Showing papers on "Oral hygiene published in 1983"

Epidemiologic Patterns of Smoking and Periodontal Disease in the United States

Abstract: The adverse effect of smoking on periodontal health has been demonstrated in the analysis of the dental and smoking history data collected from a representative sample of the US population. The association between poorer levels of periodontal health and smoking remained even after accounting for age, sex, race, oral hygiene, socioeconomic status, and frequency of daily toothbrushing variables. When the analysis was restricted to smokers only, no clear-cut association was demonstrated between periodontal disease and the duration of smoking or the number of cigarettes smoked per day. The results of this study suggest that dental practitioners should try to discourage their patients from smoking for reasons of periodontal health as well as general preventive care.

Microbiological and clinical effects of topical subgingival antimicrobial treatment on human periodontal disease

Abstract: This study was undertaken to evaluate the microbiological and clinical effects of a subgingivally applied mixture of H2O2-NaCl and NaHCO3 followed by subgingival irrigation with 1% Betadine in the treatment of periodontal disease. 20 adults with moderate to severe periodontal disease were included in a split mouth design study. All patients were given oral hygiene instruction and were subjected to supragingival scaling in all 4 quadrants, and subgingival scaling and root planing of half the dentition. 10 patients were instructed to use the chemical antimicrobial mixture twice a day instead of dentifrice, and also received professional application of the mixture once every 14 days for 3 months in connection with reinstruction in oral hygiene procedures. The remaining 10 patients received oral hygiene instructions combined with professional tooth cleaning without use of chemicals once every 14 days during a 3-month period. The effect of treatment was evaluated by monitoring the subgingival microflora, clinical periodontal parameters, and by computer assisted subtraction analysis of serial standardized radiographs to determine changes in mass of the supporting alveolar bone. The present study revealed that subgingival debridement combined with mechanical plaque control resulted in decreased numbers of subgingival microorganisms including spirochetes and motile rods, and arrested the progressive breakdown of the periodontal tissues. Topical antimicrobial agents used in combination with subgingival scaling further reduced the subgingival microflora and substantially improved early periodontal healing including gain of probing attachment level and gain in radiographic alveolar bone mass during the 12 months of observation. No clinical improvement but a tendency to further periodontal breakdown was found in the unscaled quadrants, even in those which were subjected to a personal application of the topical antimicrobial mixture. This study indicates that professional and personal subgingival application of a mixture of H2O2-NaCl and NaHCo3 will significantly enhance the microbiological and clinical effects of periodontal scaling and root planing. These agents, and the topical mode of antimicrobial therapy seem promising in the management of human periodontal diseases.

Effect of long-term tetracycline therapy on human periodontal disease

Abstract: The present investigation was performed to study the effect of long-term, low dosage tetracycline therapy on advanced periodontal disease in humans. 14 volunteers participated in the trial. Each of the participants had at least 4 pairs of diseased sites around contralateral premolars and incisors with deep pockets and advanced bone loss. The trial extended over a 50-week period and was designed as a double-blind split-mouth study. A Baseline examination included assessments of oral hygiene, gingival conditions, probing depth, attachment level and analysis of the composition of the subgingival microbiota in samples obtained from 8 selected diseased sites. All participants received oral hygiene instruction. In each patient 2 quadrants of the mouth, chosen at random, were treated by scaling and root planing. The 2 remaining quadrants were left unscaled. Following the Baseline examination the patients were randomly distributed into 2 groups of 7 members each. In one of the groups the patients received tetracycline on a daily basis during a 50-week period. The participants of the control group received placebo. Reexaminations were performed 2, 10, 20, 30 and 50 weeks after the Baseline examination. The findings demonstrated that in patients with advanced periodontal disease long-term tetracycline therapy in the absence of scaling resulted in the establishment of a subgingival microbiota almost devoid of motile bacteria and in markedly reduced signs of gingivitis, probing depth and attachment loss. In fact, the alterations observed as a result of tetracycline administration to patients with excellent self-performed plaque control were similar to those obtained by conventional scaling and root planing in the control group.

