Effect of chlorhexidine on dental plaque and gingivitis in mentally retarded children

ABSTRACT The purpose of the investigation was to determine the effect of chlorhexidine mouthrinses as a supplement to toothbrushing in the plaque control of mentally retarded children. Fifty-four mentally subnormal children 7–14 years of age took part in the investigation. During the first period, half of the children rinsed their mouths with 0.2 % chlorhexidine gluconate solution twice a day. The rest of the children used a placebo mouth-rinse. After an 8-week interval a “cross-over” experiment was carried out during which a 0.1 % chlorhexidine solution was used. Plaque and gingival indices were scored at the beginning of each period, after 3 weeks, and at the termination after 6 weeks. The results revealed that mouthrinses with 0.1 % as well as 0.2 % chlorhexidine gluconate reduced plaque and gingivitis in mentally retarded children. The results were statistically significant (P < 0.05) for both concentrations. Furthermore, the investigation confirmed the occurrence of certain side effects such as discoloration of teeth and tongues.     

Dental health of 9–10-year-old mentally retarded children in Eastern Finland

Abstract All 9–10-year-old children in one Finnish county were screened with a standardized set of tasks for their mental performance. 58 verified mentally retarded and 58 randomly selected healthy children were examined for dental and gingival status and level of oral hygiene Comparisons were made between the retarded and the healthy, as well as between subgroups of the retarded. Similar DFS-values, higher DS-values and an inferior level of oral hygiene in terms of VPI were found in mentally retarded when compared with healthy children. No evident difference was found in gingival status (by GBI) between the retarded and the healthy. The mildly or moderately retarded found by the screening and not yet included in special welfare had the highest DFS-scores, the highest prevalence of untreated caries and the poorest gingival health among the retarded.     

Prevalence of malocclusion in mentally retarded young adults

Occlusal anomalies were recorded in 218 mentally retarded young adults, aged 13-19 yr. Down's syndrome was diagnosed in 37 cases. Among the Down's syndrome individuals 41% had mandibular overjet, 54% mesial molar occlusion, 38% frontal open bite and 65% crossbite. Also, the mentally retarded subjects without Down's syndrome had markedly increased frequencies of some of the anomalies when compared to normal individuals. Thus, 27% had extreme maxillary overjet, 6% mandibular overjet, 17% mesial molar occlusion, 23% frontal open bite and 29% crossbite. Orthodontic dental service for the mentally retarded has been neglected for a long time. Though many factors may contraindicate treatment, it should in many cases be possible to improve the dental situation for this group, thereby helping these patients to a better oral function.     

Periodontal conditions in a randomly selected population in Switzerland

The aim of the present study was to evaluate the periodontal conditions of a randomly selected population in the Canton of Berne, Switzerland. From a total of 350 selected persons, 206 (59%) attended the examinations. The Plaque Index (PlI), Gingival Index (GI) and Retention Index (RI), the width of the keratinized gingiva, pocket probing depth (PD) and loss of probing attachment (LA) were recorded on four surfaces per tooth in the entire dentition of the subjects. The statistical analyses were performed using the Statistical Analysis System (SAS). A total of 4253 teeth were scored. On average the patients had 20.7 teeth. The mean PlI of this population was 1.16, the mean GI was 1.34 and the mean RI was 0.81. All three indices were higher in older age groups. 72% of all measurements for pocket probing depths were less than or equal to 3 mm, 26% were between 4 and 6 mm, and only 2% were more than 6 mm. 76% of all sites had lost less than or equal to 3 mm of probing attachment, 21% of the sites had lost between 4 and 6 mm and only 3% had lost more than 6 mm. There were no statistically significant differences either between females and males or between the rural and the urban populations. These results indicate that only a relatively small percentage of the sample representative for the respective area in Switzerland suffered from advanced periodontitis, while the great majority may be treated by rather conservative approaches to periodontal therapy.     

