An in vivo study of the plaque control efficacy of Persica: a commercially available herbal mouthwash containing extracts of Salvadora persica.

AIM: This study compared the oral health efficacy of Persica mouthwash (containing an extract of Salvadora persica) with that of a placebo. DESIGN: In a double-blind, cross-over trial, participants were randomly allocated to use either the Persica mouthwash or a placebo for a three-week period. Plaque accumulation, gingival bleeding and the salivary concentrations of mutans streptococci (MS) were measured before and immediately following the experimental period. After an eight-week 'washout' period, the study was repeated with participants using the alternative mouthwash. PARTICIPANTS: Twenty-eight healthy students (aged between 18 and 42 years) volunteered to take part in this investigation. RESULTS: Compared with the pre-treatment values, both placebo and experimental groups demonstrated significantly reduced gingival bleeding (p < 0.01). Plaque scores were not significantly reduced following use of either Persica or the placebo. However, the use of Persica, but not the placebo, resulted in significant reduction in the carriage of MS (p < 0.05). CONCLUSION: Use of Persica mouthwash resulted in improved gingival health and lower carriage rate of cariogenic bacteria when compared with the pre-treatment values. The placebo (vehicle control) also improved gingival health significantly. Neither the Persica nor the placebo reduced the accumulation of dental plaque.

Ovine periodontitis as a potential model for periodontal studies. Cross-sectional analysis of clinical, microbiological, and serum immunological parameters.

OBJECTIVES: : To investigate infection and host immunity patterns in sheep with naturally occurring "broken-mouth" periodontitis. MATERIALS AND METHODS: : Eight periodontally healthy (HS) and eight periodontally diseased ewes (PDS) were selected. Subgingival plaque and sera were collected and examined for evidence of human periodontitis-associated pathogens. Serum IgG titers were measured by ELISA to multiple strains of Porphyromonas gingivalis, Bacteroides forsythus, Dichelobacter nodosus, Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Fusobacterium nucleatum as well as several purified antigens (cysteine proteases, LPS, K, and fimbriae). RESULTS: : Neither the organism Aa nor antigens to Aa were found in any animal. Most animals were positive for Pg, Bf, and Pi, but DNA probes detected no difference between HS and PDS relative to amounts of pathogens in subgingival plaque. PDS had significantly higher serum IgG titers to all Pg strains, to 50% of Bf strains, to the Pi and Fn strains, and to fimbriae and the two cysteine proteases (p-values ranging from 0.05 to 0.001). Regression analysis demonstrated a significant association between number of teeth lost and serum IgG antibody titers to whole-cell sonicate antigens of P. gingivalis strains (p<0.01) and body weight (p<0.01). CONCLUSIONS: : The presence of pathogens associated with periodontitis was reflected in differences in serum IgG titers between healthy and diseased sheep. This may have influenced animal body weight and might have systemic health and economic consequences. The data suggest that susceptible and non-susceptible sheep can be identified for periodontal research.

Smoking in adolescence as a predictor of early loss of periodontal attachment.

OBJECTIVES: On the basis of information from studies of older adults, smoking is considered to be an important risk factor for periodontal disease. Examining periodontal loss of attachment among younger adults means a lower contribution from cumulative exposure to other environmental risk factors. The aim of this study was to examine the role of chronic exposure to cigarette smoking as a risk factor for greater prevalence and extent of periodontal loss of attachment among 26-year-old participants in a longstanding prospective cohort study. METHODS: Loss of attachment (LOA) was measured at three sites per tooth in two randomly selected contralateral quadrants (one upper, one lower). Cigarette smoking history was obtained at ages 15, 18, 21 and 26, and used to categorise participants as "never-smokers", "ever-smokers", "long-term smokers" or "very longterm smokers". RESULTS: Periodontal data were available for 914 Study members, among whom the prevalence of LOA of 4+mm was 19.4%. Among those who smoked at ages 15, 18, 21 and 26, it was 33.6%, and, after controlling for sex, selfcare and dental visiting, they were nearly three times as likely to have one or more sites with 4+mm LOA. CONCLUSIONS: Chronic exposure to smoking is a strong predictor of periodontal disease prevalence in young adults.

Clinical effects of removable acrylic appliance design on gingival tissues: a short-term study.

