Supportive periodontal care with or without subgingival instrumentation: Microbiological results of a 2-year randomized clinical trial.

AIM: To compare the subgingival microbiota of patients receiving supportive periodontal care (SPC) with and without subgingival instrumentation, over 2 years. MATERIALS AND METHODS: This study was a randomized clinical trial that included 62 participants (50.97 ± 9.26 years old; 40 females) who completed non-surgical periodontal therapy. Participants were randomly assigned to receive oral prophylaxis with oral hygiene instructions alone (test) or in combination with subgingival instrumentation (control) during SPC. Pooled subgingival biofilm samples were obtained from four sites per patient at SPC baseline and at 3, 6, 12, 18, and 24 months. Real-time polymerase chain reaction was used for absolute quantification of Eubacteria and the target bacteria Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Data were analysed using generalized estimating equations, taking into consideration the clustering of observations within individuals. RESULTS: No significant differences were found between the experimental groups regarding the mean counts of Eubacteria and target bacteria, as well as the periodontal parameters at the sampled sites. Although significant variability in bacterial counts was present during SPC, all counts after 2 years were not statistically different from those at baseline. Bacterial counts were associated with the presence of plaque, bleeding on probing, mean probing depth ≥3 mm, and follow-up period. CONCLUSIONS: SPC with or without subgingival instrumentation can result in comparable subgingival microbiological outcomes. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov: NCT01598155 (https://clinicaltrials.gov/study/NCT01598155?intr=supragingival%20control&rank=4#study-record-dates).

In vitro evaluation of temperature changes in the root canal induced by ultrasonic scalers.

OBJECTIVE: To evaluate in vitro the thermal effects induced by four different ultrasonic scalers on the temperature in the root canal during ultrasonic scaling. METHODS: An extracted lower central incisor provided with a thermocouple in the root canal and a tube, entering the tooth incisally and exiting it apically to simulate an artificial bloodstream, was placed in a model of the lower jaw with soft artificial gingiva. Tested ultrasonic scaler systems included: EMS PM-600, Satelec P-max, Dürr Vector and Dentsply Cavitron. The tooth was scaled with each system at full water supply of 21°C. Furthermore, the amount of water supply was determined to maintain during scaling a constant temperature in the root canal. Finally, thermal changes due to scaling without water were assessed. RESULTS: Except for the Vector all scaler systems showed a temperature decrease in the root canal. The Vector with water/polish suspension showed a trend towards an increase in temperature. To maintain a constant temperature in the root canal the Cavitron needed twice the amount of water compared with PM-600 and P-max. Without water, all scaling systems induced a temperature increase. CONCLUSION: For safe ultrasonic scaling, care should be taken that the cooling water has room temperature and that, dependent on the scaler system, the proper amount of water is supplied.

The efficacy of chlorhexidine dentifrice or gel on plaque, clinical parameters of gingival inflammation and tooth discoloration: a systematic review.

AIM: Based on the existing scientific literature, the effect of chlorhexidine (CHX) dentifrice/gel as compared to a regular or placebo dentifrice/gel is established in healthy adults on the primary outcome parameters of plaque and gingivitis scores. As secondary parameter, tooth surface discoloration was evaluated as a side effect. MATERIALS AND METHODS: MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched up to July 2013 to identify eligible studies. Included were (randomized) controlled clinical trials, regarding self-performed brushing by adults without periodontitis with a minimum duration of 4 weeks. RESULTS: Independent screening of 389 unique titles and abstracts resulted in 16 comparisons. Of these, nine evaluated CHX dentifrice (0.4-1.0%) and 7 CHX gel (0.2-2.0%). It was not possible to perform a meta-analysis; therefore, a descriptive analysis was carried out. Regarding plaque score reduction, the majority of the experiments using a CHX dentifrice provided a significant positive effect. All studies assessing gingival bleeding as parameter for gingivitis observed a significant reduction in favour of CHX dentifrice over placebo dentifrice. Tooth surface discoloration was more pronounced with CHX dentifrice. The combined data concerning parameters of interest for CHX gel compared with a placebo did not show a trend towards a beneficial effect on plaque and bleeding scores. CONCLUSIONS: Within the limitations of this analysis, it may be concluded that toothbrushing with a CHX gel does not provide conclusive evidence. Brushing with a CHX dentifrice can be effective with regard to the control of plaque and gingivitis. Tooth surface discoloration was observed as side effect, which potentially can have a negative impact on patients' compliance.

