-two participants showed less calculus formation in the alga group than in the control group. Plaque (p = 0.008) and gingival bleeding (p = 0.02) were also significantly less in the alga group. However, no significant difference was found between the groups for gingivitis (p = 0.13).

CONCLUSIONS

The alga intake significantly reduced the formation of supragingival calculus and plaque and occurrence of gingival bleeding. The alga has a systemic effect on oral health.

CLINICAL RELEVANCE

Daily intake of the alga Ascophyllum nodosum as an adjunct to customary oral hygiene showed a major reduction of supragingival calculus formation and reduced plaque formation. In addition, the calculus in the alga group was characterized by a more porous and less solid structure and was easier to remove than the calculus in the control group.

Effect of cleansing of biofilm formed on titanium discs

OBJECTIVES

To study the combined effect of mechanical and chemical cleansing on a 4-day biofilm grown intra-orally on titanium discs with different surface characteristics.

MATERIAL AND METHODS

Twenty subjects used a splint with two metal plates in the upper jaw. Each plate was placed in the premolar-molar region and carried four titanium discs with four different surface characteristics (OsseoSpeed(™), TiOblast(™), experimental and turned surface). After 4 days of biofilm growth, the discs were cleaned mechanically and chemically with saline or chlorhexidine. Following cleansing, microbial samples were obtained and analysed by culture. The titanium discs were processed for scanning electron microscope (SEM) analysis. The experiment was repeated 3 days later using delmopinol or a mixture of essential oils during cleansing.

RESULTS

The combination of mechanical and chemical cleansing was ineffective in complete biofilm removal from all four titanium discs. The microbiological analysis did not reveal any statistically significant differences between surface types or between cleaning agents regarding logarithmic mean counts of CFU for specific bacteria, aerobes, anaerobes or the TVC. Aerobes were more numerous than anaerobes on all surface types. The SEM analysis disclosed that the remaining biofilm on moderately rough surfaces (OsseoSpeed(™), TiOblast(™) and experimental) was complex and firmly attached, while the biofilm on turned surface had a pattern of spread bacteria forming less clusters.

CONCLUSIONS

Cleansing may call for prolonged time of chemomechanical debridement and/or more effective disinfectants to suppress biofilms on dental implant surfaces.

The effect of a dentifrice containing Magnolia extract on established plaque and gingivitis in man: a six-month clinical study

AIM

The aim was to evaluate the clinical effect of a dentifrice containing 0.3% Magnolia extract on dental plaque and gingivitis.

MATERIAL AND METHODS

The trial was a 6-month double-blind, stratified, randomized and 2-armed parallel group study. Forty-six subjects in the test group brushed their teeth with a dentifrice containing 0.3% Magnolia extract and 48 subjects in the control group brushed with a placebo dentifrice. Plaque and gingivitis were assessed at baseline, 3 and 6 months.

RESULTS

There was a significantly larger gingivitis reduction in the Magnolia group than in the control group (0.26 ± 0.11 versus 0.11 ± 0.12) (P < 0.001). There was a greater increase in the total number of healthy gingival units Gingival Index (GI score 0) in the Magnolia group than in the control group (149% versus 31%) and a larger reduction in inflamed gingival units (GI score 2/3) (60% versus 30%). Furthermore, at sites with similar amounts of plaque, less clinical signs of gingival inflammation were observed in the Magnolia group than in the control group.

CONCLUSION

Six months' unsupervised use of a dentifrice containing 0.3% Magnolia extract resulted in significantly greater gingivitis reduction than a corresponding control dentifrice.

Clinical and biological indicators of dental caries and periodontal disease in adolescents with or without obesity

OBJECTIVE

This study aims to assess clinical, microbiological and inflammatory parameters as indicators for caries and periodontal disease in adolescents with obesity.

MATERIAL AND METHODS

Twenty-seven adolescents with obesity [body mass index (BMI) 37 ± 4 kg/m(2)] and 28 controls (BMI 20 ± 2 kg/m(2)) answered questionnaires and were investigated regarding salivary parameters, plaque pH drop after a 1-min glucose rinse, oral clinical parameters, inflammatory markers in gingival crevicular fluid (GCF) and sub-gingival mirobiota.

RESULTS

Compared with controls, adolescents with obesity had a lower stimulated salivary secretion rate (1.55 ± 0.63 vs. 2.05 ± 1.05 mL/min, p < 0.05), higher concentrations of secretory immunoglobulin A (sIgA) (p < 0.001), more decayed tooth surfaces (3.4 ± 6.6 vs. 0.8 ± 1.1, p < 0.05) and more gingivitis (p < 0.01) after controlling for possible confounders. Overall, similar snacking habits, plaque amounts and numbers of deep periodontal pockets were observed. Following the glucose rinse, a slightly more pronounced drop in plaque pH was observed in the obesity group (p > 0.05). No differences in sub-gingival inflammatory or microbial indicators were detected (p > 0.01).

CONCLUSIONS

More caries and gingival inflammation were observed in adolescents with obesity. Of the indicators tested, salivary secretion rate was lower and sIgA levels were higher in the obesity group. We are unable to confirm whether differences in caries and gingival inflammation are due to systemic changes that are associated with obesity or due to possible irregular dietary/oral hygiene habits.

CLINICAL RELEVANCE

Customised oral health preventive programmes and appropriate collaboration with medical personnel in selecting the best diet, medication and psychological support can help improve the general well-being, including oral health, of children with obesity. This may even reduce the risk of oral diseases.

Label-free quantitative proteomics reveals differentially regulated proteins in experimental gingivitis

We investigated the sequential protein expression in gingival crevicular fluid samples during the induction (I) and resolution (R) of experimental gingivitis. Periodontally and systemically healthy volunteers (n = 20) participated in a three-week experimental gingivitis protocol, followed by debridement and two weeks of regular plaque control. Gingival crevicular fluid (GCF) samples were collected at baseline, Day 7, 14, and 21 (induction; I-phase), and at Day 21, 25, 30, and 35 (resolution; R-phase). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) for label-free quantitative proteomics was applied. A total of 287 proteins were identified including 254 human, 14 bacterial, 12 fungal, and 7 yeast proteins. Ontology analysis revealed proteins primarily involved in cytoskeletal rearrangements, immune response, antimicrobial function, protein degradation, and DNA binding. There was considerable variation in the number of proteins identified, both among subjects and within subjects across time points. After pooling of samples between subjects at each time point, the levels of 59 proteins in the I-phase and 73 proteins in the R-phase were quantified longitudinally. Our data demonstrate that LC-MS/MS label-free quantitative proteomics is valuable in the assessment of the protein content of the GCF and can facilitate a better understanding of the molecular mechanisms involved in the induction and resolution of plaque-induced gingival inflammation in humans.

Oral health in young adults with long-term, controlled asthma

OBJECTIVE

To study oral health in young adults with long-term, controlled asthma.