Significance of frequency of professional tooth cleaning for healing following periodontal surgery

Abstract: The present investigation was undertaken to study the significance of frequently repeated professional tooth cleaning for healing results following periodontal surgery. 24 patients suffering from moderately advanced periodontai disease were selected for the study. Following a Baseline examination comprising asses.sment oforal hygiene status, gingival conditions, probing dcplhs and attachment levels, all patients were given detailed instruction in proper oral hygiene mea.sures. They were then subjected to periodontal surgery (ising the modified Widman flap procedure. During the initial 6 months after surgery ail patients were enrolled in a maintenance care program which included measures such as scaling and professional tooth cleaning. The patients were randomly distributed into 3 different maintenance care groups. S patients (Group 1) received maintenance care once every 2 weeks, another 8 patients (Group 2) received a similar treatment once every 4 weeks while the remaining % patients (Group 3) were recalled once every 12 weeks. Following a reexamination at the termination of this 6month period the recall program was changed. Thus, during the subsequent 18 months of maintenance {the maintenance phase) al! 24 patients were recalled for prophylaxis once every 3 months. A final reexamination was performed 24 months after completion of active therapy. The reexamination performed 6 months after surgery revealed that while patients who had been recalled for professional tooth cleaning once every 2 weeks had low numbers of inflamed gingival units and deep ( > 3 mm) periodontai pockets, test subjects recalled less frequently exhibited an increasing number of inflamed gingival units and deep pockets. In addition, the frequency of sites exhibiting attachment loss of > 1 mm was closely related to the frequency of maintenance care. Patients recalled once every 12 weeks for maintenance therapy had 3 times the number of sites with attachment loss(>l mm) as compared to those who were recalled once every 2 weeks. With the use of regression analysis critical probing depth values were calculated. Thi.s analysis showed that while the critical probing depth value was Jow in patients frequently recalled during the healing phase, this parameter adopted gradually increasing values in patients recalled with les.s frequent intervals. Between the 6and 24-month reexaminations there were no significant alterations of the oral hygiene status, the gingival condition or the probing depth and attachment level data in any of the 3 groups of patients. Periodontal therapy aims at establishing heaiings from different research groups indicate thy gingivae and arresting the progressive dethat while the technique used during surgery struction of the supporting apparatus. Surgical (e.g. gingivectomy, apically positioned flap, procedures are often employed in the treatment replaced flap, curettage) plays only a minor role of periodonta! disease (I) to obtain accessto the for the overaii result, the quality of the mainroot surfaces for proper debridement and (2) to tenance care program foliowing surgery seems excise soft and hard tissues in such a way that to be of decisive importance. Rosling et al. ideal conditions for healing are provided. Find{i976b) and Nyman et al. {1977} studied the MAINTENANCE CARE AFTER PERIODONTAL SURGERY healing capacity of the periodontal tissues following 5 different modes of periodontal surgery. They reported that healing occurred in all patients whose oral hygiene was professionally maintained at an optima! level following active treatment, while recurrence of disease was an obhgatory finding in patients unable to meet requirements regarding a proper oral hygiene standard. Similar findings have subsequently been presented by e.g. Poison & Heijl (1978), Isidor (1981), Lindhe et al. (1982a, b). On the other hand, recent observations by Pihlstrom et al. (1981) and Ramfjord et al. (1982) tend to place more emphasis on regularly repeated (once every 3 months) scaling and root planing, than on professionally or self performed oral hygiene measures for the success of periodontal therapy. The aim of the present clinical trial was to further evaluate the relative importance of the plaque control program maintained immediateiy following periodonta! surgery for healing results. Material and Methods The study was carried out in 24 subjects, 13 females and ! 