The aim of this study was to assess the effects on the gingiva when an experimental palatal acrylic removable appliance, was worn for 3 weeks. Clinical parameters were reassessed after a 3 week recovery period when the appliance was no longer worn. The appliance design featured a base plate on the right side which extended to the gingival margin, but which on the left, was relieved from the gingival margin by 6mm. Plaque index, gingival index, and probing depth were recorded on days 0, 7, and 21, and at day 42. Results indicated that there was increasing gingival inflammation in the right palatal gingiva by day 7, and this became worse by day 21. Statistically significant differences in gingival inflammation were evident when right and left sides were compared at day 7 and 21, although there were no significant differences in plaque accumulation during this period. Probing depth measurements also increased significantly on the right side by day 21. All these gingival changes reversed to baseline levels during the recovery period by day 42. This paper demonstrates the rapid effect of acrylic denture design on gingival tissues.

The prevalence and intraoral distribution of periodontal attachment loss in a birth cohort of 26-year-olds.

BACKGROUND: Most research efforts in periodontal epidemiology have focused on middle-aged or older people, giving a picture of disease occurrence at a relatively late stage in the natural history of the condition. There is a paucity of comprehensive descriptive data from younger age groups. Understanding the epidemiology and clinical presentation of the condition earlier in the disease course may enable more appropriate interventions. METHODS: The aim of this study was to describe the occurrence of gingival recession, probing depth, periodontal attachment loss (AL), and gingivitis among participants at age 26 in the Dunedin Multidisciplinary Health and Development Study. Gingival recession and probing depth were measured at 3 sites per tooth in 2 randomly selected contralateral quadrants. RESULTS: At age 26, 980 (96.2%) of the surviving cohort participated and periodontal data were available for 914 individuals. Over 70% of the sample had one or more teeth with > or = 1 mm of gingival recession and it was observed at over 20% of midbuccal sites. Over 15% had 1 or more sites with probing depths of > or = 4 mm and nearly 20% had 1 or more sites with > or = 4 mm of AL. The extent of gingival recession was greatest for midbuccal sites on mandibular premolars, followed by midbuccal sites on maxillary premolars and mandibular molars. In the mandible, more distolingual sites had probing depths of > or = 4 mm, but a higher percentage of mesiobuccal sites was affected in the maxilla, and molars were the most affected, followed by premolars, incisors, and canines. Bleeding after probing was more extensive in the mandible than in the maxilla. CONCLUSIONS: Periodontal disease appears to be well-established among a small proportion of young adults. The prevalence of gingival recession was higher than expected, with clear differences by site. Pocketing and AL were more prevalent in mesiobuccal and distolingual sites than the buccal sites, with differences between the jaws.

Guided tissue regeneration with and without demineralized freeze-dried bone allografts for maxillary Class II furca invasions of rapidly progressive periodontitis.

BACKGROUND: Guided tissue regeneration (GTR) using an expanded polytetrafluorethylene (ePTFE) membrane is an established treatment modality for periodontal disease. This study was designed to compare the effects of ePTFE membranes with and without demineralized, freeze-dried bone allografts (DFDBA) for treating maxillary class II buccal furca invasions of rapidly progressive periodonitis. METHODS: Seven patients with pairs of maxillary class II buccal furca invasions comprised the study group. The clinical parameters investigated were probing depth, probing attachment level and marginal tissue recession. One defect from each pair of teeth was randomly selected for the ePTFE membrane and DFDBA group and the other tooth defect received ePTFE membrane treatment only. During the operation, horizontal probing depths at the buccal furcation areas were measured. The membrane was removed 6 weeks after insertion. All measurements were repeated 1 year later at surgical re-entry of the buccal furcation. The Wilcoxon ranked sum test was used to test the significance of the difference between the groups 1 year after treatment. RESULTS: In the ePTFE membrane and DFDBA group, the mean probing depth reduction was 2.1 +/- 0.8 mm. The probing attachment gain was 2.6 +/- 1.0 mm and the bone fill was 3.1 +/- 1.7 mm. There was no statistically significant difference between the groups for these parameters. The marginal tissue recession was reduced 0.4 +/- 0.7 mm in ePTFE membrane and DFDBA group but increased 0.9 +/- 0.6 mm in ePTFE membrane only group. This difference was statistically significant (p = 0.016). CONCLUSIONS: There was no difference in probing depth reduction, probing attachment gain or bone fill between the two treatment modalities for treating maxillary class II buccal furca invasion of rapidly progressive periodontitis. Marginal tissue recession can be significantly reduced with the treatment of combined ePTFE membrane and DFDBA.

