Factors influencing the oral health behaviour of Dutch adolescents with mild to borderline intellectual disabilities living in residential care: A qualitative study.

BACKGROUND: Toothbrushing, limiting intake frequency, and scheduled visits to an oral healthcare professional (OHP) are key for good oral health. We aimed to explore factors influencing these oral health behaviours in Dutch adolescents with mild to borderline intellectual disabilities (MBID) in residential care. METHOD: Using a qualitative, descriptive approach, we conducted focus groups and interviews with 12 adolescents, 9 counsellors, and 6 OHPs. Thematic analysis mapped factors influencing adolescents' knowledge, attitude, planning, and execution of oral health behaviours to oral care stakeholders. RESULTS: Of nine identified influencing factors, three were pivotal: Structure (influencing toothbrushing and intake frequency), Anxiety (impeding dental visits), and Support (provided by counsellors). CONCLUSIONS: Counsellors should provide structured daily guidance on oral hygiene and diet for adolescents with MBID, while respecting the adolescents' autonomy. As intermediaries between adolescents and OHPs, counsellors are key in reducing dental anxiety. Counsellors need clear oral health policies within care facilities to address competing priorities.

Microbiological status at intake in relation to clinical periodontal status at intake and the response to non-surgical periodontal therapy-A retrospective analysis.

AIM: Retrospective analysis of subgingival microbiological data at intake in relation to the clinical periodontal status at intake and following non-surgical periodontal treatment. MATERIALS AND METHODS: Data were obtained from a population that consisted of patients diagnosed with moderate-to-severe periodontitis who had undergone non-surgical periodontal treatment between 2016 and 2020. The presence and number of eight selected putative periodontal pathogens [Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf), Parvimonas micra (Pm), Fusobacterium nucleatum (Fn), Treponema denticola (Td) and Filifactor alocis (Fa)] at intake and the percentage of teeth and sites with PPD >5 mm at intake and after treatment were extracted. Correlations within collected data were analysed with adjustment for multiple comparisons. Sub-analyses were performed based on gender, age, and smoking and diabetic status. RESULTS: Six hundred and sixty-one patients could be included. The percentage of teeth with PPD >5 mm and the percentage of sites with PPD >5 mm at intake were significantly correlated to Pi, Tf, Pm, Fn and Fa. Patients with higher numbers of these pathogens at intake had a better treatment response. Those patients with higher numbers of Aa had a lower percentage of teeth and sites with PPD >5 mm at intake. Those with higher numbers of Aa also showed a smaller decrease in the percentage of sites with PPD >5 mm. CONCLUSION: The clinical periodontal status at intake and the response to treatment showed a weak but significant positive relationship for Pi, Tf, Pm, Fn and Fa. Conversely, higher numbers of Aa at intake were associated with more localized periodontitis and a reduced treatment response.

The efficacy of an oscillating-rotating power toothbrush compared to a high-frequency sonic power toothbrush on parameters of dental plaque and gingival inflammation: A systematic review and meta-analysis.

AIM: To establish the efficacy of oscillating-rotating power toothbrush (OR-PTB) compared to high-frequency sonic power toothbrush (HFS-PTB) on improving parameters of plaque and gingival inflammation. Safety and participants' preference were secondary interests. MATERIALS AND METHODS: MEDLINE-PubMed and Cochrane-CENTRAL databases were searched, up to April 2021. Inclusion criteria were (randomized)controlled clinical trials that evaluated healthy humans brushing with an OR-PTB compared to a HFS-PTB. Evaluation for a minimum of 4 weeks, of one or more of the following parameters: plaque index scores (PI), bleeding scores (BS), number of bleeding sites (NoB) and gingival index scores (GI). RESULTS: Thirty two publications involving 38 comparisons were included after the independent screening. The descriptive analysis showed that in 54% of the comparisons, a significant difference in favour of the OR-PTB was found for PI, BS and GI scores. The Quigley and Hein index showed a significant difference of means (DiffM) between the end scores (DiffM 0.13, 95% CI [0.05;0.21] p < 0.001), as well as for the Rustogi-modified Navy index (DiffM 0.01, 95% CI [0.01;0.03] p = 0.002). This is in line with the meta-analysis for BS (DiffM 0.09, 95% CI [0.03;0.14] p = 0.003), for which the results were in favour of the OR-PTB and considered potentially clinically relevant. NoB showed a significant difference in favour of the OR-PTB for the end scores (DiffM 3.61, 95% CI [2.63;4.58] p < 0.00001). No difference in safety was indicated, 78% of participants preferred the OR-PTB. CONCLUSION: For patients to maintain good plaque control and improve gingival health, there is a small but significant difference based on longer-term studies between OR-PTB and HFS-PTB. This difference is potentially clinically relevant.

