NSAID chronotherapy after impacted third molar extraction: a randomized controlled trial.

OBJECTIVES: Postoperative pain management impacts patients' quality of life and morbidity. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are widely used for this following a 3-doses-per-day regime. However, pain and inflammation follow a circadian rhythm, and animal models assessing the scheduling of NSAID administration (e.g., chronotherapy) have shown that while their use during the active phase of the day enhances postoperative recovery, their administration during the resting phase could have detrimental effects. This observation has led us to hypothesize that night administration of NSAID might be unnecessary in post-surgical scenarios. Therefore, a randomized clinical trial was conducted to test this hypothesis in surgical third molar extractions. MATERIALS AND METHODS: Seventy (18-35 years) healthy participants requiring surgical removal of impacted lower third molars were recruited and randomized into a double-blind placebo-controlled study. For three days postoperatively, the treatment group (n = 33) received ibuprofen (400 mg) at 8 AM, 1 PM, and a placebo at 8 PM, while the control group (n = 37) received ibuprofen (400 mg) at 8 AM, 1 PM, and 8 PM. Pain severity was assessed by visual analog scale (VAS) and healing indicators including facial swelling, mouth opening, and C-reactive protein blood levels were also measured. RESULTS: Pain VAS measures showed a circadian variation peaking at night. Also, no significant differences were observed between the two groups of the study in terms of postoperative pain scores (estimate: 0.50, 95% CI = [- 0.38, 1.39]) or any other healing indicator. CONCLUSIONS: Postoperative pain follows a circadian rhythm. Moreover, night administration of ibuprofen might not provide any significant benefits in terms of pain management and control of inflammation, and two doses during the day only could be sufficient for pain management after surgical interventions. KNOWLEDGE TRANSFER STATEMENT: Even though this study cannot rule out the possibility that a reduced regime is different than a standard regime, nocturnal doses of ibuprofen seem to have no clinical significance in the short term, and the results of this study provide evidence in favor of reducing ibuprofen administration from three doses to two doses only after third molar surgery.

Clinical and biological indicators of periodontal disease in obese and non-obese adults with and without bronchial asthma.

OBJECTIVE: The present study aims to assess clinical and inflammatory parameters as indicators for periodontal disease in obese and non-obese adults with and without bronchial asthma (BA). METHODS: 168 patients visiting the outpatient pulmonary clinics were divided into four groups according to BA and obesity. Obesity was defined by body mass index (BMI) and BA was diagnosed by a pulmonary consultant and being on inhaled asthma medication for at least 12 months. Participants were examined for clinical periodontal parameters and samples of gingival crevicular fluid (GCF) were taken and analyzed for the levels of 5 different inflammatory cytokines. RESULTS: Compared with controls, obese asthmatic group had significant higher mean clinical attachment loss (CAL) (2.64 vs. 1.00, p < .001). Also, the occurrence of periodontitis was significantly higher among obese patients compared to non-obese patients (p = 0.003). Multivariate logistic regression model showed that age was the strongest predictor of periodontitis (aOR = 1.23). The levels of IL-1ß and IL-8 were significantly higher in the non-obese asthmatic group compared to the control group (p < 0.05). The level of IL-6 was significantly lower in the control group compared to the other groups (p < 0.001). Obese patients had significantly higher concentration of hsCRP compared to non-obese patients (p < 0.001). There was no significant difference in the level of TNF- α between groups. CONCLUSIONS: BA and obesity combined did not seem to be associated with a significant increased risk of having periodontitis. BA and obesity are associated with increased levels of some local proinflammatory cytokines which adds to the local and systemic inflammatory burden.

Dental health status and hygiene in children with cerebral palsy: A matched case-control study.

