Showing papers on "Oral hygiene published in 2014"

Therapeutic management of hypophosphatemic rickets from infancy to adulthood

Abstract: In children, hypophosphatemic rickets (HR) is revealed by delayed walking, waddling gait, leg bowing, enlarged cartilages, bone pain, craniostenosis, spontaneous dental abscesses, and growth failure. If undiagnosed during childhood, patients with hypophosphatemia present with bone and/or joint pain, fractures, mineralization defects such as osteomalacia, entesopathy, severe dental anomalies, hearing loss, and fatigue. Healing rickets is the initial endpoint of treatment in children. Therapy aims at counteracting consequences of FGF23 excess, i.e. oral phosphorus supplementation with multiple daily intakes to compensate for renal phosphate wasting and active vitamin D analogs (alfacalcidol or calcitriol) to counter the 1,25-diOH-vitamin D deficiency. Corrective surgeries for residual leg bowing at the end of growth are occasionally performed. In absence of consensus regarding indications of the treatment in adults, it is generally accepted that medical treatment should be reinitiated (or maintained) in symptomatic patients to reduce pain, which may be due to bone microfractures and/or osteomalacia. In addition to the conventional treatment, optimal care of symptomatic patients requires pharmacological and non-pharmacological management of pain and joint stiffness, through appropriated rehabilitation. Much attention should be given to the dental and periodontal manifestations of HR. Besides vitamin D analogs and phosphate supplements that improve tooth mineralization, rigorous oral hygiene, active endodontic treatment of root abscesses and preventive protection of teeth surfaces are recommended. Current outcomes of this therapy are still not optimal, and therapies targeting the pathophysiology of the disease, i.e. FGF23 excess, are desirable. In this review, medical, dental, surgical, and contributions of various expertises to the treatment of HR are described, with an effort to highlight the importance of coordinated care.

Treatment of aggressive periodontitis.

Abstract: Despite etiological differences between aggressive and chronic periodontitis, the treatment concept for aggressive periodontitis is largely similar to that for chronic periodontitis. The goal of treatment is to create a clinical condition that is conducive to retaining as many teeth as possible for as long as possible. When a diagnosis has been made and risk factors have been identified, active treatment is commenced. The initial phase of active treatment consists of mechanical debridement, either alone or supplemented with antimicrobial drugs. Scaling and root planing has been shown to be effective in improving clinical indices, but does not always guarantee long-term stability. Antimicrobials can play a significant role in controlling aggressive periodontitis. Few studies have been published on this subject for localized aggressive periodontitis, but generalized aggressive periodontitis has been subject to more scrutiny. Studies have demonstrated that systemic antibiotics as an adjuvant to scaling and root planing are more effective in controlling disease compared with scaling and root planing alone or with supplemental application of local antibiotics or antiseptics. It has also become apparent that antibiotics ought to be administered with, or just after, mechanical debridement. Several studies have shown that regimens of amoxicillin combined with metronidazole or regimens of clindamycin are the most effective and are preferable to regimens containing doxycycline. Azithromycin has been shown to be a valid alternative to the regimen of amoxicillin plus metronidazole. A limited number of studies have been published on surgical treatment in patients with aggressive periodontitis, but the studies available show that the effect can be comparable with the effect on patients with chronic periodontitis, provided that proper oral hygiene is maintained, a strict maintenance program is followed and modifiable risk factors are controlled. Both access surgery and regenerative techniques have shown good results in patients with aggressive periodontitis. Once good periodontal health has been obtained, patients must be enrolled in a strict maintenance program that is directed toward controlling risk factors for disease recurrence and tooth loss. The most significant risk factors are noncompliance with regular maintenance care, smoking, high gingival bleeding index and poor plaque control. There is no evidence to suggest that daily use of antiseptic agents should be part of the supportive periodontal therapy for aggressive periodontitis.

Role of dental plaque, saliva and periodontal disease in Helicobacter pylori infection.

Abstract: Helicobacter pylori (H. pylori) infection is one of the most common bacterial infections in humans. Although H. pylori may be detected in the stomach of approximately half of the world's population, the mechanisms of transmission of the microorganism from individual to individual are not yet clear. Transmission of H. pylori could occur through iatrogenic, fecal-oral, and oral-oral routes, and through food and water. The microorganism may be transmitted orally and has been detected in dental plaque and saliva. However, the role of the oral cavity in the transmission and recurrence of H. pylori infection has been the subject of debate. A large number of studies investigating the role of oral hygiene and periodontal disease in H. pylori infection have varied significantly in terms of their methodology and sample population, resulting in a wide variation in the reported results. Nevertheless, recent studies have not only shown that the microorganism can be detected fairly consistently from the oral cavity but also demonstrated that the chances of recurrence of H. pylori infection is more likely among patients who harbor the organism in the oral cavity. Furthermore, initial results from clinical trials have shown that H. pylori-positive dyspeptic patients may benefit from periodontal therapy. This paper attempts to review the current body of evidence regarding the role of dental plaque, saliva, and periodontal disease in H. pylori infection.

