Chlorhexidine digluconate mouthwash alters the oral microbial composition and affects the prevalence of antimicrobial resistance genes.

Introduction: Chlorhexidine (CHX) is a commonly used antiseptic in situations of limited oral hygiene ability such as after periodontal surgery. However, CHX is also considered as a possible factor in the emergence of cross-resistance to antibiotics. The aim of this study was to analyze the changes in the oral microbiota and the prevalence of antimicrobial resistance genes (ARGs) due to CHX treatment. Materials and methods: We analyzed the oral metagenome of 20 patients who applied a 0.2% CHX mouthwash twice daily for 4 weeks following periodontal surgical procedures. Saliva and supragingival plaque samples were examined before, directly after 4 weeks, and another 4 weeks after discontinuing the CHX treatment. Results: Alpha-diversity decreased significantly with CHX use. The Bray-Curtis dissimilarity increased in both sample sites and mainly streptococci showed a higher relative abundance after CHX treatment. Although no significant changes of ARGs could be detected, an increase in prevalence was found for genes that encode for tetracycline efflux pumps. Conclusion: CHX treatment appears to promote a caries-associated bacterial community and the emergence of tetracycline resistance genes. Future research should focus on CHX-related changes in the microbial community and whether the discovered tetracycline resistance genes promote resistance to CHX.

Impact of supportive implant therapy on peri-implant diseases: A retrospective 7-year study.

AIM: Few data are available regarding the long-term impact of supportive implant therapy (SIT) on peri-implant diseases. We present long-term results on the possible effects of SIT on the peri-implant tissues. MATERIAL AND METHODS: In a private practice, 50 consecutive patients with 101 implants had attended an SIT programme for >6 years (SIT group). A second consecutive group comprised patients without SIT compliance (C group). We assessed pocket probing depth (PPD), bleeding on probing (BOP), bone loss (BL) and implant hygiene (QHI). Correlations between SIT compliance and the prevalence of peri-implant diseases were evaluated statistically. RESULTS: The inclusion criteria were met by 48 patients with 98 implants (SIT group) and 43 patients with 121 implants (C group). SIT group: Mucositis rate 30%; mean PPD 3.76 ± 0.86 mm; bone loss 1.02 ± 0.85 mm, peri-implantitis rate 4%. C group: Mucositis rate 68%; mean PPD 4.07 ± 1.18 mm; bone loss 1.53 ± 1.46 mm; and peri-implantitis rate 17%. Significant associations were found between SIT compliance and reduced peri-implant mucositis (p = .019), reduced highest PPD (p = .038) and peri-implantitis rates (p = .027). CONCLUSIONS: Patients under SIT were associated with lower incidence of peri-implant diseases. Patients without regular maintenance might exhibit a 4.25-fold increased risk for peri-implantitis. Therefore, SIT programmes should be considered essential.

The impact of motivational interviewing on communication of patients undergoing periodontal therapy.

AIM: There has been growing interest in motivational interviewing (MI) as a structured method for supporting health behaviour change in periodontal therapy. The aim of this study was to investigate the influence of communication techniques used in MI on statements of patients undergoing periodontal therapy. MATERIALS AND METHODS: Thirty audio-recorded sessions between dental MI providers and their patients undergoing periodontal therapy were coded using the German version of the Motivational Interviewing Sequential Code for Observing Process Exchanges (MISCOPE; D). Sequential analyses were performed to access transition probabilities among certain counsellor and patient statements. RESULTS: MI-consistent counsellor statements were statistically significantly positive correlated with patients' language in favour of change (change talk) (OR = 1.31; p = 0.027). MI-inconsistent statements were statistically significantly more likely to be followed by patients' language against change (sustain talk) (OR = 2.27, p = 0.002). An additional sequential analysis revealed significant correlations between certain evocative counsellor behaviours and the language of their patients. CONCLUSION: Specific verbal expressions described in the theory of MI significantly influence the subsequent statements of the patient in periodontal therapy. Accordingly, the periodontist can guide patient communication in a desired direction, evoke motivational statements and reduce expressions of resistance.

Trehalose powder for subgingival air-polishing during periodontal maintenance therapy: A randomized controlled trial.

BACKGROUND: Air-polishing appears to be a promising procedure for subgingival biofilm removal in periodontal treatment. The aim of this study was to compare trehalose powder for subgingival air-polishing with sonic debridement in residual periodontal pockets during maintenance therapy. METHODS: In this blinded, randomized, controlled clinical trial conducted over 6 months with a split-mouth design, single-rooted teeth in 44 participants with residual pocket depths of 5 mm and bleeding or >5 mm with and without bleeding were included in this study. Subgingival debridement was carried out using either trehalose powder with an air-polishing device (test) or a sonic device (control). The reduction in the probing depths after 3 and 6 months was defined as the primary endpoint. A visual analog scale was used to evaluate the discomfort of both procedures. RESULTS: Both procedures showed statistically significant intragroup reductions in probing depths (test baseline [BL] 5.52 ± 0.93, 6 months 3.66 ± 0.81, control BL 5.55 ± 0.9, 6 months 3.68 ± 0.86, P < 0.001), clinical attachment level (test BL 6.93 ± 1.5, 6 months 5.3 ± 1.52, control BL 7.27 ± 1.8, 6 months 5.84 ± 1.71, P < 0.001), and bleeding on probing (test BL 86%, 6 months 41%, control BL 89%, 6 months 34%, P < 0.001) after 6 months with no significant intergroup differences (P > 0.05, respectively). The visual analog scale showed a significantly lower incidence of discomfort for air-polishing compared with sonic scaling (test 2.33 ± 2.14, control 4.91 ± 2.65, P < 0.001). CONCLUSIONS: Subgingival air-polishing with trehalose powder showed comparable clinical outcomes to sonic scaling. Sonic scaling evoked more discomfort compared with air-polishing.