Plaque-removing efficacy of new and used manual toothbrushes--a professional brushing study.

OBJECTIVES: The present study assessed whether 3-month-old used manual toothbrushes are less effective in reducing plaque scores compared with new toothbrushes with or without the use of dentifrice. MATERIAL AND METHODS: The present study was performed employing a single-use, examiner-blinded, professional brushing model. Four brushing modalities were randomly allocated to one of four quadrants, that is, 3-month-old used toothbrushes and new toothbrushes both with and without the use of dentifrice. Prebrushing and post-brushing plaque scores (Quigley Hein plaque index) and gingival abrasion (GA) scores were obtained. A dental hygienist performed the professional brushing procedure. The 3-month-old used toothbrushes were assessed for wear. RESULTS: No significant differences were observed among the treatments with regard to the prebrushing scores. The post-brushing plaque scores ranged from 1.59 for the new brush with dentifrice to 1.76 for the old brush with dentifrice. There was a significant difference (P = 0.036) among the four treatments regarding the old brush with dentifrice, which removed less plaque than the other treatment modalities. Regarding GA scores, no significant differences were observed. With regard to toothbrush wear after 3 months of use, the scores varied widely among the individually evaluated brushes. CONCLUSION: The present study did not show a clinically relevant difference in plaque score reductions following a 2-minute brushing exercise among 3-month-old used and new manual toothbrushes. However, the wear rate of the brushes seemed to be the determining factor in loss of efficacy, rather than the age of the toothbrush. Furthermore, dentifrice did not show an additional effect on instant plaque removal.

Influence of dental education in motivational interviewing on the efficacy of interventions for smoking cessation.

AIM: To test whether education of dental students in motivational interviewing (MI) for smoking cessation counselling will increase the number of patients and students who quit smoking and will improve knowledge and attitudes of dental students towards tobacco cessation counselling. METHODS: Over 2 years, during four successive undergraduate periodontal courses, student groups received either no education in MI or MI with increasing quality and extent of the education. Smoking habits were assessed before, and 1, 6 and 12 months after periodontal treatment by means of a questionnaire. In the same way, attitudes and knowledge related to tobacco cessation and the perceived quality of the education in MI of the students were evaluated. RESULTS: A significant reduction in smokers was achieved only in the group of students receiving the most extensive MI education followed by a formative assessment: 20% quit rate after 1 year for patients and 39% for students. Owing to MI education, the knowledge of the students on the relationship between smoking and periodontitis increased from 33% without MI to over 96% in the groups with MI. CONCLUSION: Engaging dental students in smoking cessation with MI has promise when incorporated in the periodontal education.

Micronutritional approaches to periodontal therapy.

AIM: Periodontitis results from the loss of a delicate balance between microbial virulence factors and a proportionate host response. Nutritional factors have been implicated in several chronic inflammatory diseases that are associated with periodontitis. This manuscript reviews the evidence for nutritional exposures in the etiology and therapeutic management of periodontitis, and makes recommendations for daily nutritional intake for vitamin C (ascorbic acid), vitamin D, calcium, and antioxidants. RESULTS AND CONCLUSION: Periodontitis is associated with low serum/plasma micronutrient levels, which may result from dietary and/or life-style factors as well as nutrigenetic characteristics. Early evidence suggests beneficial outcomes from nutritional interventions; supporting the contention that daily intake of certain nutrients should be at the higher end of recommended daily allowances. For prevention and treatment of periodontitis daily nutrition should include sufficient antioxidants, vitamin D, and calcium. Inadequate antioxidant levels may be managed by higher intake of vegetables, berries, and fruits (e.g. kiwi fruit), or by phytonutrient supplementation. Current evidence is insufficient to support recommendations of mono-antioxidant vitamin supplements and randomised controlled double-blind intervention studies are needed to provide evidence to underpin future recommendations. Inadequate supply of vitamin D and calcium may be addressed by implementing changes in diet/life style or by supplements.

