In-vitro comparison of two different toothbrush bristles about peri-implant sulcus penetration

OBJECTIVE

The aim of this preclinical study was to compare the ability of tapered and cylindrical bristles to penetrate the peri-implant sulcus.

METHODS

A full mandibular dental arch was reproduced in plaster cast. In site #3.6 a hollow glass cylinder was positioned simulating a 4 mm diameter implant and the gingival component was recreated by using dedicated silicone. A Bass brushing technique was performed from the vestibular side in humid environment. During it, the penetration of the bristles between the gum and the implant was recorded by mean of an optic fibre fixed inside the cylinder. The protocol included 5 toothbrushes per group and 10 tests per toothbrush, for a total of 50 assessments for each of the two groups. A scale of 5 grades for bristle penetration was defined: grade 0 (× < 2 mm), grade 1 (2 ≤ × < 3 mm), grade 2 (3 ≤ × < 4 mm), grade 3 (4 ≤ × < 5 mm) and grade 4 (5 ≤ × < 8 mm). From the video recordings the highest value of penetration was identified for each test.

RESULTS

The tapered bristles showed an 8 times greater penetration capacity (p = 0.001) in respect to the cylindrical bristles (multilevel analysis). The percentage of tests reaching depths ≥3 mm was 86% for tapered group and 28% for the cylindrical group.

CONCLUSION

This preclinical study shows a clear and superior penetration capacity of the tapered bristles in respect to traditional cylindrical ones. For tapered bristles, a potentially greater hygienic efficacy around dental implants is suggested.

Periodontitis and hypertension are linked through systemic inflammation: A 5-year longitudinal study

AIM

To investigate the associations between periodontitis and hypertension and potential mediation via systemic inflammation through a 5-year longitudinal study.

MATERIALS AND METHODS

The severity and extent of periodontitis were determined using probing depth (PD). Oral hygiene was assessed using plaque scores. The associations between periodontal variables and 5-year blood pressure changes or incident hypertension were analysed using linear or Poisson regression, adjusting for potential confounders. Mediation analysis of two systemic inflammatory biomarkers, namely white blood cell count (WBC) and C-reactive protein (CRP) levels, was performed.

RESULTS

The study population included 901 hypertension-free participants, aged 50-73 years. Greater mean PD, higher percentage of sites with PD ≥ 6 mm and poor oral hygiene were associated with elevated systolic blood pressure and increased hypertension risk (relative risks = 1.17 [95% confidence interval [CI]: 1.02-1.34], 1.13 [95% CI: 1.02-1.26] and 1.08 [95% CI: 1.03-1.13], respectively). Periodontitis and poor oral hygiene were associated with higher WBC and CRP levels (p < .05), which, in turn, were associated with increased hypertension risk (p < .05). WBC and CRP jointly mediated 14.1%-26.9% of the associations between periodontal variables and incident hypertension.

CONCLUSIONS

Periodontitis and poor oral hygiene were associated with increased hypertension risk, and systemic inflammation was, in part, a mediator of these associations.

Comparison of the effectiveness of two manual toothbrushes: Conventional design versus double-sided toothbrush design. A pilot study

OBJECTIVES

Dental hygiene is the most effective method in the prevention of oral diseases. However, most patients do not use the recommended teeth brushing techniques and/or time brushing is insufficient. With this objective, modifications in conventional toothbrushes have been developed to deal with these findings. The aim of this study was to compare plaque removal effectiveness of a manual toothbrush with a modified head (MTMH) with a wrap-around design versus a conventional manual toothbrush.

METHODS

This pilot prospective clinical study was designed according to STROBE guidelines. The patients suspended oral hygiene habits for 24 h (baseline). Subsequently, the teeth were brushed for 60 s. Both toothbrushes followed the same study procedure, separated by 1 month. Plaque-removing effectiveness was measured before and after tooth brushing using the modified O'Leary Plaque Index (PI).

RESULTS

Seven patients were included in this pilot study. The mean age was 37.66 ± 10.68 years. PI mean differences between baseline and after brushing were 51.99% ± 16.43 for MTMH and 27.93 ± 6.85, for conventional toothbrush (p = 0.0013). After brushing, mean PI values were 18.36% ± 6.95%, and 37.61% ± 10.57% respectively (p < 0.001).

CONCLUSION

Within the limitations of the present study, it can be concluded that the effectiveness of plaque removal by using MTMH is significantly higher than the conventional manual toothbrush.

Assessing the quality of YouTube™ videos on fixed dental implant home-care and maintenance protocols

OBJECTIVES

The implant's supporting structure differs from that of the teeth when plaque accumulates, making it more prone to inflammation and bone loss. To ensure the implant's longevity, an effective maintenance protocol should be followed. This study aimed to evaluate the information on oral hygiene procedures at home for implant-supported fixed prosthesis.

METHODS

The keywords 'cleaning dental implant,' 'how to clean dental implant,' and 'dental implant hygiene' used to search for videos on YouTube™. Following the exclusions, two researchers independently analysed the remaining 100 videos for demographic data and content usefulness.

RESULTS

In terms of usefulness score distribution, 53.52% of the videos were considered slightly useful, 38.4% moderately useful and 8.1% very useful. The video content had the least quantity of knowledge about toothpaste choice (11.1%), but the greatest quantity of knowledge on flossing (68.7%).

CONCLUSIONS

According to the study's findings, there is presently no evidence-based information on YouTube™ on dental implant oral hygiene protocols for home care procedures hygiene education. Therefore, dental care professionals should analyse the information's quality and reliability before recommending it to patients.

Periodontal disease prevalence and oral hygiene status of adults with cystic fibrosis: A case-control study

AIM

To investigate the prevalence of gingivitis and periodontitis, and the oral hygiene status of adults with cystic fibrosis (CF) in the Republic of Ireland.

MATERIALS AND METHODS

A case-control study in the form of a clinical examination of 92 adults with a diagnosis of CF was carried out in the adult CF unit in Cork University Hospital. A 40-item questionnaire was used to capture socio-demographic variables and medical and dental information. Two calibrated examiners carried out a periodontal assessment on participants, using the WHO-recommended CPI-modified index, and oral hygiene status was measured using the Greene-Vermillion index. The results were compared with a population-based control group of similar socio-demographic profile.

RESULTS

Oral hygiene levels (plaque and calculus) were significantly worse in people with CF, with a median plaque index of 0.83 (interquartile range [IQR] 0.333-1.542) in the CF group compared with 0.5 (IQR 0.167-0.667) in the non-CF group. Calculus index in the CF group was 0.33 (IQR 0.17-0.83) compared with 0.33 (IQR 0.125-0.33) in the non-CF group. However, periodontal disease levels were significantly lower in the CF group. Gingivitis (bleeding on probing ≥ 10% sites) was seen in 67.4% of the CF group, compared with 83.7% of the non-CF group, OR 0.365 (95% confidence interval [CI] 0.181-0.736), relative risk (RR) 0.779 (95% CI 0.655-0.928). Mild periodontitis (periodontal probing depth [PPD] < 5 mm) was seen in 15.2% of the CF group, compared with 31.5% of the non-CF group, OR 0.390 (CI 0.190-0.800), RR 0.483 (95% CI 0.273-0.852). Severe periodontitis (PPD ≥ 6 mm) was seen in 0% of the CF group, compared with 9.8% of the non-CF group. There was a tendency, albeit non-significant, towards reduced periodontitis in PWCF who regularly took antibiotics, particularly azithromycin.

CONCLUSIONS

In this study, adults with CF had poor oral hygiene practices, with high levels of plaque and calculus. Despite this finding, adults with CF had lower levels of clinical gingivitis and periodontitis than seen in a non-CF control group. Further study is required to examine the causes of this phenomenon.

Orthodontists' instructions for oral hygiene in patients with removable and fixed orthodontic appliances

INTRODUCTION

The aim of this questionnaire-based survey was to evaluate information on frequencies, instructions and products relating to oral hygiene (OH) in orthodontic practices.

METHODS

Using a computer-generated randomization list, 1000 orthodontists were selected and sent a questionnaire. The size and number of inhabitants of the federal states of Germany were considered. The federal states with the highest return rate (Baden-Wuerttemberg [BW], Bavaria [B], Hesse [H], Lower Saxony [LS], Nordrhein-Westphalia [NRW]) were considered and differences between the 16 federal states were divided into North, South, East and Central Germany.

RESULTS

The response rate of the questionnaires was 52.4%. The majority (53.8%) worked in one practice alone. Most (59.1%) have been orthodontists for 5-25 years. For vestibular multibracket appliances (MBA) in BW, B, H and LS over 90% recommended interdental brushes (IDB). In NRW 91.4% recommend fluoride gel. In B and H more than 80% chose electric toothbrush (ETB), in BW, LS and NRW more than 80% manual toothbrush (MTB). For lingual MBA (LMBA) in BW, H, LS and NRW with approximately 50% each fluoride gel, IDB and MTB were chosen. In B fluoride gel, IDB and ETB. For removable apparatus (RA), five federal states recommended MTB (>80%) and ETB (BW, B, H > 80%; NRW > 70%; LS > 60%).

CONCLUSION

Electric toothbrushes are recommended for the use with all appliances, only with removable appliances manual toothbrushes are favoured. For vestibular MBA it is strongly advised to use IDB additionally.

Changing from disease-centred to person-centred - Swedish dental hygienists' views on a theory-based behavioural intervention for improved oral hygiene among adolescents

OBJECTIVES

To explore dental hygienists' (DHs') views on (i) a person-centred, theory-based, behavioural intervention for improving oral hygiene among adolescents and (ii) professional and organizational factors to consider in the implementation of such an intervention in daily dental practice.

