Occurrence and predictors of gingivitis and supragingival calculus in a population of Brazilian adults.

The aim of this study was to determine the occurrence of gingivitis and calculus and their predictors in a population of adults in Brazil. A representative sample of 758 adults from 35 to 59 years of age from Porto Alegre city was examined. A structured questionnaire was applied. The Gingival Bleeding Index and the presence of calculus were measured at 4 sites/tooth. Multivariable logistic models were fitted to determine the predictors for gingival bleeding at >20% of sites. Overall, 96.5% (95% confidence interval [CI]=95.1-98.0) of individuals had ≥ 1 bleeding site. The mean percentages of sites with gingivitis and calculus were 26.1% and 44.6%, respectively. The odds of gingivitis decreased by ∼45% for individuals ≥40 years old compared to younger adults. Individuals that never performed interproximal cleaning and non-whites had an approximately two times higher chance of gingivitis. Smokers had lower chances of gingivitis than never-smokers (odds ratio=0.40; 95% CI=0.24-0.68). Higher numbers of missing teeth were associated with higher chances of gingivitis. The percentage of calculus was significantly associated with skin color, education, proximal cleaning, smoking exposure, dental visits, and tooth loss. It can be concluded that the occurrence of gingivitis and calculus was high in this Brazilian population, and it was associated with age, skin color, education, self-reported proximal cleaning, smoking, dental care, and tooth loss.

Occurrence and predictors of gingivitis and supragingival calculus in a population of Brazilian adults

Abstract: The aim of this study was to determine the occurrence of gingivitis and calculus and their predictors in a population of adults in Brazil. A representative sample of 758 adults from 35 to 59 years of age from Porto Alegre city was examined. A structured questionnaire was applied. The Gingival Bleeding Index and the presence of calculus were measured at 4 sites/tooth. Multivariable logistic models were fitted to determine the predictors for gingival bleeding at >20% of sites. Overall, 96.5% (95% confidence interval [CI]=95.1-98.0) of individuals had ≥ 1 bleeding site. The mean percentages of sites with gingivitis and calculus were 26.1% and 44.6%, respectively. The odds of gingivitis decreased by ∼45% for individuals ≥40 years old compared to younger adults. Individuals that never performed interproximal cleaning and non-whites had an approximately two times higher chance of gingivitis. Smokers had lower chances of gingivitis than never-smokers (odds ratio=0.40; 95% CI=0.24-0.68). Higher numbers of missing teeth were associated with higher chances of gingivitis. The percentage of calculus was significantly associated with skin color, education, proximal cleaning, smoking exposure, dental visits, and tooth loss. It can be concluded that the occurrence of gingivitis and calculus was high in this Brazilian population, and it was associated with age, skin color, education, self-reported proximal cleaning, smoking, dental care, and tooth loss.

Oral health status of adult heart transplant recipients in China: A cross-sectional study.

Limited information on the oral health status of adult heart transplant recipients (HTRs) is known, and no available data exist in China. A prerequisite dental evaluation is usually recommended for patients' postorgan transplantation because lifelong immunosuppression may predispose them to infection spread.The aim of this study was to investigate the oral health status of Chinese adult HTRs and determine the association between oral health status and history of heart transplantation (HT).We carried out a cross-sectional study to collect clinical, demographic, socioeconomic, and behavioral data from 81 adult patients who received heart transplantation during 2014 to 2015 in China. Clinical examinations for the presence of dental plaque, dental calculus, dental caries, and periodontal health conditions were performed in a standardized manner by one trained examiner. Sociodemographic, socioeconomic, and behavioral data were self-reported using questionnaires. The prevalence of the above conditions was compared with 63 age- and sex-matched controls. General liner regression analysis was used to assess associations between mean number of decayed, missing, and filled teeth (DMFT) and mean community periodontal index of treatment needs (CPITN) scores and history of heart transplant.Mean age of the HT group was 47.7 ±â€Š12.2 years and men accounted for 69.1% of the sample. The overall median DMFT score in the HT group was 3 (1-5) and caries prevalence was 80.2%, which were similar to the control group (P > .05). The overall mean CPITN score of the HT group was 1.84, which was significantly higher than the control group (1.07, P = .001). Participants in the HT group had worse oral hygiene status and more teeth with probing depth ≥ 4 mm than controls (P = .043). Compared with participants who had no history of heart transplantation, HTRs presented worse periodontal health conditions (mean CPITN score, adjusted odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.12-1.71, P = .003) and similar dental caries status (DMFT score, adjusted OR = 0.58, 95% CI = 0.37-0.91, P = .058).Periodontal health status was positively associated with history of heart transplantation in Chinese adult HTRs.

