Oral-hygiene-related self-efficacy in periodontal therapy: A 4-year longitudinal study.

AIM: Oral hygiene-related self-efficacy (OHSE) describes one's confidence to successfully execute oral hygiene behaviour. The aim of this study was to investigate the long-term course of OHSE in patients during initial periodontal therapy (IPT) and supportive periodontal therapy (SPT) and its association with clinical parameters. MATERIALS AND METHODS: Patients diagnosed with periodontitis, undergoing either IPT or SPT, were evaluated at two timepoints. Clinical examination included pocket probing depths (PPDs), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI) and gingival index (GI). Patients' OHSE was assessed with a questionnaire. Statistical analyses included t-tests and linear regression models. RESULTS: Ninety-eight patients from an initial group of 201 patients were evaluated after 4 years. The overall OHSE score increased significantly in the IPT group (mean 11.65 ± 15.6, p = .001). The increase in the OHSE category 'interdental cleaning' was significantly correlated with a decrease in the number of pockets requiring treatment (Spearman correlation rs = -.2349, p = .022) and periodontal inflamed surface area (PISA) (rs = -.2099, p = .042). CONCLUSIONS: Patients under IPT showed a significant increase of OHSE compared to those under SPT. Improved OHSE, particularly in interdental cleaning, appears to be associated with sustained success of periodontal therapy.

Free sugars and gingival inflammation: A systematic review and meta-analysis.

AIM: Consumption of free sugars has been associated with chronic non-communicable diseases. The aim of the study was to investigate the effect of free-sugar consumption on gingival inflammation using a systematic review and meta-analysis based on the PICO question 'What impact does the restriction of free sugars have on the inflammation of gingival tissue?' MATERIALS AND METHODS: Literature review and analyses were based on the Cochrane Handbook for Systematic Reviews of Interventions. Controlled clinical studies reporting on free-sugar interventions and gingival inflammation were included. Risk of bias was performed with ROBINS-I and ROB-2, and effect sizes were estimated with robust variance meta-regressions. RESULTS: Of the 1777 primarily identified studies, 1768 were excluded, and 9 studies with 209 participants with gingival inflammation measures were included. Six of these studies reported on the dental plaque scores of 113 participants. Restriction of free sugars, when compared with no such restriction, was associated with statistically significantly improved gingival health scores (standard mean difference [SMD] = -0.92; 95% confidence interval [CI]: -1.43 to -0.42, p < .004; I2 [heterogeneity] = 46.8) and a trend towards lower dental plaque scores (SMD = -0.61; 95% CI: -1.28 to 0.05, p < .07; I2 = 41.3). The observed improvement of gingival inflammation scores with restricted consumption of free sugar was robust against various statistical imputations. No meta-regression models were feasible because of the limited number of studies. The median publication year was 1982. Risk-of-bias analysis showed a moderate risk in all studies. CONCLUSION: Restriction of free sugar was shown to be associated with reduced gingival inflammation. The systematic review was registered at PROSPERO (CRD 42020157914).

The tissue renin-angiotensin system (tRAS) and the impact of its inhibition on inflammation and bone loss in the periodontal tissue.

Recently, the existence of the tissue renin-angiotensin system (tRAS) has been described for multiple tissues in humans, suggesting its fundamental role in the progression of inflammation and fibrosis. Evidence arises that tRAS might have an impact on the progression of periodontitis and bone loss. However, neither the role of tRAS nor its impact as a therapeutic target have been systematically evaluated for periodontal tissue. The present study sought to characterise tRAS in the periodontal tissue and the effect of its inhibition on periodontal inflammation and bone loss. This systematic review was performed according to the preferred reporting items for systematic reviews and meta analyses (PRISMA) statement. Literature was searched using Web of Science core collection (Web of Science), Medline (Ovid), Cochrane central register of controlled trials (Ovid), Cochrane database of systematic reviews (Ovid), Google Scholar databases and the references of the retrieved studies in March 2020. Information on study design, sample size, population, procedure, type of intervention, observation time, as well as information on sources of bias, was extracted and evaluated. From 455 identified articles, 17 were included in the qualitative synthesis and 11 were included in the quantitative synthesis. Outcomes of studies indicated that the inhibition of tRAS components led to a reduction of periodontal bone loss and inflammation, dependent on the inhibitor used. The findings suggested an important role of tRAS in the periodontal tissue and indicate a potential therapeutic approach for periodontal diseases.

An oral health optimized diet can reduce gingival and periodontal inflammation in humans - a randomized controlled pilot study.

BACKGROUND: The aim of this pilot study was to investigate the effects of four weeks of an oral health optimized diet on periodontal clinical parameters in a randomized controlled trial. METHODS: The experimental group (n = 10) had to change to a diet low in carbohydrates, rich in Omega-3 fatty acids, and rich in vitamins C and D, antioxidants and fiber for four weeks. Participants of the control group (n = 5) did not change their dietary behavior. Plaque index, gingival bleeding, probing depths, and bleeding upon probing were assessed by a dentist with a pressure-sensitive periodontal probe. Measurements were performed after one and two weeks without a dietary change (baseline), followed by a two week transitional period, and finally performed weekly for four weeks. RESULTS: Despite constant plaque values in both groups, all inflammatory parameters decreased in the experimental group to approximately half that of the baseline values (GI: 1.10 ± 0.51 to 0.54 ± 0.30; BOP: 53.57 to 24.17 %; PISA: 638 mm(2) to 284 mm(2)). This reduction was significantly different compared to that of the control group. CONCLUSION: A diet low in carbohydrates, rich in Omega-3 fatty acids, rich in vitamins C and D, and rich in fibers can significantly reduce gingival and periodontal inflammation. TRIAL REGISTRATION: German Clinical Trials Register; https://www.germanctr.de (DRKS00006301). Registered on 2015-02-21.

