Effects of professional toothbrushing among patients with gingivitis.

OBJECTIVES: This study aimed to evaluate the biological and clinical effect of professional toothbrushing on the periodontal health of patients with gingivitis. METHODS: We enrolled 21 university students with gingivitis in Jinju City in this study between April 24 and October 28, 2014. A dental hygienist performed a professional toothbrushing routine on the participants twice, once at baseline and after 3 months. Oral examinations were performed at baseline, 3, and 6 months to assess the periodontal health. The patient hygiene performance index, gingival bleeding rate, periodontal pocket depth, amount of gingival sulcus fluid, and number of bacterial colonies in the gingival sulcus (CFU/mL) were evaluated during the oral examination. RESULTS: The patient hygiene performance index, gingival bleeding rate, pocket depth, amount of gingival sulcus fluid, and CFU/mL within the gingival sulcus significantly decreased after professional toothbrushing (p < 0.05), indicating an improvement in the periodontal health. The patient hygiene performance index, gingival bleeding rate, pocket depth, amount of gingival sulcus fluid, and CFU/mL within the gingival sulcus decreased more among those whose pocket depth was 4-5 mm than among those whose PD was ≤3 mm (p < 0.05). CONCLUSIONS: Professional toothbrushing improved the periodontal health in patients with gingivitis in respect of both biological and clinical results.

Effectiveness of a sonic-flosser toothbrush with different size brush heads and manual toothbrush plus dental floss on plaque, gingival bleeding and inflammation in adults with naturally occurring gingivitis: A 4-week randomized controlled trial.

OBJECTIVE: To compare the effectiveness of three oral hygiene groups: a novel sonic-flosser toothbrush with a compact brush head, a novel sonic-flosser toothbrush with a full size brush head and manual toothbrush plus dental floss on the reduction of gingival bleeding after 4 weeks. Secondarily, the groups were compared on the reduction of gingival inflammation and dental plaque. MATERIALS AND METHODS: One hundred and five (n = 105) healthy adults were enrolled in this randomized, examiner-blind, three-group, parallel clinical trial. Subjects were assigned to one of three groups: sonic-flosser toothbrush with full size brush head (SFF), sonic-flosser toothbrush with compact brush head (SFC), or manual toothbrush and string floss (MTF). Bleeding on probing (BOP), Modified Gingival Index (MGI), and Rustogi Modification of the Navy Plaque Index (RMNPI) scores were recorded at baseline, 2-weeks, and 4-weeks. RESULTS: All subjects completed the study. All three groups demonstrated a significant reduction in BOP, MGI and RMNPI from baseline to 4-weeks for all areas recorded (p < 0.001), except gingival margin plaque scores for SFF, SFC and MTF (p = 0.203, p = 0.082, p = 0.324 respectively). Both the SFF and SFC groups were statistically more effective than MTF for whole mouth BOP, MGI and RMNPI (p < 0.001) and proximal areas (p = 0.022 or less). There were no adverse events reported by the subjects or identified by the examiner during the study. CONCLUSION: The sonic-flosser toothbrush with a full size or compact brush head was statistically and clinically more effective at improving gingival health and reducing plaque than manual toothbrush and dental floss for adults with naturally occurring gingivitis over 4-weeks.

General Health, Systemic Diseases and Oral Status in Adult Patients with Coeliac Disease.

The prevalence of coeliac disease in the general population is 0.5%-1%; however, most patients remain undiagnosed until adult age. In some cases, the onset is represented by sub-clinical signs, some of which can be found in the mouth. The aim of this research was to identify any associations between the clinical characteristics of coeliac disease and oral manifestations. A structured questionnaire was administered to a group of 237 individuals with coeliac disease. 100% of the subjects fully completed the questionnaire. Among them, 182 (76.7%) were female, 64 patients (27%) were aged 15 to 24 years, 159 (67%) were aged 25 to 55 and 14 (6%) were aged 56 and over. Significant associations were observed in caries prevalence and dentin sensitivity; in addition, an inappropriate diet was related to oral manifestations; following a gluten-free diet could be important to control the gingival bleeding levels and to manage oral symptoms associated to coeliac disease. In general, the presence of inflammatory symptoms in the mouth seems to be associated with general symptoms of inflammation related to coeliac disease.