BACKGROUND: Children with cerebral palsy (CP) are at risk for oral pathology and parafunctional habits, and are reliant on caregivers for oral hygiene. AIM: To evaluate oral hygiene habits and oral examination findings among a group of children with CP and a healthy age- and gender-matched control group. DESIGN: A comparative, cross-sectional study, consisting of a questionnaire component and a standard dental examination component, each applied to both groups. RESULTS: Eighty-three children with CP and 84 healthy children were included. Parents of children with CP were more likely to be of low educational level and lack a professional line of occupation (P < .05). Children with CP were less likely to be responsible for oral hygiene maintenance, adhere to toothbrushing, or receive procedural dental care (P < .001). Food packing and drooling were significantly more likely in children with CP. Malocclusion type III was more prevalent among children with CP, as was higher gingival index and gingival enlargement index-horizontal component (P < .001). There were no differences in caries experience between the CP and control groups. CONCLUSIONS: Children with CP have suboptimal oral hygiene habits, limited access to procedural dental care, higher parafunctional habits, and increased periodontal pathology.

Efficacy of serratiopeptidase after impacted third molar surgery: a randomized controlled clinical trial.

BACKGROUND: Serratiopeptidase has been clinically used in controlling surgical and non-surgical inflammatory conditions. This study was conducted to assess the therapeutic effect of Serratiopeptidase in patients undergoing surgical removal of impacted mandibular third molar. METHODS: This randomized clinical trial investigated the efficacy of Serratiopeptidase and Paracetamol after surgical removal of impacted third molar for 5 days (n = 67) as compared with an equivalent dose of placebo and Paracetamol (n = 66). Outcome measures were reported pain, trismus and swelling using Laskin method. All outcome measures were recorded on days 0, 1, 2, 4, and 5 post-surgeries. RESULTS: In this clinical trail 133 patients (mean age 23 years, 54% female) completed the study. Baseline characteristics were comparable across treatment groups. Serratiopeptidase significantly improved trismus compared with control on the 4th day (27.30 ± 7.3 mm and 32.06 ± 7.7 mm, respectively (P < 0.001) Swelling markedly improved, The distance from the lower edge of the earlobe to the midpoint of the symphysis for cases vs control were 111.49 ± 8.1 mm and 115.39 ± 9.9 mm, respectively (P < 0.001). Reported pain, showed no statistical significance difference. CONCLUSION: Serratiopeptidase resulted in better inflammation improvement than placebo over 5 days. Further studies are warranted to assess longer-term and clinical outcomes, as well as safety. CLINICAL RELEVANCE: Serratiopeptidase administered postoperatively helps in improving trismus and swelling after removal of impacted lower third molars. Trial registration The study was registered in ClinicalTrial.gov under the number NCT02493179. Registered 1st of June 2015, https://clinicaltrials.gov/ct2/results?cond=serratiopeptidase .

Effect of cigarette smoking on subgingival bacteria in healthy subjects and patients with chronic periodontitis.

BACKGROUND: Cigarette smoking is known to increase the risk of periodontal destruction and developing chronic periodontitis (CP). It is also reported to affect the subgingival bacterial profile among CP patients. However, studies on the effect of smoking on the bacterial profile among healthy subjects are still limited. Therefore, the aim of this study was to investigate the impact of smoking on the subgingival bacterial profile in both healthy adults and CP patients. METHODS: Subgingival plaque samples were collected from CP patients (30 nonsmokers and 9 smokers) and healthy subjects (37 non-smokers and 18 smokers). Genomic DNA was extracted and 25 bacterial species were detected using PCR of 16S rRNA. Comparing smokers to non-smokers from each group was conducted using chi2 and binary logistic regression analysis. RESULTS: After correcting for confounding factors, the odds of having Slackia exigua, Selenomonas sputigena and Campylobacter rectus was higher among healthy smokers (ORadj = 10.1, 6.62 and 5.62 respectively). While for CP group, the highest odds were observed for Treponema amylovorum, Treponema medium, Slackia exigua and Treponema vincentii (ORadj = 20.7, 7.97, 6.37 and 5.37 respectively) and the increase in Treponema amylovorum was statistically significant (p = 0.05). CONCLUSION: Smoking affects the subgingival bacterial profile in healthy individuals and is responsible for the depletion of beneficial bacteria and the increase in periodontopathogenic bacteria. In the CP patient group, our study suggests that subgingival bacteria (particularly Treponema species) make a more substantial contribution in the etiology of CP among non-smokers. Further studies using a larger sample set and more sensitive and quantitative techniques (such as real -time PCR) are needed to enhance our understanding of the exact effect of smoking on subgingival biofilm.

