Dental caries and associated factors among Turkish children and adults: Findings from the 3rd National Oral Health Survey.

BACKGROUND: Information on the current status of oral health and related risk factors is lacking in Turkiye. This study aimed to evaluate dental caries and associated factors among the Turkish population using the findings of the third national oral health survey. METHODS: This cross-sectional epidemiological survey was carried out between March and September in 2018 including five index ages and age groups (5-, 12-, 15-year-olds, 35-44 and 65-74 age groups). A multistage cluster sampling design was used to obtain a national representative sample of these age groups. Participants were interviewed face-to-face using a structured questionnaire, and oral examinations were performed based on the methods and criteria suggested by the World Health Organization. The adjusted prevalence ratio for dental caries was estimated considering sociodemographic and behavioural characteristics by using log-binomial and robust Poisson regression analysis in R and SAS software. RESULTS: After data cleaning, a total of 11 091 participants remained. The prevalence of dental caries was 76.5% (95% confidence interval: 75.4%-77.7%) and determined to be associated with age, dental visit, and pain or discomfort history during the previous year among the Turkish population. Prevalence was also associated with the mother's education level among 5-, 12- and 15-year-olds. For the 35-44 age group, individuals living in urban areas had lower dental caries than those living in rural areas. For 65-74 age group, none of the factors were significantly associated with dental caries. CONCLUSION: A high prevalence of dental caries was observed in Turkish children and adults. Therefore, it is necessary to strengthen current preventive oral health programs. Regular disease surveillance should be maintained. National oral health targets should be formulated in accordance with Turkiye's needs, resources and structure.

Evaluation of pain levels after Nd: YAG laser and scalpel incisions: an experimental study in rats.

BACKGROUND: Postoperative pain is a recognized sequel of periodontal surgery. The pain experience has been shown to peak in the first 24 hours following the procedure, and to decrease rapidly in subsequent days. The aim of the present study was to evaluate the pain levels following scalpel- and laser-incision of rat hind paws. METHODS: The study was carried out on 10 albino Wistar male rats. Rats were randomly assigned to two groups: Group I (n = 5, laser surgery), or Group II (n = 5, conventional surgery with scalpel). For measuring mechanical hyperalgesia, the nociceptive threshold of the hind paw after mechanical stimulation was quantified using a Basile algesimeter. The measurements were done before the surgery and on the postoperative 1(st), 2(nd), 3(rd), and 7(th) days. RESULTS: While the pain levels of the groups were similar before the surgical procedures, the laser-applied rats had significantly fewer nociceptive thresholds of the hind paw after mechanical stimulation compared with the scalpel-incised rats on the postoperative 1(st), 2(nd), 3(rd), and 7(th) days. Functional complications were not observed in the laser groups at three days after the surgery. CONCLUSION: The results suggested that, for soft tissue surgery, Nd: YAG lasers have often led to shorter operative times, less pain, and fewer postoperative adverse events.

The changes in the T-lymphocyte subsets in a population of Turkish children with puberty gingivitis.

OBJECTIVE: The aim of the study was to investigate the number of CD4 and CD8 T lymphocytes, analyse subjects with gingivitis and those without, and determine the role of T lymphocytes in the pathobiology of puberty gingivitis. MATERIAL AND METHODS: Fifty individuals with and without puberty gingivitis were recruited for this study. The CD4(+) and CD8(+) T-lymphocyte counts were determined using flow cytometry on the biopsy samples, and the CD4(+)/CD8(+) ratio was calculated. At the same time, periodontal index scores were recorded to assess the periodontal status. Acquired data were analysed statistically using a paired t-test to compare laboratory values obtained before and after the treatment in individuals with puberty gingivitis and disease-free individuals. In addition, Pearson's correlation analysis was performed to investigate the relation between laboratory values and clinical measurements. RESULTS: The CD4(+)/CD8 ratio in gingival tissues obtained from test group was significantly higher (P < 0.05) than that found in the gingival tissue obtained from control group. We found that the CD4(+) and CD8(+) lymphocyte counts continued to increase significantly (P < 0.001) and the CD4(+)/CD8(+) ratio continued to drop significantly (P < 0.05) after treatment in test group. CONCLUSIONS: T lymphocytes could play a significant role in the pathobiology of puberty gingivitis.

An evaluation of different treatments for recurrent aphthous stomatitis and patient perceptions: Nd:YAG laser versus medication.

