Efficacy of two soft-bristle toothbrushes in plaque removal. A randomized controlled trial / Eficácia de duas escovas de cerdas macias na remoção de Placa. Um ensaio clínico randomizado

ABSTRACT The aim of the present examiner-blind randomized controlled clinical study was to compare the efficacy two soft-bristle toothbrushes in terms of plaque removal. Seventy volunteers were randomly allocated to Group A (tapered-tip toothbrush) or Group B (end-rounded toothbrush). At baseline appointment (Day 0), volunteers underwent plaque examination using the Improved Plaque Identification Index. Under supervision, they brushed their teeth for 1 minute with their assigned toothbrushes and the plaque examination was repeated. Volunteers continued the oral hygiene regimen (assigned toothbrush and a regular dentifrice provided by the researchers) for 7 days. The experimental procedures of Day 0 were then repeated. Separate statistical analyses were performed for mean percent reduction of plaque in the whole-mouth, interproximal and gumline scores at both times, usingMann-Whitney test, p<0.05. After a single toothbrushing, on Day 0, mean percent plaque was significantly reduced in both groups (p<0.05), with statistically greater reductions of whole-mouth (21.39±12.44 vs. 11.40±11.17), gumline (6.32±7.37 vs. 2.89±4.57) and interproximal (10.82±10.49 vs. 5.21±7.68) for Group A as compared to Group B. However, on day 7, no significant difference was observed between groups for whole-mouth (29.94±20.91 vs. 26.58±18.64), gymline (14.04±18.82 vs. 13.78±17.63) and interproximal surfaces (26.41±22.77vs. 23.12±20.98) (p>0.05). In conclusion, on Day 0, Group A presented higher efficacy in supragingival plaque removal than Group B, as reflected by whole-mouth, gumline and interproximal plaque scores.

RESUMO O objetivo desse ensaio clínico, examinador-cego, randomizado e controle foi de comparadas a eficácia de duas escovas de cerdas macias em relagäo ao controle de placa. Setenta vo-luntários foram randomicamente alocados para Grupo A (es-cova com ponta cónica) ou Grupo B (escova com ponta arredondada). Na consulta inicial (dia 0), voluntarios receberam exame de placa utilizando o Índice de identificagäo de placa melhorado. Sob supervisäo, eles escovaram seus dentes por 1 minuto com as escovas designadas e o exame de placa foi repetido. Voluntarios continuaram seu regime de higiene oral (escova dental alocada e dentifrício comum fornecidos pelos pesquisadores) durante 7 dias. Os procedimentos da consulta inicial foram novamente repetidos. Análises estatísticas distintas foram realizadas para percentual de redugäo média de placa para os escores de boca toda, interproximal e linha gengi-val em ambos os momentos, utilizando teste de Mann-Whitney, p<0,05. Após único uso da escova, no dia 0, o percentual de redugäo média de placa foi significativamente reduzido em ambos os grupos (p<0,05), com reduções significativas para boca toda (21,39±12,44 vs. 11,40±11,17), linha gengival (6,32±7,37 vs. 2,89±4,57) e interproximal (10,82±10,49 vs. 5,21±7,68) no Grupo A quando comparada com o Grupo B. Entretanto, no dia 7, nenhuma diferenga significativa foi observada entre os grupos para boca toda (29,94±20,91 vs. 26,58±18,64), linha gengival (14,04±18,82 vs. 13,78±17,63) e interproximal (26,41±22,77 vs. 23,12±20,98) (p>0,05). Em conclusäo, no dia 0, a escova do Grupo A apresentou eficácia superior na remo-gäo de placa suprageng ival quando comparada com a escova do Grupo B, como demonstrado nos escores de placa de boca toda, linha gengival e interproximal.

Tratamiento no quirúrgico del agrandamiento gingival asociado a la pubertad: reporte de caso clínico / Non-surgical treatment of gingival enlargement associated with puberty: a clinical case report

RESUMEN Introducción: los agrandamientos gingivales suelen tratarse a través de terapias quirúrgicas de gingivectomías; su tratamiento no quirúrgico mecánico también es una opción sobre todo en los casos de gingivitis asociada a la pubertad como consecuencia de los cambios hormonales. Objetivo: describir el tratamiento no quirúrgico de una paciente de 12 años con agrandamiento gingival asociado a la pubertad y lesiones gingivales inducidas por biofilm dental. Presentación del caso: el caso presentó un agrandamiento gingival leve localizado que remitió al cabo de un mes a la primera fase de tratamiento, después de tres sesiones de fisioterapias con la remoción de biofilm calcificado se obtuvo una reducción del porcentaje del índice de higiene oral sin requerir intervención quirúrgica. A los cuatro años de seguimiento se observó reducción completa del agrandamiento gingival y bolsas periodontales. Conclusiones: la terapia periodontal mecánica es una alternativa eficaz en la reducción de la inflamación gingival inducida por hormonas durante la pubertad sin la necesidad de requerir intervenciones quirúrgicas para el tratamiento del agrandamiento gingival. Otras alternativas como las gingivectomías son aplicables; sin embargo requieren procedimientos más complejos, costosos y aumento de la morbilidad del paciente; en ese sentido el tratamiento mecánico no quirúrgico se muestra como una opción viable(AU)

