The OralChromaTM CHM-2: a comparison with the OralChromaTM CHM-1.

OBJECTIVES: Already decades ago, the diagnosis of halitosis was facilitated with the arrival of chair-side instruments to score the breath odor. These devices are used for a more objective assessment of halitosis compared with organoleptic scoring, but these too have their disadvantages. To overcome some of the drawbacks of the original model of the OralChromaTM (CHM-1), few years ago a second generation of this machine (CHM-2) was introduced. This study compared both devices in a clinical setting. MATERIALS AND METHODS: All records of the patients visiting a specialized halitosis consultation over a period of 5 years (2012-2017) were examined. The correlations of the OralChromaTM CHM-1 and CHM-2 with the organoleptic and Halimeter® measurements were analyzed. Additionally the sensitivity, specificity, and negative and positive predicted values were calculated. RESULTS: A total of 581 data points were included (CHM-1: 292, CHM-2: 289). The correlations between both models with the organoleptic measurements were not statistically significant different. The CHM-2 seemed superior to the CHM-1 in the quantification of dimethyl sulfide with a detection rate of 95% and 61%, respectively. Additionally, the CHM-2 was significantly more sensitive for dimethyl sulfide than the CHM-1. However the latter showed in turn a better sensitivity for hydrogen sulfide and methyl mercaptan. CONCLUSION: The CHM-2 showed a better sensitivity for dimethyl sulfide than its predecessor. However, its sensitivity for hydrogen sulfide and methyl mercaptan was worse. CLINICAL RELEVANCE: Dimethyl sulfide is the main volatile implicated in extra-oral blood-borne halitosis, this makes the OralChromaTM CHM-2 the instrument of choice when this is suspected.

Influence of tongue brushing and scraping on the oral microflora of periodontitis patients.

OBJECTIVE: To examine the effect of tongue cleaning with a tongue scraper (TS) or toothbrush (TB) in patients with periodontitis. BACKGROUND: The tongue is a possible reservoir for bacterial (re)colonization of the periodontal tissues in patients with periodontitis. To date, it is not known what the influence of tongue cleaning is on the tongue coating of patients with periodontitis. MATERIAL AND METHODS: Eighteen systemically healthy, untreated moderate to severe adult patients with periodontitis with some degree of tongue coating were randomly assigned to the use of a TS or TB for cleaning the tongue. Microbial load of the saliva and tongue dorsum, amount of tongue coating and patient perception about tongue cleaning were studied at baseline and 2 weeks later. RESULTS: Two weeks of tongue cleaning with either a TB or a TS, did not influence the microbiological counts, neither in the saliva, nor in the tongue coating, even though tongue coating was significantly less. The patients themselves experienced no differences in breath odour or taste sensation after 2 weeks of tongue cleaning; however, they felt that their tongue was cleaner at the end of the study compared to baseline. No differences could be detected between the uses of a TS vs a TB. CONCLUSION: In patients with periodontitis, tongue cleaning does not influence the bacterial load in the saliva or on the tongue dorsum.

Periodontal screening and referral behaviour of general dental practitioners in Flanders.

OBJECTIVES: The objective of this study was to investigate the screening and referral behaviour of Flemish dentists concerning periodontitis and more specific, the use of the Dutch Periodontal Screening Index (DPSI). MATERIALS AND METHODS: An online questionnaire was electronically distributed through the different professional dental societies. It consisted of two parts: the first aimed at describing the profile of the dentist. The second part inquired the screening method, when this was applied, periodontal risk factors and referral behaviour. RESULTS: One thousand fifty dentists attended to the questionnaire. One hundred fifty-nine questionnaires were excluded since they did not match the target audience. Sixty-four percent of Flemish dentists used DPSI as a periodontal screening method, 28% screened based on probing pocket depth, 4% used solely radiographs and 4% had no screening method at all. The usage of DPSI is influenced by the year of graduation: the longer the dentists were graduated, the less they used DPSI. No influence of sex, education centre and location was found. Referral behaviour is influenced by different patient- and dentist-related factors. CONCLUSIONS: Regarding the screening behaviour, there seems a consensus among Flemish dentists that a periodontal probe should be used. For referral, there is no consensus about if and when to refer to a specialist. CLINICAL RELEVANCE: It is encouraging that 92% of the Flemish general dental practitioners use a probe when screening for periodontitis. However, DPSI is mainly used by younger dentists. An effort should be made to encourage all dentists to use this, so that in every patient, periodontitis can be detected timely, securing the best treatment outcome.

