Factors related to oral hygiene in persons with scleroderma

Objectives: The purpose of this study was to assess potential risk factors for the development of poor oral hygiene and increased dental caries in individuals with scleroderma. Methods: Twenty‐two subjects with scleroderma participated in this study. All subjects were examined with the Patient Hygiene Performance (PHP) Index, which assesses the extent of plaque and debris over a tooth surface. In addition, oral aperature, xerostomia and dominant upper extremity strength, motion, skin thickness, and dexterity were measured. Results: None of the subjects had good or excellent hygiene. Fifteen subjects had fair oral hygiene and seven subjects had poor oral hygiene as measured by the PHP Index. Significant differences were seen between these two groups for oral aperture, percentage of teeth with caries, skin thickness, dexterity and finger flexion. Dexterity and joint motion correlated significantly with the number of decayed surfaces and number of caries. Oral aperture correlated with the PHP Index and the number of dental caries. Conclusions: Subjects with poor oral hygiene required more time to complete manual dexterity task and had decreased hand strength and joint motion. Moreover, these same subjects had more contractures, scars, ulcers, and higher skin scores (more disease activity) than subjects in the fair hygiene group. In addition to frequent dental exam and routine cleaning, dental personnel may want to consider exercises to increase oral aperature and investigate toothbrush and dental floss selection used by persons with scleroderma.     

A cross-sectional study into the prevalence of root caries in periodontal maintenance patients

Abstract. The aim of this cross-sectional study was to investigate cross-sectionally the prevalence and several risk indicators of root caries in 45 periodontal maintenance patients, who had been actively treated for adult periodontitis 11–22 years ago. These patients were part of a routine 3–6 monthly maintenance schedule. Active and inactive root caries and root fillings were recorded, as well as coronal caries experience. Plaque and bleeding scores, number of exposed root surfaces, rate of saliva secretion, saliva buffering capacity, mutans streptococci counts and Lactobacilli were also scored. From the total of 45 study subjects, 37 patients (82%) showed root lesions (root caries and/or root fillings), while only 8 patients were free of any root lesions. On average, there were 4.3 root lesions per patient (range 0–19) in the present study. 10 patients had active root caries lesions. Of all damaged root surfaces, 9% were active lesions, mostly located on mandibular teeth at lingual and vestibulair sites; 40% were inactive lesions often detected at vestibular sites. The remaining damaged root surfaces (51%) were restored; they were equally divided over both jaws. A higher number of root lesions was observed in those patients with >10⁶mutans streptococci/ ml saliva. Although the actual number of lesions per patient was low in relation to the large number of sites with gingival recession, the results from this cross-sectional study in periodontal maintenance patients indicate that: (1) root caries can be regarded as a complication in periodontal maintenance patients; (2) the individual number of root lesions correlate with individual dental plaque scores; (3) a high number of root lesions is associated with high counts of salivary mutans streptococci; (4) no relation between root caries and coronal caries experience, salivary secretion rate or salivary buffering capacity seems present. Therefore, repeated oral hygiene instructions and adjunctive preventive measures including diet counseling and fluoride rinses, as well as fluoride and chlorhexidine varnishes, should be advocated in high-risk patients.     

Oral hygiene and dental caries--a review.

Numerous studies have related dental caries experience of children with the frequency of their toothbrushing or with their oral cleanliness at the time of examination. Conflicting results were obtained and, therefore, no conclusions may be drawn from these studies. In other studies, the incidence of new carious lesions over a number of years was related to oral cleanliness during the same period of time. These studies showed that children with good oral hygiene had a lower caries incidence than those with poor oral hygiene, but the differences were small. Toothbrushing with a fluoridated toothpaste, which is now the usual practice, is effective in reducing caries incidence. Flossing can remove plaque from approximal tooth surfaces, and there is some evidence that it can reduce caries incidence. Dental caries can be largely prevented by highly efficient removal of plaque by toothbrushing and flossing. However, the available evidence suggests that regular prophylaxis by dental personnel is essential to maintain the necessary high level of efficiency. It is not known to what extent individuals are capable of removing their own plaque to the same high level of efficiency. It is probable that only highly-motivated individuals can maintain such a high standard of plaque control.     

Xylitol in the prevention of oral diseases

Special needs populations such as the mentally disabled or developmentally disabled present a unique challenge for the dental professionals providing dental treatment. Among those challenges is oral health promotion through primary prevention of dental caries and periodontal disease. There are many barriers to adequate oral care for these special needs patients that include cost, physical limitations, low levels of perceived need and lack of dental knowledge by residents and staff, if the person resides in an institution. Primary prevention to maintain oral comfort and function tor these patients is a priority to support their quality of life. Typical oral health problems of these patients include hyposalivation, root‐surface caries, poor oral hygiene, a high prevalence of periodontal disease and dental caries. The purpose of this paper is to review information for the inclusion of xylitol in primary preventive regimens as an adjunct tor the prevention of oral diseases tor special needs patients.     

