Comparison of the use of different modes of mechanical oral hygiene in prevention of plaque and gingivitis

BACKGROUND: The objective of this study was to evaluate the effect of an oscillating/rotating/pulsating powered toothbrush on plaque and gingivitis prevention over a 9-month period. METHODS: The study had an examiner-masked, randomized, three-group parallel design. A total of 122 subjects >or= 18 years of age in good general health and with at least five teeth per quadrant and no pockets >or= 5 mm were included. A 3-week preexperimental period of extensive oral home care, including rinses, was started to improve gingival health. Professional oral hygiene instruction with a manual brush was provided. At baseline, subjects were assigned to one of three regimens: twice daily brushing with a manual toothbrush, a manual toothbrush and the use of floss, or a powered toothbrush. Subjects were professionally instructed in their regimen and given a prophylaxis. Two weeks later, oral hygiene reinforcement was provided. Gingival bleeding, plaque, staining, and gingival abrasion were assessed during the preexperimental period and at baseline, 10 weeks, and 6 and 9 months. RESULTS: There was a significant reduction in plaque and gingivitis from the preexperimental period to baseline. At 10 weeks and 6 and 9 months, the level of plaque was statistically significantly lower with the powered toothbrush versus the other two regimens (P 相似文献   

Effectiveness of oral hygiene techniques on plaque and gingivitis in patients placed in intermaxillary fixation

Twenty-one patients undergoing reconstructive maxillofacial surgery volunteered to learn and practice specific oral hygiene techniques while in intermaxillary fixation in order to compare the effectiveness of different regimens. Oral irrigation was taught to all subjects; one third of the subjects were also instructed in the use of the sulcus brush, and another third were instructed in the use of the Perio-Aid. Scoring was done every 2 weeks for a 6-week period, with measurements taken of the amount of plaque and the amount of inflammation present in papillary, marginal, and attached gingiva. Results show that the group employing only the Water Pik had less inflammation in the attached gingiva than the group using the Perio-Aid and less plaque accumulation and papillary inflammation than the group using the sulcus brush. While more research is necessary to confirm these results, the simplest home care regimen, use of the Water Pik only, appears to offer the best way for intermaxillary fixation patients to remove plaque and minimize inflammation during convalescence.     

Clinical efficacy of a new manual toothbrush on gingivitis reduction and plaque removal

PURPOSE: To evaluate the safety and efficacy of a new manual toothbrush by comparing plaque removal and gingivitis reduction after 4 weeks of use. METHODS: This monadic clinical study included 46 subjects from the Northern New Jersey area who reported to the clinical facility for a baseline plaque and gingivitis examination after having refrained from all oral hygiene procedures and chewing gum for 8 hours, and from eating, drinking, or smoking for 4 hours. The population was comprised of healthy adult male and female subjects aged 27-68 years. Subjects were instructed to brush their teeth for 1 minute, twice a day with their assigned toothbrush and a commercially-available fluoride toothpaste (Colgate Cavity Protection Great Regular Flavor). After 4 weeks of use, subjects returned to the clinical facility for a final gingivitis and plaque examination. RESULTS: All 46 subjects complied with the protocol and completed the 4-week clinical study. The results of the study indicated that the new manual toothbrush was significantly effective in reducing gingivitis and removing plaque after 4 weeks of use. Specifically, the results indicated a 17-39% reduction in gingival sites. In addition, the results indicated plaque removal of up to 96.5% in some parts of the mouth.     

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.     

Effects of topical application of chlorhexidine on plaque and gingivitis in monkeys

All teeth except the lower right canine, premolars and molars, in each of 4 adult male macaque monkeys with heavy plaque deposits and severe gingivitis, were scaled and polished daily for 5 days, followed by daily topical applications of 2% aqueous chlorhexidine gluconate. Minimal amounts of simple plaque containing epithelial cells and Gram positive cocci formed on the treated teeth whereas the untreated teeth retained heavy deposits of complex plaque. In chlorhexidine treated areras the clinical level of gingivitis appeared to subside to a minimum after 15-20 days. Histomorphometric assessments of gingivitis after 42 or 52 days treatment were made on decalcified paraffin sections, by measuring the total area of gingival connective tissue and the area containing inflammatory cells and calculating the proportion of gingival tissue affected. A total of 21 teeth were assessed. Untreated teeth had from 16-40% of the gingivba inflamed, treated teeth only 0-6%. Thus daily topical application of chlorhexidine significantly inhibits plaque accumulation and maintains a significant reduction in gingivitis in these animals. No differences in the nature or degree of keratinization could be detected between treated and untreated areas, nor were there any visible side effects of the use of chlorhexidine for this period.     