[Thyroid nodules: benign or malignant?]. / Le nodule thyroïdien: bénin ou malin?

A thyroid nodule is a frequent occurrence. Its prevalence in a general adult population is about 50% and can even reach 67% when a cervical echography is performed. Only 5% of these nodules are cancers, and it is therefore important to avoid an useless and riskful surgery. We review the clinical factors and diagnostic tools available to reach the best options. The patient history and clinical signs give some informations about potential risks. Thyroid tests shall evaluate thyroid functional status and a thyroid scintigraphy shall detect hot thyroid nodules. The thyroid echography is a key element before fine needle aspiration cytology. Some echographic criteria in the TIRADS (Thyroid Imaging Reporting and Data System), classification can reach a 88% sensitivity, a 49% specificity, a 49% positive predictive value, a 88% negative predictive value and a 94% diagnostic accuracy. The fine needle aspiration cytology performed with echography will be crucial to decide if the patient is to be eligible for surgery. In 70 to 80% of the cases, nodules can be classified as benign or malignant with a 92% negative predictive value for a benign diagnosis and a 100% positive predictive value for a diagnosis of cancer. The discovery of a follicular proliferation (cancer incidence of 20-30%) is a grey zone. Follicular proliferation and definite cancer lead of course to a surgical option. A decisional tree summarizes the different steps leading to a therapeutic decision. The type of surgery and its complications are described at the end.

Alternative therapies in controlling oral malodour: a systematic review.

Is there a role for alternative therapies in controlling intra-oral halitosis? Treatments other than tongue cleaning and anti-halitosis products containing zinc, chlorhexidine and cetylpyridinium chloride were considered as alternative therapies. Four databases were searched (PubMed, EMBASE, Web of Science and The Cochrane Library). Inclusion criteria were: examination of alternative halitosis therapies, study population with oral malodour, a (negative or positive) control group and evaluation of breath odour via organoleptic and/or instrumental assessment. Data were extracted for descriptive analysis. The screening of 7656 titles led to the inclusion of 26 articles. Analysis showed heterogeneity concerning the population of interest (from cysteine-induced to genuine halitosis), the examined treatment and the reported outcomes. This made a meta-analysis impossible. Essential oils, fluoride-containing products and herbal substances were the most studied. Results varied enormously and none of the active ingredients had an unambiguously positive effect on the malodour. The risk of bias was assessed as high in all articles. Given the fact that little evidence was found for each of the investigated treatments, it could be concluded that there is currently insufficient evidence that alternative therapies are of added value in the treatment of halitosis.Clinical relevanceScientific rationale:Halitosis is a common problem causing social isolation. Out of embarrassment, patients search the internet, leading to many questions about alternative solutions (e.g. oil pulling, herbs). This is the first systematic review on these alternative therapies.Principal findings: Results varied among studies. Some promising results were found for fluoride-containing toothpastes and probiotics. For other products (such as herbal and antibacterial products and essential oils) results were inconsistent. Long-term follow-up studies on these products are scarce. Moreover, the quality of the studies was poor.Practical implications:No clear evidence was found to support a certain alternative anti-halitosis therapy.

Importance of clinical and radiological follow-up in head and neck cancers.

