Oral Health and Preventive Dentistry, 03/2015

Purpose: To assess the efficacy of a mouthwash containing 2% green tea as compared to a placebo mouthwash for the control of plaque and gingivitis. Materials and Methods: A randomised controlled clinical trial was conducted on 110 male subjects 18-60 years of age. The inclusion criteria were having a minimum of 20 sound natural teeth, a plaque index (PI) of at least 1.5 and a gingival index (GI) of at least 1.0. The subjects were randomised into two parallel groups, test and control. Subjects in the test group and control group were instructed to rinse twice daily for 1 min with 10 ml of test (mouthwash containing 2% green tea) and placebo mouthwash, respectively. After 28 days of using the mouthwash, inter- and intragroup differences for mean plaque index and gingival index scores were analysed. Results: There was a significant (p 0.05) reduction in mean GI and PI scores among the test group from baseline to 28 days, whereas it was not significant in the control group. A statistically significant (p 0.05) reduction was found in the mean difference in GI scores in the test group (0.67 ± 0.22) as compared to the control group (0.05 ± 0.11) and a statistically significant (p 0.05) reduction was observed in the mean difference in PI scores in the test group (1.65 ± 0.68) compared to the control group (0.45 ± 0.99). Conclusion: The results showed that the green tea mouthwash was effective in the reduction of plaque and gingivitis scores. Keywords: gingival index, green tea, mouthwash, plaque index, randomised controlled trial

Purpose: To determine whether mechanical cleaning with interdental brushes combined with the use of cetylpyridinium chloride (0.3% CPC) gel was more effective at plaque control than mechanical cleaning with interdental brushes alone. Materials and Methods: Forty individuals (30-70 years old) with at least 20 teeth and moderate chronic periodontitis who had no experience with interdental cleaning aids were randomly assigned to a treatment group (brush + gel, n = 20) or a control group (brush, n = 20). Both groups were examined by a dentist at baseline and at 3 and 6 months for changes in interdental plaque (interproximal plaque index [API]) levels, gingival inflammation (sulcus bleeding index [SBI]), probing depth (PD) and bleeding on probing (BOP). Results: No baseline differences in age, gender or number of teeth were observed between the two groups. During the study period, improvements in API and BOP were comparable between groups. However, improvements in SBI and PD were significantly greater in the test group than in the control group (p = 0.046 and p = 0.029, respectively). Conclusion: Mechanical interdental plaque control using interdental brushes combined with the use of CPC gel significantly improved 6-month gingival and periodontal outcomes (SBI and PD) compared with mechanical cleaning with interdental brushes alone. Keywords: disease, inflammation, interdental brush, interdental cleaning, periodontitis

Purpose: To examine the effect of chocobar ice cream containing bifidobacteria on salivary mutans streptococci and lactobacilli. Materials and Methods: A double-blind, randomised controlled trial was conducted with 30 subjects (18 to 22 years of age) divided into 2 groups, test (chocobar ice cream with probiotics) and control (chocobar ice cream without probiotics). The subjects were instructed to eat the allotted chocobar ice cream once daily for 18 days. Saliva samples collected at intervals were cultured on Mitis Salivarius agar and Rogosa agar and examined for salivary mutans streptococci and lactobacilli, respectively. The Mann-Whitney U-test, Friedman and Wilcoxon signed-rank tests were used for statistical analysis. Results: Postingestion in the test group, a statistically significant reduction (p 0.05) of salivary mutans streptococci was recorded, but a non-significant trend was seen for lactobacilli. Significant differences were was also observed between follow-ups. Conclusion: Short-term daily ingestion of ice cream containing probiotic bifidobacteria may reduce salivary levels of mutans streptococci in young adults. Keywords: Bifidobacterium, ice cream, Lactobacillus acidophilus, probiotics, saliva, Streptococcus mutans

Purpose: To examine the impact of oral disorders, socioenvironmental factors and subjective perceptions on children's school performance. Materials and Methods: The sample of 515 12-year-old children was randomly selected by conglomerate analysis. The children were clinically evaluated (DMFT index, bleeding on probing and DAI index) and asked to complete the questionnaire about family environment, self-perception of health status, oral health-related quality of life (OHRQoL) and school (questions in Child Perceptions Questionnaire - CPQ11-14). A questionnaire about socioeconomic status and perceptions about their children's health was sent to the parents. School performance was measured. Results: In a multivariate logistic model, the following variables remained statistically significant when associated with adolescents' poor school performance in the final model: number of people living in household, household overcrowding, parental perceptions about their children's oral health, presence of carious lesions and a question from CPQ11-14 about difficulty in paying attention in class because of their teeth, lips, jaws or mouth. Conclusion: The results of this study showed that socioenvironmental factors, subjective perceptions and oral health status of children - particularly carious lesions, have an important impact on school performance, demonstrating the need for planning public health dentistry based on intersectoral public policies. Keywords: oral health, school performance, socioenvironmental conditions

