Professional use of social media platforms by independent dental hygienists in the Netherlands: A quantitative study.

AIM: This study examines the prevalence of the professional use of social media platforms by independent DHs in the Netherlands and assesses the associated personal and demographic factors. METHODS: In this exploratory, observational, cross-sectional study, independent DHs who were members of the Dutch Dental Hygienist Association (Nederlandse Vereniging voor Mondhygiënisten: NVM) were included. Data were collected from the DH practices' websites. Statistics included frequency distributions, percentages, chi-square tests for the relationship between the parameters, and multiple logistic regression for the associations between social media use and the personal and demographic factors. RESULTS: A total of 830 independent DHs from 670 different practices were included in the study. Of these DHs, 34.4% had a link to a social media platform on their website. DHs with practices in the west or south of the Netherlands were more likely to use Facebook (p = 0.035 and p = 0.002, respectively) than those in the east or north. The likelihood of DHs with 4 years of training using Facebook was 1.910 greater than those with 2 years of training (p = 0.002). Furthermore, DHs who graduated in Utrecht were more likely to use Instagram (p < 0.001). CONCLUSION: Over a third of the independent DHs in the Netherlands used social media for professional purposes. DHs who trained in Utrecht for 4 years and who had a practice in the west or south of the Netherlands were more likely to use social media for professional purposes.

Edentulism among diabetic patients compared to non-diabetic controls: A systematic review and meta-analysis.

OBJECTIVE: The purpose of this paper is to systematically and critically appraise the available scientific evidence concerning the prevalence of edentulism among diabetic patients compared to non-diabetic people. METHODS: MEDLINE-PubMed and Cochrane-CENTRAL databases were comprehensively searched up to April 2023 to identify appropriate studies. The inclusion criteria were observational studies conducted in human subjects ≥18 years of age with the primary aim of investigating the prevalence of edentulism among diabetic patients. Based on the extracted data, a meta-analysis was performed. Recommendations based on the body of evidence were formulated using the GRADE approach. RESULTS: Independent screening of 2085 unique titles and abstracts revealed seven publications that met the eligibility criteria. Study size ranged from 293 to 15,943 participants. Data from all seven studies were suitable for meta-analysis. Overall, 8.3% of the studied population was edentulous. The weighted mean prevalence of edentulism among diabetic and non-diabetics was 14.0% and 7.1%, respectively. The overall odds ratio for diabetic patients to be edentulous as compared to non-diabetics was 2.39 (95% CI [1.73, 3.28], p < 0.00001). CONCLUSION: There appears to be moderate certainty that the risk of being edentulous for diabetic patients compared to non-diabetic people is significant, but the odds ratio is estimated to be small.

Health action process approach in oral health behaviour: Target interventions, constructs and groups-A systematic review.

OBJECTIVE: The aim of this study was to systematically map the Health Action Process Approach (HAPA)-based interventions in dentistry in relation to the type of intervention, the target groups and the constructs of the HAPA model that are used in the study and to assess the clinical relevance of the studies. METHODS: A search in the databases of the National Library of Medicine (MEDLINE-PubMed), PsychINFO and Cochrane-CENTRAL was conducted. A quality assessment to estimate the risk of bias and a qualitative descriptive analysis were performed. The overall gathered evidence was graded. RESULTS: Ten randomized controlled trials and three observational studies thus in total 13 studies were included. Flossing was the targeted behaviour in ten studies. The target groups consisted of students, adolescents and dental patients. Overall, all nine HAPA constructs were used, but only one study used all HAPA constructs. Six studies presented the used behavioural change techniques according to the BCT taxonomy. Based on the number of the used constructs, only two studies were classified as HAPA intervention studies. The most frequently used constructs were action control as an intervention and behaviour as an outcome measure. The overall evidence was graded with moderate certainty. CONCLUSION: In the majority of the studies, the targeted intervention was flossing and the population consisted of students, adolescents and dental patients. All studies used only a selection of the HAPA constructs. Therefore, only a minority of the studies can be considered real HAPA intervention studies.