The effect of a triclosan/copolymer/fluoride toothpaste on plaque formation, gingivitis, and dentin hypersensitivity: A single-blinded randomized clinical study.

OBJECTIVE: The daily removal of supragingival dental plaque is a key factor in the prevention of gingivitis. The aim of the study was to compare the gingival health benefits of a triclosan/copolymer/fluoride toothpaste (Colgate Total, a fluoride toothpaste containing an antiseptic) to a commercially available toothpaste containing 0.243% sodium fluoride in a silica base (Colgate Herbal, a conventional fluoride toothpaste with herbal extracts). METHOD AND MATERIALS: A total of 50 patients with gingivitis and at least one sensitive tooth were included. The subjects were randomly stratified into two groups: Colgate Total toothpaste, and Colgate Herbal toothpaste. After a 4-week pre-experimental phase, baseline Plaque Index (Quigley-Hein Index) (PI), Gingival Index (GI), Gingival Bleeding Index (GBI), and Visual Analog Scale (VAS) were assessed. The PI, GI, GBI, and VAS were reexamined at weeks 4, 12, and 24 after the baseline. RESULTS: Fifty subjects complied with the protocol and completed the study. The conventional fluoride toothpaste with herbal extracts group and the fluoride toothpaste containing an antiseptic group exhibited significant reductions in PI, GI, GBI, and VAS over time. The amount of reduction after 6 months of the treatment was higher in the Total group compared to Herbal group (1.82 vs 1.39, P = .015 for PI; 0.67 vs 0.37, P < .005 for GI; and 56.64% vs 34.26%, P < .005 for GBI). No significant difference was seen for VAS. CONCLUSION: Twice daily brushing with a toothpaste containing 0.3% triclosan and polyvinyl methyl ether and maleic acid copolymer provides a more effective level of plaque control and gingival health with no effect on decreasing dentin hypersensitivity compared to conventional fluoride toothpaste. Toothpastes containing triclosan/copolymer, in addition to fluoride, result in a higher reduction in plaque, gingival inflammation, and gingival bleeding when compared with fluoride toothpastes without triclosan/copolymer.

The relationship between body mass index and periodontitis among postmenopausal women.

BACKGROUND: Periodontitis and overweight/obesity prevalence are both increasing worldwide. Overweight/obesity has been suggested as a risk factor for developing periodontitis. The aim of this study was to determine the association between obesity and periodontitis among postmenopausal Jordanian women. MATERIAL AND METHODS: Cross-sectional associations between obesity and periodontitis were examined in 400 postmenopausal women aged 50-79 years. All women completed a questionnaire, had a clinical periodontal examination and had their weight and height recorded. Multivariable analysis was carried out using logistic regression with adjustment for possible confounders. RESULTS: Based on body mass index (BMI), 23.5% of the women were considered overweight and 70% were obese. Obese participants with BMI≥25 had decreased odds (OR) for having periodontitis compared to participants with normal weight (OR: 0.54; 95% confidence interval [CI]: 0.27-0.87). The obese patients showed significantly higher loss of clinical attachment (CAL), calculus, as well as plaque and gingival index and as compared to normal and overweight (p<0.01). The extent of periodontal disease was also significantly higher in obese women as measured by average percent of sites with the deepest CAL≥5 mm (p=0.025). There was no significant difference in mean and percentage of sites with alveolar crestal bone loss (ACH) among different categories of obesity. In conclusion, BMI may be inversely associated with prevalence of periodontitis but positively related to the severity of periodontitis assessed by several periodontal parameters such as CAL, recession, plaque, and calculus. Additional prospective studies to further quantify, or understand the mechanisms, of this association are merited.

Association Between Obstructive Sleep Apnea and Periodontitis Among Male Adults Attending a Primary Healthcare Facility in Jordan.