Effects of Domiciliary Professional Oral Care for Care-Dependent Elderly in Nursing Homes - Oral Hygiene, Gingival Bleeding, Root Caries and Nursing Staff's Oral Health Knowledge and Attitudes.

PURPOSE: The primary aim was to describe the effects for nursing home residents of monthly professional cleaning and individual oral hygiene instruction provided by registered dental hygienists (RDHs), in comparison with daily oral care as usual. The secondary aim was to study the knowledge and attitudes among nursing staff regarding oral health care and needs. PATIENTS AND METHODS: In this randomised controlled trial (RCT), 146 residents were recruited from nine nursing homes in Regions of Stockholm and Sörmland and were randomly assigned (on nursing home level) to either intervention group (I; n=72) or control group (C; n=74). Group I received monthly professional cleaning, individual oral hygiene instructions and information given by an RDH. Group C proceeded with daily oral care as usual (self-performed or nursing staff-assisted). Oral health-related data was registered with the mucosal-plaque score index (MPS), the modified sulcus bleeding index (MSB), and root caries. The nursing staff's attitudes and knowledge were analysed at baseline and at six-month follow-up. Statistical analysis was performed by Fisher's exact test and two-way variance analysis (ANOVA). RESULTS: Improvements were seen in both Group I and Group C concerning MPS, MSB and active root caries. The nursing staff working with participants in Group I showed significant improvements regarding the Nursing Dental Coping Beliefs Scale (DCBS) in two of four dimensions, oral health care beliefs (p=0.0331) and external locus of control (p=0.0017) compared with those working with Group C. The knowledge-based questionnaire showed improvement (p=0.05) in Group I compared with Group C. CONCLUSION: Monthly professional oral care, combined with individual oral health care instructions, seems to improve oral hygiene and may reduce root caries among nursing home residents. This may also contribute to a more positive attitude regarding oral hygiene measures among nursing home staff, as compared with daily oral care as usual.

Bactericidal and clinical efficacy of photochemotherapy in acute necrotizing ulcerative gingivitis.

AIM: This study was designed to investigate the clinical and microbiological parameters with photochemotherapy (PCT) against conventional debridement (CD) among patients with necrotizing ulcerative gingivitis (NUG). MATERIALS AND METHODS: Patients with a diagnosis of NUG were divided into two groups: 'Group-PCT' that underwent indocyanine green-mediated PCT with adjunctive mechanical debridement, and Group-CD that underwent mechanical debridement with adjunctive 3 % hydrogen peroxide/chlorhexidine rinse. Clinical inflammatory gingival parameters including full-mouth plaque scores (FMPS), bleeding scores (FMBS), and probing depth (PD) were measured. Counts of Treponema microdentium, Fusobacterium nucleatum and Prevotella intermedia were assessed using polymerase chain reaction technique. All assessments were done at baseline, 3 weeks and 6 weeks. RESULTS: Twenty-six participants were contacted and agreed to participate in the trial. The mean age of participants in group-PCT was 24.5 years while the mean age of patients in group-CD was 26.7 years. FMPS showed significant but equal reduction in both the groups at 3 weeks and 6 weeks (p < 0.01). The reduction in mean FMBS was higher in the group-PCT at 6 weeks follow-up (p < 0.05). All bacterial levels reduced from baseline to follow-up with both PCT and CD groups (p < 0.05). Group-PCT showed significantly reduced counts of T. microdentium and F. nucleatum at 3 weeks and 6 weeks compared with group-CD (p = 0.024). Equal reduction was shown for P. intermedia between both the groups at 3 and 6 weeks, respectively. CONCLUSION: Application of adjunctive photochemotherapy was both clinically and microbiologically effective in the treatment of NUG.

