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Showing papers on "Oral hygiene published in 1997"


Journal ArticleDOI
TL;DR: It is shown that smoking was the most important factor affecting the rate of peri-implant bone loss, and that oral hygiene also had an influence, especially in smokers, while other factors, e.g., those associated with occlusal loading, were of minor importance.
Abstract: While many factors are conceivable, occlusal loading and plaque-induced inflammation are frequently stated as the most important ones negatively affecting the prognosis of oral implants. Currently, little is known about the relative importance of such factors. The aim of this study was to analyze the influence of smoking and other possibly relevant factors on bone loss around mandibular implants. The participants were 45 edentulous patients, 21 smokers and 24 non-smokers, who were followed for 10-year period after treatment with a fixed implant-supported prosthesis in the mandible. The peri-implant bone level was measured on intraoral radiographs, information about smoking habits was based on a careful interview, and oral hygiene was evaluated from clinical registration of plaque accumulation. Besides standard statistical methods, multiple linear regression models were constructed for estimation of the relative influence of some factors on peri-implant bone loss. The long-term results of the implant treatment were good, and only three implants (1%) were lost. The mean marginal bone loss around the mandibular implants was very small, about 1 mm for the entire 10-year period. It was greater in smokers than in non-smokers and correlated to the amount of cigarette consumption. Smokers with poor oral hygiene showed greater marginal bone loss around the mandibular implants than those with good oral hygiene. Oral hygiene did not significantly affect bone loss in non-smokers. Multivariate analyses showed that smoking was the most important factor among those analyzed for association with peri-implant bone loss. The separate models for smokers and non-smokers revealed that oral hygiene had a greater impact on peri-implant bone loss among smokers than among non-smokers. This study showed that smoking was the most important factor affecting the rate of peri-implant bone loss, and that oral hygiene also had an influence, especially in smokers, while other factors, e.g., those associated with occlusal loading, were of minor importance. These results indicate that smoking habits should be included in analyses of implant survival and peri-implant bone loss.

289 citations


Journal ArticleDOI
TL;DR: Dental calculus is calcified dental plaque, composed primarily of calcium phosphate mineral salts deposited between and within remnants of formerly viable microorganisms, which is the result of petrification of dental plaque biofilm.
Abstract: Dental calculus, both supra- and subgingival occurs in the majority of adults worldwide. Dental calculus is calcified dental plaque, composed primarily of calcium phosphate mineral salts deposited between and within remnants of formerly viable microorganisms. A viable dental plaque covers mineralized calculus deposits. Levels of calculus and location of formation are population specific and are affected by oral hygiene habits, access to professional care, diet, age, ethnic origin, time since last dental cleaning, systemic disease and the use of prescription medications. In populations that practice regular oral hygiene and with access to regular professional care, supragingival dental calculus formation is restricted to tooth surfaces adjacent to the salivary ducts. Levels of supragingival calculus in these populations is minor and the calculus has little if any impact on oral-health. Subgingival calculus formation in these populations occurs coincident with periodontal disease (although the calculus itself appears to have little impact on attachment loss), the latter being correlated with dental plaque. In populations that do not practice regular hygiene and that do not have access to professional care, supragingival calculus occurs throughout the dentition and the extent of calculus formation can be extreme. In these populations, supragingival calculus is associated with the promotion of gingival recession. Subgingival calculus, in "low hygiene" populations, is extensive and is directly correlated with enhanced periodontal attachment loss. Despite extensive research, a complete understanding of the etiologic significance of subgingival calculus to periodontal disease remains elusive, due to inability to clearly differentiate effects of calculus versus "plaque on calculus". As a result, we are not entirely sure whether subgingival calculus is the cause or result of periodontal inflammation. Research suggests that subgingival calculus, at a minimum, may expand the radius of plaque induced periodontal injury. Removal of subgingival plaque and calculus remains the cornerstone of periodontal therapy. Calculus formation is the result of petrification of dental plaque biofilm, with mineral ions provided by bathing saliva or crevicular fluids. Supragingival calculus formation can be controlled by chemical mineralization inhibitors, applied in toothpastes or mouthrinses. These agents act to delay plaque calcification, keeping deposits in an amorphous non-hardened state to facilitate removal with regular hygiene. Clinical efficacy for these agents is typically assessed as the reduction in tartar area coverage on the teeth between dental cleaning. Research shows that topically applied mineralization inhibitors can also influence adhesion and hardness of calculus deposits on the tooth surface, facilitating removal. Future research in calculus may include the development of improved supragingival tartar control formulations, the development of treatments for the prevention of subgingival calculus formation, the development of improved methods for root detoxification and debridement and the development and application of sensitive diagnostic methods to assess subgingival debridement efficacy.

