Oral Health and Preventive Dentistry, 01/2007

Purpose: To assess the impact of different types of malocclusions on the quality of life in 18-year-old young male adults. Materials and Methods: A cross-sectional survey with a randomly selected sample of 414 young male adults who applied for military service in the city of Florianópolis in 2003 was carried out. Data on malocclusions were obtained through the dental aesthetic index variables. The impact of the oral health conditions on the quality of life was assessed, using the Oral Impact on Daily Performance index. Chi-squared tests were performed and the malocclusions statistically associated with the impact were included in models of unconditional multiple logistic regression. Results: The incisal crowding [OR 2.6 (95%CI 1.4-4.8)] (p = 0.002) and the anterior maxillary irregularity greater than 2 mm [OR 2.5 (95%CI 1.3-4.7)] (p = 0.006) had an impact on 'smiling, laughing and showing teeth without embarrassment'. An overjet measure greater than 5 mm [OR 3.7 (95%CI 1.2-11.2)] (p = 0.021) had an impact on 'maintaining emotional state without being irritable'. The molar relationship did not have an impact. Conclusions: Some types of malocclusions have an impact on quality of life, especially in terms of satisfaction with appearance. Schlagwörter: epidemiology, impact, malocclusions, self-perception, young adults

Purpose: Previous studies have compared the use of interdental brushes and dental floss. However, none have attempted to compare their effects on subgingival plaque. Nor have smokers been excluded from previous studies, where they may have affected the assessment of gingival inflammation. Materials and Methods: The present study compared, in untreated patients suffering from mild to moderate periodontitis, the efficacy of dental floss (DF) and interdental brushes (IDB) in the reduction of plaque, gingival inflammation and probing depth in a one-month period prior to subgingival debridement. Ten patients used DF for one side of the dentition and IDB for the other side for one month. Oral hygiene instruction was given at baseline. Measurements were made at baseline and at one month. Results: With IDB, the mean approximal plaque score reduced supragingivally from 14.5 to 5.7 at one month, and with DF, from 12.9 to 5.3; subgingivally the score reduced from 17.3 to 6.7, and 16.7 to 8.1 respectively (p 0.001). BOP and mean probing depth reduced over time for IDB sites, but not DF sites (p 0.01). Overall there were no differences between the two devices. Patients preferred IDB because of its simpler method of use. Conclusions: The use of IDB and DF resulted in similar beneficial effects on subgingival plaque and proximal gingival health.

Aim: To evaluate the outcomes of short (15 minutes) oral hygiene vs. hand hygiene education for preschool children 4 weeks after these interventions. Materials and Methods: Sixty-one preschool children (age range 4-6 years) attending four kindergarten classes participated in a 15-minute health education programme on the importance of body cleanliness for general health. In addition, specific instructions on oral hygiene were provided for two randomly selected classes (30 children), while the remaining two classes (31 children) were given instruction of hand and nail cleaning. The oral hygiene status was assessed using the plaque control record (PCR). The cleanliness of the hands and fingernails was determined using a hand hygiene index (HHI) and a nail hygiene index (NHI). All three parameters were assessed before the intervention as well as 4 weeks thereafter. Results: Four weeks after education, the PCR had improved for all children from 79.95% to 72.35% (p 0.001). The NHI had improved from 74.91% to 61.71% (p 0.001). In addition, the mean PCR of the children given oral hygiene instruction decreased from 83.67% to 72.40%, while the mean PCR of the children given hand and nail cleaning instruction decreased from 76.23% to 72.29% (interaction effect 'time x type of instruction': p = 0.044). Girls' PCR improved significantly more than boys' PCR (Girls, 80.98 vs. 69.71; boys, 78.33 vs. 75.31; p = 0.021). Conclusions: The results of the study show that even a short, school-based educational intervention at an early age may affect children's oral health promotion significantly. Teachers should, therefore, be encouraged to educate children from an early age about oral hygiene promotion. Schlagwörter: children, health education, oral hygiene instruction, motivation, prevention