Change in oral hygiene behaviour after non-surgical periodontal therapy - A retrospective analyses.

AIM: This retrospective analysis investigates changes in daily oral hygiene behaviour after the initial phase of non-surgical periodontal therapy (NSPT). MATERIALS AND METHODS: This retrospective study includes 189 consecutive periodontitis patients treated for moderate to severe periodontitis. The authors used the oral hygiene behaviour questionnaire (OHB-9) to assess and evaluate the oral hygiene self-care practices at both intake and evaluation after an active phase of NSPT which consisted of repeated oral hygiene instruction (OHI), supra- and subgingival debridement and polishing. In addition, data on pocket probing depth and bleeding upon pocket probing (BOP) were extracted and PISA and PESA scores were collected. All these parameters are descriptive of the periodontal status at intake and the clinical response to NSPT. RESULTS: The OHB-9 showed an increased oral hygiene self-care level after the active phase of NSPT. At the evaluation, 85% of patients used a power toothbrush (PTB), representing an increase of 26% as compared with the intake. In addition, 64% reported brushing 3 min or longer, representing an increase of 33%. The use of woodsticks (WS) and interdental brushes (IDB) at least once a day increased with 15% and 40% respectively. The distribution changes on the answering scale were significant for IDB, WS and brushing duration. However, no significant relationship was found between oral hygiene behaviour at the evaluation and the improvement of the gingival inflammation evaluated by BOP percentage. CONCLUSION: The finding of the OHB-9 questionnaire reported was an increase of patients who brushed longer and used the PTB, WS and IDB on a daily basis. The observed improvements in gingival inflammation assessed as bleeding on probing tendency were not significantly associated with oral hygiene behaviour at the evaluation of NSPT.

The efficacy of an oscillating-rotating power toothbrush compared to a high-frequency sonic power toothbrush on parameters of dental plaque and gingival inflammation: A systematic review and meta-analysis.

AIM: To establish the efficacy of oscillating-rotating power toothbrush (OR-PTB) compared to high-frequency sonic power toothbrush (HFS-PTB) on improving parameters of plaque and gingival inflammation. Safety and participants' preference were secondary interests. MATERIALS AND METHODS: MEDLINE-PubMed and Cochrane-CENTRAL databases were searched, up to April 2021. Inclusion criteria were (randomized)controlled clinical trials that evaluated healthy humans brushing with an OR-PTB compared to a HFS-PTB. Evaluation for a minimum of 4 weeks, of one or more of the following parameters: plaque index scores (PI), bleeding scores (BS), number of bleeding sites (NoB) and gingival index scores (GI). RESULTS: Thirty two publications involving 38 comparisons were included after the independent screening. The descriptive analysis showed that in 54% of the comparisons, a significant difference in favour of the OR-PTB was found for PI, BS and GI scores. The Quigley and Hein index showed a significant difference of means (DiffM) between the end scores (DiffM 0.13, 95% CI [0.05;0.21] p < 0.001), as well as for the Rustogi-modified Navy index (DiffM 0.01, 95% CI [0.01;0.03] p = 0.002). This is in line with the meta-analysis for BS (DiffM 0.09, 95% CI [0.03;0.14] p = 0.003), for which the results were in favour of the OR-PTB and considered potentially clinically relevant. NoB showed a significant difference in favour of the OR-PTB for the end scores (DiffM 3.61, 95% CI [2.63;4.58] p < 0.00001). No difference in safety was indicated, 78% of participants preferred the OR-PTB. CONCLUSION: For patients to maintain good plaque control and improve gingival health, there is a small but significant difference based on longer-term studies between OR-PTB and HFS-PTB. This difference is potentially clinically relevant.

The effect of omega-3 fatty acids on active periodontal therapy: A systematic review and meta-analysis.

