Effect of malocclusion severity on oral health and its correlation with socioeconomical status in Iranian adolescents.

BACKGROUND: This study aimed to assess the effect of malocclusion severity according to the Index of Treatment Need (IOTN) on oral health (dental caries and gingivitis), and its correlation with socioeconomic status (SES) in Iranian adolescents. METHODS: This descriptive cross-sectional study was conducted on adolescents between 10 and 16 years in Tehran city, who underwent clinical dental examination. The Dental Health Component (DHC) of the IOTN was used to assess the severity of malocclusion. The DMFT index was calculated to assess dental caries, and the gingival index (GI) was calculated for gingival health assessment. For oral hygiene assessment, the Oral Hygiene Index-Simplified (OHI-S) was calculated, and a questionnaire was used. RESULTS: Totally, 306 adolescents participated in this study. The frequency of IOTN grades was 88 (28.8%), 89 (26.1%) ,49 (16%), 60 (19.6%), and 29 (9.5%) for grades 1 to 5, respectively. The multinomial logistic regression showed that by an increase in OHI-S score, the odds of having IOTN grade 4 compared to grade 1 increased. Postgraduate parental level of education decreased the odds of having IOTN grade 4 compared to grade 1. Furthermore, there was an inverse correlation between oral hygiene practice and the odds of having IOTN grade 5 compared to grade 1. CONCLUSIONS: Malocclusion may hinder oral hygiene practice, and resultantly increase plaque accumulation. This risk may be amplified in children with lower SES, highlighting the need for preventive and educational oral health programs.

Determinants of oral health among Iranian soldiers: a structural equation modeling study.

BACKGROUND: Military personnel often face unique challenges in maintaining optimal oral health. This study investigated the oral health status, caries experience, and associated factors among a sample of Iranian soldiers, employing a structural equation modeling (SEM) approach to explore the complex interplay of socioeconomic and behavioral determinants. METHODS: A cross-sectional study was conducted among 658 male soldiers aged 18-30 years from three military barracks in Fars province, Iran. Data were collected through a structured instrument and clinical oral examinations. The study employs the DMFT index, which measures caries experience based on decayed, missing, and filled teeth, along with the Simplified Oral Hygiene Index (OHI-S) to assess overall oral health status. Structural equation modeling was employed to analyze the complex relationships between socioeconomic factors, oral health behaviors, and oral health outcomes. RESULTS: The mean DMFT score was 3.57 ± 5.91, and the mean OHIS score was 0.56 ± 1.42. SEM analysis revealed that socioeconomic status (SES) indirectly influenced DMFT and oral hygiene scores, mediated by drug use, oral hygiene practices, dietary sugar consumption, and dental visit frequency. Lower toothbrushing frequency was significantly associated with higher DMFT (Estimate = -0.064, p < 0.001) and OHIS scores (Estimate = -0.637, p < 0.001). Drug use (smoking, qalyan, alcohol) was linked to poorer oral health outcomes, while more frequent dental visits were associated with lower DMFT and OHIS scores. CONCLUSION: This study reveals the complex interplay between socioeconomic conditions, oral health behaviors, and oral health outcomes among Iranian soldiers. The findings highlight the need for targeted interventions to address modifiable risk factors and improve access to preventive dental care within military settings. Future longitudinal studies are warranted to elucidate further the causal pathways between these factors and oral health outcomes in military populations.

Manual toothbrushes, self-toothbrushing, and replacement duration to remove dental plaque and improve gingival health: A scoping review from recent research.