261 citations


Journal ArticleDOI
TL;DR: The study revealed that oral care assistance is viewed as more disagreeable than other nursing activities, and a gap between knowledge and practice in nursing personnel's attitudes toward oral health care of dependent elderly and severely disabled patients.
Abstract: This study compares differences in attitude, of oral health care of nursing personnel working with dependent elderly and severely disabled patients. A questionnaire was administered to 398 personnel covering (1) personal oral health care habits. (2) experiences and attitudes in assisting oral care and (3) willingness to assist patients/residents with their daily oral hygiene. Three hundred and sixty - four persons answered the questionnaire, including 70 registered nurses, 148 nursing assistants and 146 home care aides. The study revealed that oral care assistance is viewed as more disagreeable than other nursing activities. Although registered nurses were found to have more positive attitudes toward oral care assistance than the other nursing groups, they were seldom invoked in the daily practice of oral hygiene care. The results indicate a gap between knowledge and practice in nursing personnel's attitudes toward oral health care of dependent elderly and severely disabled patients.

164 citations


Journal ArticleDOI
TL;DR: A conceptual framework for oral health appears to be represented by a set of reasonably independent components, including two groups of clinically assessed oral health, which together more fully represent oral health than any one single variable.

139 citations


Journal ArticleDOI
TL;DR: The prevalence of oral mucosal lesions in 338 76-, 81- and 86-year-old home-living elderly people, who completed the oral health investigation at the Institute of Dentistry, University of Helsinki, is reported here.
Abstract: summary A large epidemiological health investigation, the Helsinki Ageing Study (HAS), was performed in 1989–1991 in Helsinki, Finland. We report here the prevalence of oral mucosal lesions in 338 76-, 81- and 86-year-old home-living elderly people, who completed the oral health investigation at the Institute of Dentistry, University of Helsinki. One or more lesions were found in 128 subjects (38%). Fifty-one per cent of the edentulous complete-denture wearers and 31% of the elderly with some natural teeth had mucosal lesions. The most common finding was inflammation under the denture, which occurred alone or combined with other lesions in 25% of the denture wearers. The three most common mucosal changes not related to denture wearing were coated changes of the tongue (7%), angular cheilitis (6%) and varicose veins under the tongue (4%). No differences were found in the number of mucosal lesions among the three age groups. Angular cheilitis and inflammation under removable dentures were more frequent in women than in men. However, no other differences were found in the presence of mucosal lesions between sexes. The total number of mucosal lesions correlated positively with the number of medications used daily. Ninety-six per cent of the subjects with complete dentures, and 98% of those with some natural teeth reported cleaning their dentures at least once a day. Of the denture wearers, 88% reported cleaning their oral mucosa also, as part of their oral hygiene routine. The presence of mucosal lesions was related to self-reported cleaning of the denture-bearing mucosa. However, no association was observed between cleaning frequency and presence of mucosal changes.

124 citations


Journal ArticleDOI
TL;DR: The dental condition of 626 12-year-old handicapped children with mild mental or moderate to severe mental retardation or learning impairment, being 25% of the population of each of these groups, was examined in Flanders.
Abstract: The dental condition of 626 12-year-old handicapped children with mild mental or moderate to severe mental retardation or learning impairment, being 25% of the population of each of these groups, was examined in Flanders. An evaluation of oral cleanliness showed poor oral hygiene in 31.8% of the children. No significant differences were found in oral cleanliness among types of handicapping conditions, The mean DMFT score was 2.9 (s: 2.6) and DMFS score was 5.4 (s: 5.6). Almost 21% of the children were free of caries or fillings. No significant differences were found among groups of handicapped children. Handicapped children presented a low level of restorative care (restorative index score: 48.7%). Mildly mentally retarded children demonstrated the lowest restorative index (43.9%). The caries experience of first permanent molars represented the largest part of the DMFT score (64.1%). Sealants were present in 7.9% of children examined. A considerable percentage of mildly mentally retarded children and learning impaired children did not brush daily (22.1% and 20.9%) and did not receive help with toothbrushing from their parents or carers (91.0% and 94.7%, respectively).