Antimicrobial efficacy of indocyanine green-mediated photodynamic therapy compared with Salvadora persica gel application in the treatment of moderate and deep pockets in periodontitis.

BACKGROUND: In order to prove the idea that topical application of drugs can improve the clinical parameters affecting periodontal disease, a sound comparison should be made between topical therapeutic models. The aim of the present study was to assess the clinical efficacy of photodynamic therapy (PDT) and Salvadora persica (SP) gel as adjuncts to scaling and root planning (SRP) in the treatment of chronic periodontitis. METHODS: The selected patients were divided into three groups, Group I (PDT + SRP), Group II (SP + SRP) and group III (SRP alone). Clinical inflammatory periodontal parameters including plaque index (PI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL) gain were assessed. Assessment of crevicular fluid interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) was performed using enzyme-linked immunosorbent assay technique. All measurements were recorded at baseline, 3 months and 6 months follow-up periods, respectively. RESULTS: A total of 73 patients completed the study. A significant improvement in the BOP was seen in Group II at both follow up visits when compared with other groups (p < 0.05). Only in Group-I that showed statistically significant reduction in moderate periodontal pockets at 3 months (p = 0.021), and significant reductions in deep pockets at 3-months (p = 0.003) and 6-months (p = 0.002), respectively. CAL gain also was reported to be seen in group-I at both visits (p < 0.05). Group- I and II significantly reduced the levels of IL-6 at 3-month period compared to Group-III. This reduction was further maintained by group-II and group-III at 6 months, respectively. TNF-α showed statistically significant decrease in Group II as compared to Group I and Group-III and this reduction was maintained by the end of 6-month visit (p = 0.045). CONCLUSION: Both the treatment modalities PDT and SP helped in reducing periodontal inflammation. PDT reported significant gain in clinical attachment level, whereas the SP significantly reduced the bleeding levels.

Oral tranexamic acid associated with platelet transfusion to prevent hemorrhage in a patient with Glanzmann thrombasthenia.

Glanzmann thrombasthenia (GT) is a rare genetic disorder that alters platelet function. The clinical manifestations include purpura, epistaxis, gingival bleeding, and menorrhagia. For patients with GT, conventional surgical dental treatment may result in hemorrhagic complications. There are many reported ways to prevent hemorrhage in patients with GT during surgical procedures but no standardized recommendations. In this case study, a woman diagnosed with GT required 2 types of surgery (periodontal surgery and third molar extractions), which were performed on separate days. Preoperative evaluation and planning with a hematology service led to the transfusion of 1 pack of platelet concentrate immediately before each surgery. Additionally, the patient was prescribed oral tranexamic acid, which was started 1 day before each surgery and continued for 3 additional days. A distal wedge procedure was performed for the mandibular right third molar, and later the maxillary and mandibular left third molars were extracted. The use of oral tranexamic acid associated with a single platelet bag was effective in the present case, and no bleeding or thrombotic events were observed after either surgery. Although this coagulopathy is rare, dentists must be aware of its implications, which necessitate specific precautions for oral surgical procedures. Multidisciplinary integration and surgical planning can reduce the risk of complications for the patient.

Effect of a Toothpaste/Mouthwash Containing Carica papaya Leaf Extract on Interdental Gingival Bleeding: A Randomized Controlled Trial.