Parotid gland swelling following mouthrinse use.

BACKGROUND: Unilateral or bilateral swelling of the parotid gland is a reported side effect of rinsing the mouth with chlorhexidine. Although the incidence rate is extremely low, there have been several case reports on this topic and the authors of these reports have suggested several explanations for the mechanism of this complication. METHODS: In this report, two cases of parotid gland swelling are discussed. Both patients developed unilateral parotid swelling following the use of a mouthwash, case 1 after using a chlorhexidine mouthwash following flap surgery and case 2 after using a hexetidine mouthwash in an approved clinical trial that was testing different mouthwashes. RESULTS: In both of the cases, differential diagnoses were made to explain the cause of the parotid swelling. However, discontinuing use of the product resulted in an eventual complete resolution of symptoms in both patients. CONCLUSIONS: Swelling of the parotid gland following use of a mouthwash has previously been reported, although previous reports found this side effect only in patients who used chlorhexidine mouthwashes. This complication has therefore been informally linked to chlorhexidine. The present case report questions this hypothesis and suggests that parotid gland swelling may not be related to the type of mouthwash used, but may instead be a consequence of the rinsing action itself.

Safety and efficacy of two manual toothbrushes.

OBJECTIVE: The purpose of this study was to test the efficacy and safety of a newly designed multi-level manual toothbrush (Profit-Haije-Brush) compared with a control flat-trimmed manual reference toothbrush from the American Dental Association (ADA). MATERIAL AND METHODS: For this study, 36 healthy subjects without previous experience in the use of the Profit-Haije-Brush (PHB) were selected. Subjects were given a period of 2 weeks to become familiar with both types of brushes and were instructed to use them on alternate days for 2 min twice daily. Prior to their visit, subjects refrained from all oral hygiene procedures for 48 h. Prebrushing plaque and gingival abrasion scores were assessed. Subsequently, two randomly chosen contra-lateral quadrants were brushed with one of both brushes and the other two quadrants with the alternate brush. Subjects were supervised during their 2-min brushing exercise. After brushing, plaque and gingival abrasion were re-assessed. A questionnaire was filled out to investigate the subjects' attitudes towards both brushes. RESULTS: The overall mean prebrushing PI was 2.47 for the PHB and 2.44 for the ADA. The reduction in PI was 1.32 and 1.23 respectively (P < 0.05). With regard to gingival abrasion the overall mean prebrushing scores were 4.57 (PHB) and 5.34 (ADA). Post-brushing scores were 13.49 and 13.77 for the PHB and ADA respectively. CONCLUSION: Statistically, the multi-level PHB was significantly more efficacious than the flat-trimmed ADA. However, the difference is clinically considered small and the amount of remaining plaque was not significantly different between brushes. No greater potential to cause gingival abrasion to the oral tissues was observed.

The effect of 1% chlorhexidine gel and 0.12% dentifrice gel on plaque accumulation: a 3-day non-brushing model.