OBJECTIVE: To investigate characteristics of manual toothbrushes, self-toothbrushing methods, and replacement duration of manual toothbrushes that effectively remove dental plaque, reduce gingivitis, and promote gingival health. STUDY DATA AND SOURCES: PubMed-MEDLINE, Scopus and Central Register Cochrane of Controlled trials (CENTRAL) were searched for randomized control trials (RCTs) from 01 January 2018 to 12 December 2023. Articles were subjected for including participants aged six years and older with a study duration of at least four weeks to investigate the efficacy of manual toothbrushes used self-toothbrushing. To investigate the appropriate time to replace manual toothbrushes, this study was focused on the physical properties of the bristles and changes in the microorganisms present in the bristles over time. STUDY SELECTION: Of 1520 retrieved articles, 26 studies were included after screening. The total number of manual toothbrushes was 40 and 5 kinds of self-toothbrushing techniques were selected in the review. 4 studies investigated the changes the physical properties bristles of manual toothbrushes. CONCLUSIONS: Among manual toothbrushes, the cross-angle and indicator bristles were found to significantly improve dental plaque index and gingival condition. Most toothbrushes with soft bristles had a trend of superior dental plaque removal and gingivitis improvement efficacy. Toothbrush with end-round shape bristles tip has tended to reduce the dental plaque and gingival index scores. Studies reported that brushing twice a day for at least two minutes using the Bass method had a positive effect on the dental plaque and gingival index. Further research is required to investigate the relationships between property physical bristle and clinical intraoral indices to clarify the replacement duration of manual toothbrushes. CLINICAL SIGNIFICANCE: The findings of this study could guide people's daily self-brushing habits, thereby aiding the prevention of periodontal disease. Moreover, our findings suggest the need for strategic clinical trial designs to verify the ideal timing to replace manual toothbrushes.

Autistic spectrum disorder children and adolescents' oral health characteristics - scoping review.

This study aimed to conduct a scoping review to know children and adolescents' main oral health concerns with Autism Spectrum Disorder (ASD) and thus identify any oral characteristic that stands out, aiming at preventive and interceptive clinical conduct. A search was performed in the three electronic databases and the gray literature; in September 2021. A total of 562 studies were identified, and after applying the eligibility criteria, 73 articles were included in the synthesis of this scoping review. The mean decayed, lost, and restored teeth index (DMFT/dfmt) ranged from 0 to 12.37; the mean DMFT index (permanent dentition) from 0.06 to 6.2; and the average dmft index (deciduous dentition) ranged from 0.29 to 9.91. The mean simplified oral hygiene index (OHIS) ranged from 0 to 3.4; gingival index (GI) from 0.29 to 2; and plaque index (PI) from 0.005 to 3.15. Plaque prevalence was 25.9% to 90%; dental calculus from 4.7% to 59.41%; gingivitis from 36.7% to 100%. Bruxism was 10.3% to 73%, and dental trauma was 4.7% to 100%. This disparity in the results shows the heterogeneity of this population, with different degrees of socio-behavioral impairment, which can directly influence oral hygiene and the consequent accumulation of biofilm.

Oral health related knowledge, attitude and behavior among group of mothers in relation to their primary school children's oral health: a cross-sectional study.

The etiology of oral diseases in children is complex and multifactorial. The oral health of children can be influenced by various factors, including parental knowledge, attitudes and behaviors, as well as socioeconomic status. The objective of this study was to assess, among mothers of children aged 6-12 years, (1) mothers' knowledge about their children's oral health, (2) mothers' attitude toward their children's oral health, and (3) mothers' dental behavior concerning their oral health and to evaluate their influence on their children's dental caries. This cross-sectional study involved three questionnaires to be filled in by mothers of primary school children in addition to an oral examination of their children to measure decayed, missing, filled teeth for primary (dmft) and permanenet (DMFT) dentitions. The mother-child pairs were recruited through multistage stratified random sampling of primary schools in Jeddah, Saudi Arabia. The questionnaire was comprised of four sections: 1-demographic characteristics and socioeconomic status 2-Hiroshima University Dental Behavioral Inventory (mothers' attitudes and behavior pertaining to their oral health) 3-mothers' knowledge regarding the oral health of their children 4-mothers' attitude toward their children oral health. A total of 1496 mother-child pairs completed the study. The mean values of dmft were 4.08 ± 3.47; DMFT was 1.82 ± 2.07; total dmft and DMFT were 5.65 ± 4.05. According to the questionnaire results, mothers in private schools had a more favorable attitude and behavior toward their oral health, as well as a more favorable knowledge and attitude toward their children's oral health. The multiple linear regression model revealed that children's dmft/DMFT scores were significantly related to mother education, mother questionnaire scores, and the Simplified Oral Hygiene Index. Children's oral health is significantly impacted by oral health-related knowledge, attitude and behaviors of their mothers in addition to income status and education level.

