Oral Health and Preventive Dentistry, 01/2017

Periodontitis, the chronic inflammatory disease of the supporting tissues of the teeth, has now been implicated in a variety of disparate systemic infections of various organs such as the lungs, heart, kidneys and brain. This review examines various associations involving chronic inflammatory processes arising from the periodontium and Alzheimer's disease, a progressive dementia of the brain with an as yet unknown origin. Causal pathways are also reviewed, e.g. the direct invasion of oral pathogens such as T. socranski and T. denticola from the periodontium across the blood-brain barrier, as well as common susceptibilities between the two tissues in terms of systemic dissemination from oral infections. Finally, potential anti-inflammatory therapies targeted at both the periodontium and brain are discussed, as periodontal infections are one of the treatable, preventable aetiopathologies involved in Alzheimer's disease. Keywords: association Alzheimer's periodontitis, bi-directional Alzheimer's periodontitis, curcumin Alzheimer's periodontitis, periopathogens Alzheimer's, periopathogens blood-brain barrier

Purpose: To examine the methodological quality of systematic reviews (SR) and meta-analyses on biomarkers in oral squamous cell carcinoma (OSCC) using validated checklists. Materials and Methods: A systematic literature search was performed to identify SR and meta-analyses focusing on biomarkers in OSCC published between January 1990 and March 2014. Details of the relevant aspects of methodology as reported in these SR were extracted from the full text publications. The methodological quality of these SR and meta-analyses was evaluated using the AMSTAR and Glenny checklists. Results: After screening 1098 abstracts from the electronic database, seven studies were included in quality assessment. The mean AMSTAR score of all SR was 4.6 ± 1.9 of a possible 11 (range: 2-7) and the mean score of all SR using the checklist devised by Glenny et al was 7.1 ± 1.6 of a possible 14 (range: 5-9). Spearman correlation analysis revealed that AMSTAR and Glenny scores were highly correlated (rs = 0.757; p = 0.049). The methodological quality in journals with an impact factor above 2.5 (AMSTAR: p = 0.031; Glenny: p = 0.046) was significantly higher. In addition, in SR published after 2007, higher AMSTAR and Glenny scores were noted; however, this was not statistically significant (AMSTAR: p = 0.076; Glenny: p = 0.232). Conclusions: Systematic reviews and meta-analyses on biomarkers in OSCC presented marked methodological and structural variability, which elevates the risk of bias and hence invalid conclusions. Checklists such as AMSTAR or Glenny may improve quality and uniformity of SR, and would thus also increase the clinical validity and applicability of SR. Keywords: AMSTAR, biomarker, Glenny, oral cancer, OSCC, quality assessment, review

Purpose: To answer the question of whether powered toothbrushing is more effective than manual toothbrushing, this paper reviews various aspects of powered toothbrushes in terms of efficacy, safety, acceptability and special considerations for certain patient groups. Future research directions and gaps in the current knowledge are also discussed. Materials and Methods: The literature review was conducted using PubMed. A hand search of the references of the retrieved articles was also performed. Results: Powered toothbrushes have been found to be as effective as manual toothbrushes in removing plaque and reducing gingival inflammation. They are safe with no adverse effects on hard or soft tissues. Among the powered toothbrushes, there is evidence to suggest that rotation-oscillation toothbrushes may be more effective than others. The results seem to suggest that certain special-needs patient groups, such as the elderly and the disabled, may benefit from the use of powered toothbrushes. Conclusion: Powered toothbrushes are as effective as manual toothbrushes in facilitating oral hygiene. They may be recommended for certain patient groups to improve the efficacy of oral hygiene measures. More data on the safety and acceptability of powered toothbrushes are necessary. Keywords: powered toothbrushes, oral hygiene methods, powered toothbrushes, toothbrushing

Purpose: To test the cleaning efficacy of different manual toothbrushes in orthodontic patients in a single-blind randomised clinical trial. The brushes tested were selected based on previous in vitro tests. Materials and Methods: Thirty-five regular orthodontic patients with a minimum of six bonded brackets on the maxillary anterior teeth were randomly assigned to three experimental groups: staged (2-level) (Candida Parodin, 12 patients) and V-shaped (Oral-B Ortho, 12 patients) toothbrush head designs were compared in a two-phase study to planar control brushes (Paro M 43, 11 patients). First, all participants were advised to brush their teeth twice daily for 2 min for 3 weeks. Prior to the start and at the end of the study, the gingival index was assessed to evaluate the level of oral hygiene. Afterwards, cleaning efficacy was assessed planimetrically by disclosing the respective teeth after two days of not performing any oral hygiene measures. Results: Of the initial 35 participants, two did not attend after 3 weeks and had to be excluded. After 3 weeks, the control (5 out of 180 sites or -2.8% with GI ? 2) and staged groups (16 out of 216 sites or 7.5% with GI ? 2) showed minor improvement in the oral hygiene level. In contrast, the V-shaped group (29 out of 198 sites or 14.6 % with GI ? 2) showed a statistically significant improvement of the oral hygiene level. Planimetric evaluation, however, showed no superior cleaning efficacy of any of the tested head designs. Conclusions: The use of V-shaped and staged toothbrush head designs might be beneficial in patients with inadequate oral hygiene undergoing orthodontic treatment with a fixed appliance. Further large-scale investigations are, however, necessary to validate the presented results. Keywords: bracket, efficacy, orthodontic, RCT, toothbrush

