Partial recording of gingivitis and dental plaque in children of different ages and in young adults

In epidemiologic studies, total recordings of the amount of dental plaque and the degree of gingival inflammation tend to be too time-consuming. Various partial recording methods have accordingly been suggested. However, the validity of these methods when applied to different age groups has not been investigated sufficiently. The aim of the present study was to test whether different systems for partial recording of plaque and gingivitis can take the place of a full-mouth recording in children of different ages and in young adults. Ninety children, divided into three age groups (4-6, 7-9, 14-16 yr), and 30 adults (20-22 yr) were examined. The degree of gingival inflammation was recorded using the Gingival Index and the amount of dental plaque using the Plaque Index. Two partial recording methods were tested. One of these covered the teeth suggested by Ramfjord, modified for children with a primary dentition, and the other the front segment of the maxilla. The results were compared with those from an examination of all tooth surfaces. In all age groups excellent agreement was found between the partial recording method suggested by Ramfjord and a full-mouth recording of both the gingival state and the amount of dental plaque. Examination of the maxillary front segment was less accurate and resulted in a systematic underestimate.     

Gingival inflammation at deciduous and permanent teeth An intra-individual comparison

Previous studies showed that the tendency to develop gingivitis differed between pre-school children with deciduous dentition and adults. A similar difference was noted between juvenile dogs with deciduous teeth and adult dogs with permanent teeth. The juvenile dogs showed morphologic characteristics which might interfere with the permeability of the junctional epithelium, thus protecting the underlying tissues from bacterial irritation. An indirect way to test whether structural differences of clinical importance exist in humans between the gingiva at deciduous and that at permanent teeth is to study the gingival reaction to a controlled amount of plaque in children with mixed dentition. The present paper reports an intra-individual comparison of the gingival reaction at deciduous teeth with that at permanent teeth. 30 children, 7-9 years of age, took part in the study. The amount of plaque was assessed in terms of the plaque index and the degree of gingival inflammation by applying the gingival index. The mean distribution of gingival index scores did not differ significantly between deciduous and permanent teeth, but a higher % of plaque index score 2 + 3 was found in permanent teeth. In the comparison based on areas of similar plaque irritation, a tendency toward a higher degree of gingivitis was found at the deciduous teeth. The results indicate that structural differences, if any, between the gingiva at deciduous teeth and that at permanent teeth have no impact of clinical significance on the gingivitis reaction.     

The effect of different types of composite resin fillings on marginal gingiva

Earlier studies of plaque accumulation on and gingival response around conventional composite resin fillings have produced conflicting results. No studies have been found in which the gingival reaction around newer types of resin fillings had been recorded. The aim of this study was to measure plaque retention and gingival conditions around in vivo, aged, subgingivally located, composite fillings of conventional, hybrid and microfiller types. This study was performed in 2 groups of patients. In the 1st group, there were 108 1-year-old class-III restorations of the 3 composite types and in the 2nd group, 228 3- or 4-year-old class-III or class-IV fillings. Plaque and gingival index scores and the amount of crevicular fluid were recorded. In the group with 1-year-old fillings, the composite resins did not adversely affect the health of the gingival tissues. The amount of plaque on and the degree of gingivitis around the composite fillings were not significantly higher than those for the enamel surfaces. Significant differences in the amount of crevicular fluid were found between both the conventional and hybrid composites and the enamel. In the groups with 3-4 year-old fillings, the indices for each material were significantly higher than those for the enamel surfaces and the fillings showed greater amounts of plaque and a higher degree of gingivitis than the 1-year-old fillings. Differences among the 3 types of composite resins were minimal in both groups and not statistically significant.     

Oral hygiene and gingival condition among 12-year-old children in the Brussels Region

The study analyses oral hygiene and gingival status in a group of 12-yr-old children from the Region of Brussels. In 1998, a total of 496 children from eight selected schools participated in the sample. All children were interviewed about their socio-economic status and oral health care. Records of the plaque index and the gingival index were made. The mean plaque and gingivitis were 1.24 (+/- 0.03) and 1.32 (+/- 0.03), respectively. Seventy percent of the examined sites presented plaque and gingivitis. Privileged children showed lower means than non-privileged counterparts. Multiple linear regression showed that dental plaque was significantly associated to age, toothbrushing and appointment in case of discomfort or pain (P = 0.02). Age, gender, type of the toothbrush and use of dental floss were associated to gingivitis (P = 0.05). Daily home-based mechanical plaque removal is critical for the maintenance of gingival health and when efficiently performed it leads to remission of gingivitis. Dentists should be encouraged to give information and training on regular plaque removal to their patients.     