METHODS

Semi-structured interviews were conducted with 13 DHs who had applied the person-centred, theory-based, behavioural intervention directed at adolescents with poor oral hygiene in a field study within the Public Dental Service, Region Västra Götaland, Sweden. The interviews were audio-taped, transcribed verbatim and analysed using qualitative content analysis.

RESULTS

The main theme 'From individual experts to partners - DHs changing direction from a disease-centred towards a person-centred approach' illustrated a changed professional approach among DHs, from exerting their roles as experts to encouraging partnership in treatment by supporting the adolescents in taking health behavioural decisions and responsibility for their oral health. The DHs considered the changed approach as challenging, but also more enjoyable, compared to conventional information/instruction. Adequate knowledge and skills, personal interest and willingness for a change as well as support from colleagues and clinic management were identified as prerequisites for implementing the person-centred, theory-based, behavioural intervention in daily practice, while the expenditure of time needed in relation to economic demands in care were seen as barriers.

CONCLUSIONS

The findings elucidate that DHs considered the application of a person-centred, theory-based, behavioural intervention to be challenging but also enjoyable. For such an intervention to be implemented in daily practice, prerequisites and barriers need to be considered on both personal/professional and organizational levels.

Periodontal health literacy in Germany-Results of a telephone survey

OBJECTIVE

Assess the periodontal health literacy of German adolescents, adults and senior residents.

BACKGROUND

The prevalence of periodontitis is high. One explanation for this may be that people lack periodontal health literacy (PHL).

METHODS

This was a cross-sectional descriptive study. Former participants of the 5th German Oral Health Study (n = 333 16-year-olds, n = 307 39-48-year-olds, n = 332 69-78-year-olds) participated in a computer-assisted telephone interview. Open-ended questions (OEQs) were used to assess the participants' current knowledge. Corresponding single- and multiple-choice questions (SCQs and MCQs) supplemented the OEQs to allow detailed analyses of the nature of the knowledge gaps.

RESULTS

Less than 10% of the participants in the three age groups could explain the term 'periodontitis' or select the correct answer in an SCQ. Responding to the OEQs, 89% of 16-year olds, 64% of 39-48-year-olds, and 59% of 69-78-year-olds, could not name any consequence of periodontitis, and 83%, 51%, and 60%, respectively, could not name any risk factors. The OEQs regarding proper oral hygiene behaviour revealed that participants lacked awareness regarding important aspects of oral hygiene (e.g., systematics) or areas to which they should pay attention to (e.g., interdental spaces and gingival margins).

CONCLUSIONS

The survey revealed PHL deficits in German adolescents, adults, and seniors and a need for community-based measures to improve PHL in all age groups. Dental teams should be aware that their patients might lack the PHL necessary for understanding and adherence to professional dental advice, and that they might even lack PHL regarding the proper use of oral hygiene devices.

Oral hygiene care and the management of oral symptoms in patients with cancer in palliative care: a mixed methods systematic review protocol

OBJECTIVE

The objective of this review is to examine the effectiveness of oral hygiene care in the management of oral symptoms in patients with cancer under specialist palliative care and the patients' experience of such symptoms and care.

INTRODUCTION

Oral symptoms, such as xerostomia, mouth pain, or dysgeusia, are highly prevalent in patients with cancer under specialist palliative care. These symptoms have a negative effect on patients' quality of life. Oral hygiene care can manage oral symptoms and could be improved with a more systematized approach, adequate guidelines, and training to properly integrate oral hygiene into the care provided in specialist palliative care.

INCLUSION CRITERIA

This review will consider quantitative, qualitative, and mixed methods studies on the effectiveness and experience of oral hygiene care intended to manage oral symptoms in patients with cancer aged 18 years or older, diagnosed with any type of cancer, under specialist palliative care.

METHODS

The search will be conducted in MEDLINE (PubMed), CINAHL (EBSCOhost), Cochrane Central Register of Controlled Trials, Dentistry and Oral Sciences Source (EBSCOhost), and MedicLatina (EBSCOhost). Sources of unpublished studies and gray literature to be searched will include Networked Digital Library of Theses and Dissertations and Repositórios Científicos de Acesso Aberto de Portugal. Studies in English, Portuguese, and Spanish published from 2000 to the present will be considered. Methodological quality of included studies will be assessed and data will be extracted. Synthesis and integration will follow the JBI segregated approach for mixed methods reviews.

REVIEW REGISTRATION

PROSPERO CRD42023400554.

Oral health of individuals with cerebral palsy in Saudi Arabia: A systematic review

OBJECTIVE

This systematic review aimed to comprehensively summarize and critically assess studies conducted on oral health outcomes among individuals with cerebral palsy (CP) in Saudi Arabia.

METHODS

This study followed the Participants, Exposure, Control and Outcomes (PECO) framework to formulate a focused research question. We conducted an extensive literature search across multiple databases, including PubMed, Medline, Scopus and Embase, in addition to clinical trial registers. Inclusion criteria encompassed clinical studies conducted in either English or Arabic, focusing on CP as defined by the International Classification of Diseases 10 (ICD10), and examining various oral health conditions and parameters. Nonclinical studies, commentaries, other systematic reviews and letters to the editor were excluded. Data extraction included comprehensive information about the study characteristics, oral health outcomes (dental, oral or periodontal disease; changes in standardized indices; dental trauma and other types of oral diseases) and an assessment of the risk of bias using the Appraisal Tool for Cross-Sectional Studies (AXIS).

RESULTS

The initial search yielded a total of 879 articles, ultimately resulting seven studies that met our stringent inclusion criteria. All of these studies were conducted as cross-sectional investigations in different cities within Saudi Arabia. The sample sizes ranged from 46 to 400 participants, all falling within the age range of 2-18 years. Notably, the prevalence of dental caries among individuals with CP in these studies varied significantly, with rates ranging from 52.9% to as high as 98.6%. Additionally, a substantial portion of CP patients exhibited poor oral hygiene, with figures ranging between 34.6% and 66.2%, and dental trauma was reported in 47.5% of the cases. Moreover, these studies underscored the influence of motor function and intellectual disabilities on the oral health status of CP individuals. Furthermore, various secondary outcomes, including periodontal parameters and oral health-related quality of life, were also assessed. However, it is essential to acknowledge that several sources of bias were identified within these studies, raising questions about the generalisability of their findings.

CONCLUSION

In conclusion, the systematic review revealed a concerning pattern of high dental caries prevalence and other oral health issues among individuals with CP in Saudi Arabia. Nevertheless, the need for comparative studies between CP patients and those without CP is evident to establish a definitive understanding of the oral health status of CP individuals. Initiating early interventions such as oral hygiene education, preventive dentistry programs, and orthodontic interventions could potentially contribute to improved oral health outcomes for individuals with CP in Saudi Arabia.

Natural history of periodontal disease: The original Sri Lanka and Oslo studies

Susceptibility to periodontal disease depends on individual factors within the host response to the bacterial challenge. The study of these factors requires longitudinal studies of an undisturbed development of the disease process. On the basis of the original longitudinal studies on the natural histology of periodontal disease staged in Sri Lanka and Oslo/Norway, several analyses of periodontal parameters and tooth status have been performed. The main findings were that in the first 20 years of complete absence of oral hygiene practices or preventive services attachment was lost at various rates. Three groups of subjects could be identified: rapidly progressing (RP) (8%), moderately progressing (MP) (81%), and subjects with no disease progression (NP) (11%). In the second two decades, the RP subjects have lost most of their teeth and no NP patients were identified anymore. The progression rate in these two decades was much slower, and the tooth mortality decreased. It could be predicted that subjects who had lost more than 2 mm at age 30 would not maintain a functional dentition at age 60. The corresponding control population in Oslo was used to study the influence of gingival inflammation on the initiation and progression of periodontal disease. The pattern and rates of attachment loss were identified in a population that was exposed to optimal and regular preventive services from age 3 onward. In the observation period of 26 years, it could be demonstrated that gingival inflammation varied little throughout adult life and always bleeding sites occurred consistently in 10% to 20%. The role of ongoing gingivitis in the pathogenesis of attachment loss was identified and also reflected stability whenever it was absent. Tooth mortality was only found in subjects with ongoing gingivitis. After 50 years of tooth age, 63% of the teeth were still maintained, while 99.8% were maintained after 50 years when gingival inflammation had been absent. Consequently, continuous gingivitis represented a risk factor for tooth loss.

Volatile sulfur compounds in asthmatic children and adolescents: A cross-sectional study in breath and saliva

BACKGROUND

Halitosis in children implies psychosocial repercussions. Risk factors associated with this condition are unclear, and detection methods are inaccurate.

AIM

To quantify the levels of sulfur-like compounds in children with asthma and healthy children from a novel validated assay, and to establish the risk factors related to halitosis.

DESIGN

One hundred and twenty-eight individuals (63 healthy and 65 asthmatic) from 3 to 17 years of age were tested using a passive colorimetric sensor to measure the levels of sulfur-like compounds in breath and saliva. Information was collected on oral hygiene habits, gingival and dental health, breathing type, and dental malocclusion.

RESULTS

The mean values of hydrogen sulfide were 4.0 ± 6.8 and 19.7 ± 12.2 ppbv (parts per billion in volume) in the control and asthmatic groups, respectively (p < .001). The presence of higher concentrations of sulfur compounds was significantly associated (p < .05) with the presence of gingival inflammation, tongue coating, dental plaque, mouth breathing, hypomineralization, age, tongue brushing, and the use of dental floss.

CONCLUSION

The level of sulfur in breath and saliva was significantly higher in patients with asthma. These results can serve as a precedent to raise awareness among paediatricians and parents about oral hygiene care in children and adolescents.