Purpose: To evaluate the associations between gingivitis, emotional status and quality of life in children. Materials and Methods: Sixty-four Brazilian students (11 to 12 years old) were examined for clinical and self-reported gingivitis. The participants were divided into two groups: those with gingivitis (n = 21) and controls (n = 43). Quality of life, anxiety and depression were measured using self-administered questionnaires. Saliva was collected 30 min after waking and at bedtime to measure the diurnal decline in salivary cortisol. The results were analysed using bivariate and multivariate analyses. Results: There were significantly more female participants in the control group. Approximately 90% of the children with gingivitis had good oral hygiene and 10.5% had satisfactory oral hygiene. There was a significant positive correlation between anxiety and depression in both clinical groups. Anxiety was negatively correlated with quality of life in the control group. Depression was negatively correlated with quality of life and cortisol concentrations in the group with gingivitis, and with quality of life in the control group. Children with gingivitis were more likely to be older and males. Conclusions: Older children are more likely to experience gingival bleeding. The presence of gingivitis in children may be associated with worse psychological well-being, possibly compromising the quality of life. Keywords: cortisol, gingivitis, psychological factors, quality of life, saliva

Purpose: To describe the prevalence and severity of dental erosion and caries experience of Chinese university students in Hong Kong. Materials and Methods: First-year Chinese students were invited to attend a dental clinic at a university campus in Hong Kong during their freshman orientation. A questionnaire was used to investigate the potential factors affecting their dental status, including sociodemographic factors, toothbrushing habits, dietary habits (consumption of sugary drinks), time elapsed since last dental check-up and self-perceived dental erosion status. Three calibrated dentists performed the clinical examinations. Dental erosion was evaluated using the modified Basic Erosive Wear Examination (BEWE) and dental caries experience was measured using the DMFT index. Results: In total, 600 participants aged 18-21 were examined and 44% showed some signs of dental erosion (maximum BEWE > 0). Severe dental erosion (BEWE = 3) was found in 1% of the adults. Many (69%) had caries experience (DMFT > 0); their mean DMFT score was 2.5 ± 2.7 (± SD). The total BEWE scores were found to be associated with age and self-perception of tooth misalignment. No correlation was found between BEWE score and dietary habits, oral hygiene practices or self-perceived dental erosion status. Females, those whose last dental check-up was more than a year ago and those who perceived having dental decay or tooth wear had higher caries experience. Conclusions: Nearly half of the Chinese Hong Kong university students had signs of dental erosion, but very few showed signs of severe erosion. Caries experience was widespread but not high. Keywords: BEWE, Chinese, dental caries, dental erosion, erosive tooth wear

Purpose: To determine whether smokers report having less adequate oral hygiene habits than nonsmokers. Materials and Methods: Using a 24-item questionnaire addressing both smoking and oral hygiene habits, patients from three periodontal practices in Spain were evaluated. In order to assess the periodontal status of all patients, immediately following the survey, the patients were examined clinically and categorised according to the American Dental Association (ADA) classification for periodontal diseases. Results: 762 patients with ADA type I gingivitis (4.1%), type II early periodontitis (31.2%), type III moderate periodontitis (39.2%) and type IV advanced periodontitis (25.5%) were surveyed. A total of 289 smokers (38.0%) and 402 (52.8%) nonsmokers participated in the study: 77 (10.1%) participants were identified as heavy smokers (>20 cigarettes/day), along with 122 (16.0%) moderate smokers (10-20 cigarettes/day) and 90 (11.8%) light smokers (20 cigarettes/day). A greater proportion of nonsmokers brushed their teeth two (37.8%) or more (22.9%) times a day compared with moderate smokers (twice: 32.0%, more: 15.6%) and heavy smokers (twice: 32.5%, more: 15.6%), respectively (p 0.05). Heavy smokers used dental floss statistically significantly less frequently (10.4%) than nonsmokers (21.6%) (p 0.05). No statistically significant differences were found between smokers and nonsmokers regarding the use of mouthwashes (p > 0.05). Conclusions: This study revealed comparable oral hygiene habits in nonsmokers and light smokers. However, heavy smokers were found to have worse oral hygiene habits than nonsmokers. Keywords: dental floss, mouthwash, oral hygiene habits, smoking, toothbrush

Purpose: To determine the effect of waterpipe smoking on periodontal health. Materials and Methods: The study included 190 participants who were categorised into four groups; cigarette smokers, waterpipe smokers, dual smokers and nonsmokers. Intraoral examination included plaque (PI), gingival (GI) and calculus (CI) indices, probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP). Results: The four groups differed significantly in the prevalence and extent of periodontal disease. Pairwise comparison tests showed that the means of percentages of sites with PPD > 3 mm, PPD > 4 mm, CAL > 1 mm and bleeding on probing were significantly higher among smoking groups compared to the nonsmoking group (p 0.05). After adjusting for age, cigarette smokers (OR = 4.6), waterpipe smokers (OR = 4.3) and dual smokers (OR = 4.9) were significantly more likely to have periodontal disease compared to nonsmokers. When data were analysed according to the smoking method, no significant differences in the odds of periodontal disease were detected between different smoking groups (p > 0.05). Conclusion: Waterpipe tobacco smoking is not an alternative, safe way of smoking considering periodontal disease. Thus, global actions against waterpipe smoking are required. Keywords: hookah, periodontal disease, periodontal health, tobacco smoking, waterpipe