MATERIAL AND METHODS

Twenty 18- to 24-year-olds with a mean duration of asthma of 13.5 [standard deviation (SD) 5.4] years and 20 matched healthy controls were included. A clinical examination was performed and the prevalences of caries, erosions, gingival inflammation, cervicular fluid and periodontal pockets and the plaque formation rate were registered. The salivary flow rate and the numbers of mutans Streptococci and Lactobacilli in saliva were determined. Plaque pH was measured after a sucrose rinse for up to 40 min at two approximal sites. The participants were interviewed regarding dietary and oral hygiene habits.

RESULTS

The mean (SD) DFS, including manifest and initial caries, was 8.6 (10.6) in the asthma group and 4.0 (5.2) in the control group (P = 0.09). Initial caries lesions were more common in the asthma group than in the control group: 6.0 (8.1) and 1.3 (2.0), respectively (P = 0.02). The asthma group had more gingivitis (P = 0.01) and a lower stimulated salivary secretion rate than the controls (P = 0.01). The asthmatics also had a somewhat, although not statistically significant, lower initial pH value in plaque and a more pronounced pH drop compared with the controls. In the asthma group, 65% reported frequent mouthbreathing, compared with 10% of the controls (P = 0.01). No differences were found in tooth-brushing or dietary habits between the groups.

CONCLUSION

Young adults with long-term, controlled asthma had more initial caries, more gingival inflammation and a lower stimulated salivary secretion rate than individuals without asthma.

Gingival tissue transcriptomes in experimental gingivitis

AIMS

We investigated the sequential gene expression in the gingiva during the induction and resolution of experimental gingivitis.

MATERIAL AND METHODS

Twenty periodontally and systemically healthy non-smoking volunteers participated in a 3-week experimental gingivitis protocol, followed by debridement and 2-week regular plaque control. We recorded clinical indices and harvested gingival tissue samples from four interproximal palatal sites in half of the participants at baseline, Day 7, Day 14 and Day 21 (the "induction phase"), and at Day 21, Day 25, Day 30 and Day 35 in the other half (the "resolution phase"). RNA was extracted, amplified, reversed transcribed, amplified, labelled and hybridized using Affymetrix Human Genome U133Plus2.0 microarrays. Paired t-tests compared gene expression changes between consecutive time points. Gene ontology analyses summarized the expression patterns into biologically relevant categories.

RESULTS

The median gingival index was 0 at baseline, 2 at Day 21 and 1 at Day 35. Differential gene regulation peaked during the third week of induction and the first 4 days of resolution. Leucocyte transmigration, cell adhesion and antigen processing/presentation were the top differentially regulated pathways.

CONCLUSIONS

Transcriptomic studies enhance our understanding of the pathobiology of the reversible inflammatory gingival lesion and provide a detailed account of the dynamic tissue responses during the induction and resolution of experimental gingivitis.

Effect of post-brushing mouthrinse solutions on salivary fluoride retention

Fluoride (F) toothpaste is one of the most effective means of caries prevention. There is also evidence that mouthrinse solutions with antimicrobial agents reduce plaque formation and gingivitis and may be used as adjuncts to daily self-performed oral hygiene for risk patients. The authors hypothesize that using these solutions--without or with just a low F concentration after brushing--will have a "wash-out" effect on F toothpaste. Mouthrinse solutions with more F might be beneficial in this respect. Two groups of 10 (Series 1) and 12 (Series II) healthy subjects were recruited. They brushed for 1 min with toothpastes containing either 1450 or 5000 ppm F. After brushing and spitting out the toothpaste, the participants in Series I rinsed for 30 sec with 10 ml of a variety of products with various F concentrations (0, 100, 226 or 900 ppm F). In Series II, they first rinsed with water after the brushing and directly thereafter with 20 ml of the post-brushing rinsing solution for 30 sec. Saliva samples in both series were collected at different time points up to 1 h and the F concentration was measured. There was significantly less F in saliva after rinsing with no F or with a low F concentration (100 ppm) compared with just brushing with a F toothpaste. Rinsing with 226 ppm F displayed significantly higher F concentrations in saliva compared with only toothbrushing. Products with a high F concentration (i.e. toothpaste with 5000 ppm F or a mouthrinse solution with 900 ppm F) produced the highest F retention in saliva compared with all other protocols. The quantity of mouthrinse solution (20 vs. 10 ml) did not seem to have any effect on the F retention. The results from both test series show that a post-brushing rinsing solution without F or with just 100 ppm F exerts a "wash-out" effect on toothbrushing with either 1450 or 5000 ppm F, which may be negative for all patients, especially those with a risk of caries. The general population will benefit more from higher concentrations of F in mouthrinse solutions and, based on the results of the present investigation, 226 ppm F (corresponding to 0.05% NaF) should be the lowest concentration used. Furthermore, caries risk patients are recommended to use a high-F toothpaste (5000 ppm F) or a post-brushing mouthrinse solution with 900 ppm F (corresponding to 0.2% NaF).

The effect of a triclosan dentifrice on mucositis in subjects with dental implants: a six-month clinical study

OBJECTIVE

The objective of the present clinical study was to assess the effect of the use of a dentifrice containing triclosan on peri-implant mucositis in subjects that had been restored with dental implants.

METHODS

The trial was designed as a double-blind, randomized, two-treatment, parallel-group clinical study. Sixty male and female subjects, aged 30-70 years, were recruited. All subjects had lost teeth due to periodontal disease, and had been restored with a minimum of two implants at least one year prior to the start of the trial. Subjects were randomly assigned to two treatment groups. The subjects in the test group (Test) brushed their teeth and implant-supported restorations with a dentifrice containing triclosan, while the control subjects brushed with a sodium fluoride dentifrice. Only subjects with a minimum of one implant site showing clinical signs of peri-implant mucositis, i.e., bleeding after probing, were enrolled in the study. Clinical examinations were performed at baseline, and after three and six months. The following parameters were scored: Probing pocket depth (PPD), bleeding on probing (BoP), and plaque. The change from baseline within each treatment group at three months and six months was evaluated for all parameters using ANOVA and ANCOVA.

RESULTS

Subjects with peri-implant mucositis who used a dentifrice containing 0.3% triclosan, as an adjunct to mechanical tooth brushing, exhibited significantly fewer clinical signs of inflammation than subjects who used a regular fluoride dentifrice at six months. The BoP scores were reduced from 53.8% to 29.1% in the Test group, whereas in the same interval there was an increase from 52.3% to 58.8% in the Control group. Furthermore, the individual mean PPD, as well as the frequency of sites with 5 mm and > or = 6 mm deep pockets, were reduced significantly more in the Test than in the Control group.

CONCLUSION

The regular use of a dentifrice containing triclosan may reduce the clinical signs of inflammation in the mucosa adjacent to dental implants.

Periodontal conditions in male adolescents using smokeless tobacco (moist snuff)

AIM

The aim of this study was to evaluate the potential association of the use of smokeless tobacco (moist snuff) on the periodontal conditions of adolescents.