ABSTRACT Introduction: Gingival enlargement is usually treated with gingivectomy as an alternative to surgery; however, non-surgical mechanical treatment is another option especially in cases of gingivitis associated with puberty as a result of hormonal changes. Objective: To describe the non-surgical treatment of a 12-year-old patient with gingival enlargement associated with puberty and gingival lesions induced by dental biofilm. Case presentation: The patient presented a localized mild gingival enlargement that relapsed to the first phase of treatment after one month. Three months after physiotherapy sessions with removal of calcified biofilm, a reduction in the percentage of oral hygiene index to "good" was obtained; therefore, surgical treatment was not required. Four years later, there was a complete reduction in gingival enlargement and periodontal pockets. Conclusions: Mechanical periodontal therapy is an effective alternative to reduce gingival inflammation induced by hormones during puberty not requiring surgical intervention to treat gingival enlargement. Other alternatives such as gingivectomies are performed; however, they require more complex, expensive procedures and they can also increase patient morbidity. In that sense, the uniqueness of the non-surgical mechanical treatment is chosen as a feasible option(AU)

Manejo odontológico del paciente con hipoacusia neurosensorial profunda bilateral / Dental management of patients with bilateral profound sensorineural hearing loss

Introducción: la hipoacusia es la disminución de la agudeza auditiva o de la capacidad para captar el sonido; esta puede ser neurosensorial, conductiva o mixta. La hipoacusia neurosensorial resulta de alteraciones en el oído interno, nervio auditivo o en los núcleos auditivos del tronco cerebral. El manejo de estos pacientes requiere disposición, conocimientos y calidez para el correcto desarrollo de la atención estomatológica. Objetivo: reportar el manejo odontológico de un paciente con hipoacusia neurosensorial profunda bilateral. Presentación del caso: paciente femenino de 7 años y 10 meses de edad con diagnóstico de hipoacusia neurosensorial profunda bilateral, quien acude a consulta por presentar dolor. A la inspección física, paciente mesofacial, perfil convexo. Intraoralmente se observan tejidos blandos clínicamente sanos, alteraciones de número y posición, caries moderada e higiene deficiente. Durante la inspección clínica la paciente se mostró poco cooperadora (Frankl II). El plan de tratamiento consistió en prevención, operatoria, ortopedia y cirugía. Para el manejo del paciente se incluyó un lenguaje de señas básico con uso de careta y sin cubreboca, modelado con otros pacientes. Se modificó la técnica decir, mostrar y hacer por mostrar/oler, tocar y hacer. Conclusiones: el odontopediatra debe tener las competencias necesarias para la atención integral de pacientes con capacidades diferentes. El manejo de la conducta y el cuidado multidisciplinario del paciente en edades tempranas es fundamental para el éxito del tratamiento. En el caso clínico que se presenta se resalta la efectividad del manejo conductual modificado, lo cual incrementó la posibilidad de éxito de la rehabilitación dental del paciente, así como de su seguimiento(AU)

Introduction: hearing loss is reduced auditory acuity or a decrease in the ability to perceive sound. It may be sensorineural, conductive or mixed. Sensorineural hearing loss results from alterations in the inner ear, the auditory nerve or the auditory brainstem nuclei. Dental management of these patients requires willingness, knowledge and warmth on the part of the dental practitioner. Objective: report the dental management of a patient with bilateral profound sensorineural hearing loss. Case presentation: a female patient aged 7 years and 10 months diagnosed with bilateral profound sensorineural hearing loss attends consultation for dental pain. At physical inspection, it is observed that the patient is mesofacial with a convex profile. Intraoral examination found clinically healthy soft tissue, tooth alterations in number and position, moderate decay and poor hygiene. During clinical inspection, the patient was uncooperative (Frankl II). Treatment consisted in prevention, restoration, orthopedics and surgery. Management of the patient included use of basic sign language and a mask without the practitioner wearing a facemask, and modeling with other patients. The technique of say, show and do was replaced by show / smell, touch and do. Conclusions: pediatric dentists should have the skills required for the comprehensive care of patients with different capabilities. Behavior management and multidisciplinary care of very young patients is essential for a successful treatment. The clinical case herein presented highlights the effectiveness of modified behavior management, which increased the chances of success in the patient's dental rehabilitation and follow-up(AU)

Asociación bidireccional entre enfermedad periodontal y diabetes / Two-way association between periodontal disease and diabetes

El propósito de esta presentación es marcar el concepto de que la asociación entre enfermedad periodontal y diabetes es una vía bidireccional; la primera puede determinar el inicio o agravamiento de la diabetes, en tanto que ésta es uno de los factores de riesgo más estudiados que puede aumentar la gravedad de las enfermedades periodontales que son siempre iniciadas por los microorganismos patógenos.

Pigmentações extrínsecas negras do esmalte em Odontopediatria / Pigmentos negros extrínsecos del esmalte en Odontopediatría / Extrinsic dark-pigmentation of the tooth enamel in pediatric dentistry

As pigmentações negras do esmalte se devem à coloração extrínseca e estão associadas com problemas estéticos. O objetivo é apresentar dois casos clínicos de crianças com pigmentações extrínsecas negras do esmalte dentário, com ênfase no tipo de tratamento e no acompanhamento. Trata-se de um paciente de 5 anos de idade que utilizava constantemente sulfato ferroso para tratamento de anemia por deficiência de ferro; e outro paciente de 12 anos de idade com diabetes mellitus tipo 1 e dermatomiosite. No primeiro caso observou-se a presença de pigmentações negras extrínsecas nos dentes decíduos e nos primeiros molares permanentes, principalmente nas superfícies lingual e vestibular na região cervical e terço médio, além de lesões de cárie incipientes nas superfícies oclusais dos molares e manchas brancas ativas nos primeiros molares permanentes. No segundo caso, havia pigmentações negras extrínsecas na região cervical das superfícies lisas dos dentes decíduos e permanentes. No primeiro caso, foi realizado tratamento para remoção das pigmentações negras e polimento dos dentes por meio de profilaxia profissional com creme dental abrasivo que contém pedra pomes microgranulada. Houve uma melhora no aspecto clínico a partir da segunda sessão e finalizado na quinta sessão. Para o caso 2, observou-se dificuldade na remoção de manchas pigmentadas na região cervical e risco de sangramento gengival. Uma vez que a criança necessitava de antibiótico profilático, optamos pelo controle diário de biofilme e não remoção pela profilaxia profissional, uma vez que o paciente não se queixava do impacto estético. Conclui-se que as pigmentações negras extrínsecas podem ser observadas facilmente em crianças, e ainda que haja um comprometimento estético, não traz danos à manutenção da saúde bucal. Cabe ressaltar que não está claro como sua presença na superfície dentária reduz a suscetibilidade à cárie. Além disso, a escolha do tratamento sempre deverá ser baseada no risco-benefício para o paciente(AU)