Effectiveness of theory-based educational interventions of promoting oral health among elementary school students.

BACKGROUND: The aim of the present study was to determine the effect of oral health education programs on the oral health of primary school students. METHODS: In this randomized controlled trial study, 190 elementary fifth-grade female students were chosen using the multistage cluster sampling method. In this study, the Plaque Index (PI), Simplified Oral Hygiene Index (OHI-S), Community Periodontal Index (CPI), tooth brushing using fluoride toothpaste, dental flossing frequency and factors affecting them were determined according to social cognitive theory (SCT). Interventions were implemented using the play method and with the help of three pamphlets, five posters, a celebration of oral health, and the creation of a Telegram group. Data were analyzed using descriptive statistics indexes, t tests, paired sample t tests, chi-square tests, and Pearson correlation tests. RESULTS: The results showed that 3 months after the intervention, compared to before the intervention, the percentage of participants in the intervention group who brushed their teeth twice or more per day increased by 48.5%, and the percentage of participants who used dental floss at least once per day increased by 64.2%. The rate of gum bleeding decreased by 6.3%. The good OHI-S rate increased by 44.4%. Dental plaque decreased by 38.1%. CONCLUSION: The results demonstrated that a gamification design can be effective and useful in promoting the oral health of students. TRIAL REGISTRATION: registration timing: retrospective, registration date: 18/10/2022, registration number: IRCT20141128020129N2.

Association Between Oral Health Status and Survival Time in Terminally Ill Cancer Patients.

INTRODUCTION: Patients with terminal cancer often experience various oral problems. Whether oral health status is associated with the survival of terminally ill cancer patients receiving palliative care remains unclear. METHODS: We analyzed the data of 59 Korean patients with terminal cancer receiving palliative care, including their oral health status, using a modified Korean version of the Oral Health Assessment Tool (OHAT). Patients were categorized into "Good," "Moderate," or "Poor" groups based on OHAT scores. The Kaplan-Meier method was used to compare the median survival time, and the prognosis between groups was estimated using Cox proportional hazard models. RESULTS: The most common oral symptoms observed were xerostomia (69.5%) and mucositis (17.0%). Significantly shorter survival times were observed in patients with hyperbilirubinemia, elevated creatinine levels, and no use of dentures. The "Poor" group had a shorter survival than the "Good" oral group (P = .010). A multivariate Cox proportional hazards analysis revealed that the "Poor" group was significantly associated with poor survival compared to the "Good" group (hazard ratio, 2.05; P = .047). CONCLUSION: Terminally ill cancer patients with poor oral health may have a higher risk of shorter survival. Palliative care professionals should pay attention to oral health. Further research is needed to determine the effects of oral care on survival.

Salivary Amylase and Mucin in Chronic Periodontitis: Pre- /Posttherapy.