MATERIAL AND METHODS

A subject sample of one hundred and three 19-year-old male individuals (33 snuff users, 70 controls) living in Göteborg, Sweden, were clinically examined with regard to oral hygiene, gingivitis, probing pocket depth (PPD), clinical attachment loss (CAL) and gingival recession. Bitewing radiographs were obtained for assessments of alveolar bone level. Information about tobacco and oral hygiene habits was obtained by a structured questionnaire. Student 's t-test, chi(2)-test and logistic regression analysis were used for statistical analysis.

RESULTS

The mean plaque and gingivitis scores in snuff-users were 59% (SD 21.0) and 47% (18.6), respectively, and in controls 64% (22.4) and 50% (18.3), respectively. The average PPD and CAL in snuff-users amounted to 2.3 mm (0.3) and 0.2 mm (0.1), respectively, and in controls 2.4 mm (0.3) and 0.1 mm (0.1) (p>0.05), respectively. The mean bone level was 1.3 mm (0.2) in both groups. The prevalence of subjects showing recession was 42% among snuff-users and 17% among controls (p=0.006). In snuff users, an average of 4% (0.9) of the teeth showed recession, compared with 1% (0.3) in controls (p<0.001). Limiting the analysis to the maxillary anterior tooth region, 33% of the snuff-users and 10% of the controls presented recessions (p=0.002). The use of snuff entailed an OR=5.1 to have gingival recessions.

CONCLUSION

In the present population sample of adolescents, the use of smokeless tobacco (moist snuff) was not associated with the presence of periodontal disease except for a significantly high prevalence of gingival recessions.

The effect of a mouth rinse containing phenolic compounds on plaque formation and developing gingivitis

BACKGROUND

The clinical effect of Listerine, a mouth rinse containing a mixture of phenolic compounds, is ascribed to its bactericidal properties. However, phenolic compounds are also known to interfere with the inflammatory process.

OBJECTIVE

The purpose of this clinical trial was to evaluate the effect of regular mouth rinsing with Listerine on plaque and gingivitis during a 2-week period of no mechanical oral hygiene.

MATERIAL AND METHODS

Twenty-one subjects were recruited for the study. On Day 0 of each 2-week experimental period, the participants were told to abstain from all mechanical plaque-control measures but to rinse twice a day with 10 ml of the assigned solution (test: Listerine, positive control:0.1% chlorhexidine (CHX), negative control: saline) for 60 s. Each experimental period was preceded by a 2-week period including oral hygiene instruction, scaling and professional mechanical tooth cleaning. Examinations included assessments of plaque and gingivitis (Days 0 and 14), sampling of plaque and collection of gingival crevicular fluid (GCF) (Days 0, 7 and 14). From the supragingival plaque samples, six different morphotypes of bacteria were counted using dark-field microscopy. The GCF collected was analysed with respect to the content of lactoferrin and albumin.

RESULTS

During the experimental periods, it was observed that significantly less plaque formed and less gingivitis developed when the participants rinsed with the Listerine mouthwash than with saline solution. However, significantly more plaque formed during the Listerine than during the CHX rinse period, while there was no significant difference in the development of gingival bleeding between the Listerine and the CHX rinse regimens. Significantly smaller proportions of motile rods and fusiforms were found in the List and CHX groups than in the control (Ctrl) group. The increase of the lactoferrin/albumin ratio in the List group was significantly smaller than that in the Ctrl group but significantly larger than in the CHX group.

CONCLUSION

It was suggested that the effect of Listerine on gingivitis is more pronounced than on plaque formation. This indicates that the phenolic compound may have anti-inflammatory effects.

The effect of systemic administration of ibuprofen in the experimental gingivitis model

BACKGROUND

Studies in humans have indicated that systemically administered flurbiprofen and ibuprofen may reduce gingivitis. De novo plaque formation is enhanced at tooth surfaces adjacent to inflamed gingivae.

OBJECTIVE

The aim of the present clinical trial was to evaluate the effect of systemic administration of ibuprofen on gingivitis and plaque build-up.

MATERIAL AND METHODS

Eleven subjects were recruited for the study and were given oral hygiene instruction, scaling and professional mechanical tooth cleaning (PTC). At the end of a preparatory period (Day 0), the participants were told to abstain from all mechanical plaque control measures during a 2-week experimental period but to rinse with an assigned mouth rinse (positive control: 0.1% chlorhexidine digluconate; negative control: saline) or administer ibuprofen (tablets of 200 mg twice daily). Mouth rinsing was performed twice a day (after breakfast and in the evening), for 60 s with 10 ml. Re-examination was performed after 14 days of experiment. After a 2-week "wash-out" period, the participants received a new PTC and a second 14-day experimental period was initiated. The experimental and "wash-out" periods were repeated until all volunteers had been involved in all three regimens. Dental plaque was scored using the Quigley & Hein Plaque Index system and gingivitis according to the Gingival Index (GI) system. Supragingival plaque was collected and prepared for dark-field microscopy. One hundred bacterial cells were counted and classified into six different groups: coccoid cells, straight rods, filaments, fusiforms, spirochetes and motile rods. Gingival crevicular fluid (GCF) was collected from the same sites that were sampled for plaque. The volume of GCF collected in each strip was measured and analysed regarding content of lactoferrin and albumin.

RESULTS

During the period when the panelists rinsed with saline they accumulated large amounts of plaque and developed marked signs of gingivitis. When they rinsed with chlorhexidine digluconate, small amounts of plaque formed and few sites received GI score > or =2. After the 2 weeks of ibuprofen administration, the panelists presented with significantly fewer sites that scored GI > or =2 but had formed similar amounts of plaque as during the negative control period.

CONCLUSION

It is suggested that ibuprofen administered via the systemic route has an effect on gingivitis but not on de novo plaque formation.

The effect of a chlorhexidine regimen on de novo plaque formation

OBJECTIVE

To evaluate the effect of a pretreatment regimen that combined meticulous mechanical tooth cleaning with the daily use of chlorhexidine (rinse, gargle and tongue application) on de novo plaque formation and on the recolonization of various microbiological species in plaque and saliva during a 4-day period of no oral hygiene.

MATERIAL AND METHODS

Ten subjects aged 24-36 years with gingivitis were recruited. The study was designed as a double blind cross-over clinical trial including two phases. Each experimental phase comprised one preparatory period of 7 days and one plaque accumulation period of 4 days. During the preparatory period, the volunteers (i) performed meticulous mechanical tooth cleaning using toothbrush and dentifrice and (ii) were, in addition, given two sessions of professional tooth cleaning (PTC) The final PTC was delivered after bacterial sampling had been made on Day 0. In the Control group, no additional plaque control measures were included. In the Test group, the participants in addition to the mechanical measures (i) rinsed twice daily, for 60 s each time with a 0.2% chlorhexidine solution, (ii) gargled twice daily for 10 s with the chlorhexidine preparation, and finally (iii) brushed the dorsum of the tongue for 60 s, twice daily, with a 1.0% chlorhexidine gel. During the 4-day plaque accumulation period, the participants abstained from all mechanical and chemical plaque control measures. On Days 0, 1, 2 and 4 the quantity and quality of plaque formed was assessed by clinical means and by DNA probe techniques. The microbiota of the saliva was studied in samples obtained on Days 0 and 4.