Oral leukocytes and gingivitis in the primary dentition

A survey was performed to evaluate the relationships among orogranulocytic migratory rale, gingival index and plaque index in a group of systematically healthy preschool children.
The fifty children selected for study had only primary teeth, no pharyngeal or extragingival inflammation and were taking no medication. Each child was subjectively scored for the amount of bacterial plaque and gingival inflammation present. The rate of migration of leukocytes into the oral cavity per 30 second period was determined from the last three of ten 30 second consecutive oral saliva rinses as an objective measure of gingival inflammation.
A minimal amount of localized mild marginal gingivitis was observed in the presence of a rather large plaque accumulation. No significant correlation was observed between rates of oral leukocyte migration and the degree of gingival inflammation. However, the leukocyte migratory rates in this group were quite low as compared to those found in adults by other investigators.     

Immunoglobulin A, G and M levels in saliva in children between 3 - 12 years of age, healthy and with gingivitis

The aim of this study was to measure the level of immunoglobulin A, G and M in saliva of 3- to 12-year-old children, both healthy and diagnosed with gingivitis. Methods: A sample of 177 children was selected, of whom 24 were healthy and 153 were diagnosed with gingivitis according to Loe 's index. Samples of saliva were taken and the ELISA test was applied to obtain the immunoglobulin concentrations expressed in microg/ml. A relationship was established between the immunoglobulin levels, the disease (gingival index) and Loe 's bacterial plaque index. IgG levels were higher in healthy children. In the group with gingivitis, 95.8% of the children had incipient gingivitis with a low average index of bacterial plaque (1.33). A direct correlation was found between age and gingival index, while an inverse correlation was found between age and bacterial plaque index. The analysis of the behavior of immunoglobulin according to age showed that age was only significantly correlated to IgA levels. The analysis comparing immunoglobulin levels and clinical parameters for gingivitis showed a direct correlation between gingival index and lgM The gingival index was found that to increase with the age of the subject, even though bacterial plaque decreases. It was also found that age is a better predictor of lgA level than gingival index and bacterial plaque index are; and that gingival index is a better predictor of lgM level than age and bacterial plaque index are.     

Development of gingivitis in pre-school children and young adults

Earlier studies suggest that children and adults differ in the propensity to develop gingivitis when oral hygiene is abandoned. To confirm the existence of such a difference, a comparative study of pre-school children and young adults was made with objective registration methods. The author performed all registrations. After a period of intensive oral hygiene, all cleaning of teeth was discontinued for 21 days. The amount of bacterial plaque, the amount of gingival exudate and crevicular leukocytes and the bleeding tendency were registered on days 0, 7, 14 and 21. During the experiment the amount of bacterial plaque increased continously in both groups. The amount of gingival exudate and the tendency to gingival bleeding increased to high values in the adults, while only a small rise was seen in the children. The amount of crevicular leukocytes increased in both groups, but the increment was greater in the adults. A comparison concerning differences in gingival exudate and bleeding tendency between pre-school children and adults was undertaken for gingival units that showed a similar plaque development. Under these statistically acceptable prerequisites, it was shown that there is a real difference in the tendency to develop gingivitis between pre-school children and adults.     

Experimental gingivitis in young and elderly individuals

Abstract The development of experimental gingivitis was studied in young and elderly humans during a 21-d period of oral hygiene abstention. The state of the gingiva was assessed by the Gingival Index and by measurements of the amount of gingival exudate on filter paper strips placed at the entrance of the gingival sulcus of the lower lateral incisors and cuspids. Soft deposits were assessed by the Plaque Index and by differential counts of microorganisms in gram stained smears of dento-gingival plaque. At the end of the plaque growth period, the patients were given a thorough dental prophylaxis. Gingival condition and plaque were assessed at regular intervals during a subsequent period of controlled oral hygiene. The development of gingivitis during the oral hygiene abstention period was more rapid and more severe in old than in young individuals. Plaque accumulation was greater in the older persons. A definite difference in plaque consistency was also observed. However, microscopic counts of various types of microorganisms did not reveal any differences throughout the period of plaque accumulation. When active oral hygiene was reinstituted, the state of the gingiva rapidly returned to pre-experimental levels in both groups. The findings of this study indicate that with age there is an altered host response to the microorganisms of the plaque.     