Association between high risk for preterm birth and changes in gingiva parameters during pregnancy-a prospective cohort study.

OBJECTIVES: The objective of this study was to investigate clinical and microbiological gingival changes during pregnancy in women without periodontal disease. Additionally, these parameters were to be compared in women with high risk for preterm birth and women with a normal course of pregnancy. METHOD AND MATERIALS: Group I consisted of 40 subjects at high risk for preterm birth, while group II involved 49 subjects with a normal course of pregnancy. The control group (III) was made up of 50 non-pregnant women. Clinical parameters (plaque index, gingival index, probing pocket depths, gingival swelling, bleeding on probing) and microbiological changes were monitored during pregnancy and 2-4 weeks after parturition. RESULTS: In the high-risk preterm group (I), 19 women could be included in data analysis. This group was compared to 41 women in the normal pregnancy group (II) and 50 non-pregnant women (III). Gingival inflammation was significantly higher in women with high risk for preterm birth (I) compared to non-risk pregnant women (II, p < 0.05). In addition, in this group (I), the subgingival amounts of Fusobacterium nucleatum (> 105) were found to be significantly higher after childbirth compared to non-pregnant women (p < 0.05). CONCLUSIONS: Even without having periodontal disease, women with high risk for preterm birth showed worse clinical values compared to non-risk pregnant and non-pregnant women and an increased detection of Fusobacterium nucleatum after delivery. CLINICAL RELEVANCE: High risk for preterm birth might be associated with the occurrence of increased gingival inflammation.

Gehirnabszess nach parodontaler Therapie. Ein Fallbericht über einen Gehirnabszess assoziiert mit Fusobacterium nucleatum nach parodontaler Therapie.

Background Nonsurgical periodontal treatment implicates bacteraemia. In rare cases oral pathogens can be found associated with abscesses of brain or liver Case Description A brain abscess was found in a patient after several periodontal treatments causing neurological seizures. In the drain masses of Fusobacterium nucleatum were found. An oral examination revealed a severe periodontally damaged dentition. The woman had been in a generally healthy condition before the event. After neurosurgical treatment and intravenous antibiotic therapy the patient fully recovered. In order to eradicate any possible focus of inflammation, several teeth had to be extracted. Clinical Implications This case report implicates that also patients without particular need for antibiotic prophylaxis can be at risk of developing a brain abscess caused by bacteraemia after periodontal treatments.

Decementation Rates and the Peri-Implant Tissue Status of Implant-Supported Fixed Restorations Retained via Zinc Oxide Cement: A Retrospective 10-23-Year Study.

BACKGROUND: Long-term data on clinical outcomes of restorations attached to implants via zinc oxide (ZnO) cement have been sparse. PURPOSE: The purpose of this study was to retrospectively investigate decementation rates and peri-implant tissue status of implant-supported fixed restorations retained by ZnO cement. MATERIALS AND METHODS: Between 1989 and 2003, 63 partially edentulous patients received 93 implants. Of these, 27 patients received 36 screwed single crowns (SC) and served as a control (C group). The other 36 patients had their restorations cemented using ZnO cement. They were subdivided into a SC group and a fixed dental prosthesis (FDP) group. After between 10 and 23 years (mean: 13.22 ± 3.21), all decementation events and peri-implant soft tissue status were evaluated using patient records. RESULTS: Decementation was assessed in 57 implants supporting 30 SCs and 16 FDPs. Five cases of decementation (8.77%) were recorded after a mean of 9.27 ± 7.05 years (range: 4.81-21.79). In the control group of vertically screwed SCs, five events of screw loosening (13.89%) were recorded in five patients (18.52%) after a mean of 5.84 ± 5.96 years (range: 0.56-15.05) within a 14.30 year observation period. No cases of peri-implantitis were observed in any group. The mean values of periodontal probing depths and bleeding on probing (BOP+) were 3.74 mm and 31.58%, respectively, for ZnO-cemented restorations, versus 3.76 mm and 25%, respectively, for the C group. No significant correlations regarding technical/biologic complications between the groups were detected. CONCLUSIONS: Within the limitations of this study, we conclude that the use of ZnO cement provides sufficient retention of implant-supported fixed restorations over long periods without biologic complications in form of peri-implantitis.