Research progress on the application of photodynamic therapy in periodontal treatment / 口腔疾病防治

@#Periodontitis is a chronic inflammatory disease that is initiated by bacteria. Pathogens and their virulence factors alter normal cellular metabolic activity and deteriorate periodontal microconditions. Owing to the complexity of tooth structure and the limitation of conventional treatment, we may not live up to all patients’ expectations, especially those with grade C and stage Ⅲ or Ⅳ periodontitis. With the advantages of bactericidal effects, high safety, inhibition of bacterial drug resistance and promotion of tissue healing, photodynamic therapy （PDT） seems to be an ideal technology in periodontal treatment. However, it cannot remove subgingival stones and still cannot replace mechanical treatment to preliminarily control periodontal inflammation. Therefore, near-infrared low-energy light combined with traditional photosensitizers is mostly used in clinical periodontal adjuvant treatment. In periodontal maintenance treatment on a regular basis, a single application can also reduce the sensitivity of patients and effectively control plaque, but its effect will be affected by the degree of periodontal inflammation, the concentration and type of photosensitizer, the energy of the light source, etc. With the further development of material science, the performance of photosensitizers to accelerate oxides and target bacteria will be optimized. In the future, parameters of PDT need to be designed in large-scale studies in accord with different stages and grades of periodontitis.

Clinical efficacy of chlorhexidine 0.12% spray versus chlorhexidine mouth rinse on plaque control and gingival health in healthy pediatric patients: A randomized controlled trial

BACKGROUND@#Difficulties in providing proper oral health hygiene is accentuated in special populations. Effective plaque control is necessary to minimize the potential risks of dental disease. Chlorhexidine (CHX) mouth rinse is an efficacious means of plaque control yet may be difficult to use.@*OBJECTIVES@#To compare the clinical efficacy of 0.12% CHX spray versus 0.12% CHX mouth rinse on existing supragingival plaque and gingivitis in a group of healthy pediatric patients.@*METHODS@#This is a randomized, controlled, single blind, open label clinical trial. Participants were assigned by simple randomization to: (1) Group A used 0.12 CHX mouth rinse, and (2) Group B administered 0.12% CHX spray, to be used for a period of 4 weeks or 28 days.@*RESULTS@#28 children were included in the analysis. After 4 weeks of CHX use, there was no difference in the gingival status. Within the mouth rinse group, the plaque scoring index (from 3 to 2, p value =0.005) and the plaque severity index (from 0.65 to 0.51, p value =0.017) decreased. While in the spray group, only the plaque severity index had significant decrease (from 0.55 to 0.46, p value =0.019). @*CONCLUSIONS@#CHX spray delivery system is an efficacious method in decreasing plaque severity and is comparable to plaque reduction seen with the use of mouth rinse. The decrease/maintenance in gingival index values proves that there is no progress in gingivitis disease process.@*RECOMMENDATIONS@#CHX spray has been proven to reduce plaque severity and should be considered as an adjunct of oral hygiene maintenance for children.

Effects of plaque control according to professional toothbrushing and oral health education of orthodontic patients / 대한구강보건학회지

OBJECTIVES: This study aimed to contribute to the development of an oral health education program on organized professional toothbrushing by determining its effects on plaque control in patients undergoing orthodontic treatment. METHODS: The subjects in the experimental group participated in the professional toothbrushing and oral health education weekly for 4 weeks, and those in the control group participated in the same program without professional toothbrushing education. RESULTS: The difference in knowledge, attitude, and behaviors on oral health was higher among the experimental group who underwent professional toothbrushing and oral health education program than those in the control group. The effects of toothbrushing time on the plaque index were significantly lower in experimental group than those in the control group. CONCLUSIONS: It is suggested that adequate oral health and professional toothbrushing education program should be implemented to improve oral health.