RESULTS

It was demonstrated that chlorhexidine used as a mouthrinse combined with gargling and tongue application during the preparatory period significantly retarded the amount of plaque that formed on tooth surfaces during the following 4 days of no oral hygiene. Further, the number of microorganisms present in the biofilm representing Days 0, 1 and 2 of the "plaque accumulation period" was apparently affected by the use of the antiseptic. Among the microorganisms influenced by the chlorhexidine regimen, a substantial number belonged to the genus Actinomyces. It was also observed that the adjunctive use of chlorhexidine reduced the number of bacteria present in saliva at the end of the preparatory period (i.e. on Day 0). After 4 days of no oral hygiene, the microbiota of the newly formed plaque in the Test and Control groups had many features in common.

CONCLUSION

Habitat is critical in controlling the bacterial composition of the dental biofilm. The microbiota will tend to go back to the one that is characteristic of a given subject, once chemical antimicrobial means are withdrawn.

Effect of various chlorhexidine regimens on salivary bacteria and de novo plaque formation

AIM

The aim of the present experiment was to study the effect of different chlorhexidine regimens on the number of bacteria in saliva, and on de novo plaque formation.

MATERIAL AND METHODS

Ten subjects with gingivitis, but no signs of destructive periodontitis, were recruited. Following a screening examination, the volunteers were given oral hygiene instruction, meticulous scaling and professional mechanical tooth cleaning (PTC). The PTC was repeated once every 3 days during a 2-week period to establish healthy gingival conditions. The study was designed as a double-blind cross-over clinical trial including three phases. Each experimental phase comprised one preparatory period of 7 days and one plaque accumulation period (no oral hygiene measures) of 4 days. During all preparatory periods, the volunteers (i) performed mechanical tooth cleaning using a toothbrush and dentifrice and (ii) were, in addition, given two sessions of PTC. The final PTC was delivered after bacterial sampling had been made on Day 0. Preparatory period A: the participants continued the self-performed plaque control regimen that employed only mechanical means. Preparatory period B: the participants were in addition instructed to rinse and gargle, twice daily, with a 0.2% chlorhexidine mouthrinse. Preparatory period C: in addition to the above, the participants were instructed to brush the dorsum of the tongue for 60 s, twice daily, with a 1.0% chlorhexidine gel. Following each plaque accumulation period, there was a 10-day washout interval. The presence and amount of dental plaque (QHI) was scored after 1, 2 and 4 days of no oral hygiene. Samples of saliva were obtained on Day 0 and after 1 and 2 days. The samples were placed on Brucella agar plates and incubated (anaerobically) for 5 days. The total number of colony-forming units was determined and used to estimate the density of bacteria in saliva.

RESULTS

In period A, the mean QHI increased from 1.0 (Day 1) to 1.4 (Day 2) and 2.1 (Day 4). The corresponding scores for periods B and C were 0.5, 0.8, 1.6 and 0.3, 0.8, 1.2, respectively. At all re-examination intervals more plaque formed during period A than during periods B and C. Further, during period C, less plaque formed than that during period B. Saliva samples from Day 0 in period A contained a larger number of TVC than the baseline samples in periods B and C. There was no significant difference in TVC among the groups on Day 2.

CONCLUSION

The daily use of chlorhexidine as an adjunct to mechanical tooth cleaning markedly reduced the number of microorganisms that could be detected in saliva. The number of salivary bacteria may have influenced the amount of plaque that formed during an early phase of no oral hygiene.

Bacterial colonization during de novo plaque formation

OBJECTIVE

To determine microbial changes that occur during plaque formation in a dentition free of gingival inflammation.

MATERIAL AND METHODS

Ten subjects were recruited. The study included one preparatory period (2 weeks) and a plaque accumulation period (4 days). The volunteers exercised proper tooth cleaning methods, were scaled and received repeated professional mechanical tooth cleaning during the preparatory period. During the plaque accumulation period, the participants abstained from plaque control measures. Plaque was scored on the approximal surfaces of maxillary and mandibular premolars on Days 0, 1, 2 and 4 using a scale from 0 to 5 and according to the criteria of the Quigley and Hein Plaque Index (QHI). Supragingival plaque samples were obtained from the same intervals and surfaces and evaluated using a checkerboard DNA-DNA hybridization technique.

RESULTS

The mean QHI increased from 0 to 1.6 (Day 4). The total number of organisms on Day 0 averaged 140 x 10(5) and increased to about 210 x 10(5) after 4 days without oral hygiene. The most dominant species on Day 0 were members of the genus Actinomyces. These organisms comprised almost 50% of the microbiota evaluated. None of the Actinomyces species increased significantly during the 4 days. Some Streptococcus species increased significantly over time as well as species of the genera Capnocytophaga, Campylobacter, Fusobacteria and Actinomyces actinomycetemcomitans.

CONCLUSION

In the present investigation, the preparatory phase established a situation with minimal gingival inflammation and close to zero amounts of dental plaque. The Day 0 plaque samples exhibited high proportions of Actinomyces species. During the 4 days of no oral hygiene, there was a small increase in total numbers of organisms as well as a modest increase in the proportion of "disease-associated" taxa such as species of the "orange complex" species.

The effect of systemic antibiotics in the treatment of patients with recurrent periodontitis

BACKGROUND

Subjects with periodontal disease exist who either (i) respond poorly to initial mechanical therapy ("refractory" periodontitis) or (ii) fail to adopt adequate self-performed plaque control techniques and hence develop recurrent disease ("recurrent" periodontitis) at multiple sites during the supportive treatment phase (SPT). Various systemic antibiotic regimens have been tried as adjuncts to the mechanical (re-) treatment of such "difficult to treat"-patients. While most studies indicated a positive outcome of the adjunctive therapy, some clinical investigators reported that this additional measure provided little or no benefit.

AIM

The aim of the present investigation was to study the more long term effect of adjunctive antibiotic therapy in the re-treatment of patients with a well defined history of recurrent periodontitis.

MATERIAL AND METHODS

17 subjects with recurrent advanced periodontal disease were, following a baseline examination, subjected to non-surgical therapy including the use of systemic antibiotics (amoxicillin and metronidazole). They were placed in a careful SPT program and re-examined after 1, 3 and 5 years. The examinations included both clinical and microbiological assessments.

RESULTS

It was demonstrated that in subjects with advanced and recurrent periodontitis, re-treatment including (i) comprehensive scaling and root planing (SRP), (ii) systemic administration of antibiotics and (iii) meticulous supragingival plaque control by both mechanical and chemical means established periodontal conditions that in the short term (3 years) and in the majority of subjects could be properly maintained by traditional SPT measures. Between 3 and 5 years, however, only 5 of the 17 subjects exhibited stable periodontal attachment levels.

