Evaluation of a Curved Design Rubber Bristle Interdental Cleaner on Patients with Gingivitis.

Purpose: The purpose of this clinical study was to evaluate the effectiveness of a curved rubber bristle interdental cleaner, as compared to dental floss, in the reduction of gingivitis and plaque.Methods: Gingival Index (GI), Bleeding on Probing (BOP), Periodontal Probing Depth (PPD) and Modified QH Plaque Index (MQH-PI) parameters were evaluated in an examiner-masked, parallel group, controlled clinical study. A total of 50 participants with gingivitis (no site with PPD >4 mm, BOP ≥10% but ≤50%) met the eligibility criteria. Participants were randomly assigned to either the curved rubber bristle interdental cleaner (cRBIC) group or the ADA-accepted dental floss (Floss) group. Participants used the devices for four weeks. Parameters were obtained at 2 and 4 weeks. Participants scored their level of product familiarity, satisfaction and motivation for interdental cleaning.Results: There were no statistically significant differences between the two groups in changes from baseline to 2 or 4 weeks in GI, BOP%, and MQH-PI. However, cRBIC group showed greater reduction of PPD at 4 weeks from baseline, compared with Floss group (p<0.05). The cRBIC group showed overall better compliance level than Floss group. The mean score of "ease of use" of the cRBIC group was significantly greater than that of Floss group. However, Floss group showed higher levels of "satisfaction" than cRBIC group. Motivation for interdental cleaning was higher in cRBIC.Conclusion: The cRBIC was similar to Floss in clinical effectiveness; however, PPD reduction at 4 weeks was greater with the cRBIC. Ease of use of cRBIC may have affected the participants' motivation for interdental cleaning, resulting in better compliance.

MicroRNA Expression Profiles in External Cervical Resorption.

INTRODUCTION: External cervical resorption (ECR) has been challenging for its diagnosis, prevention, and treatment. Its etiology and pathogenesis are largely unknown. This study characterized microRNA (miRNA) expression patterns of human tissues from ECR lesions and identified potential messenger RNA targets and pathways. METHODS: Granulomatous tissues from ECR (n = 5) and their adjacent nonaffected asymptomatic gingival connective tissues (n = 5) were collected. Similarly, chronic periodontitis (CP) and control samples were collected (n = 3). Quantitative reverse transcription polymerase chain reaction array analysis compared the expression profiles of 88 miRNAs between diseases. Differentially expressed miRNAs were identified using the Student t test. Bioinformatics for messenger RNA (miRWalk) and KEGG pathway analyses were performed to identify predicted target genes and biological/cellular functions and signaling pathways. RESULTS: Three miRNAs (miR-20a-5p, miR-210-3p, and miR-99a-4p) were significantly down-regulated and 1 miRNA (miR-122-5p) was significantly up-regulated in ECR (P < .05). One up-regulated and 1 down-regulated miRNA reached the significance threshold in CP. A comparison of miRNA expression in ECR and CP identified 3 differentially expressed miRNAs, indicating differences in disease pathobiology. Inflammation-associated Wnt, PI3K-Akt, mitogen-activated protein kinases signaling, and bone formation-associated transforming growth factor beta pathways were identified and predicted to be modulated by differentially expressed miRNAs in both ECR and CP. Biological processes unique to each disease entity were identified, such as T- and B-cell receptor signaling pathways, osteoclast differentiation, and extracellular matrix-receptor interaction for CP. Glycosaminoglycan biosynthesis, mineral absorption, and insulin signaling pathways for ECR were identified. CONCLUSIONS: This proof-of-principle in vivo study indicated that ECR has both common and unique miRNA expression profiles in comparison with CP, which are predicted to target genes regulating inflammation, immunity, and metabolism of mineralized tissues.

Knowledge, attitudes and behaviours of patients regarding interdental deplaquing devices: A mixed-methods study.

OBJECTIVES: This mixed-methods study assessed patients' oral health literacy, motivation level and barriers regarding interdental plaque control. METHODS: Participants (n = 49) from a study comparing the use of Glide® Pro-Health Floss Original (F) or GUM® Curved Soft-Picks® Advance (SP) completed daily diaries and questionnaires regarding motivation, tiredness, confidence and satisfaction for their deplaquing method. The Mantel-Haenszel chi-square test was utilized. Data were also collected from 19 participants who attended focus group discussions regarding their oral health habits, knowledge, motivators and barriers with interdental plaque control. Discussions were digitally recorded, transcribed and imported into ATLAS.ti 7.5.15 to identify themes. RESULTS: There were no statistically significant differences between the two groups in relation to age, sex or ethnicity. F users reported statistically significant higher agreement about ability to remove food/debris (P = 0.01), cleaning thoroughly (P = 0.02) and clean feeling of the mouth (P = 0.01). SP users reported higher ease/efficiency of use (P = 0.01), convenience (P = 0.003), easy to hold (P = 0.0001) and easy use away from home (P = 0.008). Daily diaries revealed higher motivation and compliance/ease of use (SP). During the focus groups, some reported that they did not feel clean unless they deplaqued interdentally; however, most reported that they lacked motivation due to constraints on time, no desire due to lack of immediate or tangible rewards, and lack of knowledge on proper use of interdental devices or the benefits of using them. CONCLUSION: This study showed that the lack of compliance may be due to poor literacy and lack of motivation in patients due to gaps in patient education.