Purpose: The aim of this double-blind, randomised cross-over study was to compare the antibacterial effect and the substantivity of two toothpaste formulations containing amine fluoride (AmF) or zinc chloride (ZnCl2). Materials and Methods: After a professional tooth cleaning, 20 volunteers refrained from all oral mechanical hygiene measures for the subsequent 24 hours (day 0). Subsequently, a plaque sample was taken from three teeth and analysed for vitality of the plaque bacteria by means of the vital fluorescence technique (VF0; in %). After assessment of this baseline value the subjects had to brush their teeth for 2 minutes with 1.2 ml of the allocated toothpaste containing (a) 0.66% AmF or (b) 0.2% ZnCl2. For the following 8 hours no oral hygiene measures were allowed. After 4 and after 8 hours further plaque samples were analysed for biofilm vitality (VF4, VF8). During the following 3 days the volunteers had to brush twice daily for 2 minutes with the allocated toothpaste. On day 4, plaque index was assessed using the criteria of Quigley and Hein (Turesky modification). After a washout time of 9 days the next test cycle with the other toothpaste was started. Results: Both toothpastes reduced the biofilm vitality significantly at VF4 and VF8 compared with VF0 (p = 0.001). While after 8 hours the vitality values for the ZnCl2-toothpaste obtained significantly higher reductions (53%) than for the AmF-toothpaste (44%), results for plaque index were not significantly different (0.98 and 1.04 respectively). Conclusions: Both toothpastes showed a significant and prolonged antibacterial effect up to 8 hours with a benefit in favour of the ZnCl2 toothpaste. Schlagwörter: amine fluoride, antibacterial agents, substantivity, toothpastes, zinc chloride

Purpose: The aim of this crossover study was to compare the efficacy of conventional and end-tufted toothbrushes and two methods of plaque removal on partially erupted occlusal surfaces in schoolchildren. Materials and Methods: Thirty-seven subjects, aged 5-7 years, with at least one partially erupted lower permanent first molar, were randomly divided into three groups. Occlusal plaque (baseline) was scored using a disclosing solution applied to the occlusal surface of an erupting molar. Subjects were instructed to use a conventional toothbrush with horizontal scrubbing (conventional group); a conventional toothbrush with transverse technique (modified group); or an end-tufted toothbrush (end-tufted group). Subjects returned after a one-week washout period and brushed with the alternate toothbrush or technique. Final plaque condition was evaluated again using the same scoring as at baseline. Occlusal plaque reduction (baseline to final) percentiles were compared using paired t-test. Results: No statistically significant difference was found among transverse and end-tufted techniques (modified and endtufted groups respectively) (p > 0.05). The conventional group was less effective on occlusal plaque removal in erupting first molars than the other groups (p 0.05). Conclusion: The conventional toothbrushing technique was not satisfactory compared with other tested techniques on occlusal plaque removal. Moreover, the use of a conventional toothbrush with a modified technique was very effective on erupting first permanent molars without any additional costly device. Schlagwörter: dental plaque, effectiveness, tooth eruption, toothbrushing

Purpose: The present study was designed to develop a new periodontal risk assessment model based on the periodontal risk assessment (PRA) model by Lang and Tonetti, and to evaluate the risk assessment capability of the proposed model. Materials and Methods: Twenty-six patients diagnosed with chronic periodontitis were selected randomly and a thorough examination and charting of the periodontal status was performed. An intra-oral periapical radiograph of the area with the deepest probing depth was also taken. The following parameters were recorded: percentage of sites with BOP, number of sites with pocket depths >= 5mm, number of teeth lost, bone loss/age ratio, attachment loss/age ratio, diabetic and smoking status, dental status, other systemic factors and risk determinants. Using Microsoft Excel®, the parameters were plotted on the radar chart as per the original and the proposed model. Results: Of the cases identified by the original model, 42.3% were high-risk cases and 30.8% of the cases were low-risk cases. In the proposed model, 46.2% of high-risk cases and 46.2% of low-risk cases were identified. Only 7.7% of the cases identified with the new model were moderate-risk cases. Statistical analysis demonstrated that there was no significant difference between the risk scores of the two models. Conclusions: The results suggest that risk assessment by this model does not vary significantly as compared to the original model, and both are equally adept at detecting potential risk groups. Schlagwörter: periodontal disease, periodontal risk assessment, risk assessment, risk determinants, risk factors

Purpose: The purpose of this study was to determine the prevalence of dentine hypersensitivity and to examine some associated factors such as initiating stimuli among adult patients attending the Dental Clinic of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Materials and Methods: All consecutive adult patients that presented at the oral diagnosis unit over a period of 13 months, from March 2003 to March 2004, were included in the study. Relevant history, such as nature of the pain, initiating stimulus, frequency of episode, interference with eating, drinking and toothbrushing were taken. Evidence of tooth surface loss was noted. Dentine hypersensitivity was confirmed clinically by the use of air blast from the air-water jet and scratching suspected surfaces with a dental probe. Results: Of the 2165 patients examined, 29 were diagnosed as having dentine hypersensitivity, giving a prevalence figure of 1.34%. The commonest teeth affected were the molars and the commonest initiating factor was cold water. Occlusal surfaces were most affected, followed by cervical surfaces. A male predominance was observed. Conclusion: A lower prevalence figure was found in the present study in comparison to earlier reported studies. The prevalence of dentine hypersensitivity is slightly lower in females, with female to male ratio of 1 to 1.42. Dentine hypersensitivity resulted in more severe disturbance when drinking water than when eating or brushing. Schlagwörter: abrasion, adults, attrition, dentine hypersensitivity, erosion

