The prevalence of temporomandibular disorder signs in people with mental retardation

Summary The purpose of this study was to determine the prevalence of temporomandibular disorder (TMD) signs and tooth wear levels in a group of hospitalised patients with mental retardation (MR). A total of 118 patients with MR and 104 mentally healthy individuals (control) were included in this study. The groups consisted of equal numbers of male and female patients. TMD signs were evaluated according to the Research Diagnostic Criteria to assess the limitation in maximum mouth opening, the alterations in the mouth opening pathway and temporomandibular joint sounds. In addition, tooth wear was recorded. The frequency of at least one sign of TMD observed in patients with MR (79·7%) was significantly higher than in controls (69·2%) (P = 0.03). In addition, 43.2% of the patients with MR had more than one sign of TMD compared with 28.8% of the control group (P = 0·02). Prevalence of each sign exhibited in the MR and control groups was as follows: limitation in mouth opening, 24·6% vs. 13·5% (P = 0·02); deviation, 18·6% vs. 26·9% (P = 0·001); deflection, 29·7% vs. 10·6% (P = 0·001); TMJ sounds, 46·6% vs. 41·1% (P = 0·43); bilateral joint sounds 28·8% vs. 16·3% (P = 0·05) respectively. Prevalences of TMD signs were not different between genders in both groups (P > 0·05). Severe tooth wear was evident in 43·2% of the patients with MR compared with 20·6% of the controls (P = 0·001). In conclusion, patients with MR seem to be more prone to having TMD signs compared with the control population.     

Oral sensorial complaints,salivary flow rate and mucosal lesions in the institutionalized elderly

Summary The aims of this study were to determine the prevalence of oral sensorial complaints, salivary flow rate and oral mucosal lesions in the institutionalized and non‐institutionalized elderly. The study included 280 institutionalized and 61 non‐ institutionalized elderly people. Dry mouth, burning mouth sensations, taste disturbances, salivary flow rate and oral mucosal lesions were assessed and compared between groups. A greater number of the institutionalized elderly had dry mouth (P = 0·001) and taste disturbance (P = 0·035) compared to non‐institutionalized elderly. The institutionalized elderly also had significantly lower salivary flow rate (P < 0·0001). Positive correlation was found between salivary flow rate and perception of dry mouth in the institutionalized elderly (r_s = 0·26; P < 0·05), as well as in the non‐institutionalized elderly (r_s = 0·35; P < 0·05). Moreover, positive correlation was observed between salivary flow rate and the sensation of burning mouth in the institutionalized elderly (r_s = 0·13; P < 0·05) and non‐institutionalized elderly (r_s = 0·31; P < 0·05). The number of institutionalized elderly people with oral mucosal diseases was higher compared with non‐institutionalized ones (P = 0·01). The most common oral mucosal lesions in both groups were related to wearing dentures. It can be concluded that the institutionalized elderly are significantly affected with oral sensorial complaints, including dry mouth and taste disturbance, as well as decreased salivary flow rate and oral mucosal diseases compared with the non‐institutionalized elderly.     

Rectal sedation with diazepam or midazolam during extractions of traumatized primary incisors: a prospective,randomized, double-blind trial in Swedish children aged 1.5-3.5 years

The aim of this study was to compare rectal sedation with diazepam and rectal sedation with midazolam with regard to sedative effect, treatment acceptance, and amnesia. Ninety children, 1.5-3.5 years of age, consecutively referred for extractions of traumatized primary incisors were randomly sedated with diazepam (0.7 mg/kg body weight) or midazolam (0.3 mg/kg body weight). The study design was randomized and double-blind. The level of sedation (state of mind) was assessed prior to and 10 and 60 min after administration of the drug by use of a behavioral scale (Wilton). The children's acceptance of procedures was assessed using another behavioral scale (Holst) during administration of the sedative, application of topical anesthesia, injection of a local anesthesia, and extraction. Amnesia was evaluated by the parents on the following day, with the child being asked standardized questions. Parental ratings of the child's and their own distress during and after treatment were made on a visual analog scale (VAS). No differences were found between the sedatives concerning level of sedation during treatment, acceptance of procedures, or amnesia. At discharge, 60 min after administration of the sedative, the children receiving diazepam were significantly more agitated (P = 0.006). Parental rating on a VAS of the child's discomfort after treatment was significantly higher in the diazepam group (P = 0.006). There was a tendency for children with poor acceptance of the rectal administration to display a more negative acceptance of the dental treatment. In conclusion, the present results, in combination with known pharmacological advantages, indicate that midazolam is preferable in outpatients when sedation is needed and amnesia is desirable.     