AIM: "Host modulatory therapy" (HMT) with ω-3 fatty acids aims at reducing inflammation. With HMT as an adjunct, a better result of periodontal therapy is expected. The aim of this systematic review and meta-analysis (MA) was to examine the additional effect of ω-3 fatty acids to non-surgical periodontal therapy (SRP) on the probing pocket depth (PPD) and the clinical attachment level (CAL). MATERIALS AND METHODS: MEDLINE-PubMed and Cochrane-CENTRAL libraries were searched up to January 2021 for randomized controlled trials in patients with chronic periodontitis, treated with SRP/placebo as controls and SRP/ω-3 fatty acids as the test group. RESULTS: The search identified 173 unique abstracts, and screening resulted in 10 eligible publications. Descriptive analysis showed a significant effect on the PPD and CAL in favour of the groups with ω-3 fatty acids in the majority of comparisons. MA revealed that adjunctive use of ω-3 fatty acids to SRP resulted in 0.39 mm more PPD reduction (95% CI: -0.58; -0.21) and 0.41 mm more CAL gain (95% CI: -0.63; -0.19) than SRP alone. CONCLUSIONS: In patients with periodontitis, dietary supplementation with ω-3 fatty acids as an adjunct to SRP is more effective in reducing the PPD and improving the CAL than SRP alone. If SRP is indicated, the use of ω-3 fatty acids can be considered for a moderate extra added effect on PPD reduction and CAL gain. The strength of this recommendation is moderate.

Effect of a sodium hypochlorite mouthwash on plaque and clinical parameters of periodontal disease-a systematic review.

OBJECTIVE: The present study aimed to establish the efficacy of sodium hypochlorite mouthwash (NaOCl-MW) compared with a control mouthwash on plaque and clinical parameters of periodontal disease. METHODS: MEDLINE-PubMed, Embase and Cochrane-CENTRAL databases were searched for clinical trials on patients with gingivitis or periodontitis that assessed the effect of NaOCl-MW in comparison with a negative or positive control on plaque index (PI), gingival index (GI), and bleeding index (BI) scores and probing pocket depth (PPD). Data were extracted from the eligible studies. RESULTS: Seven eligible papers were retrieved, which together represented six clinical trials. The studies showed considerable heterogeneity regarding methodological and clinical aspects that did not permit a meta-analysis. Two of the three studies in which NaOCl-MW was compared with a negative control showed that NaOCl-MW significantly reduced PI, GI and BI, and no effect was found on PPD. In three studies, NaOCl-MW was assessed using chlorhexidine mouthwash (CHX-MW) as a positive control; no difference was found for GI and BI. One of the three comparisons showed a statistically significant PI score favouring NaOCl-MW. One study measured PPD and found it to be significant in favour of NaOCl-MW. CONCLUSIONS: Studies with a negative control group provided very weak quality evidence for a very small beneficial effect of NaOCl-MW on PI, GI and BI scores. Studies with a positive control group provided very weak quality evidence that NaOCl-MW had a similar effect as CHX-MW on PI, GI and BI scores. The outcome for PPD was inconclusive.

The efficacy of a rubber bristles interdental cleaner on parameters of oral soft tissue health-a systematic review.