AIM: The purpose of the study was to compare the effects of four treatments on 'de novo' plaque accumulation. Treatments included tray application of 1% chlorhexidine gel (CHX-Gel), 0.12% chlorhexidine dentifrice-gel (CHX-DFG), a regular dentifrice (RDF) tray application, or 0.2% chlorhexidine mouthwash (CHX-MW) in a 3-day non-brushing model. MATERIAL AND METHODS: The study was designed as a single blind, randomized parallel clinical trial. After professional prophylaxis, subjects abstained from all other forms of oral hygiene during a 3-day non-brushing period. Subjects were randomly assigned to one of the four test groups (CHX-Gel, CHX-DFG, RDF applied in a fluoride gel tray or rinsing with a CHX-MW). After 3 days, the Quigley & Hein plaque index (PI) and Bleeding on Marginal Probing (BOMP) index was assessed. Subsequently, all subjects received a questionnaire to evaluate their attitude, appreciation and perception towards the products used employing a Visual Analogue Scale. RESULTS: After 3 days, the full-mouth PI means were 0.88 for the CHX-gel regimen, 0.79 for CHX-MW, 1.16 for CHX-DFG and 1.31 for the RDF regimen. The two dentifrices (CHX-DFG and RDF) were significantly less effective than the CHX-Gel or the CHX-MW. CONCLUSION: Within the limitations of the present 3-day non-brushing study design, it can be concluded that the effect of a 1% CHX-Gel application tray is significantly greater than that of 0.12% CHX-DFG or RDF in inhibiting plaque accumulation. The 1% CHX-Gel applied via a tray and 0.2% CHX-MW rinse were comparably effective.

The influence of a hydrogen peroxide and glycerol containing mouthrinse on plaque accumulation: a 3-day non-brushing model.

AIM: To evaluate the inhibition of plaque growth by an experimental mouthrinse (BioXyl) based on hydrogen peroxide/glycerol. DESIGN: It was a double-blind, randomized study involving 40 volunteers in good general health. At the start of the trial, all participants received a dental prophylaxis to remove all plaque deposits. During the next 3 days subjects refrained from any mechanical oral hygiene procedure, except for the allocated mouthrinse being either the hydrogen peroxide (H(2)O(2); 0.013% H(2)O(2)/0.004% glycerol) or the placebo without H(2)O(2). At the third day of appointment, plaque levels were assessed at six sites per tooth. RESULTS: The test group had a mean overall plaque score of 2.66 and the placebo group of 2.70. The difference in plaque scores between the two groups was not statistically significant. CONCLUSIONS: The results of this pilot study showed that there was no statistically significant difference between the H(2)O(2)/glycerol group and the placebo group with respect to plaque inhibition within this study design.

Who will pass the dental OSCE? Comparison of the Angoff and the borderline regression standard setting methods.

AIM: Aim of this study is to elucidate which standard setting method is optimal to prevent incompetent students to pass and competent students to fail a dental Objective Structured Clinical Examination (OSCE). MATERIAL AND METHODS: An OSCE with 14 test stations was used to assess the performance of 119 third year dental students in a training group practice. To establish the pass/fail standard per station, three standard setting methods were applied: the Angoff I method, the modified Angoff II with reality check and the Borderline Regression (BR) method. For the final decision about passing or failing the complete OSCE, three methods were compared: total compensatory (TC), a partial compensatory (PC) within clusters of competence and a non-compensatory (NC) model. The reliability of the pass/fail standard of the three methods was indicated by the root mean square error (RMSE). As a criterion measure, a sample of the students (n = 89) was rated in the clinic by their instructors and accordingly these students were divided into two groups: competent and incompetent students. The students' clinical rating (considered for this study as 'true qualification') was compared with the pass-fail classification resulting from the OSCE. Undeserved passing of an incompetent student was considered as more damaging than failing a competent student. RESULTS: The BR method showed more acceptable results than the two Angoff methods. In terms of pass rate the BR method showed the highest pass rates: for the TC model the Angoff method I and II and the BR showed pass rates of 86.6%, 86.6% and 97.5% respectively. For the PC model the pass rates were 30.3%, 34.5% and 61.3%, and for the NC model the pass rates were 0.8%, 1.7% and 7.6%. The BR method showed lower RMSEs (higher reliability): for the TC model the RMSEs were 1.3%, 1.0% and 0.3% for the Angoff I, Angoff II and BR method respectively, and for the PC model the RMSE of the clusters of competence range was 2.0-3.7% for Angoffs I; 1.8-2.2% for Angoff II and 0.6-0.7% for the BR method. In terms of incorrect decisions, the BR method had a higher loss due to incorrect decisions for the TC model than for the PC model which is in accordance with the results of other studies in medical education. CONCLUSIONS: Therefore we conclude that the BR method in a PC model provides defensible pass/fail standards and seems to be the optimal choice for OSCEs in health education.

