Showing papers by "G.A. van der Weijden published in 2017"

On the ecosystemic network of saliva in healthy young adults.

Abstract: A dysbiotic state is believed to be a key factor in the onset of oral disease. Although oral diseases have been studied for decades, our understanding of oral health, the boundaries of a healthy oral ecosystem and ecological shift toward dysbiosis is still limited. Here, we present the ecobiological heterogeneity of the salivary ecosystem and relations between the salivary microbiome, salivary metabolome and host-related biochemical salivary parameters in 268 healthy adults after overnight fasting. Gender-specific differences in the microbiome and metabolome were observed and were associated with salivary pH and dietary protein intake. Our analysis grouped the individuals into five microbiome and four metabolome-based clusters that significantly related to biochemical parameters of saliva. Low salivary pH and high lysozyme activity were associated with high proportions of streptococcal phylotypes and increased membrane-lipid degradation products. Samples with high salivary pH displayed increased chitinase activity, higher abundance of Veillonella and Prevotella species and higher levels of amino acid fermentation products, suggesting proteolytic adaptation. An over-specialization toward either a proteolytic or a saccharolytic ecotype may indicate a shift toward a dysbiotic state. Their prognostic value and the degree to which these ecotypes are related to increased disease risk remains to be determined.

A reproducible microcosm biofilm model of subgingival microbial communities

Abstract: Objective To develop a reproducible subgingival microcosm biofilm model. Material and Methods Subgingival plaque samples were collected from four deep pockets (probing pocket depth ≥6 mm) in each of seven patients with periodontitis and from shallow pockets (probing pocket depth ≤3 mm) in two periodontally healthy donors. An active attachment model and a peptone medium (Thompson et. al., Appl Environ Microbiol 2015;81:8307–8314) supplemented with 30% serum was used. Biofilms were harvested at 2 and 4 weeks. DNA of dead cells was blocked for amplification by propidium monoazide treatment. Composition was analyzed using 16S rRNA gene amplicon pyrosequencing. Similarities between the biofilm samples were assessed by non-metric multidimensional scaling using the Bray-Curtis similarity index and similarity percentage analysis. Data from duplicate experiments, different biofilm sources and different biofilm age were compared. Results The non-metric multidimensional scaling revealed a strong clustering by the inoculum source, the donor and their periodontal status. Statistically significant differences were found between the sources of inoculum (P=.0001) and biofilm age (P=.0016). Furthermore, periodontitis biofilms (P) were distinct in composition from health-derived biofilms (H) by genera: Porphyromonas (P=19%; H=0%), Filifactor (P=10%; H=0%), Anaeroglobus (P=3%; H=0%), Phocaeicola (P=1.5%; H=0%), Parvimonas (P=19%; H=14%), Fusobacterium (P=2%; H=26%), Peptostreptococcus (P=20%; H=30%), Veillonella (P=7%; H=8%) and 57 other genera. Similarity distances (Bray-Curtis) (mean 0.73, SD 0.15) and the Shannon diversity index (mean 2, SD 0.2) revealed no differences between duplicate experiments (P=.121). Conclusion This biofilm model allows reproducible production of complex subgingival microbial communities.

The effectiveness of conically shaped compared with cylindrically shaped interdental brushes - a randomized controlled clinical trial.

Abstract: Aim The purpose of this study was to compare the effectiveness of conically shaped versus cylindrically shaped interdental brushes (IDB) in patients receiving supportive periodontal therapy. Materials and methods Periodontal maintenance patients volunteered to be enrolled into this randomized controlled examiner-blind parallel study. At baseline and after 3 months, plaque scores, bleeding upon pocket probing scores and probing pocket depth (PPD) were assessed. The type of IDB (conical or cylindrical) was randomly assigned to each patient and individual instruction was provided regarding the method of use and the appropriate size. Only those approximal sites that had sufficient space for the IDB were eligible, and for those sites the data were analysed separately. Analyses were performed for all eligible approximal surfaces and a sub-analysis was performed for vestibular and lingual surfaces. Results In total, 51 participants attended the baseline and the 3-month clinical appointments. Overall, there was no difference between conical and cylindrical IDBs. However, the conical IDB showed significantly higher plaque and bleeding scores at the lingual approximal sites. The cause of this difference was an increase in plaque and bleeding scores compared with baseline. With respect to the PPD, no difference between the IDBs was observed. Conclusion Within the limitations of this experiment, the conical IDBs are less effective than cylindrical IDBs with respect to lingual approximal plaque removal. Thus, in patients receiving supportive periodontal therapy, the cylindrical shape should be the first choice of IDB to obtain and maintain gingival health around natural teeth.