PURPOSE: To determine the association between periodontitis and a high risk for obstructive sleep apnea (HR-OSA). MATERIALS AND METHODS: A sample of 296 males with a mean (±SD) age 40 (8.5) years was selected. Subjects who scored positive in two or more categories of the Berlin questionnaire were considered as having HR-OSA. RESULTS: Based on the self-reported symptoms of obstructive sleep apnea, 15% of patients were considered as HROSA. Patients with HR-OSA showed higher probing pocket depth (PPD) and clinical attachment level (CAL) compared with those with low risk for obstructive sleep apnea (LR-OSA)-2.35±0.69 vs 1.97±0.34 (p=0.000) and 2.95±0.82 vs 2.12±0.55 (p=0.000), respectively. Patients with HR-OSA were more likely to have periodontitis (OR=2.3; 95% CI: 1.03/5.10) compared to patients with LR-OSA. The prevalence of periodontitis varied significantly only among patients according to their response to category 1 (37% responded positively and 20% responded negatively, p=0.003). When the OSA variable was replaced by the individual categories (1, 2 and 3), patients with a positive category 1 (OR=2.27; 95% CI: 11.14/4.45) were more likely to have periodontitis than were patients with a negative response. CONCLUSION: The risk of finding periodontitis in HR-OSA patients was approximately double that of LR-OSA patients. Habitual snoring was also associated with increased risk for periodontitis.

Photodynamic therapy in periodontal and peri-implant diseases.

OBJECTIVE: In recent years, photodynamic therapy (PDT) using a combination of photosensitizer and laser light source has been used in periodontal therapy. The aim of this review is to provide an overview of the current status and use of PDT. DATA SOURCES: A review of pertinent literature was carried out in PubMED to determine the current position of PDT applications in periodontal and peri-implant diseases. CONCLUSIONS: In spite of different results and suggestions from various researchers, the present review showed that use of PDT may help improve periodontal outcomes. Therefore, it could become a new method for antibacterial treatment and may be used as an adjunct to or as conventional therapy for the treatment of periodontal and peri-implant diseases. Based on the results presented herein, there is promising, albeit preliminary, information regarding the benefits of PDT use on periodontal treatment outcomes. However, the conclusions are a reflection of a relatively small sample size and therefore need to be demonstrated in the general population. CLINICAL RELEVANCE: Periodontal diseases and peri-implantitis are among the specific targets where PDT can be applied.

Prediction of preterm and low birth weight delivery by maternal periodontal parameters: receiver operating characteristic (ROC) curve analysis.

In this study we used receiver-operating characteristic (ROC) analysis to comparatively evaluate maternal periodontal parameters to predict preterm (PB) delivery and low birth weight (LBW) delivery among Jordanian women. A total of 277 pregnant women (20 weeks of gestation or less) had periodontal examination at baseline and followed up until delivery. Gestational age and birth weight were retrieved from their medical records. ROC curve analyses were used to examine the overall discriminatory power of the studied periodontal parameters to predict PB, LBW, and PB or LBW. For the three outcome variables, the area under curve (AUC) ranged from 0.84 to 0.87 for average clinical attachment level (CAL), 0.78-0.86 for percent of sites with CAL ≥ 5 mm, 0.63-0.74 for percent of sites with CAL ≥ 6 mm, and 0.71-0.82 for number of missing teeth indicating that they had high discriminating power to predict adverse pregnancy outcomes. All other parameters had AUC less than 0.60 and thus had low discriminating power. Average CAL performed the best in predicting the studied adverse pregnancy outcomes because it has the highest AUC. The severity and extent of periodontal disease as measured by CAL can be used to predict the occurrence of adverse pregnancy outcomes.

Patients' perception of cross-infection prevention in dentistry in Jordan.

PURPOSE: To explore the public perception of cross-infection prevention methods and their role in disease transmission, among patients attending Jordan University Hospital. MATERIALS AND METHODS: A systemic random sample of 310 dental patients with a mean (SD) age of 35.1 (14.80) years was selected (42.6% males and 57.4% female). Patients were interviewed prior to dental appointments by a specially trained and calibrated dentist. Responses of the patients were recorded in the structured questionnaire, maintaining their privacy and confidentiality. The data were entered into a Microsoft Excel spreadsheet and analysed using the SPSS statistical package to obtain the prevalence rates of patients' perceptions, which were then cross tabulated with gender, age and other variables. Significant differences were determined using the chi-square test, when appropriate. RESULTS: Of the respondents, 83.5% found it necessary for the dentist to wear gloves, and 65.8% stated the reason was to prevent cross infection from one patient to another. About three-quarters (74.8%) found it necessary for the dentist to wear a mask; when asked about the reason, 52.3% stated prevention of cross infection from dentist to patient. Regarding wearing protective glasses, about three-quarters (73.9%) found it unnecessary for the dentist to do so. The majority (76.8%) stated the method of HIV transmission was by dentists using needles previously used for patients infected with AIDS; 71% knew there is no vaccine against HIV. Only half (49%) reported that hepatitis could be transmitted by blood transfusion. Approximately two-thirds (67.4%) knew there is a vaccine against hepatitis. About 53.5% claimed their knowledge regarding infection transmission was obtained through watching television programmes about cross infection. CONCLUSION: Dental patients in Jordan need to be equipped with adequate knowledge about cross-infection control, thus education reinforcement is imperative.

