Periodontal conditions in medically compromised elderly subjects: Assessments of treatment needs

Periodontal conditions were studied in 42 dentate elderly subjects (mean age, 84.1 ± 8.0 years). None of them had received recent dental care or was routinely seen by a dentist. Overall, they had 20.2 ± 7.1 teeth (range, 6–32). The CPITN was used to assess periodontal status. Twenty-nine percent of all sextants were either edentulous or had only one remaining tooth. The overall oral hygiene was poor (Plaque Index, 1.8 ± 0.5) and gingival inflammation severe (Gingival Index, 1.9 ± 0.8). Significant correlations were found between: Gingival and Plaque Indices (r = 0.82, p < 0.001), and pocket depth and Gingival Index (r = 0.38, p < 0.05). Plaque Index was negatively correlated to the number of remaining teeth (r = 0.43, p < 0.050). Age and remaining teeth were negatively correlated (r = 0.38, p < 0.05). Thirty percent of the posterior sextants had a CPITN score of "4," and 75% of the posterior sextants had at least one site with a pocket depth 4 mm. Only 2.9% of all sites demonstrated pocket depth 6 mm and these sites were distributed among 67% of the subjects. The CPITN index was correlated to the mean pocket depth for the various sextants, the correlation varying between r = 0.67, p < 0.001 (upper right posterior) and 0.36, p < 0.05 (upper left posterior) sextants. The total manpower estimated to complete initial therapy for 42 patients was approximately 63 hours by a dentist and 85 hours by a dental hygienist.     

Plaque, gingival health and post-operative sensitivity in titanium inlays and onlays: a randomized controlled clinical trial

OBJECTIVES: Few clinical data on the use of titanium for restorative appliances are available. The aim of this study was to clinically evaluate titanium restorations compared to gold alloy restorations with regard to plaque, gingival health and post-operative sensitivity. METHODS: In 54 patients, 99 titanium restorations were placed. The control group comprised 56 patients with 96 high gold alloy restorations. The material was chosen by random. Each patient received one or two Class II restorations. Plaque Index (Silness and L?e, 0-3), Gingival Index (L?e and Silness, 0-3), and post-operative sensitivity (1-4, 1=none) were rated at 2 weeks, 3 months, 6 months, 12 months, and 18 months, post-operatively. RESULTS: The mean plaque scores ranged from 0.89 to 0.99 in the titanium group, and from 0.88 to 1.04 in the gold group. The mean gingival scores ranged from 0.91 to 1.07 in the titanium group, and from 0.82 to 0.99 in the gold group. The mean plaque and gingival scores of the titanium and gold group did not differ significantly at any visit (P>0.05). To evaluate post-operative sensitivity, patients with one MOD restoration each were included, resulting in 46 titanium and 44 high gold restored teeth. Mean values of the post-operative sensitivity scores in the titanium group were significantly higher than in the gold group (P<0.05). The restoration material was found to be the dominating variable with regard to post-operative sensitivity, which was not influenced by age, sex and the application of calcium hydroxide liner. CONCLUSIONS: It is concluded that neither higher plaque scores nor adverse effects on gingival health are to be expected in titanium restorations.     

Field trial on caries prevention with xylitol candies among disabled school students

BACKGROUND: In a 1999 survey high caries levels were found among physically disabled school students in Kuwait. OBJECTIVES: A field study was planned to test the efficacy of xylitol candies in preventing caries among individuals in two special schools in Kuwait. METHODS: Altogether 176 students were examined in 2002 and 145 (105 in xylitol group and 40 in the control group) after 18 months' intervention. The WHO criteria were used in recording caries according to surfaces (third molars were excluded) by 2 calibrated examiners (E.H., M.S.). The students were allocated to the xylitol group only if the parent/caregiver returned the informed consent form. School health nurses distributed xylitol candies to the students 3 times during the school day (after breakfast and lunch, and before leaving the school). RESULTS: In the xylitol group, the baseline DS and DMFS scores were 3.4 and 8.2 and in the follow-up 1.9 and 7.1, respectively. In the control group, the baseline scores were DS 3.9 and DMFS 9.8, and the follow-up scores DS 3.9 and DMFS 13.2. CONCLUSION: Xylitol seemed to have a strong preventive and a clear remineralizing effect on caries.     

