Oral Health and Preventive Dentistry, 01/2015

Purpose: The present study was conducted to assess the effectiveness of Terminalia chebula on plaque and gingival inflammation and compare it with the gold standard chlorhexidine (CHX 0.2%) and distilled water as control (placebo). Materials and Methods: A double-blind randomised control trial was conducted among undergraduate students who volunteered. They were randomly allocated into three study groups: 1) Terminalia chebula mouthwash (n = 30); 2) chlorhexidine (active control) (n = 30); 3) distilled water (placebo) (n = 30). Assessment was carried out according to plaque score and gingival score. Statistical analysis was carried out to compare the effect of both mouthwashes. ANOVA and post-hoc LSD tests were performed using SPSS version 17 with p ≤ 0.05 considered statistically significant. Results: Our result showed that Terminalia chebula mouthrinse is as effective as chlorhexidine in reducing dental plaque and gingival inflammation. The results demonstrated a significant reduction of gingival bleeding and plaque indices in both groups over a period of 15 and 30 days as compared to the placebo. Conclusion: The results of the present study indicate that Terminalia chebula may prove to be an effective mouthwash. Terminalia chebula extract mouthrinse can be used as an alternative to chlorhexidine mouthrinse as it has similar properties without the side-effects of the latter. Keywords: chlorhexidine, oral health, periodontal index, Terminalia chebula

Purpose: To evaluate supragingival and subgingival plaque formation on the dentogingival area in smokers and neversmokers using the experimental gingivitis model and a plaque scoring system that considers the presence of an area free of plaque between plaque and the gingival sulcus called the plaque free zone (PFZ). Materials and Methods: Male volunteers, 9 current smokers and 10 never-smokers, refrained from oral hygiene procedures in the maxillary incisors and canines (test teeth) for 25 days. Under conditions of clinically healthy gingiva (phase 1) and gingival inflammation (phase 2), the supragingival plaque formation pattern was observed for 4 days in the dentogingival area. Gingival crevicular fluid was also measured. Plaque was dyed with fucsine and its presence was recorded by a calibrated examiner based on a 3-criteria scoring system: 0 - absence of stained plaque; 1 - presence of stained plaque and supragingival PFZ; 2 - presence of stained plaque and absence of PFZ, indicating that subgingival plaque formation has taken place. Results: In both phases, smokers presented a significantly lower relative frequency of sites with subgingival plaque compared to never-smokers (P 0.001). Mean gingival crevicular fluid was significantly higher in the presence of gingival inflammation for both groups (P = 0.001), whereas smokers demonstrated a significantly lower frequency of gingival bleeding than did non-smokers (23.6% vs 66.1%; P 0.001). Conclusion: Smokers presented significantly lower percentages of sites with subgingival plaque in all experimental periods and presented less gingival inflammation as shown by GBI and gingival crevicular fluid quantification. Keywords: dental plaque, gingival crevicular fluid, gingivitis, smoking

Purpose: To present a short review of recent literature available on the association of periodontal and cardiovascular diseases (CVD) and the role of peridontal disease as a risk factor to exacerbate CVD. Materials and Methods: A thorough search of articles was carried out on the databases PUBMED and MEDLINE on the association of periodontal and cardiovascular diseases (CVD). The selected literature included review articles, observational and case-control studies as well as randomised control trials. While selecting articles, priority was placed on papers published within the last 12 years. A brief description of periodontal diseases, atherosclerosis, underlying pathophysiology and oral bacteria has been included. Results and Conclusion: There is growing evidence of the association of periodontal diseases and CVD, as reviewed by the epidemiological studies. The in vitro studies also highlight a potential link between oral bacteria and atherosclerosis. Thus, there is urgent need for proper case controls and efficient interventional trials to analyse how such interventions can produce a positive outcome on cardiovascular diseases. Some recent interventional trials have shown that periodontal treatment can decrease markers of systemic inflammation. The relationship between periodontal diseases and CVD deserves further research because of its consequences for public health. Keywords: atherosclerosis, cardiovascular disease, C-reactive protein oral bacteria, periodontal diseases

Oral squamous cell carcinoma (OSCC) is the most prevalent cancer of the head and neck with over 500,000 new cases every year worldwide. The stage of disease at diagnosis is associated with the 5-year survival rate. Unfortunately, approximately two-thirds of patients are diagnosed with advanced disease with local and regional or distant spread. Earlier detection of OSCC may be improved with the development of adjunctive techniques for clinical detection and diagnosis, which is expected to enhance the prognosis of the disease. This narrative review aims to provide an overview of adjuncts that are available for clinical use to assist in improving detection of potentially malignant epithelial lesions and early-stage OSCC. Keywords: cytology, diagnostic techniques, fluorescence, oral cancer, toluidine blue