NOD1 gene polymorphisms in relation to aggressive periodontitis.

BACKGROUND: NOD proteins are part of innate immunity mechanisms. They play a role in epithelial barrier functions and inflammatory responses to bacteria. Single nucleotide polymorphisms (SNPs) in the NOD1 gene have proven to be associated with inflammatory bowel disease (IBD) and asthma. OBJECTIVE: To investigate SNPs in the NOD1 gene in relation to aggressive periodontitis (AgP), a multifactorial, inflammatory disease of the supporting tissues of the teeth. MATERIALS AND METHODS: Five SNPs in the NOD1 gene (4 intronic and 1 exonic) were tested for association in a total of 415 AgP patients and 874 controls both of Northern European ancestry. RESULTS: The frequencies of the rare SNP alleles ranged between 21% and 26% among cases, and 20-27% among controls, and were not statistically different between cases and controls. Two SNPs were in strong linkage disequilibrium (r(2) = 0.97 in cases and 0.94 in controls). The overall haplotype distributions did not differ between cases and controls. We observed 8 haplotypes with a frequency of >or=1% among cases and/or controls, but none of these haplotype frequencies differed significantly among cases and controls. Logistic regression analyses with adjustment for gender and smoking status did not reveal significant associations with AgP for any of the 5 SNPs. This study had a power of >or=95% to detect associations with variants carrying relative risks of >or=1.5 for heterozygote carriers and >or=2.25 for homozygote carriers. CONCLUSIONS: Although SNPs in the NOD1 gene have been strongly associated with cases of IBD, the current study failed to show an association of NOD1 SNPs with AgP.

Cigarette smoking enhances T cell activation and a Th2 immune response; an aspect of the pathophysiology in periodontal disease.

Smoking is a strong risk factor for periodontitis. Treated patients who smoke show increased risk for further periodontal breakdown, despite receiving maintenance care. Previous work indicated that such patients have a monocytic cytokine response favoring Th2 activity. The purpose of this study was to investigate the T lymphocytic cytokine production representing Th1 and Th2 subpopulations in smokers and non-smokers. Venous blood was collected from 30 treated periodontitis patients (12 smokers) and 24 healthy subjects (12 smokers). Whole blood cell cultures were stimulated and interferon (IFN)-gamma and interleukin (IL)-13 were measured in the culture supernatants, representing types 1 and 2 Th subpopulations, respectively. Unadjusted data showed that smokers had more lymphocytes, and higher levels of IFN-gamma and IL-13, irrespective of being periodontal patient. However in a multivariate analysis, increased IFN-gamma production was not significantly explained by smoking, while higher IL-13 was strongly explained by smoking (21%, p<0.001). We suggest that the increased Th activity and specifically an elevated Th2 profile in smokers may constitute a risk for smoking patients which may induce conversion of periodontal stability into progressive disease. This phenomenon may be equally important in other conditions, where connective tissue and bone loss are hallmarks of disease pathophysiology.

Effects of smoking on the ex vivo cytokine production in periodontitis.

BACKGROUND AND OBJECTIVE: Smoking is associated with increased severity of periodontitis. The underlying mechanisms of this phenomenon are not well understood. The purpose of the present study was to compare the monocyte-derived T cell directing (Th1/Th2) response and pro-inflammatory cytokine production in ex vivo whole blood cell cultures (WBCC) of smoking and non-smoking chronic periodontitis patients. MATERIAL AND METHODS: Venous blood was collected from 29 periodontitis patients (18 non-smokers and 11 smokers) receiving supportive periodontal treatment, and diluted 10-fold for WBCC. The WBCC were stimulated for 18 h with Neisseria meningitidis lipo-oligosaccharide (LOS) or Porphyromonas gingivalis sonic extract (Pg-SE). The production of the T cell directing cytokines interleukin (IL)-12 p40 and IL-10, as well as the pro-inflammatory cytokines IL-1beta, IL-6 and IL-8, was measured in the culture supernatants. RESULTS: After LOS stimulation of WBCC, smokers showed a lower IL-12 p40/IL-10 ratio than non-smokers (P < 0.05). Interleukin-1beta production was significantly lower in smokers compared with non-smokers after stimulation with either LOS or Pg-SE (P < 0.05). Interleukin-6 and IL-8 production was similar in WBCC from both smokers and non-smokers, for both LOS and Pg-SE. CONCLUSION: A more pronounced Th2 response in smoking periodontitis patients may be related to increased severity of the disease.