Efficacy and safety of a new power toothbrush in a population with mild to moderate gingivitis

OBJECTIVE: To evaluate the efficacy and safety of a novel ultrasound power toothbrush over a 30-day period in a population with mild to moderate gingivitis. METHODOLOGY: A 30-day, randomized, examiner-blind, parallel-arm study was conducted to evaluate the safety and efficacy of a ultrasound novel power toothbrush (Ultreo - ULT) as compared to a control manual toothbrush (Oral-B 35-MTB). Fifty-three subjects (n = 26 ULT, n = 27 MTB) with a minimum of 18 natural teeth and a L?e and Silness Gingival Index of > or = 1.5 were enrolled. An intraoral examination (oral soft and hard tissues, restorations) was performed, and L?e and Silness Gingival Index scores were recorded at baseline and 30 days. Subjects were instructed to brush at home twice per day with their assigned toothbrush and study toothpaste. A product evaluation questionnaire was also completed at the 30-day study visit. RESULTS: Oral examinations indicated normal findings at all time points for both groups, and no adverse events were reported during the study. There were no significant differences in gingivitis scores at baseline between the toothbrush groups (p > 0.05). From baseline, each treatment group demonstrated a significant reduction in gingivitis over the 30-day period (p < 0.001). However, subjects in the ULT group demonstrated a significantly greater reduction in gingivitis compared to those using the manual toothbrush (p = 0.010). Results from the questionnaire, on average, indicated subjects in the ULT group scored their device higher with respect to the clean feeling after brushing and perceived improvements in gingival health. CONCLUSION: The novel Ultreo ultrasound power toothbrush significantly reduced gingivitis over the 30-day study, and resulted in a significantly greater reduction in gingivitis than a manual toothbrush. No adverse events or safety concerns were identified with either the power or manual toothbrush.     

Evaluation of clinical effects of amine fluoride/stannous fluoride containing toothpaste and mouthrinse

The aim of the study was to evaluate the effects of amine fluoride (AmF)/stannous fluoride (SnF2) containing toothpaste and mouthrinse on gingival health of young adults. Altogether 42 persons participated in the study (mean age: 28.3 +/- 7.2) and were evaluated for Plaque Index (PI) (Silness and L?e, 1963) and Gingival Index (GI) (L?e and Silness, 1964). The probands were randomly divided into two groups, both of them used AmF/SnF2 containing toothpaste twice a day for three minutes toothbrushing. One group (combined group) after toothbrushing rinsed with mouthrinse containing AmF/AnF2 combination. After four weeks the participants were re-examined. At the end of the study statistically significant decrease was found in dental plaque (PI) and gingival index (GI) values. Values of PI and GI in the group using only toothpaste were as follows (mean +/- S.D.): PI values-baseline: 1.03 +/- 0.20; final: 0.60 +/- 0.13; p<0.001; GI values-baseline: 0.87 +/- 0.22; final: 0.505 +/- 0.22; p<0.01. The values of PI and GI in the combined group were as follows: PI values-baseline: 1.10 +/- 0.20; final: 0.52 +/- 0.10; p<0.001; GI values- baseline: 1.05 +/- 0.27; final: 0.50 +/- 0.17; p< +/- 0.001. The reduction of PI and GI values was significant in all groups but it was higher in the combined (toothpaste + mouthrinse) group than in the one using toothpaste only. It is concluded that regular use of AmF/AnF2 toothpaste has a beneficial effect for reduction of plaque accumulation but its effect can be enhanced with additional use of Am/SnF2 containing mouthrinse.     

Supervised toothbrushing and oral health education program in Kuwait for children and young adults with Down syndrome

The authors report on the effectiveness of a school-based, supervised toothbrushing program among a group of 112 children with Down syndrome in Kuwait. The study involved 45 boys and 67 girls, who ranged in age from 11–22 years (mean, 14.8 years). The participants had moderate mental retardation and attended one of two special needs schools. Plaque was scored according to the Silness and Loe plaque index and gingivitis according to the Loe and Silness gingival index. Supervised toothbrushing and dental health education sessions were conducted twice a week. The program was evaluated at the end of three months. The mean plaque score decreased from 1.93 to 0.95 (p < 0.001), and the mean gingival score from 2.00 to 0.83 (p < 0.001). This three-month supervised toothbrushing program was effective in reducing plaque and gingivitis scores, but the key to long-term success of the program is sustaining the children's motivation to make oral hygiene a part of their daily life.     

