Mechanical Self-performed Oral Hygiene of Implant Supported Restorations: A Systematic Review

A systematic review of self-performed oral hygiene practices for optimal maintenance of dental implant-supported restorations reveals a lack of evidence to support best practices.BackgroundThe standard of the patients' home care is a key factor for long term stability of dental implants and the prevention of biological complications. The objective of this systematic review is to evaluate and summarize the literature with respect to various mechanical oral hygiene modalities around implant-supported restorations.MethodsMEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to October 2013 to identify eligible studies. Five studies that met the inclusion criteria were included. Two cohort studies about powered toothbrushes and three (randomized) controlled trials comparing powered to manual toothbrushes were reviewed. All studies showed an improvement in the clinical parameters over time. Powered toothbrushes were found to perform better than manual toothbrushes but no firm conclusions can be made between treatment modalities.ConclusionsThere is a lack of evidence with respect to effective and optimal self-performed oral hygiene around dental implants. At present, home care recommendations are based on the knowledge that is available with respect to cleaning of natural teeth. It becomes evident that there is an urgent need for academic institutions and industry to initiate and support high quality randomized controlled clinical trials on this topic in the near future.     

上海市在职成年人口腔保健与牙周健康状况的调查

目的:调查上海市不同职业在职成年人口腔卫生习惯和牙周健康状况,初步探讨口腔卫生习惯对牙周病流行情况的影响程度.方法:采取分层、整群、随机的抽样方法,通过问卷调查了解400名上海市不同职业在职成年人的口腔卫生习惯,检测简化口腔卫生指数(OHI-S)、牙龈指数(GI)、探诊出血(BOP)、牙周袋探诊深度(PD)、临床附着丧失(CAL)、松动度(Mobility,M)及余留牙数等指标以评价牙周健康状况.结果:上海市不同职业在职成年人口腔卫生习惯、口腔卫生状况及牙周健康状况有极显著差异;上海市成年人人群简化口腔卫生指数OHI-S=2.16±0.99,牙龈炎为中度流行(GI=1.23±0.50),牙周健康者比率为5.75%,牙周炎的患病率为71.5%.结论:上海市在职成年人口腔卫生习惯和口腔卫生状况与职业存在相关性;其牙周健康状况与职业也存在相关性;调查结果证实口腔卫生习惯是影响口腔卫生状况以及牙周病流行的一个至关重要的因素.     

口腔卫生指导效果的临床评价

目的：评价口腔卫生指导的临床效果。方法：对82名慢性龈缘炎和牙周炎患者，分组采用2次、5次进行口腔卫生指导(Ⅰ组为5次指导组；Ⅱ组为2次指导组；Ⅲ组为对照组)。分别于1，2，6，12周通过菌斑控制百分率(plaque control rate，PCR)和探诊出血百分率(blooding on probing rate，BOPR)来评价口腔卫生指导效果。结果：1周时．PCR和BOPR都显著的降低。在2周时，Ⅰ、Ⅱ组的PCR都由基线的88％降至30％左右，且BOPR由基线55％降至12％左右；而对照组，PCR由89％降至50％，BOPR由55％降至44％。在6周后，Ⅰ、Ⅱ组的PCR和BOPR一直维持低水平；而对照组，在6周时，PCR为83％，BOPR为50％。12周时，PCR和BOPR分别显著性降至57％和25％。结论：口腔卫生指导可以非常有效地控制菌斑和改善出血状况，2次与5次指导无差异。     

Poor oral Hygiene may be the Sole Cause of Oral Cancer

Purpose

The purpose of this case–control study was to draw attention to the possibility that poor oral hygiene resulting from infrequent and inadequate use of chewing sticks might be the sole cause of oral cancer in 60 patients investigated in the maxillofacial units of two specialist hospitals in eastern Nigeria.

Methods

Sixty cases and 60 controls made up the study population. We matched them for age, gender, period of admission and study site. The interview of all the participants contained data on demographic factors, family history of cancer, tobacco habits, oral hygiene, dietary habits and use of alcohol. We took biopsies of the lesions for histo-pathological examination. We entered the collected data into Microsoft excel package and transported it to Stata for generation of statistical test.