Dark enamel pigments are due to extrinsic staining and associated with aesthetic problems. The objective is to present two cases of children with black extrinsic pigmentation in the tooth enamel, with emphasis on the type of treatment and monitoring. This is a 5-year-old patient of who constantly used ferrous sulfate to treat anemia by iron deficiency, and another 12-year-old patient with type 1 diabetes and dermatomyositis. In the first case, we observed the presence of black extrinsic pigments in the primary teeth and the first permanent molars, especially in the lingual and vestibular part in the cervical region and middle third, together with incipient caries lesions on the occlusal surfaces of molars and active white spots on the first permanent molars. In the second case, there were strange black pigmentation in the cervical region of the smooth surfaces of the primary and permanent teeth. In the first case, the treatment performed was to remove black pigments and polishing the teeth by means of professional prophylaxis and using an abrasive toothpaste containing micro-granules of pumice. There was an improvement in the clinical aspect from the second session and the treatment ended at the fifth session. For the second case, we observed difficulty to remove the pigmented spots in the cervical region, together with the risk of bleeding gums. When the child needed prophylactic antibiotics, we opted for the daily control of the biofilm and it was not removed by professional cleaning, because the patient did not complain about the aesthetic impact. As conclusions, the extrinsic black pigments can be easily observed in children, and despite its aesthetic effect, it does damage oral health. It should be noted that it is unclear how their presence on the tooth surface reduces susceptibility to caries or tooth decay. In addition, the choice of treatment should always be based on the relation risk-benefit for the patient(AU)

Los pigmentos de esmalte negro se deben a la tinción extrínseca y están asociados con problemas estéticos. El objetivo es presentar dos casos clínicos de niños con pigmentaciones extrínsecas negras del esmalte dental, con énfasis en el tipo de tratamiento y el seguimiento. Se trata de un paciente de 5 años de edad, que utilizaba constantemente sulfato ferroso para el tratamiento de la anemia por deficiencia de hierro, y otro paciente de 12 años de edad con diabetes mellitus tipo 1 y dermatomiositis. En el primer caso se observó la presencia de pigmentos extrínsecos negros en los dientes primarios y los primeros molares permanentes, principalmente en la parte lingual y vestibular en la región cervical y tercio medio; además de lesiones de caries incipientes en las superficies oclusales de los molares y manchas blancas activas en los primeros molares permanentes. En el segundo caso, había pigmentaciones negras extrañas en la región cervical de las superficies lisas de los dientes primarios y permanentes. En el caso 1, se realizó el tratamiento para eliminar los pigmentos negros y el pulido de los dientes por medio de una profilaxis profesional con crema dental abrasiva que contiene microgránulos de piedra pómez. Hubo una mejora en el aspecto clínico a partir de la segunda sesión y se finalizó en la quinta sesión. Para el caso 2, se observó dificultad en la eliminación de manchas pigmentadas en la región cervical y el riesgo de sangrado de las encías. Una vez que el niño necesitaba antibióticos profilácticos, optamos por el control diario de la biopelícula y no se eliminó por la limpieza profesional, ya que el paciente no se quejaba del impacto estético. Se concluye que los pigmentos negros extrínsecos pueden observarse fácilmente en los niños, y aunque haya un efecto estético, no hace daños al mantenimiento de la salud bucal. Cabe señalar que no está claro cómo su presencia en la superficie del diente reduce susceptibilidad a la caries. Además, la elección del tratamiento siempre se debe basar en el beneficio-riesgo para el paciente(AU)

Enfermedad periodontal y síndrome de Down / Periodontal disease and Down´s syndrome

El síndrome de Down es un factor de riesgo no modificable para la enfermedad periodontal; los individuos con síndrome de Down tienen una mayor prevalencia y severidad de enfermedad periodontal que no puede ser explicada únicamente por una higiene bucal deficiente, y diversos estudios sugieren que esto se debe a cambios en su respuesta inmune y en la composición microbiológica de su biofilm. En este trabajo se hará una revisión de las siguiente anormalidades del sistema inmune que fueron encontradas: - defectos en la quimiotaxis de los neutrófilos - fagocitosis parcial de los leucocitos contra los estafilococos - distribución alterada de subclases de IgG en saliva - aumentados niveles de prostaglandinas E2 - aumentada cantidad de metaloproteinasas de la matriz en el fluido gingival crevicular - reducida expresión de IL-10. Por estos motivos, la atención periodontal de los pacientes son síndrome de Down es ligeramente diferente...