Influence of denture surface roughness and host factors on dental calculi formation on dentures: a cross-sectional study.

BACKGROUND: Dental calculi formation on dentures can worsen the oral cavity environment by complicating oral hygiene. However, few studies have investigated the effect of how patients use and manage their dentures, denture surface roughness, and host factors such as oral cavity dryness and saliva properties on denture cleanliness and denture dental calculi formation. Accordingly, we conducted the present survey to evaluate these factors to clarify the strength of the influence of each factor. METHODS: We enrolled 53 patients who had used dentures for at least 3 months and used a dental prosthesis that covered at least the six front teeth including the left and right mandibular canines. After staining the dentures, we divided the participants into a group that was positive for dental calculi (DCP group) and a group that was negative for dental calculi (DCN group). After removing all the stains, we evaluated the surface roughness of the dentures. A questionnaire was used to survey how the participants used and managed their dentures. Oral cavity dryness was evaluated, and resting saliva samples were collected to assess saliva properties. Correlations between the presence or absence of dental calculi and denture use and management were evaluated using a chi-square test. Correlations with denture surface roughness, oral cavity dryness, and saliva properties were evaluated using the Mann-Whitney U test. Correlations between the presence or absence of dental calculi and all factors were analyzed using multivariate analysis (quantification II). RESULTS: Surface roughness was significantly greater in the DCP group (p < 0.01), and the DCP group members wore their dentures during sleep significantly more often and used a denture cleaner when storing their dentures significantly less often (both p < 0.01). No significant differences were observed for oral cavity dryness or saliva properties. The multivariate analysis showed significant correlations of dental calculi formation with denture surface roughness and items related to denture use and management, but not for oral cavity dryness or saliva properties. CONCLUSIONS: Our findings indicate that dental calculi formation is influenced by how dentures are used and managed and by denture surface roughness, but not by oral cavity dryness and saliva properties.

Bonded versus vacuum-formed retainers: a randomized controlled trial. Part 2: periodontal health outcomes after 12 months.

Background: Retainer have the potential to compromise periodontal health. Objectives: Evaluate the periodontal health implications of upper and lower bonded retainers (BRs) versus upper and lower vacuum-formed retainers (VFRs) over 12 months. Trial design: Two-arm parallel group multicentre randomized controlled clinical trial. Methods: Sixty consecutive patients completing upper and lower fixed appliance therapy and requiring retainers were recruited from three hospital orthodontic departments. They were randomly allocated to either upper and lower labial segment BRs (n = 30) or upper and lower full-arch VFRs (n = 30). Periodontal health was assessed using the plaque and gingival indices of Silness and Loe, and the calculus index of Greene and Vermillion. Data were collected at debond and placement of the retainers (T0), 3 months (T1), 6 months (T2), and 12 months (T3). A random sequence of treatment allocation was computer-generated and implemented by sealing in sequentially numbered opaque sealed envelopes independently prepared in advance. Patients, operators, and outcome could not be blinded due to the nature of the intervention. Results: Thirty patients received BRs (median age 16 years, interquartile range [IQR] = 2, 50% female, 50% male) and 30 received VFRs (median age 17 years, IQR = 4, 60% female, 40% male). Gingival inflammation decreased from baseline for both types of retainer. There was significantly less plaque and calculus accumulation and better gingival health with VFRs than BRs over the evaluated 12 months. No serious harm was observed. Limitations: It is not known how much the patients chose to wear their removable retainers. The results reported are after 1 year only. Conclusions: After 1 year, BRs were associated with greater accumulation of plaque and calculus than VFRs and minimally worse gingival inflammation than VFRs, but this did not appear to produce any clinically significant, adverse periodontal health problems. Trial registration: This trial was not registered. Funding: There was no funding.

Long-term influence of fixed lingual retainers on the development of gingival recession: A retrospective, longitudinal cohort study.

