The effect of an antiseptic mouthrinse on implant maintenance: plaque and peri-implant gingival tissues.

The purpose of this controlled double-blind, parallel, randomized clinical study was to determine the effect of antiseptic mouthrinse on parameters important to dental implant maintenance. Plaque, peri-implant gingivitis, gingival bleeding, probing depth, and attachment level were assessed over a 3-month test period. Twenty healthy adult patients each of whom had at least two dental implants, a modified gingival index > 1.5, and a modified Quigley-Hein plaque index score > 1.7 were enrolled into the study. After a thorough oral prophylaxis, patients were randomly assigned to either the antiseptic mouthrinse or a 5% hydroalcohol placebo mouthrinse group and instructed to rinse twice daily for 30 seconds with 20 ml of their assigned mouthrinse as an adjunct to their usual oral hygiene procedures. The baseline examination included plaque index, gingival index, bleeding index, probing depth measurement, and attachment level measurements. The plaque and gingival indices were rescored at 1, 2, and 3 months. Probing depths, attachment levels, and bleeding index were determined again at 3 months only. At the end of 3 months, the antiseptic mouthrinse group had statistically significant reductions in plaque index, gingival index, and bleeding index compared to the placebo group. There were no significant differences between groups in probing depth or attachment level. The results of this clinical study indicate that twice daily use of an antiseptic mouthrinse may provide benefits in the maintenance of dental implants.

Effects of subgingival chlorhexidine irrigation on peri-implant maintenance.

PURPOSE: To evaluate the effect of irrigation with 0.06% chlorhexidine (PerioGard) (CHX) using a powered oral irrigator (Water Pik) with a special subgingival irrigating tip (Pik Pocket Subgingival Tip) compared to rinsing with 0.12% chlorhexidine gluconate once daily. MATERIALS AND METHODS: Following a prophylaxis, patients were randomly assigned to an irrigation or a rinse group. The following clinical parameters were measured at baseline and at the 3-month end of the study: Modified Gingival Index (MGI), Plaque Index (PI), Bleeding Index (BI), and Calculus Index (CI). Also, a Stain Index (SI) was measured at 3 months. RESULTS: Patients irrigating with diluted CHX showed a statistically significant reduction (P < 0.05) from their baseline in the MGI, PI, BI, and CI scores at 3 months. In the rinse group both MGI and BI showed statistically significant reduction from their baseline (P < 0.05) at 3 months. The rinse group showed a nonsignificant (P > 0.05) increase from baseline in CI and a nonsignificant decrease in PI. Intergroup comparisons showed that CHX irrigation produced statistically significantly greater reductions than CHX rinsing in the PI, MGI, and SI. The irrigation group also showed a greater reduction in BI and CI than the rinsing group but these differences were not statistically significant (P = 0.12). The results of this study suggest that use of diluted 0.06% CHX when used in a powered irrigator may be a valuable adjunct to oral health in patients with implants.

Clinical evaluation of an automatic flossing device vs. manual flossing.

The aim of this study was to compare the effectiveness of an automatic flossing device to manual flossing. A total of seventy adult subjects (20 males and 50 females) were stratified into two groups balanced for age, sex, modified gingival index (MGI), plaque index (PI) and bleeding sites (Eastman Bleeding Index) using screening data. One group was randomly assigned the automatic power flosser and the other group was assigned manual dental floss. The subjects were instructed to brush their teeth twice a day (in the morning and before bedtime) for 30 seconds using the provided manual toothbrush and toothpaste. They were also to use their assigned dental floss or automatic power flosser once in the morning following toothbrushing. There was no significant difference between manual flossing and automatic flossing with respect to the MGI and the BI. There was, however, a significant difference at day 15 in the PI; however, this difference was only 0.73%. There was no significant difference in the PI at day 30 between the two techniques. The statistically significant difference noted in the interproximal PI at both day 15 and day 30 was less than 2%. Since the differences in plaque scores between the groups were so small, there was no apparent impact on gingival health since both flossers resulted in similar health benefits. Since there was a marked preference for the automatic flosser, patient compliance with the automatic flossing device may be better than with manual floss. Therefore, overall gingival health may benefit from this device.

Clinical evaluation of the effect of a hydrogen peroxide mouth rinse, sodium bicarbonate dentifrice, and mouth moisturizer on oral health.