Use of the Arabic version of Oral Health Impact Profile-14 to evaluate the impact of periodontal disease on oral health-related quality of life among Jordanian adults.

We used the short-form of the Oral Health Impact Profile (OHIP-14) to assess the impact of periodontal diseases on the quality of life of Jordanian adults. A systematic random sample of 400 individuals was selected from patients referred to the periodontics clinic at the Dental Teaching Center in Irbid, Jordan. Those willing to participate were examined by specifically trained dentists and requested to complete the Arabic short-form version of the OHIP-14 questionnaire. Multivariate analysis of differences in OHIP-14 subscales among the periodontal disease groups was conducted using the general linear model multivariate procedure. This study included 400 adults (164 men and 236 women) aged between 18 and 60 years, with a mean (SD) of 36.7 (11.9) years. Of the 400 participants, 41.8% had chronic gingivitis, 19.8% had mild periodontitis, 23.3% had moderate periodontitis, and 15.3% had severe periodontitis. "Fairly often" or "very often" was reported for one or more items of the OHIP-14 by fewer than one-third of patients with gingivitis (32.9%) or mild periodontitis (31.6%), by about one-half of patients with moderate periodontitis (53.8%), and by about two-thirds of those with severe periodontitis (63.9%). There was a statistically significant association between the severity of periodontal disease and OHIP-14 scores (P < 0.05). Severe chronic periodontitis had a significantly greater impact on quality of life, specifically with regard to physical pain and physical disability (P < 0.05). Physical pain and physical disability were the dimensions most affected, and all OHIP-14 scores were significantly associated with severity of periodontal disease after adjusting for common confounders.

Furcation entrance dimensions of the first and second mandibular molars among Jordanians.

PURPOSE: The complexity of molar furcation areas provides a challenge for periodontal treatment that leads to more tooth loss when compared to other tooth types. Furcation entrance dimension (FED) of molar teeth affects treatment outcomes and prognosis considerably. The aim of the present study was to determine the FED in first and second mandibular molars among Jordanian adults and to assess the relationship to gender. MATERIALS AND METHODS: The sample consisted of 430 first and second mandibular molars that were extracted in four dental clinics of the Ministry of Health. The teeth were sorted according to gender after extraction and those meeting the following conditions were selected: intact crowns with completely preserved cementoenamel junction, intact furcation areas and roots lacking restorations. The FEDs were measured under magnification using a computer system (AutoCad 2005) equipped with a digital camera (HP Photosmart). RESULTS: A high percentage (63.5%) of FEDs were wider than 0.75 mm, with buccal furcations wider than lingual ones and first molar furcations having wider furcations than those of second molars among Jordanian adults. A significant difference in the mean FEDs between male and female patients was observed in the second molar. CONCLUSIONS: Furcation involvements in Jordanian adults are more suitable for treatment with standard hand curettes than those reported in other cultures, as a high percentage (63.5%) of the FEDs were wider than the width of a standard Gracey curette blade. A significant difference between sexes in the second molar was observed. The use of other instruments, such as ultrasonic devices, should be taken into account during scaling and root planing as about 37.5% of the furcation would not be adequately instrumented with standard curettes.

Association between periodontal disease and osteoporosis in postmenopausal women in jordan.

