Is Your Knowledge Up‐To‐Date?

Abstract:  Based on scientific proof, only few mouthrinse solutions can be recommended. However, it is impossible to construct an extended table that would provide precise recommendations or advices for mouthrinse utilisation related to any possible discomfort or diseases. Only reliable information on the drugs available against periodontal disease can be offered to the therapist. By evaluation of her or his individual experiences, she or he has to judge all the armamentarium she or he possesses to react in the best possible way in each specific situation.     

Do life‐ or school‐satisfaction and self‐esteem indicators explain the oral hygiene habits of schoolchildren?

OBJECTIVES: The aim of this study was to ascertain how frequently toothbrushing and flossing are practiced among schoolchildren in Kuwait and whether life- and school-satisfaction and self-esteem indicators are associated with oral hygiene habits. METHODS: A sample of 2312 schoolchildren between 11 and 13 years old filled out a structured questionnaire anonymously in school classrooms during 2002 and 2003. For this study, nationally representative samples of children were drawn from all six governorates of Kuwait. Only government schools were included. The questionnaire of the Health Behaviour in School-Aged Children Study was used in this study after it was modified to suit Kuwait. A chi-squared test and logistic regression model were used for analyzing the data. RESULTS: Over half of the pupils reported brushing their teeth more than once a day; girls reported brushing more frequently than boys did. One-fifth of the pupils did not brush their teeth even on a daily basis. The life- and school-satisfaction and self-esteem indicators were associated with more-than-once-a-day toothbrushing frequency. The strongest predictors for recommended brushing were: feeling very happy (OR 2.0, 95% CI 1.38-2.77), feeling that other pupils always accept him/her (1.5; 1.16-2.02), never/sometimes feeling lonely and feeling that it is very easy to make friends (1.4; 1.06-1.94). The summary variables of life-satisfaction, school-satisfaction and self-esteem seemed to be strongly associated with brushing. Dental floss was never used by 45% of the children, weekly by 18% and daily by 17%; 20% did not even know what dental floss was. CONCLUSIONS: Among intermediate schoolchildren in Kuwait, oral hygiene practices were far behind the international recommendations. Special emphasis should be placed on children who have personal problems with their life, school and self-esteem.     

Can Peri‐Implant Crevicular Fluid Assist in the Diagnosis of Peri‐Implantitis? A Systematic Review and Meta‐Analysis

Background: A broader understanding of the immune inflammatory profile of peri‐implant diseases could be helpful in the development of host‐targeted preventive and therapeutic strategies. The aim of this study is to answer two clinical questions: 1) whether patients with peri‐implantitis (PP) present higher prevalence of any specific inflammatory cytokine in peri‐implant crevicular fluid (PICF) compared with healthy patients; and 2) whether local inflammation measured in PICF can be used as a predictor for incipient PP. Methods: A systematic review of the literature on the most common cytokines released in PICF in healthy and PP‐affected sites was conducted from 1996 up to and including October 2013 using predefined search strategies. Cross‐sectional and prospective longitudinal studies were considered. Meta‐analyses were done separately for healthy, mucositis (MU), and PP outcomes. Results: Interleukin (IL)‐1β was the most studied cytokine (n = 12), followed by tumor necrosis factor (TNF)‐α (n = 10). Other cytokines were also linked to PP, such as IL‐4, IL‐6, IL‐8, IL‐10, IL‐12, and IL‐17. Statistical differences were revealed when IL‐1β release was compared between healthy implant sites and PP (P = 0.001) or MU sites (P = 0.002), respectively; when PP and MU were compared, no statistical differences could be detected (P = 0.80). For TNF‐α release, significant differences were found between healthy and PP implants (P = 0.02). Conclusions: PICF containing inflammatory mediators, such as IL‐1β and TNF‐α, can be used as additional criteria for a more robust diagnosis of peri‐implant infection. Additionally, once the inflammatory process is installed, no differences were found between peri‐implant MU and PP.     

Why do adults entitled to free or highly subsidized dental services select fully out‐of‐pocket‐paid care?

Bayat F, Vehkalahti MM, Murtomaa H, Tala H. Why do adults entitled to free or highly subsidized dental services select fully out‐of‐pocket‐paid care? Community Dent Oral Epidemiol 2010; 38: 88–95. © 2009 John Wiley & Sons A/S Abstract – Objective: To investigate patients’ reasons for selecting a dental clinic given their choice of free or highly‐subsidized dental services. Methods: The study was based on cross‐sectional data obtained through phone interviews with adults in Tehran, Iran. The present study included those entitled to free or highly‐subsidized dental services (n = 726). The data covered the patients’ awareness of subsidized dental services and type of dental clinic for their most recent visit and their reasons for selecting that clinic. Awareness of subsidized dental services was dichotomized as being either aware or unaware of such subsidy. The type of clinic was dichotomized as providing either free or highly‐subsidized (FHS) or fully out‐of‐pocket paid (FOP) services. Free format answers about the subjects’ reasons for selecting a particular clinic were later sub‐grouped as: convenient access, good technical aspects, good interpersonal aspects, low or reasonable fees, recommendation by a friend, and no reason. Socio‐demographic status was based on background. Data analysis included the chi‐square test and logistic regression model. Results: Of the subjects (n = 726), 60% were women and 58% were under 35 years of age. The subjects’ mean age was 33.5 years with no difference by gender (P = 0.24) and the majority had public insurance (91%). Of all the subjects, 60% selected FOP. Good interpersonal aspects were the strongest reason for selecting FOP (OR = 4.6), follow by good technical aspects (OR = 2.3). Those subjects who were unaware of their benefit had 4.6 times the odds of selecting FOP. Conclusions: Despite the opportunity to use highly‐subsidized dental services, good interpersonal and good technical aspects lead patients to select private dentists and to pay fully out of pocket.     

