Plaque removal efficacy of a new toothbrush with a double-sided head and rotating handle-a pilot randomized control trial in acquired brain injury patients.

OBJECTIVES: To assess the efficacy of a new toothbrush (Balene) for the mechanical removal of dental plaque in patients with acquired brain injury. MATERIAL AND METHODS: The study group consisted of 25 adults with acquired brain injury. The participants underwent 2 sessions of toothbrushing lasting 1 min, one with a conventional toothbrush and the other with the Balene toothbrush. This new double-headed toothbrush has 6 active sides, which allows for the simultaneous toothbrushing of both alveolar arches, with elastomer bristles angled at 45°, as well a handle that rotates up to 180°. Therefore, the user does not need to remove the toothbrush from the oral cavity during the toothbrushing process. Dental plaque accumulation was assessed using the simplified oral hygiene index of Greene and Vermillion. RESULTS: The plaque index was significantly reduced both with the Balene toothbrush (p < 0.001) and with the conventional toothbrush (p < 0.001). The dental plaque removal efficacy was similar with the two toothbrushes. There were also no statistically significant differences in the removal of plaque with the Balene toothbrush between the autonomous and assisted toothbrushing modalities (p = 0.345). CONCLUSIONS: For patients with acquired brain injury, the Balene toothbrush was as effective as a conventional toothbrush, regardless of whether the toothbrushing modality was autonomous or assisted. CLINICAL RELEVANCE: The Balene® toothbrush's efficacy in removing dental plaque is similar to that of conventional toothbrushes, both with the autonomous and assisted toothbrushing modality. Given its particular ergonomics, this toothbrush could be indicated for certain select patients with acquired brain injury (i.e., those whose degree of cooperation allows for toothbrushing, with a sufficient mouth opening, with no substantial abnormalities in the intermaxillary relationship, and with no significant edentulous sections).

World Workshop on Oral Medicine VII: Bleeding control interventions for invasive dental procedures in patients with inherited functional platelet disorders: A systematic review.

OBJECTIVES: The objective of this study was to determine bleeding control interventions (BCIs) that were reported to be effective in controlling postoperative bleeding in patients with inherited functional platelet disorders (IFPDs) undergoing invasive dental procedures. STUDY DESIGN: We searched MEDLINE/PubMed, Embase, Cochrane Library (Wiley), and Scopus from 1960 through April 2020 for studies on patients with IFPD undergoing invasive dental procedures. Two reviewers conducted assessments independently. RESULTS: We found a total of 620 nonduplicate published articles, of which 32 studies met our inclusion criteria. Management with BCI in patients with IFPD included in this systematic review was effective in 80.7% of treatment sessions. Local measures used intraoperatively were found to be effective. Three different protocols of BCI were noted; the most effective protocol consisted of antifibrinolytics, scaffold/matrix agents, and sutures (P < .01). An adjunct protocol consisting of a tissue sealant was also effective (P < .01). A third protocol of platelet transfusion and antifibrinolytics was ineffective in controlling postoperative bleeding in 4 of 6 dental sessions. CONCLUSIONS: This systematic review supports the use of local measures intraoperatively and antifibrinolytics postoperatively. It also supports making decision regarding platelet transfusion based on the clinician's clinical judgment and medical history of the individual patient.

World Workshop on Oral Medicine VII: Non-opioid pain management of head and neck chemo/radiation-induced mucositis: A systematic review.

OBJECTIVE: To evaluate the current evidence regarding the effectiveness of non-opioid interventions for the therapeutic management of pain in head and neck cancer patients with oral mucositis resulting from radiotherapy only or chemoradiotherapy. MATERIALS AND METHODS: A literature search was conducted which included randomised controlled trials that assessed patient-related outcome of pain in patients with oral mucositis associated with radiation therapy only or chemoradiotherapy. Literature searches were conducted in MEDLINE via Pubmed, Embase, Scopus and CINAHL. RESULTS: The electronic searches identified 846 articles. Screening revealed that six articles met all eligibility inclusion criteria. Interventions showing statistically significant benefits to reduce oral mucositis associated pain compared to placebo included doxepin (p < 0.001, 95% CI -6.7 to -2.1), amitriptyline (p = 0.04), diclofenac (p < 0.01) and benzydamine (p = 0.014). CONCLUSIONS: Non-opioid interventions, including topical doxepin, amitriptyline, diclofenac and benzydamine, were found to provide relief of pain due to mucositis, and when effective may allow for reduction in the use of opioids in pain management.

