Microbial differences between dental plaque and historic dental calculus are related to oral biofilm maturation stage.

BACKGROUND: Dental calculus, calcified oral plaque biofilm, contains microbial and host biomolecules that can be used to study historic microbiome communities and host responses. Dental calculus does not typically accumulate as much today as historically, and clinical oral microbiome research studies focus primarily on living dental plaque biofilm. However, plaque and calculus reflect different conditions of the oral biofilm, and the differences in microbial characteristics between the sample types have not yet been systematically explored. Here, we compare the microbial profiles of modern dental plaque, modern dental calculus, and historic dental calculus to establish expected differences between these substrates. RESULTS: Metagenomic data was generated from modern and historic calculus samples, and dental plaque metagenomic data was downloaded from the Human Microbiome Project. Microbial composition and functional profile were assessed. Metaproteomic data was obtained from a subset of historic calculus samples. Comparisons between microbial, protein, and metabolomic profiles revealed distinct taxonomic and metabolic functional profiles between plaque, modern calculus, and historic calculus, but not between calculus collected from healthy teeth and periodontal disease-affected teeth. Species co-exclusion was related to biofilm environment. Proteomic profiling revealed that healthy tooth samples contain low levels of bacterial virulence proteins and a robust innate immune response. Correlations between proteomic and metabolomic profiles suggest co-preservation of bacterial lipid membranes and membrane-associated proteins. CONCLUSIONS: Overall, we find that there are systematic microbial differences between plaque and calculus related to biofilm physiology, and recognizing these differences is important for accurate data interpretation in studies comparing dental plaque and calculus.

Proteomic evidence of dietary sources in ancient dental calculus.

Archaeological dental calculus has emerged as a rich source of ancient biomolecules, including proteins. Previous analyses of proteins extracted from ancient dental calculus revealed the presence of the dietary milk protein ß-lactoglobulin, providing direct evidence of dairy consumption in the archaeological record. However, the potential for calculus to preserve other food-related proteins has not yet been systematically explored. Here we analyse shotgun metaproteomic data from 100 archaeological dental calculus samples ranging from the Iron Age to the post-medieval period (eighth century BC to nineteenth century AD) in England, as well as 14 dental calculus samples from contemporary dental patients and recently deceased individuals, to characterize the range and extent of dietary proteins preserved in dental calculus. In addition to milk proteins, we detect proteomic evidence of foodstuffs such as cereals and plant products, as well as the digestive enzyme salivary amylase. We discuss the importance of optimized protein extraction methods, data analysis approaches and authentication strategies in the identification of dietary proteins from archaeological dental calculus. This study demonstrates that proteomic approaches can robustly identify foodstuffs in the archaeological record that are typically under-represented due to their poor macroscopic preservation.

The dental calculus metabolome in modern and historic samples.

INTRODUCTION: Dental calculus is a mineralized microbial dental plaque biofilm that forms throughout life by precipitation of salivary calcium salts. Successive cycles of dental plaque growth and calcification make it an unusually well-preserved, long-term record of host-microbial interaction in the archaeological record. Recent studies have confirmed the survival of authentic ancient DNA and proteins within historic and prehistoric dental calculus, making it a promising substrate for investigating oral microbiome evolution via direct measurement and comparison of modern and ancient specimens. OBJECTIVE: We present the first comprehensive characterization of the human dental calculus metabolome using a multi-platform approach. METHODS: Ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) quantified 285 metabolites in modern and historic (200 years old) dental calculus, including metabolites of drug and dietary origin. A subset of historic samples was additionally analyzed by high-resolution gas chromatography-MS (GC-MS) and UPLC-MS/MS for further characterization of metabolites and lipids. Metabolite profiles of modern and historic calculus were compared to identify patterns of persistence and loss. RESULTS: Dipeptides, free amino acids, free nucleotides, and carbohydrates substantially decrease in abundance and ubiquity in archaeological samples, with some exceptions. Lipids generally persist, and saturated and mono-unsaturated medium and long chain fatty acids appear to be well-preserved, while metabolic derivatives related to oxidation and chemical degradation are found at higher levels in archaeological dental calculus than fresh samples. CONCLUSIONS: The results of this study indicate that certain metabolite classes have higher potential for recovery over long time scales and may serve as appropriate targets for oral microbiome evolutionary studies.