The objective of this 60-day single-blind, parallel trial, using 150 subjects, was to evaluate the effect of a 20% sodium bicarbonate dentifrice, a 1.5% hydrogen peroxide solution and a mouth moisturizer on oral tissues and microflora. Subjects were randomly assigned to one of five groups. The treatments were: 1) Sage dentifrice (sodium bicarbonate). Toothette Plus containing baking soda saturated with the hydrogen peroxide solution and use of a mouth moisturizer, 2) Crest dentifrice, Toothette Plus containing baking soda saturated with the hydrogen peroxide solution and use of a mouth moisturizer, 3) Crest dentifrice, Toothette Plus containing baking soda with a control solution and no mouth moisturizer, 4) Crest dentifrice, Toothette (without baking soda), saturated with a control solution and no mouth moisturizer, and 5) Crest dentifrice, Toothette saturated with 1.5% flavored H2O2 and no mouth moisturizer. From a subgroup of 35 patients (seven from each group) buccal smears for exfoliative cytology were taken as were supragingival microbiological samples from the mesial aspect of first molars (pooled). Buccal smears were evaluated for signs of histopathological changes. Microbiological samples from supra- and subgingival plaque for P. gingivalis, P. intermedia, A. actinomycetemcomitans. A viscosus, F. nucleatum, F. sanguis and C. albicans were evaluated. Clinical parameters measured were a stain index (SI), the modified gingival index (MGI), and a plaque index (PI). There were no adverse changes in the oral microflora and no anaplastic or other pathological changes in any subjects. Clinical parameters showed a statistically significant reduction in the MGI ranging from 26.7-29.9% with no significant differences among the groups (p > 0.05). The PI showed small reductions in all groups except group 2, but the differences were not statistically significant from each other or baseline (p > 0.05). The SI revealed slight increases in all groups and no differences among the groups. It can be concluded that use of Sage dentifrice, Toothette Plus saturated with Perox-A-Mint and Sage Mouth Moisturizer are safe to oral tissues. Using these components did not result in clinically noticeable stain formation, promote plaque formation, or produce any significant adverse changes in the oral microflora.

Metabolomics reveals elevated macromolecular degradation in periodontal disease.

Periodontitis is a chronic inflammatory disease characterized by tissue destruction. In the diseased oral environment, saliva has primarily been considered to act as a protectant by lubricating the tissue, mineralizing the bones, neutralizing the pH, and combating microbes. To understand the metabolic role that saliva plays in the diseased state, we performed untargeted metabolomic profiling of saliva from healthy and periodontitic individuals. Several classes of biochemicals, including dipeptide, amino acid, carbohydrate, lipids, and nucleotide metabolites, were altered, consistent with increased macromolecular degradation of proteins, triacylglycerol, glycerolphospholipids, polysaccharides, and polynucleotides in the individuals with periodontal disease. These changes partially reflected the enhanced host-bacterial interactions in the diseased state as supported by increased levels of bacterially modified amino acids and creatine metabolite. More importantly, the increased lipase, protease, and glycosidase activities associated with periodontitis generated a more favorable energy environment for oral bacteria, potentially exacerbating the disease state.

Clinical evaluation of the effect of two types of dental floss on plaque and gingival health.

The aim of this clinical study was to evaluate two different flosses (an expanded PTFE-type floss and a nylon waxed floss) on the reduction of dental plaque, gingival health (MGI and BI), and patient preference when used in an oral hygiene program. Sixty adult subjects with gingival inflammation were assigned randomly to two groups. The control group were those subjects that used the nylon waxed floss and the test group were those subjects that used the PTFE-type floss. At 0, 2, 5, and 6 weeks, the patients were scored for plaque (PI), gingivitis (MGI), and interproximal bleeding sites (BI). The data were then analyzed statistically within each group and between both groups using Student t tests. It was found that there was no statistical difference between the two types of dental floss regarding PI, MGI, and BI. The only discrepancy was at the end of the second week, where the PTFE-type floss showed a significantly greater reduction in BI as compared to the nylon floss (p less than 0.01). Here the percent reduction of the PTFE-type floss was 56.1%, while the nylon waxed floss showed a percent reduction of only 39.1%. At the fifth week of examination the type of floss used was reversed for one week. This was done to determine patient preference. It was found that 74.5% of the study population preferred the PTFE-type floss while only 24.5% preferred the nylon waxed floss.