121 citations


Journal Article
TL;DR: The data suggest that in the oral hygiene motivated patients of the present study, gingivitis and periodontitis do not occur, during the first six months of treatment: the significant modification of oral microbiota, shown by subjects with fixed appliances, however, suggests that the risk for gingvitis in the following months of therapy is still high and the risk of periodontal disease cannot be excluded.
Abstract: The present study evaluated microbiological and clinical changes occurring during the first six months of orthodontic therapy with fixed and removable appliances and the consequent risk for gingivitis and periodontal disease. This study was justified by the disagreement among different authors: only some of them reported gingivitis development and changes in dental plaque composition during orthodontic therapy with fixed appliances, others did not. Thirty, 7-to-15-year-old children, fifteen with fixed and fifteen with removable appliances, previously motivated to oral hygiene, completed the study. They were clinically examined by a dentist at baseline and at the end of the study. Three supra and subgingival microflora samples were collected from the first molars, when the appliances were inserted (T0), 6-8 weeks later (T1) and 6-7 months later (T2). Microflora was examined using dark-field and light microscopes and cultural methods. An indicator of healthy status (percentage of Gram positive cocci in total bacterial count) and some risk indicators for gingivitis (bacterial count evaluated with light microscope, percentage of Gram negative rods) and for periodontitis (motile rod and spirochete percentages, presumptive Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis prevalence) were investigated. Patients with fixed appliances were clinically healthy at T2; yet they showed significantly increased counts, motile rods, subgingival spirochetes and a decrease of Gram positive cocci. At T2, patients with removable appliances were clinically healthy and the only significant microbiological changes were supragingival motile rods and subgingival spirochetes. These data suggest that in the oral hygiene motivated patients of the present study, gingivitis and periodontitis do not occur, during the first six months of treatment: the significant modification of oral microbiota, shown by subjects with fixed appliances, however, suggests that the risk for gingivitis in the following months of therapy is still high and the risk for periodontitis cannot be excluded.

94 citations


Journal ArticleDOI
TL;DR: To compare cross-cultural differences of dental health behavior, 376 dental students in Japan and 213 in Australia were surveyed using a twenty-item Hiroshima University-Dental Behavior Inventory questionnaire (HU-DBI) questionnaire.
Abstract: To compare cross-cultural differences of dental health behavior, 376 dental students in Japan and 213 in Australia were surveyed using a twenty-item Hiroshima University-Dental Behavior Inventory (HU-DBI) questionnaire (in Japanese and English versions respectively). The mean DBI score of Year 1 Australian students was significantly greater than that of their Japanese peers (Australian 6.56, Japanese 5.57; P < 0.001), which suggested a higher level of dental health awareness in Australian students on entry. Only 7 percent of the Japanese students had been told by their dentist that they were performing a high level of plaque control, as contrasted with 50 percent of the Australian students. Furthermore, while only a small proportion of the Australian students (8 percent) reported a belief that they may eventually require dentures, 37 percent of the Japanese students held this belief (P < 0.001). The mean HU-DBI score of the Japanese students was lower than that of the Australian students until Year 4. Differences between the genders were not a major feature.

90 citations


Journal ArticleDOI
TL;DR: It is suggested that self-concept may play a significant role in mediating changes in dental health behaviour and there was a strong and consistent correlation between recalled advice about toothbrushing and lower self- esteem and external locus of control.
Abstract: The purpose of this investigation was to examine the relation between some dental health behaviours and 2 measures of self-concept in adolescents. Data from a survey of 41142, 12-16-year-old children from 244 secondary schools throughout England were analysed to obtain information about their frequencies of toothbrushing, use of dental floss and dental attendance, and whether they recalled advice about toothbrushing, in relation to self-esteem and health locus of control (HLOC). Subjects completed a questionnaire, anonymously, in school class. The results showed a significant positive correlation (Spearman) between the frequencies of flossing and toothbrushing, in both sexes, and between social group and toothbrushing frequency, where brushing frequency increased as socio-economic status improved. Some association between use of floss and social group emerged, but this was smaller and less consistent than that observed with toothbrushing brushing frequency. Self-esteem was positively correlated with toothbrushing frequency at ages 12-15 years, while HLOC showed correlations at some ages but not others. Use of dental floss showed no relation to self-concept. Subjects with more favourable self-concept were more likely to make more frequent dental visits than those with a poorer self-view. There was a strong and consistent correlation between recalled advice about toothbrushing and lower self- esteem and external locus of control. The results are in agreement with our earlier reports and suggest that self-concept may play a significant role in mediating changes in dental health behaviour.