Oral health status and behaviours of children with Autism Spectrum Disorder: a case-control study.

Abstract: Background Autism Spectrum Disorder (ASD) is a lifelong neuro-developmental disorder characterized by abnormalities in social interactions and communication and by stereotyped, repetitive activities. Purpose Assess the oral health status and behaviours of children with ASD. Methods The study included 100 children with ASD and 100 healthy children from Alexandria, Egypt. Data were collected using a questionnaire and clinical examination. Questionnaire assessed socio-demographics, medical history, dental history, oral hygiene, dietary habits, and presence of self-injurious behaviours. Clinical examination assessed behaviour during examination, gingival condition, plaque accumulation, caries, and other oral conditions. Results Children with ASD had significantly poorer oral hygiene and gingival condition than healthy children (P < 0.001 for both). No significant differences were found in caries prevalence or experience in primary or permanent dentition. More children with ASD behaved ‘negatively’ or ‘definitely negatively’ (37% and 11%) than did healthy controls (11% and 2%) (P < 0.0001). Self-injurious behaviour and bruxism were more practised by children with ASD (32% of children with ASD and 2% of healthy children, P < 0.001). More children with ASD had difficulty in accessing dental care (P = 0.002). Conclusions The oral condition of children with ASD might increase the risk of developing dental diseases. Their behaviour and life factors may complicate provision of services and limit access to dental care. Therefore, individualized oral health education programmes should be implemented for those children.

Pattern and severity of early childhood caries in Southern Italy: a preschool-based cross-sectional study

Abstract: This survey was intended to investigate prevalence and severity of early childhood caries (ECC) in a sample of children in Southern Italy and to identify factors that may be related to this condition The study was designed as a cross-sectional survey The study population (children aged 36–71 months) attending thirteen kindergartens was randomly selected through a two-stage cluster sampling procedure Parents/guardians of all eligible children were invited to participate filling out a structured self-administered questionnaire, and after having returned the informed consent form an oral examination of the child was performed at school The questionnaire included information on: socio-demographics about parents/guardians and child, pregnancy and newborn characteristics, oral hygiene habits of child, eating habits particularly on consumption of sweets, access to dental services, and infant feeding practices The WHO caries diagnostic criteria for deciduous decayed, missing and filled teeth (dmft) and surfaces (dmfs) were used to record ECC and severe-ECC (S-ECC) Univariate and multiple logistic regression analyses were conducted to evaluate statistical associations of social demographics, infant feeding practices, oral hygiene habits, and access to dental services to ECC, S-ECC, dmft and dmfs 515 children participated in the study 19% had experienced ECC, and 27% S-ECC, with a mean dmft and dmfs scores of 051 and 099, respectively Mean dmft was 268 in ECC subjects, and 686 in S-ECC subjects Statistical analysis showed that prevalence of ECC significantly increased with age (OR = 195; 95% CI = 13-291) and duration of breastfeeding (OR = 126; 95% CI = 101-157), whereas it was significantly lower in children of more educated mothers (OR = 064; 95% CI = 042-096), and higher in those who had been visited by a dentist in the previous year (OR = 329; 95% CI = 172-633) Results of our study demonstrate that even in Western countries ECC and S-ECC represent a significant burden in preschool children, particularly in those disadvantaged, and that most of the known modifiable associated factors regarding feeding practices and oral hygiene are still very spread in the population

Poor oral health, a potential new geriatric syndrome

Abstract: This article presents a brief introduction to the medical aspects of ageing and age-related diseases, and to some geriatric syndromes, followed by a discussion on their impact on general and oral healthcare provision to community-dwelling older people. Recent investigations suggest that inflammation constitutes a biological foundation of ageing and the onset of age-related diseases. Multimorbidity and polypharmacy, together with alterations in pharmacokinetics and pharmacodynamics, make older people at risk of adverse medication reactions. A side effect of several medications is causing xerostomia and hyposalivation, and both the type and number of medications used are relevant. New options of general healthcare provision to community-dwelling older people are the use of mobility aids and assistive technology devices, domiciliary health care, respite care and telecare. Their oral health status may be jeopardised by frailty, disability, care dependency and limited access to professional oral health care. Recommendations for improvement are the following: better integrating oral health care into general health care, developing and implementing an oral healthcare guideline, providing customised oral hygiene care aids, domiciliary oral healthcare provision, visiting dental hygienists and/or nurses, oral hygiene telecare, easily and safely accessible dental offices, transforming dentistry into medical oral health care and upgrading dentists to oral physicians. In case oral healthcare providers do not take the responsibility of persuading society of the importance of adequate oral health, weakened oral health of community-dwelling older people will become a potential new geriatric syndrome.