Crevicular fluid levels of interleukin-1alpha and interleukin-1beta during experimental gingivitis in young and old adults

The purpose of the present investigation was to study the effect of age on interleukin-1alpha (Il-1alpha) and interleukin-1beta (Il-1beta) production during experimental gingivitis. One group of five young subjects (20-22 years old) and another group of five older subjects aged 61-65 years were involved in the study. A professional plaque control programme was undertaken to establish healthy gingival conditions at baseline. The examination included the mesiobuccal sites of the Ramfjord teeth (16, 21, 24, 36, 41, 44). Clinical measurements and gingival crevicular fluid (GCF) samples were obtained at baseline, at 21 days of no oral hygiene and one week later after professional cleaning and re-establishment of oral hygiene procedures. Results showed significant differences between the two groups with regard to the amount of plaque accumulation clinical signs of gingival inflammation and GCF volume all of which proved to be more pronounced in the older group. The laboratory data presented a remarkable increase of Il-1alpha levels at day 21 for both groups which were significantly reduced at day 28. For the older adults group the Il-1beta values increased significantly at day 21 and recovered at day 28. For the young adults group these values, despite a small statistically insignificant progressive increase at day 21, remained at low levels during the experimental process. This was the only difference in the cytokines values between older and young adults. It was concluded that low Il-1beta levels observed in the young adults group might explain the less pronounced clinical signs observed during the development of gingivitis in the younger subjects.     

Development of experimental gingivitis in the juvenile and adult beagle dog

Abstract. In a previous paper a lower tendency to develop gingivitis was reported among preschool children compared to adults. The aim of the present study was to clarify if the same age-dependent difference exists in dogs.
Six beagle dogs from the same litter were used. two periods of discontinued oral hygiene were studied, one period when the dogs were 3 months old and the other at 12 months. Prior to and between the experimental periods the animals were subjected to meticulous toothcleaning. During the experimental periods the Gingival and Plaque Index scores as well as the amounts of gingival exudate and crevicular leukocytes were determined on days 0, 4, 7, 14, 21 and 28.
During the juvenile period the development of dental plaque was lower compared with the adult period. The frequency of gingival units with high Gingival Index scores was lower at every registration interval during the juvenile period. The amounts of gingival exudate and crevicular leukocytes increased to high values during the adult stage but only small increments were found in the juvenile stage. An intraindividual comparison of the increase in the amount of gingival exudate from day 0 to day 28 in areas with the same amount of dental plaque accumulation showed a lower increase in gingival exudate during the juvenile stage in all dogs.     

Dental caries, visible plaque, and gingival bleeding in young adult Danes in alternative dental programs

From 16 to 19 years of age three groups of young adults received alternative dental programs on termination of the Public Child Dental Health Service (PCDHS) in different municipalities: public group, n = 386; mixed group, n = 161; and private group, n = 261. Dental caries status at the start of the study was assessed from the standard PCDHS records, and caries, plaque, and gingivitis were examined in an epidemiologic survey at the end. Caries experience at 16 years was 11.6 DMFS, highest in the mixed group and increased in all groups during the study. Initial placement in caries severity zones did not change. Visible plaque index (VPI) and gingival bleeding index (GBI) showed that plaque and gingival bleeding were present in most subjects, but rather few surfaces were affected. Association between gingival bleeding and non-use of dental services was found. Overall, it is concluded that none of the alternative programs differed from each other in having measurable effects on the oral health status.     

Oral hygiene, gingivitis and periodontal status of Libyan school children.

There is relatively little information about the dental health of Libyan children, so this study was initiated to assess the level of oral hygiene and the gingival and periodontal status in children living in urban and rural parts of Libya. Two thousands and fifteen children aged 7-16 years were examined during 1987 using World Health Organization criteria. The oral hygiene was found to be good (mean oral hygiene index = 0.12); boys demonstrated significantly worse oral hygiene than girls (P less than 0.001). Overall, gingival inflammation was categorised as mild (mean gingival index = 0.05). Boys had more gingivitis than girls (P less than 0.001). Periodontal pockets of more than 3.5 mm were found in 4.1 per cent of 15-16-year-old children.     

Immunopotentiation by dental microbial plaque and its relationship to oral disease in man

The relationship between cell-mediated immunity and past caries experience, as well as experimental gingivitis, was investigated under the immunopotentiating conditions of dental plaque which had been allowed to accumulate for 28 days. The lymphoproliferative responses induced by Streptococcus mutans, plaque, Veillonella alcalescens and Actinomyces viscosus showed negative correlations with the DMF index, but positive correlations with the gingival index. No relationship with the DMF or gingival index was found with the unrelated purified protein derivative, or with the mitogen, phytohaemagglutinin. A second episode of plaque accumulation in the same subjects revealed that the lymphoproliferative response appeared earlier, was greater in magnitude and lasted longer in the second, as compared with the first plaque accumulation experiment. The results suggest that dental bacterial plaque has an immunopotentiating effect on cell-mediated immune responses to oral bacteria and facilitates recall of the immunological memory for bacterial antigens. A unified hypothesis is postulated for dental caries and gingival disease; immunopotentiation by dental microbial plaque has a protective immune effect on dental caries and a damaging, allergic effect on gingival disease.     