Family history of periodontal disease and prevalence of smoking status among adult periodontitis patients: a cross-sectional study.

Abstract: Objectives What is the family history of periodontal disease and the prevalence of smoking status among patients with professionally diagnosed periodontitis? Are these factors related to extent and severity of periodontitis? Methods Over a 10-year period, referred patients from a clinic for periodontology in the Netherlands were examined in a cross-sectional study. Patients received at the intake appointment a full-mouth periodontal examination. Data regarding family history of periodontitis and smoking status were recorded. Results A total of 5375 adult periodontitis patients were included in this study sample with a mean age of 50 years. The prevalence of smoking was 34% and 37% of the subjects had at least one parent or sibling with periodontitis. The chance to have severe periodontitis was higher if the patient was male, smoker or had a brother with periodontitis. Being male, smoker and having a parent with periodontitis were significantly associated with a larger extent of periodontitis. Conclusions Within the investigated population familial aggregation, smoking status, age and gender are factors that were related to extent and severity of adult periodontitis.

Self-reported periodontal conditions among Dutch women during pregnancy.

Abstract: Background Women can experience symptoms of gingival inflammation during pregnancy. However, whether clinical signs of gingival inflammation were present already before pregnancy and whether women perceive an alteration in their periodontal health status during pregnancy compared to their periodontal health status before pregnancy remain unclear. Objectives The aim of this study was to evaluate the self-reported periodontal conditions in pregnant Dutch women as perceived before and during pregnancy. Methods This cross-sectional survey was performed by asking women visiting two midwifery practices to complete a structured questionnaire. The data, which considered the women's oral hygiene habits, perceived periodontal health status before and during pregnancy and dental visits, were gathered and analysed. Parametric and nonparametric tests were used when appropriate. Results Most of the respondents (mean age: 29.6 years) brushed their teeth twice a day (72.2%), and 62.0% used interdental cleaning devices. Significant differences in periodontal health before and during pregnancy were perceived. No differences with respect to periodontal disease symptoms between the three trimesters during pregnancy were found. The symptom with the greatest increase was bleeding gums. This was followed by symptoms of painful and swollen gums. Of the 61.5% women who disclosed their plans to become pregnant to their dental care practitioner, 53.9% received information regarding the possibility of alterations in oral health status during pregnancy. Because of the perceived alterations in oral health status during pregnancy, approximately 11% of the women scheduled an additional appointment with their dental care professional for advice. Conclusion During the pregnancy period, perceived alterations in periodontal health status were reported as compared to the oral health situation before pregnancy. Furthermore, approximately 50% of the women who visited a dental professional and disclosed their (plans) of pregnancy did not receive specific information concerning their periodontal health during pregnancy.

Effectiveness of various interventions on maintenance of gingival health during 1 year - a randomized clinical trial

Abstract: Background: Rinsing with the combined use of an oxygenating-agent (OA) and chlorhexidine (CHX) in addition to mechanical oral hygiene could improve and/or maintain good gingival health over a long period. Methods: This study had an examiner-blinded, randomized, six-group parallel design consisting of two-phases: a 3-week treatment phase and a subsequent 12-month experimental phase. A total of 267 subjects in good general health (≥18 years), without periodontitis, with at least five teeth per quadrant, and with moderate to advanced gingivitis were enrolled. A 3-week treatment phase was initiated to improve gingival health. Subjects were assigned to one of the six groups: two basic oral hygiene groups (Control I & II), one professional oral hygiene instruction group (OHI), one professional prophylaxis group (PP), an OA&CHX rinse group and a group receiving a combination of all regimens (COMBI group), being OHI + PP + OA&CHX. Dental plaque, gingival bleeding and staining assessments were performed at the start of the treatment phase, at baseline and at 4, 7, 10, and 12 months. Results: There was a significant reduction in dental plaque-scores for the OA&CHX and COMBI-group (0.51 [SD = 0.37], 0.38 [SD = 0.33] respectively) and a significant reduction in gingivitis scores for the OA&CHX and COMBI group (6.9% [SD = 14.0], 13.4% [SD = 13.4] respectively) from the start of the treatment phase to baseline. No clinically relevant changes were observed for the other four groups. After baseline, bleeding and plaque-scores increased back to a non-significant level between groups, and this level remained throughout the study. Conclusion: OA&CHX and COMBI-group showed a clinically relevant improvement after the treatment phase in terms of dental plaque and gingival bleeding levels. At the 4-month clinical assessment, there was no longer a significant difference between groups.