CONCLUSIONS

Some deep pockets and furcations were most likely inadequately instrumented during the active treatment phase. Microorganisms residing in biofilms left in such locations were probably not sufficiently affected by the 2 weeks of adjunctive antibiotic therapy. It is suggested that removal of certain subgingival deposits, therefore, may require surgical intervention.

The long-term effect of systemic tetracycline used as an adjunct to non-surgical treatment of advanced periodontitis

AIM

In the present study both the short- and the long-term effects were evaluated of a treatment that, during the phase of basic therapy, included administration of systemic tetracycline and non-surgical intervention.

MATERIAL AND METHODS

35 adult human subjects with advanced periodontitis, 19 females and 16 males, aged between 24 and 60 years, were included in a test group. 80 age- and sex-matched adult periodontitis subjects were recruited for a control group (42 females and 38 males). A baseline examination included assessment of the following parameters: number of teeth, plaque, bleeding on probing, probing attachment level, probing pocket depth. In radiographs, the distance between the cemento-enamel junction and the alveolar bone crest was determined at all interproximal sites. The subjects were given oral hygiene instruction. The members of the test group were provided with tablets with 250 mg of tetracycline hydrochloride and were instructed to take 1 tablet 4x per day for a period of 3 weeks. No antibiotic was given to the subjects in the control group. During the 3-week interval, all participants received 4-6 sessions of non-surgical periodontal therapy. All subjects were subsequently enrolled in a maintenance care program and were provided with supportive periodontal therapy (SPT) 3-4x per year. Clinical re-examinations were performed after 1, 3, 5 and 13 years.

RESULTS

The present investigation demonstrated that tetracycline administered during a 3-week period concomitant with non-surgical treatment enhanced the outcome of mechanical therapy. At the re-examination 1 year after active therapy, there was in the test group an average gain in probing attachment that was almost 3x higher than the gain that occurred in an age and sex matched Control group. Re-examinations after 3, 5, and 13 years of SPT disclosed that this short-term benefit was not maintained in the longer perspective.

CONCLUSION

The beneficial effect of systemically administered tetracycline on probing attachment level occurred in the first year post-therapy. Annual rates of probing attachment level change from 1 to 13 years did not differ between groups.

The use of PVP-iodine as an adjunct to non-surgical treatment of chronic periodontitis

OBJECTIVE

The present study was performed to assess the effect of topically-applied PVP-iodine, used as an adjunct both during basic non-surgical therapy and at re-treatment during the long-term maintenance of patients with advanced periodontal disease.

MATERIAL AND METHODS

223 patients with advanced destructive periodontitis were recruited. The participants met the following inclusion criteria: (i) a minimum of 8 non-molar teeth, (ii) probing pocket depth of > or = 6 mm at > or = 2 teeth in each dentate quadrant, and radiographic bone loss exceeding 40% at the same teeth. A baseline I examination included assessment of plaque, gingivitis, probing pocket depth (PPD), probing attachment level (PAL) and radiographic bone height (RxBL). Following baseline I, the patients were stratified into 2 treatment groups; 2 subjects out of 3 were included in a control group and 1 in a test group. All participants, on an individual basis, received a case presentation and were instructed in proper self-performed plaque control measures. Non-surgical therapy was performed by the use of an ultrasonic device. The instrumentation in the test group was combined with the administration of 0.1% PVP-iodine. All subjects were recalled for comprehensive examinations 3, 6 and 12 months (baseline II) after baseline I and then after 3, 5 and 13 years of maintenance therapy. PAL determinations were performed annually. Subjects (losers) who at the re-examinations after 1, 2 and 3 years of maintenance demonstrated an annual further loss of PAL > or = 2 mm at > or = 4 teeth were exited from the study and referred for re-treatment. There were 9 losers in the test and 31 in the control group. In addition, 8 subjects in the test and 25 subjects in the control group withdrew from the trial for reasons unrelated to the study. These 73 subjects were not included in the data presentation from the various examinations.

RESULTS

It was demonstrated that non-surgical periodontal therapy resulted in (i) improved gingival conditions, (ii) reduced PPD, (iii) gain in PAL. It was also documented that the topical application of 0.1% PVP-iodine in conjunction with the mechanical root debridement established conditions which further improved the outcome of therapy. This was evidenced by the fact that at the 3, 6, and 12 months re-examinations after baseline I, the test group had significantly lower mean PPD values and significantly more gain of PAL than the control group. During the 12 years of SPT, it was possible for most subjects in both groups to maintain shallow pockets and to avoid marked further loss of PAL. There were, however, a larger number of losers in the control than in the test group.

CONCLUSION

PVP-iodine, topically applied during subgingival instrumentation, may improve the outcome of non-surgical periodontal therapy.

Initial outcome and long-term effect of surgical and non-surgical treatment of advanced periodontal disease

AIM

A clinical trial was performed to determine (i) the initial outcome of non-surgical and surgical access treatment in subjects with advanced periodontal disease and (ii) the incidence of recurrent disease during 12 years of maintenance following active therapy.

MATERIAL AND METHODS

Each of the 64 subjects included in the trial showed signs of (i) generalized gingival inflammation, (ii) had a minimum of 12 non-molar teeth with deep pockets (> or =6 mm) and with > or =6 mm alveolar bone loss. They were randomly assigned to 2 treatment groups; one surgical (SU) and one non-surgical (SRP). Following a baseline examination, all patients were given a detailed case presentation which included oral hygiene instruction. The subjects in SU received surgical access therapy, while in SRP non-surgical treatment was provided. After this basic therapy, all subjects were enrolled in a maintenance care program and were provided with meticulous supportive periodontal therapy (SPT) 3-4 times per year. Sites that at a recall appointment bled on gentle probing and had a PPD value of > or =5 mm were exposed to renewed subgingival instrumentation. Comprehensive re-examinations were performed after 1, 3, 5 and 13 years of SPT. If a subject between annual examinations exhibited marked disease progression (i.e., additional PAL loss of > or =2 mm at > or =4 teeth), he/she was exited from the study and given additional treatment.

RESULTS

It was observed that (i) surgical therapy (SU) was more effective than non-surgical scaling and root planing (SRP) in reducing the overall mean probing pocket depth and in eliminating deep pockets, (ii) more SRP-treated subjects exhibited signs of advanced disease progression in the 1-3 year period following active therapy than SU-treated subjects.

CONCLUSION

In subjects with advanced periodontal disease, surgical therapy provides better short and long-term periodontal pocket reduction and may lead to fewer subjects requiring additional adjunctive therapy.