Assessment of osseous morphology of temporomandibular joint in asymptomatic participants with chewing‐side preference

Chewing‐side preference (CSP) may be associated with temporomandibular disorders. However, little information exists regarding whether CSP will lead to osseous changes of temporomandibular joint (TMJ) in asymptomatic participants. The aim of this study was to investigate the relationship between osseous morphology of TMJ in asymptomatic participants with CSP and without CSP. Of the 121 healthy dentate participants, 35 participants with left CSP, 38 with right CSP and other 48 without CSP were scanned by cone‐beam computed tomography. The dimensions of the reconstructed images of opposing TMJs were compared. Statistical analyses were performed using spss 16.0 software. The results showed that there were no significant differences between the dimensions of bilateral structures of the TMJ (P1 > 0·05) in participants without CSP. However, the posterior–superior, posterior and lateral joint space of the preferred side were smaller than that of the unpreferred side in participants with CSP (P2 < 0·01) and bilateral TMJ in participants without CSP (P3 < 0·01). In addition, width of condylar neck of the unpreferred side both in sagittal and perpendicular to the long axis of condyle views was greater than that of the preferred side in participants with CSP (P2 < 0·01) and bilateral TMJ of participants without CSP (P4 < 0·01). Also, the inclination of articular eminence of the preferred side in view perpendicular to the long axis of condyle was less than that of the unpreferred side (P2 < 0·05). These findings suggest CSP affects osseous morphology of TMJ in asymptomatic participants.     

Comparison of utility weighted DMFT with patient‐reported oral well‐being

This study investigated a method of measuring oral health, as opposed to measuring disease. The objective was to compare DMF score and whole mouth utility scores to a patient‐reported outcome measure (PROM). Disutility values for lost and restored teeth were used to weight the decayed, missing and filled teeths(DMFTs) of 10 adult patients. This gave two whole mouth utility scores (WMU). These scores were then compared with a patient‐reported oral health outcome measure recorded by the use of a visual analogue scale (VAS). The anchors for the VAS were ‘my mouth could not be worse’ and ‘my mouth could not be better’. There was a positive correlation (r = 0·6457) between WMU1 and the patient‐reported outcome measure (P < 0·05) and a negative correlation (r = ?0·8383) between WMU1 and DMFT which was significant at the P < 0·01 level. There was a statistically significant positive correlation of r = 0·7926 between WMU2 and the patient‐reported outcome measure (P < 0·01) and a negative correlation (r = ?0·9393) between WMU2 and DMFT (P < 0·01). The Pearson's correlation between DMFT and the patient‐reported outcome measure was ?0·8757, which was significant at the 0·01 level. Patient reports of their perceived level of health correlate well with DMFT scores. Weighting DMFT scores according to the differential values assigned to missing, or missing and filled, teeth does not increase the degree of correlation between the measure and the patients’ personal quantification of their oral health. Decayed, missing and filled teeth therefore seems to adequately capture the patient's sense of well‐being.     

Comparison of applying particulate demineralized bone matrix (DBM), putty DBM and open flap debridement in periodontal horizontal bone defects. A 12-month longitudinal, multi-center, triple-blind, split-mouth, randomized, controlled clinical study. Part 1 – clinical and radiographic evaluation

Summary Putty form graft materials may have additional favourable effects when compared with particulate ones in periodontal bone defects. The purpose of this study was to assess clinical and also radiographic changes following application of (i) putty form demineralized bone matrix (DBM), (ii) particulate form DBM and (iii) open flap debridement (control), using modified curtain suturing technique in the treatment of interproximal suprabony (horizontal) defects. Twenty‐five chronic periodontitis patients with 125 sites (radiologically ≥4 mm horizontal bone defect) were selected to participate in this triple‐blind, split mouth, randomized, controlled clinical trial. Putty and particulate form DBM grafts were placed at experimental sites. Clinical measurements included probing depth (PD), relative attachment level (RAL), gingival recession and bone probing depth (BPD) were made at baseline and repeated 12 months after the operations. Standardized digital radiographs were also taken to measure radiographic bone level (RBL) at baseline and 12 months later to be compared in a software. Probing depth reductions and RAL gains were significantly improved in all treatment groups (P < 0·001). No significant differences in soft tissue parameters were found among three groups (P > 0·05). Bone probing depth measurements indicated comparable significant bone gain in graft applied groups (P < 0·01) and a significant bone resorption in open flap debridement group (P < 0·01). Radiographic evaluation did not show any significant bone gain or resorption in all treatment groups (P > 0·05). The results of this study indicate that either putty or particulate DBM demonstrates similar enhancements in soft and hard tissue parameters. Applying putty or particulate form DBM results with slight bone formation when compared with open flap debridement in horizontal bone defects at 1‐year post‐operative examination according to BPD measurements.     