Grip Strength in Women Being Treated for Breast Cancer and Receiving Adjuvant Endocrine Therapy: Systematic Review

Abstract: Background Adjuvant endocrine therapy in breast cancer has increased survival rates; however, it is not without musculoskeletal side effects. Purpose The purpose of this review was to systematically and critically appraise the available scientific evidence concerning the effect of adjuvant endocrine treatment on grip strength in women being treated for breast cancer. Data sources and study selection The National Library of Medicine (MEDLINE-PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medical Database by Elsevier (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence Database (PEDro) were searched from inception to February 2017 for appropriate papers that could answer the focused question. The searches were independently screened by 2 reviewers. The data from 7 papers that met the eligibility criteria were processed for further analysis. Data extraction and synthesis The collective data and the statistical analysis of all included studies were summarized and presented in a descriptive manner. If not provided, based on data from the individual included studies, a mean percent change in grip strength was calculated. The included studies evaluating aromatase inhibitors had inconclusive outcomes, and studies with a follow-up of 6 or 12 months showed a percent reduction in grip strength varying from 0.1% to 9.7%. None of the included studies showed a significant decrease in grip strength in tamoxifen users, with a percent reduction in grip strength varying from 1.4% to 2.2%. Limitations The 7 studies included cohort studies lacking a control group. Conclusions There is inconclusive evidence for a small decrease in grip strength in women treated for breast cancer who are also receiving aromatase inhibitors. In those that use tamoxifen, grip strength did not change significantly.

The effectiveness of a dentifrice without sodium lauryl sulphate on dental plaque and gingivitis - a randomized controlled clinical trial.

Abstract: Objectives The purpose of the study was to evaluate the effect on dental plaque and gingivitis of a dentifrice without sodium lauryl sulphate (SLS) compared to two SLS-containing dentifrices. Material and methods For this double-blind, parallel study, 90 volunteers having moderate gingival inflammation (≥40%) were randomly divided among three groups: one group using non-SLS dentifrice containing enzymes, colostrum and low concentrations of zinc and two control groups each using different SLS-containing dentifrices. Dental plaque scores (Turesky modification of Quigley & Hein) and gingivitis scores (Bleeding On Marginal Probing) were assessed at baseline, after 2 and 4 weeks. Results Eighty-nine participants provided evaluable data. A slight decrease in gingivitis scores was observed for all groups over 4 weeks, which was statistically significant for the non-SLS group. Mean values for dental plaque scores did not show major differences over 4 weeks. For both parameters, no significant differences between groups could be observed at any time point. Patient appreciation was in favour of the SLS groups especially regarding the foaming effect. Conclusion No significant differences could be observed with respect to the effect on plaque and gingivitis between SLS-containing and SLS-free dentifrice containing enzymes, colostrum and low concentration zinc. Patients enjoyed the duration of taste and the ‘foaming effect’ of SLS-containing dentifrices better.

User perception on various designs of tongue scrapers: an observational survey

Abstract: Aim The aim of this study was to identify the participants' preference and perception of effectiveness with respect to nine commercially available tongue scrapers. As secondary aim, perception of discomfort and suspected sharpness were assessed. In addition, the first impression of the design of the various tongue scrapers was evaluated. Materials and methods This was an observational survey without blinding to the products. At first impression, participants were given nine tongue scrapers and were asked to immediately use all, and to point out which of the scrapers they preferred most. Subsequently, a 14-day familiarization period followed. At the follow-up appointment, all participants received a questionnaire which used a visual analogue scale (VAS) to evaluate their perception of the various scrapers used. Questions regarding the perceived efficacy, discomfort and pain were posed. Data were analysed statistically by anova. T-tests were used for ‘post hoc’ analysis and Bonferroni corrections were used for multiple comparisons. Results In total, 50 participants completed the assessment. The primary parameter ‘efficacy’ showed scores that ranged from 4.09 to 6.43 (P < 0.001) for the nine tongue scrapers. The secondary parameters ‘sharpness’ (range from 3.31 to 6.26) and ‘discomfort’ (range from 5.67 to 8.33) showed significant differences as well (P < 0.001). A significant negative correlation (R = −0.850; P = 0.004) between the perceived sharpness and discomfort was observed. Conclusion The perception of effectiveness varied among the various tongue-cleaning device designs. No single feature stood out as being specifically related to perception of effectiveness. Sharpness and comfort were negatively correlated. Comfort and effectiveness were positively correlated. The results from this study indicated that participants found TS6 and TS8 to be the most comfortable and the most effective. However, TS8 scored higher for inducing a higher gag reflex.