Periodontal status assessment before orthodontic treatment and opportune moment selection for orthodontic treatment / 华西口腔医学杂志

The aesthetic demands of teeth by the public have improved with the increase in the living standard. Orthodontics, which is a method of aesthetic dentistry, is becoming increasingly important. Orthodontic treatment mainly involves the application of orthodontic force to the teeth and guides the reconstruction of the periodontal tissue, thereby changing the position of the teeth at the occlusal bone. Orthodontic treatment can also improve the dental occlusion caused by dentition crowding and teeth mobility to achieve long-term stability of periodontal tissue. The number of patients with periodontal disease is high in China, and the number of patients with periodontal disease that are eager to receive orthodontic treatment is increasing. Hence, the periodontal status during the orthodontic therapy should be explored along with periodontal therapy and orthodontic treatment. This article briefly demonstrates the assessment criteria of periodontal status before orthodontic treatment, the opportune moment selection for orthodontic treatment, and the supportive periodontal therapy. This study helps dentists develop individualized treatment programs and win a balanced, stable, and aesthetic impression.

Supportive Periodontal Therapy- A Review

Research has provided evidence that chronic inflammatory periodontal diseases are treatable. As a result of advances in knowledge and therapy, the great majority of patients retain their dentition over their lifetime with proper treatment, reasonable plaque control, and continuing maintenance care. However, there are some situations when traditional therapy is not effective in arresting the disease. In these instances the progression of the disease may be slowed, but eventually the teeth may be lost. Numerous studies have indicated that periodontal therapy in the absence of a carefully designed maintenance program invariably results in the relapse of the disease condition. Accordingly, periodontal care provided without a maintenance program deal with significant patient management and disease management issues. Hence supportive periodontal treatment forms an integral part of periodontal therapy, with all treatment accomplishments channeled into achieving a healthy periodontal status that can be effectively maintained. In this regard, supportive periodontal therapy becomes the most decisive aspect of dental treatment. This article gives an overview of the significance of supportive periodontal therapy in maintaining the integrity of the periodontium.

Phenytoin-Induced Gingival Overgrowth Management with Periodontal Treatment

Phenytoin-induced gingival overgrowth (PIGO) is a common complication of the continuous use of medications. This paper presents a case of PIGO hindering oral function and compromising oral hygiene and aesthetics, which was treated with a combination of nonsurgical and surgical periodontal therapies. A 39-year-old male patient was referred for dental treatment with several complaints, especially upper and lower gingival overgrowth that hindered speech and swallowing. Generalized deep probing pockets and bone loss were detected. Diagnosis of gingival overgrowth associated with phenytoin and chronic periodontitis was established. The treatment plan consisted of conservative therapy with education on oral health, motivation and meticulous oral hygiene instruction in combination with scaling and root planing. During the revaluation period, a marked reduction in the clinical parameters was noted, particularly probing pocket depth reduction. Surgical therapy for removal of gingival overgrowth was also performed to achieve pocket reduction. Supportive periodontal therapy was proposed and the patient is currently under follow-up for 4 years. Management of PIGO may be obtained by the use of periodontal procedures combined with good oral hygiene and periodontal supportive care.

O crescimento gengival induzido pela fenitoína é uma complicação comum do uso contínuo da medicacão. Este artigo apresenta um caso de crescimento gengival excessivo que dificultava a função oral e comprometia a higiene oral e a estética, o qual foi tratado com uma combinação de terapias periodontais não-cirúrgicas e cirúrgicas. Paciente masculino de 39 anos de idade foi encaminhado para tratamento odontológico com várias queixas, especialmente do crescimento gengival superior e inferior que prejudicava a fala e deglutição. Profundidades de sondagens severas generalizadas e perda óssea foram detectadas. Diagnóstico de crescimento gengival induzido pela fenitoína e periodontite crônica foi estabelecido. O plano de tratamento consistiu de terapia conservadora com educação, motivação e meticulosa instrução de higiene oral em associação com raspagem e alisamento corono-radicular. Durante o período de reavaliação, uma acentuada redução nos parâmentros clínicos foi observada, principalmente uma redução das profundidades de sondagem. Terapia cirúrgica para remoção do excesso de tecido gengival também foi realizada para conseguir redução das bolsas. Terapia periodontal de suporte foi proposta e o paciente está atualmente sob acompanhamento por um período de 4 anos. O manejo do crescimento gengival induzido pela fenitoína pode ser obtido pelo uso de procedimentos periodontais combinados com uma boa higiene oral e cuidados periodontais de suporte.