Assessment of the calibration of periodontal diagnosis and treatment planning among dental students at three dental schools.

Calibration in diagnosis and treatment planning is difficult to achieve due to variations that exist in clinical interpretation. To determine if dental faculty members are consistent in teaching how to diagnose and treat periodontal disease, variations among dental students can be evaluated. A previous study reported high variability in diagnoses and treatment plans of periodontal cases at Indiana University School of Dentistry. This study aimed to build on that one by extending the research to two additional schools: Marquette University School of Dentistry and West Virginia University School of Dentistry. Diagnosis and treatment planning by 40 third- and fourth-year dental students were assessed at each of the schools. Students were asked to select the diagnosis and treatment plans on a questionnaire pertaining to 11 cases. Their responses were compared using chi-square tests, and multirater kappa statistics were used to assess agreement between classes and between schools. Logistic regression models were used to evaluate the effects of school, class year, prior experience, and GPA/class rank on correct responses. One case had a statistically significant difference in responses between third- and fourth-year dental students. Kappas for school agreement and class agreement were low. The students from Indiana University had higher diagnosis and treatment agreements than the Marquette University students, and the Marquette students fared better than the West Virginia University students. This study can help restructure future periodontal courses for a better understanding of periodontal diagnosis and treatment planning.

Does Lip-Repositioning Surgery Improve Long-Term Smile Outcome and Dental Esthetics in Patients With Excessive Gingival Display? A Review of the Current Literature.

Focused Clinical Question: In patients with normal crown dimensions and excessive gingival display, does lip-repositioning surgery improve long-term smile outcome and dental esthetics? Clinical Scenario: A 27-year-old systemically healthy female presents with the chief complaint of "excessive gingival display when smiling" (Fig. 1). She reports that orthodontic treatment was performed and that she was referred for orthognathic surgery to correct the maxillary vertical excess and altered passive eruption. Clinically, the patient is periodontally healthy with favorable long-term periodontal prognosis. She is unsatisfied with her smile and states that it is "compromising her self-esteem." However, she refuses to accept the orthognathic surgery because of the extensiveness and morbidity of the procedure. She inquires about alternative solutions for her esthetic problem and whether it is possible to solve her gummy smile with a less invasive procedure. Lip-repositioning and anatomic crown-lengthening surgeries are presented as treatment options. The patient decides to pursue these treatment options. Lip-repositioning surgery is performed as described by Rosenblatt and Simon1 and Simon et al.,2 and healing is uneventful. Anatomic crown lengthening is performed 6 months after the previous surgery. The patient is pleased with the reduction of the excessive gingival display after these procedures (Fig. 2). However, there is lack of clinical evidence regarding the long-term stability of this surgical procedure.

Gingival esthetic outcome around a bone-level implant--a case report.

The objective of this case report is to review the clinical thinking, decision making, and actions of the authors, from the time of the first patient visit to the final esthetic outcome. Initial uncertainty led the authors to perform procedures that were believed to provide best outcomes or alternatives for further procedures, if necessary. An optimal final esthetic outcome was the goal, and the short-term (one-year) esthetic results are presented.

Extrinsic stain removal efficacy of a stannous fluoride dentifrice with sodium hexametaphosphate.

