Association Between Dental Calculus and Hypertension Phenotypes in Highly Fit Adults: CHIEF Oral Health Study.

BACKGROUND: Poor oral health evaluated by presence of dental calculus has been associated with hypertension (HTN) among middle- and old-aged adults. However, it is unclear for the association of HTN phenotypes with dental calculus in young adults. METHODS: This study examined the association between dental calculus and HTN in 5,345 military personnel, aged 19-45 years, without antihypertensive medications therapy in Taiwan from 2018 to 2021. Dental calculus was defined as presence of supragingival calculus in any teeth, except impacted teeth, and third molar. Combined HTN (CHTN) was diagnosed as systolic blood pressure (SBP) ≥130 mm Hg and diastolic blood pressure (DBP) ≥80 mm Hg. Isolated systolic and diastolic HTN were, respectively, defined as SBP ≥130 mm Hg only (ISHTN) and DBP ≥80 mm Hg only (IDHTN). Multiple logistic regression with adjustments for sex, age, toxic substance use, anthropometrics, lipid profiles, fasting glucose, and blood leukocyte counts were used to determine the association between dental calculus and HTN phenotypes in young adults. RESULTS: The prevalence of those with dental calculus, CHTN, ISHTN, and IDHTN was 20.8%, 10.8%, 10.2%, and 7.0%, respectively. The dental calculus was associated a greater possibility with CHTN [odds ratio (OR) and 95% confidence interval: 1.60 (1.31-1.95)]. However, the associations of dental calculus with ISHTN and IDHTN were null [OR: 1.05 (0.81-1.27) and 1.12 (0.86-1.46), respectively]. CONCLUSIONS: Our findings suggest that among young adults, poor oral health manifested by presence of dental calculus was associated with a greater possibility of CHTN, while not for ISHTN and IDHTN.

Comparative In Vitro Evaluation of WHO Periodontal Probe and #11/12 Dental Explorer for Subgingival Calculus Detection.

AIM: The World Health Organization (WHO) periodontal probe is recommended for epidemiologic surveys and periodontal screening, but its ability to identify subgingival dental calculus (DC) relative to a #11/12 explorer is not known. This study compared in vitro the ability of the WHO probe and a #11/12 explorer to detect subgingival DC. MATERIALS AND METHODS: Three typodont models with randomly distributed artificial DC on mandibular molar and premolar root surfaces were assessed with a WHO periodontal probe and a #11/12 explorer by two periodontists. The diagnostic performance of the two instruments for subgingival DC detection was compared using 2 × 2 contingency table analysis. RESULTS: A #11/12 explorer provided better reproducibility, a higher level of sensitivity, higher positive predictive values, higher negative predictive values, and greater overall accuracy (diagnostic effectiveness) (76.9% vs. 68.5% for the first periodontist; 87.0% vs. 75.0% for the second periodontist) for detection of subgingival DC than the WHO probe. CONCLUSION: The in vitro diagnostic performance of a #11/12 explorer was superior to the WHO periodontal probe for identification of subgingival DC. CLINICAL SIGNIFICANCE: A #11/12 explorer, rather than the WHO probe, is recommended for identification of subgingival DC.

Improved detection of subgingival calculus by laser fluorescence over differential reflectometry.

Laser fluorescence (LF) and differential reflectometry (DR) are two new optical methods which have been used to help diagnose subgingival deposits of dental calculus. This study compared the performance of LF using the KEY3 laser system versus DR using the DetecTar system under controlled laboratory conditions designed to simulate clinical conditions as much as possible. A total of 30 extracted human posterior teeth were set in an anatomical configuration in stone typodonts with impression material replicating the periodontal soft tissues. LF was more accurate than DR (76.2% vs. 68.2%) and gave higher reproducibility (Bangdiwala's B statistic 0.71 vs. 0.54). The better performance of LF makes it the preferred option of the two methods for detection of subgingival dental calculus.

Comparison of calculus detection among dental hygienists using an explorer and ultrasonic insert.