Clinical research on herbal-based dentifrice +/- mouth rinse products is very limited compared with the plethora of research on conventional oral care products under normal oral hygiene conditions. The aim of this study was to determine the anti-inflammatory effects of a novel plant Carica papaya leaf extract (CPLE) on interdental bleeding in healthy subjects. In this randomized, single-blind parallel-design study, the eligible subjects were generally healthy non-smokers, aged 18⁻26, who exhibited healthy periodontal conditions upon study entry. The participants were equally randomized into the following four groups: CPLE dentifrice, CPLE dentifrice and mouthwash, sodium lauryl sulfate (SLS)-free enzyme-containing dentifrice and SLS-free enzyme-containing dentifrice with essential oil (EO) mouthwash. Subjects were instructed to brush their teeth twice a day without changing their other brushing habits. Interdental bleeding (BOIP) was measured from inclusion (T0) until the fourth week (T4) of the study. Clinical efficacy was assessed after one, two, three and four weeks of home use. The analyses compared BOIP between groups and were then restricted to participants with ≥70% and then ≥80% bleeding sites at T0. Pairwise comparisons between groups were performed at T0 and T4, and a logistic regression identified correlates of gingival bleeding (T4). Among 100 subjects (2273 interdental sites), the median percentage of bleeding sites per participant at T0 was 65%. The bleeding sites dramatically decreased in all groups between T0 and T4 (relative variations from -54% to -75%, p < 0.01 for all). Gingival bleeding did not significantly differ between the CPLE dentifrice and the SLS-free dentifrice +/- EO mouthwash groups (from p = 0.05 to p = 0.86), regardless of the baseline risk level. Among the CPLE dentifrice users, fewer bleeding sites were observed when toothpaste and mouthwash were combined compared to bleeding sites in those who used toothpaste alone (21% vs. 32%, p = 0.04). CPLE dentifrice/mouthwash provides an efficacious and natural alternative to SLS-free dentifrice +/-EO-containing mouthwash when used as an adjunct to mechanical oral care to reduce interdental gingival inflammation.

Single-blind randomized clinical trial on the efficacy of an interdental cleaning device in orthodontic patients.

BACKGROUND: It is well-known that poor oral hygiene during orthodontic treatment may lead to development of gingivitis, probing pocket depth, hyperplastic tissue, decalcification, dental caries and white spot lesions on the coronal surfaces of teeth. METHODS: Twenty-two patients with the following inclusion criteria were enrolled in the present study: fixed orthodontic treatment, age 12-18 years, systemically healthy, no history of periodontal treatment, periodontal health or gingivitis. The following clinical parameters were collected: periodontal screening and recording, plaque control record, and bleeding on probing. Oral hygiene instructions were given and a specifically designed technique for orthodontic patients was suggested. Complete information about the mechanical interdental device were also provided. Means and standard deviations or medians and interquartile ranges for each parameter were collected. RESULTS: There was a statistically significant reduction in plaque control record on both sides. The reduction in the experimental group was significantly greater compared to controls after adjusting for baseline values. There was also a statistically significant reduction in bleeding on probing in the experiment group, but not in controls. CONCLUSIONS: The combination of manual toothbrush and mechanical interdental device demonstrated a better plaque control and gingival inflammation levels in orthodontic patients compared to manual brushing alone.

A Comparison of Oral Hygiene Products and Professional Care: A six-week randomized clinical trial.

Purpose: To investigate the anti-gingivitis efficacy of a novel oral hygiene routine consisting of a two-step stannous fluoride dentifrice and hydrogen peroxide whitening gel system, an interactive oscillating-rotating electric toothbrush, and expanded polytetrafluoroethylene floss.Methods: A total of 52 participants (n=52;mean age 35.8±11.23 years) were enrolled in the study and randomized 1:1 to the experimental hygiene group or control (dental prophylaxis followed by use of standard sodium fluoride dentifrice and a manual toothbrush). Participants were instructed to brush twice daily; those in the experimental group were instructed to floss once daily. Oral examinations were conducted at Baseline, Week 2, Week 4, and Week 6.Results: Both groups experienced significant declines in the mean number of bleeding sites from Baseline at all time points, evident as early as Week 2. Bleeding sites continued to decline throughout the trial in the experimental group, whereas they showed an increasing trend between Weeks 2 and 6 in the control group. The experimental group had 55% fewer bleeding sites at Week 2, 85% fewer bleeding sites at Week 4, and 98% fewer bleeding sites at Week 6 (p<0.0001 for all) as compared to the control group. At Week 6, 84% of participants in the experimental group had no bleeding, while all participants in the control group had bleeding.Conclusion: The experimental oral hygiene group showed significantly greater reductions in gingival bleeding than the control oral hygiene group, with benefits seen as early as Week 2 and increasing over the six-week study.