89 citations


Journal ArticleDOI
TL;DR: The contribution by toothbrush abrasion to the overall wear in the eroded dentition of bulimics is not significant, therefore, immediate post-vomiting oral hygiene practices can be recommended and the proportional nutritional intake values of carbohydrates, fats, and proteins in this group of Bulimics are acceptable.
Abstract: Objective To determine the influence of oral hygiene practices and additional fluoride on erosive tooth wear in eating disorders. The proportional dietary intake of carbohydrates, fats, and proteins was also investigated. Method: Tooth wear was measured with the use of the tooth wear index (TWI). All subjects completed a questionnaire on past dental history as well as a 1-week diet sheet. A total of 33 subjects participated in the study, 20 of whom were follow-ups, allowing the progress of dental erosion to be made. All subjects were referred from the Department of Clinical Psychology. Results: Oral hygiene practices between subjects with and without severe erosion were not significantly different. Only 8 bulimics spent more time brushing after vomiting than at other times. The pH of vomitus from 6 subjects ranged between 2.9 and 5.0, with a mean of 3.8, well below the critical pH for enamel demineralization to occur. Of the 20 follow-up subjects, 12 (60%) exhibited worsening tooth wear. The mean values for daily carbohydrate, protein, and fat intake were not significantly different at baseline and at recall, and the proportional dietary intake was similar to recommended energy provision at 47%, 40%, and 13%, respectively. Discussion: The contribution by toothbrush abrasion to the overall wear in the eroded dentition of bulimics is not significant. Therefore, immediate post-vomiting oral hygiene practices can be recommended. The proportional nutritional intake values of carbohydrates, fats, and proteins in this group of bulimics are acceptable. © 1997 by John Wiley & Sons, Inc. Int J Eat Disord 21: 195–199, 1997.

86 citations


Journal ArticleDOI
TL;DR: Female gender, education, certain oral health beliefs, household income, and the presence of a usual source of care were revealed with multivariate analysis to show a significant positive relationship with higher oral hygiene scale scores (indicating better personal oral hygiene practices).
Abstract: In this study, socio-behavioral determinants of oral hygiene practices were examined across several dentate ethnic and age groups. Oral hygiene scale scores were constructed from toothbrushing and dental floss frequencies self-reported by population-based samples of middle-aged (35-44 years) and older (65-74 years) dentate adults representing Baltimore African-American and White, San Antonio Hispanic and non-Hispanic White, and Navajo and Lakota Native American persons participating in the WHO International Collaborative Study of Oral Health Outcomes (ICS-II) survey. Female gender, education, certain oral health beliefs, household income, and the presence of a usual source of care were revealed with multivariate analysis to show a significant positive relationship with higher oral hygiene scale scores (indicating better personal oral hygiene practices). Other socio-behavioral variables exhibited a more varied, ethnic-specific pattern of association with oral hygiene scale scores.

Journal ArticleDOI
TL;DR: It is shown that the implemented school-based OHE programme did not result in significant reductions of the clinical parameters measured, and the present study shows that the practical aspects of oral hygiene and information on the cause and prevention of caries and gingivitis were the components of oral health education.
Abstract: This study aimed to assess the clinical oral health outcome effects among schoolchildren participating in a school-based oral health education (OHE) programme. Local social, cultural and environmental conditions were determinants of the school-based OHE programme, which was compiled on the basis of prevailing beliefs and on what teachers and educational authorities considered to be important for the oral health of schoolchildren. Consequently, the practical aspects of oral hygiene and information on the cause and prevention of caries and gingivitis were the components of oral health education. The teachers were prepared to carry out weekly supervised toothbrushing sessions and monthly lessons on aspects of oral health for the school year in grade 4. Eight participating schools were selected for the clinical effect evaluation and four non-participating schools served as the control. In total, 309 children from the participating schools and 122 children from the non-participating schools were available for the evaluation. Their ages varied between 9 and 14 years. The mean plaque score, calculus score and gingival bleeding score at baseline and at follow-up examinations 3, 8, 15 and 36 months later were not significantly different for participating schools and controls. The mean DMFT value at baseline was 0.4 and 3 years later 0.9 in both the participating and control schools. In conclusion, the present study shows that the implemented school-based OHE programme did not result in significant reductions of the clinical parameters measured.