1 males, 32-72 years of age, who were randomly selected from the patients referred to the Department of Periodontology, University of Gothenburg, for treattnent of moderately advanced periodonta! disease. Prior to treatment al! patients were examined in order to determine their orai hygiene standard, gingiva! condition and degree of periodontal tissue breakdown. At this Baselitie exatttinalion the following parameters were investigated: Oral hygiene status. Presence of p!aque was assessed on a!l tooth surfaces using the criteria of the Plaque Index system (Silness & Loe 1964). Individual mean values were ca!cu!ated. Gingival condition. Gingiva! inOammation was assessed using the criteria of the Gingival Index system (Loe & Silness 1963). Individual mean vaiues were calculated. Probing depth. Individually fabricated acrylic stents were instaUed prior to the c!inica! examination. At each tooth surface probing depth and the dinica! attachment !evel (see below) were measured from reference points prepared in the stents to enable repeated assessment of these parameters at the same site in the course of the study. The probing depth was measured with a calibrated probe. The diameter of the probe tip was 0.5 mm. Attachment level. The clinical attachment ievei was measured from the reference points and expressed as the distance between the acrylic stent and the bottom of the pocket. The measurements used to determine the probing depth and clinical attachment ievei in different parts of the dentition have been described previously (Lindhe et al. 1982a). In all, 182 sites were monitored if ail 32 teeth were present. Teeth scheduled for extraction following the Baseline examination were not included in the study. Fo!!owing the Baseline examination all patients were given detailed instruction in proper ora! hygiene measures in conjunction with a \"case presentation\" session. They were then subjected to periodonta! surgery using the modified Widman f!ap procedure described by Ramfjord & Nissie (1974). Angular bony defects were not eliminated, but curetted only. For a detailed description of the surgical procedure used the reader is referred to previous papers by Lindhe et al. (1982a) and Westfeit et ai. (1983). Surgical treatment was carried out in 2 sessions with an interval of 2 weeks. Following the phase of active periodontal treatment (surgery) all patients were enrolled in a maintenance care program including professional tooth cleaning ad modum Axe!sson & Lindhe (!974). The patients were random!y distributed into 3 different maintenance groups. WESTFELT, NYMAN, SOCRANSKY AND LINDHE 1, 2 and 3. The intervals between the maintenance sessions were 2 weeks (Group 1: 8 patients), 4 weeks (Group 2: 8 patients) or 12 weeks (Group 3: 8 patients). Following a reexaminatiort after 6 months of healing (the healing phase) the recall program was changed. Thus, during the subsequent 18 months of maintenance {the maintenance phase) all 24 patients were recalled once every 3 months for prophylaxis. At each recall appointment, both during the phase of healing and the phase of maintenance, plaque was stained with a disclosing solution and, if needed, the instruction in proper oral hygiene methods repeated. This instruction comprised demonstration of the Bass' method of tooth brushing (Bass 1954) and interdental cleaning wiih the use of interproximal toothbrush, denta] floss or toothpick. Supraand subgingival scaling was carried out when indicated. Finally, the teeth were polished with a rubber cup and an abrasive paste (Jodka® polerpasta, Adaco AB, Sweden). The maintenance care program was conducted by a dental hygienist. All patients were reexamined with regard to oral hygiene, gingival condition, probing depth and clinical attachment level 6 and 24 months after completion of active therapy. The assessments were confined to the same tooth surfaces and location points where the recordings had been made at the Baseline examination. Statistical analysis The mean, standard deviation and 95% confidence intervals as well as the determination of significance of difference of means using the ttest were performed according to standard methods. Regression anaiysis was carried out to determine the so-called \"critical probing depth\", i.e. the initial probing depth below which the treatment resulted in loss of attachment and above which gain of clinical attachment occurred. The initial probing depth was used as the independent (x axis) variable. The x Table. I. Individual mean Plaque index and Gingival Index scores at tlic Ba.st'line examinaiion and percentage distribution of scores 0, I and 2+3 ai the 6and 24-month rccxaminations Indivicluelie mittlere Beurieihmgseinheiten f.^care.^) des PlaqueundGingivalindex bci der Ausgangsuntersuchung, sowie die prozentuale yerieikmg der Beurteilungseinheiten 0. I und 2+ 3 bei den Nachuniersuclningen nacb 6 und24 Mon a ten Scores individuals moyem de I'Indice de Plaque et de I'Jndice Gingival a Pcxamcn initial et distribution en % de.f .scores 0, 1 et 2+3 tors des examen.'i apres 6 et 24 mois Plaque Index score Baseiine examination (X±s.d.) Group ! Group 2 Group 3 Gingival Index score Ba.scline examination (X + s.d.) Group i Group 2 Group i 6 months Group 1 Group 2 Group 3 24 months Group 1 Group 2 Group 3 L6 + 0.6