Comparing the diagnostic efficacy of intraoral radiography and cone beam computed tomography volume registration in the detection of mandibular alveolar bone defects.

OBJECTIVES: The aim of this study was to (1) compare bone loss detection accuracy with intraoral radiography and registered cone beam computed tomography (CBCT); (2) assess repeatability with both modalities; (3) determine factors affecting defect detection; and (4) determine the effect of buccolingual bone thickness on defect detection. STUDY DESIGN: Six observers viewed intraoral radiographs and CBCT scans before and after the defect to determine defect presence and extent. Receiver operating characteristic (ROC), sensitivity, specificity, logistic regression, odds ratio, intraclass correlation coefficient, and weighted kappa were used. RESULTS: CBCT and intraoral radiography mean ROC area under the curve values were not statistically different (0.90 vs 0.81; P = .06). CBCT had higher sensitivity compared with intraoral radiography (0.85 vs 0.63; P = .01) but similar specificity (0.91 vs 0.84; P = .45). Bone thickness, imaging modality, and observer had significant effects on defect detection (P < .001). Odds ratios for CBCT vs intraoral radiography were 2.29 for diagnostic accuracy and 1.52 for buccolingual bone thickness. There was moderate interobserver agreement for detection of defects and substantial intraobserver agreement for measurement of extent. CONCLUSIONS: CBCT showed equivalent diagnostic efficacy and specificity for defect detection and higher sensitivity compared with intraoral radiography. CBCT increases the odds of accurate defect assessment more than 2-fold compared with intraoral radiography. The odds of bone loss detection increase by approximately 50% per millimeter of buccolingual alveolar bone loss.

Evaluation of Microbial Contamination in the Inner Surface of Titanium Implants Before Healing Abutment Connection: A Prospective Clinical Trial.

PURPOSE: The objective of this investigation was to assess the microbiologic contamination in the inner surface of titanium implants prior to prosthetic abutment placement. MATERIALS AND METHODS: The study population consisted of partially edentulous individuals who had previously received at least one internal hexagon titanium dental implant. A bacterial sample of the inner surface of the individual dental implant was taken after surgical reopening for healing abutment placement. The samples were allocated in order to evaluate three distinctive variables as follows: (1) location (mandible vs maxilla), (2) early exposure of implants to the oral cavity (cover screw) throughout the healing stage (exposed vs not exposed), and (3) existence or lack of keratinized mucosa (KM). The microorganism species detected were examined by checkerboard DNA-DNA hybridization. RESULTS: A total of 32 partially edentulous patients with 78 implants placed in both the maxilla and mandible were enrolled: 8 men and 24 women, ranging in age from 27 to 64 years (mean age: 47.7 years). Bacteria were detected in 20 patients, distributed in 41 implants. Spontaneous early implant exposure and absence of KM did not increase bacterial contamination in the inner surface of implants. A significant increase in the detection of 22 bacterial species was found in the mandible when compared with the maxilla. CONCLUSION: Microbial biofilm accumulation in the implant's internal surface might happen before healing abutment placement. Exposure of implants to the oral cavity and absence of KM were not directly related to a greater microbial biofilm count. The results suggested that submerged healing does not protect implants against bacterial colonization.

Potential correlation between statins and pulp chamber calcification.