AIM: The study aims to investigate the potential of salivary amylase as a reliable biochemical marker for assessing periodontal disease progression, establishing a potential correlation between salivary amylase levels and periodontal disease severity. MATERIALS AND METHODS: The study included 40 participants, aged 25-65, equally divided into a control and study group of 20 individuals each. Clinical parameters, such as oral hygiene index, gingival index, probing depth, and clinical attachment level were recorded. Saliva samples were collected and analyzed for amylase and mucin levels using a semi-auto analyzer and spectrophotometer, respectively. These clinical parameters and salivary biomarkers were evaluated before and after 45 days of phase I periodontal therapy. Statistical analysis, including independent samples t-test, paired samples t-test, and correlation analysis were performed to assess the treatment effectiveness and explore associations between clinical parameters and salivary biomarkers. RESULTS: The study group with chronic generalized periodontitis showed significantly higher salivary amylase (27022.5 ± 8598.9) and mucin levels (3258 ± 724.2) and worse clinical parameters than the control group at baseline. However, after phase I periodontal therapy, the study group exhibited reduced salivary biomarkers amylase (17924.0 ± 4703.6) and mucin (1828.45 ± 314.07) and improved clinical parameters, indicating the effectiveness of the treatment in enhancing periodontal health compared with the control group. Positive correlations were found between clinical parameters and salivary amylase/mucin levels both before and after therapy (p < 0.001). CONCLUSION: Salivary amylase and mucin levels hold promise as valuable biomarkers for diagnosing active periodontal disease and evaluating treatment outcomes after phase I therapy. CLINICAL SIGNIFICANCE: Salivary biomarker comparison offers a noninvasive diagnostic tool for periodontal disease, improving early detection and personalized treatment planning. Further research is required to validate its clinical value fully.

Sleep disorders and work-related stress with oral hygiene among Indian shift workers.

Construction workers are mostly migrants from isolated villages and are not vigilant about health care measures besides poor language skills. Majority of the population works in shifts across the globe. As a result of poor sleep architecture, excessive sleepiness or insomnia, the construction labourers working in shifts have approximately twice the risk of OSA when compared with those working in the daytime. Likewise, the performance and the productivity of employees in construction sites are impeded by added stress. Therefore, it is of interest to investigate the sleep disorders, work-related stress and its impact on oral hygiene among the construction workers in Chennai. A cross sectional study was conducted among 518 workers in various construction sites at Chennai, South India. The study incorporated BerlinQuestionnaire to evaluate disordered breathing during sleep, the Work Ability Index that contains questions concerning work, working ability and health and the Oral Hygiene Index Simplified (Greene and Vermillion, 1964) that was used for recording the oral hygiene status. Pearson correlation between education and OHI-S was statistically significant (r=-0.108). Multiple linear regression analysis revealed that mean WAI score had a positive significant association with work experience (B=0.059, SE=0.030, p=0.05), habits (B=0.032, SE=0.017, p=0.05) and marital status (B=0.135, SE=0.54, p=0.01). In contrast, education (B=-0.0.052, SE=0.023, p=0.02) and work schedule (B=0.022, SE=0.037, p=0.54) were inversely associated with the mean score. Based on the current findings, it is imperative to restore work ability for those with poor work ability thereby enhancing productivity in the migrant workers. As shift work may be extremely detrimental to poor sleep quality, the employers should arrange shift schedules in accordance with sleep physiology. Additionally, dental awareness and interventions are required to improve oral hygiene among migrant workers.

Evaluation and relation of oral health-related quality of life and oral health status in Thalassemia Major patients, a cross-sectional study.

BACKGROUND: Beta-Thalassemia is the most common human inherited disease, directly impacting patients' physical and psychosocial aspects. The present study evaluated oral health status, oral health-related quality of life (OHRQoL), and their correlation in Thalassemia Major patients. METHODS: Two hundred Thalassemia Major patients aged 12-49 participated in this cross-sectional study. Subjects were selected among the patients referred to the Faculty of Dentistry of Isfahan University of Medical Sciences using simple sampling. Oral Health Impact Profile 14 (OHIP 14) was used to assess OHRQoL. The decayed, Missing, and Filled Teeth (DMFT) index was used as an oral health index. SPSS 22 was used for analysis, using T and Pearson Correlation tests. RESULTS: 53% of participants were female, and 47% were male. The mean OHIP-14 score (± SD) was 13.20 (± 7.01). The mean DMFT score was 9.54 (± 5.72). DMFT and total OHIP 14 scores correlated significantly (p < 0.001, r = 0.78). All domains of the OHIP-14 score were also significantly correlated with DMFT (p < 0.05). CONCLUSIONS: Poor oral health conditions might adversely affect OHRQoL in TM patients. It seems necessary to provide oral treatment needs in order to improve OHRQoL in patients suffering from this particular disease.