Oral hygiene practices and periodontal health in primary school children in Nairobi, Kenya.

The purpose of this study was to obtain data on the oral hygiene practices, oral hygiene status, and periodontal health among primary school children in Nairobi. The study group consisted of 513 children, 262 aged 6-8 years and 251 aged 13-15 years. The children were from 6 schools randomly selected among the 154 public primary schools in the city. The clinical examination was performed in a room with natural daylight, using the WHO (1980) criteria. Although most of the children reported brushing habits, 75% of the index tooth surfaces in the younger and 55% in the older age group had visible plaque. In both age groups about 25% of the index sites had gingivitis. Moderate amounts of calculus were recorded among the older children. Only two children had periodontal pockets greater than or equal to 4 mm. There was no statistically significant difference (p greater than 0.05) between males and females recorded with plaque and gingivitis in the younger age group. In the older group, however, a significantly higher proportion of males (p less than 0.05) were recorded with plaque and gingivitis. The oral hygiene practices and oral hygiene status were poorer among children from low than from high socioeconomic status. Provision of dental health education for children in Nairobi is recommended.     

The effect of glass ionomer cement and composite resin fillings on marginal gingiva

Abstract Glass ionomer cement and composite resin are the most popular restorative materials in operative dentistry today. Earlier studies have shown more crevicular exudate around different types of composite resins than around intact enamel surfaces. The aim of this study was (1) to investigate plaque, retention on and the condition of the gingiva around, 1-year-old, subgingivally located, glass ionomer cement and composite resin fillings, and (2) to compare the initiation of gingival inflammation around these materials with that around enamel during a 14-day period of experimental gingivitis. Plaque index, gingival index, bleeding on probing and crevicular fluid were recorded and compared intra-individually. The amount of plaque and the degree of gingivitis adjacent to the composite fillings were not significantly higher than those for the glass ionomer cement and enamel surfaces in both the cross sectional and the experimental gingivitis study. Composite resin surfaces showed significantly higher crevicular fluid levels than did enamel at all days in the experimental gingivitis study. Glass ionomer cement showed significantly higher values at day-0 and day-7.     

The influence of cigarette smoking on the development of experimental gingivitis

The aim of this investigation was to study the influence of cigarette smoking on the development of gingivitis. Experimental gingivitis was induced in the mandibular anterior region by abstention from oral hygiene for 28 days. The study group consisted of 20 healthy dental students, 10 of whom were regular smokers. The clinical parameters studied were gingival bleeding on probing (60 g), gingival redness and gingival exudate. The results showed that the plaque formation rate was similar in both groups. However, smokers displayed a less pronounced gingival inflammatory reaction as compared with non-smokers. Concerning gingival bleeding and gingival redness, the reaction in smokers was significantly less elevated from d 14 through d 28 and concerning the amount of gingival exudate it was significantly less elevated from d 21 through d 28. The differences between groups tended to increase with time. These results suggest that the inflammatory gingival response to accumulating plaque may be suppressed under the influence of cigarette smoking.     

Six-month study of the effects of a chlorhexidine mouthrinse on gingivitis in adults

The effects of a chlorhexidine gluconate mouthrinse on plaque and gingivitis were studied among 430 adults in a six-month clinical trial. Subjects were divided in two comparable treatment groups matched for age, sex, and initial gingivitis severity. Following a thorough oral prophylaxis, they were instructed to rinse twice a day for 30 seconds with 15 ml of a 0.12% chlorhexidine gluconate mouthrinse or a placebo mouthrinse. After three and six months of mouthrinse use, the chlorhexidine group had significantly less gingivitis, gingival bleeding, and plaque accumulation compared to the placebo group. As expected, accumulation of dental calculus and extrinsic dental stain increased in the chlorbexidine group. No significant differences in adverse oral soft tissue effects were observed between the two groups.
Since use of oral antimicrobial agents has been reported to produce tooth and tongue stain, gingivitis examinations were done with and without tooth covers to eliminate the potential for examiner bias. Comparable reductions in the Gingival Index scores and gingival bleeding were obtained when the evaluations were conducted with or without the tooth covers.
It was concluded that a 0.12% chlorhexidine gluconate mouthrinse can provide an important adjunct to the prevention and control of gingivitis when used with regular personal oral hygiene procedures and professional care.     