Comparison of amine fluoride and chlorhexidine mouth rinses in the control of plaque and gingivitis – A randomized controlled clinical trial.

Objectives: The objective of this triple blind randomized controlled clinical trial was to compare the efficacy of a mouth rinse containing amine fluoride (AmF) and chlorhexidine in controlling the supragingival plaque accumulation and gingival inflammation during a 4‑week period in patients with chronic gingivitis. Subjects and Methods: A total of 30 patients were participated in this study. Fifteen patients were prescribed an AmF‑containing mouth rinse and 15 were prescribed a chlorhexidine mouth rinse. Plaque index, gingival index, bleeding index, tooth stain, and tongue stain (TS) were recorded at baseline, 15 days and 1‑month. Patients’ perception of odor, taste and any discomfort were recorded. Results: The comparisons between the groups were done using Mann–Whitney U‑test. The comparison within the group at different time visits were done using Wilcoxon signed rank test. Both the mouth rinses resulted in a significant decrease in plaque index, gingival index, bleeding index. However, AmF mouth rinse resulted in a statistically significant decrease in bleeding index and gingival index compared to chlorhexidine group. There was no significant difference in tooth stain and TS in both the groups. Conclusions: The 4 weeks use of AmF containing mouth rinse is effective in reducing the gingival inflammation and plaque.

Irrigación subgingival com clorhexidina en terapia periodontal no quirúrgica

El objetivo del siguiente estudio es evaluar los efectos clínicos de la irrigación profesional subgingival con Clorhexidina como terapia adjunta a los procedimientos de raspado y alisado radicular. Este estudio fue desarrollado en 17 pacientes con cuatro bolsas periodontales de 6 mm o más de profundidad, los pacientes fueron divididos en cuatro grupos: solo raspado y alisado radicular; raspaje y alisado radicular más irrigación con solución salina; raspado y alisado radicular más irrigación con 0.12% e irrigación previa con 0.12% seguida de raspado y alisado radicular. Los parámetros clínicos evaluados fueron Índice de Placa, Índice Gingival, Profundidad Clínica al Sondaje, Nivel de Inserción, Sangramiento y Supuración después del sondaje del fondo de la bolsa. El análisis fue realizado al inicio del estudio y 60 días después de los procedimientos clínicos. Los resultados muestran mejora en todos los parámetros de todos los grupos experimentales, estadísticamente fueron similares, con excepción del Sangramiento al Sondaje del fondo de la bolsa que mostró mejores resultados en los grupos irrigados en relación al grupo que fue solo instrumentado mecánicamente. Por tanto, se puede concluir que la irrigación como un adjunto, ya sea con Clorhexidina o solución salina, brinda mejor reparo en los procedimientos de la terapia periodontal no quirúrgica.

The present study had as objective to evaluate the clinical effect of professional subgingival irrigation with chlorhexidine as adjunct to scaling and root planning procedures. The study was developed in 17 patients with 5 periodontal pockets 6 or more millimeters depth and similar, which were divided in 4 groups: only subgingival scaling and root planning, scaling and root planning plus subsequent irrigation with saline, scaling and root planning and subsequent irrigation with chlorhexidine 0.12% and irrigation with chlorhexidine 0.12% previous to scaling and root planning. The clinical parameters evaluated were Plaque Index, Gingival Index, Probing Depth, Level of Attachment, Bleeding and Suppuration upon probing of the bottom of the pocket. The analysis was done at the beginning of the study and 60 days after the clinical procedures. The results demonstrate improvement in all parameters of all experimental groups, statistically similar, with exception of Bleeding on Probing of the bottom of the pocket that showed better results to the irrigated groups in relation to the group that was only mechanically instrumented. Thus, it was concluded that irrigation as an adjunct, either with chlorhexidine or with saline solution, provides better repair of non-surgical periodontal therapy procedures.