A clinical comparison of 2 electric toothbrush designs.

A single blind 30 day study compared the reduction of plaque and gingivitis for the Hapika Powerbrush to the Interplak ultra 10 tuft. A longitudinal parallel group design was utilized and screening evaluation was performed to determine patient eligibility prior to study enrollment, 66 subjects were entered into the study and assigned to 1 of 2 groups, each using one of the toothbrushes. At baseline, subjects received an oral soft tissue exam, a dental hard tissue exam, and were scored by the Lobene modification of the Löe and Silness gingival index (GI). Plaque was then disclosed and scored both pre and post brushing using the modified Turesky plaque/debris examination and an interproximal bleeding examination was performed post-brushing. On days 15 and 30, after an oral soft tissue and GI examination, plaque was graded by the Modified Turesky plaque/debris exam. Subjects then brushed and were graded by the Modified Turesky plaque/debris examination and an interproximal bleeding index examination. The results showed that both brushes provided a similar change in clinical indices. All produced a statistically significant reduction from baseline to day 30 for the gingival index (26.5-29.1%), the bleeding index (13.8-24.1%), and the plaque index (16.9-19.4%). A comparison of pre and post brushing scores for the plaque index at 30 showed that both brushes reduced plaque similarly with a statistically significant reduction (P < 0.05) from their pre-brushing plaque index scores at all time periods.

Studies on the relationship between changes in radiographic bone height and probing attachment.

The aim of this investigation was to determine the relationship between loss of radiographic crestal bone height and probing attachment loss. As part of this aim, we are introducing a new method for determination of a threshold for significant probing attachment loss which takes into account the error contributed by alteration in tissue tone. 57 adults with established periodontitis were selected. Radiographs were taken using the Rinn alignment system. Crestal change was determined from bone height measurements on digitized images of pairs of radiographs using the "side-by-side" technique of analysis developed recently by us. Probing attachment loss was measured using the Florida electronic probe system. Radiographic and probing measurements were made at baseline and after 1 year. No treatment was given during this period. A direct and significant relationship was observed between radiographic bone loss and probing attachment loss on a site basis (p = 0.0001, r2 = 0.018) and between subject means (p = 0.0014, r2 = 0.16). Radiographic and probing attachment change at all categories of sites, dichotomously classified as to not changing or loosing indicated 13% of sites were loosing by measurement of radiographic change and 9.6% were loosing by measurement of attachment change. Concordance in radiographic and attachment level change was found in 82% of sites examined. The relative diagnostic import of change in probing attachment or change in radiographic bone height requires treatment outcome studies based on use of diagnostic information of the 2 measuring techniques used singly and in combination.

Clinical effects of a stannous fluoride mouthrinse on plaque.

The purpose of this 3-week, double-blind study was to determine the effect of a stannous fluoride-containing mouthrinse on existing and developing dental plaque. A total of 55 subjects (mean age = 31.42 yrs.) received a professional prophylaxis in randomly assigned contralateral quadrants and were then stratified into two balanced groups based on screening plaque scores: one group (27 subjects) used the placebo rinse, the second group (28 subjects) used the test mouthrinse (0.63% diluted to 0.1% stannous fluoride). Plaque index (PI) and stain index (SI) were scored at baseline, week 1 and week 3. Gingival inflammation (GI) was monitored as a measure of product irritancy potential. The PI for the stannous fluoride rinse was significantly lower than the placebo, (p < 0.0001), for both prophied and unprophied sites with an average reduction of 29% at week 1 and 28% at week 3. There was no statistically significant difference between the presence or absence of prophylaxis. Plaque indexes for both stannous fluoride and placebo showed significant reduction (p < 0.0001) compared to baseline in all sites. Differences in staining potential between stannous fluoride and placebo were not significant (p > 0.05) at any time during the study. The stain index for both stannous fluoride and placebo showed a non-significant increase from baseline in the prophied and unprophied sites. No irritancy was noted, although a trend towards lower GI scores was observed at 3 weeks for the stannous fluoride group.(ABSTRACT TRUNCATED AT 250 WORDS)