The attitudes of New Zealand dentists and dental hygienists towards toothbrushes and toothbrushing.

The purpose of this study was to survey the attitudes of dentists and dental hygienists who practise in New Zealand, with respect to their personal habits, and the recommendations they give to their patients about toothbrush use. A questionnaire was mailed to 800 dentists and 74 dental hygienists with a response rate of 58% and 66% respectively. The results indicate that 76.6% of dentists and 89.1% of dental hygienists recommend toothbrush replacement every two to three months to their patients and generally follow this recommendation themselves. Both groups feel patients should replace their toothbrushes more often than they currently do and the majority tell their patients when to replace brushes. Dentists and dental hygienists have identified bristles that "no longer remove plaque" and "bent, splayed bristles" as the two most important indicators of when a new toothbrush is needed. Soft, compact head brushes are most often recommended by both groups. Most offices give toothbrushing instruction and distribute complimentary brushes. Dentists most often assume this task, but when a hygienist is employed, this duty is typically their responsibility. Oral B and Colgate toothbrushes are the brands most often recommended by both dentist and dental hygienists.

An example of measurement and reporting of periodontal loss of attachment (LOA) in epidemiological studies: smoking and periodontal tissue destruction.

The measurement and reporting of periodontal disease in epidemiological studies can be complex, with the common indices having well-recognised shortcomings. The aim of this study was to illustrate the use of the periodontal loss of attachment (LOA) approach in investigating the association between cigarette smoking and loss of periodontal attachment in a convenience sample of adults, in order to determine whether or not smoking was a risk indicator for periodontal disease. All participants were given a detailed periodontal clinical examination in two randomly assigned contralateral diagonal quadrants, with LOA measurements made at six sites per tooth. Information was also collected on participants' socio-demographic characteristics, oral hygiene practices, smoking history, and attitudes towards smoking. The 240 participants examined comprised 81 current smokers (CS), 79 former smokers (FS) and 80 nonsmokers (NS). Substantial differences and a gradient in disease existed for LOA among the three groups. CS exhibited the greatest (and NS the least) prevalence, extent, and severity of LOA. CS had more plaque and calculus than either of the other two groups, but the groups did not differ with respect to bleeding on probing. Overall, smoking was associated with the disease outcome, and this persisted after potential confounders were controlled using multivariate analysis. Although the observed differences may have been due to the self-selected nature of the sample, the gradient evident across the three smoking exposure groups suggests that smoking cessation can slow the progression of the disease. The LOA approach appears to be a versatile and informative method for recording, analysing, and presenting data on periodontitis in epidemiological studies.

Dental services and needs in developing countries.

People in developing countries are burdened excessively by oral diseases, particularly periodontal disease. These are aggravated by poverty, poor living conditions, ignorance concerning health education, and lack of government funding and policy to provide sufficient oral health care workers. WHO and FDI have identified the problems and developed strategies. However, acceptable goals and standards of oral health have to be agreed. Furthermore, barriers to oral health promotion need to be overcome through co-operation at all levels and appreciation of cultural sensitivity. There is the need for research to determine which types of oral health care systems are most effective in reducing the extent of inequality in oral health. In developing countries where there are huge problems, intervention programmes focusing on primary care and prevention should be designed and implemented urgently and their effectiveness monitored and analysed scientifically. The WHO, FDI and national and international professional organisations should play a leading role in encouraging a determined, co-ordinated effort towards improving the oral health status of disadvantaged people in developing countries.

The effect of transforming growth factor beta one (TGF-beta 1) on wound healing, with or without barrier membranes, in a Class II furcation defect in sheep.