A Proposal for a Multidisciplinary Integrated Oral Health Network for Patients Undergoing Major Orthopaedic Surgery (IOHN-OS)

The passing of the years of life physiologically leads to the accumulation of changes in tissues in the oral cavity, influencing dentition, chewing and swallowing mechanisms, and the oral microbiota. Some diseases and medications can aggravate oral symptoms and negatively influence eating behaviours, increasing the likelihood of becoming malnourished. This could make older individuals more vulnerable to complications when undergoing major orthopaedic surgery. Hidden infection foci in the oral cavity are a recognised cause of post-operative periprosthetic joint infections. Dysfunctional oral problems might also compromise feeding after surgery when good nutrition represents a fundamental aspect of a proper recovery. To manage these shortcomings, in this article, the authors hypothesise a multidisciplinary path of care named the Integrated Oral Health Network applied to major Orthopaedic Surgery (IOHN-OS). This peri-operative initiative would include pre-operative oral health screening and risk management by a dental team, patient education programmes before and after surgery, and bedside gerodontology actions like oral care and meal and eating support for fragile individuals. The IOHN-OS has the potential to reshape the concept of suitability for major orthopaedic surgery and generate momentum for designing community-based surveillance programmes that can keep the mouths of older subjects healthy for a long time.

Strategies for Preventing and Treating Oral Mucosal Infections Associated with Removable Dentures: A Scoping Review

Oral infections occur due to contact between biofilm rich in Candida albicans formed on the inner surface of complete dentures and the mucosa. This study investigated historical advances in the prevention and treatment of oral mucosal infection and identified gaps in the literature. Bibliographic research was conducted, looking at PubMed, Embase, Web of Science, and Scopus, where 935 articles were found. After removing duplicates and excluding articles by reading the title and abstract, 131 articles were selected for full reading and 104 articles were included. Another 38 articles were added from the gray literature. This review followed the PRISMA-ScR guidelines. The historical period described ranges from 1969 to 2023, in which, during the 21st century, in vitro and in vivo studies became more common and, from 2010 to 2023, the number of randomized controlled trials increased. Among the various approaches tested are the incorporation of antimicrobial products into prosthetic materials, the improvement of oral and denture hygiene protocols, the development of synthetic and natural products for the chemical control of microorganisms, and intervention with local or systemic antimicrobial agents. Studies report good results with brushing combined with sodium hypochlorite, and new disinfectant solutions and products incorporated into prosthetic materials are promising.

Significant enhancement of swallowing function and oral hygiene following multidisciplinary team nursing in tongue cancer patients after radical resection

OBJECTIVE

To determine the effects of multidisciplinary team (MDT) nursing mode on the swallowing function and oral hygiene in patients after radical resection of tongue cancer (TC).

METHODS

The data of 88 patients with TC treated in West China School/Hospital of Stomatology, Sichuan University were analyzed retrospectively. Among them, 42 patients who received routine nursing between February 2019 and February 2020 were assigned to a control group, and 46 patients who received MDT nursing between March 2020 and February 2022 were assigned to an observation group. The two groups were compared in the changes of postoperative swallowing function and oral hygiene, postoperative swallowing-related quality of life (QoL), and the survival rate for myocutaneous flap. The risk factors affecting swallowing function were analyzed through Logistic regression.

RESULTS

After one month of nursing, the score of swallowing function decreased notably in both groups, with notably lower score in the observation group than that in the control group (P < 0.05). The control group exhibited notably lower oral cleanliness than the observation group after nursing (P < 0.05). Additionally, a notably lower survival rate of myocutaneous flap was found in the control group than that in the observation group (P < 0.05). The QoL scores of the two groups increased notably after nursing, and the observation group had notably higher QoL score than the control group (P < 0.05). The extent of glossectomy and nursing plan were independent risk factors impacting the recovery of swallowing function (P < 0.05).

CONCLUSION

MDT nursing have a positive impact on oral hygiene as well as the swallowing function of patients after radical resection of TC, and MDT is a protective factor for swallowing function in the patients after radical resection.

Effect of coffee staining and simulated oral hygiene methods on the color and translucency of a nanoceramic resin

OBJECTIVE

Evaluate the color and translucency of a nanoceramic resin subjected to hygiene practices and immersion in coffee over time.

MATERIALS AND METHODS

Specimens (n = 80, HT and LT, 0.5-mm thick) of a nanoceramic resin were obtained and were divided in groups according to the simulated oral hygiene: no intervention (NT), brushing with an electric brush and water (BN), brushing with an electric brush and toothpaste for 10 s (BT), and immersion in mouthwash for 30 s (MW). Oral hygiene practices were repeated after staining in coffee solution for 15, 48, 336, 1440, 8640, and 35,040 min. Spectral wavelengths were recorded with a spectrophotometer at each time. ∆E00 , ∆L', ∆C', ∆H', and TP00 were calculated by CIEDE2000 and were evaluated by 2-way ANOVA, repeated measures ANOVA, and Tukey's HSD test (α = 0.05).

RESULTS

ANOVA showed significance among factors for ΔE00 (p < 0.05), with higher ΔE00 for NT-HT (11.7) and NT-LT (11.2). After T6 (2-year simulation), the lowest values were found for BT-HT (5.3) and BT-LT (4.9). All groups showed a reduction in lightness and translucency and increased chroma and hue. However, the smallest variations were found in the BT groups (p < 0.05).

CONCLUSIONS

Brushing with toothpaste effectively minimized the color change of NCRs caused by coffee staining.

CLINICAL SIGNIFICANCE

Oral hygiene practices, such as brushing with toothpaste, might be important to minimize staining of nanoceramic resin restorations, especially in patients who frequently consume coffee.

Cultural factors and family influences on adolescent oral health: qualitative research in a socially disadvantaged population

AIM

This qualitative study sought to assess the influence of cultural factors and family on oral health behaviour of 12- to 15-year-old adolescents from the socially disadvantaged population.

DESIGN

A qualitative design was developed with focus group discussions (FGDs) among 12- to 15-year-old adolescents. Four focus groups (n = 32 participants) were created from a selected sample to capture oral health beliefs and practices, oral health-seeking behaviour along with other relevant information. Focus group discussions were audio-recorded, transcribed verbatim and translated. Data were analysed thematically and structural coding was applied.

RESULTS

Three key themes that emerged from FGDs were importance of oral health; role of family in oral health behaviour; and beliefs influencing access, prevention and treatment of oral diseases. Cultural background, family values and beliefs were imperative in moulding the behaviour of adolescents towards oral health. The use of traditional oral hygiene aides was a norm in this population.

CONCLUSIONS

Findings of the study provide greater insights into the authoritative role of family and cultural barriers in the uptake of dental services. The study also highlights the potential value of qualitative research and emphasizes the need to integrate oral health-associated cultural beliefs and attitudes of the adolescents towards a wider evidence base.

Comparison of facilitators and barriers to providing oral hygiene measures in dependent older people and young children: A systematic review

OBJECTIVE

The objective of the study was to systematically compare barriers/facilitators providing oral hygiene to young children and dependent older people and to generate ideas to improve the implementation of oral hygiene measures.

BACKGROUND

Many older people, like children, rely on third-party assistance for teeth cleaning. Barriers/facilitators in providing oral care services have been described in recent works. The aim of our study was to compare these results for both groups and to increase knowledge on analogies/differences in barriers/intermediaries.

METHODS

We performed a systematic review. Studies reporting on knowledge, attitudes and beliefs acting as barriers/facilitators for provision of teeth cleaning were included. Thematic analysis was used and identified themes translated to domains and constructs of the theoretical domains framework and aligned to the behaviour change wheel. Based on three published reviews in children or older people, our search (PubMed via Medline), Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science, Google Scholar, last search (21 January 2023) encompassed both populations dated from their last publication (28 February 2018). The review was registered (Prospero, CRD42021278944). For quality assessment, the Newcastle-Ottawa Scale (NOS) was used.

RESULTS

Seventeen articles were identified (older people (n = 8), children (n = 9)). Deficits exist for both in terms of "knowledge/skills" among caregivers, with special difficulties in children with challenging behaviour and older people. "Capability" as one of the main elements of behavioural factors that are the basis for behaviour to take place (COM-B, Capability, Opportunity, Motivation-Behaviour) is most often mentioned for children and "opportunity" for older people.

CONCLUSIONS

Most of the facilitators and barriers affecting oral care provision in children are also relevant in older people. Approaches for the development of strategies for better implementation of oral hygiene measures in older people are presented.

Impact of Orthodontic Treatment on the Incidence of Dental Caries in Adolescents: A Prospective Cohort Study

BACKGROUND

Orthodontic treatment is a widely embraced intervention aimed at enhancing dental aesthetics and correcting malocclusions among adolescents. However, concerns persist regarding its potential impact on oral health, particularly on the development of dental caries. This study aimed to systematically investigate the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents.

METHODS

A prospective cohort design involving adolescents aged 12-18 years was employed. A total of 82 patients met the inclusion criteria. In addition, an age-matched control group of 82 participants who did not undergo orthodontic treatment was included. The study included both a treatment group undergoing orthodontic treatment (braces or aligners) and an age-matched control group that did not undergo any orthodontic intervention. Demographic characteristics, orthodontic treatment details, and oral hygiene practices were documented at baseline and throughout the study period. Dental examinations at six-month intervals post-treatment were conducted to track the incidence and progression of carious lesions.

RESULTS

The demographic characteristics, baseline oral health status, orthodontic treatment details, and oral hygiene practices were comparable between the treatment and control groups. Post-orthodontic treatment assessment revealed a slightly higher incidence of new carious lesions in the treatment group (14.6%) than in the control group (9.8%), although this difference was not statistically significant (p = 0.15). Dental examinations at six-month intervals demonstrated a gradual increase in caries incidence over time in both groups, with no substantial disparities observed.

