The involvement of New Zealand dentists in smoking cessation interventions.

OBJECTIVES: To determine the attitudes and practices of dentists towards smoking cessation interventions (SCI), to identify perceived barriers to providing SCI, and to determine the level of interest in future training in smoking cessation for dental staff. DESIGN: Self-administered questionnaire. SUBJECTS AND METHODS: 204 NZDA members in Wellington, Otago, and Southland completed a self-administered questionnaire about SCI. RESULTS: There has been little change in attitudes and practices of dentists towards SCI over the last decade. Few are actively involved in providing these services for their patients. Most dentists believe that there are significant barriers to providing SCI in their daily practice. CONCLUSION: Dentists require greater access to appropriate forms of training in SCI, and increased support (including resources) in order to increase the level of SCI provided in the dental setting.

Periodontitis in a 13-year old: an illustration of a new periodontal classification.

This report describes a periodontal abscess and bone loss in a 13-year-old boy being treated as a patient in the Dental Benefit Scheme, a year after his entry to the Scheme. His condition illustrates well the rationale of a new classification for periodontitis. We suggest that periodontal screening is important so that instances such as this can be identified earlier; a small number of young patients require conventional, conservative periodontal treatment and ongoing monitoring of periodontal disease.

Guided tissue regeneration with and without demineralized freeze-dried bone allografts for maxillary Class II furca invasions of rapidly progressive periodontitis.

BACKGROUND: Guided tissue regeneration (GTR) using an expanded polytetrafluorethylene (ePTFE) membrane is an established treatment modality for periodontal disease. This study was designed to compare the effects of ePTFE membranes with and without demineralized, freeze-dried bone allografts (DFDBA) for treating maxillary class II buccal furca invasions of rapidly progressive periodonitis. METHODS: Seven patients with pairs of maxillary class II buccal furca invasions comprised the study group. The clinical parameters investigated were probing depth, probing attachment level and marginal tissue recession. One defect from each pair of teeth was randomly selected for the ePTFE membrane and DFDBA group and the other tooth defect received ePTFE membrane treatment only. During the operation, horizontal probing depths at the buccal furcation areas were measured. The membrane was removed 6 weeks after insertion. All measurements were repeated 1 year later at surgical re-entry of the buccal furcation. The Wilcoxon ranked sum test was used to test the significance of the difference between the groups 1 year after treatment. RESULTS: In the ePTFE membrane and DFDBA group, the mean probing depth reduction was 2.1 +/- 0.8 mm. The probing attachment gain was 2.6 +/- 1.0 mm and the bone fill was 3.1 +/- 1.7 mm. There was no statistically significant difference between the groups for these parameters. The marginal tissue recession was reduced 0.4 +/- 0.7 mm in ePTFE membrane and DFDBA group but increased 0.9 +/- 0.6 mm in ePTFE membrane only group. This difference was statistically significant (p = 0.016). CONCLUSIONS: There was no difference in probing depth reduction, probing attachment gain or bone fill between the two treatment modalities for treating maxillary class II buccal furca invasion of rapidly progressive periodontitis. Marginal tissue recession can be significantly reduced with the treatment of combined ePTFE membrane and DFDBA.

Local delivery of chlorhexidine using a tooth-bonded delivery system.

Films containing 20% w/w chlorhexidine base (particle size 63-125 microm) in poly(epsilon-caprolactone), MW 35,000-45,000, were prepared by solvent evaporation and sections attached to the mesio-lingual and mesio-buccal surfaces of the lower first molar in healthy volunteers. Saliva (<1.5 microl) was collected on Periopaper and chlorhexidine concentrations measured by HPLC were typically higher in the area immediately adjacent to the tooth-bonded film sections and lower at more distant sites. Analysis of variance of chlorhexidine concentrations, adjacent to the film sections, showed concentrations were significantly different on the buccal and lingual sides of the tooth and depended on the time of sampling (n=5, P<0.05).

The Community Periodontal Index of Treatment Needs--uses and abuses?

The CPITN system has undergone modifications to enable it to be used for the screening of patients in general practice. Many of the features of the original index are retained. The modifications overcome some of the concerns raised by critics of CPITN by allowing recession and furcation defects to be recorded. The widespread use of the modified Index indicates that it has a useful role to play in the diagnosis and management of periodontal diseases, and is a tribute to its original design.