AIM: This study aimed to establish the efficacy of a rubber bristles interdental cleaner (RBIC) as an adjunct to toothbrushing (TB) compared to that of the adjuvant use of other interdental cleaning devices and TB alone on plaque and gingivitis parameters. Additionally, the safety aspects and panellists' appreciation were evaluated. MATERIALS AND METHODS: Databases were searched for randomized controlled clinical trials (RCTs) evaluating plaque (PI), bleeding (BS), and gingival index (GI) scores, safety assessments, and participants' appreciation. Extracted data were summarized in a descriptive and, if possible, a meta-analysis. RESULTS: The search retrieved 142 unique papers; six studies with 10 comparisons were included in a descriptive analysis. Five RCTs compared RBICs with interdental brushes (IDBs), four with dental floss (DF) and one with manual TB only. No comparisons to wood sticks were retrieved. Using an RBIC resulted in no difference in plaque scores compared to DF and IDBs. For overall bleeding scores, no difference was found. Two studies analysing the accessible sites separately found RBICs to be more favourable than DF and IDBs. Conversely, one study evaluating the efficacy of RBICs compared to IDBs, according to the GI scores, showed that IDBs achieved significantly greater reduction. Moreover, RBICs caused fewer gingival abrasions and were preferred by the study participants. CONCLUSION: Based on a descriptive and a meta-analysis of the available literature, it is synthesized that in gingivitis patients, a weak to very weak certainty exists that a RBIC is indicated for gingivitis and plaque reduction. The evidence supports user safety and participants' preferences.

Success of supportive periodontal therapy in periodontitis patients - A retrospective analysis.

OBJECTIVE: The aim of this retrospective analysis was to evaluate, in adult patients treated for periodontitis, the periodontal stability during supportive periodontal therapy (SPT). METHODS: Data were collected and analyzed retrospectively for periodontitis patients aged ≥36 years who underwent active periodontal therapy (APT) and were following an SPT programme. The stability of the APT success, defined as a probing pocket depth (PPD) of ≤5 mm, was the main outcome parameter. Analyses were performed in which PPD, tooth loss (TL), bleeding on probing (BOP), periodontal epithelium surface area (PESA), and the effects of age, gender, smoking status, and the number of years in SPT were evaluated. The annual TL and BOP of <10% in addition to a PPD of ≤5 mm were considered to be secondary outcome variables. RESULTS: In total, 993 patients were included, in 36% of whom a PPD ≤5 mm was found at the evaluation of APT. If the outcome was defined as a BOP of <10% in addition to a PPD of ≤5 mm, this was present in only 16% of the patients. During SPT, a small overall increase in clinical parameters for the total population and an annual average TL of 0.15 per patient was observed. Patients of male gender and smokers negatively affected the success of SPT. CONCLUSION: The periodontal clinical status remained 'fairly' stable during SPT in chronic periodontitis patients aged ≥36 years. Smoking negatively affects the outcome of APT and periodontal stability during SPT.

The risk of tooth loss in patients with diabetes: A systematic review and meta-analysis.

AIM: The aim of this systematic review was to comprehensively and critically summarize and synthesize the risk of losing teeth among with diabetes mellitus (DM) compared to those without DM, as established in observational studies. MATERIALS AND METHODS: MEDLINE-PubMed and Cochrane databases were searched through a period from their inception through October 2020 to identify eligible studies. Papers that primarily evaluate the number of teeth in DM patients compared to non-DM individuals were included. A descriptive analysis of the selected studies was conducted, and when feasible, a meta-analysis was performed. The quality of the studies was assessed. RESULTS: A total of 1087 references were generated, and screening of the papers resulted in 10 eligible publications. A descriptive analysis demonstrated that six of these studies indicate a significantly higher risk of tooth loss in DM patients. This was confirmed by the meta-analysis risk ratio of 1.63 95% CI (1.33; 2.00, p < 0.00001). Subgroup analysis illustrates that this is irrespective of the risk-of-bias assessment. The higher risk of tooth loss in DM patients was also higher when only DM type II patients or studies with a cross-sectional design were considered. Patients with a poor DM control status presented a significantly increased risk of tooth loss. When the data were separated by the world continent where the study was performed, Asia and South America had numerically higher risks and a 95% CI that did not overlap with Europe and North America. CONCLUSION: There is moderate certainty for a small but significantly higher risk of tooth loss in DM patients as compared to those without DM.

Dental plaque score reduction with an oscillating-rotating power toothbrush and a high-frequency sonic power toothbrush: a systematic review and meta-analysis of single-brushing exercises.

