A single-centre investigator-blinded randomised parallel group clinical trial to investigate the effect of probiotic strains Streptococcus salivarius M18 and Lactobacillus acidophilus on gingival health of paediatric patients undergoing treatment with fixed orthodontic appliances: study protocol.

BACKGROUND: There is limited data on the beneficial effects of probiotics on the gingival health of patients undergoing treatment with fixed orthodontic appliances. This study aims to compare the effect of probiotic tablets combined with regular oral hygiene versus regular oral hygiene alone on gingival status in these patients. The effect of probiotic intake on plaque formation and salivary microbiome composition will be also assessed. METHODS AND ANALYSIS: This is a 3 month single-centre, single blind (clinical and laboratory examiners), parallel group randomised controlled two arm superiority trial. Fifty paediatric patients attending the Postgraduate Orthodontic Clinic at the Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates, who meet the eligibility criteria will be recruited. Block randomisation with 1:1 allocation and concealment of allocation will be carried out. The treatment group will receive probiotic tablets containing Streptococcus salivarius M18 and Lactobacillus acidophilus together with regular oral hygiene versus the control group on regular oral hygiene alone. Clinical examination and collection of saliva for microbiome assay will be carried out at baseline and end of study. Self-reporting by patients will be used to document acceptability and adverse effects. Statistically significant decrease in gingival bleeding on probing in the treatment group will be classified as primary outcome of treatment success. Statistically significant reduction in Plaque Index, Gingival Index and shift in the composition of the oral microbiome in favour of beneficial bacteria are secondary outcomes indicative of efficacy of probiotic intake. ETHICS AND DISSEMINATION: Ethical approval for the study has been granted by the HBMCDM, MBRU, Institutional Review Board (Reference #: MBRU-IRB-2018-015). Study findings will be disseminated via publication in peer-reviewed journal. TRIAL REGISTRATION NUMBER: ISRCTN95085398.

Dental Treatment Considerations for Children with Complex Medical Histories: A Case of Townes-Brock Syndrome.

It is common for oral health and dental care to be considered a lesser priority for children with complex medical histories than other aspects of their health care. Often, these patients are at a high risk for caries and infection due to poor oral health practices at home, special or restricted diets, and no early establishment of a dental home for routine dental care. Unfortunately, many of these patients present to their first dental visits with caries and require aggressive treatment, such as extractions instead of pulp therapy, or crowns instead of fillings, due to their high caries risk and the difficulty in safely managing them medically during treatment. A unique example of this occurred at the Children's Hospital of Michigan, where a patient with Townes-Brock syndrome (TBS) presented to the dental clinic with advanced caries. TBS is a rare autosomal dominant disorder characterized by major findings such as anomalies of the external ear, imperforate anus, renal malformations, and malformations of the hand. Like many medically complex cases, dental anomalies are not a direct consequence of TBS; however, due to the necessity of high calorie and high sugar feeding supplementation, many of these patients are at high risk for advanced dental caries. Due to this high caries risk, a more aggressive treatment plan is necessary to minimize the risk of recurrent decay and infection. It is critical to stress that even if the disease, syndrome, etc., of a patient does not have inherent dental consequences, it is imperative for regular dental care to be part of the comprehensive treatment plan for these patients. This includes the establishment of a dental home at a young age and proper oral health education of the patient's caregivers and their physicians. In the case of the patient with TBS, recommendations for daily brushing, especially after high sugar feedings was stressed, as well as the reduction of any other sweets within the diet.

Effect of Cinnamon Extract and Chlorhexidine Gluconate (0.2%) on the Clinical Level of Dental Plaque and Gingival Health: A 4-Week, Triple-Blind Randomized Controlled Trial.

AIM: To compare the effect of cinnamon extract, chlorhexidine mouthwash and placebo on dental plaque level and gingivitis. MATERIALS AND METHODS: One hundred five healthy dental and medical students aged 21 to 25 years participated in the study. The subjects were randomly divided into three groups: i.e., the cinnamon group, the chlorhexidine gluconate mouthwash group and the placebo (distilled water) group. Data were collected at baseline, the 15th and the 30th day. Plaque was disclosed using erythrosine disclosing agent and scores were recorded using the Quigley and Hein plaque index modified by Turesky-Gilmore-Glickman. Gingival scoring was done by the gingival index of Löe and Silness. Statistical analysis was carried out to compare the effect of all three treatments groups; p ≤ 0.05 was considered statistically significant. RESULTS: The chlorhexidine group showed the maximum decrease in both plaque and gingival scores, followed by cinnamon extract, but the result was statistically insignificant. The plaque and gingival scores remained almost unchanged in the distilled water group. Conclusion: The results of the present study indicate that cinnamon may prove to be an effective agent owing to its ability to reduce plaque level and gingivitis.