青春期龈炎龈下菌斑中牙龈卟啉单胞菌的检测

目的:检测青春期龈炎患者龈下菌斑中牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)的存在情况,探讨青春期Pg与牙龈健康状况的关系。方法:14～17岁青春期龈炎患者及牙龈健康者各36例,采用16SrRNA聚合酶链反应(polymerase chain reaction,PCR)检测2组受检者的龈下菌斑样本中Pg的存在,并用电泳凝胶成像分析软件检测各电泳条带的平均灰度值,计算Pg的相对含量;同时检测并记录受检者的各牙周指数测值,观察其与Pg相对含量的相关性。数据用SPSS11.5软件包作统计学分析。2组Pg阳性检出率的比较采用χ2检验;Pg的相对含量以及Pg阳性检出者与阴性检出者的牙龈炎严重度的比较采用Wilcoxon秩和检验;Pg的相对含量与各牙周指数之间的相关关系采用Spearman相关分析。结果:青春期龈炎组与牙龈健康组的龈下菌斑中Pg的阳性检出率分别为47.22%和25.00%,两者之间具有显著性差异(P<0.05);青春期龈炎组与牙龈健康组的Pg在龈下菌斑中的平均相对含量分别为48.02%和21.46%,统计学上有高度显著性差异(P<0.01);在青春期龈炎组Pg阳性个体中,Pg的相对含量与牙龈指数(gingivalindex,GI)、龈沟出血指数(sulcusbleedingindex,SBI)、探诊深度(probedepth,PD)数值的高低呈正相关;青春期龈炎组中,Pg阳性检出者的GI、SBI数值高于阴性检出者,两者之间具有高度显著性差异(P<0.01)。结论:青春期个体的龈下菌斑中有Pg的定植,且与牙龈健康状况有密切关系。     

Increase in the level of oral neutrophils with gingival inflammation – A population survey

ObjectivesHost responses to oral inflammation include a continuous and substantive response with the influx of polymorphonuclear leukocytes (PMN). PMN, referred to as first responders, migrate rapidly from the circulatory system through the connective tissue to mitigate stimuli and localize in the saliva. This study examined the relationship between the well-established clinical indices of gingivitis and dental plaque and the PMN level.Materials and MethodsThis study enrolled adults aged 18–75 years, who provided voluntary informed consent. Oral rinse samples were collected from 159 participants to estimate the PMN levels prior to the full-mouth assessment for gingivitis and dental plaque using the respective clinical indices.ResultsThe gingival index and dental plaque index scores were in the range of 0.098–2.71 and 0.73–4.78, respectively. Regardless of the age and gender, higher number of PMN was observed with higher gingival index and dental plaque index scores. Our analyses indicated a significant correlation between the oral PMN level and gingival index with a correlation coefficient of 0.66 (p < 0.0001). Similarly, the correlation between the PMN level and dental plaque index was statistically significant with a correlation coefficient of 0.57 (p < 0.0001). Regression analysis identified a significant relationship between the PMN level and clinical indices (p < 0.0005).ConclusionsIncrease in the PMN levels with increasing clinical scores (gingival and dental plaque indices) reflect the oral inflammatory burden, irrespective of age or gender. These observations warrant future studies on participants stratified by health status and research directed toward examining the effects of interventions.     

Distribution of plaque and gingivitis and associated factors in 3- to 5-year-old Brazilian children

This cross-sectional study investigated the distribution of plaque and gingivitis and its association with demographic, socioeconomic, and orthodontic variables (spacing in anterior teeth, anterior open bite, and crossbite), and visible plaque level (low, medium, high) in Brazilian preschoolers. The sample comprised 490 3- to 5-year-old children from nursery schools in Canoas, a city in southern Brazil. One single, trained observer examined children's oral cavities and determined visible plaque index (VPI) and gingival bleeding index (GBI). Results showed that 99% of the children had visible plaque and 77% had gingivitis (GBI>0). A positive (r(s)=0.32) and significant correlation was found between VPI and GBI. VPI and GBI were significantly higher in posterior teeth and buccal and lingual surfaces. VPI was significantly higher in boys, children of low-income families, and without spacing in maxillary anterior teeth. Gingivitis was associated with absence of spacing in maxillary anterior teeth and plaque level. The most prevalent areas of plaque and gingivitis identified in this study should be taken in consideration during oral hygiene instructions, which should be given to children and mothers-particularly those with a low socioeconomic status--to motivate self-care and prevent gingivitis.