CONCLUSIONS

This study provides a comprehensive examination of the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents. While a trend towards higher caries incidence in the treatment group was observed, the difference was not statistically significant. These findings contribute to the existing body of knowledge and emphasize the need for ongoing research to guide clinical practice.

Prevalence of Acute Tonsillitis and Its Association With Oral Hygiene Among the Population of Taif City, Saudi Arabia

Introduction  Dental surfaces have dense bacterial deposits, and poor oral hygiene can exacerbate bacterial infections, causing acute tonsillitis. The study aims to quantify acute tonsillitis prevalence and assess its association with oral hygiene practices. Methods  A descriptive cross-sectional study aimed to assess the prevalence of acute tonsillitis and its association with oral hygiene was conducted among adults aged 20 and above in Taif City, Saudi Arabia. Illiterates and those unwilling to participate were excluded. We employed an Arabic online self-administered questionnaire that was disseminated conveniently via Google Forms to social media assessing oral hygiene such as last dental visit, age at starting dental care, number of toothbrushes per day, frequency of toothbrush change, and duration of brushing teeth, and acute tonsillitis characteristics of the participants. Results About 393 participated in the study. Of them, 54% were aged 20-30, 53% were males, and 70% had a university education. The prevalence of acute tonsillitis was 64%. Approximately 28% reported dental clinic visits within three months, and 21% initiated oral hygiene practices at age 20. Among participants, 43% brushed twice daily, with 33% spending one minute and 43% two minutes. About 31% replaced toothbrushes every three months, while 23% acknowledged having bad breath. Experiencing bad breath, changing toothbrushes every three months, and having dental visits within less than three months were associated with having acute tonsillitis (p<0.05). However, regression analysis revealed that experiencing bad breath (OR: 2.11, 95% CI: 1.23, 3.70) was associated with a higher risk of acute tonsillitis, while less frequent toothbrush changes correlated with a lower risk (OR: 0.54, 95% CI: 0.30, 0.94). Conclusion  This study revealed a substantial prevalence of acute tonsillitis among adults in Taif City. Oral care practices need improvement. There are significant associations between oral hygiene practices, bad breath, and the occurrence of acute tonsillitis. Addressing oral hygiene practices could be a key focus for preventative measures.

Oral Hygiene Status, Salivary and Microbiological Parameters Among Visually Impaired and Normal-Sighted Children After Specialized Oral Health Education: An Interventional Study

Aim and objectives To assess oral hygiene status and salivary and microbiological parameters among 12 to 15-year-old visually impaired and normal-sighted children before and after oral health education (OHE). Methodology An interventional study was conducted among 25 visually impaired children (Group A) and 25 normal-sighted children (Group B) in the age range of 12 to 15 years. Simple random sampling was used to select the study participants. A questionnaire was designed to record socio-demographic data and the dietary habits of the children on pre-decided days. The oral hygiene practices and the Decayed Missing Filled Teeth (DMFT) index were recorded, and salivary physicochemical parameters for all the selected children were evaluated, followed by saliva collection for microbial analysis. After baseline assessment, the Audio-Tactile Performance technique for Group A and the animated visual performance technique for Group B children were used to impart OHE. Periodic assessments of salivary parameters were conducted at one-month and three-month intervals. Unpaired T test/Mann-Whitney U test, repeated measures analysis of variance (ANOVA)/Friedman test, followed by Bonferroni's post hoc test were carried out to determine the difference between and within groups, respectively. All statistical tests were performed at a significance level of 5%. Results Group A demonstrated a greater change in salivary pH (6.20 ± 0.41 to 6.96 ± 0.20), salivary buffering capacity (5.80 ± 0.82 to 7.20 ± 0.65), and Streptococcus mutans count (9.36 ± 0.41 to 8.7 ± 0.45 x 104 CFU/mL) when compared to Group B. Group B demonstrated a greater Lactobacillus acidophilus count reduction (7.96 ± 0.66 to 7.50 ± 0.64 x 104 CFU/mL) when compared to Group A. Conclusion The appropriate use of specialized OHE holds particular significance in the improvement of oral hygiene status and salivary parameters, along with a reduction in the bacterial count in both visually impaired children and normal-sighted children.

Dry Socket Prevalence and Risk Factors in Third Molar Extractions: A Prospective Observational Study

Background Third molar extraction is a routine oral surgical procedure that is often complicated by the development of a dry socket (alveolar osteitis). This prospective observational study aimed to investigate the prevalence of dry sockets and identify associated risk factors and causes, contributing to a comprehensive understanding of the postoperative outcomes of oral surgery. Methods This study employed a prospective observational design with a 12-month follow-up period. Participants aged 18-40 years scheduled for third molar extraction were included, whereas those with coagulopathies, pregnant or lactating women, patients with vitamin deficiencies, and individuals on medications affecting healing were excluded. Data collection involved comprehensive assessments at baseline, intraoperative details, and postoperative evaluations at 48 hours, one week, and two weeks. Statistical analyses included descriptive statistics, chi-square tests, t-tests, or Mann-Whitney U tests, and logistic regression for the risk factor analysis. Results A total of 238 participants with diverse demographic characteristics were enrolled in this study. The prevalence of dry sockets increased progressively from 20.6% at 48 hours to 41.2% at two weeks post-extraction. Smoking, poor oral hygiene, and surgical technique emerged as significant risk factors, with corresponding odds ratios of 6.41 (95% CI: 2.86-14.36, p < 0.001), 9.53 (95% CI: 2.12-42.84, p = 0.003), and 3.27 (95% CI: 2.08-5.15, p < 0.001), respectively. Pain intensity, measured using a Visual Analog Scale, gradually decreased from 48 hours to two weeks post-extraction. Conclusion This study provides valuable insights into the prevalence and risk factors associated with dry sockets following third molar extractions. Smoking, poor oral hygiene, and poor surgical techniques were identified as significant contributors, emphasizing the importance of preoperative counseling and targeted interventions.

The need for cannabis education in dental hygiene programs

PURPOSE/OBJECTIVE

Cannabis and the endocannabinoid system (ESC) are rarely included in training programs for healthcare providers. Knowledge within the medical and dental health professionals is lacking regarding the treatment of patients using medical or recreational cannabis. Patients are unaware of the risks associated with cannabis use, and healthcare providers should be prepared to assess, educate, and treat the patients who use cannabis. With the increased legalization and use of cannabis for medical and recreational purposes across the US, this study demonstrated the lack of cannabis education provided in dental hygiene programs.

METHODS

In 2021, an online survey was conducted with 327 dental hygiene program directors. Respondents were asked to answer 26 questions.

RESULTS

With a 21% response rate and 100% completion rate, 60% of the participants responded that cannabis content was provided in their dental hygiene program, 38% responded with a "no," and one responded with "I do not know." No significant difference was found regardless of whether cannabis was legal in the state for medical or recreational use and whether the cannabis content was included in the dental hygiene curriculum.

CONCLUSIONS

The results indicate that every dental hygiene program should provide cannabis content, and each patient should receive a cannabis assessment at every dental hygiene appointment. Further research is required to identify standardized educational content on cannabis and the ESC, which will enable educators to teach students. The development and implementation of a standardized cannabis use assessment and the creation of standardized recommendations for patients who use cannabis to alleviate adverse oral health effects are important.

Mouthguard-Type Wearable Sensor for Monitoring Salivary Turbidity to Assess Oral Hygiene

Salivary turbidity is a promising indicator for evaluating oral hygiene. This study proposed a wearable mouthguard-type sensor for continuous and unconstrained measurement of salivary turbidity. The sensor evaluated turbidity by measuring the light transmittance of saliva with an LED and a phototransistor sealed inside a double-layered mouthguard. The sensor was also embedded with a Bluetooth wireless module, enabling the wireless measurement of turbidity. The mouthguard materials (polyethylene terephthalate-glycol and ethylene-vinyl acetate) and the wavelength of the LED (405 nm) were experimentally determined to achieve high sensitivity in salivary turbidity measurement. The turbidity quantification characteristic of the proposed sensor was evaluated using a turbidity standard solution, and the sensor was capable of turbidity quantification over a wide dynamic range of 1-4000 FTU (formazine turbidity unit), including reported salivary turbidity (400-800 FTU). In vitro turbidity measurement using a saliva sample showed 553 FTU, which is equivalent to the same sample measured with a spectrophotometer (576 FTU). Moreover, in vivo experiments also showed results equivalent to that measured with a spectrophotometer, and wireless measurement of salivary turbidity was realized using the mouthguard-type sensor. Based on these results, the proposed mouthguard-type sensor has promising potential for the unconstrained continuous evaluation of oral hygiene.

Assessing effectiveness of WhatsApp messaging program in oral hygiene care for orthodontic patients: A randomised controlled trial

OBJECTIVE

To evaluate the difference in the oral hygiene status of participants with fixed appliances between a 'weekly WhatsApp application oral hygiene message reminders' trial group and a 'verbal instructions' control group over a follow-up duration of 12 weeks.

DESIGN

Prospective, single-blind, randomised controlled trial with an allocation ratio of 1:1 over a 12-week follow-up.

SETTING

Government Orthodontic Unit, Raub Dental Clinic, Raub, Pahang, Ministry of Health, Malaysia.

PARTICIPANTS

A total of 40 patients aged 13-25 years undergoing orthodontic treatment with fixed appliances.

METHODS

The 40 patients were recruited and randomly allocated to a control (n = 20) or trial group (n = 20). Participants in the trial group received weekly oral hygiene reminders via the WhatsApp application for 12 weeks, while the control group did not receive any reminders. The primary outcome was oral hygiene, which was measured by the single-blinded examiner using the Orthodontic Plaque Index (OPI) at three orthodontic check-ups: baseline (T0); 6-week follow-up (T1); and 12-week follow-up (T2).

