Plaque removal with variable instrumentation

Abstract The purpose of this study was to evaluate dental plaque removal in a normal healthy mouth, during routine oral hygiene appointments using different techniques and without the use of any disclosing agents. 12 dental hygienists, randomly selected from a continuing education course, were asked to perform oral hygiene on the same patient to remove all the supra-gingival plaque without any time restriction and without the use of any disclosing agents. The plaque index score (O'Leary) was assessed before and after each session with the use of fluorescine and UV light source by an independent examiner. 3 groups of instruments were utilized: group A: ultrasonic scalers+prophy cups: group B: ultrasonic scalers+prophy cups+dental floss: group C: Gracey curettes+prophy cups. While no group was able to remove all the plaque, groups B and C performed significantly better.     

Evaluation of various feedback mechanisms in relation to compliance by adult patients with oral home care instructions

The purpose of the present study was to examine the effect on oral hygiene and gingival health of plaque scoring and the performance of a 'tooth brushing test" at each visit during initial periodontal treatment. A total of 63 adult periodontal patients (22-67 years of age) was allocated to 4 matched groups: Brushing test group (B), open scoring group (O), minimal feedback group (M) and control group (C). The oral hygiene instruction for groups B, O and M was provided by handing out a self-educational manual on oral home care, while the patients of control group (C) received a short brochure describing the Bass brushing technique and the use of toothpicks. Feedback on the improvement of oral hygiene performance was delivered to groups B and O by scoring of plaque and gingival bleeding by probing while this feedback was avoided in the 2 other groups (M, C). The patients of group B performed a tooth brushing test at each of 3 visits. After 3 months the plaque scores of groups B (27%) and O (22%) had improved more than those of the 2 other groups (35%). However, the improvement in gingival bleeding scores was similar in all 4 groups (from 55% initially to 17% at 3 months). At later examinations only minor differences in plaque and gingival bleeding scores were recorded between the various groups. The findings show that, irrespective of the mode of instruction, a considerable improvement occurs and that this improvement is not related to open scoring of plaque or the tooth brushing test.     

Impact of a periodontal course on oral hygiene and gingival health among senior dental students

This survey attempted to determine the impact of the periodontal course on oral hygiene and gingival health among 50 senior dental students. The course included the following: patient motivation, instruction in oval hygiene procedures and plaque control, scaling and curellage, temporary splinting and occlusal adjustment. Without advance notice, plaque deposits were scored using the Plaque Index and gingival health was determined using the Gingival Index. The results were collected at the beginning and at the end of the periodontal course (about 2 months). The results were analyzed using the paired t-test. No improvement of either oral hygiene or gingival health was noted at the end of the periodontal course. It seems that even some dental students, who should know the direct relationship between bacterial plaque and periodontal diseases and should be better motivated than the average patient, failed to demonstrate effective oral hygiene. It is difficult to expect an improvement of patient oral hygiene, when the patients have been motivated by students who are unable to perform satisfactory personal oral hygiene themselves. It is suggested that a greater emphasis be placed on patient motivation and instruction in oral hygiene throughout the dental curriculum.     

Oral hygiene instruction of adults by means of a self-instructional manual

Abstract The need for improved oral cleanliness in adults presents a large scale resource requirement for professional manpower if oral hygiene instruction is to be accomplished conventionally on an individual basis at the chairside. Therefore a self-instructional manual in oral hygiene measures, to be used by the patients at home, has been designed. The effect on oral hygiene of periodontal patients following instruction by means of this manual has been compared with the effect of one instruction carried out by a dental hygienist as well as with the effect of minimal instruction by the aid of a short brochure. Thirty-seven patients (25–64 years of age) were allocated to three groups matched with regard to baseline scares of dento-gingival plaque, age and sex. Presence of disclosed dento-gingival plaque (Plak-lite®) and gingival bleeding on probing were recorded at the start, 1,2 and 6 weeks, 3 and 6 months. Toothbrushing performance of the patients was evaluated at each visit by a “brushing test”. The treatment of all the patients consisted of scaling and polishing of the teeth at the start and after 3 months as well as the patients being supplied with the necessary oral hygiene aids including a lighted mouth mirror, a toothbrush, toothpicks and disclosing tablets. The baseline mean plaque and bleeding scores of 64 and 40% decreased during the first 6 weeks to a level of 20 and 14%. This improvement was maintained during the 6-month study period. Among the three groups no significant differences were observed in oral hygiene and gingival health. The results indicate that an oral hygiene instructional mode relatively independent of professional manpower may be equally effective as one single personal instruction. Furthermore the results suggest that factors other than the instruction per sc are important for obtaining improvements in oral home care.     