PROBLEMS/OBJECTIVES: To evaluate the relevance of routine head and neck ultrasonography (US), computed tomography (CT), chest X-ray, and standard clinical examination for the early detection of recurrences, second primary tumours, and distant metastases in the followup of patients treated for head and neck cancers. METHODOLOGY: Retrospective cohort study. RESULTS: One hundred ninety-five patients were reviewed. Seventy-one recurrences appeared during the follow-up period. Five recurrences were diagnosed during head and neck US and CT. Sixty-four recurrences were diagnosed based on patients' complaints or standard clinical examination. Two lung malignancies were diagnosed during the annual chest Xray. CONCLUSION: Systematic head and neck US and CT exams revealed recurrent cancers with poor efficiency and should be performed only after clinical suspicion of recurrence or second primary tumours. The value of an annual chest X-ray remains debatable. Routine clinical follow-up is clearly crucial for the detection of early recurrences and second primary tumours.

Increase in cariogenic bacteria after initial periodontal therapy.

This study examined the hypothesis of an intra-oral shift, during initial periodontal therapy, from a periopathogenic to a cariogenic flora. Seventy-one patients with periodontitis were randomly allocated to one of the following treatment strategies: (1) scaling and root planing, quadrant by quadrant, at two-week intervals (NC); (2) full-mouth scaling and root planing within 24 hrs (FRP); or (3) full-mouth disinfection within 24 hrs, including antiseptics [chlorhexidine (CHX) or amine fluoride/stannous fluoride (F) for 2 mos, or CHX for 2 mos followed by F for 6 mos (CHX+F)]. At baseline and after 2, 4, and 8 mos, bacterial samples were taken from supra- and subgingival plaque, saliva, and tongue. The detection frequencies and relative proportions of Streptococcus mutans increased in the NC and FRP groups, but decreased in the F group. In the CHX group, these species disappeared temporarily, but they disappeared for the entire 8 mos in the CHX+F group. These observations were similar for all sample locations. The periopathogens decreased in all groups. This finding confirms the abovementioned hypothesis and indicates a need for caries prophylactic regimens.

Full- vs. partial-mouth disinfection in the treatment of periodontal infections: short-term clinical and microbiological observations.

In a standard periodontal treatment strategy with consecutive root planings (per quadrant at a one- to two-week interval), re-infection of a disinfected area might occur before completion of the treatment. This study examines, both clinically and microbiologically, whether a full-mouth disinfection within 24 hours significantly improves the outcome of periodontal treatment. Ten patients with advanced chronic periodontitis were randomly allocated to a test and a control group. The patients from the control group received scalings and root planings as well as oral hygiene instructions per quadrant at two-week intervals. Full-mouth disinfection in the test group was sought by the removal of all plaque and calculus (in two visits within 24 hours). In addition, at each of these visits, the tongue was brushed with a 1% chlorhexidine gel for one min and the mouth rinsed with a 0.2% chlorhexidine solution for two min. Furthermore, subgingival chlorhexidine (1%) irrigation was performed in all pockets. The recolonization of the pockets was retarded by oral hygiene and 0.2% chlorhexidine rinses during two weeks. The clinical parameters were recorded, and plaque samples were taken from the right upper quadrant at baseline and after one and two months. The test group patients showed a significantly higher reduction in probing depth for deep pockets at both follow-up visits (p < 0.05). At the one-month visit, differential phase-contrast microscopy revealed significantly lower proportions of spirochetes and motile rods in the test group (p = 0.01). Culturing showed that the test group harbored significantly fewer pathogenic organisms at one month (p = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Discriminating power of five plaque indices.