The Effect of Supragingival Plaque Removal on Anaerobic Bacteria in Deep Periodontal Pockets

Abstract: Additional evidence shows that scrupulous personal oral hygiene measures are essential in the control of periodontal disease.

A 3‐year study of hemisectioned molars

Abstract: Over a period of 1–7 (average 2.9) years, 34 hemisectioned molars were examined clinically and radiographically. All patients were kept on a 3–6 month recall system. The indications for hemisectioning were periodontal in 9 cases and endodontic in 20 cases. In 4 cases extensive carious destruction, and in 4 case an external granuloma led to hemisectioning. Mainly mandibular molars were treated (27). Root resectioning was carried out on only 7 maxillary molars. 22 of the treated teeth were used as distal abutments for small fixed bridges. For a further 3 the same was planned. The remaining treated teeth were singly crowned. Of the 34 treated molars, 7 were considered failures, 6 for endodontic reasons (apical periodontitis) and only 1 for periodontal reasons. No correlation between failure and the length of the follow-up period was found. With 17 of the 34 molars a significant reduction in periodontal pocket depths was recorded between commencement of treatment and the final examination. No difference in periodontal pocket depth or in the height of the alveolar crest was found between hemisectioned and non-hemisectioned surfaces. The mobility of hemisectioned molars was difficult to judge because 22 of the 31 crowned teeth were used as abutments for bridges. 17 of the 22 bridges were firm, 4 showed mobility of 1°, and 1 mobility of II°. Of the singly crowned teeth, only 1 exhibited mobility of III°. This study indicates that the prognosis for hemisectioned teeth is favourable. Failures were primarily endodontic in origin rather than periodontal. Periodontal damage can be kept to a minimum by regularly reviewing oral hygiene standards. Treated teeth may be used as abutments for small bridges if attention is paid to achieving optimal articulation.

Dietary habits and oral hygiene as predictors of caries in 3-year-old children

Abstract: The value of defined levels of oral hygiene and dietary habits for predicting caries was investigated. The material comprised 143 3-yr-olds. Three levels of oral hygiene and dietary habits, respectively, were used. Oral hygiene was registered as gingival status. Dietary habits were recorded by interview. Two groups were then formed by pooling stepwise the caries data for the nine possible combinations of oral hygiene and dietary habits and setting the most discriminating border, screening level, where the properties sensitivity and specificity simultaneously reached their highest value. Children with clean teeth, irrespective of dietary habits, and children with suitable dietary habits, provided they did not have general gingivitis with bleeding, might be regarded as no caries risks, while children with other combinations of oral hygiene and dietary habits were caries risks. The difference in decayed surfaces between the two groups was statistically significant (p less than 0.001). The sensitivity was 0.89 and the specificity 0.70. The predictive value of a negative test (0.91) was higher than that of a positive test (0.64).

The potential for increase in the periodontal diseases of the aged population.

Abstract: The periodontal disease trends in the nation's older adults aged 55 to 74 years are assessed using National Center for Health Statistics data spanning an approximate 12-year period. Both the 1960 to 1962 Health Examination Survey and the 1971 to 1974 Health and Nutrition Examination Survey I surveys used similar multistaged stratified probability samples. Examinations were calibrated and the collection of periodontal disease (PI), oral hygiene (OHI) and tooth loss scores were standardized. Data were collected on 1567 persons in 1960 to 1962 and 4746 persons in 1971 to 1974. The mean PI scores between the two surveys were not statistically different. However, when the periodontal diseases were divided into individuals with or without pockets, there was a significant decline in the per cent without pockets (P < 0.001) while the per cent with pockets remained unchanged or increased. The significant reduction in OHI scores (P < 0.02) seems to validate the decrease in gingivitis. The improvement in tooth loss ...