The efficacy of a herbal-based toothpaste in the control of plaque and gingivitis: A clinico-biochemical study.

Objective: A double-blinded controlled clinical trial with parallel groups was designed to investigate the effectiveness of a herbal-based toothpaste in the control of plaque and gingivitis as compared with a conventional dentifrice. The efficacy of Colgate Herbal over Colgate tooth paste was assessed in this study. Materials and Methods: Thirty subjects with gingivitis participated in the study. All participants had at least 20 natural teeth with no probing depths greater than 3 mm and a plaque index score of 2 or more at baseline. At baseline, the clinical parameters like gingival index, plaque index and salivary pH were estimated. Paired t-test was used to compare the difference within the groups and unpaired t-test was used to compare the difference between the groups at baseline and on the 30 th day. Results: At the end of the study, there were statistically significant reductions in the gingival index and the plaque index scores within the test group. However, there were no statistically significant differences between the test and the control groups. The salivary pH changes were not statistically significant in the test group but were displaced more toward the acidic range in the control group. Conclusion: It was however concluded that the herbal-based toothpaste was as effective as the conventionally formulated dentifrice in the control of plaque and gingivitis.

Eficacia de cuatro cepillos dentales en la remoción de placa bacteriana mediante la técnica modificada de Bass en estudiantes de Salud Oral de la ciudad de Cali / Efficacy of four toothbrushes on removal of plaque with modified Bass technique in Dental Hygiene students at Cali

Objetivo: Evaluar la eficacia de cuatro cepillos dentales de diferente diseño (Colgate Microsonic®, Colgate Twister Fresh®, Colgate 360 Sensitive® y Colgate 360®) para determinar si existe superioridad clínica en la remoción de placa bacteriana de alguno de ellos mediante la técnica de Bass modificado en estudiantes de salud oral de la ciudad de Cali. Materiales y métodos: Se trata de un ensayo clínico aleatorizado que compara la eficacia de cuatro diseños de cepillos dentales a través de diferentes técnicas de cepillado en 200 estudiantes de dos programas de entrenamiento de auxiliares de salud oral, de sexo femenino, con edades comprendidas entres los 15 y 43 años, escogidos por conveniencia y los cuales conformaron los grupos control (cualquier técnica de cepillado) e intervención (técnica de cepillado de Bass modificado). El seguimiento fue realizado durante 21 días a través de la aplicación del Índice de placa bacteriana de O´leary realizada por un odontólogo. Resultados: El cepillo Colgate Twister Fresh® (33%) tuvo mayor probabilidad de reducir el índice de placa bacteriana en cualquier momento del seguimiento cuando se comparó su eficiencia con la de los otros cepillos. La técnica modificada de Bass tuvo mayor probabilidad de reducir placa bacteriana que otras técnicas pero de igual forma esta diferencia no fue significativa. Conclusiones: No se encontró diferencia significativa entre las técnicas de cepillado tenidas en cuenta en este estudio. Ninguno de los cuatro diseños de cepillos empleados en este estudio presentó significancia estadística respecto a la eliminación de la placa bacteriana.

Aim: To evaluate the efficacy of four different designed toothbrushes (Colgate Microsonic®, Colgate Twister Fresh®, Colgate 360 Sensitive® y Colgate 360®) to determine the clinical advantage on removal of plaque using modified Bass technique in dental hygiene students in Cali. Methods: This is a controlled clinical trial to compare the efficacy of four toothbrushes designs with different tooth brushing methods in 200 female dental hygiene students with ages from 15 to 43. Control group used any tooth brushing technique whereas test group used modified Bass technique. Follow up was made daily for 21 days with O´Leary Plaque Index. Results: Colgate Twister Fresh® toothbrush had more probability to reduce plaque index at any time of follow up period than other toothbrushes. Modified Bass technique had more chance to reduce plaque than other techniques but with no significant differences. Conclusions: there were no statistically significant differences between tooth brush techniques. None of the four designs of studied toothbrushes showed differences in regard to plaque elimination.