Comparison of various modalities of "simple" periodontal therapy on oral cleanliness and bleeding

Abstract 550 Chinese employees of both sexes aged 25-44 from an industrial organisation participated in a 16-month longitudinal study. Subjects were divided into 4 groups: an oral hygiene group (group A), a scaling group (group B), an oral hygiene+scaling group (group C) and a control (group D). The experimental subjects were examined at baseline. 2 weeks, 4 months, 10 months and 16 months. After 10 months, group A received scaling while group B was given oral hygiene instruction for the 1st time. The control group did not receive any treatment until completion of the programme. At 16 months, all 3 experimental groups had significantly lower plaque and bleeding scores than the control. The plaque and bleeding levels of the experimental groups were lower at all review-appointments when compared with baseline. Some variations in the clinical parameters were found between groups at 2 weeks, 4 months and 10 months. The scaling+oral hygiene group showed the best response. Although a proportion of subjects showed a substantial improvement in bleeding scores following scaling, the significant resource implications in providing such treatment has to be considered in planning community health programmes to promote periodontal health, wherein oral hygiene education must still have the highest priority.     

The effectiveness of a rotary electric toothbrush on oral cleanliness in adults

The effectiveness of an electric toothbrush (Rota-dent), which in design and mode of action resembles the rotating instruments used by professionals in tooth cleaning, was assessed. 40 adult periodontal patients were divided into 2 groups matched with regard to oral cleanliness: an electric toothbrush group (EB) comprising 20 patients who received an electric toothbrush as well as instruction in it's use by a dental hygienist; a control group (CO) comprising 20 patients who were provided with an oral hygiene kit containing a conventional toothbrush, an interspace brush, toothpicks, disclosing tablets and a lighted mouth mirror and who received the oral hygiene instruction by means of a self-teaching manual. All patients received professional mechanical tooth cleaning 1 week prior to the instruction. At a 3-week follow-up session, additional instruction was given by a dental hygienist according to needs. The presence or absence of dento-gingival plaque after disclosing with the Plak-lite system and gingival bleeding by gentle probing was recorded on 4 tooth surfaces of all teeth, initially and after 3 months. The findings showed a similar improvement in the status of oral hygiene in both groups, indicating that in the hands of the patients, the electric toothbrush was just as effective as the comprehensive oral hygiene kit.     

Oral cleanliness and gingival health following oral hygiene instruction by selfed-educational programs

The aim of the present study was to determine the motivational effect of using a periodontal self-examination manual prior to a self-instructional manual in oral hygiene and to examine whether instruction provided at a later time than the scaling procedure improves the effect of the instruction. 74 patients with periodontal disease were divided into 3 groups: (1) A group of 23 patients who performed a self-examination of their periodontal condition prior to self-instruction in oral hygiene; (2) a control group of 27 patients who used only the self-instructional oral hygiene manual; and (3) a group of 24 patients who were not given the self-instructional oral hygiene manual before 6 weeks after the baseline examination. All these patients had their teeth scaled at the start of the study and after 3 and 7 months. The effect of the various modes of instruction was evaluated by assessments of plaque and gingival bleeding scores. These parameters were determined at the baseline and after 2 and 6 weeks and 3 and 7 months. The results demonstrated a significant improvement in plaque and gingival bleeding scores following the use of the self-instructional manual in oral hygiene. The use of the periodontal self-examination manual or a delay of the instruction had no additional effect on oral cleanliness. The level of oral hygiene and gingival health achieved at 3 months was maintained in all 3 groups for an additional period of 4 months. After that time, they were divided into 2 other groups depending on whether or not their plaque score was less than 20%. A total of 26 in the group who had a plaque score higher than 20% demonstrated a plaque score of than 20% after having performed the tooth brushing test. 10 of the remaining patients, who still had a plaque score of more than 20% after the tooth brushing test, received additional instruction in oral hygiene which subsequently resulted in improved oral cleanliness after 6 months.     

