Differences in the oral health status and oral hygiene practices according to the extent of post‐stroke sequelae

Oral health and hygiene are crucial parameters in stroke patients. However, few studies have evaluated the oral health status and oral hygiene practices according to the level of function in stroke patients. The aim of this study was to evaluate the oral health status and oral hygiene practices according to ambulation and personal hygiene levels in patients with stroke. Data from the fifth (2010‐2012) and sixth (2013‐2015) editions of the Korea National Health and Nutrition Examination Survey (KNHANES) for 6 years were combined. A total of 700 stroke patients were enrolled in our study. Subjective oral health was significantly poorer in patients who experienced a moderate problem with walking (adjusted OR [AOR], 1.68; 95% CI, 1.21‐2.33) and bed‐bound patients (AOR, 2.92; 95% CI, 1.01‐8.44) than in patients who could walk without difficulty. Patients who were unable to bathe or dress independently exhibited a significantly higher risk of dental caries than did those who could perform the same activities unassisted. The probability of brushing teeth ≥2 times daily was 69% lower in bed‐bound patients (AOR, 0.31; 95% CI, 0.11‐0.87) than in patients who could walk without difficulty and 76% lower in patients who were unable to bathe or dress independently (AOR, 0.24; 95% CI, 0.09‐0.62) than in those who could perform the same activities without difficulty. There were differences in oral health status and oral hygiene practices, according to ambulation level and functional independence, in the stroke patient group. These results indicate the need for oral care for stroke patients who exhibit ambulatory and functional limitations.     

Use of Dental Coping Beliefs Scale to measure cognitive changes following oral hygiene interventions

Abstract This study employed a recently developed questionnaire, the Dental Coping Beliefs Scale (DCBS), to evaluate the effect of oral hygiene interventions on denial beliefs. The DCBS was administered to 100 subjects. Compared to an untreated control group, there was an increase in the ability to improve oral health through self-effort for the three experimental interventions: Attention (Al), Education (El) and Cognitive Behavioral (CBI). When the Dental Coping Beliefs Scale was divided into scales of Internal Locus of Control, External Locus of Control. Self-Efficacy, and Oral Health Beliefs, additional changes were evident. For the CBI Group, all four scales changed significantly between baseline measurement and post-intervention toward beliefs favoring control and prevention of dental disease using brushing and flossing. For the A and E groups, three scales paralleled the results of the CBI: Internal Locus of Control and Self-Efficacy increased and External Locus of Control decreased after the intervention. However, unlike the CBI, Oral Health Beliefs did not significantly change. Overall, for all experimental groups, there was a shift from external locus of control beliefs to internal beliefs. The untreated Control Group showed no changes across the five weeks. This study was supported by a VA Medical Research Service Merit Review Award.     

A randomized clinical 1‐year trial comparing two types of non‐submerged dental implants

Objectives: This study compared the implant stability and clinical outcomes obtained with two types of non‐submerged dental implants that have different thread designs and surface treatments. Materials and methods: A randomized clinical trial with 1 year of follow‐up was performed on 56 participants with 75 implants (control group, 36 implants in 28 subjects; experimental group, 39 implants in 28 subjects). The experimental group received the Osstem SSII Implant system; the control group received the Standard Straumann^® Dental Implant System. The diameter and length of the fixture were uniform at 4.1 mm and 10 mm and all the implants restored the unilateral loss of one or two molars from the mandible. To compare implant stability, the peak insertion torque, implant stability quotient (ISQ), and periotest value (PTV) were evaluated during surgery, and at 4 and 10 weeks after surgery. To compare marginal bone loss, standard periapical radiographs were obtained during surgery, and at 10 weeks and 1 year after surgery. Results: This study showed statistically significant differences between the two groups in peak insertion torque (P=0.009) and ISQ (P=0.003) but not in PTV (P=0.097) at surgery. In contrast, there was no statistically significant difference in the pattern of change of ISQ during the 10 weeks after surgery (P=0.339). For marginal bone loss, no significant difference was observed between the control and the experimental groups before functional loading (P=0.624), but after 1 year of follow‐up, a borderline difference was observed (P=0.048). Conclusion: The success rate after 1 year of follow‐up was 100% for both implant system despite the presence of a significant difference in implant stability during surgery. There was a borderline difference in marginal bone loss after 1 year of follow‐up. To cite this article:
Park J‐C, Ha S‐R, Kim S‐M, Kim M‐J, Lee J‐B, Lee J‐H. A randomized clinical 1‐year trial comparing two types of non‐submerged dental implant.
Clin. Oral Impl. Res. 21 , 2010; 228–236.
doi: 10.1111/j.1600‐0501.2009.01828.x     

Effect of electric toothbrush on residents' oral hygiene: a randomized clinical trial in nursing homes