The use of a triclosan/copolymer dentifrice may retard the progression of periodontitis

The present investigation was performed to examine if triclosan and a copolymer, incorporated in a dentifrice and used by periodontitis-susceptible subjects could influence clinical symptoms characteristic of recurrent periodontitis. 60 subjects, 34 to 67 years of age, were recruited for the study. They were randomly selected from a group of patients previously treated for advanced periodontal disease. This treatment had included oral hygiene instruction, subgingival debridement, but no surgical therapy. The patients had, during a 3-5 year period following active therapy, been enrolled in a maintenance care program but had, at various intervals, exhibited signs of recurrent periodontitis. The patients were stratified into 2 balanced groups with respect to mean probing pocket depth. The test group, included 30 individuals who used a dentifrice containing triclosan/copolymer/fluoride, i.e. 0.3% triclosan, 2% copolymer and 1100 ppm F from 0.243% sodium fluoride (Colgate Total). The control group also included 30 subjects who used a dentifrice identical to the one used in the test group but without the triclosan/copolymer content. Following the baseline examination, including clinical and radiographical assessments, all volunteers received detailed information on how to brush their teeth in a proper way. This information was repeated on an individual need basis during the course of the subsequent 36 months. No professional subgingival therapy was delivered between the baseline and the 36-month examinations, but the subjects were recalled every 3 months. Re-examinations were performed after 6, 12, 24, and 36 months of the trial. A 2nd set of radiographs was obtained at the final examination, i.e., at 36 months. The results demonstrated that in subjects susceptible to periodontal disease, meticulous, self-performed, supragingival plaque control maintained over a 3-year period failed to prevent recurrent periodontitis. In a similar group of subjects and plaque control program, however, the daily use of a triclosan-containing dentifrice reduced (i) the frequency of deep periodontal pockets, and (ii) the number of sites that exhibited additional probing attachment and bone loss.

Effect of triclosan on the subgingival microbiota of periodontitis-susceptible subjects

The present study evaluated the long-term effect of (i) meticulous self-performed, supragingival plaque control and (ii) the use of a triclosan/copolymer containing dentifrice in adult subjects susceptible to destructive periodontitis. 40 individuals were recruited into the trial. 3-5 years prior to the baseline examination, they had all been treated by nonsurgical means- for advanced periodontal disease. During the subsequent maintenance phase, all subjects had at different time intervals exhibited sites with recurrent periodontitis. At a baseline examination, 6 surfaces per tooth were examined regarding bleeding on probing, probing pocket depth, and probing attachment level. The deepest pocket site in each quadrant (i.e. 4 sites per subject) was selected and samples of the subgingival bacteria were taken. At baseline, all volunteers received detailed information on proper oral hygiene techniques. This information was repeated on an individual need basis during the course of the subsequent 36-months. No professional subgingival therapy was delivered between the baseline and the 36-month examinations. The subjects were randomly distributed into 2 equal groups of 20 individuals each, 1 test and 1 control group. The members of the test group were supplied with a fluoridated dentifrice containing triclosan/copolymer (Total, Colgate), while the controls received a corresponding dentifrice but without triclosan/copolymer. The findings demonstrated that in subjects with advanced and recurrent periodontitis, carefully practiced supragingival plaque control had some effects on the subgingival microbiota, but also that this was insufficient to prevent disease progression. In a corresponding group of subjects, however, who used a triclosan/copolymer dentifrice, the subgingival microbiota was reduced in both quantitative and qualitative terms and recurrent periodontitis was almost entirely prevented.

Short-term effects of triclosan on healing following subgingival scaling

The present clinical trial was performed to evaluate short-term effects of a triclosan-containing dentifrice/gel combination on soft tissue healing, when applied supra-/sub-gingivally at periodontal sites treated with scaling and root planing. 16 subjects with moderate periodontitis participated in a 2x 2-week, split-mouth designed clinical trial. 2 combinations of gel/dentifrice (the test combination containing triclosan) were used. 2 pairs of contralateral sites with probing pocket depth (PPD) > or 5 mm, and which bled on probing (BoP +) were selected in each patient as experimental units. A baseline examination included assessments of PPD, BoP, gingival index scores, plaque index scores, and the composition of the subgingival microbiota (dark-field microscopy). The assigned quadrant was anaesthetized and the teeth exposed to meticulous scaling and root planing. Immediately after the completion of mechanical therapy, either the test or control gel was applied subgingivally at the experimental sites. The volunteer was instructed to brush his/her teeth with an assigned dentifrice and to apply the gel (via a custom-made stent) supra-gingivally 2x daily for the following 2 weeks. He/she was recalled on day 7 for a second professional subgingival gel application. Re-examinations were carried out on days 2, 7 and 14 after treatment. 1-week wash-out periods separated the 2 experimental periods. The mean PPD reductions (between days 0 and 14) were 1.8 mm and 1.9 mm for the test and control gel/dentifrice sites. The reduction in BoP and gingival index scores was significantly greater during the test than during the control regimen. No significant differences were observed between the 2 regimens regarding plaque scores and composition of the subgingival microbiota. The findings from the present investigation demonstrated that triclosan, applied both sub- and supra-gingivally reduced soft tissue inflammation following scaling and root planing.

Saliva mediated adherence, aggregation and prevalence in dental plaque of Streptococcus mutans, Streptococcus sanguis and Actinomyces spp, in young and elderly humans

Salivary components in the pellicle mediate bacterial adherence to the tooth. Such components may also aggregate bacteria in saliva and prevent them becoming established in dental plaque. In the present study, the adherence and aggregation of Streptococcus mutans strain Ingbritt, S. sanguis strain 10556 and Actinomyces viscosus-strain 19246 mediated by parotid and whole saliva from groups of young and elderly people were examined. Significant differences were found between test strains, salivary secretions and age groups. S. sanguis 10556 and A. viscosus 19246 generally adhered more strongly than S. mutans Ingbritt, which adhered better to pellicles from parotid saliva than from whole saliva Strain 19246 bound in higher numbers to parotid saliva pellicles from elderly compared to young individuals. Strain 10556 adhered better to whole saliva than parotid saliva pellicles, and the difference was significant among the young individuals, indicating reduced adherence ability in elderly whole saliva. The streptococci were aggregated by parotid and whole saliva, and S. sanguis aggregation was less with whole saliva from the elderly than from the young participants. Besides a correlation between whole saliva aggregation of S. mutans and proportions of bacteria in plaque, no correlations were found for the individual binding properties of saliva and prevalence of bacteria in vivo. However, the level of saliva-mediated adherence in vitro was in the following order: S. mutans. Actinomyces S sanguis, which corresponded to their isolation frequency in plaque. These findings emphasize the importance of initial adherence to salivary receptors in bacterial colonization on teeth. Further studies are needed to reveal if individual patterns in the in vitro binding characteristics of saliva lead to variation of colonization in vivo.