Dental plaque, caries prevalence and gingival conditions of 14-15-year-old schoolchildren in Jerash District, Jordan

Abstract:  The aim of this cross-sectional study was to evaluate oral hygiene, gingival condition and dental caries prevalence in 14–15-year-old school children in Jerash District, Northern Jordan. Twenty schools (10 male and 10 female schools) with 1362 children of eighth and ninth grades were randomly selected and incorporated in this study. All participants had dental examinations for oral hygiene, gingival condition and dental caries experience using the Silness and Löe Plaque Index (PI), Löe and Silness Gingival Index (GI), and decayed (D), missing (M) and filled (F) teeth (DMFT) and surface (DMFS) codes respectively. The results showed that males had significant lower plaque but significantly higher gingival scores than females ( P  < 0.001). About 24% of children were caries-free. The proportions of children with one, two or three decayed teeth were between 10% and 18%. Slight non-significant variations between males and females were observed in regard to DMFT/S and their components ( P  < 0.05). It is concluded that significant gender variations were noted in PI and GI scores but not in DMFT/S or their components. However, the values of these clinical scores were lower than those results previously reported in northern Jordan.     

A randomized, parallel design study to evaluate the effects of a Sonicare and a manual toothbrush on plaque and gingivitis

OBJECTIVE: This study was designed to determine the effects of twice daily tooth brushing with the Sonicare Elite (Elite) and the Oral-B P40 manual toothbrush (MTB) on plaque accumulation and plaque-induced gingival inflammation. METHODS: One-hundred and eighty (180) subjects, with moderate gingival inflammation and a Silness and L?e Plaque Index (PI) of > or = 0.8 after refraining from oral hygiene for three to six hours, were randomly assigned to receive the Elite or MTB in this single-blinded, controlled clinical trial. At baseline and after two and four weeks of using the product at home twice daily for two minutes, efficacy was assessed with the PI and the L?e and Silness Gingival Index (GI) after brushing three to six hours prior to assessment The primary efficacy variable was reduction of baseline plaque scores over the four weeks for Elite compared to MTB. Secondary outcomes included a change in GI and number of bleeding sites. Safety was appraised using adverse event reports and soft tissue examinations. RESULTS: One-hundred and sixty-eight subjects (81 Elite, 87 MTB) completed the study. The four-week study period resulted in significant reductions of PI and GI from baseline at weeks two and four for both brushes. Reduction in mean PI from baseline to week four for Elite was 0.84 (95% CI: 0.80, 0.88), and 0.72 (0.68, 0.76) for MTB, p < 0.0001. Reduction in mean GI from baseline to four weeks for Elite was 0.56 (0.53, 0.59), and 0.47 (0.45, 0.50) for MTB, p = 0.0001. Both treatment groups demonstrated a significant reduction in number of bleeding sites relative to baseline (p < 0.0001); however, a significant difference in percent reduction in favor of Elite relative to MTB was found at week four: 82.5% vs. 75.8% (p = 0.026). Both toothbrushes were safe on oral tissues. CONCLUSION: Elite was significantly more effective than MTB in the reduction of plaque after two and four weeks of product use, and significantly more effective in the reduction of gingivitis and bleeding sites than MTB after four weeks.     

Periodontal disease in three young adult populations

The purpose of the present study was to assess periodontal destruction and related etiological factors in three young adult male populations in the U. S. A., Norway, and Sri Lanka. The clinical examination included the Plaque Index (Silness & Löe 1964), Retention Index for calculus, defective fillings, and gingival caries (Löe 1967), Gingival Index (Löe & Silness 1963), and Loss of Attachment (Ramfjord 1959).
Plaque accumulation, calculus deposition, and gingival inflammation were higher in interproximal than buccal areas. Plaque and Gingival Index scores remained constant over the entire age range in each population. The filling experience was high in Norway compared to the U. S. A. and Sri Lankan populations where few defective fillings were found. Caries related to the gingival margin were rare in all three populations. Loss of attachment increased with age and was greater on buccal surfaces than mesial surfaces. The distribution of attachment loss was similar in the three populations, and the greatest attachment loss involved maxillary first molars, maxillary and mandibular first premolars, and mandibular incisors. Rates of attachment loss in these young populations were low, averaging less than 0.06 mm per year.     