INTRODUCTION: Periodontal therapy disrupts the biofilm harbouring calculus that triggers inflammation. The explorer is primarily used for calculus detection, and the ultrasonic instrument is primarily used for calculus removal. The efficiency in dental hygiene care may improve if the ultrasonic instrument could be used in both calculus detection and removal. PURPOSE: The purpose of this study was to validate the effectiveness of calculus detection between the Thinsert® ultrasonic insert and the 11/12 explorer. METHODS: Upon IRB approval, this validation study involved three dental hygiene faculty from the Ohio State University Dental Hygiene Program and 30 patient participants from the Ohio State University community. Using both instruments, calculus was evaluated on Ramfjord index teeth and on four possible surfaces per tooth. Data were analysed to evaluate for interrater reliability, intrarater reliability, sensitivity, and specificity. RESULTS: For interrater reliability, the average measure of intraclass coefficient (ICC) value was 0.782 with a 95% confidence interval (CI) of 0.749-0.810 (F(1439, 2878)  = 4.852, P < 0.01). For intrarater reliability, mean Kappa averages were in the full agreement range (κ = 0.726, n = 2160, P < 0.01). When using the Thinsert® for calculus detection, the sensitivity was 75%, specificity was 97%, PPV was 81%, and NPV was 94%. CONCLUSION: Since calculus evaluation was comparable when using the ODU 11/12 explorer and the Thinsert®, efforts can be focused on developing the tactile sensitivity when using the Thinsert® ultrasonic instrument in the assessment, treatment, and maintenance of periodontal disease and the support of oral health. The efficiency in dental hygiene care may improve by using the Thinsert® ultrasonic instrument in both the detection and removal of calculus.

Do dental calculi predict the presence of renal stones?

OBJECTIVE: Pathological calcifications that occur in various parts of the body may cause stone formation over time. The structure of these stones is similar in many regions of the body. We have studied the relationship between dental calculi and kidney stones. MATERIAL AND METHODS: A total of 183 patients with dental stone complaints or dental calculi were included between April and August 2016 in the Cagri Dental Hospital, Elazig, Turkey. Patients were evaluated with regard to a urinary tract ultrasonography, urinalysis, oral hygiene, and stone and surgical disease history. All information was statistically investigated. RESULTS: The age of the patients in the kidney stones group was significantly higher than the non-kidney stone patients (p < 0.05). In the group with kidney stones, the percentage of dental calculus formation was significantly higher than the group without stones (p < 0.05). In the groups with and without kidney stones, dental stone recurrence rates did not differ significantly (p < 0.05). Urinary pH was significantly lower in the group with stones than the group without stones (p < 0.05). CONCLUSIONS: During a physical examination, the formation of a visible stone, such as a dental calculus, may be an indicator of other types of stones, such as kidney stones, and this should be further investigated.

Comparison of the Efficacy of Calculus Detection Between Ultrasonic Inserts and an Explorer.

Purpose: The purpose of this study was to evaluate the efficacy of calculus detection between a thin and curved ultrasonic inserts (UI) as compared to the Old Dominion University (ODU) 11/12 explorer.Methods: Three clinical dental hygiene faculty members were recruited to participate as calibrated raters for the presence of calculus in a group of 60 patient volunteers. Inclusion criteria were: adults aged >18 in good health, and no history of a professional prophylaxis within the past six months. Raters used an ODU 11/12 explorer, thin and curved UIs to evaluate 4 surfaces on Ramfjord index teeth for the presence of subgingival calculus. Data were analyzed for intra- and intrerrater reliability, sensitivity, and specificity.Results: Interrater reliability for calculus detection with an ODU 11/12 explorer and a thin UI was demonstrated with an Intraclass Coefficient (ICC) of .782, confidence interval (CI) 95%. An ICC of .714, CI 95% was demonstrated with the ODU 11/12 explorer and curved UIs. Intra-rater reliability was shown with mean Kappa averages in the full agreement range (Kappa=.726, n=2,160, p<0.01) for use of the ODU 11/12 explorer versus the thin UI as well as versus curved UIs (Kappa=.680, n=2160, p<0.01). Sensitivity was 75%, specificity 97%, PPV 81%, and NPV 94% when the thin UI was used and sensitivity measured 65%, specificity 98%, PPV 81%, and NPV 95% when curved UIs were used.Conclusion: Calculus detection was comparable when using the ODU 11/12 explorer, a thin UI and curved UIs on patients with limited amounts of calculus among the three clinicians. Efforts may be focused on developing tactile sensitivity for calculus detection in addition to calculus removal when using thin and curved ultrasonic instruments. Future studies should investigate calculus evaluation utilizing a variety of ultrasonic insert designs, varying amounts of calculus, and levels of clinical experience.

