Oral Candida carriage,quantification, and species characterization in oral submucous fibrosis patients and healthy individuals

Aim: To determine the prevalence of oral Candida carriage, candidal quantification, and various subtypes of Candida species in oral submucous fibrosis patients and healthy individuals. Methods: The study comprised 30 clinically‐diagnosed and ‐staged oral submucous fibrosis patients aged 20–40 years, and 20 age‐ and sex‐matched controls. Buccal mucosa was sampled by sterile swab technique. Each sample was inoculated on Sabouraud’s dextrose agar and CHROMagar culture media. Candida species identification was done using the KB006 Candida identification kit. Results: Eleven (36.67%) cases in the study group, and two (10%) cases in the control group, yielded Candida on culture. The value of CFU/mL increased with an increased duration of betel quid chewing habit. All Candida‐positive oral submucous fibrosis patients complained of a burning sensation. Candida albicans and Candida tropicalis were the most common species in the oral submucous fibrosis cases. Candida dubliniensis was isolated in both the study and control groups. Conclusions: Our observations in this study affirm that oral submucous fibrosis favors the colonization of Candida. Mucosal alterations due to the underlying disease process or betel quid chewing, coupled with other factors, might lead to candidal colonization, even in the absence of clinically‐related mycotic manifestations.     

Oral health status among hospitalized patients

To cite this article:
Int J Dent Hygiene 9 , 2011; 21–29
DOI: 10.1111/j.1601‐5037.2009.00423.x
Carrilho Neto A, De Paula Ramos S, Sant’ana ACP, Passanezi E. Oral health status among hospitalized patients. Abstract: Aim: To investigate into oral health status and its association with health status in hospitalized patients. Methods: A total of 82 patients were examined and 49 (59.7%) patients were men. The patients answered a survey and oral examinations to detect the number of teeth, oral hygiene index, prostheses hygiene, oral lesions, caries, dental plaque index (DPI), gingival inflammation index (GI), gingival bleeding index, periodontitis and periodontal index. Results: Oral hygiene was associated with age, but it was not related to physical disability. Difficulty eating was mainly associated with age and tooth loss. All full and partially dentate patients presented dental plaque, 38 (69%) poor oral hygiene, 58 (98.1%) gingival inflammation, 41 (74.5%) periodontal disease and 33 (60%) caries. Oral lesions were detected in 30 (36.5%) and candidiasis (n = 16, 19.6%) was the most frequent mucous lesion. Caries were associated with smoking and poor oral hygiene. Hospital length of stay and age were associated with increased DPI and GI. Conclusions: The majority of hospitalized patients did not present satisfactory oral hygiene. Caries and periodontal diseases are associated with health behaviours. Increased time length at hospital could increase gingival inflammation and dental plaque accumulation.     

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.     

A modified cognitive behavioural model as a method to improve adherence to oral hygiene instructions – a pilot study

To cite this article:
Int J Dent Hygiene 8, 2010; 178–182
DOI: 10.1111/j.1601‐5037.2010.00457.x
Fjellström M, Yakob M, Söder B. A modified cognitive behavioural model as a method to improve adherence to oral hygiene instructions – a pilot study. Abstract: Objective: The purpose of this project was to create a modified CBT model to determine the impact on increased adherence to oral hygiene instructions. In a pilot study test, this model was compared with traditional instructions. Method: Tools developed and tested in this pilot study were a self‐reporting questionnaire, a visual information consisting of pictures and a diary to document according to a modified CBT method. Four participants were divided into two groups, control group and CBT group. At the first visit, all participants answered a self‐reporting questionnaire. The clinical examination consisted of measuring the PI, GI and GBI. The same information and instructions were given. All received toothbrushes, dental floss and professional tooth cleaning. The CBT group was instructed to document their feelings and thoughts in a diary. After 3 weeks, the participants answered the same questionnaire, and the same clinical measurements were conducted at the re‐examination. The CBT group brought their diaries for evaluation. Result: At the end of the study, there was a difference in PI, GI and GBI between the groups. The levels of PI, GI and GBI had decreased more in the CBT group than in the control group. The questionnaire also showed that the CBT group had increased their knowledge and awareness about oral health. Conclusion: This pilot study shows that using a modified model of CBT, by keeping a diary, resulted in increased adherence to oral hygiene and knowledge about gingivitis, compared with traditional instructions.     