INTRODUCTION: 3-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) are the first-line pharmaceuticals for the prevention and treatment of dyslipidemia. A recent investigation has shown that statins induced odontoblastic differentiation of dental pulp stem cells. Statins enhance the differentiation of human dental pulp cells by up-regulating mineralization nodules and odontogenic markers. This study tested the hypothesis that the systemic administration of statins results in increased dental pulp calcification. METHODS: This retrospective case-control study used digital bitewing radiographs of mandibular molars. Subjects (N = 90) aged ≥60 years were assigned to either test (n = 45) or control (n = 45) groups based on the systemic use of statins. The dimensions of the pulp chambers were measured using a standardized method for height and mesiodistal distances. The chi-square test was used to analyze the data. Multiple linear regression model analysis was performed to explore the association between statin intake and pulp calcification. RESULTS: Three of the 45 mandibular molars in the test group exhibited almost complete pulp chamber obliteration. There was a significant reduction in pulp chamber height ratio shown in the statin group compared with the control group (P < .0001). When the mesiodistal width was compared between the 2 groups, there was no significant difference (P = .3730). CONCLUSIONS: The significant increase of calcification and loss of vertical height of the pulp chamber observed in mandibular molars in patients on statin medication indicated a possible increased odontoblastic activity. Therefore, systemic statins could be a contributing factor for pulp chamber calcification.

Epigenetic regulation of TNFA expression in periodontal disease.

BACKGROUND: Tumor necrosis factor-α (TNF-α) plays a central role in the molecular pathogenesis of periodontal disease. However, the epigenetic regulation attributable to microbial and inflammatory signals at the biofilm-gingival interface are poorly understood. In this study, the DNA methylation alteration within the TNFA promoter in human gingival biopsies from different stages of periodontal disease is investigated and the regulatory mechanism of TNFA transcription by DNA methylation is explored. METHODS: Gingival biopsies were obtained from 17 patients with chronic periodontitis (CP) and 18 periodontally healthy individuals. Another 11 individuals participated in an experimentally induced gingivitis study, and gingival biopsies were collected at the baseline, induction, and resolution phase. To confirm that TNFA promoter methylation modulated TNFA transcription, THP.1 cells were treated with a DNA methyltransferase inhibitor, 5-Aza-2-deoxycytidine (5-Aza-2dC), and an RAW294.7 cell line transfected with a TNFA promoter-specific luciferase reporter system with or without methylation was used. RESULTS: In gingival biopsies from individuals with severe CP, two individual cytosine-guanine dinucleotides (CpG sites) within the TNFA promoter (at -163 and -161 bp) displayed increased methylation in CP samples compared to those with gingival health (16.1% ± 5.1% versus 11.0% ± 4.6%, P = 0.02 and 19.8% ± 4.1% versus 15.4% ± 3.6%, P = 0.04, respectively). The methylation level at -163 bp was inversely associated with the transcription level of TNFA (P = 0.018). However, no significant difference in the TNFA promoter methylation pattern was observed in samples biopsied during the induction or resolution phase of experimentally induced gingivitis, which represented a reversible periodontal lesion. THP.1 cells treated with 5-Aza-2dC demonstrated a time-dependent increase in TNFA messenger level. It was also found that the luciferase activity decreased 2.6-fold in a construct containing an in vitro methylated TNFA promoter when compared to the unmethylated insert (P = 0.03). CONCLUSION: Although the biopsy samples represented a mixed cell population, the change in promoter methylation status in chronic periodontal disease suggested that DNA methylation may be an important regulatory mechanism in controlling TNFA transcriptional expression in periodontal disease.

Bone healing in critical-size defects treated with new bioactive glass/calcium sulfate: a histologic and histometric study in rat calvaria.

This study analyzed histologically the influence of new spherical bioactive glass (NBG) particles with or without a calcium sulfate (CS) barrier on bone healing in surgically created critical-size defects (CSD) in rat calvaria. A CSD was made in each calvarium of 60 rats, which were divided into three groups: C (control): the defect was filled with blood clot only; NBG: the defect was filled with NBG only; and NBG/CS: the defect was filled with NBG covered by CS barrier. Subgroups were euthanized at 4 or 12 weeks. Amounts of new bone and remnants of implanted materials were calculated as percentages of total area of the original defect. Data were statistically analyzed. In contrast to Group C, thickness throughout defects in Groups NBG and NBG/CS was similar to the original calvarium. At 4 weeks, Group C had significantly more bone formation than Group NBG/CS. No significant differences were found between Group NBG and either Group C or Group NBG/CS. At 12 weeks, Group C had significantly more bone formation than Group NBG or NBG/CS. NBG particles, used with or without a CS barrier, maintained volume and contour of area grafted in CSD. Presence of remaining NBG particles might have accounted for smaller amount of new bone in Groups NBG and NBG/CS at 12 weeks post-operative.

Regeneration of degree ii furcation defects with a 4% doxycycline hyclate bioabsorbable barrier.