The role of oral hygiene: does toothbrushing harm?

Abstract: Although toothbrushing is considered a prerequisite for maintaining good oral health, it also has the potential to have an impact on tooth wear, particularly with regard to dental erosion. Experimental studies have demonstrated that tooth abrasion can be influenced by a number of factors, including not only the physical properties of the toothpaste and toothbrush used but also patient-related factors such as toothbrushing frequency and force of brushing. While abrasion resulting from routine oral hygiene can be considered as physiological wear over time, intensive brushing might further harm eroded surfaces by removing the demineralised enamel surface layer. The effects of brushing on eroded dentine are not fully elucidated, particular under in vivo conditions. However, there are indications that brushing after an acid impact causes less additional hard tissue loss in dentine than in enamel. Toothbrushing frequency and force as well as toothbrush hardness were shown to act as co-factors in the multifactorial aetiology of non-cervical carious lesions. In vitro studies showed that toothbrushing abrasion is primarily related to the abrasivity of the toothpaste, while the toothbrush acts as a carrier, only modifying the effects of the toothpaste. The benefits of normal oral hygiene procedure exceed possible side effects by far, but excessive toothbrushing - especially of eroded teeth - might cause some harmful effects.

Acute periodontal lesions

Abstract: This is a review and update on acute conditions affecting the gingival tissues, including abscesses in the periodontium, necrotizing periodontal diseases, and other acute conditions that cause gingival lesions with acute presentation, such as infectious process not associated with oral bacterial biofilms, muco-cutanenous disorders, and traumatic and allergic lesions. A periodontal abscess is clinically important since it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth, and because bacteria within the abscess have been identified, mainly by the type of etiology, and there are clear diffrences between those affecting a previously existing periodontal pocket ahd those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, with individual evaluation of the need for systemic antimicrobial therapy. the definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal disease (NPD) present three typical clinical features : papilla necrosis, gingival bleeding, and pain. Although the prevalence of these diseases is not high, their importance is clear, since they represent the most severe conditions associated with dental biofilm, with very rapid tissue destruction. In adittion to bacteria, the etiology of NPD includes numerous factors that alter the host response and predispose to these diseases, including HIV infection, malnutrition, stress, and tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine, and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in non-responding conditions and the best option is metronidazole.Once the acute disease is under control, definitive treatment should be provided, including the adequate therapy for the pre-existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms , are infectious diseases, muco-cutaneous diseases and traumatic or allergic lesions. In most cases, the gingival envolvement is not severe, though they are common and may prompt a dental emergency visit. These conditions may the direct result of a trauma or the consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for an adequate management of the case.

Oral health in older patients with oropharyngeal dysphagia

Abstract: Background oropharyngeal dysphagia (OD), aspiration and poor oral health status are potential risk factors in elderly patients with aspiration pneumonia (AP). Aim to assess the oral hygiene status and the prevalence of periodontal disease and dental caries in elderly patients with OD. Patients and methods fifty elderly patients (79.7 ± 6.64 years) with OD associated with ageing or neurological diseases and 15 elderly patients without OD (77.01 ± 4.51 years) were enrolled in this observational-transversal study. OD and aspiration were evaluated by videofluoroscopy (VFS). Oral health was assessed by: (i) the Simplified Oral Hygiene Index (OHI-S); (ii) a complete periodontal examination, assessing the periodontal pocket depth, clinical attachment loss and bleeding on probing to study periodontal diseases (periodontitis, gingivitis); and (iii) the presence of dental caries. Results 8/50 elderly patients with OD presented VFS signs of aspiration, half of them silent; 40/50, signs of penetration into laryngeal vestibule and 16/50, oropharyngeal residue. Prevalence of edentulism and caries was higher in patients with OD. Dentate older patients with OD (30/50) presented the following complications (i) poor oral hygiene in 18 patients (OHI-S 3.1-6), (ii) gingivitis in 2 and periodontitis in 28 and (iii) caries in 16. Conclusions older patients with OD presented polymorbidity and impaired health status, high prevalence of VFS signs of impaired safety of swallow and poor oral health status with high prevalence of periodontal diseases and caries. These patients are at great risk of developing AP. We recommend a policy of systematic oral health assessment in elderly patients with OD.