Effect of mouth breathing on masticatory muscle activity during chewing food

The aim of this study was to examine the effect of mouth breathing on masticatory muscle activity during chewing food. Masseter muscle activity during chewing of a rice ball was recorded in 45 adult volunteers (three women), identified as nose breathers. Surface electrodes were placed on the skin according to the orientation of the masseter muscle to record the activity of this muscle while the subjects chewed the food until swallowing. Each activity was recorded twice, once with nose breathing and once with mouth breathing induced by nasal obstruction. The integrated and mean electromyography values for mouth breathing were significantly lower than the values for nose breathing (P < 0·05). The resting and total duration of chewing were significantly prolonged (P < 0·05) and the active duration significantly shorter (P < 0·05) when breathing through the mouth compared with the nose. Significantly more chewing strokes were counted for mouth breathing compared with nose breathing (P < 0·05). Taken together, the results indicate that mouth breathing decreases chewing activity and reduces the vertical effect upon the posterior teeth.     

Cooperation predictors for dental patients with autism

PURPOSE: This study evaluated potential predictors of cooperation during dental appointments for children with autism. METHODS: Data were collected from 108 parent/child pairs and their dentists. Questions included: (1) medical/dental history; (2)functional language; (3) personal hygiene skills; (4) academic setting; and (5) achievements. Behavior was scored using the Frankl scale. RESULTS: Subjects were 80 males and 28 females 2.7 to 19 years old with a mean age of 9.8 years. Frankl scores were 65% uncooperative (definitely negative or negative) and 35% cooperative (positive or definitely positive). Multiple factors predicted uncooperative behavior: (1) appointment type (P=.03); (2) concurrent medical diagnoses (P=.04); (3) nonverbal/minimal or echololic language (P=.005); (4) inability to understand language appropriate for age (P=.02); (5) inability to follow multistep instructions (P=.04); (6) parents providing most/all tooth-brushing (P=.004); (7) partially or not toilet trained at 4+ years (P=.02); (8) inability to sit for a haircut (P=.01); (9) attending special education (P<.001); and (10) inability to read at 6+ years (P<.001). CONCLUSIONS: Five questions readily answered by a caregiver may indicate a child's cooperative potential. Preappointment inquiry about toilet training, toothbrushing, haircuts, academic achievement and language can give the dentist insight into the child's ability to respond positively to behavior guidance techniques based on communication.     

Cooperation during dental treatment: the Children's Fear Survey Schedule in Japanese children

Summary. Objective. The aim of this study was to evaluate dental fear and cooperation during dental treatment using the Children's Fear Survey Schedule – Dental Subscale (CFSS‐DS). Methods. From the behaviour assessment of regular patients of the Pediatric Dental Clinic in Niigata University Dental Hospital (aged 5–12 years old), the patients were classified into two groups: uncooperative and cooperative. CFSS‐DS questionnaires were sent to a total of 295 patients, 186 of which were returned, 61 from the uncooperative group and 125 from the cooperative group. Results. In the uncooperative and the cooperative groups, the CFSS‐DS mean total scores were 31·79 and 24·02 (P < 0·05), respectively, and the ratios of the patients whose scores were equal to or more than 35 were 36·1 and 11·2%, respectively. Fear of ‘injections’ and ‘the dentist drilling’ had high scores in both groups. Conclusions. The results indicated that there are many uncooperative patients with low dental fear and cooperative patients with high dental fear.     