BACKGROUND: Bacterial contamination of a healing regenerative site has been shown to affect the response to therapy adversely. Doxycycline possesses antibacterial properties as well as other biologic actions that may result in an increased production and maintenance of collagen and bone. The purpose of this study was to assess if the sustained release of 4% doxycycline through a bioabsorbable barrier would enhance the regenerative outcomes of healing furcation sites. METHODS: Individuals with a single degree II furcation defect in a mandibular molar participated. They were assigned randomly to one of three treatment groups: poly(DL-lactide) polylactic acid (PLA) barrier containing 4% doxycycline hyclate + demineralized freeze-dried bone allograft (DFDBA) (BG+PDox); poly(DL-lactide) PLA barrier without doxycycline + DFDBA (BG+P); or DFDBA alone (BG). Clinical parameters included vertical probing depth (VPD), vertical clinical attachment level (VCAL), gingival recession, and horizontal probing depth (HPD). Intrasurgical measurements to calculate vertical and horizontal furcation fill were obtained at the time of surgery (baseline) and during a reentry procedure 9 months later. Statistical tests were used to assess changes in the clinical and surgical parameters before and after treatment among groups and within each group. RESULTS: Mean changes at 9 months for all groups yielded VPD reductions and VCAL gains. However, no significant difference was noted for the group that was treated with 4% doxycycline barrier compared to the other two groups. Vertical bone fill was 0.89, 1.44, and 1.18 mm for the BG+PDox, BG+P, and BG groups, respectively. Furcation horizontal bone was 2.33, 2.11, and 1.18 mm for the BG+PDox, BG+P, and BG groups, respectively. CONCLUSIONS: Addition of doxycycline to the guided tissue regeneration barrier did not enhance treatment outcomes compared to the non-antibiotic-loaded barrier or bone graft alone. All treatment modalities provided similar improvement in clinical and intrasurgical parameters.

Sarcoidosis affecting the periodontium: a long-term follow-up case.

BACKGROUND: Clinical manifestations of sarcoidosis affecting the periodontium could mimic aggressive periodontitis. This case report documents the occurrence of sarcoidosis affecting the periodontium, including its clinical features, diagnosis, treatment, and 6-year follow-up. METHODS: An individual with a history of pulmonary sarcoidosis was referred for evaluation and treatment of an aggressive periodontal condition. Clinical, radiographic, and histopathologic findings supported the diagnosis of sarcoidosis affecting the periodontium. Initial treatment consisted of reinforcement of oral hygiene, scaling and root planing, chlorhexidine rinses, and periodontal maintenance. The systemic disease was managed with prednisone, alendronate, and losartan. Twelve months later, the patient returned with severe attachment loss of sudden onset and gingival recession affecting the facial right surfaces of maxillary posterior teeth. In addition, he complained of chronic pain of moderate to severe intensity involving both jaws. The affected teeth were extracted and the surrounding alveolar bone was debrided. Intraoral sarcoidosis was confirmed by histologic findings, and his medications were changed to methotrexate and hydroxychloroquine. RESULTS: The patient has been followed for 6 years with continuation of the systemic medications and periodontal maintenance every 3 to 4 months without recurrence of intraoral sarcoidosis. CONCLUSIONS: The main features of this unique periodontal presentation were pain, rapidly progressive gingival recession, and significant changes in alveolar bone density in focal areas. Careful review of medical history and close monitoring of intraoral conditions are critical for patients with a history of sarcoidosis. An intraoral biopsy is necessary to confirm a definitive diagnosis in cases with similar clinical findings.

Treatment of root sensitivity after periodontal therapy.

PURPOSE: To compare the effectiveness of an agent that promotes deposition of amorphous calcium phosphate (Quell Desensitizer) to a commonly used product, sodium fluoride solution (Nupro Neutral), in the reduction of root sensitivity after periodontal therapy, in a prospective, convenient sample, double-blind clinical trial. METHODS: Thirty patients were enrolled and treated, resulting in 40 teeth treated with the test product and 40 teeth treated with the control product. The clinical parameters tested at baseline and in the follow-up visits (1, 2, and 4 weeks after treatment) were the following: plaque index, gingival index, gingival recession, and response to mechanical and cold stimulation with airblast and ice. Patients were also asked to report the grade of pain response on a Visual Analogue Scale (VAS) on the same schedule as the clinical parameters. RESULTS: Plaque index and gingival index were not significantly different between test and control groups throughout the study. Most recession was observed on midbuccal surfaces. Buccal surfaces evoked higher pain response compared to lingual surfaces. It was concluded that both control and test treatments reduced root sensitivity response reported with mechanical or cold stimulation. No statistically significant differences were observed when the data of both groups were compared by a Student's t-test at the 0.05 level of significance.

Short-term success of osseointegrated dental implants in HIV-positive individuals: a prospective study.

