Gingival bleeding on probing: relationship to change in periodontal pocket depth and effect of sodium hypochlorite oral rinse.

BACKGROUND AND OBJECTIVE: This study evaluated the potential of gingival bleeding on probing to serve as a predictor of future periodontal breakdown. It also assessed the ability of 0.25% sodium hypochlorite twice-a-week oral rinse to convert periodontal pockets showing bleeding on probing to nonbleeding sites. MATERIAL AND METHODS: The study was performed as a randomized, single-blinded, clinical trial in parallel groups. Seven periodontitis patients rinsed twice-weekly for 3 mo with 15 mL of a fresh solution of 0.25% sodium hypochlorite, and five periodontitis patients rinsed with water. The 12 study patients received no subgingival or supragingival scaling. Clorox(®) Regular-Bleach was the source of sodium hypochlorite. At baseline and 3-mo visits, gingival bleeding was assessed within 30 s after probing to full pocket depth using an approximate force of 0.75 N. RESULTS: A total of 470 (38%) of 1230 periodontal pockets in the bleach-rinse group revealed bleeding on probing at the initial visit but not at the 3-mo visit; only 71 (9%) of 828 pockets in the control group became bleeding-negative during the study (p < 0.001). Bleeding on probing in 4- to 7-mm-deep pockets decreased by 53% in the bleach-rinse group but increased by 6% in the water-rinse group (p < 0.001). Ninety-seven pockets showed depth increases of ≥ 2 mm after 3 mo: 60 (62%) of those pockets exhibited bleeding on probing at both the initial and the 3-mo visits; 24 (25%) bled at only one of the two visits; and 13 (13%) never demonstrated gingival bleeding (p < 0.001). CONCLUSIONS: Persistent gingival bleeding on probing was associated with an increased risk for periodontal breakdown, and the absence of gingival bleeding seemed to be a useful, although not perfect, indicator of disease stability. Twice-weekly oral rinsing with dilute bleach (0.25% sodium hypochlorite) produced a significant reduction in bleeding on probing, even in deep unscaled pockets. Sodium hypochlorite constitutes a valuable antiseptic in periodontal self-care.

Periodontal effects of 0.25% sodium hypochlorite twice-weekly oral rinse. A pilot study.

BACKGROUND AND OBJECTIVE: The study aimed to evaluate the effect of 0.25% sodium hypochlorite twice-weekly oral rinse on plaque and gingivitis in patients with minimally treated periodontitis. MATERIAL AND METHODS: The study included 30 patients with periodontitis, it lasted 3 mo, and it was performed as a randomized, controlled, single-blinded, clinical trial in parallel groups. Fifteen patients rinsed for 30 s with 15 mL of a fresh solution of 0.25% sodium hypochlorite (test) and 15 patients rinsed with 15 mL of water (control). Clorox(®) regular bleach was the source of the sodium hypochlorite. At baseline and at 2 wk, the study patients received professional subgingival irrigation for 5 min with either 0.25% sodium hypochlorite or water, but no subgingival or supragingival scaling. The presence or absence of supragingival plaque on facial and lingual surfaces was determined by visual inspection; each tooth was dried with air and mouth mirror rotation was used to provide light reflection to identify plaque on smooth surfaces and at the tooth line angles. Gingival bleeding within 30 s after probing to full pocket depth was assessed in six sites of each tooth. Adverse events were evaluated by questionnaire and visual examination. RESULTS: All 30 patients in the study completed the baseline and the 2 wk parts of the study and a subset of 12 participants completed the 3 mo part of the study. The sodium hypochlorite rinse group and the water rinse group, respectively, showed increases from baseline to 3 mo of 94% and 29% (3.2-fold difference) in plaque-free facial surfaces, of 195% and 30% (6.5-fold difference) in plaque-free lingual surfaces, and of 421% and 29% (14.5-fold difference) in number of teeth with no bleeding on probing. The differences in clinical improvement between the sodium hypochlorite rinse group and the water rinse group were statistically significant. No adverse events were identified in any of the study patients, except for minor complaints about the taste of bleach. CONCLUSION: A twice-weekly oral rinse with 0.25% sodium hypochlorite produced marked decreases in dental plaque level and bleeding on probing and may constitute a promising new approach to the management of periodontal disease. Long-term controlled studies on the effectiveness of sodium hypochlorite oral rinse are needed and encouraged.

Fluoride use in periodontal therapy: a review of the literature.

Although the relationship between fluoride and dental caries has been widely studied and definitively determined, the relationship between fluoride and periodontal health and disease is not clear. Conflicting studies in the literature either suggest routine fluoride usage as an adjunct to conventional periodontal therapy or argue against topical fluoride use on periodontally involved teeth. This review summarizes the literature that addresses the utility of fluoride in patients with periodontal disease and aims to advance a rational criterion for the use of fluorides in the management of periodontal diseases.