The effects of different levels of brush end rounding on gingival abrasion: a double-blind randomized clinical trial.

Abstract: Objective The objective of this study was to evaluate the effect of different levels of filament end rounding on gingival abrasions (GAs). Methods The study was a crossover, split-mouth, contra-lateral, double-blinded, randomized design using professional brushing. Three manual toothbrushes, with 0%, 40–50% and >90% end-rounded filaments, were investigated. Participants refrained from all oral hygiene procedures for 48 h prior to each of the three visits. Prior to brushing, oral soft tissue (OST) and GAs were assessed. Based on the randomization, during every visit contra-lateral quadrants were brushed with one of the three test brushes. After brushing, GAs were re-assessed. The means of the GAs prebrushing and post-brushing and differences per brush were calculated. Subanalyses were performed based on the size of the abrasion and its location. Results A total of 46 generally healthy participants without periodontitis completed the study and provided a full data set. All brushes had statistically significant increases of abrasions following their use (P 90% brushes (P ≥ 0.001). A subanalysis showed that significantly more small-sized (P ≥ 0.002) abrasions located at the gingival margin (P 90% end-rounded brushes in any of the analyses. OST deviations were not observed. Conclusions Based on the results of this experiment involving professional brushing, it can be concluded that 40–50% or greater end-rounded filaments can provide a significant reduction in gingival abrasions compared to non-end-rounded filaments.

Prebrushing rinse with water on plaque removal: a split-mouth design

Abstract: Objective The aim was to evaluate whether there is an additional beneficial effect on dental plaque removal of rinsing the oral cavity with water before toothbrushing. Method In total, 48 non-dental, systemically healthy participants ≥18 years were included in this randomized controlled clinical trial using a split-mouth design. The participants were requested to refrain from any form of oral hygiene for 48 h. First dental plaque scores (PI) were assessed full mouth. Two randomly assigned contra-lateral quadrants were brushed. Next the participant rinsed for 1 min with 15 ml water. Subsequently, the opposite two contra-lateral quadrants were brushed. Brushing was performed without toothpaste. Subsequently the second full-mouth PI assessment was performed. The brushing and rinsing procedure was performed under supervision and brushing time was tracked by a timer, each quadrant was brushed for 30 s. For the buccal, lingual, and approximal surfaces and tooth type, a subanalysis was performed. Results At baseline there was no statistically significantly difference between the two sets of contra-lateral quadrants. When a water rinse was used before toothbrushing the PI-score was reduced by 58%. If water rinse was used post-brushing the PI-score reduced by 57%. The difference of 0.04 in mean plaque index score reduction between the two brushing regimens was not significant(P = 0.162). Conclusion When a 2 min brushing exercise was performed, on average more than 55% dental plaque was removed. Prerinsing with water did not contribute significantly to toothbrush efficacy.

A PhD completed. Trauma to the gingiva by oral hygiene aids and oral piercings

Abstract: Maintaining healthy teeth and soft oral tissue is important. Clinical research has shown manual toothbrushes with end-rounded filaments to cause significantly less gingival abrasions than those without end-rounding. Tapered filaments are an alternative to end-rounded filaments, but there is no solid evidence for their effectiveness. For the interdental spaces that the toothbrush doesn't reach, the use of special oral hygiene aids is advised. Clinical studies of gingivitis patients have shown that both interdental brushes and plastic-rubber bristles reduce gingivitis after 4 weeks of use. Plastic-rubber bristles result in a significant improvement in the tendency for interdental bleeding compared with interdental brushes, and they cause less abrasion of the gingiva. Other factors that can potentially traumatise soft and hard oral tissue are oral piercings. Wearing oral piercings is not without risk. Tongue and lip piercings are associated with the risk of gingival recession, and tongue piercings are associated with tooth fractures. To prevent the risk of complications, patients should be discouraged from wearing oral piercings.

[Preventive dentistry 3. Prevalence, aetiology and diagnosis of dentine (hyper)sensitivity].

Abstract: Many people sometimes experience pain when they inhale breath across the cingula, or sensitivity and/or pain when they eat ice cream, for example. In some cases, however, this can become seriously unpleasant. In those cases, one can speak of dentine hypersensitivity. In Europe, an average of 27% of the population suffers from this. Dentine hypersensitivity is characterised by a short, sharp pain reaction after a warm or cold sensation. The external sensation causes an accelerated or converse flow of fluid in the dentinal tubules that excites the extremities of the nerve cells, which results in the sensation pain. For the external sensation, it is necessary that the cingula are exposed and the dentinal tubules are open. Dentine hypersensitivity is diagnosed after other possibilities have been eliminated.