The purpose of this study was to analyse the effect of TFG-beta 1 on wound healing in standardized Class II furcation defects of 48 mandibular second premolar teeth in 24 sheep. The experimental design included a control group (carrier only, 25% pluronic F-127), and 2 experimental groups: group A (80 micrograms/ml TGF-beta 1 + carrier) and group B (80 micrograms/ml TGF-beta 1 + carrier covered with a barrier membrane). Sheep were killed either 2 wk or 6 wk after surgery. Mesiodistal sections of the decalcified specimens were quantified histologically using stereology. Percentage volumes of regenerated bone, fibrous connective tissue and cementum were calculated for each furcation defect. Mean values were analysed using multiple ANOVA; p values were calculated using paired and unpaired Student's t-tests. After 2 wk there was more bone in group B than either of the other 2 groups, but this was not statistically significant. By 6 wk more bone was present in group A than in the control group (p < 0.02) and also in group B when compared with both group A and the control group (p < 0.02 and p < 0.44), respectively. In the 4 wk between sampling significantly more bone had formed (group A < 0.05 and group B p < 0.003, respectively). A negative correlation existed between volumes of bone and fibrous connective tissue and no significant differences between the volumes of cementum were evident between any of the groups. This study demonstrated that TGF-beta 1 encouraged bone regeneration in Class II furcation defects in sheep, an effect enhanced by the presence of a barrier membrane. This is the first report on the use of TGF-beta 1 in conjunction with GTR in periodontal defects.

A comparison of stereological and computer-assisted histomorphometric analysis as tools for histological quantification in regenerative studies.

This study was designed to compare computer-assisted histomorphometric analysis (CAHA) and stereology (STER) as measurement tools for evaluating the repair response during periodontal wound healing. Thirty-six histological sections derived from 4 surgically created defects in the furcation of mandibular second premolars of sheep were measured by each technique to determine the furcation area and volume, and the percentage of new bone formation at 7 wk postoperatively. Slides were viewed in random order with the source unknown to the examiner (JL). One section from each of the 4 specimens was flagged for triplicate measurement by each technique. Intraexaminer error was determined to be low as the coefficient of variation in each of the 2 techniques was between 1% and 4%. A consistently higher percentage of bone was identified using stereology. The coefficient of agreement was plotted to determine how closely these 2 techniques were matched in their respective estimations of bone fill in a furcation defect. This analysis revealed statistical bias between the 2-techniques and a low degree of agreement between them. This study demonstrates that the 2 techniques are not interchangeable. It also emphasizes that the reader must be cautious when comparing results from studies in which different systems of measurement and analysis have been used. Stereology was determined to be the measurement tool of choice due to its high degree of reproducibility, ease of use and efficient use of time.

A comparison of 2 polytetrafluoroethylene membranes in guided tissue regeneration in sheep.

The purpose of this study was to evaluate the sheep as a suitable animal model in which to compare periodontal wound healing after surgically induced Class II furcation defects were treated with different guided tissue regeneration (GTR) membranes. 22 mandibular second premolar sites in 11 sheep were used. The experimental design included untreated control teeth, sites treated by surgery alone, and others where surgery included placement of either Gore-Tex Periodontal Material (GTPM) or Gore-Tex Soft Tissue Patch (GTSTP). Sheep were killed 7 wk after surgery. Mesiodistal sections through decalcified second mandibular premolars were evaluated histologically. Histomorphometric analysis of digitized images allowed both area and linear measurements of newly regenerated furcal tissues. Percentage areas of cementum, bone, epithelium and connective tissue filling the furcation region were calculated. Coronal regeneration of alveolar bone and cementum were expressed as a percentage of the original height of the defect. Mean values for each group were subsequently analysed by 1-way ANOVA. Significantly greater regeneration was achieved with both of the GTR membranes, by comparison with the non-GTR surgical control group, with respect to percentage areas of cementum, bone and connective tissue, and the linear measurement of cementum (p < or = 0.05). This study demonstrates successfully the use of the sheep animal model for GTR research, and shows that few differences exist between GTR healing when either GTPM or GTSTP is used in the treatment of class II furcation defects.

A combined endodontic-periodontal lesion of development origin: a case report.

This report describes an instance in which treatment of a maxillary lateral incisor tooth failed to resolve the presenting endodontic-periodontal lesion. The predisposing aetiological factor was a longitudinal developmental groove extending from the cingulum to the apex of the tooth.

Hygienists and their role in dental practice.

This paper presents the history and introduction of dental hygienists to New Zealand, and illustrates the need for hygienist services with respect to periodontal treatment needs as indicated by the most recent New Zealand epidemiological survey. Examples are given of the way in which dentists may work with hygienists in practice. Hygienists have an economic value and an important role in marketing dentistry. In addition to the benefits of offering a greater range of dental services to patients and avoiding the risk and cost of litigation by patients who previously have been unaware of periodontal problems, the conclusion is made that dental hygienists are very valuable additions to the dental team.