Validation of a dental image analyzer tool to measure alveolar bone loss in periodontitis patients.

BACKGROUND AND OBJECTIVE: Radiographs are an essential adjunct to the clinical examination for periodontal diagnoses. Over the past few years, digital radiographs have become available for use in clinical practice. Therefore, the present study investigated whether measuring alveolar bone loss, using digital radiographs with a newly constructed dental image analyzer tool was comparable to the conventional method, using intra-oral radiographs on film, a light box and a Schei ruler. MATERIAL AND METHODS: Alveolar bone loss of the mesial and distal sites of 60 randomly selected teeth from 12 patients with periodontitis was measured using the conventional method, and then using the dental image analyzer tool, by five dentists. The conventional method scored bone loss in categories of 10% increments relative to the total root length, whereas the software dental image analyzer tool calculated bone loss in 0.1% increments relative to the total root length after crucial landmarks were identified. RESULTS: Both methods showed a high interobserver reliability for bone loss measurements in nonmolar and molar sites (intraclass correlation coefficient > or = 0.88). Also, a high reliability between both methods was demonstrated (intraclass correlation coefficient nonmolar sites, 0.98; intraclass correlation coefficient molar sites, 0.95). In addition, the new dental image analyzer tool showed a high sensitivity (1.00) and a high specificity (0.91) in selecting teeth with > or = 50% or < 50% alveolar bone loss in comparison with the conventional method. CONCLUSION: This study provides evidence that, if digital radiographs are available, the dental image analyzer tool can reliably replace the conventional method for measuring alveolar bone loss in periodontitis patients.

Elevated platelet and leukocyte response to oral bacteria in periodontitis.

BACKGROUND: Periodontitis is associated with an increased risk for cardiovascular diseases (CVD), but the underlying mechanisms are poorly understood. Recently, we showed that platelets from periodontitis patients are more activated than those from controls. OBJECTIVE: Given the regularly occurring bacteremic episodes in periodontitis patients, we hypothesized that platelets and/or leukocytes from periodontitis patients are more sensitive to stimulation by oral bacteria, in particular the known periodontal pathogens, than platelets from control subjects. METHODS: Three-color flow cytometry analysis was performed to quantify activation of platelets (P-selectin, PAC-1, CD63) and leukocytes (CD11b) in whole blood from patients with periodontitis (n = 19) and controls (n = 18), with and without stimulation by oral bacteria. Phagocytosis was assessed by using green-fluorescent protein (GFP)-expressing Aggregatibacter actinomycetemcomitans (Aa). RESULTS: Neutrophils and monocytes were activated by all species of oral bacteria tested, but no differences were observed between patients and controls. In response to several species of oral bacteria, platelets from periodontitis patients showed, compared with controls, increased exposure of P-selectin (P = 0.027) and increased formation of platelet-monocyte complexes (P = 0.040). Platelet-leukocyte complexes bound and/or phagocytosed more GFP-Aa than platelet-free leukocytes (for neutrophils and monocytes, in both patients and controls, P < 0.001). CONCLUSIONS: In periodontitis, increased platelet response to oral bacteria is paralleled by increased formation of platelet-leukocyte complexes with elevated capacity for bacterial clearance. We speculate that activated platelets and leukocytes might contribute to increased atherothrombotic activity.

Expression of FcgammaRs and mCD14 on polymorphonuclear neutrophils and monocytes may determine periodontal infection.