Spiramycin as a selective dental plaque control agent

Spiramycin was tested as a chemotherapeutic plaque control agent. Sixty- three volunteers (29 experimental and 34 control) abstained from mechanical oral hygiene procedures for 11 weeks. The participants were divided randomly into exeperimental and control groupa and received, on a double blind basis, either 20–500 mg capsules of spiramycin or 20 capsules of placebo with directions to take 1 capsule 4 times a day for 5 days. At each examination visit intra-oral photographs were taken, gingival and plaque indices recored, and plaque samples collected for laboratory study. In the experimental group there was a statistically significant decrease in plaque as measured by wet weight, turbidity, nitrogen, and carbogydrat parameters for at least 3 weeks. There was a significant decrease in the number of Streptococcus mutasn and S. sanguis in the plaque samples at weeks 1 and 3, but there was no detectable influence on the number of Gram-negative organisms.     

A 3-month home use study comparing the oral hygiene and gingival health benefits of triclosan and conventional fluoride toothpastes

Abstract A number of triclosan toothpastes are available which have been shown to benefit gingival health when compared to triclosan free control formulations. There have been few studies to compare such active products with conventional fluoride toothpaste products. The aim of this study was to compare, in home use, a triclosan product with conventional fluoride products already found to show slightly less plaque inhibition in a short term plaque regrowth study. The study was a single-blind, parallel design with a total of 129 healthy dentate volunteers (32 male. 97 female) who toothbrushed with one of 4 toothpaste products at home, twice a day over a period of 12 weeks. At the beginning of the trial, each volunteer was scored for plaque and gingivitis and then received a thorough prophylaxis. Each volunteer was allocated a toothpaste according to a predetermined randomisation scheme. The volunteers were re-examined after 6 and 12 weeks. The volunteers refrained from using any other oral hygiene products during the period of the trial. The toothpastes tested were two conventional fluoride toothpastes, a children's fluoride toothpaste and a triclosan/copolymer toothpaste. Results indicated that there were no overall significant treatment differences for either plaque index or gingival index and ordering of toothpastes was not possible. All volunteers' oral hygiene and gingivitis improved following the 6-week period and continued to improve to the 12th week. This is a feature of most oral hygiene trials and presumably arises from the initial prophylaxis and a Hawthorne response of improved toothcleaning by the subjects. It must be concluded from this study that in normal home use the triclosan/copolymer toothpaste provides oral hygiene and gingival health benefits no greater than achievable with conventional toothpaste products.     

Use of food colourants as plaque disclosing agents

The effectiveness of plaque disclosure by several liquid food colourants and disclosing agents was compared in a group of eight subjects. The subjects refrained from all forms of oral hygiene for a 48-hour period prior to rinsing with 5 ml of each dye in turn at weekly intervals. Kodachrome film records were taken and projected for the assessment at weekly intervals. Kodachrome film records were taken and projected for the assessment of plaque staining efficacy by a panel of 38 assessors. Acceptability with respect to taste, extent and duration of mucosal staining and any side effects was also evaluated. The food colourants were as effective as the disclosing agents. Ability to stain plaque appears to be related not only to the constituents of each dye, but also to their concentrations and relative proportions. Other desirable properties of an ideal disclosing agent tended to be fulfilled to a level equivalent to, or better than, that reached by the proprietery disclosing agents. Difficulty in obtaining proprietary disclosing agents should not act as a handicap to achieving better levels of oral cleanliness as inexpensive food colourants of equal effectiveness to the best proprietary agent are readily available.     

The effect of a cognitive behavioral intervention on oral hygiene

Several medical areas that require patient compliance have successfully used psychological interventions emphasizing cognitive behavioral components. However, there are no published reports on the effect of cognitive behavioral interventions on oral hygiene in adults using an experimental design. For this study, 100 male veterans age 21-65 years were randomly assigned to 4 groups (cognitive behavioral, education, attention control, and control); to compare the effectiveness of these interventions on oral hygiene, a 5-week pre-test-post-test design was utilized. The dependent variables were self-report of brushing and flossing behavior and dental plaque levels utilizing the plaque index. After the interventions, there was only one significant difference between the control and the experimental groups for brushing frequency. There were no significant differences among the experimental groups for this intervention. The self-report of flossing frequency significantly increased in all 3 treatment groups, but there were no significant differences between these groups. In addition, plaque levels decreased significantly in all 3 experimental groups. Plaque levels in the cognitive behavioral group were significantly lower than those of the educational group. It was not possible to determine whether the greater plaque reduction in the cognitive-behavioral group could be attributed to the nature of the intervention or to the extra time spent with patients in the cognitive behavioral group.     