The role of family functioning in childhood dental caries.

Abstract: OBJECTIVES: This study investigated the relationship between family functioning and childhood dental caries. Further objectives were (i) to explore whether oral hygiene behaviours could account for a possible association between family functioning dimensions and childhood dental caries and (ii) to explore whether family functioning could mediate the relationship between sociodemographic factors and childhood dental caries. METHODS: A random sample of 630 5- to 6-year-old children was recruited from six large paediatric dental centres in the Netherlands. Children's dmft scores were extracted from personal dental records. A parental questionnaire and the Gezinsvragenlijst (translation: Family Questionnaire) were used to collect data on sociodemographic characteristics, oral hygiene behaviours and family functioning. Family functioning was assessed on five dimensions: responsiveness, communication, organization, partner-relation and social network. Associations with dmft were analysed using multilevel modelling.RESULTS: Bivariate analysis showed that children from normal functioning families on the dimensions responsiveness, communication, organization and social network had significantly lower dmft scores compared with children from dysfunctional families. Poorer family functioning on all dimensions was associated with an increased likelihood of engaging in less favourable oral hygiene behaviours. Children with lower educated mothers, immigrant children and children of higher birth order were more likely to come from poorer functioning families. In multivariate analysis, organization remained a significant predictor of dmft after adjusting for the other family functioning dimensions and the mother's education level, but it lost statistical significance after adjustment for oral hygiene behaviours.CONCLUSION:A relationship between family functioning and childhood dental caries was found, which may have operated via oral hygiene behaviours. Family functioning modestly explained socioeconomic inequalities in child oral health. Organization appeared to be the most important dimension of family functioning that influenced children's caries experience.

Influence of active reminders on oral hygiene compliance in orthodontic patients

Abstract: Objective: To determine if text message reminders regarding oral hygiene compliance have an influence on the level of compliance within an orthodontic population. Materials and Methods: In this prospective, randomized, controlled clinical trial, 42 orthodontic patients were assigned to a text message or control group. Parents of patients assigned to the text message group received a reminder text message one weekday each week. Oral hygiene compliance was measured using bleeding index (BI), modified gingival index (MGI), and plaque index (PI), and visual examination of white spot lesion (WSL) development at baseline (T0), two appointments after baseline (T1), and four appointments after baseline (T2). Results: BI, MGI, and PI scores were significantly lower in the text message group than in the control group at T2. Conclusion: A text message reminder system is effective for improving oral hygiene compliance in orthodontic patients.

Oral status in patients with early rheumatoid arthritis: a prospective, case–control study

Abstract: Objective. Patients with RA suffer from a higher risk of periodontal attachment loss and increased oral inflammation. We hypothesize that there are pathogenetic and immunological interactions between these diseases that go beyond impaired manual dexterity accompanying advanced RA. The primary objective of the present study was to determine whether a loss of alveolar bone can be detected in RA patients during the early course of the disease. Methods. In this cross-sectional, epidemiological casecontrol study, 22 patients with early RA (ERA) were compared with 22 matched healthy controls. Oral and periodontal status, clinical activity, and sociodemographic parameters were determined. Oral microbiota were analysed using real-time quantitative PCR specific for leading oral pathogens. Results. More advanced forms of periodontitis were found in ERA patients compared with controls. ERA patients had a greater number of missing teeth [ERA 5.7 (S.D. 5.0), controls 1.9 (S.D. 1.0), P = 0.002], deeper periodontal pockets [clinical attachment level: ERA 3.4 (S.D. 0.5 mm), controls 2.7 (S.D. 0.3 mm), P < 0.000], and greater bleeding on probing [ERA 18.6% (S.D. 9.0%), controls 10.5% (S.D. 5.1%), P = 0.001] despite comparable oral hygiene. Tannerella forsythia (6.77-fold, P = 0.033) subgingivally and Streptococcus anginosus (3.56-fold, P = 0.028) supragingivally were the characteristic pathogens in ERA. Conclusion. Increased loss of periodontal attachment and alveolar bone can be detected in patients with ERA, therefore we propose that the consulting rheumatologists inform the patients that they have a higher risk of periodontal disease. It would be beneficial if these patients were referred directly for intensive dental care.

