Impact of Maintenance Therapy for the Prevention of Peri-implant Diseases: A Systematic Review and Meta-analysis.

At the present time, peri-implantitis has become a global burden that occurs with a frequency from 1% to 47% at implant level. Therefore, we aimed herein at assessing the impact of peri-implant maintenance therapy (PIMT) on the prevention of peri-implant diseases. Electronic and manual literature searches were conducted by 3 independent reviewers using several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, for articles up to June 2015 without language restriction. Articles were included if they were clinical trials aimed at demonstrating the incidence of peri-implant diseases under a strict regime or not of PIMT. Implant survival and failure rate were studied as secondary outcomes. A meta-analysis was conducted to evaluate the influence of PIMT and other reported variables upon peri-implant diseases. Thirteen and 10 clinical trials were included in the qualitative and quantitative analysis, respectively. Mucositis was affected by history of periodontitis and mean PIMT at implant and patient levels, respectively. Similarly, significant effects of history of periodontal disease were obtained for peri-implantitis for both implant and patient levels. Furthermore, mean PIMT interval was demonstrated to influence the incidence of peri-implantitis at implant but not patient level. PIMT interval showed significance at both levels. For implant survival, implants under PIMT have 0.958 the incident event than those with no PIMT. Within the limitations of the present systematic review, it can be concluded that implant therapy must not be limited to the placement and restoration of dental implants but to the implementation of PIMT to potentially prevent biologic complications and hence to heighten the long-term success rate. Although it must be tailored to a patient's risk profiling, our findings suggest reason to claim a minimum recall PIMT interval of 5 to 6 mo. Additionally, it must be stressed that even in the establishment of PIMT, biologic complications might occur. Thus, patient-, clinical-, and implant-related factors must be thoroughly explored.

Periodontal health of Singapore school children over two decades from 1970 to 1994.

Dental health surveys of school children in Singapore from the past two decades were reviewed to document changes in prevalence and severity of periodontal disease. In 1970, 1979, 1984, 1989 and 1994 a sample of 12,801, 10,232, 4,203, 4,733 and 5,005 school children aged 6-18 years respectively, were examined in schools by the Dental Division, Ministry of Health. Parameters examined were oral hygiene, calculus, gingival inflammation/bleeding and periodontal pockets. Oral hygiene was assessed by the Oral Hygiene Index of Greene and Vermillion. Periodontal condition was assessed by observation of presence or absence of gingival inflammation and periodontal pockets in the early surveys, and the Community Periodontal Index of Treatment Needs in 1989 and 1994. Findings demonstrated oral hygiene among children in Singapore was good. The mean Debris Scores for 6-11 year old were 0.74, 0.78 and 0.72 respectively in 1979, 1984 and 1989 while those of 12-18 year old were 0.43, 0.80 and 0.56 respectively for the corresponding years. Proportions of younger children with no periodontal disease were 32.2%, 60.0%, 59.0%, 31.0% and 34.4% in 1970, 1979, 1984, 1989 and 1994 respectively. For children aged twelve and above, proportions with no periodontal disease were 24.5%, 55.8%, 29%, 12% and 30% respectively in 1970, 1979, 1984, 1989 and 1994. Prevalence of gingivitis remained relatively high. However, a decrease in gingivitis from 1970 to 1979 in both age groups was noted. The period from 1984 to 1994, trends were dealt with cautiously due to changes in indices used. Severity of periodontal disease declined in terms of reduced mean number of diseased units/sextants and decrease in prevalence of periodontal pockets. Comparison of survey data for 1970, 1979, 1984, 1989 and 1994 shows improvement in periodontal health among children in Singapore over the past 2 decades. There is a continuing need for greater effort to promote better oral hygiene practices in view that only one third of children in 1994 had no periodontal disease.

Humoral immunity to stress proteins and periodontal disease.