Effects on plaque and gingivitis of a chlorhexidine dental gel in the mentally retarded

The effectiveness of a 1% chlorhexidine-containing dental gel on dental plaque and gingival health was evaluated over a period of 6 months using a double-blind procedure. One hundred and seventeen mentally retarded subjects aged between 10-17 years resident in an institution were divided into two groups. One group was assigned daily brushing with the 1% chlorhexidine gel, the other group a placebo quinine sulfate-containing gel. No other form of oral hygiene was used during the experimental period. Assessment of dental plaque accumulation and gingivitis was made at 0, 1, 3, and 6 months. An assessment was also made 2 months after the gel was withdrawn from use and normal toothbrushing procedures resumed. No clinical or statistical advantage was noted in plaque or gingivitis scores in the group receiving chlorhexidine treatment during the 6-month period. This group showed a higher prevalence of tooth staining. It was concluded that periodontal severity and poor oral hygiene exceeded the plaque- and gingivitis-preventing potential of chlorhexidine.     

Relative importance of caries risk factors in Finnish mentally retarded children

Abstract The relative importance of associations between caries occurrence and exposure to sugar-sweetened products, fluoride preventives, medication with drugs affecting saliva secretion and the standard of oral hygiene was assessed in 125 mentally retarded and 79 healthy 9–10-yr-old Finnish children. The evaluation of the relative importance of the associations was based on logistic regression analyses. For the mentally retarded children the most important determinant of caries risk was their poor standard of oral hygiene. Frequent use of sugar-sweetened snacks was found to be an important determinant of caries risk for both the mentally retarded and the healthy children.     

Study of a fissure sealant in mentally retarded Canadian children

The occlusal fissure of 812 permanent and primary posterior teeth of 160 retarded children were sealed with a fluid resin which was polymerized with an ultra-voilet lamp. A half mouth technique was used to evaluate the effectiveness of the sealant in the prevention of fissure caries. The 1st year, the sealant was retained intact on 73 percent of the permanent teeth and on 64 percent of the primary teeth. After 2 years, the sealant was retained intact on 61% of the permanent teeth and on 40% of the primary teeth. The retention of the fissure sealant was better on premolars than molars both in the 1stand in the 2nd year. A single application of the fissure sealant was effective in reducing fissure caries up to 2 years.     

Periodontal health in Down syndrome: Contributions of mental disability,personal, and professional dental care

Fifty‐five dentate patients with Down syndrome (DS) and 74 with mental disability non‐Down (MR) were compared to 88 control subjects. Subjects in the MR and Control groups were matched by gender and ethnicity to subjects with DS. All subjects were nonsmokers. Periodontal evaluation included plaque index (PI), gingival index (GI), bleeding on probing (BOP), and clinical periodontal attachment levels. Caries and missing teeth were recorded. Measures of personal dental hygiene and the frequency of professional dental care were also recorded. Most subjects brushed their teeth at least once per day, but did not floss. Both groups with DS and MR had significantly more missing teeth, more BOP, and higher GI and PI levels than the control group. Patients with DS had more attachment loss (AL) than the other two groups (p < .001). Increased AL in patients with DS was not associated with differences in socioeconomic status, personal/professional dental care, or mental disability.     

Periodontal treatment need of the Finnish population aged 30 years and over

A representative sample (n = 8000) was drawn from the population aged 30 years and over, registered as living in Finland. Periodontal disease status was recorded according to the modified Periodontal Treatment Need System (PTNS). Plaque retentions were examined separately. Of the subjects with four or more teeth 3.4% had a healthy periodontal status, while 10.2% of the jaw quadrants were healthy. Plaque retentions were found in 96.6% of the subjects and 90.9% of the jaw segments. Periodontal treatment need was calculated in three ways and was 195 +/- 111 (S.D.) min when the calculation was based on WHO recommendations (1978). Number of teeth, age, sex, caries and filling scores, and education explained about 30% of the treatment need when tested by multiple linear regression analysis.     