Journal ArticleDOI
TL;DR: In order to measure social cognitive constructs in the oral hygiene domain, questionnaires containing self-efficacy and outcome expectation items were developed, and all scales demonstrated good internal consistency and test-retest stability.
Abstract: In order to measure social cognitive constructs in the oral hygiene domain, questionnaires containing self-efficacy and outcome expectation items were developed. Items were generated to measure personal beliefs in brushing and flossing ability under a variety of circumstances, and expected outcomes from performing oral hygiene behaviors that might be positive, negative, primary and secondary. In the first study, factor scales were developed on the basis of the responses from 90 subjects awaiting dental treatment. Principal components analyses with varimax rotation revealed two self-efficacy and four outcome expectations dimensions that explained 73% and 51% of the variance, respectively. A second study that utilized 103 government employees was conducted to evaluate the psychometric properties of the questionnaires. All scales demonstrated good internal consistency and test-retest stability. Correlations with extra test measures provided preliminary evidence for the validity of the instruments.

Journal ArticleDOI
TL;DR: The use of chewing gum and other xylitol-containing products have resulted in defined reduction in caries and represent interesting alternatives for high-caries-risk populations.
Abstract: In the last 20 years, mainly due to optimum fluoride exposure, and practice of good oral hygiene procedures, an important reduction in caries has been observed, despite the fact that sugar consumption was maintained and/or was increasing during the same lapse of time. A sugar-caries relationship cannot be established in most of the industrialized countries and the dietary factor is not as preponderant in the caries process as it used to be two decades ago. The factors which seem to contribute the most significantly to the cariogenicity of the diet are the frequency of carbohydrate ingestion and eating patterns. The relative cariogenicity of food is not correlated with the amount of carbohydrate it contains. Even if sucrose remains the most important sugar consumed in sweets, beverages and confectionery products, all fermentable-carbohydrate foods can be involved in the caries process. The use of chewing gum and other xylitol-containing products have resulted in defined reduction in caries and represent interesting alternatives for high-caries-risk populations. Caries risk and oral health assessments as well as the evaluation of oral hygiene procedures and fluoride exposure should become essential tools in dietary counselling. People who receive optimum fluoride exposure and follow regular oral hygiene measures can safely use dietary carbohydrates, preferably during meals and two to three times daily in snacks or drinks.

Journal ArticleDOI
TL;DR: The analysis demonstrated that virtually all subjects experienced > or = 2 mm attachment loss over the 10-year period, and frequently in a large proportion of the sites present, which was positively skewed in all age groups.
Abstract: This study describes the progression of destructive periodontal disease among Chinese aged 20 to 80 with limited access to dental health facilities and minimal traditions for oral hygiene procedures. These individuals were followed for 10 years to determine whether the rates for progression of periodontal disease were markedly different than for populations with more access to oral health care. At baseline, participants had been examined for tooth mobility, plaque, calculus, gingival conditions, attachment levels, and probing depths on 4 sites of each tooth present. These probing depth and attachment level recordings were repeated at follow-up, although third molars were excluded from examination. A total of 398 persons remained dentate at follow-up. The analysis demonstrated that virtually all subjects experienced > or = 2 mm attachment loss over the 10-year period, and frequently in a large proportion of the sites present. Attachment loss > or = 3 mm was also widespread, but the distribution of persons according to the extent of > or = 3 mm attachment loss was positively skewed in all age groups. Positive skewness was even more pronounced when attachment loss of > or = 4 mm was considered. Some types of teeth, such as mandibular incisors and maxillary molars, had higher progression rates than did, for example, maxillary incisors. The mean individual attachment loss rates did not differ significantly between age groups, and were remarkably similar to those reported for populations whose access to and tradition for oral health care is widespread.