Toothbrushing procedure in schoolchildren with no previous formal instruction: variables associated to dental biofilm removal / Procedimiento de cepillado en escolares sin previo entrenamiento formal: variables asociadas al barrido del biofilm dental

The aim of this study was to establish the association betweenfeatures regarding brushing procedure performed by school-children without previous formal training and the effectivenessof biofilm removal. Out of a population of 8900 6- and 7-year-old schoolchildrenin Buenos Aires City, 600 children were selected from schoolslocated in homogeneous risk areas. Informed consent wasrequested from parents or guardians and formal assent wasobtained from children themselves. The final sample consistedof 316 subjects. The following tooth brushing variables wereanalyzed: toothbrush-gripping, orientation of active part ofbristles with respect to the tooth, type of movement applied,brushing both jaws together or separately, including all 6sextants and duration of brushing. The level of dental biofilmafter brushing was determined by O’Leary’s index, acceptablecut-off point = 20%. Four calibrated dentists performedobservations and clinical examinations. Frequency distribution,central tendency and dispersion measures were calculated.Cluster analyses were performed; proportions of variables foreach cluster were compared with Bonferroni’s correction andOR was obtained. The most frequent categories were: palm gripping (71.51%);perpendicular orientation (85.8%); horizontal movement(95.6%); separate addressing of jaws (68%) and inclusion ofall 6 sextants (50.6%). Mean duration of brushing was 48.78 ±27.36 seconds. 42.7% of the children achieved an acceptablebiofilm level. The cluster with the highest proportion of subjectswith acceptable post-brushing biofilm levels (p<0.05) differedsignificantly from the rest for the variable “inclusion of all 6 sextants in brushing procedure”. OR was 2.538 (CI 95%1.603 – 4.017). Inclusion of all six sextants could be a determinant variable forthe removal of biofilm by brushing in schoolchildren, and shouldbe systematized as a component in oral hygiene education.

El objetivo del trabajo fue establecer la asociación entre las características del procedimiento de cepillado en escolares sin previo entrenamiento formal con la efectividad para el barrido del biofilm dental. Sobre una población de 8900 escolares de Ciudad Autónoma deBuenos Aires de 6 y 7 años de edad, se seleccionaron 600 niños concurrentes a escuelas situadas en áreas de riesgo homogéneo. Sobre esta muestra se solicito consentimiento informado a losresponsables legales y el asentimiento formal, conformando una muestra final de 316 individuos. Se analizaron las siguientes variables del procedimiento de cepillado: tipo de toma del cepillo dental, orientación de la parte activa respecto del diente, tipo de movimiento aplicado, abordaje simultaneo o no de ambos maxilares, inclusión de los 6 sextantes y duración de cepillado.El nivel de biofilm dental posterior al cepillado se determinó con el índice de O’Leary-punto de corte aceptable=20 por ciento. Cuatro odontólogos calibrados realizaron las observaciones y exámenes clínicos. Se calculó: distribución de frecuencias, medidas detendencia central y su dispersión. Se realizó un análisis de clúster y comparación de proporciones de las variables de cada conglomerado con corrección de Bonferroni y OR. Las categorías más frecuentes fueron: toma palmar (71,51 por ciento); orientación perpendicular (85,8 por ciento); movimiento horizontal (95,6 por ciento); cepillado de ambos maxilares por separado (68 por ciento) einclusión de los 6 sextantes (50,6 por ciento). La media de duración delcepillado fue de 48.78 ± 27.36 segundos. El42,7 por ciento de losescolares alcanzaron un nivel de biofilm aceptable. El clúster que mostró la mayor proporción de individuos con niveles de biofilm postcepillado aceptables (p<0,05) mostró diferenciasestadísticamente significativas con los demás respecto de la variable “inclusión de 6 sextantes en el cepillado”. El OR fueigual a 2,538 (IC 95 por ciento 1,603 – 4,017)

Efficacy of two soft-bristle toothbrushes in plaque removal: a randomized controlled trial

Abstract The aim of this study was to compare the efficacy in supragingival plaque removal of two soft-bristle toothbrushes. Seventy volunteers were allocated randomly to the Colgate Slim Soft or Curaprox CS5460 toothbrush grourps. At baseline appointment, volunteers underwent plaque examination using the Rustogi Modification of the Navy Plaque Index. Under supervision, they then brushed their teeth for 1minute with their assigned toothbrushes and the plaque examination was repeated. Volunteers performed daily oral hygiene with their assigned toothbrush and a regular dentifrice provided by the researchers for 7 days. The baseline experimental procedures were then repeated. Separate analyses of variance were performed for the whole-mouth, interproximal, and gumline plaque scores (p < 0.05). No difference in baseline pre-brushing scores was found between groups. After a single toothbrushing, the mean plaque score was significantly reduced in both groups (p < 0.05), with greater reduction of whole-mouth and interproximal plaque scores observed in the SlimSoft group compared with the Curaprox group (p < 0.05). After 7 days, the SlimSoft group showed greater reduction of the whole-mouth and interproximal plaque scores compared with the Curaprox group (p < 0.05). In conclusion, the SlimSoft toothbrush presented greater efficacy in supragingival plaque removal than did the Curaprox CS5460 toothbrush, as reflected by whole-mouth and interproximal plaque scores.

Combined effect of end-rounded versus tapered bristles and a dentifrice on plaque removal and gingival abrasion

Abstract Two previous clinical studies evaluated the effect of end-rounded versus tapered bristles of soft manual brushes on the removal of plaque and gingival abrasion. However, the combined effect of an abrasive dentifrice on these outcomes has yet to be understood. The purpose of the present study was to compare the incidence of gingival abrasion and the degree of plaque removal obtained after the use of toothbrushes with tapered or end-rounded bristles in the presence or absence of an abrasive dentifrice. The study involved a randomized, single-blind, crossover model (n = 39) with a split-mouth design. Subjects were instructed to refrain from performing oral hygiene procedures for 72 hours. Quadrants were randomized and subjects brushed with both types of toothbrushes using a dentifrice (relative dentin abrasion = ± 160). Plaque and gingival abrasion were assessed before and after brushing. After 7 days, the experiment was repeated without the dentifrice. The average reduction in plaque scores and the average increase in the number of abrasion sites were assessed by repeated-measures ANOVA and Bonferroni's post-hoc tests. End-rounded bristles removed significantly more plaque than tapered bristles, regardless of the use of a dentifrice. The dentifrice did not improve plaque removal. In the marginal area (cervical free gingiva), no difference in the incidence of gingival abrasion was detected between toothbrush types when used with a dentifrice (p ≥ 0.05). However, the dentifrice increased the incidence of abrasion (p < 0.001), irrespective of the toothbrush type tested. End-rounded bristles therefore removed plaque more effectively without causing a higher incidence of gingival abrasion when compared with tapered bristles. An abrasive dentifrice can increase the incidence of abrasion, and should be used with caution by individuals who are at risk of developing gingival recession.