Impact of Sjögren's syndrome on oral health-related quality of life in southern Chinese

summary The effect of oral symptoms of Sjögren's syndrome (SS) on health‐related quality of life is presently uncertain. This study aimed to investigate oral health‐related quality of life (OHRQOL) among southern Chinese people with SS. Twenty‐six primary SS cases, 25 secondary cases and 29 matched controls took part in this cross‐sectional study. Each participant completed a SF‐36 questionnaire, the Oral Health Impact Profile and a dry mouth measure, assisted by a trained interviewer. Data on socio‐demographic variables were also collected. The dry mouth measure revealed that people with primary and secondary SS had significant problems associated with subjective symptoms of dry mouth generally, and dry mouth when eating and speaking (P < 0·01). Sticky saliva and coughing were also problems in some primary SS cases. OHIP summary and sub‐scale scores did not reveal differences in negative impacts between groups. Mean SF‐36 sub‐scale scores were significantly different between groups (P < 0·05). In physical function, role‐physical and general health domains, primary and secondary SS sufferers had lower scores indicating poorer health. Oral symptoms of SS, notably xerostomia, had a negative effect on OHRQOL. Health‐related quality of life in general was also impaired in SS sufferers. The OHIP did not appear to discriminate oral problems of concern to SS sufferers.     

A comparison of the oral health of persons with and without chronic mental illness in community settings

Severe dental disease has been reported for patients receiving psychiatric treatment. This study compared the oral status of non-institutionalized adults with chronic mental illness with a similar group without such history, and evaluated relative risk factors, for example, xerostomia, diet, hygiene, and poverty. A sample of 37 subjects with chronic mental illness (CMI) and 29 control subjects without mental illness were assessed for dental, medical and social history; head, neck, and oral soft tissue pathology; salivary flow; DMFS, gingivitis, loss of periodontal attachment, plaque, and calculus. The groups were equivalent in socioeconomic level, education, dental history, and home care. All subjects with CMI received psychotropic medications (mean of 3.8 drugs for 10.3 years). The CMI group had significantly higher incidence in the following variables: self-reported dry mouth; consumption of carbonated beverages ( P <.001); mucosal, lip, and tongue lesions ( P <.01); coronal smooth surface caries ( P< .001); severity of plaque ( P< .001) and calculus ( P< .01); and salivary flow ( P< .05). No significant differences were evident in the M and F components of DMFS, in gingivitis or loss of attachment. The results indicate significant increases in risk factors and increased oral pathosis in persons with mental illness who live in community settings compared with a control group that showed dental neglect.     

Clinical outcomes of patients with bilateral anterior disc displacement without reduction and erosive change of the temporomandibular joint after performance of unilateral arthrocentesis and stabilisation splint therapy

The efficacy of a combination treatment of arthrocentesis and stabilisation splint for patients with bilateral anterior disc displacement without reduction (ADDWoR) and erosive change of the TMJ remains controversial. To evaluate clinical outcomes of patients with ADDWoR and erosive change of the TMJ after performance of unilateral arthrocentesis and stabilisation splint therapy. A retrospective study of 44 patients (37 females, 7 males, mean age of 34 years) with bilateral ADDWoR and erosive change of the TMJ were included in this study. Their clinical outcomes before and after arthrocentesis and stabilisation splint therapy were compared. Evaluation criteria were as follows: (a) Maximal mouth opening (MMO); (b) Right and left maximal lateral movement (RLM, LLM) and maximal protrusive movement (PM); (c) Visual analog scale (VAS) pain score during MMO, RLM, LLM and PM; and (d) VAS pain score during palpation of masticatory muscles. Wilcoxon signed-rank test, Mc Nemar test and paired t test were used for statistical analysis. Differences in VAS pain score between arthrocentesis and non-arthrocentesis sites were not statistically significant except MMO and LLM (P < .05) after 6 months. Differences in mean VAS pain scores for all variables between before arthrocentesis and 6 months follow-up in the arthrocentesis site were statistically significant. (P < .01). Unilateral arthrocentesis on more symptomatic TMJ and subsequent stabilisation splint therapy was highly successful for pain and achievement of normal range of mandibular movements in patients with both ADDWoR and bony change.     