The effect of supragingival plaque control on the subgingival microflora in human periodontitis

The aim of the present trial was to study if carefully practiced supragingival plaque control influenced the subgingival microbiota at periodontal sites with suprabony, infrabony, or furcation pockets. 12 subjects, 5 males and 7 females aged 44 to 69 years (mean age 55 years) participated in the study. None of the participants had during the last 12 months received periodontal therapy, and none of the subjects had used antibiotics during a 3-month period preceding the study. Following a screening examination, 6 to 8 sites per subject were selected which had a probing depth of > or = 5 mm. Among these sites, 1-3 sites had a suprabony location, 1-3 sites had an infrabony location, and 1-3 sites were associated with a furcation defect. The selected sites were exposed to a baseline examination at which the following parameters were recorded: plaque, gingivitis, probing pocket depth and probing attachment level. A bacterial sample was obtained from each of the selected sites: 2 sterile paper points were inserted into the pocket and kept in place for 30 seconds. The paper point samples were removed, placed in a vial containing an anaerobically prepared transport medium, and processed using routine procedures. Following the baseline examination, each subject was given a case presentation, received thorough supragingival scaling and was instructed to practice proper plaque control with the use of toothbrush and dentifrice. During the subsequent 30 weeks they were recalled 2-3xper week for professional tooth cleaning. Each session was handled by a dental hygienist and required about 15 min. Re-examinations were performed after 30 weeks. The findings indicated that professionally delivered and frequently repeated supragingival tooth cleaning, combined with careful self-performed plaque control had a marked effect on the subgingival microbiota of moderate to deep periodontal pockets. Thus, at sites with suprabony and infrabony pockets, as well as at furcation sites, the meticulous and prolonged supragingival plaque removal reduced the total number of microorganisms that could be harvested, as well as the % of sites with P. gingivalis.

Some effects of mouthrinses containing salifluor on de novo plaque formation and developing gingivitis

Three clinical trials were carried out to evaluate the effects of mouthrinses containing 5n-octanoyl-3'-trifluormethylsalicylanilide (salifluor) on plaque and gingivitis. Each trial was performed as a double-blind, randomised and cross-over designed study (studies 1, 2 and 3). In each study, 10 young individuals with healthy gingiva abolished all means of mechanical plaque control during the course of the experimental period including 6 x 4 days (study 1), 3 x 18 days (study 2) and 3 x 14 days (study 3). They rinsed, 2 x daily, with various mouthwash preparations for 4 days (study 1), for the last 4 days of a 18 day period (study 2) or for 14 days (study 3). 6 (control, vehicle control, 0.08%, 0.12% and 0.2% salifluor and 0.12% chlorhexidine), 3 (control, 0.12% salifluor and 0.12% chlorhexidine) and 3 (control, 0.12% salifluor and 0.12% chlorhexidine) mouthwash preparations were tested in studies 1, 2 and 3, respectively. The findings of study 1 indicated that (i) mouthrinses containing salifluor were significantly more effective than control rinses and that (ii) the salifluor mouthrinses were equally effective as the 0.12% chlorhexidine mouthrinse, in retarding 4-day de novo plaque formation. The findings of study 2 indicated that (i) the mouthrinse containing 0.12% salifluor retarded de novo plaque formation to the same extent as the 0.12% chlorhexidine mouthrinse at healthy as well as at inflamed sites but that (ii) the anti-plaque effects of the salifluor and chlorhexidine mouthrinses were significantly smaller at sites with inflamed than with healthy gingiva. In study 3, it was observed that there was no significant difference between the 0.12% salifluor and 0.12% chlorhexidine mouthrinses in retarding de novo plaque formation and the development of gingivitis during a 14-day period of no mechanical plaque control. Thus, the results of the 3 clinical trials demonstrated the potential of salifluor as an effective anti-plaque and anti-inflammatory agent.

The effects of antimicrobial mouthrinses on de novo plaque formation at sites with healthy and inflamed gingivae

The objective of the present investigation was to evaluate to what extent mouthrinses containing triclosan and chlorhexidine may modify the amount of de novo plaque that forms on tooth surfaces adjacent to healthy and inflamed gingival units. 10 volunteers were recruited. On day 0, gingival crevicular fluid (GCF) was obtained at predetermined sites and gingivitis (GI) was assessed. A careful oral prophylaxis was given to each of the volunteers who subsequently abstained from all mechanical plaque control measures for the following 18 days. During the first 4 days (rinse phase I), they rinsed with either 0.12% chlorhexidine, 0.06% triclosan or placebo solution. Clinical examinations (GCF, GI) were repeated and the amount of plaque formed determined on days 4, 7 and 14. On day 14, the participants received a new professional tooth cleaning after which rinse phase II was initiated. During this 2nd phase, the participants rinsed for 4 days with the same mouthwash preparation and in the same manner as during rinse phase I. The examinations were repeated on day 18. Each participant received a comprehensive oral prophylaxisis and was instructed to perform meticulous mechanical plaque control during the following 4 weeks. A 2nd experimental period was then initiated. A total of 3 experimental periods were repeated until all subjects had rinsed with the 3 different mouthwash preparations. The results demonstrated (i) that significantly more plaque formed at sites with gingivitis than at surfaces adjacent to healthy gingival units and (ii) pre-existing gingivitis significantly increased the amount of de novo plaque that formed in subjects who rinsed with mouthwash preparations containing chlorhexidine and triclosan.

The effect of triclosan on developing gingivitis

The aim of the study was to examine whether triclosan has an effect on developing gingival inflammation. 10 volunteers, with clinically healthy gingivae were enrolled. The study was performed as a 2-week, double-blind, cross-over, experimental gingivitis trial. Between each plaque accumulation period, there was a wash-out phase of 4 weeks. A baseline examination was performed which included assessment of plaque and gingivitis. The volunteers were asked to refrain from mechanical oral hygiene measures for 2 weeks. During this period, they rinsed 2x daily with one of the randomly assigned mouthrinse preparations. Solution A (period A): 0.06% triclosan+ 2%tween 80. Solution B (period B): 0.06% triclosan+ 0.25% sodium lauryl sulphate. Re-examinations were performed on days 4, 7, 11 and 14. The mean plaque score increased during period A to 2.2 (day 4), 2.8 (day 7), 3.1 (day 11) and 3.1 (day 14). The corresponding scores for period B were significantly lower; 1.2 (day 4), 1.8 (day 7), 2.0 (day 11) and 2.2 (day 14). The mean gingivitis scores at baseline were 0.17 (periods A and B). The mean gingivitis scores increased to 0.45 (day 4), 0.69 (day 7), 0.83 (day 11) and 0.96 (day 14) when the subjects rinsed with solution A and 0.42 (day 4), 0.64 (day 7), 0.78 (day 11) and 0.92 (day 14) in period B. There were no statistically significant differences between periods A and B with respect to gingivitis. Thus, although significantly more plaque formed during period A than period B, no differences could be found between the gingivitis scores in the 2 periods.

Plaque formation at healthy and inflamed gingival sites in young individuals

The present investigation was performed to evaluate the influence of gingivitis on the amount of de novo plaque that forms during a 24-h period of no oral hygiene. 292 fully dentate subjects participated in the study. The condition of the gingiva and the presence of supragingival plaque were examined at 4 surfaces of each tooth at a baseline examination. Following this examination, the participants were subjected to a comprehensive mechanical tooth cleaning and instructed to refrain from tooth cleaning measures during the subsequent 24 h. The plaque examinations were repeated at the end of the 24-h period. The results from the clinical trial revealed that during a 24-h period of no tooth cleaning, subjects with naturally occurring overt gingivitis, in general, formed more plaque than young individuals with healthy gingivae. Furthermore, plaque in all parts of the dentition, formed more frequently on tooth surfaces adjacent to sites with gingivitis than at healthy sites. It was concluded that the condition of the gingiva plays an important role for de novo plaque formation.