A comparative study for the efficacy of plaque removal of two powered toothbrushes and a manual toothbrush / 대한치주과학회지

Periodontal disease is caused by accumulation of bacterial plaque. For the reason, plaque control is essential to control and prevent periodontal disease. Among the plaque control methods, mechanical plaque removal, tooth brushing is common and reliable. But it depends on individual habituation and their manner. To catch up the gap of effectiveness, lots of oral hygiene appliances have been developing. Powered toothbrush is the most interesting field and is showing on the market with various motion type. This study was performed to compare clinical effects of plaque removal between powered toothbrush and manual toothbrush. The results were as follows: 1. Plaque index was decreased statistically after the brushing than before the brushing in every group.(p<0.05) 2. Comparing plaque index among the three groups before and after brushing, there were no statistically significant differences. 3. Interproximal plaque index was decreased statistically after the brushing than before the brushing in every group.(p<0.05) 4. Comparing interproximal plaque index among the three groups before and after brushing, there were no statistically significant differences.

Effect of embossed new dental pick on periodontitis / 대한치주과학회지

Since bacterial plaque is known as the major cause of every oral disease, it is necessary to control plaque to maintain periodontal health. Although tooth brushing has been the typical method of plaque control, additional use of plaque control devices are necessary for cleansing interdental areas. Dental floss has been used for a long time as the additional plaque control device and proved to be effective. The newly developed embossed new dental pick is composed of elastic plastic material in form with its tip longer than other toothpick. In addition, as thickness of the tip gradually increases, it can be adapted easily with minimal trauma to interdental gingiva. The embossed tip can remove dental plaque easily, and the opposite end can approach lingual and palatal areas through triple angulation. Therefore, the authors studied the effect of embossed new dental pick and dental floss on periodontally involved 15 patient. The following results were obtained. 1. For embossed new dental pick, probing depth at baseline, 1 week, 4 weeks were 3.6+/-0.6mm, 3.4+/-0.5mm, 3.2+/-0.5mm, respectively, and 4.2+/-0.9mm, 4.1+/-0.9mm, 4.0+/-0.9mm, respectivly for clinical attachment level. 2. In case of embossed new dental pick, bleeding on probing at baseline, 1 week, 4 weeks were 43.0+/-4.4%, 28.5+/-5.1%, 22.2+/-5.6%, respectively, and, at 1 week and 4 weeks, they were significantly different from that of dental floss. 3. Gingival index of toothpick at baseline, 1 week, 4 weeks were 1.7+/-0.5, 1.0+/-0.3, 0.9+/-0.2, respectively, and, 1.7+/-0.5, 1.1+/-0.4, 1.0+/-0.4, respectively for plaque index, and 3.0+/-0.5, 1.7+/-0.5, 1.4+/-0.4, respectively for proximal plaque index. proximal plaque index at 4 weeks was significantly different from that of dental floss. 4. The result of questionnaire showed that the two types of device were both satisfactory, however, embossed new dental pick had higher preference as well as satisfaction. As a result, embossed new dental pick is thought to be clinically effective for its simplicity and good accessibility.