Efficacy of a rubber bristles interdental cleaner compared to an interdental brush on dental plaque, gingival bleeding and gingival abrasion: A randomized clinical trial.

AIM: To determine the efficacy of a rubber bristles interdental cleaner (RBIC) compared to an interdental brush (IDB) in reducing gingivitis and additionally to evaluate participants' attitudes and possible side effects. MATERIAL AND METHODS: The study was a 2-treatment, parallel, split-mouth, examiner-blind RCT, evaluating the reversal of experimental gingivitis. In total, 42 systemically healthy volunteers were recruited that were currently non-users of interdental cleaning devices. After familiarization and prophylaxis, participants refrained from brushing mandibular teeth for 21 days, followed by 4-week product use of the assigned interdental cleaning device as adjunct to manual toothbrushing. Bleeding on marginal probing (BOMP), dental plaque index score (PI) and gingival abrasion score (GAs) were assessed in the lower jaw. RESULTS: Overall, no statistically significant differences between the RBIC and IDB in reducing BOMP and PI were obtained. Analysing the sites that were accessible for the RBIC/IDB only showed that the sites treated with the RBIC had significantly less BOMP after 4 weeks (P = .009). The RBIC also caused less GAs (P => .016) and was considered more pleasurable to use by the participants (P = .0001). CONCLUSIONS: In accessible sites, the RBIC, in conjunction with manual toothbrushing, was found to be more effective in reducing gingival inflammation after 4 weeks. The RBIC caused less abrasion of the gingiva and was appreciated more by the participants.

Interdental plaque reduction after use of different devices in young subjects with intact papilla: A randomized clinical trial.

OBJECTIVES: To determine the efficacy of 4 different oral hygiene regimens involving adjunctive interdental cleaning devices in unsupervised young subjects with intact interdental papilla. MATERIAL AND METHODS: Sixty periodontally healthy subjects were randomly allocated to 4 groups following different oral hygiene regimens (T-7): use of manual toothbrush alone; manual toothbrush plus dental floss; manual toothbrush plus interdental brushes; and manual toothbrush plus rubber interdental picks. Oral hygiene instructions (OHI) were given. One week after (T0), professional supragingival scaling and polishing was performed, and subjects were then reseen every 2 weeks (T14 and T28). At T-7, T0, T14 and T28, full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS) and angulated bleeding index (AngBI) were taken. RESULTS: During the first week (T-7/T0 unclean phase), FMPS decreased significantly in all groups except the group using dental floss. At T28, a significant decrease in FMPS (P < .001, all groups) and FMBS (P < .05, all groups except the group using flossing P < .001) was noted. Interdental FMPS showed significantly lower values in subjects treated with interdental brushes or rubber interdental picks vs toothbrushing alone (P < .05). The use of interdental picks was associated with reduced interdental FMBS when compared to flossing (P < .05). CONCLUSION: In young subjects, with no interdental attachment loss, toothbrushing or toothbrushing and adjunctive interdental cleaning devices such as dental floss, interdental brushes or interdental rubber picks can significantly reduce both plaque and gingival inflammation. Use of interdental brushes or rubber picks reduces more interdental plaque in comparison with toothbrushing alone.

Chitosan brush for professional removal of plaque in mild peri-implantitis.