Self-rated oral health status, oral health service utilization, and oral hygiene practices among adult Nigerians

Abstract: There is scarce information available on oral health service utilization patterns and common oral hygiene practices among adult Nigerians. We conducted the 2010–2011 national oral health survey before the introduction of the national oral health policy to determine the prevalence of oral health service utilization, patterns of oral hygiene practices, and self reported oral health status, among adults in various social classes, educational strata, ethnic groups and geopolitical zones in Nigeria. We conducted a cross-sectional survey in North-Central, North-West, South-East, South-South and South-West geopolitical zones of Nigeria. Multi-stage cluster sampling method was used for the sample selection. We administered a structured questionnaire to a total of 7,630 participants. Information on the socio-demographic characteristics, oral hygiene practices and oral health services utilization pattern of participants was obtained. We interviewed 7, 630 participants (55.6% female). The participants ages ranged between 18 and 81 years, mean age was 37.96 (SD = 13.2). Overall 21.2% of the participants rated their oral health status as very good, 37.1% as good and 27.4% as fair. Only 26.4% reported having visited the dentist at least once prior to the conduct of the survey. More than half of these visits (54.9%) were for treatment purpose. Utilization of oral health services was significantly (p < 0.05) associated with being older, more educated and being engaged in a skilled profession. More educated persons, females and younger persons used toothbrushes for daily tooth cleaning. Age, sex, marital status, level of education and occupation were significantly related to daily frequency of tooth cleaning (p < 0.05). Our results show that while most Nigerian adults have a positive view of their oral health status, majority reported poor oral health utilization habits. Older persons resident in the northern zones of the country and less educated persons displayed poorer oral hygiene practices. The study findings suggest that there is low oral health service utilization among adult Nigerians and that socio-demographic variables influence oral health utilization habits and oral hygiene behavior among adult Nigerians Further studies to identify other factors influencing oral health behavior are suggested.

Clinical correlates of a lateral-flow immunoassay oral risk indicator.

Abstract: Background: The aim of the present study is to investigate the clinical correlates of a novel lateral-flow immunoassay with bleeding on probing (BOP), oral hygiene, and periodontal probing depth. This report offers a simple, rapid, and highly sensitive tool that addresses two issues important to periodontists: 1) detecting active periodontitis, and 2) predicting chronic periodontitis. Methods: Seventy-six of 86 males requiring seminal fluid analysis as part of a separate study were serially recruited into the study. After basic dental and periodontal examination under natural light and with the use of the community periodontal index of treatment needs (CPITN) probe, debris and calculus indices were recorded per participant. Participants were subsequently grouped into ‘‘good,’’ ‘‘fair,’’ and ‘‘poor’’ oral hygiene categories based on a simplified oral hygiene index. BOP was assessed with the ball-ended tip of the probe, and periodontitis was assessed with pocket probing as well as a lateral flow of neutrophil collagenase-2 immunoassay, which measures levels of matrix metalloproteinase-8. Results: Neutrophil collagenase-2 immunoassay was 96% sensitive for poor oral hygiene, 95% sensitive for chronic periodontitis (defined as at least two sites with periodontal pockets), and 82.6% sensitive for at least two sites with BOP. Conclusion: Neutrophil collagenase-2 immunoassay had a high sensitivity for at least two sites with BOP and two sites with periodontal pockets but a lower relationship for single-site pockets and BOP. JP eriodontol 2014;85:188-194.

Effect of Oral Hygiene and 0.12% Chlorhexidine Gluconate Oral Rinse in Preventing Ventilator-Associated Pneumonia After Cardiovascular Surgery

Abstract: BACKGROUND: Ventilator-associated pneumonia (VAP) is a nosocomial infection of multifactorial etiology and has a negative influence on cardiovascular surgery (CVS) outcomes. OBJECTIVES: Determine the effect of toothbrushing plus 0.12% chlorhexidine gluconate oral rinse in preventing VAP after CVS. METHODS: In a quasi-experimental study, patients undergoing heart surgery were enrolled in a protocol for controlling dental biofilm by proper oral hygiene (toothbrushing) and oral rinses with 0.12% chlorhexidine gluconate (Group 1), and they were compared with a historical control group (Group 2), which included patients who underwent cardiac surgery between 2009 and 2010 and who received regular oral hygiene care. Seventy-two hours before surgery, a dentist provided instruction and supervised oral hygiene with toothbrushing and chlorhexidine oral rinses to patients in Group 1. RESULTS: Each group comprised 150 patients. A lower incidence of VAP (2.7% [95% CI 0.7–7.8] vs 8.7% [95% CI 4.9–14.7], P = .04) and a shorter hospital stay (9 ± 3 d [95% CI 8.5–9.5] vs 10 ± 4 d [95% CI 9.4–10.7], P = .01) were observed in Group 1. No significant differences in all-cause in-hospital death were observed between groups (5.3% vs 4.7%, P > .99). The risk for developing pneumonia after surgery was 3-fold higher in Group 2 (3.9, 95% CI 1.1–14.2). CONCLUSIONS: Oral hygiene and mouth rinses with chlorhexidine under supervision of a dentist proved effective in reducing the incidence of VAP.