Subject recruitment, retention, and compliance in clinical trials in periodontics.

Recruitment of subjects in randomized controlled trials is the process of screening and enrolling a predetermined number of subjects within a planned time. Differences between projected and actual recruitment rates are common and, when large, form a serious threat to the successful completion of the trial. Recruitment can be enhanced by 1) use of different, concurrent recruitment methods; 2) avoiding underestimations of the costs and time intensity of subject recruitment; and 3) regular monitoring of the efficiency of the recruitment effort. The recruitment process can be complicated by legal requirements of proper representation of sex and race characteristics or by stringent entry criteria. Complex designs (e.g., trials with a pre-randomization placebo run-in, split-mouth designs) have not yet shown to be cost-effective and may endanger recruitment success. Enhancing both subject retention and protocol compliance requires careful planning, attention to product design and staff training. The impact on trial findings is discussed.

The effect of local application of chlorhexidine on plaque and gingivitis.

This study compared the effects on plaque accumulation and gingival inflammation, of a 0.2 percent chlorhexidine solution applied with an interdental brush, with the effects of the interdental brush with control solution. Thirty-three subjects with at least one tooth-bounded edentulous space were chosen. The trial was of a double-blind, cross-over design with two, 28-day active periods separated by a 21-day rest period. The experimental solution was 0.2 percent aqueous chelorhexidine, and 0.1 percent quinine solution was used as the control. Prior to the commencement of the trial, plaque accumulation at the sites to be tested was recorded using the Plaque Index. Gingival condition was recorded using the Gingival Index. The surfaces were carefully scaled and cleaned to reduce the Plaque Index to 0. Subjects cleaned the selected tooth surfaces on a day using the interdental brush with the appropriate solution. After 28 days, the Plaque and Gingival Indices were recorded again. Normal oral hygiene was resumed during the rest period. The second trial followed the same format as the first, but with each subject using the alternative solution. Results were analysed using Wilcoxon signed-rank tests for matched pairs. 1. The mean Plaque and Gingival Index scores were reduced over the 28-day trial period for both experimental and control groups. 2. Although the Plaque Index scores were slightly lower after treatment with chlorhexidine when compared with the control, the difference was not statistically significant. 3. The reduction in Gingival Index was significantly greater for the chlorhexidine group than for the control group. The results indicated that 0.2 percent aqueous chlorhexidine, applied with an interdental brush to tooth surfaces adjacent to edentulous spaces, produced a significantly greater improvement in gingival health than the interdental brush with a placebo quinine solution, but the reductions in plaque accumulation were similar with the two solutions.

Determination of small sample volumes in the analysis of drugs at specific sites in the oral cavity.

Two methods for the determination of sample volumes between 0.2 and 0.6 microliters were compared by preparing standard curves for volumes over this range. The first method used a Periotron and the second the sample mass. A linear model was fitted and 95% confidence limits for volumes estimated by each method were calculated. This showed that use of either the maximum Periotron reading or the sample mass allowed estimation of volumes to within +/- 0.056 microliter and +/- 0.047 microliter respectively. It is proposed that measurement of sample mass provides a simple and accurate method to determine sample volume when analysing drug concentrations at specific sites in the oral cavity.

Familial gingival fibromatosis: a report of two patients.

This report describes two patients with familial gingival fibromatosis. Treatment for both patients involved gingivectomies to provide acceptable gingival function and appearance. The first patient has been monitored for only a short period, the second patient for 11 years. Neither patient has shown any recurrence of the condition.

Bacteraemia and tissue damage resulting from air polishing.

This study investigates the production of bacteraemia in dental prophylaxis by use of a commercially available air polishing device. Prophylaxis by means of the conventional rubber cup and paste method was used as a control. The study showed that air polishing can result in loss of epithelium at the gingival margin. The likelihood of a bacteraemia resulting from air polishing, in the absence of gingivitis, was less than in the group undergoing conventional prophylaxis. Although a higher number of bacteraemias was seen in the control group, the difference between the two groups was not statistically significant. Results indicate that patients who are at risk continue to require antibiotic cover.