BACKGROUND: Some studies suggest that females with osteoporosis are at an increased risk of periodontal attachment loss and tooth loss; however, results have varied. The aim of this study is to determine the relationship between periodontitis and osteoporosis among postmenopausal Jordanian women. METHODS: This cross-sectional study includes 400 Jordanian postmenopausal women with a mean age of 62.5 years (SD ± 6.4 years). These subjects were recruited from patients who had received a routine dual-energy x-ray absorptiometry examination in the Radiology Department, King Abdullah Hospital, Jordan University of Science and Technology, between June 2008 and February 2009. The relationship between skeletal bone mineral density (BMD) and radiographic and clinical parameters of periodontal status, including the loss of alveolar crestal height (ACH), clinical attachment level, probing depth, and percentage of sites with bleeding on probing, was evaluated after controlling for known confounders. RESULTS: Bivariate analyses revealed no significant differences in the severity and extent of clinical attachment and ACH loss among women with normal BMD, osteopenia, and osteoporosis. However, in the multivariate analysis, women with osteoporosis were more likely to have severe ACH loss (odds ratio [OR]: 4.20; 95% confidence interval [CI]: 1.57 to 11.22) and periodontitis (OR: 2.45; 95% CI: 1.38 to 4.34). CONCLUSION: Osteoporosis was significantly associated with severe alveolar crestal bone loss and the prevalence of periodontitis cases in postmenopausal Jordanian women.

Diabetes and oral health: doctors' knowledge, perception and practices.

OBJECTIVES: To assess Jordanian doctors' knowledge of the connection between diabetes and oral health and assess their willingness to advise their diabetic patients to seek dental treatment and determine the associated factors. METHODS: Data were collected from 164 doctors practising in Jordan using a structured questionnaire. Chi-squared test and regression analyses were conducted to reveal factors influencing the awareness, perception and knowledge of health care professionals regarding diabetes and oral health. RESULTS: Of the respondents, 70% had heard of the link between diabetes and oral health. The majority agreed that diabetes increased the tendency to have periodontitis but only half advised their diabetic patients to consult a dentist concerning their oral health. Only a third of doctors agreed that oral health was an issue in controlling diabetes. Books, magazines and pamphlets were the main source of information with the rate of 58%, medical journals and medical curriculum were the second and third sources, respectively. General medical practitioners were less informed than specialized doctors about the relationship between oral health and diabetes. Factors that significantly predicted doctors would advise dental visits were: (1) being a specialist (P = 0.037); (2) having positive knowledge about the association between diabetes and oral health (P = 0.02, P = 0.007 and P = 0.004, respectively). CONCLUSION: There is limited knowledge of the relationships between oral health and diabetes. The more knowledgeable doctors are, the more likely they are to make dental referrals. Screening and referral by health professionals may benefit diabetic patients by improving access to dental care. Therefore, there is a need to educate doctors about oral health and diabetes.

Knowledge and awareness about diabetes and periodontal health among Jordanians.

The aim of this study is to evaluate the awareness, perception, sources of information, and knowledge of diabetes mellitus and periodontal health among Jordanians, to examine the factors related to their knowledge, and organize effective education programs. A random sample of 500 diabetic patients was recruited from three hospitals and three comprehensive health centers that represent both urban and rural populations in Jordan between September 25, 2006, and February 20, 2007. Completed questionnaires with the answers were returned by 405 participants (response rate was 81%). Only 28% indicated that they followed up gum diseases with the dentist; 48% were aware that diabetic patients are more prone to gum diseases and oral health complications. About a third (38%) recognized that their periodontal health might affect their glycaemic level. Television and Internet were the main source of knowledge for dentists with the rate of 50%. Knowledge about diabetes and periodontal health among diabetic patients is low, and majority of patients were unaware of the oral health complications of their disease and the need for proper preventive care. Issues on education need to be addressed. Therefore, appropriate educational programs should be planned according to community needs, and the target of these programs should be patients with irregular visits to the dentist and physicians. The clinical implication of our findings is that dentists, physicians, and other health providers should inspect diabetic patients for gum diseases each time they come for care and recommend that diabetic patient see a dentist regularly.

Gingival health and relapse tendency: a prospective study of two types of lower fixed retainers.