Trends in oral hygiene, gingival status and dental caries experience in 13-14-year-old Jordanian school children between 1993 and 1999

Aims : The aim of this survey was to describe the trends in oral hygiene, gingival condition and dental caries prevalence in 13–14‐year‐old northern Jordanian school children. Method : A dental survey was conducted in 1999, similar to one carried out in 1993, utilising 10 schools (666 pupils) and 20 schools (1,695) with children of 7th grade, respectively. These schools were chosen by a simple random method from the five geographic areas of the city. All participants had dental examinations for oral hygiene, gingival condition and dental caries experience using the Silness and Löe plaque index (PI.I), Löe and Silness gingival index (GI) and decayed (D), missing (M) and filled (F) teeth (DMFT) and surfaces (DMFS) codes, respectively. Results : Boys had higher plaque and gingival scores than girls in both groups. The mean PI.I and Gl scores of males and females were significantly higher in the 1993 survey than in 1999 (P < 0.05). Also, male and female children examined in 1993 had significantly higher caries experience, as measured by DT, DS, DMFT and DMFS scores than in 1999 (P < 0.01). No differences were found between M and F values of both groups. It is concluded that oral hygiene, gingival condition and dental caries has improved since 1993.     

Results of a 20-year oral hygiene and prevention programme on caries and periodontal disease in children attended at a private periodontal practice

To cite this article:
Int J Dent Hygiene 9 , 2011; 155–158
DOI: 10.1111/j.1601‐5037.2010.00455.x
Chambrone LA, Chambrone L. Results of a 20‐year oral hygiene and prevention programme on caries and periodontal disease in children attended at a private periodontal practice. Abstract: Objectives: The objective of this study was to evaluate the long‐term effect of an oral hygiene and prevention programme on caries and periodontal disease in a group of children attended at a private periodontal practice. Methods: A total of 50 systemically healthy children, 25 males and 25 females, 03–13 years old, were invited to join a long‐term plaque control programme. All children had no caries and had no evidence of clinical bone loss. The participants were selected amongst children whose parents (mother, father or both) were treated of gingivitis, aggressive periodontitis or chronic periodontitis in a private periodontal practice. Subjects were separated in groups according to their parents’ periodontal diagnosis, i.e., gingivitis, aggressive periodontitis or chronic periodontitis. The following outcomes were evaluated: a) probing depth, b) plaque (PI) and gingival (GI) indexes. The plaque control programme applied consisted of a regular maintenance regime at 6‐to 12‐month interval with an experienced periodontist. Results: In total 30 subjects fulfilled the 20‐year period of maintenance. The mean recall frequency was 6.4 (± 3.1) months, and the mean PI and GI were 0.4 (± 0.3) and 0.3 (± 0.3) respectively. The average rate of caries lesions was 1.0 (± 1.4). None of the patients exhibited clinical or radiographic evidences of alveolar bone loss, and no tooth was lost by caries. In addition, there were no statistically significant differences between groups (P > 0.05). Conclusions: Adequate oral hygiene measures and periodic professional plaque control led to low levels of dental plaque, gingivitis and caries lesions.     

Oral Candida and nasal Aspergillus flora in a group of Saudi healthy dentate subjects

The prevalence of oral candidal carriage is widely variable in different populations but has never been studied previously in a Saudi population. Nasal mycological flora has never been investigated previously in a healthy population. OBJECTIVES: To assess the oral and nasal candidal and Aspergillus flora in a group of Saudi healthy adult dentate subjects. DESIGN: The concentrated oral rinse technique and nasal swab technique were used to sample the oral and nasal cavity respectively. RESULTS: Candida species were isolated from the oral cavity of 52 (52%) subjects. Candida albicans constituted 80.8% of the isolates, followed by C. krusei (5.8%). Aspergillus species were isolated from the nose of 21 (21%) subjects. A. flavus constituted 42.3% of the isolates followed by A. niger (31.8%) and A. fumigatus (26.9%). Subjects who did not brush their teeth had a significantly higher rate of oral Candida and nasal Aspergillus compared with those who brushed regularly (P = 0.02). CONCLUSION: Oral mycological flora in the Saudi population is not different than reported for other populations. Lack of oral hygiene increases oral candidal colonisation. Larger scale studies are encouraged to determine the prevalence of oral candidal carriage in the population generally, and the significance of nasal Aspergillus carriage should be determined.     