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.     

A comparison of partial and full mouth scoring of plaque and gingivitis in oral hygiene studies

Abstract The clinical testing necessary to demonstrate the safety and efficacy of new toothbrushes is complex and expensive. Any modification of methodology that could reduce complexity and cost without compromising quality would benefit both investigators and the public. Results from an 8-week toothbrush study were assessed for the use of partial as compared to full-mouth evaluations. The potential utility of an objective, minimally-invasive bleeding index for the evaluation of gingivitis was also tested. 2 partial evaluations, half-mouth and molar/anteriors, revealed decrements in modified gingival index (MGI), bleeding index and plaque index that were statistically significant and similar in magnitude to those derived from full-mouth examinations. % decrements in MGI and bleeding index based on the Ramfjord teeth were not significant statistically. Results for the new sulcular bleeding index were essentially similar to those for the MGI. However, the bleeding index offered the advantage of improved objectivity for use in both white and non-white subjects. These results suggest that partial evaluations and the new bleeding index may be useful elements in the design of toothbrush efficacy studies.     

The effect of partial dentures and chlorhexidine gluconate gel on plaque accumulation in the absence of oral hygiene

A study was made of the effect of wearing partial dentures upon plaque accumulation in a group of 24 partial denture wearers, when oral hygiene procedures were withdrawn. The modifying effect of a 1% chlorhexidine gluconate gel on this plaque accumulation was measured. Plaque accumulation was measured at the end of four different denture-wearing regimens each 3 days in length. The wearing of a partial denture either day only or day and night, significantly increased plaque accumulation over not wearing a denture. There was no significant difference between plaque accumulation with day wear and day and night wear. The increase in plaque accumulation with day and night wear resulted from an equal and significant increase in both buccal and lingual plaque accumulation. Chlorhexidine gluconate in the form of a gel significantly reduced plaque accumulation during daytime wear. These results tend to confirm that plaque control is a major factor in determining the long-term effects of partial dentures upon the periodontal structures and emphasize the importance of oral hygiene in partial denture wearers.     

The effect of controlled oral hygiene and topical fluoride application on caries and gingivitis in Swedish schoolchildren

ABSTRACT An attempt was made to assess the effect of regularly repeated professional mechanical tooth cleaning on caries development and gingivitis in schoolchildren. A total of 209 children from the first (7–8 years old), fourth (10–11 years), and seventh (13–14 years) classes of an elementary school in Sweden participated. Children from each age group were assigned to one test and one control group. At a baseline examination the state of the gingiva, the oral hygiene and the number of decayed and filled tooth surfaces were determined. Once every second week after the baseline examination the members of the test groups were given careful oral prophylaxis including topical application of monofluoro-phosphate. Once a month the members of the control group brushed their teeth under the supervision of a dental nurse. Twelve months after the initial examination the test and control groups were re-examined. The results show that children given frequent oral prophylaxis combined with topical fluoride applications had clean teeth, only negligible signs of gingivitis, and practically no caries.     

Evaluation of stannous fluoride and chlorhexidine sprays on plaque and gingivitis in handicapped children