The role of parental education and socioeconomic status in dental caries prevention among Lithuanian children.

Abstract: Background and objective: The aim of this study was to disclose parental attitudes toward their children's dental care and preventive measures used as well as to evaluate their associations with parental education and socioeconomic status. Materials and methods: A total of 1248 parents of 7-, 9-, and 12-year-old children from 5 largest Lithuanian cities were enrolled in the study. The questionnaire comprised 34 items, which were grouped into 4 clusters. Results: The parents with a high educational level scored better than those who had a low educational level (2.13 [SD, 0.39] vs. 2.2 [0.43], P = 0.002). The parents who reported sufficientfamily income scored their child's and their own health significantly better than those reporting insufficient-family income (2.02 [SD, 0.37] vs. 2.27 [SD, 0.41], P < 0.001). The parents cared about their child's health more than about their own (1.53 [SD, 0.51] vs. 2.15 [0.61], P < 0.001). The parents with a high educational level and those receiving sufficient income cared about education on oral hygiene and regular preventive dental check-ups more than those with a low educational level and insufficient income (36.7% and 40.8% vs. 30.2% and 28.7%, P < 0.01 and P < 0.001, respectively). The children whose parents had a high educational level brushed their teeth 2 times a day more frequently than those of the parents with a low educational level (48.5% and 42.4%, respectively, P < 0.001). Conclusions: Greater attention to children's dental care as well as keeping their teeth healthy was paid by the parents with a high educational level and sufficient income.

Root caries: a periodontal perspective.

Abstract: Background and objective A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs. Material and Methods The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders. Results Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking. Conclusion Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.

The interplay between alcohol consumption, oral hygiene, ALDH2 and ADH1B in the risk of head and neck cancer

Abstract: Alcohol consumption is an established risk factor for head and neck cancer (HNC). The major carcinogen from alcohol is acetaldehyde, which may be produced by humans or by oral microorganisms through the metabolism of ethanol. To account for the different sources of acetaldehyde production, the current study examined the interplay between alcohol consumption, oral hygiene (as a proxy measure for the growth of oral microorganisms), and alcohol-metabolizing genes (ADH1B and ALDH2) in the risk of HNC. We found that both the fast (*2/*2) and the slow (*1/*1 + *1/*2) ADH1B genotypes increased the risk of HNC due to alcohol consumption, and this association differed according to the slow/non-functional ALDH2 genotypes (*1/*2 + *2/*2) or poor oral hygiene. In persons with the fast ADH1B genotype, the HNC risk associated with alcohol drinking was increased for those with the slow/non-functional ALDH2 genotypes. For those with the slow ADH1B genotypes, oral hygiene appeared to play an important role; the highest magnitude of an increased HNC risk in alcohol drinkers occurred among those with the worst oral hygiene. This is the first study to show that the association between alcohol drinking and HNC risk may be modified by the interplay between genetic polymorphisms of ADH1B and ALDH2 and oral hygiene. Although it is important to promote abstinence from or reduction of alcohol drinking to decrease the occurrence of HNC, improving oral hygiene practices may provide additional benefit.

Risk determinants associated with early childhood caries in Uygur children: a preschool-based cross-sectional study

Abstract: The prevalence of early childhood caries (ECC) varies with geographical region and population. The Uygur people, one of 55 officially recognized ethnic minorities in China, have a population of 10,069,346. We performed a preschool-based cross-sectional study of 670 Uygur children from the southern region of Xinjiang, China, to investigate the prevalence and severity of ECC and to identify factors related to the dental health condition of this population. The study population of children ranging in age from 3 to 5 years was invited using a three-stage stratified sampling in Kashgar, the westernmost city in China. The “dmft” index was used to assess dental caries. The diagnosis of ECC or severe ECC was based on the oral health diagnostic criteria defined by the American Academy of Pediatric Dentistry. A questionnaire was completed by the children’s caregivers. The survey included questions concerning the children’s sociodemographic background; feeding and eating habits, particularly frequency of sweet beverage and food consumption; dental hygiene-related behaviors; the general oral health knowledge of caregivers; and the dental healthcare experience of caregivers and their children. A total of 670 Uygur children underwent complete dental caries examination. Most of the children (74.2%) had ECC, with a mean dmft ± SD of 3.95 ± 3.84. The prevalence of severe ECC was 40.1% (N =269), with a mean dmft of 7.72 ± 3.14. More than 99% of caries were untreated. Statistically significant correlations were found between higher ECC prevalence and increased age and lower socioeconomic background, while greater dental health knowledge of the caregiver and positive oral hygiene behaviors were found to be protective. Our findings confirm the multi-factorial etiology of ECC. The prevalence of ECC among preschool-aged Uygur children in Kashgar was high, particularly among those from lower socioeconomic backgrounds. Caries prevalence was associated with oral hygiene behaviors of children and the general oral health knowledge of caregivers. These factors could be modified through public health strategies, including effective publicity concerning general dental health and practical health advice.