Since plaque plays a major role in the development of periodontal inflammation, special attention is paid to its composition and quantity. Several indices have been designed for the quantification of the supragingival plaque. The aim of the present study was to compare the utility and discriminating power of five such plaque indices. In 14 subjects, three teeth were selected randomly on which the undisturbed plaque formation was studied over a period of 96 hours. This examination was performed twice, the first time after induction of gingivitis and a second time starting with a healthy gingiva. It is known that in the presence of gingival inflammation, the plaque growth rate slightly increases. Plaque formation was estimated at several visits with the following indices: Harrap index, Quigley and Hein index, Navy index modified by Clemmer and Barbano, Navy index modified by Hancock and Wirthlin, and a planimetrical plaque scoring system. The path of the plaque growth curve was found to depend on the selected plaque index, going from an exponential curve (planimetry) over an sigmoidal curve (Harrap index, Navy index modified by Hancock and Wirthlin) to a nearly linear relation (Quigley and Hein, Navy index modified by Clemmer and Barbano). By comparing the plaque scores on patients with healthy gingiva with those from patients with inflamed gingiva, it was found that the planimetrical plaque index had a clearly higher discriminating power. It was concluded that the choice of an index for the measurement of the plaque extension depends on the goals of the study.

The influence of gingival inflammation, tooth type, and timing on the rate of plaque formation.

The undisturbed supragingival plaque formation was recorded twice over a 100 hours period in 14 healthy dental students; first after induction of gingival inflammation and a second time starting from a healthy gingiva. During each experimental segment plaque formation was recorded on 42 randomly selected and clean teeth at the start and after 6, 12, 24, 30, 36, 48, 54, 60, 72, 84, and 96 hours. Four hours later all teeth up to the first molars were examined. The presence of disclosable plaque was calculated planimetrically as percent of the total labial surface area of the tooth. The rate of plaque formation was found to be significantly greater (P = 0.001) in the presence of gingival inflammation (+ 29.0%). Moreover, this study indicates an important variation in the plaque growth rate within the dentition; the highest scores were found for the upper premolars, the upper molars, and the lower front teeth. Finally, the rate of plaque formation was found to decrease during the night.

One stage full- versus partial-mouth disinfection in the treatment of chronic adult or generalized early-onset periodontitis. I. Long-term clinical observations.

BACKGROUND: A standard treatment strategy for periodontal infections often consists of 4 consecutive sessions of scaling and root planing (per quadrant, at 1- to 2-week intervals), without proper disinfection of the remaining intra-oral niches for periodontopathogens. This could theoretically lead to a reinfection of previously disinfected pockets by bacteria from an untreated region/niche. This study aimed to investigate, over an 8-month period, the clinical benefits of a one stage full-mouth disinfection in the control of severe periodontitis. METHODS: Sixteen patients with early-onset periodontitis and 24 patients with severe adult periodontitis were randomly assigned to test and control groups. The control group was scaled and root planed, per quadrant, at 2-week intervals and given standard oral hygiene instructions. A one stage full-mouth disinfection (test group) was sought by scaling and root planing the 4 quadrants within 24 hours in combination with the application of chlorhexidine to all intra-oral niches for periodontopathogens. Besides oral hygiene, the test group also rinsed twice daily with a 0.2% chlorhexidine solution and sprayed the tonsils with a 0.2% chlorhexidine spray, for 2 months. The plaque index, gingival index, probing depth, bleeding on probing, gingival recession, and clinical attachment level were recorded at baseline and at 1, 2, 4, and 8 months afterwards. RESULTS: The one stage full-mouth disinfection resulted, in comparison to the standard therapy, in a significant (P <0.001) additional probing depth reduction and gain in attachment up to 8 months. For initial pockets > or =7 mm, the "additional" probing depth reduction at the 8 month follow-up was 1.2 mm for single-rooted and 0.9 mm for multi-rooted teeth, with corresponding additional gains in attachment of 1.0 mm and 0.8 mm, respectively. The additional improvements were observed for all subgroups (adult periodontitis, generalized early-onset cases, smokers), with the largest differences in the non-smoking adult periodontitis patients. CONCLUSIONS: These findings suggest that a one stage full-mouth disinfection results in an improved clinical outcome for the treatment of chronic adult or early-onset periodontitis as compared to scaling and root planing per quadrant at 2-week intervals.

Full- versus partial-mouth disinfection in the treatment of periodontal infections. Long-term clinical observations of a pilot study.