Oral lichen planus and dental hygiene: a case report

To cite this article:
Int J Dent Hygiene 9 , 2011; 163–166
DOI: 10.1111/j.1601‐5037.2010.00454.x
Scattarella A, Petruzzi M, Ballini A, Grassi FR, Nardi GM. Oral lichen planus and dental hygiene: a case report. Abstract: Background: The presence of atrophic‐erosive lesions among gingival tissues makes oral hygiene procedures difficult for several reasons. Plaque control and rigorous oral hygiene are a fundamental requisite for the treatment of any oromucosal disease. Case report: A patient suffering from a mixed atrophic‐erosive form of oral lichen planus (OLP), with serious gingival involvement, was also treated with the topical application of clobetasol propionate 0.05% using gingival trays. The highest hygiene standards of both patient and trays were of fundamental importance. Discussion: The management of the patient suffering from gingival atrophic‐erosive OLP requires the synergic treatment of both dentist and dental hygienist, whose contribution supports the corticosteroid and/or immunosuppressive treatment.     

Prevalence of oral Candida carriage in Thai adolescents

Aim: Oral candidiasis is among the most common AIDS‐associated opportunistic infections. Adolescents remain at the highest risk of HIV infection and could suffer from oral candidiasis. However, information on oral Candida carriage in this population is limited. This study aims to evaluate the prevalence of oral Candida in Thai adolescents. Methods: Oral rinse samples from 80 healthy Thais (age: 15–17 years) were collected and analyzed for the prevalence of Candida species using culture‐based and polymerase chain reaction assays. Results: Twenty six adolescents (32.5%) carried Candida in the oral cavity. Candida albicans was detected in 28.75% (23/80). Non‐albicans Candida species were detected in 6.25% (5/80). The majority (92.3%, 24/26) of adolescents with Candida carried a single species. Two carried two species: one with Candida glabrata and Candida albicans, and the other with Candida parapsilosis and Candida albicans. Three adolescents harbored only non‐albicans species, with one carrying Candida tropicalis and two carrying Candida parapsilosis. Candida dubliniensis was not detected in this population. Most adolescents carried Candida at a low level (<500 c.f.u./mL). Conclusions: Oral Candida was present in approximately one‐third of adolescents. Candida albicans was the most prevalent (88.5%), and non‐albicans species were present in 19.2% of those with oral Candida.     

Relationship between oral hygiene practices and oral status in dentate elderly people living in residential homes

OBJECTIVES: To investigate the relationship between the oral hygiene practices of dentate elderly people living in residential homes, their requests for assistance and their oral health status. METHODS: 164 people (81.2+/-7.4 years) participated in an interview and oral examination, and provided a stimulated saliva sample. RESULTS: The mean number of coronal decayed surfaces (CDS) was 2.4+/-5.9, stimulated salivary levels (log(10)cfu/ml) of mutans streptococci, lactobacilli and yeasts were 1.6+/-2.1, 3.0+/-2.2, 2.1+/-1.7, respectively, and 53% had root decayed surfaces (RDS). Plaque (PI) and gingival (GI) Indices were 2.3+/-0.7 and 1.6+/-0.4 and denture debris scores (DDS) were high. 31% of the population cleaned their mouths twice daily without requesting help and they had significantly fewer yeasts, RDS, restorations on root surfaces, lower PI, GI (P<0.005) and DDS (P<0.0001) than the 69% who cleaned less often. 50% of those who cleaned less frequently requested assistance with oral hygiene but only 5% said that their carers supported them. Those residents who requested help had significantly higher levels of yeasts, lactobacilli (P<0.001), retained roots, DDS, RDS (P<0.005), PI and GI (P<0.0001). CONCLUSION: The elderly residents' perceived need for assistance with oral hygiene was related directly to oral hygiene status and to clinical indicators of mucosal and dental diseases.     