The Effect of Silicone Toothbrush on Plaque Control and Gingival Inflammation. A Comparative Clinical Study / 대한치주과학회지

A comparative clinical study on the ordinary toothbrush(Buttler(R), America) and the silicone toothbrush(Jefe(R), Korea) was performed. The volunteers who took part in this study were students of Dental college of Yonsei University and patients attending Dental Hospital of Yonsei University. They were classified into two group, control and experimental group. Control group brushed with nylon toothbrush and experimental group did with silicone toothbrush under the researcher's guidances. Volunteers were examined on Plaque Index(PI), Gingival Index(GI), Probing Depth(PD), Bleeding on Probing(BP) and Recession(R) at base line, 1st. week, 2nd. week and 4th. week. According to the results, both group have the tendency of improvement in the degrees of GI, PI and the improvement degree of GI of both group has the significant differences from base line statistically, and there are not statistically significant differences between the silicone and nylon group in respect of PI, GI values. So based on the present study, it could be carefully ascertained that the silicone toothbrush has similar effect with nylon toothbrush in respect of PI and GI. If it is sure that the silicone toothbrush is seldom abrasive and possibly enough to massage the gingiva, this new brush is worth to be recommended by the dentists.

The effects of plaque control instruction in orthodontic patients / 대한치과교정학회지

The purpose of this study w-s to predict the respose to the chincap therapy from the initial cephalometric measurements and to obtain the indication of chincap therapy. 40 patients selected for this study were classified into two groups by the occlusal stability after completion of permanent dentition and the iiu4n ovement of facial profile, after chincap therapy. One was g response group which consisted of 25 children and the other was poor response group with 15 patients. Various measurements of the craniofacial structure in the initial lateral cephalogram were calculated and analyzed by t-test and discriminant analysis. The results were, as follows 1. Good response group had more horizontal growth pattern in initial stage of treatment, and the contributing measurements were Bjork sum, anterior-posterior facial height ratio, gonial angle, lower gonial angle and occlusal plane to AB plane angle. 2. The critical points and predictive values of the influential skeletal measurements were calculated. 3. The discriminant function was obtained from three. major influential measurements; Bjork sum, gonial angle and occliml plane to AB plane angle, and this function could discreminate correctly in 85% of this samples.

The effects of horizontal orthodontic tooth movement on the periodontally diseased tissue in dogs / 대한치과교정학회지

Most adults, unlike growing children, have some periodontal problems which can influence the outcome of the orthodontic treatment. In cases where periodontal disease progression resulted in marked reduction of periodontium, orthodontic treatment could result in the worsening of the periodontal conditions, and therefore orthodontic treatment planning in such adult patients requires special considerations for the periodontal problems. This study investigates the effects of horizontal orthodontic tooth movement on the changes in the mesial, distal and furcation areas of the disease affected periodontium of adult dogs with advanced bone loss. Six adult dogs with healthy periodontium were selected, and mandibular 2nd premolars were extracted. In the mandibular 3rd premolars, angular bony defects in the mesial and distal sides, and horizontal bony defects in the furcation areas were created. Those that received the flap operation and plaque control were designated as the control, those that had horizontal tooth movement without plaque control after the flap operation as Experimental group I, those that had horizontal tooth movement under plaque control without the flap operation as Experimental group II, and those that had horizontal tooth movement under plaque control after the flap operation as Experimental group III. The control group was sacrificed 2 months postoperatively, and the experimental groups were sacrificed 5 months after the initiation of tooth movement. Specimens were histologically analyzed under light microscope. The results were as follows; 1. After the horizontal tooth movements, Experimental group I and II showed angular bony defects in the mesial sides of the roots and the distal side of the furcation areas, which correspond to the pressure sides. 2. After the horizontal tooth movements, Experimental group I and II showed decreased level of alveolar bone crest in the distal sides of the roots, which correspond to the tension sides. 3. Long junctional epithelium in the control group has not been replaced by periodontal connective tissue after the horizontal tooth movements. 4. Limited formation of new bone was observed in the angular bony defects in the mesial and distal aspects of the roots in the control group. 5. Inflammatory cell infiltration in the connective tissue was most severe in the Experimental group I, followed by Experimental group II, III, and the control group in that order. These results seem to indicate that plaque control was the most influencing factor in the alteration of the periodontal tissue after the horizontal tooth movements in the periodontal tissue with alveolar bone defects.