Purpose: This study evaluated the effect of oral health literacy (OHL) on the retention of health information in pregnant women. Materials and Methods: A total of 175 pregnant women were randomly assigned to standard oral (spoken), written and control intervention groups. With the exception of the control group, the interventions investigated the eating habits and oral hygiene among children under 2 years of age. The participants' answers before the interventions (pre-test), 15 min after the interventions (post-test) and 4 weeks after the interventions (follow-up test) were used to estimate the knowledge score (KS). Information acquisition was determined by comparing pre-test and post-test results, while retention of information was based comparing pre-test and follow-up test results. OHL was analysed by BREALD-30. The data were assessed by nonparametric tests and Poisson regression models with robust variance (? = 0.05). Results: By the end of the follow-up period, 162 pregnant women had been assessed. The BREALD-30 mean was 22.3 (SD = 4.80). Regardless of the type of intervention, pregnant women with low OHL had lower knowledge scores in the three assessments. Participants with low OHL showed higher acquisition and retention of information in the standard oral health intervention. Multiple regression models demonstrated that OHL was independently associated with KS, age, socioeconomic status and type of intervention. Conclusion: The results suggest a negative effect of low OHL on retention of information. Only the standard, spoken oral health intervention could address the differences in literacy levels. Keywords: feeding behaviour, health education, health literacy, pregnancy

Purpose: To assess the relationship between high risk oral cancer patients - age ?45 years, male gender, smoking, higher alcohol consumption - and dental attendance. Materials and Methods: Data were analysed from the SLÁN 2007 dataset of 10,364 adults living in Ireland. Binary logistic regression was used to determine the odds ratios for identified risk factors for oral cancer and attendance at a dental professional within the preceding 12 months. Results: Males, those ?45 years of age, and current smokers were less likely to have attended for a dental check-up within 12 months (p 0.05). Current smoking significantly reduced the likelihood of regular attendance (p 0.05), while current/ex-smoking and drinking above weekly recommended limits did not (p > 0.05). Medical card holders were significantly less likely to have attended, while private health insurance holders were more likely to attend regularly (p 0.05). Conclusion: Those with multiple risk factors for oral cancer are less likely to attend routine dental check-ups which allow opportunistic screening of oral cancer. Keywords: attendance, cancer, dental, oral, screening

Purpose: To evaluate and compare the quality of life and oral health indicators in patients undergoing haemodialysis considering the influence treatment duration. Materials and Methods: One hundred patients were divided into two groups according to the duration of haemodialysis: (1) 4 years (n = 60) and (2) ? 4 years (n = 40). Clinical examination of the oral cavity was performed and QoL was assessed using a validated questionnaire. Results: In comparison with group 2, statistically significantly higher mean scores were observed in group 1 in the quality of life domains of psychological (p = 0.003), social relationships (p ? 0.001) and environment (p = 0.013) as well as in total quality of life (p = 0.001) and general health (p = 0.010). Similarly, evaluation of the Simplified Oral Hygiene Index and the Decayed, Missing, Filled Teeth index demonstrated worse oral health for group 2 (p = 0.029; p = 0.012, respectively). For both groups, there was a negative correlation between these oral health indicators and psychological and social relationships domains, as well as with the total quality of life score. Conclusion: This study showed that poor oral health indicators may be a reflection of an unsatisfactory overall quality of life in patients undergoing haemodialysis for a prolonged period of time. Keywords: end-stage renal disease, haemodialysis, oral health, quality of life

Purpose: To determine the incidence of caries in a 3-year follow-up of obese adolescents. Materials and Methods: Seven-hundred eighty five 13-year-old school children were selected randomly. Caries was recorded according to WHO criteria and body mass index was assessed in a medical evaluation. With appropriate sample weighting, relationships between caries and other variables were assessed using the chi-squared test, Kruskal-Wallis H-test, and multivariable logistic regression. Results: At baseline, 185 (24.2%) adolescents presented with caries, having mean DMFT and DMFS scores of 0.9 ± 2.0 and 2.4 ± 3.6, respectively. The accumulated incidence of caries during the 3-year period of study was 16.5%, with mean DMFT and DMFS increments of 0.8 ± 0.2 and 1.1 ± 3.3, respectively. Obese and overweight adolescents had a 3.7 times (95% CI = 1.3-6.8) greater chance of developing caries after adjusting for socioeconomic status, gender, use of fluoridated dentifrice, and past caries experience. Conclusion: Obese and overweight adolescents were at a higher risk of developing new caries in a 3-year-follow-up. Keywords: caries, incidence, obesity, overweight