Toothbrushing, flossing, and dental visits in relation to socioeconomic characteristics of white American families.

Abstract: This study investigated the patterns of preventive dental behaviors, including toothbrushing, flossing, and dental visits with respect to certain selected socioeconomic characteristics, namely population density, age, family income, size of family, presence of children, and level of education. The sample of the study included 685 white American families. The results indicated that an individual's preventive dental behavior is related to certain socioeconomic characteristics. The individual who lives in an urban area, possesses a higher income or who has a higher educational level is more apt to take preventive dental actions. Among the socioeconomic variables, family income and educational level made significantly stronger differences with respect to toothbrushing, flossing, and dental visits. Dental visits, compared to other dental activities appeared to be more easily influenced by socioeconomic variables.

Gingival Sequela from a Retained Piece of Dental Floss

Abstract: A case was reported where a piece of dental floss broke and was retained in an interproximal area. The patient came to the clinic a few days later with a periodontal abscess. After the retained fragment of dental floss was removed, the abscess resolved. Therefore, a retained portion of dental floss should be immediately removed to prevent gingival irritation and tissue injury.

Application of the Community Periodontal Index of Treatment Needs (CPITN) in a population of young Brazilians.

Abstract: Recently WHO has launched an index for assessing the periodontal treatment needs of a population in terms of resources required. This Community Periodontal Index of Treatment Needs was applied in 308 Brazilian 15-yr-old schoolchildren from a population with a high prevalence of periodontitis. The results showed that almost all subjects needed some kind of care. Totally, 4133 time units were required. Most of the time needed was for motivation and instruction in oral hygiene, and scaling. Several individuals assigned for complex treatment due to pockets deeper than 5.5 mm showed no signs of radiographic bone loss, and in the cases with bone loss, the lesions were few and small. The CPITN therefore seemed to overestimate the need for treatment in this young population. To overcome this problem, it was suggested that complex treatment should not be included in planning of systematic periodontal care for young populations, and that subjects with time periodontal lesions should be given priority m community programs.

Evaluation of various feedback mechanisms in relation to compliance by adult patients with oral home care instructions

Abstract: The purpose of the present study was to examine the effect on oral hygiene and gingival health of plaque scoring and the performance of a “tooth brushing test” at each visit during initial periodontal treatment, A total of 63 adult periodontal patients (22–67 years of age) was allocated to 4 matched groups: Brushing test group (B), open scoring group (0), minimal feedback group (M) and control group (C). The oral hygiene instruction for groups B, O and M was provided by handing out a self-educational manual on oral home care, while the patients of control group (C) received a short brochure describing the Bass brushing technique and the use of toothpicks. Feedback on the improvement of oral hygiene performance was delivered to groups B and O by scoring of plaque and gingival bleeding by probing while this feedback was avoided in the 2 other groups (M, C). The patients of group B performed a tooth brushing test at each of 3 visits. After 3 months the plaque scores of groups B (27%) and O (22%) had improved more than those of the 2 other groups (35%). However, the improvement in gingival bleeding scores was similar in all 4 groups (from 55% initially to 17% at 3 months). At later examinations only minor differences in plaque and gingival bleeding scores were recorded between the various groups. The findings show that, irrespective of the mode of instruction, a considerable improvement occurs and that this improvement is not related to open scoring of plaque or the tooth brushing test.