Comparison of the effectiveness of oral diazepam and midazolam for the sedation of autistic patients during dental treatment

PURPOSE: This study was undertaken to compare the effectiveness of oral diazepam and midazolam in sedating autistic patients during dental treatment. METHODS: The treatment regimen consisted of nitrous oxide/oxygen inhalation in conjunction with oral administration of either diazepam 0.3 mg/kg or midazolam 0.5 mg/kg in a cross-over design study of 13 subjects aged 5.8 to 14.7 years. A drug was classified as being effective when over 70% of the patients taking the drug were judged as "success" in all 3 behavioral criteria: (1) sleeping; (2) body movement; and (3) crying behaviors. The study was observed by an independent clinician with an intraexaminer reliability of 88%. RESULTS: For sleeping behavior, midazolam was found to be significantly more effective than diazepam as the duration of stimulation increased (P<.05). For the movement and crying behaviors, midazolam also proved to be significantly more effective from the start of treatment through the 35- and 40-min markers, respectively (P<.05). For the remainder of treatment, however, there was no statistically significant difference in these behaviors between the trials (P>.05). Diazepam and midazolam were rated as 77% and 100% successful, according to the overall behavior evaluation criteria (P=.02). CONCLUSIONS: Both diazepam and midazolam were shown to be effective sedative agents, successfully and safely used to sedate autistic patients for dental treatment. Midazolam was significantly more effective than diazepam in those portions of the procedure with increased stimulation.     

The effect of mouth breathing on chewing efficiency

Objective:To examine the effect of mouth breathing on chewing efficiency by evaluating masticatory variables.Materials and Methods:Ten adult nasal breathers with normal occlusion and no temporomandibular dysfunction were selected. Subjects were instructed to bite the chewing gum on the habitual side. While breathing through the mouth and nose, the glucide elution from the chewing gum, number of chewing strokes, duration of chewing, and electromyography (EMG) activity of the masseter muscle were evaluated as variables of masticatory efficiency.Results:The durations required for the chewing of 30, 60, 90, 120, 180, and 250 strokes were significantly (P < .05) longer while breathing through the mouth. There was no significant difference in the glucide elution rate (%) for each chewing stroke between nose and mouth breathings. The glucide elution rates for 1- and 3-minute chewing were significantly (P < .05) lower while breathing through the mouth. However, there was no significant difference in the glucide elution rate for 5-minute chewing between nose and mouth breathings. While chewing for 1, 3, and 5 minutes, the chewing stroke and EMG activity of the masseter muscle were significantly (P < .05) lower during mouth breathing.Conclusions:It takes a longer amount of time to complete chewing to obtain higher masticatory efficiency when breathing through the mouth. Therefore, mouth breathing will decrease the masticatory efficiency if the duration of chewing is restricted in everyday life.     

Dental caries and administrative status occurrence in Finnish children with mentally handicapping conditions

Caries prevalence was recorded in 204 Finnish children, aged 9 to 10 years (125 had mentally handicapping conditions, 79 had no mentally handicapping conditions—identified in this paper as “normal”). The children with mentally handicapping conditions used preventive fluoride less frequently and their standard of oral hygiene was much poorer than that of the normal children. In the registered children with mentally handicapping conditions, caries occurrence was less than that in the normal children. In the unregistered children with mentally handicapping conditions, caries occurrence was greater than in the normal children. Irrespective of administrative status or severity of mentally handicapping conditions, these children received less dental treatment than the normal children with regard to treatment need. The need to further educate dental care personnel in the dental treatment of these children seems evident, especially as long as the dental care system is not able to meet the restorative dental treatment needs of the children with mentally handicapping conditions. The necessity of preventive regimens for these children should be emphasized even at low levels of caries occurrence.     

Comparison of applying particulate demineralized bone matrix (DBM), putty DBM and open flap debridement in periodontal horizontal bone defects. A 12-month longitudinal, multi-centre, triple-blind, split-mouth, randomized, controlled clinical study. Part 2 – evaluation of the interdental soft tissue

