Improved periodontal status through self-assessment. A 2-year longitudinal study in teenagers.

Short-term success of the use of self-assessment for motivating adults to improve their oral health status has been reported. The purpose of this trial was to evaluate the long-term effectiveness of two self-assessment strategies, one focused on gingival bleeding (group I) and another focused on plaque (group II). At baseline, 493 14- and 15-year-olds were assigned randomly to a group. Each subject was given a manual describing one of the self-assessment processes. Dental hygienists provided standardized classroom based instruction and two weeks later, individualized counselling. Examinations were conducted at baseline 6, 12, 18 and 24 months for gingival bleeding on probing, plaque, calculus, and probing depth; and at baseline and 24 months for recession and decayed, missing and filled surfaces (DMFS). Following the 12-month examination, subjects received an oral prophylaxis and individual counselling. The results revealed no statistically significant differences between groups for any clinical parameter at the final examination. However, the mean number of sites with gingival bleeding decreased steadily from baseline to 24 months with a 59% decrease and 55% decrease for groups I and II, respectively. This study suggests that self-assessment approaches can be effective in improving the long-term periodontal health status of teenagers.

Effects of supervised daily dental plaque removal by children after 3 years.

The benefits of a school-based plaque removal program are presented. Children in grades 5-8 were inclined in a study which was designed to determine the effect on oral hygiene, gingival inflammation and dental caries of removing dental plaque through supervised daily flossing and toothbrushing in school. A fluoride-free dentifrice was used. Controls did not receive instruction in plaque removal procedures nor did they engage in plaque removal activities at school. For three school years the students in the treatment group practiced daily plaque removal, supervised by trained personnel. All participants were examined initially for plaque (PHP), gingival inflammation (DHC) and dental caries (DMFS). Girls in the treatment group showed a significant reduction (28%) in mean plaque scores and, for girls and boys, the mean changes in gingivitis scores were significantly reduced (40% and 17%, respectively). Adjusted mean incremental DMF surface scores were 13% lower in the treatment group than in the control group. The difference between groups was not statistically significant and was accounted for entirely by the findings in mesial and distal surfaces (26%). This difference approached statistical significance (P=0.07).

Effects of supervised daily dental plaque removal by children: II. 24 months' results.

After two school years of a supervised daily plaque-removal program in school, children in the treatment group showed a significant reduction in plaque and gingival inflammation scores compared with children in the control group. However, differences between groups in terms of plaque and gingivitis scores virtually disappeared during the summer vacation. The increment of dental caries was lower in the treatment group than in the control group, but the reduction, which averaged about 20 percent, was not statistically significant either for teeth or for surfaces. Although the 24-month findings of the present study indicate some degree of success in reducing plaque and gingivitis and a marginal effect in reducing the incidence of dental caries among children who engaged in daily, supervised plaque-removal in school, obvious drawbacks limit the value of this regimen.

Effects of supervised daily dental plaque removal by children: first-year results.

In September 1973, a three-year school-based study was initiated in East Hampton, Connecticut, a rural nonfluoridated community. The purpose of the study is to determine the effect on dental decay, gingival inflammation and oral hygiene of removing dental plaque through supervised daily toothbrushing and flossing in school during a three-year period. To establish baseline data, three indexes were used: the DHC Index to evaluate gingivitis; the DMF Surface Index to quantify dental caries and the PHP Index to measure dental plaque. The examinations for dental caries, including radiographs, are scheduled annually in September, whereas the plaque and gingival examinations are done biannually, in September and June. After the baseline examinations the 481 children were blocked according to grade and sex and then were randomly assigned to either a treatment group or to a control group. In November, the treatment group was provided 10 sessions of instruction in plaque removal. For the remainder of the year (six months) they practiced daily plaque removal, supervised by a dental hygienist and a nurse. The control group was not instructed in oral hygiene procedures. In the treatment group, mean plaque and gingival scores at the June (first follow-up) examination were 14 percent and 29 percent lower, respectively, than at baseline. No change was seen in the control group. At the second follow-up examination in September (after summer vacation), the same indexes were nearly at baseline levels in the treatment group. There was no treatment effect on dental caries increments after one year of study. Considering the nature of the treatment regimen and the few treatments during the first year of the study, it is not surprising that there were no caries-preventive benefits demonstrated among children in the treatment group after one year. The total number of the plaque removal sessions will be greater during the second year of the study. Therefore, the possibility of detecting a caries preventive effect at the twenty-four month examinations, should one exist, will be enhanced.

Teachers as models in programs for school dental health; an evaluation of "The Toothkeeper".

An evaluation of the effectiveness of the Toothkeeper program was performed in Houston to determine if participation in the program by elementary school children would result in their having cleaner teeth and better gingival health than seen in similar children not in the program. Assessments for plaque and gingivitis were made at the beginning, at the completion of the formal 16-week program, and again after a second 16-week period. In this particular setting, the Toothkeeper was found to be ineffective. Possible reasons for the ineffectiveness of the program are discussed and several suggestions for modifying the program are offered.