Dental and oral hygiene status in Jordanian children with cleft lip and palate: a comparison between unilateral and bilateral clefts

To cite this article:
Int J Dent Hygiene 9 , 2011; 30–36
DOI: 10.1111/j.1601‐5037.2009.00426.x
Hazza’a AM, Rawashdeh MA, Al‐Nimri K, Al Habashneh R. Dental and oral hygiene status in Jordanian children with cleft lip and palate: a comparison between unilateral and bilateral clefts. Abstract: Objectives: The purpose of this study was to assess and compare the dental health and oral hygiene status of subjects with unilateral and bilateral cleft lip and palate (BCLP). Methods: Oral and dental examinations were carried out in 98 children with cleft lip and palate and 98 unaffected subjects matching in gender and age, using the standard dental indices dmft and DMFT. Plaque and gingival indices were scored using the plaque and gingival indices of Silness and Löe. Results: The prevalence of dental caries was significantly higher in children with cleft lip and palate than their control in both permanent and deciduous teeth. Patients with BCLP experienced more dental caries than unilateral cleft lip and palate (UCLP) patients in both dentitions. Similarly, plaque accumulation and gingivitis were significantly higher in the cleft lip and palate patients compared with their controls. Only plaque accumulation was significantly higher in the BCLP patients than in the UCLP patients. Conclusion: Bilateral cleft lip and palate patients appear to be at a higher risk of caries experience and poorer in oral hygiene than those with UCLP patients. These findings not only provide a baseline for oral health parameters in patients with cleft lip and palate but also emphasize the need for intensive preventive measures of oral disease to optimize clinical outcome.     

Effectiveness of a sonic toothbrush in maintenance of dental implants

Abstract. This study assessed the efficacy of a sonic and a manual toothbrush in reducing plaque and gingivitis around dental implants. Subjects were randomly assigned to either sonic (n=16) or manual (n=15) study groups. Groups were balanced according to baseline levels of plaque and gingivitis. The plaque (PI), gingival (GI), and bleeding (BI) indices as well as probing depths were determined at baseline, and at 4, 8, 12, and 24 week follow-up visits. Mean scores per person were calculated for each clinical parameter. Oral hygiene habits, compliance and acceptance were also evaluated over the study period. Within group comparisons from baseline throughout the study, as well as between group comparisons (i.e., sonic versus manual), were determined. Overall, plaque, gingival, and bleeding indices in both groups were lower at each follow-up visit when compared to the baseline. Within group comparisons demonstrated that both the sonic toothbrush subjects and the manual toothbrush subjects had significantly lower PI. GI. and BI scores at each post-baseline visit (4, 8, 12, and 24 weeks) than at baseline (p<0.005), In addition, the sonic toothbrush subjects also had significantly lower probing depths at each post-baseline visit than at baseline (p<0.005). Between group comparisons demonstrated that the sonic toothbrush subjects over time had significantly lower PI and BI scores around dental implants than the manual toothbrush subjects (Repeated measures MANOVA; PI, p=0.01; BI, p= 0.017). The sonic toothbrush subjects had lower GI scores and reduced probing depths over time when compared to manual toothbrush subjects but these scores were not statistically significant (GI; probing depth, p > 0.05). No implant problems (e.g., loose screws) were attributable to the sonic toothbrush. Relevant to oral hygiene habits, subjects in both groups demonstrated a high level of compliance with their assigned toothbrush. Overall, the results of this study demonstrated that sonic toothbrushing significantly reduced plaque, gingival inflammation and bleeding, and probing pocket depths around implants over the 6-month trial period. It is concluded that sonic brushing is an effective means of dental implant maintenance.     