Evaluation of effect of consumption of probiotics on the gingival and periodontal health status in children undergoing chemotherapy.

Background: Probiotics consist of live microbes. They do not have any adverse effects on health. They provide nutritive benefits to individuals when ingested in adequate quantities. The most common oral infections of the oral cavity are those affecting the periodontal and dental tissues. Aims and Objectives: 1) To evaluate the antimicrobial role of oral probiotics against microorganisms involved in infections of periodontal and dental tissues. 2) To evaluate the state of health of gingival and periodontal tissues of children undergoing chemotherapy after the use of oral probiotics. Materials and Methods: 60 children, between the age group of 3 and 15 years, undergoing chemotherapy were randomly distributed under control and probiotics administered test group for 90 days. The gingival, periodontal, and oral hygiene statuses were evaluated along with their caries activity test. The parameters were measured at 0, 15, 30, 45, 60, 75, and 90 days intervals. Statistical analysis was performed using Statistical Package for the Social Sciences version 18.0. Results: The oral probiotics consumption significantly reduced the plaque accumulation between days of observation among those in the treatment group (P < 0.05). There was a significant improvement in the gingival and periodontal status in the tested group (P < 0.05). Snyder test was conducted to assess caries activity. Score 1 was found in 10 children, score 2 in eight children. Score 3 was not found in any child under the study group. Conclusion: The results show that the regular consumption of oral probiotics significantly reduces plaque accumulation, calculus formation, and caries activity among the test group.

Quantifying red complex bacteria, oral hygiene condition, and inflammation status in elderly: A pilot study.

Introduction: Periodontitis is an inflammation of the periodontal apparatus leads to destruction of connective tissue attachment and tooth loss. Red complex bacteria may contribute to disease initiation. Bacterial infection in periodontitis leads to a low-grade chronic infection and inflammation in distant organs. Notably, aging can affect the immune response. Objectives: The aim of this study was to analyze the effect of aging on oral hygiene and inflammation condition. Moreover, to evaluate the correlation between the oral hygiene condition and red complex bacterial load in subgingival plaque. Materials and methods: In this cross-sectional study, we examined 20 adult and 20 elderly subjects with periodontitis. Clinical parameters included Oral Hygiene Index Simplified (OHI-S) and Papillary Bleeding Index (PBI) were recorded. Subgingival plaque was collected from the tooth with a probing depth of 5-7 mm and analyzed with a reverse transcription polymerase chain reaction (RT-PCR) for red complex bacteria quantification. Statistical analysis was performed, respectively. Results: Both groups had poor oral hygiene conditions, reflected by high OHI-S and PBI. The quantity of red complex bacteria (P. gingivalis, T. denticola, T. forsythia) in the elderly group was significantly higher in comparison to the adult group. There was significant strong linear relationship between OHI-S and red complex bacteria (r < 1, p < 0.05). Only P. gingivalis bacteria with PBI values had a strong linear relationship and statistically significant. (r < 1, p < 0.05). P. gingivalis load was significantly higher than T. denticola and T. forsythia load, and it correlated with poor oral hygiene in the adult and elderly groups and with PBI in the elderly group. Conclusions: Aging affects to the red complex bacterial load and oral hygiene condition, but not the inflammation. These findings contribute to the development of novel treatment strategies focusing on bacterial aspect for periodontitis in the elderly.

Antiplaque and antigingivitis efficacy of new and worn manual toothbrushes: A systematic review and meta-analysis.