The objective of this study was to evaluate the effect of twice-daily oral sprays of 2 ml chlorhexidine (0.2%) and 2 ml stannous fluoride (0.2%) as the sole oral hygiene measure on plaque and gingivitis in handicapped children. 52 institutionalized mentally handicapped individuals (aged 10-26 years) were divided into 4 groups to participate in a 9-week, double-blind, randomized clinically controlled trial, which included a cross-over. For the first 3 weeks, groups 3 and 2 had their mouths sprayed with chlorhexidine and stannous fluoride, respectively. Following a 3-week wash-out interval, groups 1 and 4 were sprayed with chlorhexidine and stannous fluoride, respectively. The alternate groups received a placebo, water. Plaque (PI) and gingival indices (GI) were recorded. Subgingival plaque samples were collected and counts of spirochaetes, motile rods and cocci were taken using darkfield microscopy. By the 9th week of trial, the PI and GI were reduced by 48% and 52% for the stannous fluoride group. In the chlorhexidine group, reductions of 75% (PI) and 78% (GI) were achieved. Pair-wise comparisons of placebo, stannous fluoride and chlorhexidine using the U-test of Mann-Whitney revealed significant (p less than 0.05) differences for both PI and GI scores in the placebo/stannous fluoride and placebo/chlorhexidine pair by the 9th week of the trial. In the stannous fluoride/chlorhexidine pair, only the PI was significantly reduced for those on chlorhexidine. Coccoid cells were more dominant at sites with low PI and GI scores (stannous fluoride and chlorhexidine groups), while spirochaetes and motile rods were more frequent at sites with high PI and GI scores (placebo group).     

Inhibition of plaque formation and gingivitis in beagle dogs by topical use of a degradable controlled-release system containing chlorhexidine.

The in vivo efficacy of a newly-developed dental application of a film-forming, chlorhexidine-containing system was examined in beagle dogs. A self-disintegrating film-forming solution was applied three times weekly to the dentitions of 7 out of 13 dogs, which were fed a soft-food diet. Plaque accumulation (Plaque Index) and gingival inflammation (Gingival Index) were recorded at one, two, four, six, and eight weeks. The local delivery of low-dose chlorhexidine to dogs significantly inhibited gingivitis and plaque formation. It is concluded that the dental application of a film-forming system may be a preferable method of periodontal disease prophylaxis, and may enhance supragingival plaque control in areas of isolated periodontal problems associated with obvious local predisposing factors.     

The effects of a simplified mechanical oral hygiene regime plus supragingival irrigation with chlorhexidine or metronidazole on subgingival plaque

23 patients with pockets greater than or equal to 4 mm and evidence of bone loss on radiographs received thorough scaling and root planing followed by instruction in Bass brushing. They refrained from routine interdental cleaning for the first 28 days. A pulsating jet irrigator was used once daily supragingivally with 0.02% chlorhexidine (CH) 0.05% metronidazole (MD) or 0.01% quinine sulphate inactive control (PL), on a randomized double blind basis. Molar sites were not irrigated and served as control sites; they were only mechanically cleaned. For each patient, subgingival plaque samples were obtained from 2 test and 1 control sites at baseline (day 0), and on days 7, 28, 56 and 84. Plaque samples were monitored by darkfield microscopy on the basis of morphological characteristics of 4 types of bacteria: cocci, motile cells, spirochaetes and "others" (nonmotile rods, filaments and fusiforms). The simplified oral hygiene regime of scaling, root planing and Bass toothbrushing combined with interdental supragingival pulsating jet irrigation with CH, MD or PL appeared superior to a system of simplified oral hygiene alone, particularly during the first 4 weeks. However, at most time-points, the benefits were not statistically significant except for metronidazole. By day 84, the end of the experimental period, all groups approximated baseline levels. The results indicate that supragingival pulsated jet irrigation has limited effects on the composition of subgingival plaque. More marked changes occur when the irrigation fluid contains a chemical agent such as metronidazole known to be effective against important subgingival organisms, but probably not to such an extent as to change the composition of the flora from one associated with diseased sites to one associated with healthy sites.     

Efficacy of Listerine®, Meridol® and chlorhexidine mouthrinses on plaque, gingivitis and plaque bacteria vitality

The experimental gingivitis model was used to compare the anti-plaque, anti-gingivitis and anti-microbial efficacies of a phenolic compound (Listerine) and an amine/stannous fluoride mouthwash (Meridol), using a placebo preparation as negative control and a chlorhexidine solution as positive control in a double-blind study. After professional toothcleaning, 36 volunteers performed optimal oral hygiene for a period of 2 weeks. They then ceased all oral hygiene procedures for 21 days during which they rinsed twice daily with 1 of the 4 mouthrinses. After 3 weeks of rinsing, plaque indices remained the lowest in the chlorhexidine group, while subjects using Listerine or Meridol harbored similar indices significantly lower than that of individuals rinsing with the placebo solution. Up to that time, the gingival index scores were equal in all groups except for the chlorhexidine group in which the values only amounted to half of these encountered in the other groups. The plaque vitality scores showed a bactericidal effect in vivo of chlorhexidine during the entire time of experimental gingivitis. In contrast, the data gave no evidence of an antibacterial effect in vivo of Listerine. The efficacy of Meridol to kill micro-organisms was similar to chlorhexidine during the early stages of plaque accumulation and, with time, became insignificant. This study has demonstrated that chlorhexidine was superior to Listerine and Meridol in its ability to maintain low plaque scores and gingival health during this 3-week period of no mechanical oral hygiene. Moreover, it was also shown that Meridol was as effective as Listerine in reducing plaque accumulation and, in contrast to Listerine, possessed a remarkable but transient antibacterial effect in vivo.     