BACKGROUND: There is evidence that microbial heat shock (stress) proteins (Hsp) are immunodominant antigens of many microorganisms. Immunity to these proteins has been shown in non-oral infections to contribute to protection. This study was undertaken to assess the relationship(s) between immunity to human and microbial heat shock proteins, periodontal disease status, and colonization by periodontal disease-associated microorganisms. METHODS: Subgingival plaque and blood samples obtained from 198 patients during an earlier clinical study were examined for the presence of specific periodontal disease-associated microorganisms and antibodies to selected human and microbial heat shock proteins (Hsp70, Hsp90, DnaK, and GroEL). Particle concentration immunofluorescence assay (PCFIA) was used to detect anti-Hsp antibodies and slot immunoblot assay (SIB) was used to detect subgingival plaque species. Regression models were used to examine the contribution of age, gender, gingival index, probing depth, attachment loss, calculus index, plaque index, and microbial colonization to the anti-Hsp antibody concentrations. RESULTS: Our studies demonstrated that, when evaluated by ANOVA, patients with higher anti-Hsp (Hsp90, DnaK, and GroEL) antibody concentrations tended to have significantly (P< or =0.05) healthier periodontal tissues. This was most obvious when the relationship between mean probing depths and antibody concentrations were studied. For Hsp90 antibodies, 2 variables (probing depth and P. gingivalis concentration) were found to have significant contributions (R = 0.293, P<0.0002). The equation derived from the regression model was y = 12558-2070*PD +1842*PG. This confirmed the inverse relationship with probing depth and the positive relationship with colonization by P. gingivalis. Attempts to model the other stress protein antibodies were not successful. CONCLUSIONS: We believe that the present observations reflect the presence of protective anti-Hsp antibodies, rather than simply the presence of the microorganism in the gingival sulcus. The clinical significance of these observations lies in the potential of identifying patients who are at risk for developing periodontal disease based on their inability to mount an immune response to specific Hsp or Hsp epitopes, as well as the development of vaccines based on Hsp epitopes.

Prospective survey of percutaneous injuries in orthodontic assistants.

This prospective diary survey provides documentation concerning the occurrence of percutaneous injury among orthodontic chairside assistants in the United States and Canada. A 20-day period was used to collect data regarding exposure to injuries; 693 valid responses were received from orthodontic assistants. Most chairside assistants in this sample work in a solo practice and average 33 hours per week treating patients for 49 weeks per year. The study identified a percutaneous injury rate of 0.11 for chairside assistants during this period, a rate than can be extrapolated to 1.4 episodes of percutaneous injury per year per chairside assistant. The majority of these injuries occurred outside the mouth. Those assistants with longer orthodontic experience had a lower injury rate than those with less experience. The rate of percutaneous injury to dental assistants was slightly higher than the annual rate (0.99) for orthodontists monitored by means of a companion survey and slightly lower than the rate (1.9) for a smaller sample of orthodontists from the American Dental Association survey of 1995. The annual rate of percutaneous injury for orthodontic chairside assistants is less than half of that observed for dentists in general practice.

A prospective survey of percutaneous injuries in orthodontists.

This national survey provides documentation regarding typical orthodontic practice patterns in the United States, including the prevalence of percutaneous injuries. The sample reflects a similar geographic distribution of the population as a whole, with more practitioners located in areas with higher populations. Most practitioners in this sample were in solo full-time practice, averaging 35 hours per week, and treating patients for 47 weeks per year. A 20-day prospective period was used to collect data regarding exposure to percutaneous injuries. The study identified a mean percutaneous injury rate of 0.085 during a 20-day period for practicing orthodontists, a value that can be extrapolated to slightly less than one (0.99) percutaneous injury per orthodontist per year. The majority of these injuries (84%) occurred outside the mouth. This rate is approximately one third the rate reported for dentists in general practice.

Declining prevalence of dental caries in school children in Singapore.