Analysis of root surface properties by fluorescence/Raman intensity ratio.

The aim of this study is to evaluate the existence of residual calculus on root surfaces by determining the fluorescence/Raman intensity ratio. Thirty-two extracted human teeth, partially covered with calculus on the root surface, were evaluated by using a portable Raman spectrophotometer, and a 785-nm, 100-mW laser was applied for fluorescence/Raman excitation. The collected spectra were normalized to the hydroxyapatite Raman band intensity at 960 cm-1. Raman spectra were recorded from the same point after changing the focal distance of the laser and the target radiating angle. In seven teeth, the condition of calculus, cementum, and dentin were evaluated. In 25 teeth, we determined the fluorescence/Raman intensity ratio following three strokes of debridement. Raman spectra collected from the dentin, cementum, and calculus were different. After normalization, spectra values were constant. The fluorescence/Raman intensity ratio of calculus region showed significant differences compared to the cementum and dentin (p < 0.05). The fluorescence/Raman intensity ratio decreased with calculus debridement. For this analysis, the delta value was defined as the difference between the values before and after three strokes, with the final 2 delta values close to zero, indicating a gradual asymptotic curve and the change in intensity ratio approximating that of individual constants. Fluorescence/Raman intensity ratio was effectively used to cancel the angle- and distance-dependent fluctuations of fluorescence collection efficiency during measurement. Changes in the fluorescence/Raman intensity ratio near zero suggested that cementum or dentin was exposed, and calculus removed.

Mapping of adolescents with gingivitis and dental calculus / Mapeamento de adolescentes com gengivite e cálculo dental / Mapeo de adolescentes con gingivitis y cálculo dental

Objective: The aim of this study was to map the distribution of periodontal disease in adolescents in the Jequitinhonha Valley. Methods: We constructed maps with varying Community Periodontal Index (CPI). The cities were selected based on population size and performance of oral health services. The sampling plan was composed of 450 individuals between 15 and 19 years, randomly selected in number corresponding to the proportion of the adolescent population in each municipality. Results: Of the 450 adolescents examined were 16 (3.5%) code 0 (Healthy), 232 (51.5%) of the code 1 (bleeding), 38 (8.44%) code 2 (Calculus) and 164 (36.44%) code 6 (bleeding and calculus). The pattern of mosaic maps was kind and may indicate that the worst periodontal conditions of adolescents were distributed throughout the region. Conclusion: maps described the oral health status of adolescents and can provide information for planning oral health.

Objetivo: Este estudo foi mapear a distribuição da doença periodontal nos adolescentes do Vale do Jequitinhonha. Métodos: Foram construídos mapas com variáveis do Índice Periodontal Comunitário (IPC). Os municípios foram selecionados com base no porte populacional e no desempenho do serviço de saúde bucal. O plano amostral foi composto por 450 indivíduos entre 15 e 19 anos, selecionados aleatoriamente, em número correspondente à proporção da população adolescente de cada município. Resultados: Dos 450 adolescentes examinados foram 16 (3,5%) de código 0 (Saudável), 232 (51,5%) do código 1 (sangramento), 38 (8,44%) de código 2 (Calculus) e 164 (36,44%) de código 6 (sangramento e cálculo). O padrão dos mapas foi do tipo mosaico e pode indicar que as piores condições periodontais dos adolescentes estavam distribuídas por toda a região. Conclusão: Mapas descreveram a condição de saúde bucal de adolescentes e pode fornecer subsídios para o planejamento em saúde bucal.