RESULTS

The mean age was 17 years, and 80% were female patients. At the end of the 12-week follow-up, improvements in OPI scores were observed, regardless of the intervention. At T2, the median OPI score for the trial group (n = 20) was 0 (interquartile range [IQR = 0) while that for the control group (n = 20) was 2 (IQR = 0). A Mann-Whitney U test revealed a statistically significant difference (P <0.05), with effect size r = 0.87 between the control and trial groups, whereby the latter witnessed marked improvement in OPI throughout the visits. No harms or adverse effects occurred in this trial.

CONCLUSION

The short-term findings demonstrated that participants receiving regular reminders of oral hygiene via WhatsApp messaging had a significant improvement in oral hygiene compared to the control group.

A comparison study: The use of digital and conventional impression techniques in dental hygiene education

PURPOSE/OBJECTIVES

The study aimed to assess the applicability of digital intraoral scanning in dental hygiene education and compare the quality, efficiency, and ease of use to conventional impression techniques.

METHODS

Twenty-eight first-year dental hygiene students (DH1) at UTHealth Houston School of Dentistry (UTSD) participated in this 2022 study. Each student participated in two 4-h lab sessions. Students took traditional alginate impressions and digital intraoral scans using Planmeca Romexis on standardized teeth during the first and second sessions. Both techniques were assessed by faculty for quality and efficiency using a standardized rubric. Participants completed a post-survey providing insight into their perceptions of both techniques and ease of use.

RESULTS

The study had 100% participation in the lab sessions and survey responses (N = 28). The results showed digital scanning produced a statistically higher quality product than conventional alginate impressions (p = 0.023). The study found no statistical difference in the efficiency between the two methods. The majority of students (82%) agreed that digital intraoral scanning was easy to use (p = 0.001), and 89% agreed they would use digital intraoral scanning in clinical courses to help with patient care (p = 0.03).

CONCLUSION

In this study, dental hygiene students with limited clinical experience learned new technology and used it to produce quality impressions compared to the conventional technique, indicating the value of introducing digital dentistry early in dental hygiene education.

Meta-analysis with systematic review to synthesize associations between oral health related quality of life and anxiety and depression

OBJECTIVES

The present systematic review aimed to investigate how oral health related quality of life (OHQOL) associates with anxiety and depression. The study protocol was registered prospectively in the PROSPERO database (CRD42023389372).

MATERIALS AND METHODS

Studies investigating associations between OHQOL and depression and/or anxiety were included. Fisher's Z scores were used to summarize associations between OHQOL and depression/anxiety. Funnel plots and Begg's Tests were used to assess publication bias. Meta-regression was conducted to examine potential moderator effects in the associations. Academic databases including the ISI Web of Knowledge, Scopus, ProQuest and PubMed were systematically searched. The quality of included studies was checked with the Newcastle Ottawa Scale (NOS).

RESULTS

All 15 included studies were cross-sectional (14,419 participants from nine countries; mean age=43.74 years). The pooled estimates showed weak associations between OHQOL and depression (Fisher's z-score of 0.26 [95% CI = 0.17, 0.35; I2 = 96.2%; τ2 = 0.03]) and anxiety (Fisher's z-score of 0.22 [95% CI = 0.001, 0.43; I2 = 97.9%; τ2 = 0.06]). No severe problems in methodology quality, publication biases, or moderator effects were observed.

CONCLUSION

Both depression and anxiety were weakly associated with individuals' OHQOL. Although the synthesized associations were not strong, they were significant, indicating that depression and anxiety are potential factors influencing individuals' OHQOL.

Magnetic Hydroxyapatite-Coated Iron-Chromium Microspheres for Dental Surface Polishing and Plaque Removal

This research aimed to engineer magnetic hydroxyapatite-coated iron-chromium (HAp-FeCr) microspheres to enhance dental surface polishing and plaque elimination. Utilizing a tailored sol-gel approach, the HAp-FeCr microspheres were synthesized and exhaustively characterized via scanning electron microscopy, energy-dispersive X-ray spectroscopy, ζ-potential, X-ray diffractometry, and X-ray photoelectron spectroscopy methodologies. Key findings showcased that these microspheres retained their magnetic properties post-HAp coating, as evidenced by the magnetization curves. An innovative magnetic polishing system was developed, incorporating these microspheres and a 2000 rpm magnet. Comparative evaluations between traditional air-powder polishing and the proposed magnetic technique demonstrated the latter's superiority. Notably, the magnetic polishing led to a substantial reduction in dental plaque on the tooth surface, decreasing bacterial adhesion and early biofilm formation by Streptococcus gordonii and Lactobacillus acidophilus, where the most pronounced effects were observed in samples with elevated HAp content. A significant 60% reduction in dental plaque was achieved with the magnetic method relative to air-powder polishing. Furthermore, the HAp-FeCr microspheres' biocompatibility was verified through cytotoxicity tests and animal studies. In essence, the magnetic HAp-FeCr microspheres present a novel and efficient strategy for dental treatments, holding immense potential for improving oral health.

Oral and dental health promotion for children's nurses

Tooth decay remains one of the most common preventable oral health concerns in children. After birth, advice to caregivers predominantly focuses on medical health with little attention paid to dental health. Before discharge from the maternity unit and during future hospital and community appointments, opportunistic dental advice should be provided by midwives, nurses and health visitors where possible, with the aim of preventing early onset dental disease. Registering with a dentist at birth is crucial due to long NHS dental waiting lists. Simple advice on toothbrushing should be offered, including brushing twice a day with a soft toothbrush using an age-appropriate amount of fluoride toothpaste. Mothers should be provided with information on the benefits of breastfeeding for oral health alongside tailored preventive care. Appropriate advice on bottle-feeding and weaning is required, including minimising the use of added sugar, drinking from free-flow cups after six months of age, and discouraging the use of milk bottles at bedtime and in general after one year of age. Written visual summaries can be shared with parents to consolidate verbal advice on oral and dental health.

Phytocannabinoids and gingival inflammation: Preclinical findings and a placebo-controlled double-blind randomized clinical trial with cannabidiol

OBJECTIVE

The aim of this study was to: (1) evaluate the anti-inflammatory effects of cannabidiol (CBD) on primary cultures of human gingival fibroblasts (HGFs) and (2) to clinically monitor the effect of CBD in subjects with periodontitis.

BACKGROUND

The use of phytocannabinoids is a new approach in the treatment of widely prevalent periodontal disease.

MATERIALS AND METHODS

Cannabinoid receptors were analyzed by western blot and interleukin production detected using enzyme immunoassay. Activation of the Nrf2 pathway was studied via monitoring the mRNA level of heme oxygenase-1. Antimicrobial effects were determined by standard microdilution and 16S rRNA screening. In the clinical part, a placebo-control double-blind randomized study was conducted (56 days) in three groups (n = 90) using dental gel without CBD (group A) and with 1% (w/w) CBD (group B) and corresponding toothpaste (group A - no CBD, group B - with CBD) for home use to maintain oral health. Group C used dental gel containing 1% chlorhexidine digluconate (active comparator) and toothpaste without CBD.

RESULTS

Human gingival fibroblasts were confirmed to express the cannabinoid receptor CB2. Lipopolysaccharide-induced cells exhibited increased production of pro-inflammatory IL-6 and IL-8, with deceasing levels upon exposure to CBD. CBD also exhibited antimicrobial activities against Porphyromonas gingivalis, with an MIC of 1.5 μg/mL. Activation of the Nrf2 pathway was also demonstrated. In the clinical part, statistically significant improvement was found for the gingival, gingival bleeding, and modified gingival indices between placebo group A and CBD group B after 56 days.

CONCLUSIONS

Cannabidiol reduced inflammation and the growth of selected periodontal pathogenic bacteria. The clinical trial demonstrated a statistically significant improvement after CBD application. No adverse effects of CBD were reported by patients or observed upon clinical examination during the study. The results are a promising basis for a more comprehensive investigation of the application of non-psychotropic cannabinoids in dentistry.

Efficacy of Ceragenins in Controlling the Growth of Oral Microorganisms: Implications for Oral Hygiene Management

Ensuring proper dental hygiene is of paramount importance for individuals' general well-being, particularly for patients receiving medical care. There is a prevailing utilization of conventional oral hygiene items, including toothbrushes and mouthwashes, which have gained widespread acceptance; nevertheless, their limitations encourage investigating novel options in this domain. Our study indicates that ceragenins (CSAs) being lipid analogs of host defense peptides, well-recognized for their wide-ranging antimicrobial properties, may be a potentially efficacious means to augment oral hygiene in hospitalized individuals. We demonstrate that ceragenins CSA-13, CSA-44, and CSA-131 as well as undescribed to date CSA-255 display potent antimicrobial activities against isolates of fungi, aerobic, and anaerobic bacteria from Candida, Streptococcus, Enterococcus, and Bacteroides species, which are well-recognized representatives of microbes found in the oral cavity. These effects were further confirmed against mono- and dual-species fungal and bacterial biofilms. While the ceragenins showed similar or slightly diminished efficacy compared to commercially available mouthwashes, they demonstrated a highly favorable toxicity profile toward host cells, that may translate into better maintenance of host mucosal membrane stability. This suggests that incorporating ceragenins into oral hygiene products could be a valuable strategy for reducing the risk of both oral cavity-localized and secondary systemic infections and for improving the overall health outcomes of individuals receiving medical treatment.

