Microbial Sampling Using Interdental Brushes and Paper Points around Teeth and Implants: A Pilot Study for Comparison.

Inflammatory periodontal and peri-implant diseases follow dysbiotic shifts in a susceptible host. A well-established tool for microbial sample collection is the use of paper points. The purpose of this pilot study was to evaluate the use of interdental brushes compared to paper points. Biofilm samples were collected with paper points and later interdental brushes from ten patients. Five patients were represented with a community periodontal index of treatment needs (CPITN) of 0-2 around the teeth and an implant with PPD ≤ 5 mm and no radiological bone loss. The remaining five patients had a CPITN ≥ 3 and one implant with peri-implantitis. Microbial samples were analyzed with quantitative polymerase chain reaction (qPCR) and next-generation sequencing (NGS). The results showed higher amounts of DNA in samples taken by interdental brushes but also higher Ct values. Both methods detected Filifactor alocis, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola in the majority of samples, while Aggregatibacter actinomycetemcomitans was rarely found. A microbial dysbiosis index showed comparable or higher values in sites with no periodontitis/peri-implantitis with interdental brushes. The results of this pilot study indicate that interdental brushes might be a valid technique for microbial sampling and particularly advantageous in the early detection of dysbiotic shifts around teeth and implants. Larger studies with more participants are needed to validate the proposed microbial sampling method with interdental brushes.

The effect of clinical education on optimizing self-care by dental students in Switzerland.

Students, who may begin their dental education with sub-optimal oral self-care practices, are taught they should motivate patients to clean interdentally and reduce/stop smoking. To better understand their internalization of these concepts, students were surveyed at two distinct time points. Student cohorts from four Swiss universities were asked to complete an interdental cleaning/smoking habit questionnaire at the beginning of their pre-clinical education (n = 110) and again a year later, when beginning treatment of patients (n = 115). A local cohort (n = 28) was observed for comparison. All subjects participated voluntarily and anonymously. Interdental cleaning ≥ 3 times per week was performed by 48% first-year and 43% secondyear students in Basel, 60% and 76% in Bern, 60% and 70% in Geneva, 41% and 49% in Zurich, and 29% in the local cohort. Logistic regression using gender, class year and school as explanatory variables showed gender (p < 0.001) and school (p = 0.018) influenced cleaning frequency, with the odds being 3.16 [95% CI: 1.76, 5.67] times higher for females to perform interdental cleaning ≥ 3 times per week. Smoking was reported both years in numbers too low to analyze. Approximately 29% of the local cohort and 52% of the first-year students displayed an interdental cleaning frequency congruent with oral health recommendations. Adequate cleaning frequency increased for second-year students to 58%, which was not significant. Further study is needed to determine why more dental students do not themselves clean interdentally.

Preclinical competency in scaling/root planing: comparing dental and dental hygiene student's outcomes

Dental students in Zurich receive 8.5 hours of preclinical training in scaling/root planing. Dental hygiene students receive a multiple of this amount. This study was undertaken to assess the students' acquired preclinical competencies and to what degree they may differ. 34 undergraduate dental students and 20 dental hygiene (DH) students from two different schools in Zurich were tasked with scaling/root planing a maxillary left canine, coated with black lacquer from the apex to ca. 5 mm above the cemento-enamel junction, after completing their preclinical periodontal instrumentation course. The students were allowed to use any instrument in their set (Gracey or universal curettes) for a 5-minute period. Positive (experienced DHs) and negative (laypeople) control groups performed the same task. After instrumentation, teeth were scanned and planimetrically assessed. The percentage of cleaned tooth surface was calculated and statistically analysed (Kruskal-Wallis rank sum test, Conover's test for pairwise comparisons). The dental students achieved the highest median cleaning efficacy (80.6%), followed by the experienced DHs (65.3%), the DH students (62.0%) and the laypeople (26.7%). When split by schools, a significant difference in instrumentation efficacy by the student DHs was seen (p <0.001). Despite their limited instruction time, the dental students acquired preclinical scaling/root planing skills comparable to, or better than, DH students with more training time.

Influence of ultrasonic tip distance and orientation on biofilm removal.

OBJECTIVE: The aim of this study is to assess the effects of ultrasonic tip distance and orientation on the removal of a multispecies biofilm under standardized conditions in vitro. METHODS: Six-species biofilms were grown on hydroxyapatite discs for 64 h and treated with a magnetostrictive ultrasonic tip (Cavitron) placed either on contact or at 0.25- and 0.5-mm distance. The treatment was performed for 15 s with either the tip at right angle or sideways. Biofilm removal was evaluated by assessing the viable bacteria in each supernatant and compared to respective controls. In the latter, biofilms were mechanically removed and evaluated in supernatants to assess adhering and floating bacteria. Colony-forming units (CFU) were determined by cultivation on solid media. Any remaining biofilm on the treated discs was also visualized after staining with green-fluorescent SYTO® 9 stain using a confocal laser scanning microscope (CLSM). Mann-Whitney U tests and Bonferroni correction were used to analyze the results between the groups. RESULTS: Sideways application of the ultrasonic tip at distances of 0.25 and 0.5 mm removed as many bacteria as present on the control discs compared to the tip on contact (p < 0.05). All other application modes, especially the ultrasonic tip applied perpendicularly on contact, showed no statistical significance in removing biofilm. CONCLUSION: Overall, data indicated that bacterial detachment depended on tip orientation and distance, especially when the tip was applied sideways similar to the clinical setting. CLINICAL RELEVANCE: Biofilm removal by means of ultrasonic debridement remains a crucial aspect in the treatment of periodontal disease. To ensure sufficient biofilm removal, the tip does not necessarily require contact to the surface, but an application parallel to the surface on the side is recommended.

Influence of different post-interventional maintenance concepts on periodontal outcomes: an evaluation of three systematic reviews.

BACKGROUND: To selectively review the existing literature on post-interventional maintenance protocols in patients with periodontal disease receiving either non-surgical or surgical periodontal treatment. METHODS: Three systematic reviews with different periodontal interventions, i.e. scaling and root planing (SRP), SRP with adjunctive antibiotics or regenerative periodontal surgery were evaluated focusing on their post-interventional maintenance care. Due to the early publication of one review an additional literature search update was undertaken. The search was executed for studies published from January 2001 till March 2015 through an electronic database to ensure the inclusion of resent studies on SRP. Two reviewers guided the study selection and assessed the validity of the three reviews found. RESULTS: Within the group of scaling and root planing alone there have been nine studies with more than three appointments for maintenance care and five studies with more than two appointments in the first 2 months after the intervention. Chlorhexidine was the most frequently used antiseptic agent used for 2 weeks after non-surgical intervention. Scaling and root planing with adjunctive antibiotics showed a similar number of visits with professional biofilm debridement, whereas regenerative studies displayed more studies with more than three visits in the intervention group. In addition, the use of antiseptics was longer and lasted 4 to 8 weeks after the regenerative intervention. The latter studies also showed more stringent maintenance protocols. CONCLUSIONS: With increased interventional effort there was a greater tendency to increase frequency and duration of the maintenance care program and antiseptic agents.