AIM: To establish the effect of a single-brushing exercise on dental plaque removal using an oscillating-rotating power toothbrush (OR-PTB) as compared to a high-frequency sonic power toothbrush (HFS-PTB). MATERIALS AND METHODS: The MEDLINE-PubMed and Cochrane-CENTRAL databases were searched up to September 2019. The inclusion criteria contained (randomized) controlled clinical trials involving healthy adult participants brushing with an OR-PTB as compared to an HFS-PTB. Plaque index (PI) scores were evaluated after a single-brushing exercise. RESULTS: A total of 15 publications were included, representing 34 comparisons, of which 8 were professional brushing exercises and 26 participant brushing exercises. The potential risk of bias was estimated to be low. In the overall descriptive analysis of 34 comparisons, 19 comparisons showed a statistically significant difference in favour of the OR-PTB and 4 in favour of the HFS-PTB. The meta-analysis using the professional brushing study design showed a significant difference of means (DiffM) in favour of the OR-PTB (PI score) (DiffM 0.19; P < .0001) (95% CI [013; 0.25]). In those studies where the participants brushed themselves, the data were inconclusive. PI scores showed no difference between the two brushes (P = .15), while one plaque index (the Rustogi Modified Navy plaque index) indicated significant favour for the OR-PTB (DiffM 0.06; P = .002) (95% CI [0.02; 0.09]). CONCLUSION: Based on the estimated evidence profile, there is moderate certainty of evidence of a very small but significant beneficial effect on plaque removal after a single-brushing exercise with the OR-PTB over the HFS-PTB.

Do natural ingredients in a dentifrice contribute to prevention of plaque and gingivitis?

OBJECTIVE: To test the effectiveness of a dentifrice containing the turmeric and licorice extract compared to a control for preventing plaque and gingivitis over a four-month period. MATERIAL AND METHODS: Ninety (non-dental) participants with moderate gingival inflammation (≥ 40%) were selected. The triple blind study consisted of two phases, namely at first a 3-week pre-experimental phase of using an oxygenating and chlorhexidine (CHX) mouthrinse. Secondly, a 4-month experimental period in which participants were randomly assigned to a test or control group. All were instructed to brush their teeth twice daily for 2 minutes with their assigned dentifrice. Gingival bleeding (BI), plaque (PI) and gingivitis (GI) were assessed. RESULTS: Eighty participants completed the protocol. At the first assessment in the pre-experimental phase, the mean scores of all indices showed no differences for the two groups. At the second session, the values of all three parameters had decreased significantly (p < 0.001). At the last session, the BI values were 0.52(0.25) for the test group and 0.56(0.25) for the control, the mean GI was 0.27(0.17) for the test group and 0.31(0.16) for the control, and for PI the scores were 1.89(0.46) for the test group and 1.98(0.43) for the control group. Statistical comparison of the scores for the two groups at each stage of the study showed no significant difference for any of the parameters. CONCLUSION: Within the limits of the current study design, dentifrice formulation and concentration of turmeric/licorice extracts, the results show that the adjuvant effect of the natural ingredients in the test dentifrice was not evident on clinical parameters of gingivitis and plaque.

Definitions used for a healthy periodontium-A systematic review.

OBJECTIVE: To investigate the explicitness and variability of the definition of periodontal health in the current scientific literature. MATERIAL AND METHODS: The authors conducted a systematic literature review using PubMed and CENTRAL (2013-01/2019-05) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the guidelines of the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. RESULTS: A total of 51 papers met the predefined inclusion criteria. Of these, 13 papers did not report any explicit definitions of periodontal health. Out of the 38 remaining articles, half of them used a reference to support their definition and half of them not. The studies published in periodontics-related journals or those that scored a low risk of bias for the methodical quality presented more explicit and valid definitions. Probing pocket depth was the most frequently used individual parameter for defining periodontal health. However, there were substantial variations in the methods of measurement and cut-off values. CONCLUSIONS: Given the diversity of periodontal health definitions, a cross-study comparison is difficult. The results of this review may be useful in making others aware of the significance of standardizing the definition of a healthy periodontium.