OBJECTIVE: Two randomized, six-week, double-blind, parallel group, clinical trials were independently conducted to compare the extrinsic stain removal efficacy of a novel whitening therapeutic dentifrice containing 0.454% stannous fluoride and sodium hexametaphosphate in a formulation with high cleaning silica, relative to a positive control whitening dentifrice. METHODOLOGY: Generally healthy adults, 56 for study 1 and 60 for study 2, with visible extrinsic tooth stain were enrolled in the studies. At the baseline visit, stain was assessed on the facial surfaces of the eight central and lateral incisors using the modified Lobene Stain Index. Oral soft and hard tissue examinations were also conducted. In each study, subjects were randomized to either the stannous fluoride + sodium hexametaphosphate toothpaste (Crest Pro-Health) or the positive control toothpaste (Colgate Total Plus Whitening) to use twice per day for six weeks. Stain and safety were reassessed at weeks three and six. RESULTS: Fifty-two and 58 subjects completed studies 1 and 2, respectively. In each study, there were no statistically significant differences in Lobene composite stain scores between the two treatment groups across all three visits. Both groups showed statistically significant reductions in Lobene composite stain scores at week three (p < 0.0001) and week six (p < 0.0001) relative to baseline. The percent of Lobene composite scores with a greater than 0.5 unit reduction from baseline at week six was 86% for study 1 and 97% for study 2 for the stannous fluoride + sodium hexametaphosphate dentifrice group. CONCLUSION: Collectively, these two stain removal clinical trials demonstrate the statistically significant extrinsic stain removal efficacy for the stannous fluoride + sodium hexametaphosphate dentifrice relative to baseline. There were no statistically significant differences between the stannous fluoride + sodium hexametaphosphate dentifrice and positive control treatment group.

Clinical evaluation of the stain removal efficacy of a novel stannous fluoride and sodium hexametaphosphate dentifrice.

PURPOSE: Recently, sodium hexametaphosphate has been introduced in dentifrice formulations to aid in the control of extrinsic stain. Two independent studies were conducted to evaluate the stain removal efficacy of a novel 0.454% stannous fluoride and sodium hexametaphosphate dentifrice (Crest Pro-Health) relative to a positive control whitening dentifrice (Colgate Total + Whitening) over a 2-week period in a subject population with pre-existing natural extrinsic stain. METHODS: These studies were randomized, positive-controlled, parallel groups, double-blind, 2-week trials. Each study involved approximately 30 healthy adults with visible stain of the facial surfaces of the 12 anterior teeth. After baseline examination, subjects were randomly assigned to a treatment and instructed to brush unsupervised with the assigned dentifrice at least twice daily as they normally do. Efficacy was evaluated by modified Lobene examination on anterior teeth at baseline and end-of treatment (Week 2). RESULTS: 59 subjects, 29 in Study 1 and 30 in Study 2, were evaluable and included in the Week 2 analyses. Subjects ranged from 21-68 years of age. In each study, the positive control dentifrice statistically significantly (P < 0.0001) reduced stain scores following 2 weeks of brushing with median reductions of 61.9% and 94.4%. Similarly, the experimental 0.454% stannous fluoride and sodium hexametaphosphate dentifrice statistically significantly (P < 0.0001) reduced stain scores by 61.8% and 96.6% following 2 weeks of brushing. The adjusted mean changes between treatment groups did not differ significantly between the two dentifrice groups (P > 0.70 in each study). Both dentifrices were well tolerated. No subject discontinued treatment due to an adverse event.

Stain reduction of an integrated oral hygiene system.

This article discusses research to determine the efficacy of a prototype integrated power toothbrush and toothpaste dispensing system, the IntelliClean System from Sonicare and Crest, in the removal of extrinsic stain. The prototype integrated system and a positive control, the Sonicare Elite with conventional toothpaste, were evaluated in 2 randomized, single-blinded, parallel 4-week controlled clinical trials. There was a low dropout rate, with 28 subjects of the 31 randomized in study 1 completing the study (10% loss to follow-up) and 26 subjects of the 28 randomized in study 2 completing the study (7% loss to follow-up). Lobene stain scores were used to assess the extent and intensity of stain for all teeth meeting the criteria for inclusion in the studies. Lobene stain scores were assessed at baseline and after 4 weeks in both studies. A survey also was conducted at the conclusion of each study to determine user attitude toward the integrated system. The prototype integrated system was found to significantly reduce overall extrinsic stain over time, performing not significantly differently from the positive control. Overall, the prototype integrated system reduced the composite measure of stain that encompasses both the extent and intensity of stain by 60%. This research demonstrates that the IntelliClean System from Sonicare and Crest is highly effective in reducing extrinsic stain.