A classical treatment for chronic adult periodontitis consists of four to six consecutive sessions of scaling and root planing at a 1- to 2-week interval. Such a so-called "quadrant or sextant therapy" might result in a reinfection of a previously disinfected area by bacteria from an untreated region. The purpose of this study was to investigate, over an 8-month period, the clinical benefits of full-mouth disinfection within a 24-hour period in the control of chronic periodontitis. Ten adult patients with advanced chronic periodontitis were randomly assigned to a test and a control group. The control group received the standard scheme of initial periodontal therapy, consisting of scaling and root planing of the four quadrants was performed within 24 hours and immediately followed by a thorough supra- and subgingival chlorhexidine application to limit any transfer of bacteria. The latter involved tongue brushing with a 1% chlorhexidine gel for 60 seconds, mouthrinsing with a 0.2% chlorhexidine solution twice for 60 seconds, repeated subgingival irrigation of all pockets with a 1% chlorhexidine gel (3 times within 10 minutes), and mouthrinsing twice daily with a 0.2% chlorhexidine solution during 2 weeks. In addition, both groups received thorough oral hygiene instructions. The plaque index, gingival index, probing depth, gingival recession, and bleeding on probing were recorded prior to professional cleaning and at 1, 2, 4, and 8 months afterwards. Although the test group scored higher plaque indices than the control group, especially at months 2 and 4, the gingival index and bleeding tendency showed similar improvements with time. However, when the gingival/plaque ratio was considered, the latter was lower in the test group at all follow-up visits. For pockets > or = 7 mm, full-mouth disinfection showed a significantly (P = 0.01) higher reduction in probing depth at each follow-up visit with, at month 8, a reduction of 4 mm (from 8 mm to 4 mm), in comparison to 3 mm (from 8 mm to 5 mm) for the classical therapy. The increase in gingival recession in the full-mouth disinfection group remained below 0.7 mm, while in the control group it reached 1.9 mm after 8 months. This resulted in a gain of clinical attachment level of 3.7 mm for the test group versus 1.9 mm for the control group. A radiographical examination also indicated a superior improvement for the test group when compared to the control group. This pilot study suggests that a full-mouth disinfection in one day results in an improved clinical outcome in chronic periodontitis as compared to scalings per quadrant at 2-week intervals over several weeks.

CT scan standard reconstruction technique for reliable jaw bone volume determination.

Computed tomography can assist the surgeon in planning the exact three-dimensional positioning of endosseous implants in the jaw bone. This study examined the reliability of three CT techniques: direct imaging (normal coronal and sagittal slices), standard reconstruction (based on axial slices), and multiplanar reconstruction and display (also based on axial slices). The three imaging techniques were used to estimate the bone height, bone width, and maximal implant length in six dissected human jaw bones. These jaws were then sawed perpendicular to their axis to enable measurement of real values for comparison. The sagittal and coronal slices frequently were overestimated, especially in the canine and premolar regions. The mean absolute deviation was 1.4 mm. Standard reconstruction offered the most reliable cross-sectional images, with a mean absolute deviation of 0.5 mm. The multiplanar reconstruction and display technique frequently demonstrated underestimations (mean absolute deviation was 2.3 mm). The standard reconstruction technique seems to be the method of choice in preoperative radiographic examination of patients before implant placement.

Instrumental assessment of halitosis for the general dental practitioner.

At the moment there are no clear protocols for the assessment of bad breath. An organoleptic evaluation is still the reference. To date there are several tools available to detect and quantify specific compounds related to halitosis. This paper reviews the available information on three sulphur monitors (OralChroma™ (CHM-1), Halimeter® and Breathtron®), in order to suggest guidance for the general dental practitioner. All three devices showed an acceptable correlation with organoleptic scores. The Halimeter® and Breathtron® seem the most appropriate devices for a general dental practitioner, because they are easy to handle. Because of its capacity of distinguishing between different sulphur compounds and due to its time-consuming and complicated use, the OralChroma™ (CHM-1) seems more suitable in a research environment.