Effects of the domestic use of a disclosing solution on the denture biofilm: a preliminary study

Summary  To investigate the effect of the home use of a disclosing agent on the microbial composition of denture biofilm, by means of a cross-over randomized clinical trial. Two interventions were tested during 7 days each: (I) oral and denture hygiene instructions and (II) instructions associated with the home use of a disclosing agent (1% neutral red). Eleven participants with visible biofilm deposits over their maxillary complete dentures were randomly assigned to one of the two sequences of interventions: (i) I followed by II, and (ii) II followed by I. A washout period of 7 days was established. After each intervention, samples of denture biofilm were evaluated by DNA checkerboard hybridization for the detection of Candida spp. and 17 bacterial species. Counts were low for all the tested species, and no significant difference was found between the tested interventions (Wilcoxon test, P  > 0·05). The home use of a disclosing agent does not remarkably change the composition of denture biofilm.     

A new oral hygiene strategy

This study was designed to see if toothbrush pressure could be considered a significant factor in the reduction of plaque among a group of orthodontic patients. Eleven orthodontic patients who had been identified previously as having chronic poor oral hygiene and the ability to tolerate only small toothbrush pressures (an average of 3 oz) were selected to participate in this study. At the beginning of the study, each of the patients was supplied with a specialized toothbrush feedback mechanism that was to be used in the routine home care. The feedback mechanism permitted the patients to gradually increase their tolerance to toothbrush pressure by moving from a target pressure of 2 oz to a target pressure of 16 oz over a period of several weeks. When the target pressure was reached, a light on the end of the brush mechanism came on, thus alerting the patient that the target had been reached. Only one of the eleven patients failed to improve her plaque score. There was, on the average, a 47% reduction in plaque scores. The statistical evidence indicates that the improved plaque scores were directly related to the higher toothbrush pressures. The present study was undertaken as an extension of a previous study that indicated good orthodontic toothbrushers used four and one half times more pressure than did chronically poor toothbrushers. This study suggests that poor toothbrushers can improve their oral hygiene significantly by increasing the pressure with which they brush.     

Salt and peroxide compared with conventional oral hygiene. I. Clinical results

The purposes of this 2-year longitudinal study were to: compare the clinical effectiveness of patient applied sodium bicarbonate, hydrogen peroxide, and sodium chloride (S/P) to the use of conventional oral hygiene methods and to investigate the motivational effect of using phase-contrast microscopy in teaching effective oral hygiene. Initially, 972 subjects were screened for signs of periodontitis. From these, 347 with early to moderate periodontitis were selected and each was randomly assigned to one of four home treatment regimens after scaling and root planing. The four treatment regimens included: conventional oral hygiene procedures, conventional oral hygiene procedures plus phase-contrast demonstration of subgingival microbial forms for oral hygiene motivation, S/P oral hygiene, and S/P oral hygiene plus phase-contrast demonstration of subgingival microbial forms for oral hygiene motivation. Plaque, bleeding, gingival inflammation, probing depth, and clinical attachment level were recorded at baseline, 8, 16, and 24 months. Subjects were recalled for reinforcement of oral hygiene and periodontal prophylaxis at various intervals. Data were analyzed based on disease severity, location of index sites and compliance. The results indicated that both conventional oral hygiene procedures and the S/P regimen were effective in reducing clinical signs of disease when combined with professional care. There were no differences between the two regimens in clinical effectiveness and trends favoring microscopic viewing of subgingival plaque for motivational purposes were not statistically significant.     

Gingival enhancement in fixed prosthodontics. Part I: Clinical findings

This study assessed the efficacy of a 0.12% chlorhexidine gluconate (CHX) rinse on the enhancement and maintenance of gingival health in patients receiving fixed prosthodontic treatment. Thirty patient participants in this examiner blind study were randomly assigned into two groups, one control and another group using CHX 15 ml b.i.d. in addition to normal oral hygiene. The medication was used for 2 weeks prior to crown preparation, 3 weeks during provisional crown placement, and 2 weeks after definitive crown cementation. Plaque and gingivitis indices were measured initially and at the three aforementioned points during the 7-week period. The plaque index for the control group decreased by 0.26 units; CHX decreased by 0.63 units at 7 weeks. The gingival index of the control group decreased by 0.37 units; CHX decreased by 0.87 units. Adjunctive use of chlorhexidine with fixed prosthodontic procedures significantly reduced plaque levels and significantly improved gingival health compared with the control patients. Fixed prosthodontic procedures alone decreased plaque levels and increased gingival health.     