Test anxiety. Relationship to academic and clinical performance in dental hygiene students.

This study investigated the relationship of test anxiety, study skills, aptitude, and prior GPA to academic and clinical performance in junior and senior dental hygiene students. Eighty-nine volunteer subjects completed a test anxiety scale (TAS) and an effective study test (EST) at the beginning of the spring semester. Prior grade point average (GPA) and dental hygiene candidate aptitude (DHCAT) scores were obtained, and the relationships of all variables to spring GPA and spring clinic grade were analyzed. TAS showed significant, but weak, inverse relationships with prior GPA (r = -.24, p less than .05) and spring GPA (r = -.29, p less than .01). Verbal, science, and reading comprehension subscales of the DHCAT were significantly and moderately associated with spring GPA. In a hierarchical/stepwise regression analysis. TAS did not explain any of the variance in academic or clinical performance. Study skills explained 3% of the variance in spring GPA and 6% of the variance in spring clinic grade. Prior GPA was identified as the strongest predictor of academic performance in the dental hygiene program as it explained 44% of the variance in overall spring GPA. None of the variables studied emerged as a strong predictor of clinical performance.

Incorporating infant stimulation concepts into prenatal classes.

Prenatal classes provide an opportunity for childbirth educators to teach couples about parenting, as well as labor and delivery. Infant stimulation concepts can be interwoven into prenatal classes to help facilitate the development of prenatal bonding and parenting skills.

Effects of flossing on plaque and gingivitis in third grade schoolchildren.

The purpose of this investigation was to determine whether flossing, as an adjunct to toothbrushing, performed in a school-based program can contribute significantly to a reduction in gingivitis. Four volunteer third grade classrooms (n = 112) were randomly assigned to finger-floss, looped-floss, flossholder, and brushing-only control group. Measures taken at baseline and in four weeks included gingival (GI), plaque (PI), and flossing dexterity indices (FDI). Results using ANOVA showed no differences in PI among groups. However, both brushing-only and finger-floss groups showed GI scores significantly lower than the looped-floss group. A repeated measures ANOVA revealed that the finger-floss group improved gingivitis scores most over time, while the flossholder group improved scores the least. The ANCOVA results with FDI showed that at the final measurement, looped-floss manual dexterity was rated significantly better than finger-floss and that both groups were rated better than flossholder. Final indications are that toothbrushing alone can produce clinical results similar to use of a combination of toothbrushing and flossing.

Survey of 1980 California dental hygiene graduates to determine expanded-function utilization.

In a survey with an 81 percent response rate, 1980 California dental hygiene graduates reported that a large majority of dentists in 410 practices were delegating expanded functions. Hygienists reported that they were being delegated local anesthesia administration in 89 percent of their practice settings, soft-tissue curettage in 86 percent, and nitrous oxide and oxygen administration in 60 percent. More recent dental graduates delegated more frequently than older graduates. Teaching status of the dentist/employer did not appear to affect delegation. Periodontists delegated more than general dentists and this seemed to be related to patient need in those practices. Hygienists in general practices are feeling somewhat underutilized; however, they attribute a relatively small percentage (14.8% local anesthesia, 20.2% soft-tissue curettage and 4.1% nitrous oxide) of the underutilization to "lack of delegation" by their dentist/employer. Hygienists perceived "lack of patient need" and "lack of equipment" to be the major reasons for any underutilization in the expanded functions. In conclusion, it appears that a 1976 law change in California allowing dental hygienists to perform block and infiltration local anesthesia, soft-tissue curettage, and nitrous oxide and oxygen administration has resulted in a rather widespread change in the dental practices of this sample. Dentists are apparently delegating local anesthetic administration and soft-tissue curettage in over 85 percent of the 410 practices employing 216 hygienists. Delegation of nitrous oxide and oxygen administration, which is dependent on availability of equipment, was reported as being delegated in over 50 percent of the practices.(ABSTRACT TRUNCATED AT 250 WORDS)

Behavior modification for orthodontic patients: an exploratory approach to patient education.

The purpose of this project was to explore the usefulness of a behavior modification approach in changing oral hygiene habits of orthodontic patients. Two orthodontists identified patients in their practice who exhibited excessive plaque formation and inflammation and referred them to a health educator/dental hygienist. The health education program was subsequently presented to fifty-three patients, 8 to 18 years of age. Three counseling sessions with parental participation were scheduled approximately 2 weeks apart. The program consisted of a model for counseling, a rising and retiring survey to identify home routines, a list of "possible reinforcers" geared toward preteen interests, a monitoring card to record toothbrushing behavior, and a contract signed by both parent and child. Behavioral change in oral hygiene habits was measured through general assessment of toothbrushing technique, plaque accumulation, and soft-tissue appearance. Change in frequency of brushing was measured by patient self-monitoring. Patient and parental comments, as well as educator reactions, were considered in the over-all evaluation of the project.