Efeitos nos níveis clínicos e de s. mutans de um protocolo de controle de biofilme dental em adolescentes portadores de aparelho ortodôntico fixo / Effect on the clinical levels of s. mutans of a dental biofilm control protocol in adolescents with fixed orthodontic appliances

A utilização de acessórios durante o tratamento ortodôntico fixo aumenta o risco à ocorrência de manchas brancas, cárie e gengivite devido aos sítios retentores de biofilme dental. O objetivo deste estudo foi observar o efeito de um protocolo de controle de biofilme dental nos níveis de gengivite e risco à cárie em adolescentes portadores de aparelho ortodôntico fixo. Foram selecionados 21 pacientes de ambos os gêneros, entre 12 e 18 anos, que usavam aparelho fixo. Os critérios de exclusão foram: doenças sistêmicas, uso de antibiótico, gravidez e fumo. Os pacientes receberam instrução de higiene oral individualmente, reforçada mensalmente, e tiveram a saliva coletada no início e no final do estudo para avaliar o número de streptococcus mutans (SM) em unidades formadoras de colônias (UFC) e o risco à cárie. Nos tempos 1, 30, 60 e 90 dias, foram analisados os níveis clínicos de placa bacteriana corada (IPC) e gengivite (IG). Os pacientes receberam profilaxia com jato de bicarbonato de sódio a cada exame. Para comparação da contagem de SM nos dois tempos analisados, foi utilizado o teste t de Student; para os tempos do IPC e IG, utilizou-se a análise de variância (Anova), com post-hoc Tukey, ambos com significância de 5%. Ocorreu redução entre as avaliações iniciais e finais do IPC (72,72% ± 11,93% para 54,18% ± 16,87%), do IG (1,10 ± 0,47 para 0,44 ± 0,27) e da contagem de SM (1,16 ± 1,345 UFC para 0,536 ± 0,56 UFC), todos com p < 0,05. A implementação do protocolo melhorou as condições de gengivite e risco à cárie na população durante o período de estudo.

The use of appliances during fixed orthodontic treatment increases the risk of occurrence of white spot, caries and gingivitis due to presence of dental biofilm at the retentive sites. The objective of this study was to observe the effect of a dental biofilm control protocol on the levels of gingivitis and caries risk in adolescents with fixed orthodontic appliances. Twenty-one patients of both genders, between 12 and 18 years, participated in the study. The exclusion criteria were: systemic diseases, use of antibiotics, pregnancy and smokers. Patients received individual monthly oral hygiene instructions, and had their saliva collected at the beginning and the end of the study to assess the number of streptococcus mutans (SM) in colony forming units (CFU) and caries risk. At 1, 30, 60 and 90 days, clinical levels of bacterial plaque (CPI) and gingivitis (GI) were analyzed. Patients received prophylaxis with sodium bicarbonate jets at each exam. Student t test was used to compare SM counts at the two analyzed moments, while analysis of variance (Anova) was used for CPI and GI times, followed by Tukeyposthoc test, at a significance of 5%. Reductions in CPI levels (72.72% ± 11.93% to 54.18% ± 16.87%), GI levels (1.10 ± 0.47 to 0.44 ± 0.27) and SM counts (1.16 ± 1.345 UFC para 0.536 ± 0.56 UFC) were observed between the initial and the final assessments, all with p < 0.05. The implementation of the biofilm control protocol improved gingivitis conditions and caries risk in the population studied during the experimental period.

Evaluación de la eficacia de dos prescripciones de cepillos dentales en la remoción de placa bacteriana en pacientes ortodóncicos / Evaluation of two toothbrushes prescriptions on the removal of plaque in patients with fixed orthodontic appliances

La aparatología empleada en los tratamientos de ortodoncia, favorece la retención de placa bacteriana y dificulta su eliminación por parte del paciente, aumentando el riesgo de desarrollar caries, manchas blancas y enfermedad periodontal. Diferentes cepillos dentales se han desarrollado para facilitar la mantención de una adecuada higiene oral en estos pacientes, sin embargo, se ha observado que los cepillos comunmente indicados (cepillo ortodóncico mas cepillo unipenacho), no siempre son bien manejados y difícilmente se usan ambos. El cepillo Cross Action Pro-Salud®, se ha presentado como una alternativa simple de usar y de transportar, por ser un único cepillo que combina las caracteristicas de los dos cepillos comunmente recomendados. Para evaluar la efectividad de este cepillo, en comparación con la prescripción convencional, se evaluaron 2 grupos, de 23 pacientes cada uno, portadores de aparatología fija. Un grupo utilizó la prescripción habitual y un segundo grupo utilizó cepillo Cross Action Pro-Salud®, por un período de 45 días. Los indices de higiene de O`leary, de placa en brackets y gingival modificado fueron registrados al inicio y 45 días después del uso diario de los cepillos antes mencionados. Se utilizó test-t para comparar los resultados obtenidos y se determinó que se produjo una disminución significativa en los tres indices de higiene, no existiendo diferencias en los resultados obtenidos entre ambas prescripciones. El cepillo Oral-B Cross-Action Pro-Salud® es una alternativa recomendable, ya que permite eliminar efectivamente la placa bacteriana en pacientes ortodónticos, y al ser un único cepillo, facilita y acorta el tiempo de cepillado.