Use of Traditional Indian Plants in the Inhibition of Caries-Causing Bacteria - Streptococcus mutans

The aim of the study was to comparatively evaluate the antibacterial activity of six Indian plant extracts and 0.2% chlorhexidine against clinical strains of Streptococcus mutans, which were isolated from the plaque samples of 45 pediatric patients. Six plant extracts were prepared in three different forms, namely aqueous extracts, organic solvent-based extracts and crude (raw) extracts. The antimicrobial sensitivity testing was done by agar well diffusion method. Antimicrobial activity of the extracts was determined by measuring the mean zones of inhibition (mm) produced against the bacterial isolates. Results showed that crude garlic extract exhibited greater antibacterial activity than chlorhexidine. Aqueous extract of amla and organic solvent-based extract of ginger showed the maximum antibacterial activity against S. mutans, whereas aqueous extract of tulsi and organic solvent based extract of amla showed the minimum antibacterial activity. This study suggests that plant extracts like garlic in crude form, amla as aqueous infusion and ginger as alcoholic tincture have potential for the control of S. mutans. These extracts can be used as an alternative remedy for dental caries prevention or in the form of mouthwash, which is safe and economical.

O objetivo do estudo foi avaliar comparativamente a atividade antibacteriana de seis plantas indianas contra linhagens clínicas de Streptococcus mutans, que foram isoladas das amostras de biofilme dental de 45 pacientes pediátricos, com 0,2% de clorexidina. Seis extratos vegetais foram preparados em três formas diferentes, a saber, extratos aquosos, extratos à base de solventes orgânicos e extratos brutos. Os testes de sensibilidade antimicrobiana foram realizados por método de difusão em agar. A atividade antimicrobiana dos extratos foi determinada através da medição da zona de inibição, em milímetros, produzida contra os isolados bacterianos. Os resultados mostraram que o extrato de alho cru apresentou maior atividade antibacteriana do que a clorexidina. O extrato aquoso de amla e o extrato à base de solventes orgânicos de gengibre mostraram a máxima atividade antibacteriana contra S. mutans, enquanto o extrato aquoso de tulsi (manjericão) e o extrato à base de solventes orgânicos de amla mostraram mínima atividades antibacteriana. Este estudo sugere que extratos de plantas como o alho em forma bruta, amla como infusão aquosa e gengibre como tintura alcoólica tem um potencial para o controle de S. mutans. Estes extratos podem ser utilizados como uma via alternativa para a prevenção de cáries dentárias ou sob a forma de bochechos, que são seguros e econômicos.

Prevalence of dental erosion and association with lifestyle factors in Swedish 20-year olds.

OBJECTIVE: To investigate the prevalence, distribution and severity of dental erosion and its association with lifestyle, oral and general health in young adults. MATERIALS AND METHODS: Four hundred and ninety-four individuals, 20-years of age, participated. Dental erosion in molars and maxillary incisors was evaluated. Caries, plaque and gingivitis were registered. Saliva samples were taken and the subjects were interviewed about behavioural and dietary habits and oral and general health. Body mass index (BMI) was calculated. The individuals were sub-divided into two groups according to the presence and absence of dental erosion: within the group with erosion was a sub-group of individuals with extensive erosion. RESULTS: Of the individuals 25% had no erosion, 75% had erosion and 18% had extensive erosion. Erosion was found in molars in 74% of the individuals and on buccal and palatal surfaces in maxillary incisors in 4% and 7%, respectively. Cupping was seen in 65% of individuals and severe erosion in molars in 1.6%. Compared to subjects with no erosion, those with extensive erosion had a higher consumption of soft drinks (p = 0.05), caries prevalence (p < 0.01), prevalence of mutans Streptococci (p < 0.01) and BMI (p < 0.05). Furthermore, subjects with erosion had higher caries prevalence (p < 0.01) and BMI (p < 0.01) than those with no erosion. CONCLUSIONS: Swedish young adults have a high prevalence of dental erosion, but the level of severe erosion is low. The study disclosed a relationship between dental erosion and behavioural factors, oral health and BMI.

Intakes of calcium, vitamin D, and dairy servings and dental plaque in older Danish adults.