Oral Health Status and Oral Health-Related Behaviours of Hong Kong Students with Vision Impairment

This cross-sectional epidemiological study aimed to describe dental caries and oral hygiene conditions among visually impaired students in Hong Kong. Students aged 6-21 years from two specialised schools for those with vision impairment were invited. Information on sociodemographic background and oral health-related behaviours was collected through an online parent-reported questionnaire. Dental caries and oral hygiene were assessed using the Decayed, Missing and Filled Teeth (DMFT) index and the Visible Plaque Index (VPI), respectively. Chi-square, Mann-Whitney U and Kruskal-Wallis H tests were conducted to analyse the association between students' background and oral health status. A total of 73 participants were recruited, of whom 57.5% were male. Their mean (SD) age was 12.9 (4.7) years. Their mean DMFT score (SD) was 1.0 (1.8), and 43.8% had caries experience. The mean VPI (SD) was 0.76 (0.30). Their caries experience was significantly associated with their snacking habits (p = 0.013). Male participants had poorer oral hygiene than females (p = 0.048). In summary, dental caries is prevalent among visually impaired students in Hong Kong and their oral hygiene condition is unsatisfactory. Caries experience is significantly associated with snacking frequency, whereas oral hygiene is associated with gender. More specially designed preventive oral health measures should be provided for visually impaired students and their caretakers.

Chemical Profile and Biological Activities Of Piper mikanianum (Kunth) Steud Essential Oil for Development and Improvement of Oral Rinse

INTRODUCTION

Studies prove that the use of medicinal plants is a custom carried out by man since ancient times, the evolution of the pharmaceutical industry makes more people consume more natural products. Currently, we can observe that mouthwashes containing natural compounds have shown a growth in demand in the markets and in the professional community.

OBJECTIVE

The present study aims to carry out the chemical characterization and microbiological potential of Piper mikanianum (Kunth) Steud essential oil (EOPm), providing data that allows the development of a low-cost mouthwash formulation aimed at vulnerable communities.

METHODS

The evaluation of the antibacterial activity and modulator of bacterial resistance was performed by the microdilution method to determine the minimum inhibitory concentration (MIC). The chemical components were characterized by gas chromatography coupled to mass spectrometry, identified 28 constituents, in which Safrole Phenylpropanoid is the major compound, representing 72.6 % of the total composition, followed by α-pinene (10.7 %), Limonene (2 %), β-caryophyllene (2 %), E-nerolidol (1.9 %), spathulenol (1.3 %) and camphene (1.1 %).

RESULTS

The EOPm showed a MIC minimum inhibitory concentration≥1024 μg/mL for all bacterial strains used in the tests. When the EOPm modulating activity combined with chlorhexidine, mouthwash, ampicillin, gentamicin and penicillin G was evaluated against bacterial resistance, the oil showed significant synergistic activity, reducing the MIC of the products tested in combination, in percentage between 20.6 % to 98 .4 %.

CONCLUSIONS

We recommend the expansion of tests with greater variation of EOPm concentration combinations and the products used in this study, as well as toxicity evaluation and in vivo tests, seeking the development of a possible low-cost mouthwash formulation accessible to the most vulnerable population.

Efficacy of an Electric Toothbrush With Monitor in Dental Plaque Removal: A Crossover Randomized Controlled Trial

BACKGROUND AND PURPOSE

Plaque control is very important in the treatment of periodontitis. However, plaque is difficult to remove because one cannot see one's own oral cavity. The purpose of this study was to verify the plaque removal effect of a prototype device that has a built-in image sensor in the head of an electric toothbrush, enabling the user to brush while checking the condition of the tooth surface on a monitor in real time and to assess their sense of use.

MATERIALS AND METHODS

The subjects were 10 fifth-year students from the Graduate School of Dental Science, Fukuoka Dental College, Fukuoka, Japan. The subjects were divided into those who used electric toothbrushes while having the condition of the tooth surface checked with a monitor (monitor group) and those without a monitor (non-monitor group). O'Leary plaque control records before and after brushing and the brushing time were measured, and questionnaires were given to the subjects after brushing. Scaling and professional tooth cleaning were performed after completing the questionnaire. One week later, subjects were switched to the opposite group and had the same measurements and questionnaires. The Wilcoxon signed-rank test was used to compare both groups before and after the examination at a 5% significance level.

RESULTS

The monitor group had significantly better plaque removal than the non-monitor group. In addition, the monitor group spent significantly more time brushing than the control group.

CONCLUSION

Brushing while monitoring oral conditions in real time using an electric toothbrush with a built-in image sensor showed that significantly better plaque removal can be achieved with a longer brushing time.

A Cross-sectional Study on the Effectiveness of Two Different Tooth-brushing Exercise Methods in Blind Childrendren

OBJECTIVE

 Blind children tend to have poor oral health. Oral health education is needed to reduce the prevalence of dental caries and periodontal diseases among blind children. The aim of this study was to evaluate the effectiveness of two tooth brushing exercise methods toward blind children's knowledge, attitude, behavior, and oral hygiene.

MATERIALS AND METHODS

 The purposive sampling technique was used in this study on 80 blind children aged between 7 and 16. Children were divided into two groups of 40 children each. In group I, children received the tooth-brushing exercise through the Braille-verbal method, and group II received the tactile-verbal method. Their knowledge, behavior, and attitude were recorded by a questionnaire, and their oral hygiene was assessed during a personal oral examination. Data were analyzed using Wilcoxon-Mann-Whitney non-parametric test.

RESULTS

 Differences in effectiveness toward knowledge, attitude, and oral hygiene were found between both methods with the following values: p-value = 0.04 (<0.05), 0.04 (<0.05), and 0.0002 (<0.05). No difference in effectiveness toward behavior was found: p-value 0.30 (>0.05).

CONCLUSION

 The two tooth-brushing methods could change knowledge, attitude, and oral hygiene in blind children. The tactile-verbal method was more effective than the Braille-verbal method in changing blind children's oral hygiene.

Effect of A Fluoride Toothpaste Containing Enzymes and Salivary Proteins on Periodontal Pathogens in Subjects with Black Stain: A Pilot Study

OBJECTIVE

 Black stain (BS) is an extrinsic dental discoloration particularly difficult to treat. Although its etiology is not fully clear yet, chromogenic bacteria inside the oral cavity seem to be involved. In this pilot study, we evaluated whether a toothpaste containing enzymes and salivary proteins could improve oral health and reduce the presence of periodontal pathogens in subjects predisposed to BS discoloration.

MATERIALS AND METHODS

 Twenty-six subjects were enrolled in the study: 10 subjects without BS; 16 subjects with BS, randomly assigned in two groups: test (n = 8) and control (n = 8). The test group used a toothpaste containing sodium fluoride, enzymes, and salivary proteins. The control group used a toothpaste with amine fluoride. At enrollment and after 14 weeks, participants were subjected to professional oral hygiene, evaluation of BS (through Shourie index) and oral health status, collection of saliva and dental plaque samples. The presence of periodontal pathogens in plaque and saliva of all subjects was investigated by molecular analysis (PCR).

STATISTICAL ANALYSIS

 The prevalence of investigated microbial species in patients with/without BS was performed by Chi-squared test. The variation in the prevalence of the investigated species after treatment in test and control group was analyzed by t-test.

RESULTS

 Clinical evaluation showed that 86% of participants with BS had a reduction in the Shourie index, independently from the toothpaste used. In particular, a greater reduction in the Shourie index was observed in subjects using an electric toothbrush. We did not observe an effect of the fluoride toothpaste containing enzymes and salivary proteins on the composition of the oral microbiota of the test subjects in comparison with controls. When comparing all subjects with BS (n = 16) and without BS (n = 10), P. gingivalis detection was significantly higher in saliva samples collected from subjects with BS (p = 0.0129).

CONCLUSION

 We verified that the use of an enzyme-containing toothpaste alone is not sufficient to prevent the formation of BS dental pigmentation in subjects predisposed to this discoloration. Mechanical cleaning, especially using electrical toothbrushes, seems to be useful to counteract BS formation. Moreover, our results suggest a possible association between BS and the presence of P. gingivalis at the salivary level.

An updated systematic review on toothbrush contamination: An overlooked oral health concern among general population

OBJECTIVES

The present systematic review was conducted to give an overview of toothbrush contamination among the general population and the factors affecting toothbrush contamination with an evidence-based approach.

DATA/SOURCES

Medline (Pub Med), CINAHL Plus, Cochrane Library and Dentistry and Oral Health Sciences Source were searched for the results after applying the search strategy from January 2012 to May 2022, following inclusion and exclusion criteria. The data were collected using a self-made data collection form on study characteristics, population attributes and the main features, including the study's outcomes. The methodological quality of the included studies was independently evaluated based on the Joanna Briggs Institute's (JBI) critical appraisal checklist for cross-sectional studies and the Risk of Biasness Tool-1 (Rob-1) for randomized controlled trials (RCTs). A descriptive analysis of the included studies was done using SWiM guidelines. The impact of charcoal and non-charcoal brushes on toothbrush disinfection was quantitatively analysed using a forest plot.

STUDY SELECTION

Of the 687 studies screened by title and abstract, 27 articles were selected for full-text evaluation using the EndNote reference program (Ver. X9.2). From these, 15 qualified and were included in the systematic review. Among the selected studies, eight were RCTs, six were cross-sectional studies, and the remaining one was an in vitro experimental study.

CONCLUSIONS

The toothbrush becomes contaminated even after its first usage, and the contamination level rises with continued use. There are a number of factors that lead to the contamination of brushes, such as increased humidity brought on by a plastic cover or a toilet setting. Charcoal brushes show significant efficacy as compared to regular bristles in reducing toothbrush contamination; however, more RCTs are needed to further assess its efficacy. Nevertheless, rinsing with chlorhexidine mouthwash after daily brushing shows favourable results.