OBJECTIVE: To systematically review the literature about the antiplaque and antigingivitis efficacy of new and worn manual toothbrushes. METHODS: Five databases were searched to identify randomized controlled trials, involving adults, comparing the clinical efficacy of new and worn manual toothbrushes. Experimental groups need to have different usage time in changing their manual toothbrush. Two reviewers performed studies selection, data extraction and risk of bias assessment independently. Meta-analyses were performed comparing the toothbrushes after a single use (antiplaque efficacy) and after multiple uses (antiplaque and antigingivitis efficacy). RESULTS: Eight studies were included, totalling 344 individuals. In studies with a single-use design, no statistically difference was found between new and worn toothbrushes for antiplaque efficacy (SMD:-0.39; 95%CI:-0.80 to 0.03). Studies with a multiple-use design showed no statistically difference between groups for the antigingivitis efficacy (MD:-0.10; 95%CI:-0.24 to 0.03). However, higher antiplaque efficacy was demonstrated in new toothbrushes in the studies with a multiple-use design (SMD:-0.75; 95%CI:-1.37 to -0.14). The certainty of the evidence ranged from very low (antiplaque) to low (antigingivitis). CONCLUSION: New and worn toothbrushes presented similar antiplaque and antigingivitis efficacy. However, further randomized controlled trials, with a lower risk of bias, are needed to enhance the certainty of this evidence.

Comparison of Effectiveness of Visual and Sign Motivation on the Oral Hygiene of Students.

Aim: The aim of the study is to compare the effectiveness of visual and sign motivation on the oral hygiene of students with hearing and speech impairment studying in special schools of Meerut, Uttar Pradesh, India. Materials and methods: A cross-sectional study was carried out on 200 students. The sample was divided into two groups. Ethical clearance was obtained from the Institutional Ethical Committee. Data were collected at three points of time-at baseline, 1st and 3rd month. Results: In the age-group, 8-13 years, on intergroup comparison of mean oral hygiene index (OHI) score, no significant difference was observed on the first visit (p-value of 0.351) and second visit, respectively (p-value of 0.687), but on comparing the mean simplified oral hygiene index (OHI-S) score on third visit significant difference was observed (p-value of 0.03) and in the age 14-18 years, on intergroup comparison of mean OHI-S score no significant difference was observed on first visit (p-value of 0.593) and second visit, respectively (p-value of 0.404), but on comparing the mean OHI-S score on third visit, significant difference was observed (p-value of 0.018) Both the groups have shown that there was the positive impact of reinforcement on the oral hygiene of students in this age-group as well. Conclusion: There was a significant improvement in oral hygiene status and a significant improvement in participant satisfaction toward oral health in both groups. Sign language video playback is not as effective and efficient in improving the maintenance of oral health in hearing and speech-impaired children as compared to sign language. Clinical significance: This study has helped in the better understanding of different methods of maintaining good oral hygiene of hearing and speech-impaired children. How to cite this article: Singh R, Saraf BG, Sheoran N, et al. Comparison of Effectiveness of Visual and Sign Motivation on the Oral Hygiene of Students. Int J Clin Pediatr Dent 2023;16(5):671-677.

Oral Health Status and Related Factors in Children with Visual Impairment Aged 7-11 Years: A Cross-Sectional Study.