Objetivo: Este estudio fue determinar la distribución de la enfermedad periodontal en adolescentes del Valle de Jequitinhonha. Métodos: Se construyeron mapas con diferentes Índice Periodontal Comunitario (IPC). Las ciudades fueron seleccionadas en base al tamaño de la población y el desempeño de los servicios de salud oral. El plan de muestreo estuvo compuesto por 450 personas entre 15 y 19 años, seleccionados al azar en el número correspondiente a la proporción de la población adolescente en cada municipio. Resultados: De los 450 adolescentes examinados fueron 16 (3,5%) de código 0 (sano), 232 (51,5%) del código 1 (sangrado), 38 (8,44%) Código 2 (cálculo) y 164 (36,44%) de código 6 (sangrado y cálculo). El patrón de mapas mosaico era amable y puede indicar que las peores condiciones periodontales de los adolescentes se distribuyeron en toda la región. Conclusión: Los mapas describen el estado de salud bucal de los adolescentes y pueden proporcionar información para la planificación de la salud oral.

The oral health status of older patients in acute care on admission and Day 7 in two Australian hospitals.

Objective: to determine the oral health status of older patients in acute care wards at admission and after 7 days. Methods: a prospective descriptive study was conducted in two acute tertiary referral hospitals in New South Wales, Australia. Oral health was assessed on admission (within 24 h) and Day 7 using the Oral Health Assessment Tool. Results: a total of 575 patients were admitted under the Geriatric teams at the two hospitals. Four hundred and thirty-five (76%) patients had oral cleanliness (debris) scores in the 'not healthy' range with food particles, tartar or plaque evident in at least one area in most areas of the mouth, teeth or dentures. At Day 7 206 were reassessed. One hundred and forty-nine patients (73%) were in the 'not healthy' range and of these 127 (62%) had the same score as on admission. Conclusion: poor oral health is common in older people admitted to hospital acute care wards and does not improve over a 7-day period. Given the link between oral health and general health the next steps are to determine how oral health can be improved in this setting and see whether this leads to better patient outcomes.

Dental Treatment Needs among Children and Adolescents Residing in an Ugandan Orphanage.

BACKGROUND: Previous studies focused on the dental caries status of East African children and not on their overall dental needs. Urban children consume more sugar-rich foods. OBJECTIVES: To assess overall dental treatment needs of children living in an orphanage in Uganda. STUDY DESIGN: Teeth were diagnosed as needing treatment by obvious frank carious lesions (WHO criteria), temporary fillings, staining, or very deep pit and/or fissures possibly requiring sealants. Calculus or crowding in the mandibular anterior region and evidence of tooth fractures were recorded, as were signs of wear on the mandibular molars and canines and the maxillary incisors. RESULTS: Most of the primary teeth (64%) required no dental treatment, but almost all (98%) of the permanent teeth did. A mean (±standard deviation) of 4.81±1.92 permanent teeth required treatment. The mean number of missing teeth was 0.47. Thirty-one children (20.2%) had crowding, 52 (34%) had calculus, and 49 (32%) had signs of attrition on primary and permanent molar teeth (45 enamel only and 4 enamel and dentin). CONCLUSIONS: Most of the primary teeth required no dental treatment, while the vast majority of permanent teeth did, possibly in association with high sugar cane consumption and poor brushing habits among older children.

Dental Hygiene Faculty Calibration Using Two Accepted Standards for Calculus Detection: A Pilot Study.

Faculty calibration studies for calculus detection use two different standards for examiner evaluation, yet the only therapeutic modality that can be used for nonsurgical periodontal treatment is scaling/root debridement or planing. In this study, a pretest-posttest design was used to assess the feasibility of faculty calibration for calculus detection using two accepted standards: that established by the Central Regional Dental Testing Service, Inc. (CRDTS; readily detectible calculus) and the gold standard for scaling/root debridement (root roughness). Four clinical dental hygiene faculty members out of five possible participants at Halifax Community College agreed to participate. The participants explored calculus on the 16 assigned teeth (64 surfaces) of four patients. Calculus detection scores were calculated before and after training. Kappa averages using CRDTS criteria were 0.561 at pretest and 0.631 at posttest. Kappa scores using the scaling/root debridement or planing standard were 0.152 at pretest and 0.271 at posttest. The scores indicated improvement from moderate (Kappa=0.41-0.60) to substantial agreement (Kappa=0.61-0.80) following training using the CRDTS standard. Although this result differed qualitatively and Kappas were significantly different from 0, the differences for pre- to post-Kappas for patient-rater dyads using CRDTS were not statistically significant (p=0.778). There was no difference (p=0.913) in Kappa scores pre- to post-training using the scaling/root debridement standard. Despite the small number of participants in this study, the results indicated that training to improve interrater reliability to substantial agreement was feasible using the CRDTS standard but not using the gold standard. The difference may have been due to greater difficulty in attaining agreement regarding root roughness. Future studies should include multiple training sessions with patients using the same standard for scaling/root debridement used for evaluation of students.