OBJECTIVE: To investigate the long-term influence of fixed lingual retainers on the development of mandibular gingival recession and to compare the prevalence with untreated individuals. MATERIALS AND METHODS: The material consisted of 144 subjects: 96 orthodontically treated patients followed for 5 years after therapy and 48 untreated age-matched subjects. The treated patients were divided in two groups: one receiving a fixed mandibular retainer (n = 48) and one receiving no form of retention in the mandible (n = 48). The presence or absence of gingival recession and calculus accumulation were scored before treatment (T0), after debonding (T1), and 5 years after debonding (T5) for each tooth in the mandibular intercanine region using plaster models and intraoral photographs. The chi-square test, one-way ANOVA, and Cochran's Q test were used to evaluate inter- and intragroup differences. RESULTS: The prevalence of patients with recession increased gradually and significantly throughout the observation periods in all groups, but the intergroup differences at T5 were not significant. Significantly more calculus accumulation was observed at T5 in the retainer group compared with the group without retainers. CONCLUSIONS: Long-term presence of fixed lingual retainers does not seem to increase the development of mandibular gingival recession, but does increase calculus accumulation.

O cálculo dental e a doença periodontal / Dental calculus and periodontal disease ­ a literature review

A doença periodontal (DP) é uma infecção crônica em resposta à presença de bactérias nos tecidos ao redor do dente, sendo definida como uma doença sujeito e sítio-específica, que evolui continuamente com períodos de exacerbação e de remissão. É uma patologia fortemente associada à presença de cálculo dentário em superfícies radiculares, porém, a superfície áspera do cálculo dental por si só não é suficiente para induzir à inflamação nos tecidos periodontais adjacentes. O cálculo dental atua como um substrato ideal para a colonização microbiana subgengival, e seu papel no desenvolvimento da doença periodontal tem sido investigado em vários estudos. Esta revisão buscou encontrar na literatura disponível estudos recentes sobre a relação existente entre o cálculo dental e a doença periodontal. Diante dos artigos encontrados, concluiu-se que a superfície porosa do cálculo dental abriga um biofilme viável, que propicia o crescimento e o desenvolvimento de periodontopatógenos. Ainda, pôde-se concluir que o papel do cálculo dental na etiologia da DP é secundário e que sua remoção da superfície dentária é essencial na fase inicial da terapia periodontal. Entretanto, nenhum método utilizado para o debridamento da superfície dental é eficaz na eliminação total do cálculo.

Periodontal disease (PD) is a site-specific, chronic infection in response to bacteria surrounding teeth, with periods of exacerbation and remission. It has been strongly associated to dental calculus (DC) at root surfaces; however, the rough nature of radicular tissues is not enough to trigger soft tissue adjacent infl ammation. The dental calculus act as an ideal substrate for subgingival colonization and its role on the development of periodontal disease has been investigated in several articles. The review aimed to identify recent studies on the relationship between PD and dental calculus. Based on the available data, it can be stated that the porous nature of dental calculus harbors an active biofi lm allowing for growth and development of periodontopathogenic microorganisms. Also, it can be said that DC has a secondary role on the PD etiology, and that its removal remains essential in the early phase of periodontal therapy. Nevertheless, no actual debridement method is effective for complete elimination of DC.

Case report: a patient who had not removed her lower denture for 54 years.

BACKGROUND: A 71-year-old female presented with a left submandibular space abscess. This was found to be due to large accumulations of calculus on the lingual flanges of her lower denture ulcerating the floor of the mouth. She had not taken the prosthesis out since it was provided as an immediate denture after extractions 54 years previously. At presentation she could not take her denture out as the calculus locked the denture under lingual undercuts. The denture was sectioned in the midline to remove it and the submandibular abscess was drained via a neck incision. FINDINGS: Prior to removal the denture was remarkably stable and she had enjoyed a long period of problem free denture wearing and had had exceptional value from it. There was also surprisingly little mandibular alveolar bone resorption. CONCLUSION: The case demonstrates what may happen if a lower denture is not taken out for over half a century. The calculus on the lingual flanges provided both stability and retention for the denture, and it appeared to have protected the ridge from resorption. While the calculus may have provided some surprising benefits to her lower denture it ultimately led to a serious infection.

Role of Anatomic and Salivary Factors in Dental Calculus Formation in Primary and Mixed Dentition Stages.

PURPOSE: Clinical experience shows that formation of calculus is a very rare phenomenon in primary teeth, but it increases as the permanent teeth erupt. The purpose of this study was to assess the relationship between dental calculus, dental anatomy, and salivary factors in primary and mixed dentition stages. METHODS: A cross-sectional study was carried out to determine the buccolingual dimensions of the most concave and the most convex surfaces of the lingual aspect of mandibular central incisor crowns in a sample group of 120 three- to five-old children and 120 eight- to 10-year old children. Saliva samples were collected from 20 in each group. Data were analyzed using t tests. RESULTS: Significant differences were found between the ratio of the buccolingual dimensions of the most convex to the most concave areas of the lingual surfaces in primary and permanent incisors (P=0.028). Saliva analysis revealed significant differences in total protein (P=0.002), sodium (P=0.037), bicarbonate (P=0.003), and ammonia (P=0.025) between the two age groups. CONCLUSIONS: Anatomic and salivary factors may be important reasons for the differences in calculus formation.