A single‐blinded, randomized controlled clinical trial was performed to investigate the effect of electric toothbrushes (ET) compared with manual toothbrushes (MT) on residents in nursing homes and to evaluate the caregiver's opinion on ET. A sample of 180 nursing‐home residents were given either a new ET or a new MT. Oral examinations were performed to measure dental hygiene, using the Oral Hygiene Index‐Simplified (OHI‐S). Both groups received the same instructions for use. After 2 months participants were re‐examined. Questionnaires were then sent to their caregivers. Participants' mean age was 86.1 ± 7.7 yr, and the mean number of remaining teeth was 20 ± 5.6. No specific intervention effect was found for ET. Both groups showed identical improvements in the OHI‐S, from 1.27 ± 0.63 at baseline (the mean value for all participants) to 1.01 ± 0.53 after 2 months. Of 152 caregivers who responded to the questionnaire, the majority evaluated ET to be beneficial and less time‐consuming compared with MT, also for demented residents. In a frail population, no difference is found in the effect of ET compared with MT. However, the ET appears to be a useful aid for residents who receive assistance with dental hygiene.     

Comparative antiplaque and antigingivitis effectiveness of a chlorhexidine and an essential oil mouthrinse: 6-month clinical trial

OBJECTIVES: The objective of this study was to compare the antiplaque and antigingivitis effectiveness and the side-effect profiles of an essential oil-containing mouthrinse and a chlorhexidine-containing mouthrinse. MATERIAL AND METHODS: One hundred and eight qualifying subjects, aged 20-57 years, were randomized into three groups: essential oil mouthrinse (ListerineAntiseptic); 0.12% chlorhexidine mouthrinse (Peridex); or 5% hydroalcohol negative control. At baseline, subjects received a complete oral soft tissue examination and scoring of the Loe-Silness gingival index (GI), Quigley-Hein plaque index (PI), Volpe-Manhold calculus index (CI), and Lobene extrinsic tooth stain index (SI). Following a complete dental prophylaxis, subjects started rinsing twice daily with their respective mouthrinse as an adjunct to their usual mechanical oral hygiene procedures. One of the rinses on each weekday was supervised. Subjects were reexamined at 3 and 6 months. The treatment groups were compared with respect to baseline demographic and clinical variables. The primary efficacy variables were GI and PI. Intergroup differences for all clinical variables were tested at 3 and 6 months using appropriate statistical procedures. RESULTS: All of the 108 randomized subjects were evaluable at 3 months, and 107 subjects were evaluable at 6 months. There were no statistically significant differences among the three groups at baseline, with the exception that the control group PI was significantly lower than that of the essential oil group (p<0.05) and the chlorhexidine group (p<0.001), and the essential oil mouthrinse group had a significantly greater number of subjects than the control group with body region SI scores > or =1.0 (p=0.021). At 6 months, the essential oil and chlorhexidine mouthrinses produced statistically significant (p<0.001) GI reductions of 14.0% and 18.2%, respectively, and statistically significant (p<0.001) PI reductions of 18.8% and 21.6%, respectively, compared with the control and were not statistically significantly different from each other with respect to plaque and gingivitis reduction. The chlorhexidine mouthrinse group had significantly more calculus and extrinsic tooth stain than either the essential oil mouthrinse group or the control group. CONCLUSION: This 6-month controlled clinical study demonstrated that the essential oil mouthrinse and the chlorhexidine mouthrinse had comparable antiplaque and antigingivitis activity. Insofar as side effects associated with the chlorhexidine mouthrinse may limit patient compliance, it is suggested that each product can have a distinct role in the management of patients with periodontal diseases.     

Effect of xylitol on salivary β‐glucosidase in humans

Dental biofilm – in which a diverse set of microorganisms are embedded in a complex polysaccharide matrix that adheres to oral components – is one of the most complex microbial communities in the human body. As biofilm formation is related to oral infections, such as caries and periodontal diseases, strategies for biofilm control are crucial for maintaining oral health. Xylitol, a synthetic sugar used as a sucrose substitute, has been shown to reduce biofilm formation. However, its precise mechanism of action on biofilm reduction has so far not been elucidated. Previous studies demonstrate that bacterial β‐glucosidase action is crucial for biofilm formation. Here, we investigated the correlation between salivary β‐glucosidase activity and dental plaque occurrence. We found a positive correlation between enzymatic activity and the presence of dental biofilm. We observed that xylitol inhibits β‐glucosidase in human saliva. Kinetic studies also confirmed that xylitol acts as a mixed type inhibitor of salivary β‐glucosidase. Based on our data, we suggest that xylitol impairs oral biofilm formation by the inhibition of bacterial β‐glucosidase, which is essential for biofilm formation in the oral cavity.