Is plaque regrowth inhibited by dentifrice?: A systematic review and meta-analysis with trial sequential analysis.

OBJECTIVES: The aim of this systematic review was to establish in studies with human participants the effect of a regular fluoride dentifrice compared to water or saline on dental plaque inhibition. METHODS: MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE and other electronic databases were searched, up to April 2018. The inclusion criteria were controlled clinical trials among participants aged ≥18 years with good general health. Papers that evaluated the effect of dentifrice slurry compared with water or saline on plaque regrowth during a 4-day nonbrushing period were included. Data were extracted from the eligible studies, the risk of bias was assessed, and a meta-analysis was performed where feasible. RESULT: The search retrieved eight eligible publications including 25 comparisons. The estimated potential risk of bias was low for all studies. Based on three different indices, overall plaque regrowth was significantly (P < 0.01) inhibited for 0.25 or more by the use of a dentifrice slurry as compared to water. All subanalysis on specific dentifrice ingredients and the overall descriptive analysis supported these findings. CONCLUSION: The results of this review demonstrate moderate-quality evidence for a weak inhibitory effect on plaque regrowth in favour of the use of a dentifrice intended for daily use.

The efficacy of baking soda dentifrice in controlling plaque and gingivitis: A systematic review.

OBJECTIVE: To test the efficacy of a dentifrice containing baking soda (BS), compared with dentifrice without BS for controlling plaque and gingivitis. MATERIALS AND METHODS: MEDLINE-PubMed and Cochrane-CENTRAL were searched. The inclusion criteria were randomized controlled clinical trials including healthy participants aged 18 years or older. Studies were selected that compared the effect of toothbrushing with a dentifrice with and without BS on the clinical parameters of plaque and gingivitis. Data were extracted from the selected studies, and a meta-analysis was performed. RESULTS: The search retrieved 21 eligible publications. Among these papers, 43 comparisons were provided, with 23 involving a single-use design and 20 being evaluations with a follow-up. Negative controls were found, or positive controls for which various active ingredients had been used. The included studies showed a moderate overall potential risk of bias and considerable heterogeneity. The meta-analysis of plaque scores from the single-brushing experiments showed that BS dentifrice (BS-DF) was associated with significantly better outcomes than the negative control dentifrices (DiffM -0.20; P < 0.0001; 95% CI: [-0.27; -0.12]) or the positive control dentifrices (DiffM -0.18; P < 0.0001; 95% CI: [-0.24; -0.12]). This finding was only confirmed in studies that used a follow-up design as compared to a negative control (DiffM -0.19; P = 0.01; 95% CI: [-0.34; -0.04]). The indices of gingival bleeding also improved when the comparison was a negative control (DiffM -0.08; P = 0.02; 95% CI: [-0.16; -0.01] and (DiffM -0.13; P < 0.001; 95% CI: [-0.18; -0.08]. However, for the gingival index scores, the meta-analysis did not reveal any significant differences. CONCLUSION: BS-DF showed promising results with respect to plaque removal in single-use studies. However, the finding was partially substantiated in follow-up studies. Studies that assessed bleeding scores indicated that a small reduction can be expected from BS, relative to a control product.

Toothbrush wear in relation to toothbrushing effectiveness.