Medication‐related osteonecrosis of the jaw: Surgical or non‐surgical treatment?

Medication‐related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive (bisphosphonates and denosumab) and anti‐angiogenic therapy used in the management of oncologic and, less frequently, osteoporotic patients. While there is good international agreement on the diagnostic and staging criteria of MRONJ and the cessation of antiresorptive/anti‐angiogenic treatments, the gold standard of treatment is still controversial, in particular between non‐surgical and surgical approaches. The former usually includes antiseptic mouth rinse, cyclic antibiotic therapy, low‐level laser therapy and periodic dental checks; the latter consists of surgical necrotic bone removal. The purpose of this retrospective study was to describe the therapeutic approaches and outcomes of 131 lesions from 106 MRONJ patients treated at the Policlinic of Bari. Non‐surgical treatments were chosen for 24 lesions that occurred in 21 patients who, due to comorbidities and/or the impossibility of stopping oncologic therapies, could not undergo surgical treatment. As to the outcome, all the surgically treated lesions (107) showed complete healing, with the exception of 13.5% of the lesions, all of which were stage III, which did not completely heal but showed reduction to stage I. The 24 non‐surgically treated lesions never completely healed and, rather, generally remained stable. Only two cases exhibited a reduction in staging. Based on our observations, MRONJ occurring both in neoplastic and non‐neoplastic patients benefits more from a surgical treatment approach, whenever deemed possible, as non‐surgical treatments do not seem to allow complete healing of the lesions.     

Can Oral Health‐Related Quality of Life Measures Substitute for Normative Needs Assessments in 11 to 12‐year‐old Children?

OBJECTIVES: 1) assess the relationship between a measure of condition-specific oral health-related quality of life (OHRQoL) and the related normative need for dental treatments, and 2) test the diagnostic validity of the condition-specific OHRQoL measure for specific dental conditions in a group of primary school children. METHODS: A cross-sectional study of all 11 to 12 year-olds carried out in a municipal area of Suphanburi province, Thailand. 1034 children (91.8%) were dentally examined to assess their normative needs for 6 types of treatment (dental caries, traumatic dental injuries, enamel defects, periodontal, orthodontic and prosthodontic treatment). OHRQoL was assessed using the Child-OIDP index and its Condition-Specific impacts measure for the 6 treatment types. RESULTS: The prevalence of specific types of normative needs ranged from 3.2% (prosthodontic) to 97.0% (periodontal) and for Condition-Specific oral impacts from 0.7% (prosthodontic) to 50.6% (dental caries). Despite their statistically significant relationship for every treatment type except for periodontal treatment when need was indicated by a CPI score of 1, there were large differences between measures of normative need and oral impacts. High proportions of children had normative need without impacts and vice versa. The biggest differences were for appearance-related conditions (e.g. enamel defects and orthodontic treatment). For every type of treatment, oral impacts poorly predicted the normative needs of individuals. CONCLUSIONS: Although normative needs and OHRQoL are associated, when assessed appropriately, there was considerable discrepancy between them. OHRQoL measures cannot replace normative needs. Instead, both should be used in combination in order to cover different dimensions of oral health.     

Sinus floor augmentation with β‐tricalciumphosphate (β‐TCP): does platelet‐rich plasma promote its osseous integration and degradation?

When dental implants are to be inserted, sinus floor augmentation is an effective treatment procedure to improve bone height in the posterior maxilla. In addition to autogenous bone material, allogenic materials, e.g. beta-tricalciumphosphate (beta-TCP), have been used successfully. The purpose of this study was to investigate whether the combination of beta-TCP with platelet-rich plasma (PRP) enhances bony regeneration and resorption of the tricalciumphosphate material. In a randomized prospective trial, 45 sinus floor elevations were performed in 39 patients. In 22 sites, PRP was added to the beta-TCP granules, while in 23 sites beta-TCP without PRP was used. Six months later, bone specimens were harvested from the augmented region during the implant insertion procedure. The formation of new bone was about 8-10% higher when PRP was applied. A faster degradation of the ceramic bone substitute was not observed. In conclusion, when PRP was added to beta-TCP, bone regeneration was supported to a small extent. However, the resorption of beta-TCP was not accelerated and foreign-body giant cells and soft tissue surrounding the beta-TCP granules were present.