OBJECTIVES: We aimed to investigate oral health, oral hygiene, and associated factors in children with visual impairment aged 7-11 years. MATERIALS AND METHODS: This cross-sectional study was conducted on 47 children with visual impairment aged 7-11 years who were selected from all three schools available for visually impaired children in Tehran in December 2018. Questions regarding age, gender, status of visual impairment, level of education of the parents, self-reported dental and gingival health, oral health, and dietary habits were asked face-to-face using the World Health Organization oral health questionnaire for children. The decayed, missing, and filled teeth index for both primary (dmft) and permanent (DMFT) dentitions was determined by clinical examination. Simplified Oral Hygiene Index (OHI-S), and bleeding on probing (BOP) were also assessed. Linear and logistic regression tests were used for statistical analysis. RESULTS: Over 70% of the children were satisfied with their dental and gingival health. Daily brushing was reported by 70.2%. Over half of the children reported daily consumption of fruits and jam/honey. The mean dmft and DMFT scores were 2.85±3.21 and 0.81±1.15, respectively. The mean OHI-S was 2.09±0.58. Also, 57.4% and 34% of the children had unrestored caries in their primary and permanent teeth, respectively. BOP was seen in 78.7% of the children. A significant correlation was observed between toothache in the past 12 months and dmft score (P<0.003). Daily tooth brushing was inversely correlated with OHI-S index (P=0.02). CONCLUSION: The results highlight an urgent need for implementation of oral health programs for visually impaired children.

Dental Caries Prevalence and Oral Health Status among 15-Year- Old Adolescents in Kosovo.

Introduction: Caries has a harmful impact on oral and general health and is a major public health problem among children and adolescents. The objective of present study was to investigate into dental caries, oral hygiene, the frequency of brushing habits and dental visits among 15- year- old adolescents. Material and methods: This cross-sectional study was carried out on a random sample of 323 15- year- old adolescents in different schools and municipalities of Kosovo. Oral clinical examination and self-administered questionnaire were used to obtain information about dental caries and oral health practices. Oral hygiene and caries status in permanent dentition was assessed through the DMFT index and Oral Hygiene Index - Simplified (OHI-S). The level of statistical significance was set at p<0.05. Results: The total mean of the DMFT index was 3.21 ± 2.193, while component D of the DMFT index dominated in both genders, with slightly higher values in boys compared to girls (2.15±2.092, and 1.91±1.919). The mean OHI-S index of adolescents aged 15 was found to be 1.945±3.926. Over 50% of schoolchildren brush their teeth only once per day and they have visited the dentist only when it was necessary. Irregular tooth-brushing, dental visits and poor oral hygiene index were significantly related to dental caries. Conclusion: The results of the study showed poor oral health status among 15- year- old adolescents in Kosovo. There is an emergent need for caries-prevention programs focusing on oral health and healthy habits.

Impact of an Oral Hygiene Intervention in People with and without Dementia on Oral Health Parameters-Results from the Oral Health, Bite Force, and Dementia (OrBiD) Pilot Study.

This study aimed to assess the influence of an oral hygiene intervention on oral health, depending on the degree of dementia. A clinical evaluation of oral health parameters (index of decayed, missing, and filled teeth (DMFT-index), periodontal screening index (PSI), oral hygiene index (OHI), and bleeding on probing (BOP)) was performed in 120 subjects assigned to five groups, based on the mini mental state examination (MMSE) at baseline and after 12 months. Each MMSE group (no dementia (noDem, MMSE 28-30), mild cognitive impairment (mCI, MMSE 25-27), mild dementia (mDem, MMSE 18-24), moderate dementia (modDem, MMSE 10-17), and severe dementia (sDem, MMSE ≤ 9)) was split into control (no intervention) and experimental groups (intervention on oral hygiene: increased frequency, daily usage of high-fluoride toothpaste). In total, 99 out of 120 subjects were included in the analysis. The dropout rate was high in subjects with modDem and sDem due to death. In subjects with noDem, mCI, and mDem, no changes in the DMFT were found, but improvements in the OHI, BOP, and PSI were observed. Subjects with modDem or sDem demonstrated a deterioration in DMFT; however, in these patients, OHI improved in all control and experimental groups, BOP improved in the experimental group only, and PSI did not improve at all. The scope of improving oral health parameters by increasing the recall frequency and by continuously using high fluoride toothpaste is at its limits in people with severe dementia. Multidimensional approaches should be sought to improve the oral health of vulnerable older patients.