Orthodontic fixed appliances include elements that allow the accumulation of bacterial plaque, making tooth brushing more difficult and increasing the risk of developing caries, white spot lesions, and periodontal disease. Several toothbrushes designs have been developed to facilitate oral hygiene in orthodontic patients; however, it has been observed that most patients do not take enough time to brush using adequately both commonly prescribed toothbrushes (Oral-B End-Tufted® and Oral-B Orthodontic® brushes). Oral B Cross Action Pro-Health® has been presented as an alternative, easier to use and to transport. To assess the effectiveness of Cross Action Pro-Health® versus commonly prescribed toothbrushes, two randomly assigned groups of 23 orthodontic patients each, were evaluated. One group of patients used commonly prescribed toothbrushes and the second group used Cross Action Pro-Health®. O`Leary, modified gingival and Bracket plaque index were measured before and 45 days after the daily use of the two mentioned toothbrushes prescriptions. T-test was used to detect statistically significant differences among the brushes for each index. The results demonstrated a significant reduction of the three indexes with the daily use of Cross Action Pro-Health® and no differences were found versus commonly used prescription. Orthodontic patients may benefit from the use of a single brush prescription (Cross Action Pro-Health®), because effective plaque removal can be achieved easier and faster.

Root Dentine Sensitivity.

Background: Dentine hypersensitivity is one of the most painful, ubiquitous and least satisfactorily treated of all the chronic oral problems involving the teeth. Active Periodontal treatment appears to be one of the significant causes of hypersensitivity. Also, the role of plaque control in treatment of hypersensitivity is controversial. Thus the present study is aimed to study the degree to which a sample of patient developed Root Dentine Sensitivity (RDS) following nonsurgical periodontal treatment. Material & Methods: A total of 60 dental patients were evaluated for plaque scores and pain scoring using Scratch test and Air blast test. Visual Analogue Scale (VAS) was used for pain scoring. Oral hygiene instructions were given and non- surgical periodontal treatment was done quadrant wise over a period of 4 weeks. Results: The intensity of RDS given by VAS score and the percentage of teeth sensitive to both the test increased after scaling and root planing but gradually decreased when meticulous plaque control was maintained. Conclusion: Non- surgical periodontal treatment i.e. SRP and Oral hygiene maintenance may temporarily increase RDS, which reduces subsequently over a period of time with meticulous plaque control.

Supragingival plaque removal with and without dentifrice: a randomized controlled clinical trial

The aim of this study was to compare the efficacy of dental plaque removal by brushing with and without conventional dentifrice. Twenty-four students aged 17 to 28 years participated in this randomized controlled clinical trial. Quadrants 1-3 or 2-4 were randomly allocated to the test group (brushing without dentifrice) or control group (brushing with dentifrice). After 72 h of cessation of oral hygiene, Quigley & Hein (Turesky) plaque index was assessed before and after brushing by a calibrated and blind examiner. Overtime and intergroup comparisons were performed by Student's paired sample t-test at 5% significance level. The results showed that both groups after toothbrushing presented statistically significant reductions in plaque, with no differences between them (from 3.06 ± 0.54 to 1.27 ± 0.26 versus from 3.07 ± 0.52 to 1.31 ± 0.23). A separate analysis of the buccal and lingual aspects also showed no significant differences between groups. It may be concluded that the use of a conventional dentifrice during toothbrushing does not seem to enhance plaque removal capacity.

O objetivo deste estudo foi comparar a eficácia de remoção mecânica da placa dental através da escovação com e sem dentifrício. Vinte e quatro estudantes com idade de 17 a 28 anos participaram deste ensaio clínico randomizado. Os quadrantes 1-3 ou 2-4 foram randomizados para alocação no grupo teste (escovação sem dentifrício) ou grupo controle (escovação com dentifrício). Após 72 h de cessação de higiene bucal, o índice de placa de Quigley & Hein (Turesky) foi avaliado antes e após a escovação por um examinador cego e calibrado. Comparações intra e intergrupo foram realizadas pelo teste t pareado, a um nível de significância de 5%. Os resultados demonstraram que, após a escovação, ambos os grupos apresentaram redução significativa de placa, porém sem diferenças intergrupos (3,06 ± 0,54 a 1,27 ± 0,26 versus 3,07 ± 0,52 a 1,31 ± 0,23). Uma análise separada das faces vestibulares e linguais também não revelou diferenças entre os grupos. Conclui-se que a utilização de dentifrícios associado ao controle mecânico parece não contribuir para a remoção da placa dental.

Uso de vernizes fluoretados na avaliação do índice sangramento gengival em crianças: estudo in vivo / Use of fluoride varnishes in assessment of gingival bleeding index in children: in vivo study

Objetivo - Verificar o uso de dois vernizes fluoretados e a presença de sangramento gengival. Métodos - Participaram da pesquisa 28 crianças, de ambos os gêneros, de 8 a 12 anos de um município sem fluoretação das águas. Utilizou-se os códigos e critérios para diagnóstico de cárie do SB Brasil (2003) e índice de sangramento gengival (ISG). As crianças foram divididas em dois grupos: G1 (n = 13) Duraphat® e G2 (n = 15) Clinpro®. Inicialmente era registrado o ISG, profilaxia profissional e aplicados os vernizes (durante três sessões semanais). O exame foi realizado por apenas um examinador, previamente calibrado. O nível de significância adotado foi de 95%. Resultados - O ceod médio foi de 1,8 (± 2,0) e o CPO-D foi de 2,6 (± 2,3). Observou-se diminuição do ISG nos tempos 7, 14 e 21 dias, embora menor para o G1 do que para G2. A redução foi mais expressiva no G2 (p < 0,05). Conclusão - Dessa forma, ambos os vernizes fluoretados estudados proporcionaram redução do ISG ao longo do tempo.