The effects on the gingivae of chewing fibrous foods

The present investigation was undertaken to study the changes in the gingivae of a group of human subjects whose only active effort at oral cleanliness was to chew raw carrots. Eighteen male dental students 20–24 years of age, were studied using the Gingival Index system (GI) of Löe and Silness (1963), the Plaque Index system (P1I) of Silness and Löe (1964) and gingival exudates measurements according to Egelberg (1964). The participants were told not to use any active oral hygiene measures for a period of eighteen days. During this time, nine of the students were given three raw carrots three times a day. These were carefully chewed for two to three minutes under supervision.
That the regular chewing of raw carrots had no influence on the degree of plaque formation, is proved by the fact that at no examination was the difference between the Plaque Index scores of the experimental and the control groups statistically significant. Thus, the active mastication of the raw carrots appeared to have no significant toothcleansing effect.
This investigation has also demonstrated that, when all active tooth cleansing is discontinued, healthy gingivae will develop chronic inflammation and pre-existing gingivitis will gradually become aggravated. The Gingival Index scores and exudate measurements clearly indicate a gradual deterioration of the gingivae of all the subjects throughout the eighteen days of experiment.
The increases in the GI-values and in the gingival exudation were of the same magnitude in both the experimental and the control groups. This shows that the chewing of fibrous food had no influence on the rate of deterioration of the gingivae when no tooth-cleansing was practiced.     

A comparative study of two powered toothbrushes and one manual toothbrush in young adults

The aim of this 3-group, 3-treatment, single-blind, parallel group study was to evaluate and compare the efficacies of the Philips/Jordan HP735 powered toothbrush, the Braun/Oral-B D7 powered toothbrush, and the Oral-B Advantage B35 manual toothbrush in young adults (18-25 years). Full mouth mean (SD) modified Turesky Plaque Index (PI) and the L?e & Silness Gingival Index (GI) were recorded at baseline. After 24 hours abstinence from oral hygiene, the PI was recorded and each subject was given one of the test brushes with detailed instructions for use. Each subject then brushed under supervision for 90 seconds, during which time mean (SD) toothbrushing forces (TBF) were recorded. PIs were recorded immediately after brushing, and the subjects were then discharged for 6 weeks to use the allocated toothbrush at home. After 6 weeks, PI, GI and TBF were again recorded. There were no significant differences (ANOVA) for PI and GI between groups at baseline, or for PI following brushing at 24 hours. After 6 weeks, the powered brushes produced lower mean PI (SD) scores than the manual brushes, but the differences were significant only at interproximal sites. Mean GI scores for the HP735 group were similar at baseline and at 6 weeks, although for the other brushes the GI scores actually increased over this period. Mean (SD) TBF (grams/force) at baseline and 6 weeks, respectively, for the brushes were; HP735 233 (205), D7 159 (58), B35 279 (122) (p = 0.026): HP735 194 (86), D7 141 (57), B35 297 (113) (p = 0.0001). The within-group variability for the HP735 TBF reduced considerably over 6 weeks, which is possibly because of the click-force threshold feature of this brush.     

Effect of amine fluoride/stannous fluoride toothpaste and mouthrinse on dental plaque accumulation and gingival health

Objective: The aim was to investigate the influence of amine fluoride (AmF)/stannous fluoride (SnF₂) containing toothpaste and mouthrinse on plaque accumulation and gingival health of young adults after 4 weeks use. Subject and methods: Forty‐two young adults (mean age: 28.33 ± 7.19 years) were examined for the Plaque Index (PI; Silness and Löe, 1964 ) and Gingival Index (GI; Löe and Silness, 1963 ) scores, and divided randomly into two groups. Both groups used AmF/SnF₂ containing toothpaste twice a day for 3 min toothbrushing, and one group after toothbrushing rinsed with AmF/SnF₂ containing mouthrinse for 30 s. After 4 weeks the probands were re‐examined. Results: Statistically significant decrease in dental plaque (PI) and gingival (GI) index values were found at the end of the study. The reduction of PI and GI values was significant in all groups but it was higher in the combined (toothpaste + mouthrinsing) group, than using toothpaste only. Conclusion: The regular combined use of AmF/SnF₂ toothpaste and mouthrinse was more effective in the reduction of plaque accumulation and maintenance of gingival health than the toothpaste alone.     