The effect of four mouthrinses on oral malodor.

The purpose of the study was to compare the efficacy of four mouthrinses in clinical outcomes of changes in oral malodor measurements in a 4-week, randomized, double-blind, longitudinal clinical trial in adults. The four rinses were coded as Products 1, 2, 3, and 4 so that neither the examiners nor subjects had the knowledge of treatment. Of the four mouthrinses, two were commercially available mouthrinses with essential oils (EO) or chlorine dioxide plus zinc (CD/Zn) as active ingredients (Products 1 and 4), one mouthrinse was a formulation containing cetylpyridinium chloride (Product 2), and one was a placebo (Product 3). A total of 99 subjects who met the study criteria were assigned randomly to one of the four groups. At three separate visits (0, 2, and 4 weeks), subjects received an examination of the oral soft tissues and were assessed for baseline oral malodor by two organoleptic judges and a laboratory instrument that measures oral malodor. Subjects were instructed to use the assigned rinse, and the measurements were performed again after 2 and 4 hours. Throughout the 4-week study period, each subject was asked to use the assigned rinse twice daily per the manufacturer's recommended directions. The results showed that the four mouthrinses reduced oral malodor within 4 hours after a single usage, with Product 2 being the most effective and the placebo being the least effective. Daily use of EO, CD/Zn, and placebo rinses for up to 4 weeks did not reduce oral malodor from week 0 baseline values, and the effects on oral malodor were comparable among these three mouthrinses. Product 2 was the only mouthrinse that reduced oral malodor from baseline values after 2 and 4 weeks of daily use.

Risk indicators for periodontal diseases in Guatemalan adolescents / Indicadores de risco para as doenças periodontais em adolescentes guatemaltecos

Uma amostra selecionada ao acaso de 62 adolescentes na faixa etária de 11 a 15 anos, de 17 localidades diferentes na Guatelama, compôs o grupo a ser estudado. Profundidade de bolsa, índice de placa, e sangramento à sondagem foram computados de 6 sítios periodontais escolhidos ao acaso de cada participante (total de 372 sítios). Amostras de placa subgengival foram obtidas destes mesmos sítios. Em cada par de sítios, testes microbiológicos distintos foram processados, à saber: sítios 1 e 2 - teste BANA para T. denticola, P. gingivalis, e B forsythus, e anticorpos policlonais para A. actinomycetemcomitans; sítios 3 e 4 - detecção de fungos no agar SAB; sítios 5 e 6 - detecção de Entamoeba gingivalis pela técnica de Heidenhain. Um total de 66 por cento dos participantes evidenciaram ao menos um sítio com sangramento à sondagem, 42 por cento exibiram no minímo um sítio com profundidade de bolsa > 3mm, e 79 por cento exibiram alto índice de placa. O percentual correspondente de sítios foi 30 por cento, 12 por cento e 41 por cento. Nos sítios 1 e 2 (N = 124), 77 por cento e 47 por cento dos participantes testaram positivo para o teste BANA e para A. actinomycetemcomitans, respectivamente, totalizando 59 por cento e 31 por cento dos sítios. Nos sítios 3 e 4 (N = 124), fungos foram detectados em 43 por cento dos participantes e 39 por cento dos sítios. Nos sítios 5 e 6 (N = 124) E. giginvalis foi detectada em 21 por cento dos participantes e 11 por cento dos sítios. O risco para inflamação gengival severa e/ou profundidade de bolsa aumentada estava 1,5 e 5,2 vezes aumentado o resultado positivo para o teste de BANA ou para A. actinomycetemcomitans foi detectado num determinado sítio. Nenhuma associação foi verificada para fungos e para E.gingivalis