Degradation of bare and silanized silicon wafer surfaces by constituents of biological fluids.

The 24 h stability of bare silicon wafers as such or silanized with CH(3)O-(CH(2)-CH(2)-O)(n)-C(3)H(6)-trichlorosilane (n=6-9) was investigated in water, NaCl, phosphate and carbonate solutions, and in phosphate buffered saline (PBS) at 37 °C (close to biological conditions regarding temperature, high ionic strength, and pH). The resulting surfaces were analyzed using ellipsometry, X-ray Reflectometry (XRR), X-ray Photoelectron Spectroscopy (XPS), and Atomic Force Microscopy (AFM). Incubation of the silanized wafers in phosphate solution and PBS provokes a detachment of the silane layer. This is due to a hydrolysis of Si-O bonds which is favored by the action of phosphate, also responsible for a corrosion of non-silanized wafers. The surface alteration (detachment of silane layer and corrosion of the non-silanized wafer) is also important with carbonate solution, due to a higher pH (8.3). The protection of the silicon oxide layer brought by silane against the action of the salts is noticeable for phosphate but not for carbonate.

[Does good oral hygiene guarantee the maintenance of a health periodontium?]. / Une hygiène bucco-dentaire correcte peut-elle garantir le maintien d'un parodonte sain?

On the last European Workshop for Periodontology, it was accepted that the prevalence of periodontitis in certain regions of Europe and USA has decreased. It remains difficult to phrase a decision concerning the prevalence of periodontitis in general. This article wants to highlight the need of a good oral hygiene and different forms of prevention (primary, secondary & tertiary) in the maintenance of a healthy periodontium. The relationship between gingivitis and tooth loss is pointed out. The prevention is described in the complexity of the periodontitis proces and it's modifying factors. When dealing with different forms of periodontitis (refractory, necrotising gingivitis and periodontitis, agressive periodontitis) prevention needs to be adjusted to the etiology and specific situation. This is also the case in peri-implantitis. This article tends to find a scientific background for oral hygiene and prevention in periodontal disease.

[Dentifrices:an evaluation based on the current literature]. / Dentifrices: évaluation sur base de la littérature actuelle.

Toothpastes remain a frequently used auxilary in oral hygiene. Although some new components have been introduced, the base composition does not differ much between toothpaste types. Concerning toothpastes there is a thin border between cosmetics and drugs and it becomes more and more difficult for oral health care workers to prescribe the right toothpaste for the right patient. Production companies are frequently using commercial advertisements to promote their product. In this way, it's getting more and more difficult for the dentist (and patient) to find the suitable product. This literature review aims to search for scientific evidence for toothpaste components and their clinical use. In this way the review can be used as a compendium for health care workers to make the right choice in prescribing toothpastes. Furthermore all available toothpastes on the Belgian market are listed, following their composition.

[Mouthwashes: the supply in Belgium reviewed on the basis of recent literature]. / Les bains de bouche: l'offre en Belgique examinée sur base de la littérature récente.

In recent days mouthrinses became a more and more popular tool in the oral hygiene regime. Different manufacturers commercialize their products in the grey area between cosmetics and medicine. However, one must realize that these products must be used within the limitations of their potential. The aim of this article is to present a complete overview of mouthrinses--and their active components--available on the Belgian market based on the recent literature. The focus is placed mainly on their antibacterial capacity, but also other indications such as anticariogenic activity, halitosis management, hypersensitivity management, anti-mucositis and anti-erosive actions are discussed.

[Electric toothbrushes]. / Les brosses à dents électriques.

In the 19th century, the first electric toothbrush was introduced. As years gone by, the design and brushhead movements have been constantly changing. Companies claim that electric toothbrushes are more efficient than manual toothbrushes. In this literature review, the importance of the different brushhead movements, brushing time and brushing force and their impact on microbiology and gingival recession is pointed out. Furthermore, the efficiency of electric toothbrushes is evaluated through the available scientific evidence.