Predictors of root caries in the elderly

In an attempt to determine the association between overall health status, medication history, and oral hygiene status and root caries, 24 older persons residing independently in the community and 23 residents of a nursing home were interviewed and received oral examinations, using the Oral Hygiene Index and the Root Caries Index. The mean age of this population was 80 yr, with the nursing home subjects somewhat older than community-dwelling subjects. Only six persons had no root surface caries; three subjects had caries on all tooth surfaces with gingival recession. Mandibular teeth, particularly molars and premolars, showed the greatest attack rate. The best predictors of root caries were number of teeth remaining, calculus, plaque, and the use of medications with xerostomic effects. Medications were most predictive of maxillary root caries. The results point to the need to provide interceptive dental therapeutics for high risk geriatric populations such as those using multiple medications and with a poor history of oral care.     

Assessing the stage of caries lesion activity on the basis of clinical and microbiological examination

Abstract The dynamic nature of caries lesion progression may require that classification of caries lesions makes distinctions in activity status. The aim of the present review was to compile and discuss the literature which pertains to clinical assessment of caries lesion activity, and to examine whether recent developments in microbiological research may justify the use of microbiological methods for evaluation of caries activity. Clinical observations suggest that caries lesion progression can be arrested at any stage of lesion development, provided that clinically plaque-free conditions are obtained. However, there is no universal level of oral hygiene to be recommended. The diagnoses “active” and “inactive/arrested” caries have been validated by a range of histological and chemical methods which have supported a separation into distinct clinical categories. Simple microbiological methods have so far not been useful in differentiating between active and inactive caries lesions. Very few studies have evaluated the inter- and intra-examiner reliability of caries diagnostic criteria based on assessment of the activity state of lesions, but recent data indicate that active and inactive caries lesions can be diagnosed with a high degree of reliability. A decision-making tree for dental caries is presented by means of which it is possible to associate the assessment of caries lesion activity with an appropriate treatment modality. It is concluded that research into better methods of assessing caries lesion activity clinically should be stimulated.     

Clinical evaluation of an ionic tooth brush on oral hygiene status, gingival status, and microbial parameter.

It has long been recognised that the presence of dental plaque leads to gingivitis and periodontal disease, as well as dental caries. Today tooth brushing is the most widely accepted method of removing plaque. Hence this present clinical study was undertaken to evaluate the effectiveness of an ionic toothbrush on oral hygiene status. For this study, 20 dental students in the age group of 18-20 years were included. All the subjects after undergoing dental prophylaxis were then provided with ionic toothbrushes, either active (equipped with lithium battery) or inactive (without lithium battery). Plaque index and gingival bleeding index were examined at 7th, 14th, and 21st day. Microbial assessment was done for detection of colony forming units (CFU) from the plaque samples which were collected on 0 day and 21st day, both before brushing and after brushing. Results shown a significant reduction in all the parameters and the reduction was more significant in active and inactive ionic toothbrush users. It was concluded that both active and inactive ionic toothbrushes reduced the plaque index and gingival bleeding index scores significantly and active ionic tooth brushes were more effective as compared to inactive ionic toothbrushes. There was no soft tissue trauma following the use of both type of toothbrushes, which showed that ionic toothbrushes were equally safe for regular long-term use.     

Chewing sticks: timeless natural toothbrushes for oral cleansing

It is generally accepted that oral hygiene maintenance through regular removal of dental plaque and food deposits is an essential factor in the prevention of dental caries and periodontal disease. Methods for oral hygiene vary from country to country and from culture to culture. Despite the widespread use of toothbrushes and toothpastes, natural methods of tooth cleaning using chewing sticks selected and prepared from the twigs, stems or roots from a variety of plant species have been practised for thousands of years in Asia, Africa, the Middle East and the Americas. Selected clinical studies have shown that chewing sticks, when properly used, can be as efficient as toothbrushes in removing dental plaque due to the combined effect of mechanical cleaning and enhanced salivation. It has also been suggested that antimicrobial substances that naturally protect plants against various invading microorganisms or other parasites may leach out into the oral cavity, and that these compounds may benefit the users by protection against cariogenic and periodontopathic bacteria. Some clinical epidemiological studies are in support of this, and many laboratory investigations have suggested the presence of heterogeneous antimicrobial components extractable using different chemical procedures. A few recent studies have identified some of the active antimicrobial compounds. Today, chewing sticks are still used in many developing countries because of religion and or tradition, and because of their availability, low cost and simplicity. The World Health Organization also encourages their use. The Year 2000 Consensus Report on Oral Hygiene states that chewing sticks may have a role to play in the promotion of oral hygiene, and that evaluation of their effectiveness warrants further research.     