BACKGROUND: The aim of the study was to evaluate the effectiveness of a chitosan brush on the treatment of mild peri-implantitis. METHODS: Fifteen patients diagnosed with mild peri-implantitis contributing with single implant were treated with a chitosan brush. Modified plaque index (mPll), Modified Bleeding Index (mBoP) and probing depth (PPD) were recorded at baseline, 2, 4, 12 and 24 weeks. Chitosan brush was used at 12 weeks if diagnosis was still present. Periapical radiographs were taken at the beginning of the study and 6 months after to control the stability of bone level. RESULTS: None of the patients reported discomfort or side effects during treatment. Bone level was maintained stable during the entire study. Plaque index remained almost 0 at every control visit. PPD and mBoP were significantly reduced at 2 weeks and when compared to baseline. At 24 weeks 73% of patients presented no further bleeding on probing with stable bone level. CONCLUSIONS: Chitosan brush could be a reliable instrument for the professionally administered plaque removal and resolution of clinical signs of initial stages of peri-implant inflammation.

The effects of power toothbrushing on periodontal inflammation in a Canadian nursing home population: A randomized controlled trial.

OBJECTIVES: The aim of this study was to investigate whether twice-daily use of a rotating-oscillating power toothbrush (Oral-B Professional Care 1000™ ) in nursing home (NH) residents over a 6-week period, compared to usual care (UC), would reduce periodontal inflammation. METHODS: In this repeated measures single-blinded randomized controlled trial, 59 residents of one NH in Winnipeg, Canada, were randomized to receive either twice-daily tooth brushing with a rotating-oscillating power toothbrush (PB) or UC by caregivers. Consent was obtained from residents or their proxies. Participants had some natural teeth, periodontal inflammation, non-aggressive behaviour, no communicable diseases, were non-smokers and non-comatose. Outcomes were measured at baseline and 6 weeks, which included: inflammation (MGI, Lobene), bleeding (PBI, Loesche) and Plaque (Turesky). Comparisons of group changes in outcomes were analysed using an ANOVA with a repeated measure. RESULTS: Of 59 original study participants, one withdrew, one died prior to study commencement and three died before study completion. All oral parameters improved significantly for the remaining 54 residents over time (P<.0001), with no differences between groups. CONCLUSIONS: These results demonstrate that it is possible for caregivers to improve periodontal inflammation of residents over a 6-week period. Despite no significant group differences, periodontal inflammation of all study participants improved significantly, particularly in the reduction of bleeding, a direct measure of periodontal inflammation, which is a unique finding.

Long-term Effect of Supervised Toothbrushing on Levels of Plaque and Gingival Bleeding Among Schoolchildren.

PURPOSE: To test the hypothesis that, in high caries-risk children, supervised toothbrushing (STB) reduces visible plaque levels and gingival bleeding to a greater extent than does unsupervised toothbrushing (USTB) in comparable children and in low caries-risk USTB children over 4 years. MATERIALS AND METHODS: High caries-risk schoolchildren, ages 6 to 7, were allocated to three oral healthcare protocols using a cluster-randomised design: 1. Ultra-Conservative Treatment (UCT): small cavities in primary molars were restored using ART, while medium and large cavities were left open and cleaned under daily supervised toothbrushing together with the remaining dentition (UCT/STB); 2. Conventional Restorative Treatment (CRT): primary molars were restored with amalgam, while high caries-risk first permanent molars received resin sealants (CRT/USTB); 3. Atraumatic Restorative Treatment (ART): primary molars were restored using ART, while high caries-risk first permanent molars received ART sealants (ART/USTB). Low caries-risk children (dmft ≤ 1) formed the no-treatment/USTB group. 273 children were examined at baseline (T0) and after 4 years (T1) according to the VPI and GBI indices. Data were analysed using linear and logistic regression. RESULTS: Mean VPI and mean GBI scores were statistically significantly lower at T1 than at T0. Reduction in mean VPI scores in UCT/STB children was statistically significantly higher than for CRT+ART/USTB children over 4 years (p = 0.03), but no difference was observed between UCT/STB and no-treatment/USTB children (p = 0.361). No statistically significant difference in the reduction of mean GBI scores was observed between UCT/STB and CRT+ART/USTB (p = 0.62) and no-treatment/USTB children (p = 0.74). CONCLUSION: In high caries-risk children, the protocol based on supervised toothbrushing presented greater reduction in visible plaque levels than did protocols based on restorations and sealants over 4 years.