OBJECTIVE: To investigate to what extent the degree of toothbrush wear of 3-month-old manual toothbrushes influence plaque scores. MATERIAL AND METHODS: During a recently published study with a follow-up of 1 year, all participants performed a similar basic home-based oral hygiene regimen. Hence, they were instructed to brush for 2 minutes twice daily according to the Bass method technique and using a standard dentifrice containing sodium fluoride. Toothbrushes were turned in every 3-month, and the degree of wear was scored. The mean plaque score data were additionally analysed and correlated with wear scores of the toothbrushes. RESULTS: For analysis, for each of 172 individual participants, a set of three identical, 3-month-old used toothbrushes were available. Toothbrush wear varied widely between participants. However, per patient, the 3-month wear status of the three evaluated toothbrushes was strongly correlated (rho = 0.8, P < 0.0001). Participants who returned toothbrushes with extreme wear had significantly higher plaque scores than those who returned toothbrushes with no visible or light wear (P = 0.01). CONCLUSION: Toothbrush wear per individual patient is fairly consistent. Toothbrushes with extreme wear were less effective than those with no or light wear. Therefore, bristle splaying appears to be a more appropriate measure of brush replacement time then the commonly used toothbrush age. Splaying of the outer tufts beyond the base of the toothbrush is a condition that indicates it is time to change the brush.

The effect on clinical parameters of periodontal inflammation following non-surgical periodontal therapy with ultrasonics and chemotherapeutic cooling solutions: a systematic review.

AIM: To establish the added effect of a chemotherapeutic cooling solution in an ultrasonic device on clinical parameters of periodontal inflammation following non-surgical periodontal therapy. METHODS: The MEDLINE-PubMed, Cochrane-CENTRAL, and the EMBASE databases were searched. Probing pocket depth (PPD) and clinical attachment level (CAL) and their changes were selected as outcome variables. Subgroup analyses were performed according to the following active ingredients: essential oils (EO), povidone-iodine (PVP), and chlorhexidine (CHX). RESULTS: Screening of 100 unique papers resulted in 14 eligible publications, including 16 comparisons. The meta-analysis (MA) showed that when the ultrasonic cooling solution had adjuvant chemotherapeutic properties, the difference of means (DiffM) for end value PPD-0.12 (95% CI: -0.42; 0.18) and for CAL the DiffM+-0.13 (95% CI: -0.39; 0.14). None of these were statistically significant, and the findings were supported by the overall descriptive analysis. Subgroup analysis only revealed a small effect for PVP on the difference (DiffM = -0.23, 95% CI: -0.43; -0.02) with respect to CAL (p = 0.03). CONCLUSIONS: The collective evidence indicates that overall, no additional effects were observed. There is a "very weak" recommendation based on the sub-analysis showing that in conjunction with PVP, a very small gain in CAL may be expected. For the use of CHX or EO, the added effect can be considered to be "zero." Therefore, the strength and direction of the recommendation emerging from this review is against their use.

The concomitant administration of systemic amoxicillin and metronidazole compared to scaling and root planing alone in treating periodontitis: =a systematic review=.

BACKGROUND: The treatment of periodontitis begins with a non-surgical phase that includes scaling and root planing(SRP) and on occasion the use of systemic antibiotics. The goal was to systematically evaluate in systemic healthy adults the effect of the concomitant administration of amoxicillin (amx) and metronidazole (met) adjunctive to SRP compared to SRP alone. METHODS: The PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to November 2014 to identify appropriate studies. Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding on Pocket Probing(BOP) and Plaque Indices(PI) were selected as outcome variables. Based on the extracted data a meta-analysis was conducted. RESULTS: A total of 526 unique articles were found, 20 studies met the eligibility criteria. A meta-analysis showed that SRP + amx + met provided significantly better effects overall and more pronounced PD reduction in periodontal pockets initially measuring ≥6 mm (DiffM:-0.86 mm, p < 0.00001) and gain in CAL(DiffM:+0.75 mm, p = 0.0001). The meta-analysis for the secondary inflammatory parameter BOP showed that SRP + amx + met provided full mouth significantly greater reduction in BOP than SRP alone (DiffM:-6.98 %, p = 0.0001). CONCLUSION: Adjunctive systemic amoxicillin and metronidazole medication to SRP significantly improved the clinical outcomes with respect to mean PD, CAL and BOP compared to SRP alone. There is moderate to strong evidence in support of the recommendation that adjunctive amx + met therapy to SRP significantly improves the clinical outcomes, with respect to mean PD and CAL compared to SRP alone especially in initially deep (≥6 mm) pockets. No major side effects associated with the intake of amx + met were reported. This treatment regimen is an efficacious, minimally invasive, practical and inexpensive approach for periodontitis therapy. The key components are mechanical tooth and pocket debridement, supportive treatment of the disease with systemic antibiotics and attention to proper self-care.