National survey of caries prevalence in 6-15-year-old children in France

The prevalence of dental caries in France is not known on a nationwide basis, despite the fact that a number of epidemiological studies have been conducted in various parts of the country. The aim of the present study was to provide a national baseline examination of the dental health of children in 1987 since, beginning in November, 1986, the sale of fluoridated salt began in France. A multi-stage probability sample of 19,366 children was selected as representative of the 6-to-15-year-old population. The sample covered all the 95 departments of France. Teams of well-calibrated examiners were constituted in each of the sixteen Faculties of Dental Surgery of France. The prevalence of caries for each age group was determined by means of DMFT, DMFS, dft, and dfs indices. Periodontal conditions were assessed by means of the Plaque Index (Silness and L?e, 1964), the Calculus Index (Marthaler, 1966), and the Gingival Index (L?e and Silness, 1963). Calculation of the mean DMFT index showed, respectively, 0.5 and 1.0 new carious teeth per year under and over the age of 11. The mean values of the DMFT index at ages 6, 12, and 15 were, respectively, 0.5, 4.2, and 6.9. Under the age of 11, the mean DMFS index increased by one between each successive age group and by nearly two over the age of 11. The mean values of the DMFS index at ages 6, 12, and 15 were, respectively, 0.8, 7.6, and 13.0. The percentage of caries-free children decreased from 32.2% at age 6 to 7.9% at age 15.     

Effects of tooth loss on the periodontal condition of neighbouring teeth

The periodontal condition of 100 premolars each of which had lost the distal neighbouring tooth was compared with that of 100 contralateral teeth which had not sustained loss of neighbouring teeth. The periodontal condition was assessed by recording Plaque Index (Silness and Löe 1964), Gingival Index (Löe and Silness 1963), by measuring pocket depth according to Glavind and Löe (1967) and by measuring the distance between the cemento-enamel junction and the bone margin. The effects of the distal tooth loss seemed to be: reduced accumulation of plaque, reduced soft tissue inflammation, reduced pocket depth and loss of bone on the distal aspects of the premolars.     

Influence of patient age on the success rate of dental implants supporting an overdenture in an edentulous mandible: a 3-year prospective study

The aim of this study was to determine the influence of age on peri-implant tissues in patients treated with implant-supported overdentures in the mandible. A prospective study was carried out with 2 groups of healthy edentulous patients. The mean age of the younger group (n = 32) was 46 years (range 35 to 50 years); the mean age of the older group (n = 26) was 68 years (range 60 to 80 years). Two dental implants were placed in the interforaminal region of the mandible, and after a 3-month healing period, overdentures were fabricated. Clinical and radiographic parameters were evaluated immediately after completion of the prosthetic treatment, after 1 year, and after 3 years. The evaluated clinical parameters were implant loss, Plaque Index, Gingival Index, Bleeding Index, and probing depth. Radiographic evaluation was performed using a standardized long-cone technique with a direction device. Statistical analysis was carried out with SPSS software. One implant in the older group was lost during the healing period. After 3 years, the mean scores for Plaque Index, Gingival Index, and Bleeding Index were between 0 and 1 for both groups (out of possible scores of 0 to 3), and the mean probing depth was 3 mm in both groups. The mean bone loss after 3 years was 1.2 mm in the younger group and 0.8 mm in the older group, but this difference was not significant. It was concluded from this study population that the clinical performance of implant-supported overdentures in the mandible is equally successful in younger and older patients.     

Oral health and factors related to oral health in Polish schoolchildren

The oral health and factors related to oral health were surveyed in 168 schoolchildren, aged 10-12 years, attending one school in Warsaw. The children were examined for dental caries and gingival status, dental plaque and salivary Streptococcus mutans and Lactobacillus counts. An interview on dietary habits and use of fluoridated toothpaste was also performed. The results showed a mean DMFT of 4.7 in the sample. Gingival Index 1 and Plaque Index 3 were median scores for the majority of the children. S. mutans was demonstrated in 94% of the children and high numbers were found in 15%. Lactobacillus sp. were present in all examined children, with high counts in 56% of the subjects. The interview revealed that most of the children eat five or six times per day and consume candies or cakes each day. Fluoridated toothpaste was not used regularly by any of the children. In conclusion this study shows a high prevalence of dental disease and an unfavorable combination of etiologic factors.     