OBJECTIVE: The aim of this randomized controlled clinical trial was to determine the anxiety levels of patients with recurrent aphthous stomatitis (RAS) prior to therapy with the Nd:YAG laser or medication, and to compare the effects of these different treatment methods on the degree of post-treatment pain, discomfort, and functional complications (eating and speech) experienced. MATERIALS AND METHODS: Twenty patients with RAS-related oral problems were included in the study. Levels of pre- and post-treatment pain and functional complications were assessed at patient visits on days 1, 4, and 7. RESULTS: The results indicated that patients treated with the Nd:YAG laser had less post-treatment pain and fewer functional complications, and reported immediate relief of pain and faster healing (p +/- 0.05). However, only after 5 d was there a significant reduction in the pain levels of the patients treated with medication. CONCLUSION: Our results suggest that the Nd:YAG laser has better patient acceptance, shorter treatment time, and lower rates of pain and post-treatment adverse events among patients with RAS.

Effect of Nd: YAG laser irradiation on the treatment of oral malodour associated with chronic periodontitis.

AIM: To investigate, using a randomised-controlled, single clinical trial whether treating periodontitis with non-surgical periodontal treatment procedures and laser applications can decrease the effect of oral malodour and compare the effectiveness of the different therapies. METHODS: Sixty patients suffering from chronic periodontitis and complaining of oral malodour were included in the study. The parameters measured included organoleptic scoring, volatile sulphur compound (VSC) levels, gingival index, plaque index, probing depth and clinical attachment levels before and after the different treatment procedures (oral hygiene instructions, scaling-root planing-SRP and subgingival Nd: YAG laser irradiation). RESULTS: There were significant relationships between oral malodour and the specific periodontal parameters. For all patients, there were statistically significant (p < 0.05) decreases in the clinical index scores and VSC values after all treatments. Although the VSC values decreased in all groups after treatment, laser treatment alone did not cause as large decreases as that achieved by SRP and SRP + laser irradiation. CONCLUSION: The results confirmed that in the population studied, oral malodour levels were significantly reduced after treating chronic periodontitis. The data indicated a possible adjunctive role for Nd: YAG lasers in periodontal therapy and treatment of oral malodour.

Aggressive periodontitis with streptococcal gingivitis: a case report.

Acute streptococcal gingivitis is an acute inflammation of the oral mucosa and also may be seen with the other oral diseases as aggressive periodontitis that is characterized by a considerable attachment loss over a relatively short period of time. Streptococcal infections of gingiva are seen rarely; also the origin of this gingival inflammation is occasionally different from that of routine plaque-associated gingivitis. The clinical features and treatment methods of these diseases are already reported in previous literatures. This case report describes a patient who presented with severe gingival inflammation and attachment loss that was diagnosed as an acute streptococcal infection associated with aggressive periodontitis. In this study a supportive treatment option was demonstrated based on these data and antacid treatment as adjunctive to the recommended treatment modalities was used for streptococcal gingivitis.

The Effect of ABO Blood Types on Periodontal Status.

OBJECTIVES: The purpose of the present study was to determine whether there was a relationship between periodontal diseases and ABO blood groups. METHODS: This epidemiological study was carried out on 1351 subjects who were randomly selected from individuals referred to the Faculty of Dentistry clinics for periodontal treatment or for other reasons regarding dental health. The study based on periodontal condition, blood group, and medical history. The subjects were divided into three groups as those with gingivitis, periodontitis, and the healthy ones. The effects of blood subgroups on periodontal health, gingivitis and periodontitis were investigated separately. RESULTS: A relatively higher percentage of A group patients was found in gingivitis group and relatively higher percentage of O group patients was found in periodontitis group. A significant relationship was also determined between Rh factor and gingivitis. CONCLUSIONS: ABO blood subgroups and Rh factor may constitute a risk factor on the development of periodontal disease. However, long-term studies are needed to make a more comprehensive assessment of the effects of ABO group on periodontal diseases.

The gingival crevicular fluid ciprofloxacin level in subjects with gingivitis and periodontitis, and its effects on clinical parameters.