Journal ArticleDOI
TL;DR: It has to be concluded that dental management of institutionalized geriatric patients is an essential yet presently underfulfilled service.
Abstract: This investigation determined the level of dental care for institutionalized geriatric patients residing in nursing home facilities. A total of 364 patients from nine different geriatric care units within the city of Berlin were involved in this study. On average the patients were 84.9 years old. Women represented 87.3% of the patients. A standardized questionnaire and a clinical examination of the mouth were utilized to assess patient satisfaction with geriatric care, their general medical status and their oral health status. The results demonstrated that patients in geriatric care did not undergo routine dental check-ups. Oral hygiene was sufficient in only 12.6% of the patients, and prosthesis hygiene in 45% of the cases. Only 37.6 of the dentures exhibited sufficient retention and stability. In 80% of the patients dental treatment was necessary. Recommendations for improvement of dental care delivery to institutionalized geriatric patients are given. It has to be concluded that dental management of institutionalized geriatric patients is an essential yet presently underfulfilled service.

01 Jan 1997
TL;DR: The role of asymptomatic bacteremia as possibly explaining associations with cardiovascular disease, preterm low birth weight infants, and early death from any cause is examined, focusing on the bacterial load on the teeth as mediated via oral hygiene.
Abstract: Recently, there have been case-control and epidemiologic investigations that strongly associate poor dental health with cardiovascular disease, preterm low birth weight infants, and early death from any cause. In a 7-year prospective study, dental disease was a significant predictor of coronary events leading to death after controlling for known coronary disease risk factors. Missing teeth displaces smoking as a risk factor for ischemic heart disease in another study. Periodontal disease was seven times more likely to be associated with a preterm delivery of a low birth weight infant than mother's age, race, number of live births, and use of tobacco or alcohol. This review examines the role of asymptomatic bacteremia as possibly explaining these associations, focusing on the bacterial load on the teeth as mediated via oral hygiene.

Journal ArticleDOI
TL;DR: Current practice of cardiac physicians is to recommend that children with heart disease seek out and attend a dentist, the advice usually being accompanied by the presentation of a ‘heart card’ detailing antibiotic prophylaxis regimens if extractions are required, but the data presented here shows that this strategy has failed.
Abstract: A total of 60 children with severe congenital cardiac disease from the Great Ormond Street Hospital for Children and Guy's Hospital children's department were matched for age, gender, social class, and ethnic origin with 60 healthy children from the trauma clinic of the Department of Orthodontics and Paediatric Dentistry at Guy's Dental Hospital, London. The parents' attitude, knowledge, and dental health practices were assessed by questionnaire. The cardiac group had significantly poorer dental health practices than the healthy group. Of the cardiac children 18% had never visited the dentist compared with only 3% for the healthy group. It is difficult to assess the importance of this in terms of a serious health hazard. Current practice of cardiac physicians is to recommend that children with heart disease seek out and attend a dentist, the advice usually being accompanied by the presentation of a 'heart card' detailing antibiotic prophylaxis regimens if extractions are required. The data presented here shows that this strategy has failed.

Journal ArticleDOI
TL;DR: The systematic review of literature revealed that knowledge of the topic is mostly based on very small patient material, and close co-operation between oncological and oral health units is emphasised because many studies have shown that the oral cavity is indeed an important source of bacteraemia.

Journal ArticleDOI
TL;DR: Logistic regression analysis showed a strong correlation between the presence of dental erosion and a high level of consumption of cola-type soft drinks and type of cleaning aid and gingival bleeding index.
Abstract: This study reports on the causative factors of dental erosion in selected high- (n = 19) and low-erosion (n = 19) subgroups of a larger random sample (n = 95) or young male Saudi military inductees. By means of a questionnaire, the role of various possible factors related to oral health in general, and to dental erosion in particular, was assessed for each participant. Clinical examination included recordings of severity of dental erosion and fluorosis, presence of buccal cervical defects and first permanent molar ‘cupping’, DMFT and DMFS, visible plaque index and gingival bleeding index. In addition, bitewing radiographs, study casts, and intraoral color transparencies were obtained for each individual. Logistic regression analysis showed a strong correlation between the presence of dental erosion and a high level of consumption of cola-type soft drink. Other statistically significant associated factors, although of less predictive strength, were ye of cleaning aid and gingival bleeding index. In subgrou...