Objective - The purpose of this study was to evaluate the therapeutic effect of two different fluoride varnishes and the presence of gingival bleeding. Methods - The sample consisted of 28 students of both genders, 8-12 years old of a public school from a city without fluoride water. The codes and criteria used for caries diagnosis were SB BRASIL (2003) and gingival bleeding index (GBI). The children were divided in two groups: G1 (n = 13) Duraphat® and G2 (n = 15) Clinpro®. Before applying the varnishes, the gingival bleeding index (GBI) was recorded, prophylactic performed with prophylactic paste and then varnishes applied in three sessions followed at weekly intervals. The examination was accomplished by one examiner, previously calibrated. The level of significance was set at 95% (CI). Results - The mean dmft index was1.8 (± 2.0) and DMFT was 2.6 (± 2.3). There was a decrease of GBI times 7, 14 and 21 days, although lower for G1 than for G2. The reduction was greater in G2 (p<0.05). Conclusion - Thus, both fluoride varnishes studied caused gingival bleeding reduction over time.

Gingival overgrowth and drug association: A review.

Drugs used locally or systemically induce several alterations in micro and macroscopic tissues. However, nearly 20 drugs have been reported so far in the literature associated with gingival enlargement. Many systemic diseases have limited therapeutic options and such drugs or their metabolites have an adverse influence on different systems/organs, and one of these is that they initiate or accelerate the overgrowth of gingival tissue. The increase in size may be to the extent that teeth may be partially or completely covered, and the resultant 'gummy smile' may result in aesthetic concern for the patient.In the presence of bacterial inflammation in the gingiva, many of these drugs enhance the production of collagen by fibroblast cells, and simultaneously retard the destruction of collagen and hence increase the bulk of gingival tissue. It is apparent that there is a subpopulation of fibroblasts which is sensitive to these drugs. The exuberant growth of gingival tissue is of great aesthetic concern, which may require mechanical removal of bacterial plaque, calculus, and surgical intervention, and/or substitution of the drug with analogs. A relatively healthy oral environment provided by the dentist will reduce local microflora that will help in eliminating the major focus of infection. Physicians, general practitioners, and dentists need to make a coordinated and concise treatment plan that will be beneficial for the patients. This article will facilitate full information to physicians to involve dentists in the multidisciplinary treatment plan.

Efeito da amarração em Ortodontia, com ligaduras elastoméricas e de aço inoxidável, na saúde periodontal / Effects of orthodontic ligation-using elastomeric and stainless steel ligatures-on periodontal health

OBJETIVO: o presente estudo avaliou clinicamente as condições periodontais de um grupo teste e um grupo controle utilizando-se os seguintes três sistemas de indexação periodontal: índice de biofilme, índice de sangramento e profundidade de sondagem. MÉTODOS: o grupo teste foi composto por 20 indivíduos com média etária de 13,5 anos, submetido ao tratamento ortodôntico fixo, que recebeu duas formas de ligaduras: a elastomérica e a de aço inoxidável. Os resultados foram comparados entre si e com um grupo controle, sem tratamento ortodôntico, composto de 15 indivíduos com média etária de 15,3 anos. As mensurações foram realizadas previamente ao tratamento ortodôntico (T1) e seis meses após a colocação do aparelho ortodôntico fixo (T2); e, no grupo controle, após seis meses da mensuração inicial (T2). Ambos os grupos foram orientados quanto à higiene bucal, segundo a técnica de Bass, antes do início do tratamento. RESULTADOS E CONCLUSÕES: os resultados das análises das faces dentárias demonstraram um aumento estatisticamente significativo nos índices de biofilme (P=0,000), sangramento gengival (P=0,000) e profundidade de sondagem (P=0,000), quando T1 e T2 e os grupos foram comparados; entretanto, não foram encontradas diferenças estatisticamente significativas entre as ligaduras elastoméricas e de aço inoxidável na avaliação desses índices periodontais.

OBJECTIVE: This study aimed to conduct a clinical evaluation of the periodontal conditions of a test group and a control group using three periodontal indexing systems, namely: dental biofilm index (DBI), bleeding index (BI) and pocket probing depth (PPD). METHODS: The test group consisted of 20 subjects with a mean age of 13.5 years undergoing fixed orthodontic treatment involving the use of two types of ligature: elastomeric ligature (EL) and stainless steel ligature (SSL). The results were compared with a control group without prior orthodontic treatment, comprising 15 subjects with a mean age of 15.3 years. The measurements were performed prior to orthodontic treatment (T1) and six months after placement of a fixed orthodontic appliance (T2); and in the control group, six months after the initial measurement (T2). Both groups were instructed about oral hygiene, according to the Bass technique, before treatment. RESULTS AND CONCLUSIONS: Dental surfaces showed a statistically significant increase in levels of biofilm (P=0.000), gingival bleeding (P=0.000) and probing depth (P=0.000). When the T1 and T2 groups were compared, however, no statistically significant differences were found between EL and SSL in terms of these periodontal indexes.