Laser fluorescence detection of subgingival calculus using the DIAGNOdent Classic versus periodontal probing.

Deposits of subgingival calculus on the root surfaces of the teeth are difficult to detect with conventional methods such as tactile probing. This study compared the performance of a 655-nm wavelength laser fluorescence (LF) system (DIAGNOdent Classic with a periodontal tip) with conventional periodontal probing under defined conditions in a laboratory simulation, using an experienced examiner. Models with a total of 30 extracted teeth with varying levels of subgingival deposits scattered on their root surfaces were prepared, and silicone impression material applied to replicate periodontal soft tissues. The models were located in a phantom head, and the presence of subgingival calculus recorded at 8 points per tooth (240 sites), then the entire scoring process repeated after 1 and 2 weeks. The optimal LF threshold was determined as a fluorescence score of 7 using Receiver Operating Characteristic curves. When compared the gold standard of direct microscopic examination of roots, LF was more sensitive, specific, and accurate than tactile probing (68.3 vs. 51.7 %; 92.1 vs. 67.8; and 80.2 vs. 59.8 %, respectively), and was also more reproducible (Cohen kappa 0.60 vs. 0.39). These data support the concept of using LF as an adjunct to clinical diagnosis.

Dental disorders in brown howler monkeys (Alouatta guariba clamitans) maintained in captivity.

BACKGROUND: The aim of this study was to investigate dental disorders of brown howler monkeys maintained in captivity. The hypothesis is that the identification and diagnosis of the lesions may contribute to control and prevention. METHODS: Sixteen intact brown howler monkeys (Alouatta guariba clamitans), eight females and eight males, weighing from 3.9 to 6.8 kg, were studied. Under general anesthesia, the teeth were evaluated by visual inspection, probing, palpation, and intra-oral radiographic exam. The findings were registered on a dental chart specific for primates. RESULT: Of the 16 monkeys evaluated in the present study, 94% (n = 15) had some type of dental disorder. The lesions observed were dental calculus (88%), dental wear (81%), missing teeth (38%), gingivitis (19%), gingival recession (6%), dental fracture (19%), pulp exposure (19%), and dental staining (25%). CONCLUSIONS: Alouatta guariba clamitans maintained in captivity have a high rate of dental problems.

Performance differences in the detection of subgingival calculus by laser fluorescence devices.

This study compared the performance of three laser fluorescence (LF) devices (DIAGNOdent Classic, DIAGNOdent Pen and KEY3 laser) under standardized laboratory conditions for detecting subgingival deposits of calculus on root surfaces of extracted teeth in typodonts. While some studies show the efficacy of LF devices for calculus detection compared with conventional periodontal probes, little is known regarding the differential performance of different LF devices. In this laboratory study, extracted teeth were set in an anatomical configuration in stone typodont models in a phantom head and impression material used to replicate periodontal soft tissues. A total of 240 sites were assessed on three occasions using the three different LF devices and results compared to direct microscopic examination of the roots of the extracted teeth under magnification. The KEY3 showed greater accuracy (86.4 %) than the DIAGNOdent Pen (84 %) and DIAGNOdent Classic (80.2 %). The intra-examiner reproducibility was also higher for the KEY3 (mean Cohen kappa 0.74) than the DIAGNOdent Pen (0.66) and DIAGNOdent Classic (0.6). Of the three LF devices, the KEY3 has greater accuracy and reproducibility.