Journal ArticleDOI
TL;DR: Group oral health intervention provides an effective and relatively inexpensive means of helping patients improve theirself-care skills and achieve high levels of adherence to an effective self-care regimen.
Abstract: A randomized clinical trial assessed the effect of a group-based behavior modification intervention on oral hygiene skills, adherence and clinical outcomes for older periodontal patients. Subjects (n = 107) were aged 50-70 yr with moderate periodontal disease. They were randomly assigned to usual care or intervention. Intervention consisted of 5 weekly, 90-min sessions that included skill training, self-monitoring, weekly feedback about bleeding points and group support focused on long-term habit change. Four-month follow-up indicated significant improvements in the intervention versus the usual periodontal maintenance group for oral hygiene skills and self-reported flossing (p < 0.001), plaque, gingival bleeding, bleeding upon probing throughout the mouth, and pocket depth for sulcus depths that measured between 3 and 6 mm at baseline (p < 0.009). Group oral health intervention provides an effective and relatively inexpensive means of helping patients improve their self-care skills and achieve high levels of adherence to an effective self-care regimen.

Journal ArticleDOI
TL;DR: It is concluded that more research is required before the need for the chemical prevention of gingivitis to prevent severe periodontitis can be justified.
Abstract: Gingival inflammation seldom causes discomfort, social embarrassment or loss of function. As most sites with gingival inflammation do not progress to severe periodontal disease, gingivitis should not be considered a public health problem. Periodontitis is always preceded by gingivitis. But most gingivitis remains stable for years without progressing to periodontitis. The number of gingivitis sites that do convert is small. The levels of oral cleanliness achieved by the majority of populations in industrialized countries are below the threshold for severe destructive periodontal disease of personal and public health concern. Because methods of measuring the progression of periodontal disease are unreliable, definitive answers regarding conversion of gingivitis to severe periodontitis are lacking. Gingival inflammation frequently remains contained; most gingivitis remains stable for years without progressing to periodontitis. Decreasing gingivitis does reduce shallow pocketing, but the effect on severe periodontitis is not clear. Although the underlying justification for the reduction of plaque is to reduce gingival inflammation to prevent or reduce severe periodontitis and tooth loss, the basis for the approach is equivocal. A reasonably high level of plaque appears to be compatible with acceptably low levels of periodontal disease. Reducing nonspecific plaque levels to such levels is therefore a rational goal. The conventional methods of controlling periodontal disease involve mechanical removal of plaque and calculus. A complimentary ecological approach, using chemicals, would be to alter the environment of the pocket to prevent growth of putative pathogens. Any ecological approach should be sensitive to the dangers of disrupting the natural ecology of dental plaque. Some antimicrobial and antimetabolic agents such as fluoride, chlorhexidine and triclosan and zinc citrate can selectively suppress certain organisms or inhibit bacterial proteases implicated in tissue damage. The uncertainties about factors that convert gingival inflammation into periodontitis and periodontitis into severe periodontitis coupled with insufficient data from controlled clinical trials on the effectiveness of chemical reduction of gingivitis to prevent severe periodontitis leads one to conclude that more research is required before the need for the chemical prevention of gingivitis to prevent severe periodontitis can be justified.

Journal ArticleDOI
TL;DR: The main effects of denture renewal are seen in patient satisfaction, and clinically in the improved condition of oral mucosa and better fit and acceptable occlusion of dentures.
Abstract: The effect of complete denture renewal on oral health was evaluated both subjectively and clinically at follow-up 30 months (range 19-36 months) after completion of treatment in 42 edentulous patients (31 women and 11 men, aged 34-76 years) treated by dental students during 1989-1992. Ninety per cent of the patients were satisfied with the new appearance of their dentures and 71% with the way they functioned. When comparing the base data and results from follow-up it seems that general health and medication, anatomical circumstances, salivary flow rates and denture wearing habits in edentulous subjects do not change significantly over a few years. The main effects of denture renewal are seen in patient satisfaction, and clinically in the improved condition of oral mucosa and better fit and acceptable occlusion of dentures.

Journal ArticleDOI
TL;DR: This short-term study concluded that the Ortho- type toothbrush is not superior to the Plus 35-type toothbrush.

Journal ArticleDOI
TL;DR: The findings revealed that the patients in the E2 group not only had later onset of stomatitis than those in the control and the E1 groups, but also had lesser degree of oral injury measured by the overall assessment score.

Journal ArticleDOI
TL;DR: Improvements in oral health knowledge and toothbrushing behaviour were observed in 1995 as compared with 1987 and community based oral health education programmes should be implemented to further improve regular self-care practises, especially in relation to the adult population.