Utilization of locus of control in the prediction of patients'' oral hygiene performance

This study investigated the relationship between internal and external locus of control classified patients and improvement in oral hygiene skills and plaque scores. Locus of control scores, and initial and final skill and plaque scores were recorded for 22 dental patients with moderate periodontitis. Oral hygiene instruction was given over a 3-month period to each patient. Although patient oral hygiene skill level increased significantly and plaque scores declined significantly, no relationship was detected between the locus of control personality dimension and skill or plaque scores. It was concluded that personal oral hygiene instruction reinforced by self-instructional manual was effective in improving oral hygiene skill and reducing plaque scores; additional strategies for future studies investigating the locus of control dimension were presented.     

Use of gingival bleeding for reinforcement of oral home care behavior

The present study examined the use of gingival bleeding as a reinforcement mechanism for interproximal home care with the toothpick. After initial assessments of plaque and gingival bleeding, 36 subjects were given a professional toothcleaning and instructed to maintain oral hygiene by toothbrushing alone for 3 months. After 3 months of brushing only, subjects were re-examined and given another professional toothcleaning. Having been matched for age and percentage of sites bleeding on probing, as determined at the initial examination, they were than randomly attached to one of three groups. One group, the control, continued to clean their teeth with only a toothbrush, while the other two groups used the toothbrush supplemented with the toothpick for interproximal subgingival cleaning. Both toothpick groups received identical instruction in toothpick technique, but one group was taught to use bleeding as an interpretive device for health. Three months later, clinical assessments indicated significantly less gingival bleeding for both toothpick groups as compared with the control (whose gingival health worsened). Although there was no significant difference between the final scores of the toothpick groups, only the group that used gingival bleeding as a sign of disease showed a significant improvement in gingival health (P less than 0.003), and also had a fivefold higher rate of return of self-report compliance cards. These results suggest that the use of gingival bleeding as a reinforcement mechanism should be considered as a strategy in oral home care instruction to promote compliance with recommended behavior.     

An innovative method of monitoring denture hygiene

A simple and rapid test for measuring oral hygiene was recently developed. It is based on the rate of oxygen consumption of oral expectorates of milk. This investigation modified the test to study denture hygiene. The dentures of 20 patients were immersed in 10 mL of sterile milk. After a 2-minute agitation, 3 mL of milk was added to test tubes containing methylene blue. The time required for color change at the bottom of the test tube, which is indicative of the rate of oxygen consumption, was recorded. For comparison with visual plaque accumulation, the dentures were coated with disclosing solution and the extent of plaque was scored by three examiners. A correlation was found between the plaque index scores and results of the milk test (r = -0.64; p less than 0.005). The data suggests the use of this test to monitor denture hygiene.     

The effect of various disclosants on plaque accumulation in human subjects

A clinical trial was designed to evaluate the effect of daily use of three disclosants, erythrosine, fast green and sodium fluorescein, compared to a saline control, on subsequent plaque deposition. Twenty subjects refrained from all oral hygiene for four consecutive 7 day periods. Each subject rinsed each night with a disclosing solution or saline as assigned and according to a design using 5 restricted Latin Squares of 4 subjects each.
At 7 day intervals, plaque score (modified Quigley-Hein, J. Periodontology, 41:41, 1970), plaque weight and absorbance were evaluated and each subject received a rubber cup prophylaxis and another disclosant was assigned. The data revealed no significant differences between the groups of subjects using the various disclosants or saline, demonstrating that daily use of these agents has no effect on rates of plaque formation as determined clinically. There was a statistically significant increase in plaque accumulation (20 %) in all groups by completion of the experiment despite the weekly prophylaxis. All subjects had a moderate to severe gingivitis by the end of the fourth week.     

Effectiveness of a dental education program on oral cleanliness of schoolchildren in Israel

The purpose of this study was to examine the effectiveness of a dental health education program providing dental health information and toothbrushing instruction on oral cleanliness. Two methods of instruction, individual and group instruction, are presented in this study. The plaque situation was assessed in a group of 175 children, 11-14 years of age, by the Patient Hygiene Performance (PHP) method at the beginning of the study and at 1, 2, and 12 months. It was found that immediately after instruction the dental health education program resulted in improved oral hygiene home care for the two experimental groups. However, the improvement noted was achieved regardless of the method of toothbrushing instruction (individual versus group). Moreover, it was demonstrated that maintenance of a satisfactory level of oral hygiene home care was dependent upon review of educational programs and toothbrushing instruction and not related to the method of instruction.