Utilization of dental services and its relation to the periodontal status in a group of South Australian employees

Abstract: The pattern of dental service utilization, the perception of periodontal disease, and the oral hygiene habits among 642 industrial employees were evaluated using a self-administered questionnaire against background variables of age, sex, and socioeconomic strata Of the study population, 505% had their most recent dental visit within the previous 12 months and 425% claimed to seek regular check ups There was no significant association between time intervals since the last dental visit and age, sex, occupation, income or education Regular visits were made more often by subjects in the higher occupation and income level Multivariate analyses of the number of missing teeth simultaneously considering age, sex, socioeconomic level, regularity and frequency of dental visits revealed that except for age and sex, no other factors were significant The most common reason for not seeing a dentist in the previous 12 months was an assumption that "nothing was wrong" A large majority of the group surveyed were unaware of the presence of periodontal disease or the need for its treatment, despite the high prevalence in all subgroups Periodontal status was not significantly associated with sex, socioeconomic levels, regularity of frequency of dental visits, but there was a significant regression on age The study population's pattern of service utilization was found to be similar to that reported for the general population, and it was anticipated that the hygiene habits of the group was representative of the total community If that assumption is true the high prevalence of periodontal disease of the study population probably exists in the general community

Dental outpatients: Health locus of control correlates

Abstract: Examined relationships between the Multidimensional Health Locus of Control (MHLC) Scales, Beck Depression Inventory, Trait subscales of the State-Trait Personality Inventory, and dental ratings of oral hygiene and presence of periodontal disease with dental outpatients (N = 101) at a Veterans Administration Medical Center Dental Clinic. Results indicated that this sample of outpatients scored comparably on MHLC Health Internality and Health Externality to a sample reported by Wallston and Wallston. Older dental patients, in the present sample, scored significantly higher on Powerful Others Externality in contrast to younger Ss, which suggests greater reliance on health professionals for dental health. Confirmatory evidence is presented on the negative correlations of depression, anger, and anxiety with Health Internality. Differential approaches to dental treatment are discussed.

Oral hygiene instruction using a self inspection plaque index

Abstract: The need for proper oral hygiene requires large amounts of time and manpower, and relapse is still common. This paper describes a self instructional manual and self inspection plaque index that was tested in a periodontal recall population. The program was tested on 18 periodontal recall patients over a period of 6 weeks. Questionnaires were completed at the start, at 2 weeks, and at the end of the experimental period to evaluate patient opinions. Presence of plaque near the gingival margin was recorded at the start, at 2 weeks, and at 6 weeks. Patients were provided with a self instructional manual which taught them to recognize plaque on six teeth. Also, they were given a lighted mouth mirror, a toothbrush, and disclosing wafers. Initial, before-brushing plaque scores of 47% decreased to 18% during the 6 weeks of the study. After-brushing plaque scores also were significantly improved during the study. Patients were able to perform the plaque index without guidance to a high level of agreement with a dental hygienist (r = 0.72). Furthermore, the program was well accepted by the patients according to their answers on the questionnaire.

Clinical and microbiologic effectiveness of Keyes' method of oral hygiene on human periodontitis treated with and without surgery

Abstract: The objective of this study is to compare the effects of Keyes’ method with conventional oral hygiene in patients with periodontitis who are treated either by scaling and root planing alone or by scaling and root planing in combination with surgical pocket elimination.

Oral care for cancer patients.

Abstract: Pain, inability to chew, difficulty in opening the mouth, a dry mouthall are problems that confront the patient who has been treated for cancer, especially cancer of the head and neck. All of these oral problems are aftereffects of the treatment, whether surgery, radiation therapy, or chemotherapy. Much can be done to bring relief, however, by teaching simple measures designed to promote oral hygiene and to prevent further deterioration of oral tissues.

Oral complications in cancer patients.

Abstract: Ionizing radiation used in treating the head and neck area produces oral side effects such as mucositis, salivary changes, trismus and radiation caries. Sequelae of cancer chemotherapy often include oral stomatitis, myelosuppression and immunosuppression. Infections of dental origin in compromised patients are potentially lethal. Specific programs to eliminate dental pathology before radiation and chemotherapy, and to maintain oral hygiene during and after therapy, will minimize these complications.

Oral Assessment of the Edentulous Elderly Patient

Abstract: While the need for regular oral examinations increases in the aged, edentulous elderly persons generally see their dentists rarely, while most see their physicians relatively frequently. If these patients cannot be convinced to see a dentist, the physician should perform regular oral screening examinations. A technique is described for accomplishing this.