Oral hygiene instruction and motivation in children using manual and electric toothbrushes

ABSTRACT The effect of individual chairside instruction and motivation on children using either manual or electric toothbrushes was investigated. From 123 children aged 9–15 years attending the Children's Department, Eastman Dental Hospital, four groups were constructed. Group 1 acted as the control, Groups 2 and 3 used manual toothbrushes and received instruction and motivation, and Group 4 used electric toothbrushes (Touch Tronic, Teledyne Aqua Tec®) and also received instruction and motivation. For all children, modified Löe and Silness ’Gingival and Plaque Indices were scored, a disclosing agent applied and a prophylaxis completed. Children in Groups 2, 3 and 4 were additionally shown the disclosed plaque, and its importance was discussed. Their attempts to “get the stain off” were checked and their own brushing techniques modified. Re-examinations took place after 1 and 3 months. To estimate the reliability of the diagnosis, 172 of the 344 examinations were repeated by a second operator. The overall coefficient of correlation (between operators) was 0.8. In the control group no detectable improvement in the gingival health or oral cleanliness occurred over the 3-month study period. However, both gingival and plaque scores decreased significantly, by 35–50 %, in all instructed and motivated groups within 1 month and this improvement was still observable 2 months later. There were no significant differences in improvement between motivated children using manual or electric toothbrushes.     

Periodontal disease in children with Down's syndrome

Abstract – The occurrence of supra- and subgingival calculus, gingival inflammation, periodontal pockets ( 5 mm) and alveolar bone loss was determined in children (10-19 yr) with Down's syndrome (D-S) and in an aged- and sex-matched control group ( n = 39). Of D-S children ( n = 71), 39 of the patients (mean age 15.5 yr) cooperated in a clinical and roentgenologic examination. Alveolar bone loss was determined around incisors and first molars on intraoral radiographs when the distance between cementoenamel junction (GEJ) to alveolar crest (AC) exceeded 2.0 mm. Alveolar bone loss was diagnosed in 39% of the D-S children compared to 3% in the control group ( P <0.001). Of the total number of sites examined on radiographs the distance from CEJ to AC exceeded 2.0 mm in 8% in the D-S group compared to 0.2% in the control group ( P <0.001). The frequency of sites with alveolar bone loss in D-S children was significantly ( P <0.001) higher around the mandibular incisors compared to first molars. The study shows that early signs of periodontitis are frequently seen in D-S children as early as 11 yr of age and the lesions are first diagnosed in the mandibular anterior region.     

A comparison of WHO Periodontal Status Index with the Periodontal and Oral Hygiene Indices

Examination of 2,138 subjects, aged 15-65+ years, was carried out by calibrated examiners using mirrors and fibre optic illumination. Each subject was scored by the Periodontal Status Index, PSI (WHO Oral Health Surveys), Periodontal Index, PI (Russell) and the Oral Hygiene Index, OHI (Greene & Vermillion). For the PSI, PI and OHI all scores were age-dependent with the exception of soft deposits in PSI and OHI, which were age-independent. The advantages of the PSI system were considered to be the ease of scoring and the opportunity to assess treatment requirements, in terms of time, at the public health service level. Disadvantages were lack of quantitation, difficulties of diagnosis of intense gingivitis, and localized and general conditions. The PI and OHI systems provided a more objective, quantitative and sensitive basis of scoring than the PSI. Statistical tests showed the respective indices are associated and measuring the same kind of criteria. Examiner calibration and consistency were similar for both scoring systems.     

Dental caries, gingivitis, and oral hygiene among schoolchildren in Kampala, Uganda

ABSTRACT – An epidemiologic survey of dental caries, gingivitis and oral hygiene was conducted on 875 schoolchildren aged 6–15 in Kampala, the capital of Uganda. Findings arc reported in detail for the African children, and in brief for the Asian children. Among the African children, DMF teeth averaged from 0.6–2.7, and def teeth from 0.0–1.9. A significantly higher proportion of the first permanent molars was carious among the 6 to 9-year-old than among the 10 to 14-year-old Africans, which is interpreted as a sign of the rapid increase in caries prevalence occurring during these years. Among the Asian children, dental caries was more prevalent and advanced. Generalized, mild gingivitis and moderate amounts of soft debris were found uniformly throughout all groups. The need for dental health education is stressed, and the case for longitudinal socio-epidemiologic studies is discussed.     