OBJECTIVE: Dental health surveys of school children in Singapore from past decades were reviewed to document reductions in prevalence of dental caries. MATERIALS AND METHODS: Surveys were carried out in schools by the Dental Division, Ministry of Health in 1970, 1979, 1984, 1989 and 1994. A sample size of approximately 5000 school children representing 1.2% of the school population aged 6 to 18 years old was examined in each survey. RESULTS: Survey data showed an increase in the proportion of children free of caries in the permanent dentition from 30% in 1970 to 58.7% in 1994. The DMFT index for 6 to 18 year old children has dropped from 2.98 in 1970, 2.61 in 1979, 1.97 in 1984, 1.61 in 1989 to 1.05 in 1994. CONCLUSION: Fluoridation of public water supplies together with the adoption of preventive dental health programmes by the State and professional bodies is credited as the major factor in caries reduction.

The prevalence of caries and enamel defects in 229 Malaysian children 16 years after water fluoridation (a pilot study).

Two hundred and twenty-nine children aged 12-15 years who were continuous residents of Penang island, in the north of Peninsular Malaysia were examined for caries and enamel defects. Caries prevalence was 82.2% with a DMFT score of 3.4 and DMFS score of 4.9; there were very few missing teeth and very little untreated caries in the population examined. Majority of DF (decayed/filled) lesions were pits and fissures with approximal and smooth surfaces relatively caries free. The prevalence of enamel defects was 76.4% with 19.1% of all teeth examined being affected. More posterior than anterior teeth were affected by enamel defects just as there were more maxillary than mandibular teeth affected by enamel defects. Diffuse patchy opacities were the most common defect diagnosed and this was found in 60.2% of the population examined. A bilateral distribution of diffuse patchy opacities was seen in 41.5% of the population examined. Tooth surfaces with enamel defects were no more susceptible to caries than defect-free surfaces.

Prevalence of dental fluorosis in children in Singapore.

Prevalence and severity of dental fluorosis was assessed in 1739 Singaporean children aged 9, 12 and 16 yr in three different ethnic groups. All subjects had resided since birth in Singapore, which has a tropical climate. The water supply was fluoridated in 1957 at a level of 0.7 ppm. In this sample, mouth prevalence was 82.6%, tooth prevalence was 66.9%, the community fluorosis index was at 1.96; 9.2% of children had severe fluorosis and 26.2% had moderate fluorosis. There were no significant gender or racial differences. Prevalences were higher than those reported in most other studies. Due to differences in indices used and methodology, comparisons could not be made directly with other studies.

Relation between incisal overjet and traumatic injury: a case control study.

Most previous studies have shown the prevalence of traumatic dental injuries in anterior teeth to increase with increasing overjet. This study identified 36 Singapore schoolchildren, age 7-18 years, from a clinic population of 11,179, who had suffered dental trauma while playing contact or collision sports. A case control group of 36 children, matched for age, sex, race and sporting activities, but who had not suffered dental trauma, was selected from the same clinic population. Both groups were examined and the nature of injuries received, together with overjet measured to the nearest 0.5 mm were determined. The mean overjet for the trauma group was 3.42 +/- 1.45 mm and for the injured group 3.42 +/- 1.33 mm. These means were not statistically different (p = 1.00), neither did the distribution of overjet between the groups differ. These data were not in accord with the majority of studies correlating incisal overjet and dental trauma, and they suggested that overjet was not a positive correlate with traumatic dental injury in Singapore schoolchildren.

A survey of tooth injury experience and attitudes to prevention in a group of Singapore schoolboys.

A survey of 246 boys aged 12-17 years (mean 13.8 years) determined the sports played, dental injury experience, knowledge and usage of and attitudes towards mouthguard wearing. Most played basketball and soccer. Twenty-one suffered 1 injury episode, 7-2 and 10-3 or more tooth injuries. Twenty-six subluxations, 19 fractures and 1 avulsion were reported. The sports with the highest prevalence of dental injury were boxing and wrestling (33%), soccer (20%), and basketball (19%). While 144 (56%) of boys knew about mouthguards, none wore one. Only 64 (25%) would wear a mouthguard if given one. Most dental injuries were minor, but four high-risk sports (> 19% injury prevalence) would justify preventive measures, including education for injury prevention and encouragement of mouthguard use.

A comparison of periodontal disease among rural Amish and non-Amish adults.