Journal ArticleDOI
TL;DR: The results showed no statistically significant treatment differences between products for the gingival index throughout the 18 week-trial, and a small but statistically significant Treatment effect for plaque index was seen at 12 weeks in favour of the triclosan/copolymer toothpaste compared to the stannous fluoride and conventional fluoride toothpastes.
Abstract: Several triclosan and stannous fluoride toothpastes have been shown to have plaque inhibitory and more particularly gingival health benefits when compared to minus active controls. There have been relatively few studies to compare such products with conventional fluoride toothpastes in home use. The aim of this study was to compare the relative gingival health benefits of a triclosan/zinc citrate, triclosan/copolymer, stannous fluoride and conventional fluoride toothpastes in a home use study. The study was a double blind, parallel design with a total 143 healthy dentate volunteers (41 male. 102 female) who tooth-brushed 2× daily with 1 of 4 toothpastes over an 18 week period. At the beginning of the trial, each volunteer was scored for plaque and gingivitis and then received a thorough prophylaxis. Each volunteer was allocated a toothpaste according to a predetermined randomisation scheme. The volunteers were then re-examined after 6, 12 and 18 weeks. No other oral hygiene products were used during this period. The results showed no statistically significant treatment differences between products for the gingival index throughout the 18 week-trial. No statistically significant treatment effects between products for plaque index were found at 6 or 18 weeks. However, a small but statistically significant treatment effect for plaque index was seen at 12 weeks in favour of the triclosan/copolymer toothpaste compared to the stannous fluoride and conventional fluoride toothpastes, this difference had disappeared by the 18 week examination. All volunteers oral hygiene and gingivitis scores improved after the baseline examination, and this improvement continued throughout the trial. This is a feature of nearly all toothbrushing studies and can be attributed to the initial prophylaxis and the Hawthorne phenomenon. Such phenomena, noted in home use clinical trials, may mask the efficacy of proven antiplaque formulations.

Journal Article
TL;DR: The current medical treatment and the dental concerns which face the dentist, patient, and family are reviewed, and suggestions for dental management are given along with practical recommendations for caregivers.

Journal ArticleDOI
TL;DR: The presence of yeasts tended to be associated with biologic factors, but behavioral factors reflecting lifestyle may be more important in the development of denture stomatitis.
Abstract: Objectives. This study describes the association of yeasts and denture stomatitis with behavioral and biologic factors. Study design. Seven hundred eighty 55-year-old citizens of Oulu, Finland, were examined clinically; 452 of them had complete dentures. Salivary yeasts and lactobacillus counts were detected through the use of Oricult-N and Dentocult-LB dip-slide techniques. Lifestyle factors were measured by means of questions concerning physical activity, tobacco smoking, alcohol consumption, and dietary habits. Other background variables used in cross-tabulations and logistic regression analysis were unstimulated salivary secretion rate, retention of denture, oral hygiene, gender, and socioeconomic status. Results. The prevalence of denture stomatitis was greater among subjects with an unhealthy lifestyle, subjects with higher lactobacillus counts, and subjects with poor oral hygiene. Salivary secretion rate and smoking were associated with the presence of yeasts, but general lifestyle measures were not. Conclusion. The presence of yeasts tended to be associated with biologic factors, but behavioral factors reflecting lifestyle may be more important in the development of denture stomatitis.

Journal Article
TL;DR: The crucial role played by many properties of saliva in preventing dental caries, maintaining the plaque pH and controlling the equilibrium between enamel de- and remineralization has been demonstrated.
Abstract: The crucial role played by many properties of saliva in preventing dental caries, maintaining the plaque pH and controlling the equilibrium between enamel de- and remineralization has been demonstrated. This has been documented by the effects of salivary dysfunction on caries incidence and by the distribution of sites of caries predilection in areas where saliva presence is restricted. The use of sugar-free chewing gum has been increasingly accepted as one adjunct to oral hygiene procedures. It has become part of an anti-caries prevention program, especially in patients suffering from xerostomia. Chewing gum not only acts as a salivary stimulant but may also be a useful vehicle for some agents such as fluoride, chlorhexidine and calcium phosphate. Moreover, in some countries gum containing nicotine has been used to substitute the nicotine from cigarettes to reduce the effects of nicotine withdrawal reaction from people attempting to stop smoking.