Purpose: To investigate the antimicrobial efficacy of different chemical agents used for denture cleaning. Materials and Methods: Biofilm samples collected from 10 removable dentures were subjected to 10 disinfection protocols: distilled water for 30 min (negative control); 1% sodium hypochlorite for 10 min (positive control); diluted sodium hypochlorite for 10 min; vinegar for 20 min; 0.2% peracetic acid for 5 min; alkaline peroxide solution for 5 min; alkaline peroxide solution for 30 min; 0.12% chlorhexidine digluconate for 10 min; 0.05% sodium salicylate solution for 10 min; and enzymatic detergent for 2 min. Each of the samples was plated on petri dishes with Mueller-Hinton agar. The numbers of microbial colonies after 48 h at 37°C were compared using the Kruskal-Wallis and Dunn's tests (α = 0.05). Results: Diluted sodium hypochlorite, vinegar, and chlorhexidine digluconate inhibited bacterial growth, with an effect similar to that of 1% sodium hypochlorite. The 0.2% peracetic acid and 0.05% sodium salicylate solutions were ineffective against bacterial growth, while enzymatic detergent and alkaline peroxide achieved an intermediate effect. Conclusion: Diluted sodium hypochlorite, vinegar, and chlorhexidine digluconate can be considered adequate products for cleaning dentures due to their potential for inhibiting bacterial growth, similar to 1% sodium hypochlorite. However, the effect of these chemical agents on acrylic resin (polymethylmethacrylate) denture base materials needs to be examined to provide complete information about their clinical indication. Keywords: chemical cleaning, denture hygiene, microbiology, oral health

Purpose: To determine whether reducing the light-curing time of resin-based surface sealants influences their potential to prevent erosion, as well as their mechanical stability and degree of conversion. Materials and Methods: 240 bovine dentin samples were randomly divided into 10 groups (1-10). The 24 samples of one group remained unsealed and served as control. Three groups were sealed with Seal&Protect, another three groups with K-0184 (experimental sealant), and the remaining three groups with Syntac Classic. One group of each sealant was light cured for 10 s, another group of that sealant for 5 s, and the last group of the respective sealant for 2 s at 1014 mW/cm2. After 7-day water storage, the first measurement of sealant permeability was performed. The samples were stored in hydrochloric acid (pH 2.3) for 24 h and the dentin calcium release was measured by atomic absorption spectroscopy. Following thermomechanical loading (5000 cycles, 5°/50°C, 12,000 brushing strokes), the second measurement of sealant permeability was performed. Additionally, the sealants' degrees of conversion (DC) were determined by FTIR spectroscopy. Results: For the first and second measurements, no significant difference in the permeability of the sealants was observed when the light-curing duration was shortened. Additionally, no significant difference in the stability of the respective sealants was observed when light cured for different durations. Regarding DC, a significant influence of the light-curing duration was observed (p = 0.000). Conclusion: Shortening the light-curing time has no influence on permeability and stability of the investigated sealants. However, short light-curing times (2 s or 5 s) decrease the DC of the tested sealants. Keywords: degree of conversion, dentin, erosion, light-curing time, surface sealant

Purpose: To assess the prevalence of early childhood caries (ECC) in 2- to 5-year-old preschool children in Weifang City, China, and to investigate the factors related to this condition. Materials and Methods: A cross-sectional study was carried out among 2829 children (2-5 years old, including 1601 boys and 1228 girls) in twenty kindergartens in Weifang City, China, in 2014. These children were selected via cluster sampling. First, the percentages of ECC and severe ECC (S-ECC) as well as the mean dmft were compared between different genders and ages, and the tooth distribution pattern of ECC was analysed. Meanwhile, the information regarding feeding and oral hygiene practices was collected by a questionnaire with 14 questions to evaluate their relationships with the percentages of ECC and S-ECC as well as the mean dmft. The chi-squared test, t-test and one-way ANOVA were conducted to evaluate the significant differences. Results: The ECC prevalence of the preschoolers was 53.3%, and the mean dmft was 2.12 ± 2.56. 71.4% of the 1509 children with ECC were identified as S-ECC. Not only the percentages of ECC and S-ECC but also the mean dmft differed statistically significantly according to gender and age (p 0.05). Furthermore, caries was most common in primary maxillary central incisors. Feeding and oral hygiene practices were shown to be the significant determining factors for caries. Conclusions: The oral health status of children living in Weifang is very poor. Appropriate strategies must be implemented to promote oral health early on by improving feeding and oral hygiene practices. Keywords: China, dmft, early childhood caries, feeding and oral hygiene, prevalence