SARS-CoV-2 TEST OUTCOMES AMONG DENTISTS AND DENTAL HYGIENISTS WITH COVID-19-LIKE COMPLAINTS - A RETROSPECTIVE ANALYSIS FROM THE NETHERLANDS.

OBJECTIVE: This retrospective analysis aimed to evaluate, among individuals with COVID-19-like symptoms, the percentage of SARS-CoV-2 positive oral health care workers relative to health care workers in general and a non-close-contact occupation reference group in the Netherlands. MATERIALS AND METHODS: Data was retrospectively analyzed based on data extracted from the CoronIT database. This contained mass testing data for those experiencing symptoms compatible with COVID-19 recorded from June 2020 up to February 2021. The total number of tests taken and the number of SARS-CoV-2 positive tests were assessed. Sub-analyses were performed for oral health care and health care workers based in professional working locations, long-term care facilities, hospitals, or elsewhere. RESULTS: In total, data from 1,999,390 tests were obtained. Overall, 9.4% tested positive for SARS-CoV-2 in the three occupational groups. This was 9.2% for oral health care workers, 9.5% for health care workers, and 9.3% for the non-close-contact occupation reference group. For the three occupational groups the adjusted odds ratio with the month as covariate varied from 0.76 to 1.12. The odds ratio for oral health care workers compared to health care workers was 1 [95% CI:0.95;1.05] and 0.97 [95% CI:0.92;1.02] compared to the non-close-contact occupation reference group. Interpretation of the magnitude of the odds ratio indicates that the observed differences are none to very small. CONCLUSION: During the pandemic oral health care providers were required to adhere to the COVID-19-specific amendments to the national infection control guidelines. Based on the data gathered, dentists and dental hygienists with COVID-19-like symptoms do not test SARS-CoV-2 positive more often than other health care workers or those with a non-close-contact occupation. This supports the assumption that working during the pandemic using the Dutch standard hygiene guideline supplemented with the COVID guideline for oral health care is adequately safe.

Dental plaque score reduction with an oscillating-rotating power toothbrush and a high-frequency sonic power toothbrush: a systematic review and meta-analysis of single-brushing exercises.

AIM: To establish the effect of a single-brushing exercise on dental plaque removal using an oscillating-rotating power toothbrush (OR-PTB) as compared to a high-frequency sonic power toothbrush (HFS-PTB). MATERIALS AND METHODS: The MEDLINE-PubMed and Cochrane-CENTRAL databases were searched up to September 2019. The inclusion criteria contained (randomized) controlled clinical trials involving healthy adult participants brushing with an OR-PTB as compared to an HFS-PTB. Plaque index (PI) scores were evaluated after a single-brushing exercise. RESULTS: A total of 15 publications were included, representing 34 comparisons, of which 8 were professional brushing exercises and 26 participant brushing exercises. The potential risk of bias was estimated to be low. In the overall descriptive analysis of 34 comparisons, 19 comparisons showed a statistically significant difference in favour of the OR-PTB and 4 in favour of the HFS-PTB. The meta-analysis using the professional brushing study design showed a significant difference of means (DiffM) in favour of the OR-PTB (PI score) (DiffM 0.19; P < .0001) (95% CI [013; 0.25]). In those studies where the participants brushed themselves, the data were inconclusive. PI scores showed no difference between the two brushes (P = .15), while one plaque index (the Rustogi Modified Navy plaque index) indicated significant favour for the OR-PTB (DiffM 0.06; P = .002) (95% CI [0.02; 0.09]). CONCLUSION: Based on the estimated evidence profile, there is moderate certainty of evidence of a very small but significant beneficial effect on plaque removal after a single-brushing exercise with the OR-PTB over the HFS-PTB.

