Patient perceptions of buccal gingival recessions and requests for treatment.

AIMS: The aims of this study were to verify patients' perception of buccal recessions and their requests for treatment. METHODS: The patients filled out a questionnaire dealing with demographic variables and perception of buccal gingival recessions. A calibrated examiner checked for recessions and recorded the clinical variables. Then, the patients were asked to explain what they believed to be the causes of the recessions and whether they were interested in obtaining treatment of their lesions. Descriptive statistics and multilevel logistic models were used. RESULTS: Of 120 enrolled patients, 96 presented 783 gingival recessions, of which 565 were unperceived. Of 218 perceived recessions, 160 were asymptomatic, 36 showed dental hypersensitivity, 13 aesthetics, 9 aesthetic + hypersensitivity issues. Only 11 patients requested treatment for their 57 recessions. Younger individuals (p = 0.0077), deeper recessions (p < 0.0001), incisors and canines (p < 0.0001) and non-carious cervical lesions (p = 0.0441) were significantly associated with patient perception of own recessions. Younger subjects (p = 0.0118), deeper recessions (p = 0.0387) and incisors (p = 0.0232) were significantly associated with patient request of treatment. Four hundred and sixty-eight recessions (60%) were not ascribed to exact causes by the patients. CONCLUSION: This study shows that perception of gingival recessions and the patients' requests for treatment should be evaluated carefully before proceeding with decision making.

Efficacy of a U-Shaped Automatic Electric Toothbrush in Dental Plaque Removal: A Cross-Over Randomized Controlled Trial.

BACKGROUND: The aim of this single-use, four-treatment, four-period (visit), cross-over, mono-centered, examiner-blind, cross-over randomized controlled trial (RCT) was to evaluate the efficacy in dental plaque removal of a U-shaped automatic electric toothbrush (U) compared to a conventional powered toothbrush (P), a habitual toothbrushing procedure (H), and no brushing (N). METHODS: Eligible participants were volunteer students. Primary outcome measure was the reduction in full-mouth plaque score (FMPS) after brushing. The secondary outcome variable was a visual analogic scale (VAS) on subjective clean mouth sensation. Mixed models were performed for difference in FMPS and VAS. RESULTS: Twenty-two participants were randomized to the treatments in the four periods of the study. The differences between treatments in FMPS reduction after brushing were statistically significant (p < 0.0001). The differences were statistically significant between the U and P groups (difference -48; 95% CI from -54 to -41) favoring the P group, and between the U and H groups (difference -45; 95% CI from -52 to -39) favoring the H group. On the contrary, the difference between the U and N groups was not significant (difference 5; 95% CI from -2 to 12) favoring the U group. The differences between treatments in clean mouth VAS was statistically significant (p < 0.0001) favoring the P and H groups. CONCLUSIONS: The U-shaped automatic electric toothbrush tested in this study proved to be not effective in removing dental plaque.

Professional oral hygiene procedures do not influence plasma glucose levels in systemically healthy individuals: a short-term, randomised, controlled trial.

PURPOSE: The treatment of gingival inflammation is associated with improved glycaemic control in diabetic patients. The goal of this parallel-randomised controlled trial (RCT) was to test the shortterm effects of professional oral hygiene procedures on plasma glucose levels in systemically healthy individuals. MATERIALS AND METHODS: Systemically healthy individuals with gingivitis and no sign of periodontitis were enrolled at a private practice in Italy. Patients were randomised to either a 1 hour (h) session of professional oral hygiene procedures or to 1 h in the waiting room. Not fasting blood glucose levels were assessed by a blind examiner at baseline (T0), 1 h (T1) and 2 h (T2) after procedures and finally 1 week after (T3). Oral hygiene procedures were then performed also in the control group. RESULTS: Twenty patients were randomly allocated to each group. There were no drop-outs. Blood glucose levels at T0 (P = 0.0001) and time of measurement (P = 0.0001) were statistically significant, while oral hygiene procedures were not (mean difference between groups 0.77 mg/dl, 95%CI -2.64 mg/dl; 4.18 mg/dl, P = 0.6581). Mean blood glucose levels decreased between T0 and T1, were stable between T1 and T2 and showed similar levels to baseline after 1 week (T3) for both groups. CONCLUSION: This short-term RCT showed that professional oral hygiene procedures were not able to influence plasma glucose levels in individuals with gingivitis, but otherwise systemically healthy.