Risk factors of dental caries in 9-10-year-old mentally retarded Finnish children

Abstract Mentally retarded children from one age cohort and their randomly selected controls in one Finnish county were examined for standard of oral hygiene, and their parents and nurses interviewed for information on dental health habits and for other relevant background information. The mentally retarded consumed sugar containing products less frequently than the mentally normal controls. Toothbrushing and fluoride supply was also less common in the retarded than in the healthy. Among the retarded, the dental health habits were most favorable in registered outpatients and least favorable in administratively unknown retarded not included in special welfare. Differences in dental health habits between these subgroups of the retarded were large. In contrast to the findings in the healthy children, frequency of toothbrushing was not associated with the observed standard of oral hygiene in the mentally retarded. The toothbrushing subgroup of the mentally retarded consumed sugar more frequently than the toothbrushing healthy children and commonly used drugs which reduced saliva flow or promoted gingival hyperplasia.     

Partial recording of gingivitis and dental plaque in children of different ages and in young adults

In epidemiologic studies, total recordings of the amount of dental plaque and the degree of gingival inflammation tend to be too time-consuming. Various partial recording methods have accordingly been suggested. However, the validity of these methods when applied to different age groups has not been investigated sufficiently. The aim of the present study was to test whether different systems for partial recording of plaque and gingivitis can take the place of a full-mouth recording in children of different ages and in young adults. Ninety children, divided into three age groups (4-6, 7-9, 14-16 yr), and 30 adults (20-22 yr) were examined. The degree of gingival inflammation was recorded using the Gingival Index and the amount of dental plaque using the Plaque Index. Two partial recording methods were tested. One of these covered the teeth suggested by Ramfjord, modified for children with a primary dentition, and the other the front segment of the maxilla. The results were compared with those from an examination of all tooth surfaces. In all age groups excellent agreement was found between the partial recording method suggested by Ramfjord and a full-mouth recording of both the gingival state and the amount of dental plaque. Examination of the maxillary front segment was less accurate and resulted in a systematic underestimate.     

Experimental gingivitis around deciduous teeth in children with Down's syndrome

Abstract. Epidemiological studies have shown that there is a high prevalence and rapid progression of periodontal disease in children with Down's Syndrome (DS). In this respect, DS children exhibit a markedly different response compared with healthy children. In order to understand the reasons for this difference, a controlled study was set up to determine the extent and the quality of the differences in the early periodontal tissue response towards dental plaque in the deciduous dentition of DS children and matched control children. In a preliminary investigation, the gingival health was estimated by determining the bleeding tendency. 9 healthy children were selected from a group of 14 and matched with 9 DS children with respect to plaque development, sulcus depth and age. The DS children had a higher bleeding tendency than the matched controls. In the DS children, moreover, a correlation was found between bleeding tendency and age. No such correlation was found in the controls. After a period of intensive oral hygiene, all cleaning of teeth was discontinued for 21 days. The amount of plaque according to the plaque index, the gingival health according to the gingival index, and the amount of crevicular leucocytes and gingival exudate were assessed at days 0, 7, 14 and 21. During the experimental phase of the study, the amount of plaque increased at a similar rate in both groups. In the DS children, the development of gingival inflammation started earlier and was more extensive. It increased after day 14, whereas in the control children, the gingival inflammation seemed to stabilize at this time. The results of the present experimental study thus confirm earlier results from epidemiological studies. The amount of gingival exudate was very low in both groups, but in the DS group it increased after day 14. In contrast to the DS children, the amount of crevicular leukocytes increased significantly in the control children from day 0 to day 21, the highest score being found on day 14. On day 7, a significantly larger amount of crevicular leucocytes was found in the DS children than in the controls. The findings of this study suggest that DS children have a different leucocyte response together with a more extensive gingival inflammation than normal children.     