Do natural ingredients in a dentifrice contribute to prevention of plaque and gingivitis?

OBJECTIVE: To test the effectiveness of a dentifrice containing the turmeric and licorice extract compared to a control for preventing plaque and gingivitis over a four-month period. MATERIAL AND METHODS: Ninety (non-dental) participants with moderate gingival inflammation (≥ 40%) were selected. The triple blind study consisted of two phases, namely at first a 3-week pre-experimental phase of using an oxygenating and chlorhexidine (CHX) mouthrinse. Secondly, a 4-month experimental period in which participants were randomly assigned to a test or control group. All were instructed to brush their teeth twice daily for 2 minutes with their assigned dentifrice. Gingival bleeding (BI), plaque (PI) and gingivitis (GI) were assessed. RESULTS: Eighty participants completed the protocol. At the first assessment in the pre-experimental phase, the mean scores of all indices showed no differences for the two groups. At the second session, the values of all three parameters had decreased significantly (p < 0.001). At the last session, the BI values were 0.52(0.25) for the test group and 0.56(0.25) for the control, the mean GI was 0.27(0.17) for the test group and 0.31(0.16) for the control, and for PI the scores were 1.89(0.46) for the test group and 1.98(0.43) for the control group. Statistical comparison of the scores for the two groups at each stage of the study showed no significant difference for any of the parameters. CONCLUSION: Within the limits of the current study design, dentifrice formulation and concentration of turmeric/licorice extracts, the results show that the adjuvant effect of the natural ingredients in the test dentifrice was not evident on clinical parameters of gingivitis and plaque.

Mechanical plaque removal of periodontal maintenance patients: A systematic review and network meta-analysis.

AIM: This systematic review synthesizes the available clinical evidence concerning efficacy of mechanical oral hygiene devices in periodontal maintenance patients. MATERIAL AND METHODS: Three databases were searched up to October 2019 for clinical trials conducted in adult patients in periodontal maintenance which evaluated the effect of toothbrushes or an interdental device on plaque removal and parameters of periodontal diseases. Descriptive analysis and network meta-analysis (NMA) were performed. RESULTS: Sixteen eligible publications, including 17 relevant comparisons, were retrieved. Four out of five comparisons found no clinical difference between a manual and power toothbrush. Of the interdental cleaning devices, the interdental brushes (IDBs) reduced plaque scores more effectively than a manual toothbrush alone. For the oral irrigator, two out of three comparisons indicated a positive effect on gingivitis scores, and probing pocket depth. The NMA demonstrated that for plaque removal the adjuvant use of IDBs was significantly more effective than the manual toothbrush alone. For the reduction of gingival inflammation, no product ranked higher than the manual toothbrush. CONCLUSION: Due to the scarcity of studies that met the inclusion criteria for each of the oral hygiene devices and the low certainty of the resultant evidence, no strong "evidence-based" conclusion can be drawn concerning any specific oral hygiene device for patient self-care in periodontal maintenance.

What is the effect of active ingredients in dentifrice on inhibiting the regrowth of overnight plaque? A systematic review.

OBJECTIVES: The aim of this systematic review was to establish the adjuvant clinical effect of brushing with a dentifrice containing purported active ingredients as compared to a regular sodium fluoride dentifrice with respect to the inhibition of overnight dental plaque regrowth from studies with human participants. METHODS: MEDLINE-PubMed, EMBASE and Cochrane CENTRAL were searched, up to June 2019. The inclusion criteria were controlled clinical trials with participants aged ≥ 18 years in good general health. Studies were included that evaluated the effect of toothbrushing with a dentifrice on the inhibition of overnight dental plaque regrowth when an active ingredient was added to the dentifrice as compared to a common sodium fluoride product. Data were extracted from the eligible studies, the risk of bias was assessed, and a meta-analysis was performed where feasible. RESULT: Independent screening of 213 unique papers resulted in 10 eligible publications that provided 14 comparisons. Stannous fluoride and triclosan dentifrices were found as the active ingredients. The descriptive analysis indicated that all, but two comparisons demonstrated an additional effect on the active-ingredient dentifrice. The meta-analysis supported and strengthened these findings. It showed that when plaque was scored digitally, a DiffM was -3.15(95% CI [-4.61:-1.69], P < .001, prediction interval [-5.07;-1.24]). When plaque was scored clinically, the difference of means (DiffM) was -0.33(95% CI [-0.49:-0.16], P < .001, prediction interval [-0.87; 0.21]). CONCLUSION: The results of this review demonstrate moderate-quality evidence that brushing with an active-ingredient dentifrice with stannous fluoride or triclosan does provide an added clinically relevant effect concerning plaque inhibition capabilities that surpass the effect of a regular sodium fluoride dentifrice.