Purpose: To compare the HbA1c levels in nondiabetic subjects with periodontitis and periodontally healthy controls and to evaluate the effect of nonsurgical periodontal therapy on the glycaemic control in nondiabetic subjects with periodontitis. Materials and Methods: A total of 220 nondiabetic subjects between 35 and 60 years old were selected and divided into two groups: group A (case group), comprised of subjects with chronic periodontitis, and group B (control group), comprised of subjects with healthy periodontium. Periodontal clinical parameters (plaque index, modified sulcular bleeding index, probing depth and clinical attachment level) were used to assign the subjects into the respective groups. The HbA1c level was estimated for both groups using a commercially available kit. Subjects in group A underwent nonsurgical periodontal therapy in two to four sessions along with oral hygiene instructions. The periodontal parameters and HbA1c levels were again evaluated in the test group three months following periodontal therapy. Results: The HbA1c levels were higher in the case group (A) than the control group (B). Three months following periodontal therapy in group A, there was improvement in periodontal parameters. The HbA1c levels decreased significantly from baseline to 3 months. Conclusion: The results of this study found chronic periodontitis to be associated with a significant increase in glycosylated haemoglobin levels in nondiabetic periodontitis subjects. Furthermore, with improvement of periodontal status, the glycaemic levels return to near normal values. Keywords: chronic periodontitis, diabetes mellitus, glycosylated haemoglobin, HbA1c%, nonsurgical periodontal therapy, prediabetic state

Purpose: To evaluate the efficacy of brushing and flossing order on control of plaque and gingival inflammation. Materials and Methods: This cross-over clinical trial was conducted on 35 students recruited from the dental school at Hamadan University of Medical Sciences. The subjects were asked to use dental floss and then brush for a 2-week period (FB), followed by brushing and then using dental floss for another 2-week period (BF). For a 7-day washout interval between the two phases, the subjects practiced dental hygiene according to their habitual method. The participants received dental prophylaxis at the beginning and plaque control record (PCR), plaque index (PI) and bleeding point index (BPI) were measured at baseline and the end of both phases. The differences of indices between two phases were analysed with the Wilcoxon signed rank test; to assess the influence of sex and sequence on PCR, PI and BPI, analysis of covariance (ANCOVA) was used after adjustment of initial values. Results: The PCR and PI indices in the FB method were significantly lower than with the BF method (P 0.05). The PI and PCR index differences between the two phases were significant in men but nonsignificant in women. The effect of gender on PI and BPI and the interaction effect of sex and sequence of brushing and flossing on BPI were significant (P 0.05). Conclusions: Flossing followed by brushing provides more statistically significant improvements over brushing followed by flossing with respect to plaque control. Keywords: dental brush, dental floss, dental hygiene, dental plaque, gingival bleeding

Purpose: To investigate the periodontal examination profiles and treatment approaches of a group of Turkish general dentists. Materials and Methods: 457 general dentists were called and 173 dentists agreed to participate in the study. The questionnaire comprised 10 questions including gender, years of experience, periodontal probing during examination, oral hygiene motivation methods (do you perform, yes/no; the oral hygiene motivation method; verbal expression or using visual materials), periodontal treatments (supragingival scaling, subgingival scaling and planing or surgery) and knowledge about diagnosis and treatment for aggressive and chronic periodontitis. The participants were grouped according to their years of clinical experience: group 1: 0 to 10 years of clinical practice (n = 58); group 2: 10 to 20 years (n = 68); group 3: >20 years (n = 47). Results: The 'periodontal probing' performance percentages were 70.69%, 26.47% and 40.43% in groups 1, 2 and 3, respectively. The oral hygiene motivation rate was high in the first 10 years of clinical practice (60.3%). In addition, 72.4% of the dentists in group 1 used visual materials in addition to verbal expression during oral hygiene motivation. 72.25% of the general dentists performed supragingival scaling. The knowledge of diagnosis and treatment of chronic periodontitis was present in >90% of the dentists surveyed. In contrast, >50% of the general dentists were not knowledgeable in the diagnosis and treatment of aggressive periodontitis. Conclusion: Periodontal probing is a gold standard for periodontal diagnosis, but as the dentists' clinical experience increases, the frequency of its performance decreases. The percentage of the knowledge and treatment of chronic periodontitis is higher than that of aggresive periodontitis. Postgraduate education in periodontology is important to keep general dentists up to date on current periodontal practice and improve awareness of periodontal diseases. Keywords: general dentists, oral hygiene, periodontal management