Treating root-surface caries

This article summarizes the effectiveness of restorative materials used to restore root surfaces, the mechanisms by which these materials reduce caries, and placement techniques for restoring root-surface lesions. Patients may be classified into low, medium, and high caries risk groups for root caries, and specific dental restorative material recommendations are made for each category. Effective plaque control, xylitol-containing chewing gums, antimicrobial agents, fluoride-releasing restorative materials, topically applied fluoride, and fluoride-containing toothpastes provide maximum protection for the high caries risk patient.     

Oral cleanliness,gingivitis, dental caries and oral health behaviours in Jordanian children

The aims of the study were to investigate the association between oral cleanliness, gingivitis and sociodemographic factors, dental caries and oral health behaviours amongst 4-5-year-old Jordanian children. A two stage random sampling procedure was used to select children enrolled in kindergartens in Amman. Clinical examinations were carried out by one examiner. Mothers completed questionnaires relating to sociodemographic factors and oral health behaviours. Presence of gingivitis and of four or more sites with dental plaque were seen in 66% and 83% of the children, respectively. No differences in these outcomes were seen between ages and genders. Social class and oral hygiene behaviours were important risk indicators for the level of oral cleanliness and presence of gingivitis. Higher percentages of children with four or more sites with plaque and with gingivitis had a dmft score equal or greater than four. Due to the high level of dental plaque accumulation, presence of gingivitis and their association with social class, dental caries and oral hygiene behaviours, attention should be given to the oral health of these children. In particular to the oral health of children attending kindergartens in areas of lower social class in Amman.     

Oral status, oral hygiene habits and caries risk factors in home-dwelling elderly dependent on moderate or substantial supportive care for daily living

Strömberg E, Hagman‐Gustafsson M‐L, Holmén A, Wårdh I, Gabre P. Oral status, oral hygiene habits and caries risk factors in home‐dwelling elderly dependent on moderate or substantial supportive care for daily living. Community Dent Oral Epidemiol 2011;. © 2011 John Wiley & Sons A/S Abstract – Objectives: Elderly people with disabilities have an increased risk of developing oral diseases as compared with the healthy elderly. The aim of this study was to investigate oral hygiene habits, clinical variables related to oral self‐care and caries risk in elderly individuals living at home with moderate and substantial needs of home care. Methods: A random sample of 151 elderly people with moderate needs and 151 with substantial needs of home care were examined. Data concerning general health, social conditions and oral hygiene habits were collected using a questionnaire. Data showing the prevalence of caries, plaque scores and gingival bleeding were obtained through clinical examinations. Results: Elderly subjects with substantial needs of home nursing had more active caries (P < 0.01) and more often gingival bleeding (P < 0.05), as compared with elderly people with moderate needs. Forty‐nine per cent of the elderly with moderate needs performed acceptable self‐care, as compared with 25% of the individuals with substantial needs. Good self‐care was associated with women, low plaque scores, less bleeding and less caries. Factors increasing the risk of having caries were low saliva secretion, high plaque scores and a large number of fillings, while having a dentist and good oral hygiene habits increased the chance of not developing caries. Conclusions: Good oral hygiene habits were associated with less prevalence of plaque and oral disease in the elderly irrespective of extent of needs of home nursing. However, the elderly with moderate needs more often performed good self‐care, indicating that the possibilities of strengthening self‐care and learning new routines are better when functions are less affected.     

Characteristics of individuals with hydrocephalus and their dental care needs

Hydrocephalus is considered a congenital disease affecting the central nervous system, and is characterized by accumulation of cerebrospinal fluid in the lateral ventricles of the brain causing progressive ventricular dilatation. This review paper reports on the oral characteristics of persons with hydrocephalus and discusses their dental care needs. It has been reported that patients with hydrocephalus can present chronological changes in the eruption of their teeth, changes in the occlusion, greater accumulation of plaque, and have a higher caries prevalence. Regular dental visits are needed to control caries as well as to educate the caretakers about oral hygiene for children with hydrocephalus. In addition, the dental practitioner should be careful not to put pressure on the ventricular‐peritoneal drainage tube during dental treatment. Special devices are available to support the patient's head if they have macrocephally.     

Biological factors in dental caries: role of saliva and dental plaque in the dynamic process of demineralization and remineralization (part 1)

Dental caries is a complex disease process that afflicts a large proportion of the world's population, regardless of gender, age and ethnicity, although it does tend to affect more indivduals with a low socioeconomic status to a greater extent. The process of dental caries is dependent upon biological factors that are present within the saliva and dental plaque. There are many different agents within saliva and plaque that serve to protect the tooth surface against caries development. Salivary flow rate, buffering capacity, antimicrobial activity, microorganism aggregation and clearance from the oral cavity, immune surveillance, and calcium phosphate binding proteins all interact to inhibit or reverse demineralization of exposed tooth surfaces. Cariogenic bacteria levels within the saliva and plaque determine whether caries will occur or not, and the concentration in saliva and plaque are intimately related to the type of carbohydrate ingestion and the frequency of ingestion, as well as the oral hygiene practiced by the individual.     