Result

Poor oral hygiene due to infrequent tooth brushing was associated with primary oral cancer in this patient sample. On the other hand, frequent tooth brushing was related to healthy status.

Conclusion

In the absence of other known carcinogens, poor oral hygiene may be the single factor that caused oral cancer in these subjects. Research is needed to investigate the pathological mechanism that is associated with this risk factor.

Electronic supplementary material

The online version of this article (doi:10.1007/s12663-012-0359-5) contains supplementary material, which is available to authorized users.     

辽宁省中老年人口腔卫生及牙周健康状况调查分析

目的：通过流行病学调查和统计学方法分析辽宁省中老年人口腔卫生和牙周健康状况,为辽宁省中老年人牙周病预防工作的开展提供依据。方法：随机选取辽宁省各地区46岁以上中老年人共113人,填写调查问卷,进行牙周专科检查。结果：女性口腔卫生好于男性（P〈0．05）;吸烟者口腔卫生较差,牙周破坏较非吸烟者严重（P〈0．01）;46～59岁和60岁以上两组口腔卫生无显著差异,但前者附着丧失小于后者（P〈0．05）。结论：中老年人的口腔卫生普遍较差,并且存在不同程度的牙周炎,应从多种途径宣传口腔卫生维护和牙周健康知识,争取让中老年牙周炎患者尽早接受牙周治疗。     

The practical oral care video--evaluation of a dental awareness month initiative

BACKGROUND: A collaborative effort for the Australian Dental Association's Dental Awareness Month in 2002 included the production of 'Practical Oral Care - a video for residential care staff'. This evaluation of the project aimed to profile the video purchasers, evaluate the usefulness and appropriateness of the video and accompanying booklet using a mailed questionnaire, and elicit appropriate and practical themes for future geriatric oral health promotion and research. METHODS: A national mail-out of evaluation questionnaires was undertaken to all purchasers of the video. RESULTS: Of the 792 purchasers at the time of the project, 294 questionnaires were returned with 83.7 per cent from residential aged care facilities, 12.6 per cent from dental professionals and 3.7 per cent from health educators. The great majority of purchasers agreed or strongly agreed that the booklet was practical and useful, video was the best format, video length was appropriate, content was realistic, the video assisted staff to identify residents at risk for dental problems and better meet their oral care needs, and improved awareness about oral care issues. Analysis of purchasers' comments highlighted the need for the production of videos on more specific practical oral care issues with behaviourally difficult residents and residents with dementia, to be supplemented with a self-directed learning package. CONCLUSIONS: The Practical Oral Care video was a successful national collaborative geriatric oral health promotion initiative and provided the opportunity to increase awareness about oral care issues in residential care.     

Herbs in dentistry

Herbs have been used for centuries to prevent and control disease. Herbal extracts are effective because they interact with specific chemical receptors within the body and are in a pharmacodynamic sense, drugs themselves. By using herbal medicines, patients have averted the many side effects that generally come with traditional medicines, but this does not mean that side effects do not occur. Only knowledgeable practitioners can prescribe the right herb and its proper dosage. Herbal medicines had been considered in every culture, however, pharmaceutical companies overturned this type of thinking. Now, pharmaceuticals are called traditional and herbs are libeled as the 'alternative'. The biggest challenge and problem is lack of information about the effect of herbs in oral tissues, mechanism of effect, and side effects. Several popular conventional drugs on the market are derived from herbs. These include aspirin (from white willow bark), digitalis (from foxglove), and sudafed (modelled after a component in the plant ephedra). Herbal products can vary in their potency. Therefore, care must be taken in selecting herbs, even so, herbal medicines have dramatically fewer side effects and are safer to use than conventional medications. The herbs described in this article are Bloodroot, Caraway, Chamomile, Echinacea, Myrrh, Peppermint, Rosemary, Sage, Thyme, Aloe Vera, Propolis, and a summary of other herbs that are useful in dentistry. Herbs may be good alternatives to current treatments for oral health problems but it is clear that we need more research.     