Professional oral hygiene treatment and detailed oral hygiene instructions in patients affected by mucous membrane pemphigoid with specific gingival localization: a pilot study in 12 patients

To cite this article:
Int J Dent Hygiene 10 , 2012; 138–141
DOI: 10.1111/j.1601‐5037.2010.00527.x Arduino PG, Lopetuso E, Carcieri P, Giacometti S, Carbone M, Tanteri C, Broccoletti R. Professional oral hygiene treatment and detailed oral hygiene instructions in patients affected by mucous membrane pemphigoid with specific gingival localization: a pilot study in 12 patients. Abstract: Objectives: The aim of this prospective case series was to assess the clinical efficiency of an oral hygiene protocol in patients affected by mucous membrane pemphigoid (MMP) with specific gingival localization, before starting any medical treatment. Methods: Patients received oral hygiene instruction followed by non‐surgical periodontal therapy including oral hygiene instructions in a 3‐week cohort study. Clinical outcome variables were recorded at baseline and 5 weeks after intervention and included, as periodontal parameters, full mouth plaque (FMPS) and bleeding (FMBS) scores and patient‐related outcomes (visual analogue score of pain). Results: A total of 12 patients were recruited. The mean age at presentation was 59.5 ± 14.52 years. Five weeks after finishing the oral hygiene and periodontal therapy protocol, a statistical significant reduction was observed for FMPS (P = 0.001), FMBS (P = 0.022) and reported pain (P = 0.0028). Conclusions: Professional oral hygiene procedures and non‐surgical periodontal therapy are connected with improvement of gingival status and decrease in gingival‐related pain, in female patients affected by MMP with specific gingival localization.     

Association of asymptomatic oral candidal carriage, oral candidiasis and CD4 lymphocyte count in HIV-positive patients in China

OBJECTIVES: To compare the prevalence of asymptomatic oral candidal carriage in healthy volunteers with human immunodeficiency virus (HIV)-positive patients in China, as well as to investigate the relationship between CD4+ lymphocyte count and oral candidal colonization or oral candidiasis. METHODS: Oral candidal carriage and oral candidiasis were investigated in 101 patients with HIV-infection seen at Youan Hospital, Beijing, China. Two hundred and seventeen healthy volunteers were involved as a control. Culture from saliva was used to test for the presence of oral Candida. CD4+ lymphocyte count was measured by flow cytometry. All data were analyzed statistically by SAS. RESULTS: Asymptomatic oral candidal carriage rate (28.6%) in HIV-positive group was similar to that in the healthy group (18.0%; P = 0.07). No significant difference in CD4+ lymphocyte count was found between oral Candida carriers and non-carriers among HIV-positive subjects (P = 0.89). However, the frequency of oral candidiasis increased with the decrease in CD4+ lymphocyte count (P < 0.0001), and pseudomembranous candidiasis was predominant in HIV-positive patients with CD4+ <200 cells microl(-1) (66.7%). CONCLUSIONS: In HIV-positive subjects, asymptomatic oral candidal colonization is not related to CD4+ lymphocyte count of blood, and the carriage rate is similar to that in the healthy population. Oral candidiasis is more likely to be observed in HIV-positive patients who have a low CD4+ lymphocyte count.     