Plaque control and reduction of gingivitis: The evidence for dentifrices.

This paper focuses on plaque control and the management of gingivitis in adults and summarizes the evidence of commercially available dentifrices as gathered from existing systematic reviews. Three internet sources were used to search for appropriate papers (up to and including February 2017). The search strategy was designed to include any systematic review published on dentifrices that also included an evaluation of plaque and gingivitis scores. Characteristics of the individual reviews, such as methodological aspects, quantitative data and conclusions, were extracted. The potential risk of bias was estimated and the acquired evidence was graded. Independent screening of 205 unique reviews resulted in 10 published and eligible systematic reviews. One publication evaluated the mechanical contribution of dentifrice to plaque removal. Eight papers were identified that evaluated the efficacy of a proposed single active ingredients, of which two reviewed more than one potentially active ingredient. One study compared two active ingredients. This meta-review appraised the current state of evidence and found that toothbrushing with a standard fluoride dentifrice does not provide an added effect for the mechanical removal of dental plaque. Evidence suggests that compared with a standard dentifrice, those containing triclosan or stannous fluoride have benefits with respect to gingival health and control of dental plaque.

Is plaque regrowth inhibited by dentifrice?: A systematic review and meta-analysis with trial sequential analysis.

OBJECTIVES: The aim of this systematic review was to establish in studies with human participants the effect of a regular fluoride dentifrice compared to water or saline on dental plaque inhibition. METHODS: MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE and other electronic databases were searched, up to April 2018. The inclusion criteria were controlled clinical trials among participants aged ≥18 years with good general health. Papers that evaluated the effect of dentifrice slurry compared with water or saline on plaque regrowth during a 4-day nonbrushing period were included. Data were extracted from the eligible studies, the risk of bias was assessed, and a meta-analysis was performed where feasible. RESULT: The search retrieved eight eligible publications including 25 comparisons. The estimated potential risk of bias was low for all studies. Based on three different indices, overall plaque regrowth was significantly (P < 0.01) inhibited for 0.25 or more by the use of a dentifrice slurry as compared to water. All subanalysis on specific dentifrice ingredients and the overall descriptive analysis supported these findings. CONCLUSION: The results of this review demonstrate moderate-quality evidence for a weak inhibitory effect on plaque regrowth in favour of the use of a dentifrice intended for daily use.

The efficacy of baking soda dentifrice in controlling plaque and gingivitis: A systematic review.

OBJECTIVE: To test the efficacy of a dentifrice containing baking soda (BS), compared with dentifrice without BS for controlling plaque and gingivitis. MATERIALS AND METHODS: MEDLINE-PubMed and Cochrane-CENTRAL were searched. The inclusion criteria were randomized controlled clinical trials including healthy participants aged 18 years or older. Studies were selected that compared the effect of toothbrushing with a dentifrice with and without BS on the clinical parameters of plaque and gingivitis. Data were extracted from the selected studies, and a meta-analysis was performed. RESULTS: The search retrieved 21 eligible publications. Among these papers, 43 comparisons were provided, with 23 involving a single-use design and 20 being evaluations with a follow-up. Negative controls were found, or positive controls for which various active ingredients had been used. The included studies showed a moderate overall potential risk of bias and considerable heterogeneity. The meta-analysis of plaque scores from the single-brushing experiments showed that BS dentifrice (BS-DF) was associated with significantly better outcomes than the negative control dentifrices (DiffM -0.20; P < 0.0001; 95% CI: [-0.27; -0.12]) or the positive control dentifrices (DiffM -0.18; P < 0.0001; 95% CI: [-0.24; -0.12]). This finding was only confirmed in studies that used a follow-up design as compared to a negative control (DiffM -0.19; P = 0.01; 95% CI: [-0.34; -0.04]). The indices of gingival bleeding also improved when the comparison was a negative control (DiffM -0.08; P = 0.02; 95% CI: [-0.16; -0.01] and (DiffM -0.13; P < 0.001; 95% CI: [-0.18; -0.08]. However, for the gingival index scores, the meta-analysis did not reveal any significant differences. CONCLUSION: BS-DF showed promising results with respect to plaque removal in single-use studies. However, the finding was partially substantiated in follow-up studies. Studies that assessed bleeding scores indicated that a small reduction can be expected from BS, relative to a control product.