PURPOSE: Except for the occasional case report, there are no studies evaluating the success rate of osseointegrated dental implants in individuals infected with the human immunodeficiency virus (HIV). This study investigated the short-term clinical outcome of implant placement in a group of HIV-positive and HIV-negative individuals who required complete dentures. METHODS AND MATERIALS: Edentulous subjects were recruited from an HIV-dedicated clinic and a dental school clinic. Two BioHorizons dental implants were placed in the anterior mandible to support an overdenture opposing a maxillary denture. Outcome measurements obtained six months after activation of implants were presence of pain, mobility, soft tissue status, and radiographic bone level. Descriptive statistics were used. RESULTS: Twenty-nine edentulous adults, including 20 HIV-positive subjects (test) and nine HIV-negative subjects (control), participated. The test group had six females, 14 males; 13 Whites, four African-Americans, and three Hispanics with a mean age of 48.9 years (range: 35-59). The mean CD4 count was 467 cells/mm3 (range: 132-948). The control group had six females, three males; seven Whites, and two Hispanics with a mean age of 65.3 years (range: 50-82). Short-term success rate was 100% for both groups. No difference in clinical outcome was found between the groups. CONCLUSION: This study demonstrated dental implants are well tolerated and have predictable outcomes for HIV-infected individuals for the duration of the study and probably over an even longer term.

The use of enamel matrix protein in the treatment of localized aggressive periodontitis: a case report.

The previously named localized juvenile periodontitis (LJP), recently reclassified as localized aggressive periodontitis (LAP) seen in young people, is a rare condition characterized by severe periodontal destruction around first molars and incisors in individuals with little or no accumulation of visible plaque and/or calculus. Treatment of this condition has traditionally included periodontal surgery and adjunctive antibiotic therapy. Even though several periodontal regeneration techniques in these patients have been reported, there have been no reports of the use of the enamel matrix proteins in the treatment of intrabony defects caused by this disease. This report describes the case of a 15-year-old patient who was diagnosed as having LAP and the resulting treatment and outcome. The treatment consisted of systemic antibiotic therapy and periodontal surgical procedures combined with enamel matrix protein application. The 6-month clinical probing and attachment level measurements and radiographic findings are reported.

Regression of cyclosporia-induced gingival overgrowth upon interruption of drug therapy.

Immunosuppressive therapy with cyclosporin has been known to cause gingival overgrowth in humans. It usually is not feasible to suspend this therapy to treat the adverse side effect. This case report describes a renal transplant patient who had used both cyclosporin and nifedipine for more than 10 years but had to discontinue immunosuppressive drug therapy due to organ rejection. Discontinuing therapy led to almost complete regression of the gingival overgrowth in a few months after interruption of cyclosporin therapy only. These findings suggest that the discontinuation of cyclosporin results in the reversal of gingival overgrowth without surgical intervention and may be the most definitive form of therapy for this condition in susceptible individuals as new drugs become available.

Evaluation of halitosis in children and mothers.

PURPOSE: The purpose of this study was to investigate the occurrence and clinical parameters that are associated with halitosis in pediatric dental patients and compare these findings with those found for the patients' mother. METHODS: Children aged 5 to 12 years old were evaluated with mothers present during a dental visit. Each mother completed the child's medical history and a breath odor questionnaire. The mother and an oral breath judge (OBJ) evaluated the child's oral breath using organoleptic methods. A commercial breath analyzer (CBA) measured the oral and nasal levels of volatile sulfur compounds (VSCs) for child and mother before and after tongue debridement. A number of oral parameters were recorded for the children. RESULTS: Thirty children (mean age=8.8 years) and 18 mothers participated. Halitosis (VSC>100 parts per billion, or ppb) was found in 23% of children and 11% of mothers, but was not significantly correlated. In contrast, 61% of mothers reported halitosis in themselves and their child. Significant differences were found between VSC levels and frequency of tooth-brushing (P<.05, univariate ANOVA). There was significant correlation in the detection of breath odor between mother and OBJ (P<.05, Pearson); however, there was no significant correlation between evaluators and CBA. A positive correlation existed between the presence of interproximal restorations and breath odor by OBJ (P<.05, Pearson). CONCLUSIONS: Halitosis may be a problem in some healthy children, but it does not correlate well with mothers' breath odor or common oral parameters. The organoleptic and CBA results were inconsistent, suggesting factors other than VSCs may be associated with halitosis in children.

The AAMOP case challenge: a rapidly enlarging pigmented lesion of the buccal mucosa.

A slowly growing gingival enlargement of the right anterior maxilla was observed in a 56 year-old woman. The clinical features, differential diagnosis and novel management approach are discussed. See if you can make the diagnosis.