BACKGROUND: To investigate whether intakes of calcium and dairy-servings within-recommendations were associated with plaque score when allowing for vitamin D intakes. METHODS: In this cross-sectional study, including 606 older Danish adults, total dietary calcium intake (mg/day) was classified as below vs. within-recommendations and dairy intake as <3 vs. ≥3 servings/ d. Dental plaque, defined as the percentage of tooth surfaces exhibiting plaque, was classified as < median vs. ≥median value (9.5%). Analyses were stratified by lower and higher (≥6.8 µg/d) vitamin D intake. FINDINGS: Intakes of calcium (OR = 0.53; 95% CI = 0.31-0.92) and dairy servings (OR = 0.54; 95% CI = 0.33-0.89) within-recommendations were significantly associated with lower plaque score after adjustments for age, gender, education, intakes of alcohol, sucrose and mineral supplements, smoking, diseases, number of teeth, visits to the dentist, use of dental floss/tooth pick and salivary flow, among those with higher, but not lower, vitamin D intake. CONCLUSION: Intakes of calcium dairy-servings within-recommendations were inversely associated with plaque, among those with higher, but not lower, vitamin D intakes. Due to the cross-sectional nature of the study, it is not possible to infer that this association is causal.

Influence of hygienic preparations with a 3% content of ethanol extract of Brazilian propolis on the state of the oral cavity.

BACKGROUND: One of the most important measures to be undertaken in order to fight gingivitis and periodontitis is maintenance of proper hygiene of the oral cavity. The research to improve the content of toothpaste has continued for many years so that they should become better in terms of therapeutic abilities. OBJECTIVES: The aim of this work was to determine and investigate the influence of the application of toothpaste and gel with 3% ethanol propolis extract on the state of the oral cavity. MATERIAL AND METHODS: The research group comprised 80 adult patients divided into two subgroups: Group I, which comprised 40 patients without pathological changes within the boundaries of the periodontium, and Group II, also 40 patients endangered with the occurrence of periodontitis caused by dental plaque and lack of proper hygiene of the oral cavity. Qualification for both groups was based on an interview and analysis of clinical documentation and assessment of adequate indices such as API, OHI and SBI. The patients underwent three examinations: initial, follow-up after 7 days and after 8 weeks since the beginning of the program. Moreover, the patients were instructed about hygienic procedures of the oral cavity. Four groups (T, G, CT, CG), 20 patients each, were created from research groups I and II. They used the following preparations: T--Dental Polis DX toothpaste with propolis content, G--Dental Polis DX toothpaste without propolis content, CT--Carepolis gel with propolis content, CG--Carepolis gel without propolis content. The patients were informed about the type of hygienic preparation they were given to use (whether it contained propolis or not). Moreover, they were interviewed for their subjective evaluation of the product received. RESULTS AND CONCLUSION: Results of the research show the effectiveness of hygienic preparations with 3% content of ethanol propolis extract in both groups of patients: without pathological changes within the boundaries of the periodontium and in the case of patients endangered with the occurrence of gingivitis caused by dental plaque

Bactericidal action of photogenerated singlet oxygen from photosensitizers used in plaque disclosing agents.

BACKGROUND: Photodynamic therapy (PDT) has been suggested as an efficient clinical approach for the treatment of dental plaque in the field of dental care. In PDT, once the photosensitizer is irradiated with light of a specific wavelength, it transfers the excitation energy to molecular oxygen, which gives rise to singlet oxygen. METHODOLOGY/PRINCIPAL FINDINGS: Since plaque disclosing agents usually contain photosensitizers such as rose bengal, erythrosine, and phloxine, they could be used for PTD upon photoactivation. The aim of the present study is to compare the ability of these three photosensitizers to produce singlet oxygen in relation to their bactericidal activity. The generation rates of singlet oxygen determined by applying an electron spin resonance technique were in the order phloxine > erythrosine ≒ rose bengal. On the other hand, rose bengal showed the highest bactericidal activity against Streptococcus mutans, a major causative pathogen of caries, followed by erythrosine and phloxine, both of which showed activity similar to each other. One of the reasons for the discrepancy between the singlet oxygen generating ability and bactericidal activity was the incorporation efficiency of the photosensitizers into the bacterial cells. The incorporation rate of rose bengal was the highest among the three photosensitizers examined in the present study, likely leading to the highest bactericidal activity. Meanwhile, the addition of L-histidine, a singlet oxygen quencher, cancelled the bactericidal activity of any of the three photoactivated photosensitizers, proving that singlet oxygen was responsible for the bactericidal action. CONCLUSIONS: It is strongly suggested that rose bengal is a suitable photosensitizer for the plaque disclosing agents as compared to the other two photosensitizers, phloxine and erythrosine, when used for PDT.

Uses of turmeric in dentistry: an update.

Turmeric has been used for thousands of years as a dye, a flavoring, and a medicinal herb. In India, it has been used traditionally as a remedy for stomach and liver ailments, as well as topically to heal sores. Ancient Indian medicine has touted turmeric as an herb with the ability to provide glow and luster to the skin as well as vigor and vitality to the entire body. Since turmeric has antimicrobial, antioxidant, astringent, and other useful properties, it is quite useful in Dentistry also. The objective of this article is to highlight various uses of turmeric in the dental field along with its use in medical problems.