Effect of professional mechanical plaque removal on secondary prevention of periodontitis and the complications of gingival and periodontal preventive measures: consensus report of group 4 of the 11th European Workshop on Periodontology on effective prevention of periodontal and peri-implant diseases.

BACKGROUND AND AIMS: The scope of this working group was to review: (1) the effect of professional mechanical plaque removal (PMPR) on secondary prevention of periodontitis; (2) the occurrence of gingival recessions and non-carious cervical lesions (NCCL) secondary to traumatic tooth brushing; (3) the management of hypersensitivity, through professionally and self administered agents and (4) the management of oral malodour, through mechanical and/or chemical agents. RESULTS AND CONCLUSIONS: Patients undergoing supportive periodontal therapy including PMPR showed mean tooth loss rates of 0.15 ± 0.14 teeth/year for 5-year follow-up and 0.09 ± 0.08 teeth/year (corresponding to a mean number of teeth lost ranging between 1.1 and 1.3) for 12-14 year follow-up. There is no direct evidence to confirm tooth brushing as the sole factor causing gingival recession or NCCLs. Similarly, there is no conclusive evidence from intervention studies regarding the impact of manual versus powered toothbrushes on development of gingival recession or NCCLs, or on the treatment of gingival recessions. Local and patient-related factors can be highly relevant in the development and progression of these lesions. Two modes of action are used in the treatment of dentine hypersensitivity: dentine tubule occlusion and/or modification or blocking of pulpal nerve response. Dentifrices containing arginine, calcium sodium phosphosilicate, stannous fluoride and strontium have shown an effect on pain reduction. Similarly, professionally applied prophylaxis pastes containing arginine and calcium sodium phosphosilicate have shown efficacy. There is currently evidence from short-term studies that tongue cleaning has an effect in reducing intra-oral halitosis caused by tongue coating. Similarly, mouthrinses and dentifrices with active ingredients based on Chlorhexidine, Cetylpyridinium chloride and Zinc combinations have a significant beneficial effect.

Probiotics reduce mutans streptococci counts in humans: a systematic review and meta-analysis.

OBJECTIVES: Systematically review the available literature regarding the caries-preventive effect of probiotics. DATA, SOURCES AND STUDY SELECTION: An electronic search was conducted in three databases (PubMed MEDLINE, ISI Web of Science and Cochrane Library) to identify all suitable studies. The outcomes had to be presented as the effect of probiotics on the incidence of caries or on the levels of mutans streptococci and/or Lactobacillus species. Human studies, written in English, with at least 15 participants, comparing a probiotic product with a placebo/no probiotic were included. Where possible, a meta-analysis was performed to obtain quantitative data. RESULTS: Since only two articles presented useful data on the caries incidence, we focused on the surrogate endpoints: mutans streptococci and/or Lactobacillus counts. The meta-analysis showed that when the probiotic and control group are compared after treatment, significantly more patients in the probiotic group had low mutans streptococci (<10(5) CFU/ml) counts and significantly less patients had high (>10(6) CFU/ml) counts. Regarding the Lactobacillus counts, comparing the probiotic and control group at the end of the probiotic use, no significant differences could be observed, neither in low (<10(4) CFU/ml) nor in high Lactobacillus (>10(6) CFU/ml) counts. CONCLUSIONS: Within the limitations of the available data, it may be concluded that probiotics decrease the mutans streptococci counts. This suggests that probiotics could have a positive effect in the prevention of caries. CLINICAL RELEVANCE: There is insufficient evidence that probiotics can prevent caries, but they can reduce the mutans streptococci counts.