The relationship between gingivitis and plaque levels

Some confusion exists in the literature whether correlations exist between gingivitis severity and plaque levels as measured by the corresponding indices. The results of a clinical trial and a re-analysis of literature data indicate that a strong statistical correlation exists between the L?e-Silness Gingival Index values and both the L?e and the Quigley-Hein Plaque Index measurements. Furthermore, regression analyses also indicate that L?e-Silness Gingival Index can be expressed as linear functions of either the L?e Plaque Index or the Quigley-Hein Plaque Index and that for each unit increment in the mean plaque index values a half unit increase in the gingival index value can be expected.     

Estimation of dental plaque levels and gingival inflammation using a simple oral rinse technique

A simple, non-invasive test (the Oratest) has recently been proposed, which provides an estimate of oral microbial levels based on the rate of oxygen depletion in expectorated milk samples. Following 30 seconds of vigorous rinsing with sterilized milk, 3 ml of the expectorate is added to a test tube containing the redox indicator, methylene blue, and the time required for a color change from blue (i.e., aerobic conditions) to white (anaerobic conditions) at the bottom of the test tube is recorded. In the present study, Oratest scores were compared to clinical parameters (Plaque Index [PI] and Gingival Index [GI]) in a group of 49 volunteers. Significant correlations were found between the logarithm of Oratest results and PI (r = -0.58; P = 0.001) as well as GI (r = -0.66; P = 0.001). The data indicate that the Oratest provides a reliable estimate of gingival inflammation, thus extending the previously reported strong correlations between Oratest scores and microbial counts. The data suggest that the Oratest may have potential as a clinical and research tool.     

Short-term impact of a national dental education program on children's oral health and knowledge

OBJECTIVE: The objective of this four-week, examiner-blind study was to determine the impact of an educational oral health program conducted within a Boys and Girls Club of America in Chicago, Illinois, USA. The educational program focused on the gingival health (gingivitis and plaque) of participating children who were between the ages of six and 15. METHODOLOGY: The multi-week program taught the participants the basics of oral biology and disease, as well as proper oral health prevention, including oral hygiene, dietary modification, and the importance of visiting the dentist. A calibrated examiner measured whole mouth L?e-Silness Gingival Index (GI) and Turesky Modification of Quigley-Hein Plaque Index (PI) at baseline (immediately prior to the initiation of the educational program) and four weeks later. The primary efficacy analysis was based on the change from baseline for 90 subjects who were enrolled at baseline, participated in the educational program, and were examined four weeks later. In addition, subjects completed five questions at baseline and at four weeks to assess their oral health knowledge before and after exposure. RESULTS: Mean baseline GI score was 0.184, while the four-week mean GI score was reduced to 0.140. This represents a 24% reduction in GI score, with p < 0.001. The mean baseline bleeding site score was 9.99, while the four-week mean bleeding score was reduced to 7.97. This represents a 20% reduction in bleeding sites, with p = 0.005. The mean baseline PI score was 3.06, while the four-week mean PI score was reduced to 2.97. This represents a 3% reduction in PI score with p = 0.044. The subject population was found to have statistically significantly (p < 0.001) greater knowledge following the program at week four, with 37% (33 of 90) and 69% (62 of 90) of subjects answering the questions correctly at baseline and week four, respectively. CONCLUSION: Collectively, these data support the role of an educational program in promoting improved oral health in these children over a four-week period.     

Periodontal conditions in patients treated with dental bridges

The periodontal condition of 385 lingual abutment tooth areas with varying location of the retainer margins was compared with that of 385 contralateral tooth surfaces which were caries-free and devoid of fillings. The periodontal condition was assessed by recording the Plaque Index (Silness and Löe 1964), Gingival Index (Löe and Silness 1963) and by measuring pocket depth by the method of Glavind and Löe (1967). The location of the retainer margins was recorded according to the Margin Index (Silness 1970a). A supragingival position of the crown margins seemed to be the most favourable location, whereas retainer margins at and below the gingival crest interfered significantly with gingival health. The most harmful effects upon the gingival condition seemed to be produced by retainer margins located subgingivally.