Variance in expression of receptors for immunoglobulin G (FcgammaRs), complement (CR3) and lipopolysaccharide (mCD14) on polymorphonuclear neutrophils (PMNs) and monocytes might affect susceptibility for infection with certain pathogens in periodontitis, a chronic infectious disease of tooth-supportive tissues. Levels of FcgammaRI, IIa, III, CR3 and mCD14 on PMNs and monocytes were measured in 19 periodontitis patients and 18 healthy controls. Subgingival infection with Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) was determined. Activation of PMNs and monocytes in response to stimulation with Aa and Pg was assessed by means of change in mCD14 expression. Periodontitis is associated with an enrichment of the FcgammaRIII(+) monocytes (P = 0.015) with concomitant low mCD14 (P = 0.001). Unadjusted data showed that the subjects culture-positive for Aa (Aa(+)) had significantly lower expression of monocytic FcgammaRI (P = 0.005) and FcgammaRIIa (P = 0.015) than Pg(+) subjects. The FcgammaRI was still lower on monocytes from Aa(+) subjects after adjusting for the background factors (P = 0.037). PMNs from Aa(+) subjects responded in a hyper-reactive manner, in particular when stimulated with Aa (P = 0.011). Lower FcgammaRs expression by monocytes is related to a higher susceptibility of a subject to become infected with Aa. The higher proportion of FcgammaRIII(+) monocytes may be involved in the chronicity of this condition. Hyper-reactive PMNs in Aa(+) subjects may contribute to accelerated breakdown of tooth-supportive tissues.

Evaluation of two soft manual toothbrushes with different filament designs in relation to gingival abrasion and plaque removing efficacy.

OBJECTIVES: To evaluate the effect of two soft manual toothbrushes with different filament and brush head designs in relation to gingival abrasion and plaque removing efficacy to the in relation flat trimmed manual reference toothbrush of the American Dental Association (ADA). METHODS: The study had a randomized single use cross-over model (n = 76) with three sessions whereby all brushes were used by each subject. Subjects were asked to abstain from all oral hygiene procedures for 48 h. They brushed according to split-mouth design. Pre- and post-brushing plaque and gingival abrasion were assessed. RESULTS: The Sensodyne Sensitive (SENS) was more abrasive than the ADA (P < 0.001) while the Oral-B Sensitive Advantage (OBSA) was less abrasive than the SENS (P < 0.001). There was no statistically significant difference between the OBSA and the ADA (P = 0.319). All three brushes showed statistically significant reductions (49-56%) in plaque versus baseline. Compared to the ADA and the SENS, the OBSA had a smaller percentage of plaque removal (56% versus 49%, P

Tapered toothbrush filaments in relation to gingival abrasion, removal of plaque and treatment of gingivitis.

OBJECTIVES: To compare a tapered filament toothbrush (TFTB) to a control toothbrush (ADA) in their potential to cause gingival abrasion and improve the gingival condition following a period of experimental gingivitis. METHODS: Thirty-two subjects refrained from brushing mandibular teeth for 21 days. During a subsequent 4-week treatment phase, the left or right side of the mouth was brushed with either the TFTB or ADA as randomly allocated. Gingival abrasion, plaque and gingival bleeding were assessed. RESULTS: During the treatment phase gingival abrasion showed a trend to be lower with the TFTB than the ADA, which was significant at the 2-week assessment. The mean plaque scores changed from 2.98 (day 21) to 1.59 for the TFTB and from 3.00 (day 21) to 1.31 for the ADA. The mean bleeding scores changed from 1.86 (day 21) to 1.35 for the TFTB and from 1.85 (day 21) to 1.20 for the ADA. Plaque and bleeding scores were significantly lower with the ADA. CONCLUSIONS: Both toothbrushes improved gingival health and effectively removed plaque. Although there was a tendency towards fewer sites with gingival abrasion with the TFTB brush, it was less effective than the ADA in the removal of plaque biofilm and reduction of bleeding. Subjects considered the TFTB to be more pleasant to use.