Best practice recommendations for speech-language pathology in children with neuromuscular disorders: A Delphi-based consensus study

PURPOSE

Speech-language pathology (SLP) is considered an essential intervention due to the high prevalence of dysphagia and dysarthria in paediatric neuromuscular disorders (pNMD). Evidence-based guidelines for SLP in pNMD are missing and children could be deprived the best of care. This study aimed to achieve consensus and present best practice recommendations on SLP intervention in pNMD.

METHOD

A modified Delphi technique was used with a panel of experienced Dutch speech-language pathologists. In two online survey rounds and a face-to-face consensus meeting, the SLP experts proposed intervention items for cases of four types of pNMD (congenital myopathy, Duchenne muscular dystrophy, myotonic dystrophy type 1, and spinal muscular atrophy type 2), covering symptoms of dysphagia, dysarthria, drooling, and oral hygiene problems. They rated the level of agreement.

RESULT

Intervention items that achieved consensus were incorporated into best practice recommendations. These recommendations cover six core intervention components (wait and see, explanation and advice, training and treatment, aids and adjustments, referral to other disciplines, and monitoring) suitable for the described symptoms.

CONCLUSION

Insight into treatment options is essential to facilitate speech-language pathologists in clinical decision-making. The current study led to best practice recommendations for speech-language pathologists working within the field of pNMD.

Effectiveness of Online vs. In-Person Periodontal Health Workshops for Public Awareness

Background

Periodontal health is a critical aspect of overall oral health, yet public awareness and education on this topic remain limited. With the increasing prevalence of online health education platforms, it is essential to evaluate the effectiveness of online periodontal health workshops compared with traditional in-person workshops on improving public awareness.

Materials and Methods

Study Design: This randomized controlled trial (RCT) aimed to assess the impact of online and in-person periodontal health workshops on public awareness. Participants (N = 500) were randomly assigned to one of two groups: the online workshop group or the in-person workshop group. Online Workshop: Participants in this group accessed an interactive online periodontal health workshop, consisting of video presentations, animations, and quizzes. The workshop covered topics, such as gum disease prevention, oral hygiene, and the importance of regular dental checkups. In-Person Workshop: Participants in this group attended a traditional in-person periodontal health workshop conducted by dental professionals. The content and duration of this workshop mirrored the online version. Pre- and Postworkshop Assessments: Both groups completed pre-workshop and postworkshop assessments, including a knowledge questionnaire and a self-assessment of oral health habits. Arbitrary scores were assigned to quantify knowledge gain (0-100%).

Results

Participants in the online workshop group showed a mean knowledge gain of 30% (standard deviation (SD) = 5.2), while those in the in-person workshop group exhibited a mean knowledge gain of 35% (SD = 4.7). The self-assessment of oral health habits indicated an improvement in both groups, with 60% of participants reporting better oral hygiene practices.

Conclusion

Both online and in-person periodontal health workshops demonstrated effectiveness in improving public awareness and promoting better oral health habits. Combining both modalities could be an effective strategy for comprehensive public education on periodontal health.

Assessing the Impact of Smoking Cessation Interventions on Periodontal Health and Gingival Inflammation in Smokers with Periodontitis

Background

Smoking is a well-established risk factor for periodontitis, a chronic inflammatory disease of the oral cavity. While smoking cessation has been linked to improved overall health, its specific impact on periodontal health and gingival inflammation in individuals with periodontitis remains less explored.

Materials and Methods

We conducted a prospective cohort study involving 200 smokers diagnosed with periodontitis. Participants were divided into two groups: Group A received comprehensive smoking cessation interventions, including counseling and pharmacotherapy, while group B continued smoking without intervention. Periodontal health was assessed through clinical parameters, including probing depth (PD) and clinical attachment level (CAL), at baseline and 6 months post intervention. Gingival inflammation was evaluated using the Gingival Index (GI).

Results

After 6 months, group A exhibited a significant reduction in mean PD (from 4.5 mm to 3.2 mm) and CAL (from 5.0 mm to 3.5 mm) compared to group B. Conversely, group B showed no significant change in these parameters. The GI score significantly decreased in group A (from 2.8 to 1.2) but remained unchanged in group B. Furthermore, group A demonstrated a higher rate of smoking cessation (72%) compared to group B (14%).

Conclusion

Smoking cessation interventions play a crucial role in improving periodontal health and reducing gingival inflammation in smokers with periodontitis. The observed reductions in PD, CAL, and gingival inflammation highlight the potential benefits of smoking cessation on oral health outcomes in this high-risk population.

Association between acculturation, dental floss use, dental visits and unmet dental needs among Asians in the United States: Findings from National Health and Nutrition Examination Survey (NHANES) 2011-2018

OBJECTIVES

The objectives of this study were to examine the associations between acculturation and dental floss, regular dental visits and unmet dental care needs among Asian Americans, as well as the moderating effects of these associations.

METHODS

This study analysed national representative samples from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. A total of 2763 Asian Americans aged 20 and older were included in this analysis. The primary predictor, acculturation score, was determined by three questions: (i) language spoken at home (higher score for English), (ii) country of birth (higher score for United States) and (iii) length of time in the United States. Dental floss use, dental visits and unmet dental care needs were included as outcomes in this study. Descriptive statistics and logistic regressions were used to analyse the samples.

RESULTS

Acculturation was significantly associated with dental health behaviours: Individuals with higher levels of acculturation were more likely than less acculturated individuals to use dental floss (81.0% vs. 63.9%, respectively) and visit the dentist regularly (76.7% vs. 66.9% respectively). Insurance status moderated the association between acculturation and dental visits: Acculturation was significantly associated with dental visits in the past year among insured individuals (OR = 1.70, 95% CI: 1.29-2.23), but not among uninsured individuals. Unmet dental care needs were present in 11.1% of participants. While costs and insurance were the top two determinants of access to care, individuals with and without insurance differed with regard to their third major reason for unmet dental care needs: Being 'too busy' and not wanting to spend money on dental care.

CONCLUSIONS

Among the Asian population in the United States, those with high acculturation scores were more likely to engage in dental flossing and visit the dentist regularly compared to those Asians with lower acculturation scores. To encourage dental flossing and regular dental visits among Asians with lower acculturation scores, cultural adaptation and language accessibility suggests being considered. Future research is necessary to confirm the moderating effect of insurance status on the association between acculturation and regular dental visits. Additionally, our findings emphasize the impact of costs and insurance on access to dental care among Asians in the United States, highlighting the importance of future public health programmes in addressing these barriers.

Development, implementation and evaluation of a dental hygienist supported daily toothbrushing programme in Irish pre-schools: A single-case experimental design

INTRODUCTION

Many pre-school children in Ireland experience dental caries in their primary dentition. The rate of dental caries varies, impacted by the levels of fluoride in the water and socio-economic status (18%-55%). This article reports on a novel initiative in which dental hygienists (DHs) supported pre-school teachers (PST) to implement a toothbrushing programme for children attending pre-schools in Ireland. It was hypothesised that such an initiative would create an environment in pre-schools that would improve the oral hygiene skills and habits of children and increase the oral health knowledge of parents and PST.

METHODS

A storybook (Brushing our teeth with Brush Bunny), a toothbrushing song and information leaflets were developed. DHs were provided with specific online training for the programme. The resources, including toothbrushes and toothpastes, were delivered to the pre-schools and training was provided by the DHs to the PST to prepare for and implement daily toothbrushing sessions. The standards for the toothbrushing programme followed the ChildSmile© programme. Before and after questionnaires gathered quantitative and qualitative data from the parents and PST. The toothbrushing programme was implemented by PST for 3 months.

RESULTS

Sixteen DHs and PST from 19 classes in 17 schools successfully delivered the programme to 331 children, and 227 parents completed both pre- and post-questionnaires. Poor baseline knowledge in relation to the 'spit don't rinse' message increased from 29% to 48%. However, there was no improvement in awareness of the benefits of fluoride in toothpaste. Awareness of the best brushing routines in relation to frequency and length was good at baseline and remained so after the programme. Most parents (90%) felt the programme had impacted positively on their child's toothbrushing routine.

CONCLUSION

This experimental study suggests that the logistics of implementing a daily toothbrushing routine to improve the oral hygiene skills and habits of pre-school children are possible in Irish pre-school settings when PST are supported by DHs. Parents' oral health knowledge may be improved, and it may impact positively on the children's daily toothbrushing routine. A larger study is required to confirm these findings.

Dental Treatment Needs of Male Inmates in Relation to the Analysis of Medical Databases

The worldwide incarceration rate per 100,000 people varies from 30 in India, 580 in Europe, to 750 in United States. The health of prisoners is of great concern. Research in many countries has shown poor oral health conditions among prisoners, particularly reflected in the high number of lost and untreated decayed teeth. The aim of our study was to evaluate the quality and range in dental procedures conducted on male prisoners, based on a retrospective analysis of medical history gathered at the Academic Center of Dentistry and Specialistic Medicine of Medical University of Silesia in Bytom for the period 2018-2021, and its correlation with the results obtained from the analysis of the Web of Science (WoS) and SCOPUS medical databases. Our research was carried out on the examined group, 86 men (mean age 31 years old), and a control group, 106 men (mean age 32 years old). The retrospective analysis of the medical history was performed. Results of our own research showed the values for decayed and missing teeth were significantly higher in the examined group while the values for the filled teeth component were significantly higher in the control group. The chance for the occurrence of the radices was 2.5 times higher in the examined group than in the control. The examined group was characterized by 3.6 times higher chance of no root canal treatment than the control group. The number of the endodontically treated teeth was significantly higher in the control group. The examined group was characterized by 4.2 higher probability for periapical lesion occurrence in teeth that were not endodontically treated. The number of teeth qualified for the endodontic treatment was significantly higher in the examined group, while the number of teeth qualified for the reendow treatment was significantly higher in the control group. The probability for the occurrence of both vertical and horizontal atrophy in the alveolar process was twice and three times higher in the examined than in the control group. In conclusion, the oral status of inmates is worse when compared to those who live in freedom, which is why there is a need to prepare a scheme to improve the condition of the stomatognathic system in prisoners.