Active and inactive root surface caries lesions in a selected group of 60- to 80-year-old Danes.

In 90, 60- to 80-year-old patients with teeth retained in both jaws (mean 20.4 +/- 4.3), a total of 1,092 root surface lesions were recorded. Of these 156 were diagnosed as active caries lesions, whereas 509 were considered inactive, and 427 were filled. About 60% of the elderly had one or more active lesions and 79% had fillings. Seventy percent had more than 8 filled or carious (active or inactive) surfaces. The percentage of carious and filled root surfaces in relation to surfaces at risk demonstrated that the buccal surfaces of lower molars and premolars and upper canines were the most severely affected (RCI = 70%) with fillings predominating on easily accessible surfaces. A constant relationship between active and inactive lesions was found on all other surfaces but third molars and upper incisors. The data suggest that active and inactive root caries lesions must be diagnosed as separate entities if the dynamic nature of root surface caries is to be explored in epidemiological studies and clinical trials.     

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.     

Technology-enhanced caries detection and diagnosis

The prevalence of dental caries in children and adults in the United States has been declining the past 40 years primarily because of increased use of fluoride, improved oral hygiene and better oral hygiene devices, a greater emphasis on disease prevention and control, and better access to dental care made available by the dental profession. Caries diagnosis and detection for pit-and-fissure lesions has changed dramatically in the past 25 years. Research has confirmed that the carious process is bacterially mediated and is accompanied by changes in salivary flow and pH and the intake of refined carbohydrates. In recent years a number of new technologies have become available as adjuncts to traditional methods of diagnosing carious lesions. While using these new technologies, the clinician still needs to understand the concepts of caries risk, diagnosis, detection, and assessment. Working from the evidence, dental practitioners can decide on a sound clinical diagnosis and treatment plan.     

Oral hygiene as a risk indicator of enamel and dentin caries

Dental researchers have postulated that the risk factors for enamel and dentin caries may not be the same. A review of the literature ascertained that data to support this theory are lacking. Objectives: To evaluate the risk indicators of enamel and dentin caries of the permanent dentition in a study group who had limited access to fluorides and made limited use of dental services. Methods: The study was conducted in Goa, India. Data came from a cross-sectional survey of 1189 seventh grade children, which consisted of a clinical dental examination and a self-administered questionnaire to their parents. The cavitated and non-cavitated criteria were used to score for caries, and the Silness-Loe index for plaque. Results: The mean age of the children was 12.2 years. The percentage of children caries free in the permanent dentition was 22.2%, the mean± s for dmfs, enamel and dentin lesions were 4.20±5.10, 2.59±2.89 and 1.61±3.30 respectively, and the mean plaque score was 1.00±0.48. Results of regression analyses showed that the risk indicators of prevalence and severity of caries differed depending on lesion type. The only variable that was consistently a risk indicator of presence and severity of both dentin and enamel caries was poor oral hygiene. Mother's highest level of education and presence of fluorosis were also risk indicators of enamel and dentin caries. The presence of decayed primary teeth was a risk indicator of enamel caries; and fluorosis severity, use of fluoride toothpaste at the time of the survey, and toothbrushing frequency were risk indicators of dentin caries. The observed caries-oral hygiene association seen is explored further.     

Prediction of root surface caries in patients treated for advanced periodontal disease

Abstract The present investigation was undertaken (1) to analyze the prevalence of root surface caries prior to and after periodontal treatment and (2) to determine the feasibility of using simple clinical criteria for predicting a patient's risk of developing root surface canes following periodontal therapy. Thirty-one patients were given advanced periodontal treatment including periodontal surgery. At baseline they were examined for oral hygiene status, periodontal status, root surface canes experience and number of lactobacilli per ml saliva as evaluated by the Dentocult® dip-slide method. Follow-up examinations 1, 2 and 4 years after baseline showed that a majority of the patients were treated successfully and maintained in periodontal health. Root surface caries developed in approximately two-thirds of the patients during the 4–year observation period. However, the total increment of root lesions during these years was mostly extremely low. i.e. less than 5% of exposed root surfaces. In higher risk patients developing new root surface caries, significant correlations were demonstrated with initial pretreatment scorings for (1) their previous root surface caries experience, (2) high lactobacillus counts and (3) advancing age. In addition, root surface caries incidence and low saliva secretion rates were found to correlate significantly during the course of the study.