Impact of adenotonsillectomy on the dentofacial development of obstructed children: a systematic review and meta-analysis.

BACKGROUND: Dentofacial deformities frequently require orthodontic treatment. Understanding of preventable risk factors is essential for reducing treatment need. Upper airway obstruction (for example due to hypertrophic adenoids and/or tonsils) has been hypothesized to be a risk factor. OBJECTIVES: This systematic review aimed to reflect the contemporary evidence on the risk of obstruction by hypertrophic adenoids and/or tonsils, by assessing the dentofacial changes after adeno- and/or tonsillectomy. SEARCH METHODS: A systematic search of electronic databases and manual searches of grey literature and reference lists of relevant studies was performed. SELECTION CRITERIA: No restrictions were placed on publication language. Experimental, cohort, and case-control studies were eligible for inclusion. Studies reporting associations between treatment of adenoid and/or tonsil hypertrophy and dentofacial deformities in children were included. Adenoidectomy and/or tonsillectomy were performed in all patients; outcomes were assessed before and after surgery. DATA COLLECTION AND ANALYSIS: Data were extracted by two independent reviewers in duplicate. The Cochrane Risk of Bias tool was used to assess the methodological quality of the included papers. RESULTS: The initial search yielded 1196 papers, of which 16 articles could be included. All papers described controlled prospective cohort studies, reporting on a total of 461 patients and controls (mean age, 4.1-13.9 years). A descriptive and quantitative synthesis of dentofacial change postoperatively is presented. Consistent findings across studies were the normalisation towards labial inclination of the upper and lower incisors and towards a more horizontal mandibular growth pattern. No change in vertical or sagittal maxillary growth was reported after surgical treatment. Post-surgical increase in maxillary archwidth and decrease in lateral crossbite-frequency were consistently reported. Findings on overjet, overbite and angle from S to N to B (SNB-angle), mandibular arch width, and gonial angle were inconsistent. CONCLUSION: The available literature suggests that treatment of hypertrophic adenoids and/or tonsils affects dentofacial deformity. This could indicate a relationship between nasopharyngeal obstruction (i.e. upper airway obstruction) and the dentofacial growth pattern. However, the high risk of bias and considerable diversity between studies impedes a clear conclusion regarding this effect. REGISTRATION: None.

Does dentifrice use help to remove plaque? A systematic review.

AIMS: The aim of this systematic review was to establish the efficacy of brushing with and without a dentifrice for dental plaque removal. MATERIALS AND METHODS: MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE and other electronic databases were searched. The inclusion criteria were randomized controlled trials and controlled clinical trials and subjects ≥18 years of age with good general health. Studies that evaluated the effect of toothbrushing with a dentifrice compared to brushing without a dentifrice were included. Data were extracted from the eligible studies, and a meta-analysis was performed where feasible. RESULT: The search was conducted until June 2016 and retrieved 10 eligible publications that included 20 comparisons. On average, 49.2% of plaque was removed when brushing was performed with a dentifrice, and 50.3% of plaque was removed when toothbrushing was performed without a dentifrice. The descriptive analysis indicated that the majority of the comparisons did not show an additional effect of dentifrice use. Regarding the meta-analysis of post-brushing scores, no significant difference was observed between toothbrushing with and without a dentifrice (DiffM 0.00, 95%CI [-0.05: 0.05], p = 0.91). The meta-analysis of incremental data (as means or percentages) supported and strengthened these findings. CONCLUSION: The cumulative evidence for this systematic review demonstrates that there is moderate certainty that toothbrushing with a dentifrice does not provide an added effect for the mechanical removal of dental plaque.