Efficacy of Three Interdental Cleaning Methods for Peri-Implant Health Maintenance of Single Implant-Supported Crowns: A Randomised Clinical Trial

PURPOSE

To compare the effectiveness of an interproximal brush, a water flosser, and dental floss in removing plaque and reducing inflammation around implant-supported crowns.

MATERIALS AND METHODS

A randomised controlled trial was conducted involving 45 participants with implant-supported single crowns. The participants were randomly assigned to three groups: interproximal brush, water flosser, and dental floss. Plaque index scores, gingival index scores, and interleukin-6 (IL-6) levels were assessed at baseline and after a two-week period. Statistical analysis was performed to compare the outcomes among the groups.

RESULTS

Following the second visit, improvements in plaque control were observed across all three interdental cleaning methods. The water flosser demonstrated a slight reduction in IL-6 levels (60.17 ± 3.07 vs 58.79 ± 4.04) compared to the initial visit, although this decrease was not statistically significant. Conversely, both the interdental brush and dental floss exhibited a slight increase in IL-6 levels at the second visit (60.73 ± 2.93 and 55.7 ± 10.64, respectively) compared to the mean at the first visit (58.38 ± 3.24 and 54.6 ± 2.22, respectively). Among the groups, only the interproximal brush demonstrated a statistically significant difference in IL-6 levels (p=0.008), while no statistically significant differences were observed in the dental floss and water flosser groups.

CONCLUSION

Within the study's limitations, our findings suggest that all three methods of interdental cleaning effectively improve plaque control and reduce gingival inflammation. However, using a water flosser appears to reduce inflammation more effectively, highlighting its potential advantage over the other two methods. Further research is needed to evaluate the long-term efficacy and impact of these methods on implant survival.

Association Between the Frequency of Tooth Brushing and the Risk of Cardiovascular Disease: A Systematic Review and Meta-analysis

Several epidemiological studies suggested that frequency of tooth brushing may be associated with cardiovascular disease (CVD) risk, but the results remain inconclusive. Therefore, the aim of this study was to synthesize frequency of tooth brushing and CVD risk using meta-analysis. Science Direct, PubMed, CINAHL, and OVID were searched through October 15, 2022. The random-effects model was used to quantitatively assess the combined risk estimation. In addition, we performed the sensitivity analysis to evaluate the robustness of the study results by excluding the included studies one by one. A total of 9 cohort studies containing 10 reports with 803,019 individuals were included in the meta-analysis. Pooled results showed that compared with the lowest brushing frequency, the highest brushing frequency (relative risk = 0.85, 95% confidence interval: 0.80-0.90) significantly reduced the risk of cardiovascular disease. There was moderate heterogeneity among included studies (P = .002, I2 = 65.4%). The exclusion of any one study did not materially change the combined risk estimates. Our meta-analysis supported the hypothesis that higher frequency of tooth brushing can reduce the risk of CVD, which may have important implications for conducting research on the prevention strategies of CVD.

Clinical findings and self-reported oral health status of biathletes and cross-country skiers in the preseason - a cohort study with a control group

This cross-sectional study aimed to compare clinical oral conditions as well as the self-reported oral health status of biathletes and cross-country skiers (A) to age- and gender-matched non-athletic controls (C). Thirty-one A and 68 C were examined in 2020 regarding caries experience (DMF-T), partially erupted wisdom teeth, non-carious tooth wear (erosion), dental plaque biofilm, gingival inflammation, periodontal screening (PSI), salivary active matrix-metalloproteinase-8 (aMMP-8) test and screening for temporomandibular disorders (TMD). Questionnaires recorded periodontal symptoms, TMD symptoms and oral health behaviour. Group A had a lower prevalence of carious teeth and positive aMMP-8 tests, but more of them had severe gingivitis and signs of periodontitis. Both groups reported similar oral health behaviour. Only in group C, associations between aMMP-8 and periodontal findings as well as clinical findings and self-reported symptoms of TMD were identified. Group A showed a high prevalence of oral inflammation and seemed to be less aware of oral symptoms. Clinical examination seems to be necessary for periodontal/TMD screening of athletes.

Chlorhexidine and doxycycline gel versus chip as adjuncts in oral hygiene among Indians

The effectiveness of newly released medications such as Chlorhexidine (CHX) chip, Doxycycline hyclate (DH) chip, CHX gel, DH chip as adjunct to scaling and root planing in the treatment of chronic periodontitis is important. 90 adult Indian patients with moderate chronic periodontitis were enlisted. It was observed that reduction in periodontal pocket depth (PPD) and increase in clinical attachment level (CAL) was seen in patients in CHX group as compared to DH treated study participants. It was observed that CHX and DH in gel form were more effective in improving periodontal health as compared to CHX and DH in chip form in this group of subjects.

Oral Health Knowledge, Self-Assessed Oral Health Behavior, and Oral Hygiene Practices among the Adult General Population in Croatia

OBJECTIVES

Emphasizing the significance of optimal oral health for enhancing overall well-being, this study aimed to investigate oral health knowledge, self-assessed oral health behaviors, and oral hygiene practices within the Croatian general population.

MATERIALS AND METHODS

A cross-sectional observational study was conducted online, utilizing a questionnaire collecting sociodemographic characteristics and inquiring about respondents' oral health knowledge, self-assessed oral health status, oral hygiene habits, and use of oral hygiene products. Collected data underwent both descriptive and regression analyses to unveil patterns and relationships within the dataset.

RESULTS

The respondents showed a high level of knowledge about oral health (median score 9, IQR 7.00-10.00, maximum possible score 10), with significant factors for higher knowledge being engaged in dental professions; above-average socioeconomic status; and the use of an electric brush, dental floss, and interdental brushes (p ˂ 0.05). Insufficient knowledge, on the other hand, was associated with bleeding gums and daily smoking (p ˂ 0.05). Although 69.4% of respondents considered their oral health to be very good, 32.5% reported tooth decay, and 38.2% reported tooth sensitivity. The majority (62.0%) cited regular check-ups as the reason for their last visit to the dentist, with 74.1% feeling no anxiety or discomfort during these visits. Daily toothbrush use was widespread (97.8%), but only 34.1% and 19.1% of respondents reported using floss and/or interdental brushes daily. A remarkable 69.0% of respondents indicated that low oral health literacy and low prioritization contribute to suboptimal oral health.

CONCLUSIONS

While respondents demonstrated commendable oral health knowledge, the prevalence of reported issues suggests a potential gap between perception and actual oral health status. To address this, targeted educational interventions focusing on comprehensive oral hygiene practices and debunking misconceptions should be prioritized in Croatia.

Dimensions of young children's toothbrushing resistance: A qualitative content analysis of discussions on the online parenting forum Mumsnet

BACKGROUND

Young children's resistant behaviour is a barrier to parental-supervised brushing. Discussions on online parenting forums offer an insight into parental experiences, behaviour and attitudes. Analysing these discussions also demonstrates how dental advice is represented and potentially resisted.

AIM

To analyse how young children's toothbrushing resistance is discussed on an online parenting forum.

DESIGN

Qualitative content analysis of threads on toothbrushing resistance retrieved from the UK parenting forum Mumsnet.

RESULTS

A search was carried out on Mumsnet in April 2022. Overall, 204 relevant threads were identified and analysed. A coding frame was developed. Posters interacted by discussing their experiences of resistance, asking for advice, making suggestions and being both supportive and critical. Thirty-seven strategies for addressing resistance were identified. Discussions reflected attitudes and concerns relating to young children and toothbrushing resistance, including the idea brushing should be 'non-negotiable'. A key issue was the acceptability of physical force or restraint to achieve adequate brushing. Posters invoked dental authority to support their views.

CONCLUSION

Understanding how toothbrushing resistance is discussed on a parenting forum helps establish what information and advice is shared, and highlights attitudes and concerns that shape how this problem is approached.

Clinical Assessment of Plaque Removal Using a Novel Dentifrice Containing Cellulose Microfibrils

Dentifrice performance in the removal of dental plaque is influenced by the interactions of dentifrice components with tooth surfaces. This randomized controlled clinical study assessed the effectiveness and safety of a novel fluoride dentifrice formulation that included a micro-fibrillated cellulose network with entangled microcrystalline cellulose and silica particles (ProtegeraTM), and compared this to a positive control fluoride dentifrice (Crest Cavity Protection™). Whole mouth dental plaque levels in 82 healthy adults were measured after the first supervised use, and following a week of twice daily use at home. Overall, the test dentifrice was at least three times and up to four times more effective in whole-mouth plaque reductions, with a 38.6% reduction on first use, a 30.9% reduction at day 7, and a 41.6% reduction from day 1 to day 7, compared to reductions of 12.0%, 9.6% and 11.6%, respectively for the positive control, and up to seven times more effective in lingual plaque reductions, than the reference dentifrice (p < 0.001), with a 27.7% reduction on first use, a 22.3% reduction at day 7, and a 31.0% reduction from day 1 to day 7, compared to reductions of 4.4%, 2.2%, and 4.5%, respectively, for the positive control. No safety issues arose from the use of the test dentifrice. These results indicate that including micro-fibrillated cellulose enhances plaque removal effectiveness, without causing adverse changes to oral soft tissues.