Surgical treatment of single gingival recessions: clinical guidelines.

PURPOSE: The purpose of this clinical guidelines project was to determine the most appropriate surgical techniques, in terms of efficacy, complications, and patient opinions, for the treatment of buccal single gingival recessions without loss of interproximal soft and hard tissues. METHODS: Literature searches were performed (electronically and manually) for entries up to 28 February, 2013 concerning the surgical approaches for the treatment of gingival recessions. Systematic reviews (SRs) of randomised controlled trials (RCTs) and individual RCTs that reported at least 6 months of follow-up of surgical treatment of single gingival recessions were included. The full texts of the selected SRs and RCTs were analysed using checklists for qualitative evaluation according to the Scottish Intercollegiate Guidelines Network (SIGN) method. The following variables were evaluated: Complete Root Coverage (CRC); Recession Reduction (RecRed); complications; functional and aesthetic satisfaction of the patients; and costs of therapies. RESULTS: Out of 30 systematic reviews, 3 SRs and 16 out of 313 RCTs were judged to have a low risk for bias (SIGN code: 1+). At a short-term evaluation, the coronally advanced flap plus connective tissue graft method (CAF+CTG) resulted in the best treatment in terms of CRC and/or RecRed; in case of cervical abrasion and presence of root sensitivity CAF + CTG + Restoration caused less sensitivity than CAF+CTG. CAF produced less postoperative discomfort for patients. Limited information is available regarding postoperative dental hypersensitivity and aesthetic satisfaction of the patients. CONCLUSION: In presence of aesthetic demands or tooth hypersensitivity, the best way to surgically treat single gingival recessions without loss of interproximal tissues is achieved using the CAF procedure associated with CTG. Considering postoperative discomfort, the CAF procedure is the less painful surgical approach, while the level of aesthetic satisfaction resulted higher after CAF either alone or with CTG. It is unclear how much tooth hypersensitivity is reduced by surgically covering buccal recessions. It is important to note that the present recommendations are based on short-term data (less than 1 year). SOURCE OF FUNDING: The guidelines project was made possible through self-financing by the authors.

Efficacy and preference of manual toothbrushes: a randomised, single blind, controlled trial.

PURPOSE: Toothbrushes are manufactured in different designs but it is unclear whether these differences may lead to improvement in the removal of bacterial plaque or make the toothbrushes more appealing to users. The aim of this study is to compare the efficacy of 11 toothbrushes in terms of plaque removal and their acceptance by patients. MATERIALS AND METHODS: Eleven toothbrushes were randomly assigned to one of the 12 sectors of the mouth of 48 patients. Each patient underwent one plaque recording before and after toothbrushing. Eleven sectors of the mouth were brushed by 11 different toothbrushes, while one sector was used as a control (no toothbrushing). Two questionnaires were also administered to investigate the aesthetic and comfort preference by each participant. RESULTS: All 11 toothbrushes resulted in effective plaque reduction with respect to the control sector (P < 0.0001). No significant differences were found between them. Colgate Massager showed the highest score for aesthetic preference by the patients when compared with Butler 311 and Gum Super Tip 463 (P = 0.0148). Oral-B Indicator 35 exhibited the highest score in terms of comfort felt by the patients compared to Colgate Omni and Gum Technique 493 (P = 0.0095). CONCLUSIONS: All of the tested toothbrushes, even though different with respect to shape and scope of function, demonstrated efficacious plaque removal.