Patterns of tooth agenesis in individuals with Down syndrome: A secondary analysis using the Tooth Agenesis Code.

AIMS: Tooth agenesis (TA) is common in Down syndrome (DS). It is unknown whether this agenesis occurs in specific patterns, which is important regarding treatment planning and aetiological research. This study aimed to aggregate and analyze patterns of TA, excluding third molars, in individuals with DS using the tooth agenesis code (TAC). METHODS AND RESULTS: The study was designed as a secondary analysis, following STROSA guidelines. The search (MEDLINE-PubMed) and selection process resulted in six included studies encompassing 241 individuals with DS. TA data were systematically converted into TACs and analyzed per dentition, per jaw, and per tooth type. Symmetry was evaluated. The prediction was calculated for oligodontia. In the 155 cases with TA 86 distinct Overall-TAC patterns were identified. The most common patterns were bilateral maxillary lateral incisor agenesis (TAC002.002.000.000;10.3%), bilateral mandibular second premolar agenesis (TAC000.000.016.016;5.8%), and unilateral left maxillary lateral incisor agenesis (TAC000.002.000.000;5.2%). Symmetry in TA patterns was observed in 49.6% of TA cases in the maxilla and 52.3% in the mandible. The simultaneous absence of both mandibular central incisors had a large predictive value for oligodontia (OR12.44;95% CI:4.97-31.84; p < .001). CONCLUSION: Predominant TA patterns exist in DS. Observation of mandibular central incisor agenesis can promote early diagnosis of oligodontia in DS.

Powered or manual toothbrushing for people with physical or intellectual disabilities - A systematic review.

AIMS: The aim of this systematic review is to compare the effectiveness of a powered (PTB) and a manual (MTB) toothbrush in the hands of people with physical (PD) or intellectual (ID) disabilities or in the hands of a caregiver on parameters of plaque and gingival inflammation. METHODS: MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE databases were searched from initiation up to February 2022. The inclusion criteria were clinical trials conducted in people with PDs or IDs and comparing the effect of toothbrushing with a PTB to an MTB on plaque removal and gingival health. Data were extracted from the eligible studies and analyzed in four subgroups based firstly on the person performing the toothbrushing, either the participants or a caregiver, not a dental professional, and secondly on the main disability of the participants, either PD or ID. Heterogeneity and risk of bias were assessed, data were extracted from the eligible studies, and a descriptive analysis was performed. RESULTS: The search yielded 294 unique papers; after selection 16 eligible publications describing 25 comparisons were included: 12 self-brushing and 13 caregiver-brushing comparisons. Considerable clinical and methodological heterogeneity was present; together with limited numerical data, not allowing for a meta-analysis. The descriptive analysis showed, in the majority, no statistically significant difference between PTB and MTB. This applied to self-brushing and caregiver-brushing in both disability groups. CONCLUSION: This review demonstrates with a low level of evidence that a PTB compared to an MTB in the hands of people with PD or ID or in the hands of their caregivers results in no clinical difference in effectiveness on parameters of plaque and gingival inflammation.

Comparison of three qPCR-based commercial tests for detection of periodontal pathogens.

In periodontal practice microbial results of periodontal test kits for identification of key pathogens are an aid in the treatment planning. Information on the performance of commercially available test kits is therefore essential for the clinician. In this retrospective analysis three commercially available qPCR kits for detection and quantification of selected periodontal bacterial species were compared, using 100 clinical samples from patients with untreated periodontitis. The analysis involved two separate comparisons in which kit A (LabOral Diagnostics, The Netherlands) was compared with kit B (Advanced Dental Diagnostics, The Netherlands), and with kit C (OralDent diagnostics, The Netherlands). Analytic procedures for detection and quantification of selected periodontal bacterial species were carried out according to the instructions of the laboratories. Kit A detected target species more often, and absolute numbers of bacterial cells were higher than with kit B. A high degree of similarity was found between the test outcomes by kit A and kit C. All three kits performed satisfactory but small and significant differences exist between kits.