Periodontal disease can be more efficiently studied within a homogeneous population where genetic influences and lifestyles are similar enough to negative their effect on the disease process. This study focuses on an Amish population in southern Michigan who isolate themselves from outside influences and their non-Amish neighbors. A total of 425 Amish and 290 non-Amish were contacted resulting in 330 Amish and 215 non-Amish who were examined in their homes giving a participation rate of 76.2%. Ages ranged from 18 to 82 years. Prevalence of periodontal disease tended to be higher among males and increased with age. There were slightly more Amish females (52%) than non-Amish (49%). Means of periodontal conditions for Amish were 1.35 mm for attachment loss, 2.59 mm for pocket depth, 0.24 for calculus, 0.77 for plaque and 0.74 for gingivitis. For non-Amish, the means were 1.03 mm for attachment loss, 2.38 mm for pocket depth, 0.40 for calculus, 0.95 for plaque and 0.87 for gingivitis. It is of interest that the Amish do not practice routine oral hygiene. Only 36.8% of Amish reported brushing at least 1 x a day compared to 84.6% of non-Amish. Similarly, only 8.2% of Amish reported flossing at least 1 x a week compared to 40.8% of non-Amish.

Mouthguards: an easy-to-fabricate element of practice preventive programmes.

Mouthguards reduce the prevalence of dental injuries in contact sports. All types are effective, but those which are closely adapted to the teeth are the best retained, most comfortable, and therefore best accepted by sports people. Closely fitting mouthguards can be directly adapted in the mouth or laboratory-made on a stone model of the dental arch. The mouth-formed types can be fitted without professional supervision, but the procedure is often more successful if undertaken or supervised by a dental professional. The mouth forming procedure is quick and involves little material cost compared to the laboratory-made type. These savings can be passed on to patients in the form of lower fees which should encourage the widespread acceptance of mouthguards as a cost-effective preventive measure. Professionally fitted laboratory-made mouthguards are particularly suitable for high risk activities such as boxing, where more specialised protection such as a bimaxillary guard is indicated.

Singapore dentists' knowledge, advocacy and utilisation of mouthguards.

A questionnaire was distributed to Singapore Registered Dental Practitioners, seeking demographic details, knowledge of mouthguards in preventing dental injury during contact sport, current attitudes to advice and provision to at-risk patients. 636 questionnaires were posted and 226 valid replies were received. Most dentists believed that mouthguards reduced the prevalence of dental injury in contact sports. Undergraduate education was the primary source of dentists' knowledge. Seventy-four per cent of respondents actively recommended mouthguards, but only 26 per cent made one or more in 1992. Only 3 dentists made more than 10. Twenty-eight per cent were comfortable with their knowledge in this area, and 76 per cent would be willing to assist a public awareness campaign.

Periodontal disease in an Amish population.

Epidemiological studies of periodontal disease have attempted to focus on defined groups in which the variables thought to be responsible for disease could be controlled or more easily identified. This study documents periodontal disease parameters in a unique population of Amish farmers. A total of 371 Amish were contacted and 282 were examined in their homes giving a participation rate of 76%. Ages ranged from 18 to 79 years. Overall means for periodontal conditions were 1.54 mm for attachment loss, 2.63 mm for pocket depth, 0.17 for calculus, 0.63 for plaque and 0.61 for gingivitis. One dental examiner conducted all examinations. Prevalence of periodontal disease tended to be higher among males and increased with age. The majority of Amish examined had little evidence of destructive periodontal disease; about 3.4% of teeth examined had attachment loss of 6 mm or more. These findings indicate a modest level of periodontal disease among the Amish. It is of interest that this population does not generally seek routine dental care. Preliminary analyses of health behavior data collected indicate a lack of regular oral hygiene practices. It appears that the Amish may have protective factors which affect their level of disease.

Relationship of dental caries and fluorosis to fluoride supplement history in a non-fluoridated sample of schoolchildren.