[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.

Self-inflicted lesions of the mouth and lips in mentally retarded young subjects.

OBJECTIVE: To evaluate the type and frequency of self-mutilation lesions of the mouth and lips in a large group of institutionalized mentally retarded subjects. SUBJECTS AND METHODS: Two hundred and forty-five institutionalized mentally retarded patients were evaluated clinically by a systematic inspection of the perioral cutis, lips, tongue, oral mucosa, palate, gingivae and teeth. Moreover, the drug therapy taken by each patient was carefully reviewed. RESULTS: Numerous lesions were found involving the tongue, lips, oral mucosa, perioral skin, gingivae and teeth, prevalently supported by a self-mutilation mechanism (such as cheek and tongue biting and nodular traumatic lesions), which were differentially expressed in patients with different degrees of mental retardation. A possible effect of anti-epileptic or neuroleptic drugs was also detected. CONCLUSIONS: These findings indicate that inspection of the oral cavity should always and carefully be performed in all patients with mental retardation and in those with neuroleptic and anti-epileptic drug therapy, in order to avoid or even extinguish self-mutilation of the oral cavity by means of an accurate hydration of the mucosa which might counterbalance some iatrogenic undesired effects.

Comparison of periodontal health status of smokers versus non-smokers.

BACKGROUND: This study aims to compare the periodontal health status of current smokers versus nonsmokers. The study was carried out in the Dental department, Pakistan Institute of Medical Sciences (PIMS) between May 2009 and June 2010. A total of 280 male subjects, married, over the age of 18 were selected to take part in the study and their periodontal health was assessed by presence of calculus, bleeding on probing and pocket depth greater than four millimetres. METHODS: Patients including smokers and non smokers were selected on the basis of the inclusion and exclusion criteria. Subjects were clinically evaluated by using a specially designed CPITN probe which was used to measure pocket depths in the mouth. The mouth was divided into six sextants. The other variables examined included bleeding on probing and presence of calculus. The data was subsequently analyzed using the SPSS statistical software programme. The statistical significance level was set at 5%. RESULTS: There was decreased incidence of bleeding on probing (31.7%) in smokers than non-smokers (53.5%) however, there was an increased incidence of calculus formation among smokers (89.4%) compared to the subjects who did not smoke (69.6%). There was a significant difference between the overall mean pocket depth in smokers (3.7 +/- 1.4) and non-smokers (3.0 +/- 1.1). All of the above differences were found to be statistically significant. CONCLUSION: There was a marked association between cigarette smoking and periodontal disease.

Dental calculus formation in children and adolescents undergoing hemodialysis.

BACKGROUND: This study aimed to determine whether dental calculus formation is really higher among patients with chronic kidney disease undergoing hemodialysis than among controls. Furthermore, the study evaluated correlations between dental calculus formation and dental plaque, variables that are related to renal disease and/or saliva composition. METHODS: The Renal Group was composed of 30 patients undergoing hemodialysis, whereas the Healthy Group had 30 clinically healthy patients. Stimulated whole saliva and parotid saliva were collected. Salivary flow rate and calcium and phosphate concentrations were determined. In the Renal Group the saliva collection was carried out before and after a hemodialysis session. Patients from both groups received intraoral exams, oral hygiene instructions, and dental scaling. Three months later, the dental calculus was measured by the Volpe-Manhold method to determine the rate of dental calculus formation. RESULTS: The Renal Group presented a higher rate of dental calculus formation (p < 0.01). Correlation was observed between rate of dental calculus formation and whole saliva flow rate in the Renal Group after a hemodialysis session (r = 0.44, p < 0.05). The presence of dental calculus was associated with phosphate concentration in whole saliva from the Renal Group (p < 0.05). CONCLUSION: In conclusion, patients undergoing hemodialysis presented accelerated dental calculus formation, probably due to salivary variables.

Exotic encounters with dental implants: managing complications with unidentified systems.