Safety and efficacy of two manual toothbrushes

To cite this article:
Int J Dent Hygiene  8 , 2010; 280–285
DOI: 10.1111/j.1601‐5037.2010.00475.x
Rosema NAM, Timmerman MF, Versteeg PA, van Palenstein Helderman WH, van der Velden U, van der Weijden GA. Safety and efficacy of two manual toothbrushes. Abstract: Objective: The purpose of this study was to test the efficacy and safety of a newly designed multi‐level manual toothbrush (Profit‐Haije‐Brush) compared with a control flat‐trimmed manual reference toothbrush from the American Dental Association (ADA). Material and methods: For this study, 36 healthy subjects without previous experience in the use of the Profit‐Haije‐Brush (PHB) were selected. Subjects were given a period of 2 weeks to become familiar with both types of brushes and were instructed to use them on alternate days for 2 min twice daily. Prior to their visit, subjects refrained from all oral hygiene procedures for 48 h. Prebrushing plaque and gingival abrasion scores were assessed. Subsequently, two randomly chosen contra‐lateral quadrants were brushed with one of both brushes and the other two quadrants with the alternate brush. Subjects were supervised during their 2‐min brushing exercise. After brushing, plaque and gingival abrasion were re‐assessed. A questionnaire was filled out to investigate the subjects’ attitudes towards both brushes. Results: The overall mean prebrushing PI was 2.47 for the PHB and 2.44 for the ADA. The reduction in PI was 1.32 and 1.23 respectively (P < 0.05). With regard to gingival abrasion the overall mean prebrushing scores were 4.57 (PHB) and 5.34 (ADA). Post‐brushing scores were 13.49 and 13.77 for the PHB and ADA respectively. Conclusion: Statistically, the multi‐level PHB was significantly more efficacious than the flat‐trimmed ADA. However, the difference is clinically considered small and the amount of remaining plaque was not significantly different between brushes. No greater potential to cause gingival abrasion to the oral tissues was observed.     

HIV感染者口腔念珠菌负荷及生物型研究

目的调查人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染者口腔中念珠菌负荷状况、生物分型及与口腔念珠菌病临床表现的关系。方法采取漱口法对64例HIV感染者和42名健康对照者进行口腔念珠菌的定量分离培养，并综合利用革兰染色、厚壁孢子生成实验、CHROMagar显色培养和API 20C AUX酵母菌鉴定系统对分离株进行生物型鉴定。结果64例HIV感染者中，52例中可分离出念珠菌74株，阳性分离率为81．3％，而42名健康对照者口腔念珠菌阳性分离率仅为16．7％（P〈0．001）。通过对74株念珠菌的生物型进行鉴定，发现有39株白色念珠菌，15株热带念珠菌及其他6个生物型20株。健康对照组中，分离出5株白色念珠菌和其他裂2株。结论HIV感染者口腔念珠菌感染率明显增加，其口腔念珠菌的检出率和负荷量亦明显增加，白色念珠菌和热带念珠菌为其主要分离菌；与健康对照组相比，HIV感染者的口腔念珠菌分离株生物类型旱现多样化。     

Oral health status and treatment needs among school children in Sana’a City,Yemen

To cite this article:
Int J Dent Hygiene
DOI: 10.1111/j.1601‐5037.2009.00398.x
Al‐Haddad KA, Al‐Hebshi NN, Al‐Ak’hali MS. Oral health status and treatment needs among school children in Sana’a City, Yemen. Abstract: Data on the oral health status and treatment needs among Yemeni children are lacking. Objectives: To assess caries prevalence, treatment needs and gingival health status among school children in Sana’a City and to examine how these are affected by age, gender and khat chewing. Methods: 1489 children (6‐ to 14‐year old) were randomly selected from 27 schools representing all nine districts of Sana’a City. Dental caries and treatment needs were evaluated using standard WHO oral survey methods. The plaque index (PI), calculus index (CI) and the gingival index (GI), recorded at the six Ramfjord’s teeth, were used to assess gingival health status. Results: 4.1% of the study subjects were caries‐free. Prevalence of these was significantly higher among the males. Overall, mean dmfs, dmft, DMFS and DMFT scores were 8.45, 4.16, 3.59 and 2.25 respectively. The decayed component accounted for >85% of the scores. The highest dmfs/dmft means were found among the 6–8 years age group, while the highest DMFS/DMFT means were scored by the 12–14 years age group. The need for restorative treatment and extractions was high; the former was significantly higher among the females. All subjects had gingivitis; the mean PI, CI and GI were 1.25, 0.3 and 1.36 respectively. Khat chewing did not affect caries experience; however, it was significantly associated with higher PI, CI and GI scores. Conclusions: The prevalence of caries, gingivitis and treatment needs among children in Sana’a city is high. More surveys in other Yemeni cities to generate comprehensive data are required.     