Adolescent toothbrushing and the home environment: sociodemographic factors, family relationships and mealtime routines and disorganisation

Levin KA, Currie C. Adolescent toothbrushing and the home environment: sociodemographic factors, family relationships and mealtime routines and disorganisation. Community Dent Oral Epidemiol 2010; 38: 10–18. © 2009 John Wiley & Sons A/S Abstract – Objectives: Previous studies have shown that sociodemographic factors are associated with adolescent toothbrushing. While there has been some investigation of parental modelling of oral health behaviour and the association between parental support and oral health, there has been no investigation of the home environment and its effect on oral health behaviour. The current study examines variables related to the family, including mealtime routines and family relationships to determine the best predictors of adolescent toothbrushing. Methods: Data from the 2006 Health Behaviour in School‐Aged Children Survey were modelled using logistic univariate and multivariable modelling with outcome variable twice‐a‐day toothbrushing. Results: Higher family socioeconomic and affluence were significantly associated with greater odds of toothbrushing twice a day or more. Family structure was also significantly associated with girls’ toothbrushing. However, under the multivariable model, eating breakfast was found to be the best predictor of twice‐a‐day toothbrushing among boys and girls. The next best predictor of boys’ toothbrushing was eating family meals and of girls’ toothbrushing, never going to bed hungry, followed by family affluence for both boys and girls. Under the multivariable model, family structure was no longer significantly associated with girls’ toothbrushing. Conclusions: The study shows that the family and home environment should play a central role in the promotion of oral health, through mealtime routines, incorporating a fair parenting style and developing open and positive family relationships. Not only are these strongly associated with twice a day toothbrushing but, unlike sociodemographic factors, they may be relatively easy to adopt.     

口腔健康教育对社区特定人群口腔卫生状况改善的效果评价

目的：评价口腔健康教育对社区特定人群口腔卫生状况改善的效果评价。方法：选取湖北省武汉市某小区的老年人、妊娠期妇女、学龄前儿童、中小学生共501人,随机分为口腔健康教育组和对照组。对教育组人群通过椅旁方式进行口腔健康知识宣传教育或发放口腔卫生宣教的小册子自学;对照组暂不做任何干预措施。结果：3个月后,与对照组相比,教育组人群的简化口腔卫生指数有明显改善（P〈0.05）,同时菌斑控制百分率和探诊出血百分率都显著的降低（P〈0.01）。结论：口腔健康教育对于社区特定人群口腔卫生状况的改善具有重要意义。     

Establishment of a New Marginal Plaque Index With High Sensitivity for Changes in Oral Hygiene

Background: Although several plaque indices exist, they rarely assess in detail the plaque adjacent to the gingival margin, an area most important for periodontal health. This study aims to develop a new marginal plaque index (MPI) and to assess its validity and treatment sensitivity compared to the internationally accepted Turesky modification of the Quigley and Hein Index (TQHI). Methods: Data from two studies with n = 64 and n = 67 participants, respectively, are reported here. Convergence of MPI with TQHI and concurrent and predictive validity with papillary bleeding index were assessed, as was treatment sensitivity to a treatment of proximal hygiene (study 1) or toothbrushing (study 2), respectively. Results: Convergent validity with TQHI is very good. Concurrent and predictive validity parameters of the MPI are similar to the TQHI. The treatment sensitivity of MPI exceeds TQHI by far. This results in a reduction by >70% of the sample size needed to discover significant treatment effects. As expected, the largest treatment sensitivity was observed for proximal MPI measures in study 1, whereas study 2 showed largest effects for cervical measures. Conclusions: MPI appears to be a valid plaque‐scoring system that assesses plaque at the gingival margin. It responds with high sensitivity to treatments aimed at plaque reduction at the gingival margin. Its treatment sensitivity and capacity to differentiate between proximal and cervical plaque make it a promising tool for periodontal research.     

Oral hygiene: past history and future recommendations

Review of the dental literature reveals a changing emphasis attached to maintenance of optimal oral hygiene among patients over time. Moreover, a different relationship to this topic has been evident in the USA, Britain and Scandinavia. These changes, differences, and the rationale behind them, are described. The age of initiating oral hygiene practice and the optimal frequency of dental cleaning is discussed. Finally, recommendations are offered concerning oral hygiene promotion, both at the individual and community levels.     