BACKGROUND: Different types and diameters of wire are used in bonded lingual retainers. Some clinicians bond a small diameter multistrand wire to each tooth, while other clinicians bond a large diameter wire to the lingual surfaces of the lower canines. AIM: To compare the gingival health, plaque accumulation, tooth stability and integrity of multistrand wire and round wire bonded lingual retainers. METHODS: Sixty-two subjects, who had completed treatment and who required fixed retention for the lower anterior segment, were assigned to either the Round wire retainer group or the Multistrand wire retainer group. In the Round wire retainer group, a 0.036 inch round, stainless steel wire was bonded to the lingual surfaces of both lower canines. The Multistrand retainer group had a 0.015 inch multistrand wire bonded to the lingual surfaces of all lower anterior teeth. At least 12 months after debonding, the subjects were recalled and the following variables were recorded: Oral Hygiene Index (OHI), Plaque Index (PI) of the lower anterior teeth, Gingival Index (GI) of the lower anterior teeth, Irregularity Index (IRI) of the lower anterior teeth, and the number of broken retainers. RESULTS: There were no significant differences between the PI (p = 0.165) and GI (p = 0.150) of the two groups. More plaque was found on the distal surfaces of the lower anterior teeth in the group with multistrand wire retainers (p = 0.02). The lower anterior teeth were significantly more irregular in the group with round wire retainers compared to the group with multistrand wire retainers (p = 0.002). Although the multistrand wire retainers fractured more frequently than the round wire retainers the difference was not statistically significant (p = 0.325). CONCLUSION: More plaque accumulated on the distal surfaces of the lower anterior teeth in subjects with multistrand wire retainers than in subjects with round wire retainers. Multistrand wire retainers were better at maintaining incisor alignment than single span, round wire retainers.

Dental caries experience in patients with aggressive periodontitis compared to those with chronic periodontitis.

OBJECTIVE: It has been reported that caries prevalence in patients with aggressive periodontitis (ie, juvenile periodontitis) might be higher than that in matched controls. However, the available results are inconclusive. The aim of this study was to assess this relationship by comparing caries experience among subjects with generalized aggressive periodontitis (AgP) and those with chronic periodontitis (CP) and to identify reasons for tooth loss in both groups. METHOD AND MATERIALS: A convenient sample of subjects with AgP (210) and CP (332) was evaluated for decayed, missing, and filled teeth (DMFT) by both clinical and radiographic methods. Statistical analysis was performed by t test and ANOVA. RESULTS: The AgP subjects have significantly less caries experience than the CP subjects older than 20 (P < .001). Tooth loss was mainly due to periodontal disease in AgP subjects and caries in CP subjects. CONCLUSION: Subjects with AgP have significantly less caries experience than subjects with CP over 20 years of age (P < .001).

Factors related to utilization of dental services during pregnancy.

OBJECTIVES: The purposes of this study were to investigate factors related to utilization of dental services during pregnancy and to assess the extent of mothers' knowledge regarding oral health during pregnancy and its effect on pregnancy outcomes. MATERIALS AND METHODS: Cross-sectional data were collected from 625 women using a structured questionnaire mailed to mothers who had given birth in Johnson County, Iowa from August 2001 to March 2002. The survey assessed knowledge, behaviours, attitudes toward dental care during pregnancy, and personal, demographic and pregnancy-related factors. Variables which showed associations in bivariate analysis (p< or =0.1) were considered as candidates for building logistic regression models separately by domain (demographics, dental health care behaviours, lifestyle, financial variables, pregnancy-related variables, and knowledge of the possible association between oral health and pregnancy). Significant domain-specific regression results (p< or =0.05) were used to develop a final model using forward stepwise logistic regression analyses. RESULTS: The overall response rate was 69%. Dental visits during pregnancy were reported by 49% of respondents. Forty-three percent were aware of the possible connection between oral health and pregnancy outcomes. In the final logistic regression analysis, factors significantly associated with reporting dental visits during pregnancy were: (1) personal factors (being married, greater frequency of visiting the dentist when not pregnant and use of inter-proximal cleaning aids); (2) financial factors (dental insurance); and (3) knowledge of the possible connection between oral health and pregnancy outcomes. CONCLUSIONS: There was limited knowledge of the possible relationships between oral health and pregnancy outcomes in a fairly homogeneous population of women who were of relatively high socioeconomic standing. This study suggests that better education of the importance of dental care before and during pregnancy is needed.