Purpose: This study was carried out to assess the carriage rates, counts and species distribution of Candida in saliva of 6- to 12-year-old Yemeni children and relate that to their caries experience. Materials and Methods: One hundred eighty children were recruited. Oral hygiene and caries were assessed using the simplified oral hygiene index and dft/DMFT index, respectively. Detection and quantification of 4 Candida species in unstimulated saliva were performed using CHROMagar Candida medium. Data were analysed using regression analysis. Results: Candida was detected in 60% of the children with a mean count of 923 ± 1875 CFU/ml. C. albicans accounted for 60% of the isolates and was the only species to be detected with more than 1000 CFU/ml. Non-albicans candida and unidentified species represented 16.3% and 23.1% of the isolates, respectively. One novel finding was that a significant proportion (38%) of the carriers harboured two or more species, which for the first time allowed the identification of four age-dependent carriage patterns (clusters). Another somewhat new observation was that carriage at ≥ 1000 CFU/ml in particular significantly correlated with caries in primary and permanent dentitions (r = 0.23 and 0.18, respectively) as well as a caries-active status (OR = 6.9). Interestingly, the C. glabrata cluster had significantly lower primary caries scores than other clusters. Conclusions: The findings substantiate claims of geographical variations in candida carriage and the relation between candida carriage and caries. The validity of carrier clusters and the use of 1000 CFU/ml as a risk marker should be further investigated. Keywords: candida species, dental caries, aetiology, risk factors, saliva

Purpose: To compare toothbrushing habits, unstimulated salivary flow rates and oral health status of elderly Hong Kong Chinese with and without dementia. Materials and Methods: A sample size calculation was performed and a sample of 82 elderly Chinese with dementia were invited who were aged 60 or above, fit for periodontal assessment with probing and attended day-care centres. Age- and gender-matched generally healthy people without dementia were recruited as controls. Toothbrushing practices were recorded using a questionnaire. Additionally, unstimulated salivary flow rate was measured. Caries experience and periodontal status were assessed through clinical examination by the DMFT index and Community Periodontal Index (CPI), respectively. Results: Fifty-nine people with dementia and 59 age- and gender-matched generally healthy controls were recruited. Their mean age was 80 (SD = 7). Compared with the individuals in the control group, fewer people with dementia performed toothbrushing twice daily (31% vs 5%; P 0.001). Furthermore, their unstimulated salivary flow rate was lower than that of the control group (0.30 ml/min vs 0.41 ml/min; P = 0.043). Their caries experience in mean DMFT (±SD) was similar to the control group (22.3 ± 8.2 vs 21.5 ± 8.2, P = 0.59). There was also no significant difference in the prevalence of periodontal pockets (CPI ?3) between the two groups (78% vs 74%, P = 0.64). Conclusion: Compared to those without dementia, fewer elderly Chinese with dementia practiced toothbrushing twice daily. Although their resting salivary secretion was reduced, their caries experience and prevalence of advanced periodontal disease were not significantly different from those without dementia. Keywords: caries, Chinese, dementia, elderly, oral health status, oral hygiene, periodontal, plaque, salivary flow rate

Purpose: To investigate the relationship between the lingual frenulum length with mandibular incisor irregularity and type of occlusion in children with ankyloglossia. Materials and Methods: Eighty children aged between 7 and 12 years with ankyloglossia enrolled in the study. The patients were classified according to Kotlow's classification. Mandibular incisor crowding was measured and the molar relationship was determined. The data were analysed statistically using Fisher's exact test, X2 and Pearson's correlation. Results: Of the 80 patients, 45 (56.3%) had mild, 23 (28.8%) had moderate and 12 (15%) had severe ankyloglossia. Fifty-nine (73.8%) of the patients had mild irregularity, 18 (22.5%) had moderate and 3 (3.8%) had severe irregularity. In 56 (70%) of the patients, Class I occlusion was observed, 17 (21.3%) had Class II and 7 (8.8%) had Class III occlusion. No significant differences were found between types of ankyloglossia with mandibular incisor irregularity and occlusion types. A significant positive correlation was determined between the length of the lingual frenulum length and mandibular incisor irregularity. There were significant positive correlations between the lingual frenulum length, incisor irregularity and age. Conclusion: Mild and moderate types of ankyloglossia are unrelated to mandibular incisor crowding and occlusion type. Keywords: ankyloglossia, crowding, occlusion type