Prevalence and risk factors of periodontal disease among pre-conception Chinese women.

BACKGROUND: Periodontal disease is one of the most common chronic infectious diseases. It has been reported that periodontal disease is associated with various adverse pregnancy outcomes including preterm birth, low birth weight, and gestational diabetes mellitus. Given the fact that the treatment for periodontal disease during pregnancy was ineffective in improving pregnancy outcomes by most of studies, the pre-conception period has been put forward as a more optimal time. However, very few studies have reported the prevalence of periodontal disease among pre-conception women. This study aimed to examine the prevalence and risk factors of periodontal disease among Chinese pre-conception women. METHODS: A survey was conducted among pre-conception women at the Maternal and Child Health Hospital, Changzhou, China between January 2012 and December 2014. A total of 987 pre-conception women were recruited for a full-mouth dental examination after providing informed consent. A dental examination was carried out by probing six sites per tooth using a manual UNC-15 probe and a recording form. RESULTS: The overall rate of periodontal disease among participants was 73.9% (729/987) (95% confidence interval (CI): 71.0-76.6%). Among women with periodontal disease, 48.0% of cases were mild, 50.9% were moderate and 1.1% were severe. Self-reported bleeding during tooth brushing was the only significant predictive factor for overall periodontal disease (adjusted odds ratio (aOR): 3.71, 95% CI: 2.24, 6.15, P < 0.001) and moderate/severe periodontal disease (aOR: 5.17, 95% CI: 3.05, 8.79, P < 0.001). CONCLUSION: A high prevalence of periodontal disease was found in pre-conception Chinese women. Women who have bleeding during tooth brushing could be at increased risk of periodontal disease, and might require further oral health care.

A randomized 3-month clinical comparison of a power toothbrush to a manual toothbrush in the reduction of gingivitis.

PURPOSE: To compare the anti-gingivitis effect of a power toothbrush relative to a manual toothbrush control. METHODS: This was a 3-month, randomized and controlled, single-center, parallel group, examiner-blinded clinical study. 123 Chinese adults in good general health and with at least 15 gingival bleeding sites, as measured by the Gingival Bleeding Index, were enrolled into the study. At baseline, pre-treatment gingivitis levels were assessed using the Mazza Bleeding Index. Subjects were then randomly assigned to receive either an oscillating-rotating power toothbrush [Oral-B Professional Care 7000 (D17u/EB17)] or a flat-trim manual toothbrush with tapered filaments (Lion Dentor Systema). Subjects brushed at home twice-daily with their assigned toothbrush and a marketed sodium fluoride dentifrice (Crest Cavity Protection dentifrice), and were reevaluated at Months 1, 2, and 3. RESULTS: 113 evaluable subjects completed the study. Both groups showed significant reductions in gingivitis from baseline for all time points measured (P< 0.001). At Months 1, 2 and 3, the power toothbrush demonstrated significantly greater gingivitis reductions of 7.11%, 9.20% and 8.47%, respectively, than the manual toothbrush (P< 0.01), and significantly fewer bleeding sites (17.3%, 23.9% and 24.3%, respectively, P< 0.05). No adverse events were reported or observed for either brush during the study. CLINICAL SIGNIFICANCE: The power brush provided statistically significantly greater reductions in gingivitis compared with a manual toothbrush at Months 1, 2 and 3.

Provisional Restorations Used in Immediate Implant Placement Provide a Platform to Promote Peri-implant Soft Tissue Healing: A Pilot Study.