Programa lúdico-pedagógico para o controle do biofilme dental em indivíduos com deficiência visual / Playful-teaching program for the control of dental biofilm in the visually impaired

Objetivo: Desenvolver um programa de prevenção e motivação odontológica para deficientes visuais, utilizando materiais lúdico-pedagógicos. Além disso, buscou comparar a eficácia do mesmo através do índice de higiene oral simplificado (IHOS) e do índice gengival (IG), em um grupo de cegos (grupo experimental) e portadores de visão subnormal (grupo controle). Materiais e Métodos: Foram avaliados 15 indivíduos com deficiência visual da Associação de Pais e Amigos dos Deficientes Visuais (APADEV), de Caxias do Sul/RS, de ambos os sexos e idades entre 13 e 49 anos. Foram divididos em dois grupos: cegos(grupo experimental) e portadores de visão subnormal (grupo controle). Durante seis encontros (inicial, 15, 45, 75, 105 e 120 dias), todos os participantes receberam as mesmas informações e participaram das mesmas atividades conduzidas pelo mesmo examinador (kappa=0,86). Após cada atividade realizava-se o IG e IHOS. Os dados foram avaliados considerando-se o nível de significância de 5% e utilizando-se os testes de Friedman e Mann-Whitney. Resultados: Em relação ao IHOS, houve diminuição do índice com diferença significativa para o grupo controle durante os momentos de 15 a 105 dias (p<0,01), o que não ocorreu como grupo experimental (p=0,77). Na avaliação do IG, observou-se diminuição do índice ao longo de todo o período no grupo controle (p<0,01). No grupo com deficiência visual o IG diminuiu entre 75 e 105 dias. Para o IHOS não houve diferenças estatisticamente significantes. Conclusão: Os indivíduos com visão subnormal apresentaram um efeito melhor (IG e IHOS) após o programa quando comparados com os indivíduos cegos.

Medición de cambios cuantitativos de la microbiota subgingival posterior a la remoción de placa bacteriana supragingival / Measurement of quantitative changes of the microbiota subgingival after to removal of bacterial plaque supragingival

Uno de los campos de interés en el estudio de la microbiología periodontal para muchos investigadores ha sido identificar si es posible que los microorganismos responsables del origen y progresión de la enfermedad periodontal que habitan sobre el margen gingival (supragingival) y bajo este (subgingival) tengan una relación directa que permita mantener interacciones influyentes en el crecimiento y desarrollo de las diferentes especies bacterianas que habitan en los tejidos periodontales. Por lo tanto, al remover los microorganismos que se ubican supragingivalmente sería posible encontrar cambios en el medio subgingival al no existir un intercambio entre los ambientes aerobios (supragingival) y anaerobios (subgingival) una vez desorganizada la placa bacteriana supragingival. Para demostrar esta relación se seleccionaron 7 individuos con diagnóstico de periodontitis crónica moderada y severa a los cuales se les realizó un destartraje supragingival de boca completa para lograr desorganizar la placa bacteriana supragingival. A su vez se tomaron muestras microbiológicas de los sacos periodontales más profundos de cada cuadrante de estos individuos, siendo la primera muestra tomada previo al destartraje supragingival considerada como muestra basal (día 0), luego se tomaron a las 24 horas, a los 7 y 21 días de removida la placa bacteriana supragingival. De los resultados del presente estudio pudimos concluir que al desorganizar el biofilm supragingival se observa una disminución en la cantidad total de microorganismos subgingivales, así como también disminuye de manera considerable la proporción de Porphyoromona gingivalis presente en el medio subgingival. Lo cual permitiría establecer la existencia de una relación directa y dependiente entre los microorganismos que habitan el medio supragingival y subgingival.

One of the fields of interest in the study of the microbiology periodontal for many investigators has been to identify if it is possible that the microorganisms responsible for the origin and progression of the disease periodontal that live on the margin gingival (supragingival) and under this (subgingival) they have a direct relation that allows to support influential interactions in the growth and development of the different bacterial species that they live in the tissue periodontal.Therefore having removed the microorganisms that are located supragingivalmente would be possible to find changes in the way subgingival when an exchange not to exist between the aerobic environments (supragingival) and anaerobic (subgingival) once disorganized the bacterial plate supragingival. To demonstrate this relation 7 individuals selected with diagnosis of periodontitis chronicle moderate and severe to which they there was realized a destartraje supragingival of complete mouth to achieve supragingival to disorganize the bacterial plate. In turn microbiological samples of the sacks took periodontales deeper of every quadrant of these individuals, being the first taken sample before the destartraje supragingival considered as sample basal (the 0th), then they took at to 1, 7 and 21 days of removed the bacterial plate supragingival anaerobios (subgingival) once disorganized the bacterial plate supragingival Of the results of the present study we could conclude that on having disorganized the biofilm supragingival a decrease is observed in the total quantity of microorganisms subgingivales, as well as also it diminishes in a considerable way the proportion of present Porphyoromona gingivalis in the way subgingival. Which would lead to thinking that there exists a direct and dependent relation between the microorganisms that live the way supragingival and subgingival.

Efeito do verniz de clorexidina 40% sobre microorganismos periodontopatogênicos e no aumento gengival em pacientes ortodônticos: estudo prospectivo "split mouth" / Effect of chlorhexidine varnish 40% on the pathogens periodontal microorganisms and gingival growth in orthodontic patients: a prospective split-mouth study

O aumento gengival generalizado é comumente causado por resposta inflamatória à placa bacteriana, muito comum em pacientes ortodônticos. O objetivo deste estudo é analisar os efeitos do verniz contendo clorexidina (40%) na flora bacteriana do sulco gengival e alterações no volume gengival em pacientes com aparelho ortodôntico e aumento do volume gengival. A amostra foi constituida de 30 pacientes provenientes da Clínica do Curso de Especialização em Ortodontia da Faculdade de Odontologia da Universidade Federal de Minas Gerais que apresentavam aumento do volume gengival. Para cada indivíduo foi coletado material do sulco gengival mesial e distal da vestibular dos segundos pré-molares do arco superior do lado direito e esquerdo...