Preliminary antiplaque efficacy of aloe vera mouthwash on 4 day plaque re-growth model: randomized control trial.

Abstract: Background : Due to increasing resistance to antibiotics and rising incidence of oral diseases, there is a need for alternative treatment modalities to combat oral diseases. The aim of the present study was to access the effect of Aloe vera mouthwash on the dental plaque in the experimental period of 4 days and to compare it with the bench mark control chlorhexidine and placebo (saline water). Material and Methods : A total of 300 systemically healthy subjects were randomly allocated into 3 groups: Aloe vera mouthwash group (n=100), control group (=100)–chlorhexidene group and saline water-Placebo (n=100). To begin with, Gingival index (GI) and plaque index (PI) were recorded. Then, baseline plaque scores were brought to zero by professionally cleaning the teeth with scaling and polishing. After randomization of the participants into three groups they were refrained from regular mechanical oral hygiene measures. Subjects were asked to swish with respective mouthwash (Aloe vera mouthwash, 0.2% chlorhexidine gluconate mouthwash, or normal saline) as per therapeutic dose for 4 days. Results : The results showed that Aloe vera mouthrinse is equally effective in reducing plaque as Chlorhexidine compared to placebo over a period of 4 days. There was a significant reduction on plaque in Aloe vera and chlorhexidine groups and no statistically significant difference was observed among them (p>0.05). Aloe vera mouthwash showed no side effects. Conclusion : The results of the present study indicated that Aloe vera may prove an effective mouthwash due to its ability in reducing dental plaque. Keywords : Mouthwash, plaque, chlorhexidine

Interventions for edentate elders--what is the evidence?

Abstract: Demographic developments indicate an increasing proportion of elderly persons in the population as well as longer life expectancies. Furthermore, the prevalence of edentulism is decreasing, and natural teeth are being retained until later in life. Geriatric patients are more frequently fragile with multiple co-morbidities, including frequent medication-related side effects such as xerostomia. Cognitive impairment also increases with age and presents a considerable challenge to oral hygiene and dental treatment. Edentulous patients present a particular challenge, as muscle skill and the ability to adapt to a new denture diminish with age. Duplication techniques reduce the adaptation of replacement dentures, and implants are increasingly used to stabilise lower complete dentures, significantly improving chewing efficiency and preventing peri-implant bone loss. Implant overdentures may reverse some of the functional, psychological and psychosocial effects of tooth loss and thus increase the oral health-related quality of life until late in life. Evidence from RCTs exists on the 10-year survival of implants and implant overdentures, but few studies have investigated the problems and survival rates when the patient loses autonomy. The standard of care in geriatric patients has to be adapted to the patient's motivation, functional and cognitive impairment, and medical condition as well as his/her socio-economic context.

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

Abstract: This study aims to assess clinical, microbiological and inflammatory parameters as indicators for caries and periodontal disease in adolescents with obesity. Twenty-seven adolescents with obesity [body mass index (BMI) 37 ± 4 kg/m2] and 28 controls (BMI 20 ± 2 kg/m2) answered questionnaires and were investigated regarding salivary parameters, plaque pH drop after a 1-min glucose rinse, oral clinical parameters, inflammatory markers in gingival crevicular fluid (GCF) and sub-gingival mirobiota. Compared with controls, adolescents with obesity had a lower stimulated salivary secretion rate (1.55 ± 0.63 vs. 2.05 ± 1.05 mL/min, p 0.05). No differences in sub-gingival inflammatory or microbial indicators were detected (p > 0.01). More caries and gingival inflammation were observed in adolescents with obesity. Of the indicators tested, salivary secretion rate was lower and sIgA levels were higher in the obesity group. We are unable to confirm whether differences in caries and gingival inflammation are due to systemic changes that are associated with obesity or due to possible irregular dietary/oral hygiene habits. Customised oral health preventive programmes and appropriate collaboration with medical personnel in selecting the best diet, medication and psychological support can help improve the general well-being, including oral health, of children with obesity. This may even reduce the risk of oral diseases.

Association between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents.