As the application of dental implants increases worldwide, so is the number of technical and biological complications that general dental practitioners will be called to manage, while maintaining implant patients. In addition, the greater patient mobility encountered today combined with a growing trend of 'dental implant tourism' will very often result in situations where the dentist is requested to deal with complications in implants placed elsewhere and which sometimes might be of an 'exotic' system one cannot directly recognize. Such a situation can pose significant challenges to even experienced clinicians. The challenges are not only in the scientific field, but often include professional and ethical implications. This case report will discuss strategies for the management of implant complications in cases of unidentified implant systems. Critical factors in such situations would be the clinician's experience and special training, the correct radiographic technique, as well as access to the appropriate tools and devices.

Ankylosis of nonresorbable hydroxyapatite graft material as a contributing factor in recurrent periodontitis.

Many studies have shown that alloplastic bone grafts are clinically stable and safe. Nevertheless, postoperative problems such as ankylosis and root resorption are associated with alloplastic bone grafts. This report examined two cases of ankylosis of nonresorbable hydroxyapatite (NHA) alloplastic grafts associated with recurrent periodontitis. There was no clear border between the NHA particles and dentin. The particles were irregularly shaped and had plaque on the surfaces. It is postulated that ankylosis of NHA particles and dentin is a contributing factor in recurrent periodontitis.

Methamphetamine abuse and oral health: a pilot study of "meth mouth".

Abuse of methamphetamine (meth), a potent central nervous system stimulant, has been associated with significant dental disease. Current descriptions of "meth mouth" are limited in their scope and fail to illuminate the potential pathogenic mechanisms of meth for oral disease. The purpose of this pilot study was to characterize the oral health of subjects with a history of meth abuse as compared to nonabusing control subjects. A total of 28 meth abusers and 16 control subjects were enrolled. Interviews and surveys regarding meth abuse, dental history, oral hygiene, and diet were collected. A comprehensive oral cavity examination including salivary characterization was completed. We observed significantly higher rates of decayed surfaces, missing teeth, tooth wear, plaque, and calculus among meth abusers. No significant difference in salivary flow rates were noted, yet results showed significant trends for lower pH and decreased buffering capacity. These findings suggest that salivary quality may play a more important role in meth mouth than previously considered. Salivary analysis may be useful when managing a dental patient with history of methamphetamine abuse.

Plaque, gingival bleeding and calculus formation after supragingival scaling with and without polishing: a randomised clinical trial.

PURPOSE: The aim of this study was to compare the effect of polishing after scaling and root planing on supragingival plaque, calculus formation, and gingival bleeding. MATERIALS AND METHODS: The study was designed as a split-mouth randomised clinical trial. Seventy-six patients were submitted to supragingival scaling on the six mandibular anterior teeth with manual curettes until a smooth surface was achieved. Subsequently, quadrants were randomly selected to be polished (test) or not (control) with a rubber cup and pumice. One, two and three weeks following treatment, a blinded examiner evaluated the visible plaque index, gingival bleeding index and the presence of supragingival calculus on the lingual tooth surfaces. RESULTS: The results showed that unpolished surfaces exhibited higher mean percentages of visible plaque in the third week. No statistically significant differences were observed between unpolished and polished sites related to gingival bleeding. Calculus formation was higher on unpolished sites than on polished sites at 2 and 3 weeks. Dental polishing after supragingival scaling contributed to reducing plaque and calculus formation. CONCLUSIONS: Polishing exerts an inhibitory effect on plaque and calculus formation.

Case report: hypodontia and short roots in a child with Fraser syndrome.

BACKGROUND: Fraser syndrome is a rare autosomal recessive disorder of which there has only previously been one case reported in the dental literature. The main characteristics are cryptophthalmos, syndactyly and genital abnormalities. Orofacial findings reported are: facial asymmetry, cleft lip and palate, high arched palate, dental crowding, fusion of primary teeth, dental hypoplasia, malocclusion, and supragingival calculus. CASE REPORT: A 15 year old girl with Fraser syndrome attended Bradford and Airedale salaried dental services complaining of painful mandibular anterior teeth. On examination she presented with hypodontia, shortened roots, and the mandibular anteriors had a titanium trauma splint fixed to reduce the mobility. This had been placed 4 years previously by a paediatric specialist. However oral hygiene was poor around it and therefore the patient had calculus and gingivitis. TREATMENT: The splint was removed followed by subgingival scaling under local analgesia, fissure sealants of all posterior teeth, regular oral hygiene instruction and scaling, and occasional use of chlorhexidine gel. FOLLOW-UP: She has been reviewed regularly with frequent scalings over two years. CONCLUSION: This case reports the possibility of hypodontia and short roots being associated with Fraser syndrome.