A temporary filling material used for coronal sealing during endodontic treatment may cause tooth fractures in large Class II cavities in vitro.

AIM: To investigate the use of a zinc oxide/zinc sulphate-based cement (Coltosol(®) F, Coltène Whaledent, Cuyahoga Falls, OH, USA) as a temporary filling material during multiple-visit root canal treatments and the occurrence of cracks within the filling material or the tooth. METHODOLOGY: Root canals of one hundred and twenty-two extracted human molars were prepared using ProTaper instruments up to size F2. After root canal preparation, standardized mesial-occlusal-distal cavities were prepared. The buccal-lingual/palatal width of the cavities was 4.5 mm), so that the remaining cavity walls had a mean thickness of 3.5 mm. Teeth were checked for cracks and fracture lines using a stereomicroscope with 10× magnification. A calcium hydroxide slurry was used as an intracanal dressing. The teeth were divided into three groups. In the Coltosol group, the cavity was filled with Coltosol(®) F. In the Coltosol-Clearfil group, a 2-mm layer of Coltosol(®) F was placed into the coronal pulp chamber, the remaining cavity was filled with Clearfil(™) . In the Clearfil group, a foam pellet was placed onto the orifices of the root canals, the remaining cavity was filled with Clearfil(™) . In the control group, the cavities were left without any filling material. The teeth were stored in water at 37 °C for 14 days and examined every 24 h under a stereomicroscope for fracture lines occurring on the tooth surface or in the filling material. RESULTS: In the Coltosol group, fractures within the filling material were observed in 28 (85%) of 33 teeth. 13 (39%) teeth had tooth fractures. Amongst these teeth, 8 (61%) had root fractures, 1 (8%) had a crown fracture and 4 (31%) had a root-crown fracture. CONCLUSION: Coltosol(®) F, when used alone as a restorative material, led to tooth fractures in Class II cavities in teeth undergoing root canal treatment. Tooth fractures may occur 4 days after placement of the filling.

Evaluation of an improved endodontic teaching model: do preclinical exercises have an influence on the technical quality of root canal treatments?

AIM: To investigate whether the preclinical application of an electronic root canal length measurement device (ERCLMD) leads to more accurate working length (WL) determinations in a preclinical endodontic course and if this exercise effects the technical quality of root canal procedures when treatments are performed on patients for the first time. METHODOLOGY: Root canal treatments performed by two consecutive groups of third year students (group 1: n = 39, group 2: n = 44) were compared in the preclinical course and when root canal treatments were performed on patients in the following term. Two different teaching models were applied in the preclinical endodontic course. WL in group 1 was determined with radiographs only. The teaching model applied in group 2 allowed the application of an ERCLMD. When treatments were performed on patients, both groups used the same technique to determine WL. It was first determined using an ERCLMD and verified radiographically. Master cone and root filling lengths were evaluated using radiographs, and comparisons between both groups were made using Fischer's exact test. RESULTS: Root fillings performed by students of group 2 were more often classified as acceptable. This observation was made in the preclinical endodontic course and when treatments were performed on patients. CONCLUSIONS: The application of an ERCLMD in combination with radiographs is more accurate to determine WL than radiographs alone. Students practiced the use of ERCLMDs with the new model and benefited from this experience when performing their first root canal treatments on patients.

Can easy-to-use software deliver effective e-learning in dental education? A randomised controlled study.

INTRODUCTION: For the production of computer-based learning environments, a wide range of software solutions can be used which differ not only in their functionality but also vary in cost and ease to program. The aim of our study was to evaluate the overall efficiency and student's perception of two case-based e-learning programs that were produced with either an easy-to-use or a complex software. MATERIALS AND METHODS: Eighty-five dental students were randomly assigned to one of two experimental groups. One group studied with a laborious, high-interactive e-learning program (complex-software group). The second group studied within a low-interactive learning environment (easy-software group) that was easy to be programmed. Both programs identically referred to a case report on localised aggressive periodontitis. Learning outcome was tested by a pre- and post-test. Furthermore, questionnaires on workload, motivation, perceived usefulness and perceived learning outcome were used. RESULTS: Learners in the easy-software group showed better results in the post-test F(1, 82) = 4.173, P < 0.044). DISCUSSION: Even easy-to-use software tools have the potential to be beneficial in dental education. Students were showing a high acceptance and ability in using both e-learning environments. CONCLUSIONS: We conclude that e-learning programs for case-based learning do not have to be overly laborious to program to be useful. Based on our results, we want to encourage instructors to produce case-based e-learning tools with easy-to-use software.

The importance of teaching communication in dental education. A survey amongst dentists, students and patients.

The aim of our study was to evaluate the subjective importance of teaching communication in the dental curriculum by conducting a survey amongst dentists, students and patients. Three questionnaires about communication-related issues were developed in which different questions could be rated on a five-point Likert scale. These questions included the subjective importance of the dental team's friendliness, an elaborated consultation, modern office equipment or the dentist's technical skills. Seven hundred and twenty-nine questionnaires were completed [233 by dentists (32%), 310 by students (43%) and 185 by patients (25%)]. Eighty-seven percentage of the dentists, 84% of the students and 84% of the patients supported an integration of communicational issues in dental education; 94.7% of the dentists and 77.2% of the patients attached vital importance to the dentist-patient relationship regarding the therapeutic outcomes. Dentists with prior communicational training experience would spend significantly (P<0.001) more money for further courses. The results show the publicly perceived importance of integrating aspects of communication in dental education.