A random sample of 206 Michigan children, aged from 9 to 13, were examined for fluorosis from a larger group of 2038 children participating in a dental project. Clinical examinations included caries data (DMFS) and assessment of fluorosis by use of the Tooth Surface Index of Fluorosis (TSIF). Separate examiners were used for each index. The response rate of a questionnaire mailed to parents to gather information on residence histories, use of fluoride supplements, and antibiotics was 78%. The prevalence of fluorosis was about 20% among the respondents. Of the 4868 tooth surfaces examined, 9.2% were affected by fluorosis. In all cases, dental fluorosis was judged as mild, with most occurrences on the posterior teeth. No instances of moderate or severe fluorosis were found. The caries experience of respondents was 1.69 +/- 2.73 DMFS. Caries experience does not appear to be significantly related to income, education, or fluoride supplement use. Approximately 52% of respondents were reported to have taken fluoride supplements with various degrees of consistency. Parents' education was positively related to both prevalence of fluorosis (odds ratio = 2.2) and use of fluoride supplements (odds ratio = 2.7). No significant relation was revealed with evidence of fluorosis and use of supplements. This study shows a relatively mild level of dental fluorosis in a sample of children from a non-fluoridated area. Dental fluorosis in this group does not appear to be related to use of fluoride supplements or differences in caries experience.

Relation of sources of systemic fluoride to prevalence of dental fluorosis.

The prevalence of dental fluorosis in a nonfluoridated area was determined and related to the reported fluoride ingestion histories of the children examined. A convenience sample of 543 schoolchildren in rural areas of Michigan was examined for fluorosis using the Tooth Surface Index of Fluorosis. Questionnaires that asked about previous use of fluorides were sent to parents of all children examined. The response rate was 76 percent (412 usable questionnaires). A criterion for inclusion in the data analysis stipulated that only fluorosed surfaces that occurred bilaterally would be included. Fluorosis was found on 7 percent of all tooth surfaces and only in the mild form. Twenty-two percent of the subjects were classified as having fluorosis. Dietary supplement was the only fluoride that was found to be significantly related to the occurrence of fluorosis. A greater proportion of the subjects with fluorosis listed physicians, rather than dentists, as the source of fluoride prescriptions. The results demonstrate similarities to the fluorosis reported in other studies in nonfluoridated areas, but also suggest the need to minimize the occurrence of fluorosis through proper assessment of a child's fluoride exposure and the judicious use of additional fluoride.

Fissure sealant knowledge and characteristics of parents as a function of their child's sealant status.

A survey was conducted to identify and compare sealant knowledge and sources of sealant information of parents whose children had and had not received fissure sealants. The socioeconomic characteristics of these individuals were also compared. The sealant group was composed of the parents of children found to have a sealant on at least one permanent tooth during dental examinations of 2,036 elementary schoolchildren in southwestern Michigan. Another group of children was selected from the same population and matched to the children with sealants by child's age, sex, school location, and community. Surveys were returned by 210 of 260 sets of parents (81% response rate). Significant differences were found between the two groups with regard to parents' ages and levels of income. Parents of children with sealants had more correct information about the procedure and 74 percent of these individuals reported that the dental office was their primary source of information. For the group without sealants, 48 percent of respondents reported no source of sealant information. Findings suggest that dental personnel may strongly influence dissemination of information about sealants and utilization of this preventive procedure.

Oral health status, knowledge, and practices in an Amish population.

This study was conducted in the summer of 1985 to assess the oral health status, knowledge, and practices of an Amish population in southwest Michigan. Dental caries experience, periodontal health, and oral hygiene status were recorded using decayed, missing, and filled surfaces (DMFS), periodontal index (PI), and simplified oral hygiene index (OHI-S). Data on oral health knowledge and practices were collected by interviews using a structured questionnaire. Results showed significantly lower levels of disease among Amish. DMFS scores for 5-17-year-old Amish children were almost half that of the US general population (NIDR 1979-80). PI score of all ages combined was 2.0, which was 3.6 times lower than a national sample (1971-74). Lower levels of disease in Amish could be related to their way of life and dietary patterns. A relatively higher level of unmet need for prosthodontic care, inadequate oral health knowledge, and barriers to dental care in the study population emphasize the need for dental public health and health education programs.