Abstract: Objective. The aim was to investigate the relationship between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents. Materials and methods. A clinical dental examination and a questionnaire concerning lifestyle factors, including drinking habits, oral hygiene, dietary consumption, physical activity and screen-viewing habits were completed. Three hundred and ninety-two individuals completed the study (13–14 years, n = 195; 18–19 years, n = 197). The material was divided into high and low carbonated soft drink consumption groups, corresponding to approximately the highest and the lowest one-third of subjects in each age group. Differences between the groups were tested by the Mann-Whitney U-test and logistic regression. Results. Intake of certain dietary items, tooth brushing, sports activities, meal patterns, screen-viewing behaviors, BMI and parents born outside Sweden differed significantly between high and low consumers in one or both of the two age groups. Dent...

Effect of oral healthcare education on knowledge, attitude and skills of care home nurses: a systematic literature review

Abstract: OBJECTIVES: To systematically review the literature on the effect of providing oral healthcare education to care home nurses on their oral healthcare knowledge and attitude and their oral hygiene care skills. METHODS: A literature search was obtained for relevant articles on oral healthcare education of nurses in care homes, using five electronic retrieval systems and databases. The search was limited to human studies, articles published in English and articles published during the period January 1990 to December 2011. The methodological quality of an article was assessed on the basis of criteria published by the Cochrane Collaboration. For articles not meeting all methodological quality criteria, relevance criteria were used to determine how much scientific evidence could be assigned to the study findings. RESULTS: In accordance with the methodological quality criteria, two randomized controlled trials were included. Additionally, four studies were included after determining the scientific evidence of the study findings. The studies included revealed some scientific evidence and indications that an oral healthcare education programme for care home nurses may improve the nurses' oral healthcare knowledge and attitude. Any effect of oral healthcare education to care home nurses' oral hygiene care skills could not be determined. CONCLUSIONS: Oral healthcare education may have a positive effect on care home nurses' oral healthcare knowledge and attitude and on care home residents' oral hygiene, whereas any effect on care home nurses' oral hygiene care skills could not be found.

Mouthwashes for the control of supragingival biofilm and gingivitis in orthodontic patients : evidence-based recommendations for clinicians

Abstract: Properly performed daily mechanical biofilm control is the most important prevention strategy for periodontal diseases. However, proper mechanical biofilm control is not performed effectively by the majority of the population, mainly due to lack of motivation and of manual dexterity. Local biofilm retention factors may aggravate home oral hygiene quality. For this reason, patients wearing fixed orthodontic appliances comprise a group that may benefit from the daily use of mouthwashes. The purpose of this review was to perform a systematic search in the literature on antiseptics used to control supragingival biofilm and gingivitis in orthodontic patients. Six studies investigating the effect of chlorhexidine and 5 studies evaluating the effect of the daily use of antiseptics were found. Chlorhexidine showed better results in reducing plaque and gingivitis. However, because of its adverse effects after continuous use, it should not be indicated for long-term periods. Among the agents considered for daily use, the fixed combination of essential oils was the only one evaluated in a clinical trial, in which a comparative group presented a statistically significant clinical impact. There is no direct evidence supporting the indication of antiseptic agents for orthodontic patients other than chlorhexidine and essential oils. It can be concluded that, for patients undergoing orthodontic treatment, chlorhexidine should be considered for treating acute gingival inflammation, whereas essential oils should be indicated for long-term daily use in controlling supragingival biofilm.

Comparison of oral health among older people with and without dementia.

Abstract: UNLABELLED Older people with dementia are very dependent on nursing, and caregivers are frequently confronted with oral-care-resistant behaviour which may lead to shortcomings in oral health. OBJECTIVE To compare oral hygiene and health status of institutionalised older people suffering, or not, from dementia. BASIC RESEARCH DESIGN Prospective cohort study (single-blind). CLINICAL SETTING Institutionalised older population in south-west Germany. PARTICIPANTS Ninety-three, allocated to two groups: dementia (n = 57) and non-dementia (n = 36) based on a mini mental state examination. MAIN OUTCOME MEASURES Target variables were plaque control record (PCR), gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN), and denture hygiene index (DHI). Differences between the dementia and non-dementia groups were evaluated by univariate testing of all target variables. RESULTS Univariate analysis revealed the amount of plaque in the dementia group was significantly higher than in the non-dementia group (p = 0.004). Mean CPITN of participants in the dementia group was significantly worse than those of participants in the non-dementia group (p < 0.001). All participants in the dementia group had periodontitis in at least one of the sextants, compared with 74% in the non-dementia group (p < 0.001). For DHI (p = 0.198) and GBI (p = 0.275) no differences were found between the groups. CONCLUSIONS Some aspects of oral hygiene and health seem to be worse for the institutionalised older people with dementia. Permanent specially adapted intervention for residents suffering from dementia in long-term care homes, and training for caregivers, is desirable to maintain life-long oral hygiene and health.