Oral cancer pain.

Pain may be the initial symptom in oral cancer, and is a common complaint both in patients awaiting treatment and in those already in treatment. However, little has been published in the literature on the management of oral cancer pain. Effective pain control requires a multimodal approach in which pharmacological management based on the World Health Organization (WHO) analgesic ladder continues to play an essential role. Although different routes are available for the administration of analgesics, oral delivery continues to be the principal route for pain control in the first instance. Interventional approaches include blockade of a peripheral nerve or of the relevant ganglion, and the use of central neuraxial blockade. The intraventricular or intrathecal administration of opioids, with or without local anaesthetics, has been indicated for severe intractable pain. The development of new treatment modalities provides additional options, though further clinical research is required. There is no evidence of the efficacy of non-pharmacological methods such as acupuncture or transcutaneous nerve stimulation in the management of oral cancer pain. Surgery, radiation therapy, and chemotherapy have also been suggested, but their results have not been quantified.

Evaluation of the substantivity in saliva of different forms of application of chlorhexidine.

OBJECTIVE: To evaluate the in vivo antimicrobial activity of different forms of application of chlorhexidine digluconate (CHX). METHOD AND MATERIALS: A group of 10 volunteers performed mouth rinsings with a 0.2% and 0.12% solution of CHX and applied CHX in the form of a 0.2% gel, a 0.2% and a 0.12% spray and a swab impregnated with a 0.2% solution. Samples of saliva were taken at baseline; 30 seconds; and 1, 3, 5, and 7 hours after each application. An epifluorescence microscopy technique (BacLight Live/Dead stain) was used to evaluate bacterial vitality. RESULTS: Bacterial vitality under basal conditions was 92%. At 30 seconds after CHX application, the lowest levels of viable bacteria were detected with the 0.2% and 0.12% solutions (1% and 8%, respectively). After 3 hours, the percentage of live bacteria achieved with the gel and sprays was similar to the basal figures (80% to 91%). At 7 hours, bacterial vitality recovered basal percentages, except with the 0.2% solution (77%). CONCLUSION: The 0.2% solution of CHX had the greatest sustained antimicrobial effect on the salivary flora, confirming the influence of the concentration and form of application on CHX substantivity.

Effect of ultrasonic scaling on salivary lactate dehydrogenase.

PURPOSE: To determine Lactate Dehydrogenase Activity (LDHA) in whole saliva in individuals with periodontal disease and the effect of ultrasonic scaling on this enzyme activity. METHODS: A study group of 50 patients with PD (Community Periodontal Index of Treatment Needs > or = 3) was selected at random. Half of the patients (n=25) received ultrasonic periodontal treatment (Group 1). In the other 25 patients with PD the ultrasonic scaling was not performed (Group 2). A control group was selected (Group 3) consisting of 25 adults without PD (Community Periodontal Index of Treatment Needs = 0), with age and gender distribution similar to the study group. LDHA determinations were carried out with a Cobas Mira Plus II autoanalyzer pursuant to the recommendations of the French Society of Clinical Biology. A baseline determination of LDHA was carried out on all the participants and a second determination was performed 3 months later. RESULTS: Baseline determination of LDHA was higher in patients with PD than in the control group. These differences were statistically significant (P< 0.001). LDHA was significantly reduced in patients with PD after ultrasonic scaling with respect to baseline determination (P< 0.0001). LDHA differences between Groups 2 and 3 were statistically significant (P< 0.0001), but it was not so between Groups 1 and 3.