Purpose: To estimate the survival of retention of sealant extension to occlusal ART restorations over 6.3 years; and to test the null-hypothesis that there is no difference in dentine caries lesion development in sealant extension to ART restorations in comparison with sealant free extensions to amalgam restorations in occlusal surfaces over 6.3 years. Materials and Methods: In a parallel group design, 318 and 254 grade 2 children were randomly assigned to the ART and amalgam group respectively. Eight dentists placed 925 evaluatable single- and multiple-surfaces restorations. A total of 424 sealed extensions to occlusal ART and 284 sealant free extensions to occlusal amalgam restorations were available for analyses. The modified actuarial method was used to estimate survival percentages. The jackknife method was applied to calculate the SE in the cumulative survival percentages. Results: After 6.3 years, 11.2% (SE = 2.2%) of sealant extensions were fully retained and 16.7% (SE = 2.8%) were partially retained. After 6.3 years, 86.4% (SE = 2.2%) of the sealed pits and fissures adjacent to occlusal ART restorations and 89.9% (SE = 2.4%) of non-sealed pits and fissures adjacent to occlusal amalgam restorations were free of dentine caries lesions. Neither this difference nor those at earlier evaluation years were statistically significant (p > 0.05). Conclusion: Sealing pits and fissures adjacent to occlusal ART restorations did not result in a caries preventive benefit over non-sealed pits and fissures adjacent to occlusal amalgam restorations in this group of children over 6.3 years. Schlagwörter: amalgam, atraumatic restorative treatment, glass-ionomer, sealant extension, survival

Purpose: To present an animal model for mucositis induced by fluorouracil in rats, and test two therapeutic options, the GaAlAs laser and topical dexamethasone, analysing them with regard to the quality and quantity of tissue alterations and comparing them with the phases of mucositis. Materials and Methods: Forty-five Wistar rats (250 g) were treated with fluorouracil (60 mg/kg) and, in order to mimic the clinical effect of chronic irritation, the palatal mucosa was irritated by superficial scratching with an 18-gauge needle. When all of the rats presented oral ulcers of mucositis, they were randomly allocated to one of three groups: group I was treated with laser (GaAlAs), group II was treated with topical dexamethasone, and group III was not treated. Excisional biopsies of the palatal mucosa were then performed, and the rats were killed. Tissue sections were stained with haematoxylin and eosin for morphological analyses, and with toluidine blue for mast-cell counts. Results: Group I specimens showed higher prevalence of ulcers, bacterial biofilm, necrosis and vascularisation, while group II specimens showed higher prevalance of granulation tissue formation. There were no significant statistical differences in the numbers of mast cells and epithelial thickness between groups. Conclusion: For the present model of mucositis, rats with palatal mucositis treated with laser (GaAlAs) showed characteristics compatible with the ulcerative phase of oral mucositis, and rats treated with topical dexamethasone showed characteristics compatible with the healing phase of mucositis. Topical dexamethasone was more efficient in the treatment of rats' oral mucositis than the laser. Schlagwörter: chemotherapy, dexamethasone, low level laser, mucositis, rats

Purpose: This study measured the flow rate, pH and buffering capacity of saliva from well- and poorly metabolically controlled Type 2 diabetic patients in three cities of the southern part of Brazil, compared with healthy individuals from the same cities. Materials and Methods: Whole saliva was collected by mechanical stimulation and buffering capacity and glucose level were measured. Blood was collected after 12 hours fasting and glucose and glycosylated haemoglobin concentrations were determined. The data were analysed by one-way ANOVA and Student-Newman-Keuls (α = 0.05). Results: The flow rate was lower in the Type 2 diabetic patients, regardless of whether they were well or poorly metabolically controlled, compared with healthy individuals (p 0.05). Salivary glucose concentration was higher in both diabetic patient groups, i.e. well and poorly metabolically controlled, than in the control (p 0.05). Conclusion: The metabolic control of hyperglycaemia was not sufficient to improve the salivary flow rate or the salivary glucose concentration. Schlagwörter: buffering capacity, flow rate, pH, saliva, Type 2 diabetes