The influence of gingival inflammation on de novo plaque formation

The aim of the present clinical trial was to examine the influence of gingival inflammation on de novo plaque formation. In addition, the effect of a varying number of salivary bacteria on early plaque formation was evaluated. 10 subjects were recruited for the trial which was designed to establish 2 different starting points for de novo plaque formation, 1 in a healthy dentition and 1 in a gingivitis dentition. On Day 0 and at regular intervals during a 5-week period, the panelists were examined with respect to gingivitis, plaque and number of salivary bacteria. The findings from the study demonstrated that the condition of the marginal gingiva plays an important role in the early stages of plaque formation. Thus, in both phases of the study, it was observed that at sites with initially healthy gingival units, less plaque formed (PlI = 0.93 and 0.82) than at sites with GI > 0 (PlI = 1.24 and 1.28) at the 2 different starting points. The number of salivary bacteria seemed to be less important than the state of the gingiva for the amount of plaque that formed during a 4-day period of no active mechanical tooth cleaning.

A model for studying the effects of mouthrinses on de novo plaque formation

The aim of the present study was to describe a 4-day no oral hygiene model to assess the pattern of de novo plaque formation and to use this model to appraise the potential of some mouthwash preparations to retard or inhibit plaque formation in the human dentition. 10 subjects were recruited for the trial. During a preparatory period, the participants were exposed to repeated professional plaque control and given oral hygiene instruction to eliminate signs of gingivitis. At the end of the preparatory period, each participant received a final professional tooth cleaning and was subsequently told to abstain from mechanical plaque control efforts for the next 4 days. They were asked to rinse twice daily for 60 s with 10 ml varying test solutions. On Day 4, the volunteers were exposed to a new clinical examination and the presence and amount of plaque were examined by the use of the plaque index system (P1I). The participants were subsequently given a professional tooth cleaning and asked to exercise proper self performed plaque control during the next 10 days. A new test period was then initiated. 6 different mouthwash preparations were tested in each subject namely, (1) placebo (a negative control rinse), (2) Veadent mouthrinse, (3) Listerine mouthrinse, (4) 0.06% triclosan + polyvinyl phosphonic acid (PVPA), (5) 0.06% triclosan + phenolic flavor and (6) 0.12% chlorhexidine digluconate (a positive control rinse). The results from the study revealed that the mean P1I values for individuals, groups of teeth and tooth surfaces provide an adequate but gross overall estimation of the potential of a given mouthrinse to retard/inhibit plaque build up. More detailed information on the effects of the test rinses could be obtained by data describing the % distribution of different P1I score categories; a high frequency of score 0 describes the potential of a mouthrinse to maintain tooth surfaces free from plaque while a low frequency of score 2/3 describes the ability of a treatment to retard/prevent gross plaque formation. The plaque pattern displays finally allowed assessment of the magnitude of plaque prevention, in comparison to the positive and negative controls, that could be achieved by a given compound in various parts and surfaces of the dentition. In this model, all test rinses (i) were significantly more effective than the placebo rinse in retarding de novo plaque build up and (ii) had a minor effects on plaque build up in the maxillary molars and at the approximal surfaces.(ABSTRACT TRUNCATED AT 400 WORDS)

Patterns of de novo plaque formation in the human dentition

The objective of the present clinical trial was to carefully assess the pattern of de novo plaque formation in the human dentition. 10 subjects aged 24-29 years were recruited for the study. None of the participants showed signs of destructive periodontitis. At the start of the preparatory period, they were given a thorough dental prophylaxis and oral hygiene instruction. For the next 2 weeks, the participants were carefully monitored and 1 x every 2 days examined with respect to plaque and gingivitis. At the re-examinations, they were also given professional tooth cleaning and instruction in proper plaque control measures. Towards the end of this 2-week period, the Day 0 examination was performed which revealed that the gingival tissues of all participants were in excellent clinical health. Following the Day 0 examination, all 10 subjects were exposed to professional tooth cleaning. During the next 14 days, they abolished all mechanical tooth cleaning efforts but were examined with respect to plaque on Days 1, 4, 7 and 14. The amount of plaque formed was examined using the criteria of the Plaque Index system (PlI). Each of 6 surfaces of each tooth in the dentition was given a score from 0 to 3. The results from the re-examinations demonstrated that in humans with clean teeth and normal gingiva, the abolishment of mechanical tooth cleaning rapidly resulted in de novo plaque formation. Most plaque, as assessed by the plaque index system, formed during the first 4 days of no tooth cleaning after which moderate additional amounts of plaque formed. It was observed that the mean PlI values for individuals, for groups of teeth and tooth surfaces, provide a proper overall estimation of plaque build up. The dynamics of plaque formation between examinations and in different parts of the dentition were more easily disclosed by the data describing % distributions of different score categories and the transition between scores from one examination to the next. The total amount of plaque formed on various tooth surfaces was best presented by so called "plaque pattern displays". The results also revealed that (i) the mandibular dentition harbored more plaque than the maxillary dentition, (ii) there was a difference in the mean PlI scores between the molar and the anterior tooth regions in the maxilla, but in the mandible such a difference could not be observed (except on Day 1), (iii) plaque accumulated most at the approximal surfaces and least at the palatal surfaces, and that (iv) differences in PlI scores between groups of teeth and tooth surfaces observed on Day 4 persisted through the Day 14 examination.

Prevalence of periodontal disease in young diabetics

In the present study, the frequency of sites exhibiting gingival inflammation and periodontal tissue breakdown was assessed in one group of 46 individuals (19-25 years old; test group T) who had suffered from diabetes mellitus (Type 1) for 10 years or more, and in another group of 41 non-diabetic controls (18-26 years old; control group C). Each individual was examined regarding oral hygiene status, gingival conditions, probing depths, probing attachment levels and gingival recessions. The interproximal marginal bone level was assessed in bitewing radiographs. No significant differences were found between the 2 groups regarding their oral hygiene status, frequency of sites with probing depths of greater than 3 mm and the position of the interproximal alveolar bone margin. The mean distance between the cemento-enamel junction (CEJ) and the interproximal bone crest was in group T, 0.91 +/- 0.14 (SD) mm and in group C, 0.95 +/- 0.18 (SD) mm. About 80% of the individuals in both groups were free from signs of marginal bone loss and only 1 subject in each group had greater than 6 sites with definitive bone loss. The group of diabetic patients had higher frequencies of inflamed buccal/lingual gingival units, gingival recessions and sites with attachment loss of greater than or equal to 2 mm. Most of the sites (85%) with attachment loss were located at the buccal and lingual surfaces. There were no significant correlations between the periodontal variables and the duration of diabetes, insulin dosage and HbA1 level. Individuals with both retinopathy and nephropathy had significantly more gingival inflammation than diabetic individuals without complications.