Tratamiento del liquen plano oral: una revisión / Treatment of oral lichen planus: a review

El objetivo del presente estudio fue realizar una revisión sobre los actuales tratamientos del liquen plano oral(LPO). Antes de iniciar el tratamiento al paciente, debe de realizarse una biopsia para establecer el correcto diagnóstico. Dado que para el LPO no hay tratamiento curativo, el primer objetivo en los pacientes sintomáticos es el efecto paliativo. Entre las alternativas terapéuticas se incluyen: corticosteroides tópicos, sistémicos e intralesionales; retinoides tópicos o sistémicos; ciclosporina tópica, tacrolimus tópico, azatioprina, fototerapia y tratamiento quirúrgico (AU)

The aim of the present study was to review about the current treatment of oral lichen planus (OLP). Before a patients is started on therapy a biopsy must be done to establish an accurate diagnosis. Because there is no curative therapy for OLP, the primary goal for symtomatic patients is palliative. Treatment modalities include the use of: topical, systemic and intralesional corticosteroids; topical and systemic retinoids, topical cyclosoporine; topical tacrolimus; azathioprine; phototherapy and surgical procedures (AU)

Comparative effect of chewing sticks and toothbrushing on plaque removal and gingival health.

PURPOSE: The aim of the study was to compare the effect of the chewing stick (miswak), and toothbrushing on plaque removal and gingival health. MATERIALS AND METHODS: The participants comprised 15 healthy Saudi Arabian male volunteers aged 21 to 36 years, attending the Dental Center at Al-Noor Specialist Hospital in Makkah City in Saudi Arabia. The study was designed as a single, blind, randomized crossover study. The Turesky modified Quigley-Hein plaque and Löe-Silness gingival indices and digital photographs of plaque distribution were recorded at baseline, one week after professional tooth cleaning, and again following three weeks use of either the miswak or toothbrush. Professional tooth cleaning was repeated, and after a further three weeks use of either the miswak or toothbrush (using the alternative method to that used in the first experimental period), plaque and gingival indices, and digital photographs of plaque distribution were recorded anew. RESULTS: Compared to toothbrushing, the use of the miswak resulted in significant reductions in plaque (p < 0.001) and gingival (p < 0.01) indices. Image analysis of the plaque distribution showed a significant difference in reduction of plaque between the miswak and toothbrush periods (p < 0.05). CONCLUSION: It is concluded that the miswak is more effective than toothbrushing for reducing plaque and gingivitis, when preceded by professional instruction in its correct application. The miswak appeared to be more effective than toothbrushing for removing plaque from the embrasures, thus enhancing interproximal health.

Assessment of plaque prevention on dentures using an experimental cleanser.

STATEMENT OF PROBLEM: Adequate plaque control is essential for the maintenance of a healthy oral mucosa. Denture cleansers are a popular method used by denture wearers for cleaning. The clinical effectiveness of a new cleanser in tablet form has not been tested in vivo. Methods used for the in vivo assessment of denture cleanser effectiveness are often not standardized. PURPOSE: The aims of this in vivo study were to develop a new method for assessing plaque levels on dentures by using digital imaging and to use this methodology, together with a validated visual scoring method, to evaluate plaque buildup on dentures. MATERIAL AND METHODS: Thirty-five subjects were randomized to 1 of 2 treatment groups: (1) dentures soaked in a new cleanser, or (2) dentures soaked in water. The treatment period lasted 14 days. Plaque was assessed at baseline and on days 2 and 14 by using digital image analysis and a visual scoring technique. Results were analyzed with ANOVA at the 95% confidence interval. RESULTS: The new cleanser showed a statistically significant reduction in mean visual plaque of 51% at day 2 (P = 0.0002) and 42% (P = 0.0014) at day 14 compared with water. Similar results were seen with digital imaging. CONCLUSION: The new denture cleanser proved to be effective at preventing plaque accumulation on dentures. The analysis of digital images gave similar results as the visual scoring method.

Chewing sticks, toothpaste, and plaque removal.

The aim of the present study was to assess the efficacy of brushing with chewing sticks in removing plaque and to evaluate whether toothpaste has any additional effect on the removal of established dental plaque. Kenyan schoolchildren had their plaque deposits disclosed by means of disclosing tablets and subsequently recorded on four buccal sites of all permanent teeth. The children were then allocated to two groups in a crossover design; in one group the children brushed with chewing sticks and toothpaste; the other group brushed with chewing sticks only. Substantial amounts of plaque were recorded at base line in most children. Brushing with a chewing stick for 5 min resulted in a net reduction of the proportion of plaque deposit sites per child. Toothpaste resulted in no additional effect.