Summary To date, there have been many studies clinically evaluating periodontal regenerative procedures by the help of routinely used hard and soft tissue parameters; however, these parameters are not capable of assessing interdental soft tissue located above the regenerative periodontal surgery area. The purpose of this study was to assess interproximal soft tissue changes following application of (i) particulate form demineralized bone matrix (DBM), (ii) putty form DBM and (ii) open flap debridement (OFD, control), using modified curtain technique in the treatment of interproximal suprabony (horizontal) defects located in anterior maxillary region, as previously reported. Twenty‐five chronic periodontitis patients with 125 interproximal surgery sites (radiologically ≥4 mm horizontal bone defect) were also participate in this second stage of the triple‐blind, split mouth, randomized, controlled clinical trial. Surgery sites were assessed by (i) plaque index (PI), (ii) gingival index (GI), (iii) the presence of interdental soft tissue clefts or craters and (iv) the loss of interdental papilla height by using papilla presence index (PPI), during the healing period. At the baseline and 3, 6, 9 and 12 months after the operations, these measurements were repeated. In all groups, there is a significant increase in the prevalence of soft tissue cleft and crater formation (P < 0·01), with increase in PI and GI scores at interdental soft tissue defect areas (P < 0·001), 3 months after the operations. There was also an increase in PPI scores after the operations in all treatment groups (P < 0·01). Three procedures affected the interproximal soft tissues similarly. There was no significant difference among groups in terms of all parameters (P > 0·05). Particulate DBM, putty DBM and OFD demostrated similar interproximal soft tissue changes especially increasing interproximal PI and GI scores in 3 months follow‐up.     

Effect of chlorhexidine on dental plaque and gingivitis in mentally retarded children

ABSTRACT The purpose of the investigation was to determine the effect of chlorhexidine mouthrinses as a supplement to toothbrushing in the plaque control of mentally retarded children. Fifty-four mentally subnormal children 7–14 years of age took part in the investigation. During the first period, half of the children rinsed their mouths with 0.2 % chlorhexidine gluconate solution twice a day. The rest of the children used a placebo mouth-rinse. After an 8-week interval a “cross-over” experiment was carried out during which a 0.1 % chlorhexidine solution was used. Plaque and gingival indices were scored at the beginning of each period, after 3 weeks, and at the termination after 6 weeks. The results revealed that mouthrinses with 0.1 % as well as 0.2 % chlorhexidine gluconate reduced plaque and gingivitis in mentally retarded children. The results were statistically significant (P < 0.05) for both concentrations. Furthermore, the investigation confirmed the occurrence of certain side effects such as discoloration of teeth and tongues.     

Clinical and Immunoinflammatory Evaluation of One‐Stage Full‐Mouth Ultrasonic Debridement as a Therapeutic Approach for Smokers With Generalized Aggressive Periodontitis: A Short‐Term Follow‐Up Study

Background: This study aims to evaluate the effect of one‐stage full‐mouth ultrasonic debridement (OSFMUD) on clinical and immunoinflammatory parameters in smokers with generalized aggressive periodontitis (GAgP). Methods: Fourteen smoking and 14 non‐smoking patients with GAgP were selected. After initial supragingival therapy, patients were treated by OSFMUD. Full‐mouth parameters evaluated were: 1) plaque index (PI); 2) bleeding scores (BS); 3) probing depth (PD); and 4) clinical attachment level (CAL). Clinical evaluation was performed, and gingival crevicular fluid (GCF) was collected for selected sites (ss) at baseline and 1, 3, and 6 months. GCF was analyzed via enzyme‐linked immunosorbent assay for: 1) receptor activator of nuclear factor‐κ B ligand (RANKL); 2) osteoprotegerin (OPG); 3) interleukin (IL)‐6; and 4) tumor necrosis factor (TNF)‐α, whereas secreted osteoclastogenic factor of activated T‐cells (SOFAT) was evaluated by Western blotting. Results: Significant reduction (P <0.05) was observed between baseline and 6 months for: 1) PI; 2) BS; and 3) PD, with no difference between smoking and non‐smoking patients (P >0.05). Regarding CAL, only non‐smoking patients showed a significant decrease (P <0.05). Significant reduction (P <0.05) was observed in both groups for: 1) PIss; 2) PDss; 3) bleeding on probing; and 4) relative CAL. Smoking and non‐smoking patients presented significantly decreased levels of IL‐6 and TNF‐α over time (P <0.05); however, no difference was observed between groups (P >0.05). RANKL was significantly different (P <0.05) only for non‐smokers at 6 months, whereas OPG was not significant (P >0.05). SOFAT expression was significantly lower (P <0.05) after OSFMUD for non‐smokers only. Conclusion: Considering the clinical and immunoinflammatory parameters evaluated in this short‐term follow‐up study, it can be concluded that OSFMUD can be used as an alternative treatment for smokers with GAgP.