Oral conditions in Australian children of Aboriginal and Caucasian descent

Oral health parameters were examined for 211 schoolchildren (128 Aborigines and 83 Caucasians) representative of the 6–8 and 10–11 year age groups in the Brewarrina and Walgett areas of western New South Wales (fluoride in water ≤ 0.02–0.26 parts/10⁶). Despite similar dietary carbohydrate challenge and tooth eruption patterns, Aboriginal children, most of whom were members of a transitional community within a low socioeconomic stratum, had higher prevalence of caries (DIMFT) and severity rating of carious lesions (SR), poorer oral hygiene (OHI) and more gingivitis (PI) than Caucasian children, in both age groups. Tooth defects were more frequent (2.5 times) and severe in Aborigines than in Caucasians. Outstanding treatment needs were very high in both ethnic groups, but more so in Aborigines.     

Periodontal conditions in adults with rheumatoid arthritis

Periodontal conditions among an adult population of 161 dentate patients with rheumatoid arthritis (RA) were compared with those of an age and sex-matched random sample of non-rheumatic subjects. The number of teeth and prevalence of dental plaque, calculus, gingivitis, and deepened periodontal pockets were recorded. Alveolar bone breakdown and the distribution of subjects according to severity of periodontal disease were also registered. There was a tendency towards better periodontal conditions among RA-patients, severe periodontal breakdown occurring less frequently among RA-patients (12%) than among the controls (16%). The RA-patients had less plaque and calculus than the control group, a finding which could indicate a difference in periodontal care.     

Oral hygiene and gingivitis in a Swedish adult population 1973, 1983 and 1993

Abstract. The periodontal condition of the inhabitants of Jönköping County, Sweden was followed for 20 years by means of 3 cross-sectional investigations performed in 1973, 1983, and 1993. The study comprised individuals in the age groups 20, 30, 40, 50, 60, and 70 years. The number of dentate individuals was 537 in 1973, 550 in 1983, and 552 in 1993. All individuals participating in the studies were examined clinically and radiographically. They also filled out a questionnaire about dental care habits, socio-economic status, and general health. A clear reduction in the plaque score was seen between 1973 and 1983 in all age groups. With one exception, no further significant change in plaque levels was found between 1983 and 1993: the increase in plaque among the 20-year-olds was significant. In 1993 the mean % of surfaces with plaque was between 30% and 40% in all age groups. Gingivitis values corresponded well with the values of dental plaque: the same pattern with a clear reduction in gingivitis score was seen in all age groups between 1973 and 1983, and an increase in the mean frequency of gingival inflammation between 1983 and 1993 was seen in the 20-year age group. 30% of the individuals in this age group had more than 50% gingivitis in 1993 compared with 9% of the individuals in 1983. The 20-year-olds were further analyzed in a linear regression model using gingivitis as a dependent variable against some socio-economic, general health, and dental care variables associated with poor oral hygiene and gingivitis. In 1993, the most important explanatory variable was gender: significantly more males than females had higher gingivitis scores. The second most important explanatory variable was toothbrushing habits. Together they explained 10.9% of the variance. The multivariate analysis did not reveal approximal cleaning habits to be significant, probably due to their strong connection to gender and toothbrushing habits. In the 1983 sample, no significant explanatory variables were found. It was concluded from this data that it is important not only to renew but also to direct preventive guidelines more towards young adults who have no previous extensive experience of oral disease so that they will not be excluded from dental care and their dental health thereby jeopardised. In addition to preventive programmes aimed at the population as a whole, individual programmes based on risk targeting are also necessary to reduce the number of people developing dental disease and to increase the quality of dental care.