Effects of a chewable sodium bicarbonate oral composition on plaque and gingivitis

The purpose of this pilot study was to evaluate the effects of an effervescent sodium bicarbonate based oral composition on plaque and gingivitis. Subjects selected for this study presented at screening with moderate plaque and American Academy of Periodontology (AAP) Type I/II periodontal status. At baseline, subjects were allocated to one of two groups by simple randomization; placebo (n=16) and active (n=16). During the study two subjects withdrew due to non-compliance and one because of a death in the family. Data were collected at baseline, day 14, and day 28. The Plaque Index (PI) of Silness and Loe was used to quantify the amount of supragingival plaque surrounding six selected teeth (3,14,8,19,24,30), and the Gingival Index (GI) of Loe and Silness was used to assess bleeding tendencies and visual appearance on the same six teeth. A soft tissue oral assessment was completed at each visit. Subjects were asked to perform study treatment three times a day, after meals, and continue with normal oral hygiene procedures. Subjects were requested to complete a 28-day diary to assess compliance. Data were analyzed using repeated measures analysis of variance. There were no statistically significant differences between the placebo and the active product groups and no statistical significant interaction between product and location within the mouth or visit for either the plaque or gingival scores. Results reveal the product was safe to oral tissues and was well accepted by subjects.     

Classification and prevalences of plaque streptococci after two years oral use of chlorhexidine

The purpose of the present study was to examine the influence of two years daily oral use of chlorhexidine (Löe et al. 1976) on the distribution of different streptococcal types in dental plaque. Plaque samples were collected from the molars in 16 persons in the chlorhexi dine group and from 17 control persons having used placebo solution. The samples were homogenized in yeast extract, and dilutions plated on mitis salivarius agar incubated micro aerophilically for 24 hours followed by aerobic storage at room temperature for 24 hours.
Colonies of each morphological type present were counted on plates having 30–300 colonies and their number related to the total number. One colony of each type was isolated and identified by biochemical tests. The study showed that 84.8 % of the strains could be classified as S. mutans, S. sanguis, S. mitior, S. milleri, S. salivarius , a group intermediary to S. sanguis and S. mitior , and a group resembling S. milleri , using only five biochemical tests: production of extracellular polysaccharide from sucrose, fermentation of mannitol, raffinose and inulin, and hydrolysis of esculin. In the chlorhexidine group the prevalences of S. sanguis and the group of streptococci intermediary to S. sanguis and S. mitior were higher, and the prevalence of S. milleri plus streptococci resembling S. milleri lower, among the streptococcal flora in dental plaque than those observed in the control group.     

The effects of a chlorhexidine toothpaste on the development of plaque, gingivitis and tooth staining

Abstract Chlorhexidine has found many uses in clinical dentistry as an antiplaque agent. To date, effective chlorhexidine-containing toothpastes have not been made available. This study was the first phase in the evaluation of a 1% chlorhexidine toothpaste, formulated to ensure a high availability of the contained antiseptic. The study was a 19-day, randomised double-blind placebo-controlled, crossover experimental gingivitis clinical trial employing 14 healthy human volunteers. From a zero plaque and low gingivitis baseline, the development of plaque, gingivitis and dental staining was measured on days 12 and 19 of the 2 study periods. The toothpaste was used 2 × a day as a slurry rinse with no other form of oral hygiene. The washout period was 21 days. The development of plaque and gingivitis was statistically and clinically highly significantly reduced during the use of the active compared to the placebo product. Conversely, dental staining was statistically and clinically significantly increased. The product deserves further evaluation for potential clinical use.