Calculus detection calibration among dental hygiene faculty members utilizing dental endoscopy: a pilot study.

Dental and dental hygiene faculty members often do not provide consistent instruction in the clinical environment, especially in tasks requiring clinical judgment. From previous efforts to calibrate faculty members in calculus detection using typodonts, researchers have suggested using human subjects and emerging technology to improve consistency in clinical instruction. The purpose of this pilot study was to determine if a dental endoscopy-assisted training program would improve intra- and interrater reliability of dental hygiene faculty members in calculus detection. Training included an ODU 11/12 explorer, typodonts, and dental endoscopy. A convenience sample of six participants was recruited from the dental hygiene faculty at a California community college, and a two-group randomized experimental design was utilized. Intra- and interrater reliability was measured before and after calibration training. Pretest and posttest Kappa averages of all participants were compared using repeated measures (split-plot) ANOVA to determine the effectiveness of the calibration training on intra- and interrater reliability. The results showed that both kinds of reliability significantly improved for all participants and the training group improved significantly in interrater reliability from pretest to posttest. Calibration training was beneficial to these dental hygiene faculty members, especially those beginning with less than full agreement. This study suggests that calculus detection calibration training utilizing dental endoscopy can effectively improve interrater reliability of dental and dental hygiene clinical educators. Future studies should include human subjects, involve more participants at multiple locations, and determine whether improved rater reliability can be sustained over time.

[A woman with a painful mouth]. / Een vrouw met pijn in haar mond.

A 44-year old woman presented with a painful mouth. This pain was the result of prolonged inadequate dental hygiene. Extensive calculus formation was present on the molars next to the parotid oroficia.

Endoscopic vs. tactile evaluation of subgingival calculus.

PURPOSE: Endoscopic technology has been developed to facilitate imagery for use during diagnostic and therapeutic phases of periodontal care. The purpose of this study was to compare the level of subgingival calculus detection using a periodontal endoscope with that of conventional tactile explorer in periodontitis subjects. METHODS: A convenience sample of 26 subjects with moderate periodontitis in at least 2 quadrants was recruited from the University of Minnesota School of Dentistry to undergo quadrant scaling and root planing. One quadrant from each subject was randomized for tactile calculus detection alone and the other quadrant for tactile detection plus the Perioscope ™ (Perioscopy Inc., Oakland, Cali). A calculus index on a 0 to 3 score was performed at baseline and at 2 post-scaling and root planing visits. Sites where calculus was detected at visit 1 were retreated. T-tests were used to determine within-subject differences between Perioscope™ and tactile measures, and changes in measures between visits. RESULTS: Significantly more calculus was detected using the Perioscope™ vs. tactile explorer for all 3 subject visits (p<0.005). Mean changes (reduction) in calculus detection from baseline to visit 1 were statistically significant for both the Perioscope™ and tactile quadrants (p<0.0001). However, further reductions in calculus detection from visit 1 to visit 2 was only significant for the Perioscope™ quadrant (p<0.025), indicating that this methodology was able to more precisely detect calculus at this visit. CONCLUSION: It was concluded that the addition of a visual component to calculus detection via the Perioscope™ was most helpful in the re-evaluation phase of periodontal therapy.

Simplified basic periodontal examination (BPE) in children and adolescents: a guide for general dental practitioners.

UNLABELLED: Dental plaque-induced periodontal diseases are common in children and adults. Guidelines were previously not available for the periodontal screening of under 18s. However, new guidelines have been introduced by the British Society of Periodontology and the British Society of Paediatric Dentistry which set out recommendations for the periodontal screening and management of under 18s in primary dental care. This article provides a practical guide for general dental practitioners on how to use the BPE in children and adolescents, and highlights the importance of early detection and management of periodontal diseases in this age group. A failure to use the modified BPE in a young patient who is later diagnosed with periodontitis may leave a dentist vulnerable to a medico-legal complaint or claim. CLINICAL RELEVANCE: New BPE guidelines for children and adolescents have been introduced by the BSPD and BSP; it is important that all dentists are aware of these guidelines and how to implement them in general practice.