A comparison of WHO Periodontal Status Index with the Periodontal and Oral Hygiene Indices

Examination of 2,138 subjects, aged 15-65+ years, was carried out by calibrated examiners using mirrors and fibre optic illumination. Each subject was scored by the Periodontal Status Index, PSI (WHO Oral Health Surveys), Periodontal Index, PI (Russell) and the Oral Hygiene Index, OHI (Greene & Vermillion). For the PSI, PI and OHI all scores were age-dependent with the exception of soft deposits in PSI and OHI, which were age-independent. The advantages of the PSI system were considered to be the ease of scoring and the opportunity to assess treatment requirements, in terms of time, at the public health service level. Disadvantages were lack of quantitation, difficulties of diagnosis of intense gingivitis, and localized and general conditions. The PI and OHI systems provided a more objective, quantitative and sensitive basis of scoring than the PSI. Statistical tests showed the respective indices are associated and measuring the same kind of criteria. Examiner calibration and consistency were similar for both scoring systems.     

Oral Hygiene Instruction and Health Risk Assessment in Dental Practice

We studied oral hygiene instruction given to 109 patients in 19 Washington State dental practices to investigate the extent to which therapists targeted their efforts toward patients with high disease risk. Patients were examined prior to instruction and prophylaxes. Therapists' instructions were tape-recorded and their content analyzed: therapists' expectations were scored. There were no statistically significant associations between patients' initial plaque levels and the process/content of the oral hygiene instructions delivered. On average, therapists spent 9.4 minutes of each prophylaxis session discussing oral hygiene. Therapists were judged more genuine with those patients for whom they had higher expectations of compliance, i.e., those with less plaque and low disease risk. We conclude that dental practitioners were not employing effective risk assessment strategies in selection of patients most in need of intensive instructional efforts.     

A Comparison Between Written,Verbal, and Videotape Oral Hygiene Instruction for Patients with Fixed Appliances

Abstract

The objective of the study was to compare the effectiveness of written, videotape, and one-to-one instruction upon the knowledge, oral hygiene standard, and gingival health of subjects undergoing orthodontic treatment with a lower fixed appliance.

Subjects for whom fixed appliances had been fitted recently were divided randomly into three groups of 21, 22, and 22, respectively. Group 1 received written oral hygiene instruction, group 2 a specially made videotape, and group 3 saw a hygienist for one-to-one instruction. Results were assessed in terms of improvement in knowledge concerning oral hygiene procedures, and of plaque and gingival index scores.

Analysis of variance revealed no significant main effects or interactions at P = 0?05, although the difference in the plaque index scores before and after instruction was close to significance.     

口腔卫生状况与慢性胃炎关系的调查研究

目的：初步探讨口腔卫生情况与慢性胃炎的关系。方法：对半岛地区城乡２９４５名中老年人的口腔卫生状况进行并抽样测定软垢指数（ＤＩ）、牙石指数（ＣＩ）、菌斑指数（ＰＬＩ）,牙龈指数（ＧＩ）和牙周病指数（ＰＤＩ）,并通过聚合酶链反应（ＰＣＲ）检测菌斑中幽门螺杆菌（Ｈｐ）,通过胃镜检查慢性胃炎发病情况。结果：慢性胃炎组与对照组间各指数检测结果差别显著（Ｐ〈０．０１）;两组菌斑Ｈｐ阳性率分别为８１．１％和３７     

A Systematic Review of Oral Health Assessment by Nurses and Carers for Residents with Dementia in Residential Care Facilities