Picture exchange communication system as a behavior modification technique for oral health assessment in autistic children.

OBJECTIVE: The aim of this study was to establish a modality for behavioral intervention for dental management in autistic children using Picture Exchange Communication System (PECS). STUDY DESIGN: A prospective interventional study was carried out on 30 autistic children in the age range of 4-18 years diagnosed with mild to moderate grades of autism to evaluate the effectiveness of PECS in improving oral health over a period of 6 months. RESULTS: PECS Phases showed a gradual rise from first to third visit, which was statistically highly significant (p < 0.001). Oral Hygiene Index-Simplified (OHI-S) scores improved significantly from first visit and second visit. Definitely substantial correlation was seen between PECS and OHI-S. CONCLUSION: Gradual decrease was observed in OHI-S scores over a period of 6 months, indicating an improvement in the oral hygiene status of autistic children. Gradual progress in Phases of PECS proved to increase cognitive ability of autistic children towards understanding the dental setup related PECS cards.

Effectiveness of orthodontic toothbrush versus conventional toothbrush on plaque and gingival index reduction: A systematic review and meta-analysis.

OBJECTIVE: In orthodontic patients submitted to oral hygiene instruction, what is the efficacy of orthodontic toothbrush (O-TB) versus conventional toothbrush (C-TB) on plaque and gingival index reduction in randomized and non-randomized controlled clinical trials? METHODS: Electronic database search was performed on PubMed, ClinicalTrials.gov, Cochrane Library and Google Scholar. Database research, study selection, data extraction and ROBINS-I and Risk of Bias Tool 2.0 analysis were conducted by two independently examiners in duplicate. Two different meta-analyses were performed for plaque index and gingival index, followed by the analysis of overall quality of the evidence using GRADE. RESULTS: A total of 158 studies were identified for screening; six articles were included in qualitative synthesis, and of those, three were subjected to a quantitative synthesis (meta-analysis). Three non-randomized studies presented an overall 'low', 'moderate' and 'high' risk of bias for each one of the articles, and the three randomized clinical trials presented 'low risk' for two articles and 'some concerns' quality for the other one. The overall strength of evidence was ranked 'very low' quality for plaque index and gingival index subgroups. CONCLUSIONS: Gingival bleeding is not modified by orthodontic design toothbrush, but there is circumstantial scientific evidence for recommending the use of an O-TB instead a C-TB based on the analysis of plaque index control. Although major plaque removal of the O-TB was validated by meta-analysis, this improvement is not completely clarified which calls for further clinical studies to assess the effects of using an O-TB compared with a C-TB.

The Clinical Pattern and Prevalence of Streptococcus mutans and Streptococcus sobrinus among Adult and Children Patients with Dental Caries

Abstract Objective: To explore the clinical pattern, host factors, and presentation of Streptococcus mutans related to caries incidence among children and adults visiting Universitas Airlangga dental clinic. Material and Methods: This was an observational study with a cross-sectional approach with 50 patients in each group of carious children (6-12 years) and adults (18-35 years). Dental decay samples were taken by sterile excavator, put in a BHI's transport medium, and directly incubated overnight at 37 ºC. The next day, they were sub-cultured microbiologically in Tryptone Yeast Cystine Sucrose Bacitracin (TYCSB) selective medium. Bacterial species and serogroups were examined by PCR. All patient's data were collected from medical records and direct observation. Results: Caries were mostly media type in both children and adults. Oral hygiene (OHIS) in children was higher than in adults but not significantly different according to their DMFT. The highest scores for decay, missed and filled teeth were 16, 8 and 7, with an average of 6.82, 1.22 and 0.63, considered quite high. Conclusion: The prevalence of S. mutans was higher in children's caries than in adults, but among the adult patients the co-incidence of S. mutans and S. sobrinus was associated with higher DMFT. The mutans serotypes e, f, and d were more prevalent among children than adults.