Evaluation of oral health related to body mass index

Oral Diseases (2012) 18 , 748–755 Objective: Poor oral health has previously been related to high body mass index (BMI). We aimed at exploring the link between BMI and several oral health markers, after adjustment for dietary patterns and plasma insulin, both of which could act as mediators. Subjects and Methods: Dental examination was performed in a sample of 186 French subjects aged 35–64 years and selected from the general population to assess number of missing teeth, periodontitis, clinical attachment loss (CAL), probing pocket depth (PD), gingival index (GI) and plaque index (PI). Data collection also included a food‐frequency questionnaire. BMI (considered as outcome variable) was categorized into quartiles, and as BMI<25; 25 ≤BMI<30; and BMI ≥ 30 kg m^?2. Results: After adjustment for age, gender, education level, smoking, physical activity, energy intake and C‐reactive protein, BMI was statistically associated with missing teeth, PD and PI, but not with CAL, GI or periodontitis. After additional adjustment for ‘high‐carbohydrate’ diet and plasma insulin or HOMA (homeostasis model assessment) index for insulin resistance, the statistical relationship between BMI and oral variables remained significant only for PD and PI. Conclusions: Plaque index, reflecting dental plaque, and PD, closely linked with periodontal inflammation and infection, are statistically associated with high BMI and obesity, independently of dietary patterns and insulin resistance.     

Type 2 diabetes mellitus and oral Candida colonization: Analysis of risk factors in a Sri Lankan cohort

Aims: Oral candidiasis is a major oral manifestation of uncontrolled diabetes mellitus, and a number of cofactors are associated with the pathogenesis of this infection. Here, we describe the prevalence of oral Candida in a Sri Lankan cohort of type 2 diabetes mellitus and risk factors that predispose them to this common fungal infection.

Methods: A case–control study was conducted in 250 diabetics with type 2 diabetes and 81 nondiabetic controls. Clinical and demographic data were collected using an interviewer administered questionnaire, and patient records. Oral rinse samples were collected to determine the candidal carriage, and the resultant yeast growth was quantified and speciated using multiplex-PCR and phenotypic analyses. Chi-square test (χ² test) and Fisher exact test were used for the determination of the significant relationships between risk factors and oral candidiasis.

Results: The oral prevalence of Candida species among both groups was similar (81%) although a significantly higher proportion of diabetics (32.8%) yielded >2000 CFU/mL of yeasts compared with only 12.3% of the healthy controls (p?p?C.albicans was the most common Candida species isolated followed by C. parapsilosis, C. tropicalis and C. glabrata.

Conclusions: The oral infestation of Candida in our Sri Lankan cohort of diabetics is significantly higher than their healthy counterparts, and co-carriage of multiple yeast species is a common finding in the study population. As there are no previous such reports of the latter phenomenon particularly from the Asian region it is noteworthy, mainly in view of the recent data on the emergence of drug-resistant yeast species the world over.     

The effect of using mobile applications for improving oral hygiene in patients with orthodontic fixed appliances: a randomised controlled trial

Objective: To investigate the effect of using mobile applications active reminders to improve oral hygiene in comparison to verbal oral hygiene instructions.

Design: Two-arm parallel randomised controlled trial.

Setting: orthodontic clinics at two branches of a university hospitals of the college of dentistry of Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia.

Participants: Forty-four 12-year-old and older subjects.

Method: Subjects undergoing orthodontic treatment with fixed appliances were randomly assigned to one of two groups using simple randomisation. Group I: subjects received a mobile application that sends active reminders of oral hygiene three times a day (n?=?22). Group II: subjects received verbal oral hygiene instructions verbally during their routine orthodontic visits (n?=?22). Two primary outcomes were assessed using plaque index (PI) and gingival index (GI) for Ramfjord teeth to evaluate the level of oral hygiene at baseline and after 4 weeks.

Results: Mean differences for PI and GI for group I were reduced from T1 to T2 (P?P?P?>?0.05, P?>?0.05). Both PI and GI significantly reduced for group I compared to group II between T1 and T2 (P?P?Conclusions: PI and GI all significantly decreased after 4 weeks of using active reminders of oral hygiene instructions on mobile application compared to verbal oral hygiene instructions.

The study was registered at clinicaltrials.gov with number: NCT03109769.