Purpose: The most commonly used oral health related quality of life measures, Oral Health Impact Profile (OHIP) and Oral Impact on Daily Performances (OIDP), are affected by cultural and linguistic factors, which may be intensified in a treatment-need driven society. This study therefore aimed to compare the psychometric properties of the OHIP-14 and OIDP measures in adult patients in Nigeria where patients typically visit the dentist when dental problems arise. Materials and Methods: This was a cross-sectional study in which 264 patients attending two dental clinics were recruited. Data were collected with OHIP-14 and OIDP structured interviewer-administered questionnaires, global selfreport and perceived need for dental treatment questions and by oral examination. Data collected were subjected to statistical analysis using SPSS version 19 and the level of statistical significance was set at a p-value of 0.05. Results: The majority (61.0%) rated their oral health status poorly and 203 (76.9%) perceived a need for treatment. The average OHIP and OIDP scores were 12.0 (range 0 to 56) and 8.9 (range 0 to 40), respectively. Both instruments showed a high index of validity and reliability; both had similar face and content validity, however, OIDP had better criterion validity while OHIP-14 had better construct validity and internal consistency. Conclusions: Both OHIP-14 and OIDP are precise, valid and reliable for evaluation of OHRQOL where dental care is treatment-need driven. They are able to discriminate between groups according to their perception of oral health status, but with OIDP detecting fewer impacts on daily activities. Keywords: OHIP, OIDP, oral health status, quality of life, treatment-need driven

Purpose: To examine the pattern of antibiotic and painkiller prescriptions per diagnosis by dentists. Materials and Methods: A cross-sectional study was conducted in Karachi, Pakistan. Dentists in the outpatient departments of the Dr. Isharat-ul-Ebad Khan Institute of Oral Health Sciences (DIKIOHS) filled out a form for each patient visiting during a two-week period. The form included: personal history of the patient, i.e. name, age, sex and education, patient's complaint(s), medical history, dental history, full examination of the teeth and oral cavity, treatment need as far as different specialties are concerned, investigations, provisional diagnosis and treatment given. The WHO ATC system for drug classification was used. The number of prescriptions and defined daily doses (DDD) were recorded. Results: A total of 709 patient forms (355 for male patients and 354 for female patients) were collected and included in the analysis. Of these, 123 (17%) included antibiotics and 455 (64%) painkillers. Caries/pulpitis was the most common diagnosis (n = 222; 31% of cases), of which 48 (21%) were prescribed antibiotics. Amoxicillin and metronidazole were the most common antibiotics prescribed for this diagnosis (n = 25); for caries/pulpitis diagnosis, 44 DDD/100 patients were prescribed. This was also the diagnosis for which painkiller prescription was most common (n = 191; 86%), with 102 DDD/100 patients. Conclusion: Our study shows the prescription pattern of antibiotics and painkillers by dentists in Pakistan for the first time. There is a clear need to emphasise correct diagnostic methods and develop contextualised prescription guidelines and educational initiatives, so that the optimum effect of antibiotics and painkillers will be achieved without compromising patients' health. Keywords: antibiotics, DDD, dentists, diagnosis, painkillers, prescription

Purpose: To evaluate the frequency, distribution and quality of root canal treatment in an adult Nigerian subpopulation and to determine the prevalence of apical periodontitis. Materials and Methods: The periapical status and length of root fillings of 756 patients attending Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria for the first time were evaluated using full mouth periapical radiographs. The length of the root canal filling was considered 'adequate' if it was ≤ 2 mm from the radiographic apex, 'underfilled' if it was > 2 mm short of the apex, and 'overfilled' if filling material extended beyond the radiographic apex. Periapical status was assessed using the periapical index (PAI) with teeth classified as having apical periodontitis if the score was over 2. Results: Overall, 61.2% of the patients had root-filled teeth and 67.2% featured apical periodontitis. Of the 21,468 teeth examined, 12.2% had been root filled, and of these 41% exhibited apical periodontitis. The prevalence of rootfilled teeth was higher in the younger patients, while the prevalence of apical periodontitis in root-filled teeth was similar between age groups. Root-treated teeth that were overfilled or were mandibular incisors had the highest prevalence of apical disease. Overfilled teeth were more prone to developing an apical radiolucency than were underfilled teeth (P 0.001 and P 0.05, respectively). Conclusions: The prevalences of endodontically treated teeth and apical periodontitis were within the range reported for other countries; however, a very large number of patients required treatment or retreatment. Keywords: apical periodontitis, root canal treatment