The use of an immediately placed provisional restoration that mirrors the cervical contours of the extracted tooth at the time of implant placement may provide a platform to promote peri-implant soft tissue healing. This study examined the association of sulcular bleeding at the time of initial disconnection of the provisional restoration with stability of the buccolingual ridge dimension following immediate implant placement. Eighteen immediate implants grafted with particulate bone were restored with a screw-retained, single-unit, provisional restoration and abutment. The presence of sulcular bleeding was recorded after 5 to 7 months of healing. Stability of the buccolingual ridge dimension at the level of the free marginal gingiva and 1, 2, 3, 5, 7, and 9 mm apical was estimated using the contralateral tooth as a control. Gingival bleeding was associated with the disconnection of the provisional restoration in 11 (61.1%) of the grafted implant sites. Bleeding upon initial disconnection of the provisional restoration was significantly correlated with smaller changes, or greater stability, in the buccolingual ridge dimension at each reference point from 0 to 3 mm apical to the free gingival margin. The use of anatomically contoured provisional restorations may provide a platform to promote peri-implant soft tissue healing and minimize remodeling of the buccolingual ridge dimension.

An Eight-Week Clinical Evaluation of an Oscillating-Rotating Power Toothbrush with a Brush Head Utilizing Angled Bristles Compared with a Sonic Toothbrush in the Reduction of Gingivitis and Plaque.

OBJECTIVE: To evaluate and compare the efficacy of an oscillating-rotating (O-R) power toothbrush with a brush head utilizing angled bristles to a marketed sonic toothbrush in the reduction of plaque and gingivitis over an eight-week period. METHODS: This study used a randomized, examiner-blind, single-center, two-treatment, parallel group, eight-week design. Subjects with mild-to-moderate plaque and gingivitis were evaluated for baseline whole mouth, gingival margin, and approximal plaque, gingivitis, and gingival bleeding. Clinical assessments were performed using the Modified Gingival Index, Gingival Bleeding Index, and the Rustogi Modified Navy Plaque Index. Subjects received either the O-R brush (Oral-B Professional Care 1000 [D16u] with Oral-B CrossAction brush head [EB50]) or the sonic brush (Sonicare DiamondClean with the standard DiamondClean brush head). Subjects brushed twice daily for two minutes per brushing with the assigned brush and a standard fluoride dentifrice for eight weeks before returning for plaque and gingivitis evaluations using the same methods. Prior to baseline and Week 8 measurements, participants abstained from oral hygiene for 12 hours. RESULTS: One hundred and forty-eight subjects completed the study; 75 in the O-R group and 73 in the sonic group. Both brushes demonstrated statistically significant reductions in plaque and gingivitis over the eight-week study period (p < 0.00 1). The O-R brush was statistically significantly more effective in reducing plaque and gingivitis than the sonic brush. Whole mouth, gingival margin, and approximal plaque reductions were 27.7%, 46.8%, and 29.3% greater, respectively, compared with the sonic brush, while the reductions in gingivitis, gingival bleeding, and number of bleeding sites were 34.6%, 36.4%, and 36.1% greater, respectively, for the O-R brush than for the sonic brush (p < 0.001 for all six measures). No adverse events were observed for either brush. CONCLUSION: The plaque and gingivitis reductions for the O-R power brush incorporating the angled-bristled brush head were significantly greater than for the sonic power brush.

Adjunctive Non-Surgical Therapy of Inflamed Periodontal Pockets During Maintenance Therapy Using Diode Laser: A Randomized Clinical Trial.

BACKGROUND: Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin-1ß (IL-1ß) in patients receiving regular periodontal maintenance therapy. METHODS: This single-masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥ 5 mm with bleeding on probing (BOP). Fifty-six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty-eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL-1ß levels were measured immediately before treatment (baseline) and 3 months after treatment. RESULTS: Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL-1ß levels between SRP + L and SRP alone were not statistically significant. CONCLUSION: In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥ 5 mm PD.