This paper presents systematic review findings to best summarize the assessment of oral health and the use of oral assessment tools by nurses and carers for adults with dementia living in residential aged care facilities. The systematic review searched electronic databases for articles in English (1980 to 2002) and supplemented these with a secondary search of references cited in articles meeting the review inclusion criteria. Delineation is needed between a comprehensive dental examination conducted by a qualified dentist and a dental assessment screening by a carer, nurse, allied health professional or medical practitioner. Dental examinations should be supplemented with oral health assessments and screenings by trained nurses and carers to monitor residents' oral health, evaluate oral hygiene care interventions, act as a trigger to call in a dentist when required, assist with residents' individualized oral hygiene care planning and assist with triaging and prioritization of residents' dental needs. To date, the most comprehensive, validated and reliable assessment screening tool for use by nurses and carers with cognitively impaired institutionalized residents is the Brief Oral Health Status Examination. Other less comprehensive oral assessment tools that are useful for nurses and carers of institutionalized dementia populations include the Index of Activities of Daily Oral Hygiene and the Mucosal Plaque Score. These review findings presented evidence to support the use of oral assessment screening tools by nurses and carers for cognitively impaired residents living in residential aged care facilities. Few validated and reliable tools have been published for use by carers in the cognitively impaired residential care population, and continued evolution of oral assessment screening tools needs to embrace the complete spectrum of residents' levels of cognitive impairment. A. Pearson²     

Oral Health Behaviour and Predictors of Oral Health Behaviour Among Patients With Diabetes in the Republic of Mauritius

ObjectivesTo investigate the oral care habits and assess the determinants of oral care behaviour among people with diabetes in the Republic of Mauritius.MethodsThe present study draws on data collected from 589 dentate persons with diabetes by means of a close-ended questionnaire. Multivariate logistic regression analyses were used to estimate the association of different demographic and clinical factors with recommended dental hygiene practices.ResultsThe majority of the participants brushed at least twice daily (84.2%), never flossed (88.6%), attended dental clinics on need only (87.1%), and did not monitor their blood glucose levels regularly (69.9%). Neither awareness about the increased risk of periodontal disease and xerostomia nor receiving advice from diabetes care providers was found to be associated with good oral hygiene or increased service utilisation. The experience of oral diseases did not encourage recommended oral health practice, with participants without experience with periodontal disease being 3 times more likely to floss (odds ratio [OR], 2.9; P = .045). Regular dental visits were strongly associated with self-reported type 1 diabetes (OR, 7.8; P = .025). Participants from urban areas were more than twice as likely to visit their dental care provider at least once annually (OR, 2.3; P = .006). Regular dental attendance (OR, 3.7; P = .011) and flossing (OR, 4.5; P = .012) were strongly associated with one another.ConclusionThere is widespread noncompliance with regular flossing and dental service utilisation. Our findings highlight the need for an emphasis on preventive care through the provision of integrated medical and dental interventions to high-risk individuals suffering from both diabetes and chronic periodontitis.     

Using the Theory of Planned Behavior to Identify Predictors of Oral Hygiene: A Collection of Unique Behaviors

Background: This study aims to identify predictors of performed oral hygiene behaviors (OHBs) based on the Theory of Planned Behavior (TPB), oral health knowledge, and demographic factors. Methods: Using a questionnaire, 381 participants in three general dental offices and one hospital dental department in York, Pennsylvania, were surveyed regarding performed OHB, attitudes, subjective norms, perceived behavioral control, oral health knowledge, income, age, and sex. Results: Three unique elements of OHB were identified for analysis: brushing, interdental cleaning, and tongue cleaning. Regression analysis revealed that attitude was the strongest predictor of brushing behavior, followed by oral health knowledge, perceived behavior control, subjective norms, and income. Perceived behavior control was the strongest predictor of interdental cleaning, followed by increased age and attitude. Female sex was the strongest predictor of tongue cleaning, followed by subjective norms, decreased age, and perceived behavior control. Respectively, these three groups of predictive variables explained 22.5% of brushing behavior, 22.7% of interdental cleaning behavior, and 9.5% of tongue cleaning behavior. Conclusions: The present findings highlight the utility of viewing OHB as a set of unique behaviors with unique predictive variables and provide additional support for use of TPB in predicting OHB. Periodontal practitioners should consider the strong associations of attitude and perceived behavioral control with brushing and interdental cleaning behaviors when designing interventional efforts to improve patient home care.