OBJECTIVES: The purpose of this study, conducted on patients with gingivitis and periodontitis, was twofold: to find out the serum and gingival crevicular fluid concentration of ciprofloxacin, which is a common drug used effectively against Actinobacillus actinomycetemcomitans and to determine the effects of ciprofloxacin administration on clinical parameters. METHOD: A total of 32 adult patients, consisting of 16 subjects with gingivitis and 16 subjects with untreated chronic periodontitis, were included in the study. The subjects were divided into four groups: group I included eight subjects with chronic gingivitis who had not previously received any ciprofloxacin; group II included eight subjects with chronic gingivitis to whom three doses of ciprofloxacin were administered (Siprosan 500 mg) to establish adequate gingival crevicular fluid and serum concentrations of the agent; group III consisted of eight subjects with chronic periodontitis who had not received any ciprofloxacin; group IV included eight subjects with chronic periodontitis to whom three doses of ciprofloxacin were administered to establish adequate gingival crevicular fluid and serum concentrations of the agent. All patients were systemically healthy, free of pain and reported no current medication usage. Each patient was treated with scaling and/or root planing using specific hand instruments under local anesthesia. Gingival index, plaque index and clinical attachment levels of the teeth were used to determine the clinical condition of the subjects and findings were recorded at the beginning, seventh day, 21st day and third month of the study. Serum ciprofloxacin level was measured in venous blood. Approximately 5 ml of venous blood was drawn from subjects in groups II and IV using a standard venipuncture technique. Gingival crevicular fluid samples were sampled from six interproximal sites with six paper strips in the posterior region of upper jaw (excluding third molar) and all gingival crevicular fluid and serum samples were evaluated by high-performance liquid chromatography. RESULTS: The serum concentrations of ciprofloxacin at the first and 72nd hour were not significantly different in subjects with periodontitis compared to subjects with gingivitis. But the gingival crevicular fluid concentrations of ciprofloxacin at the same hours were significantly high in subjects with periodontitis compared to subjects with gingivitis. Both subjects with gingivitis and periodontitis had significantly higher ciprofloxacin levels in the gingival crevicular fluid than in serum. The application of ciprofloxacin did not have any positive or statistically significant effect upon the clinical parameters of the subjects with gingivitis. On the other hand, a significant decrease in the clinical attachment level scores of the subjects with periodontitis (group IV) was observed compared to group III in the 21st day and third month. CONCLUSION: According to these results, the use of ciprofloxacin as an alternative drug in subjects with periodontitis but not gingivitis can be recommended. However, long-term studies are also needed to assess the effects of ciprofloxacin on clinical parameters.

Musculoskeletal disorders in left- and right-handed Turkish dental students.

The purpose of this study was two-fold: first, to find out the musculoskeletal disorders between left- and right-handed dentists and second, to describe the prevalence and distribution of symptoms of musculoskeletal disorders among Turkish students who are practicing general dentistry. The investigation was carried out on 221 dental students; group I consisted of 24 left-handed students (18 male, 6 female), aged 24.2+/-2.24 years; group II comprised 24 right-handed students (14 male, 10 female), aged 25.1+/-3.14 years; and group III included 173 right-handed students (102 male, 71 female), aged 24.3+/-1.45 years. The study consists of a questionnaire to identify work tasks and working conditions, and a field study to assess the pain of the neck, shoulders, and other disorders during the dental practice. Data were analyzed through tests for the difference between two population proportion, percentage, and Chi-square. Left- and right-handed students had headaches (34%, 22%), pins and needles (35%, 22%), weakness (42%, 40%), numbness (23%, 19%), neck pain (67%, 43%), back pain (56%, 47%), upper limp pain (46%, 43%) and shoulder pain (78%, 58%), respectively (Table 3). Female students were not significantly different from males in musculoskeletal symptoms (p>.05). The position adopted by the student was significantly related to the intensity of pain. Left-handed students especially suffered from neck and shoulder pain when compared with right-handed students (p<.06). The authors think that a modification of work practices appears to be effective in decreasing the prevalence of symptoms. The best ergonomic working principles should be taught to the students, dental schools should provide a comfortable working environment, and further study is required to identify factors that will reduce the prevalence of symptoms among those practicing general dentistry.

Effect of tongue brushing on oral malodor in adolescents.

BACKGROUND: Halitosis is a common problem in humans, and is a social and psychological handicap for those affected by it. Halitosis has a positive correlation with the accumulation of bacterial plaque in the oral cavity. AIMS: The aim of the present study was to determine the effect of tongue brushing on oral malodor in adolescents. METHODS: The subjects of the investigation were 28 adolescents who had oral malodor and whose average age was 16 +/- 0.12 years. Subjects were chosen to participate in the study if they had an established routine of oral care, and did not have systemic or periodontal disease or dentures (such as fixed prosthesis or partial and total dentures). The subjects with oral malodor were randomly assigned into two groups. Individuals in the first group received instructions regarding professional procedures of oral care from a periodontist. In addition, individuals in this group had the surface of their tongue cleaned using a hard toothbrush, wetted with 0.12% chlorhexidine gluconate. Individuals in the second group (control) underwent the same professional procedures of oral care executed by the same periodontist, however, they did not have their tongues cleaned. Oral malodor of individuals was then evaluated for all individuals using the organoleptic method. The pH of the subjects tongues were recorded before and after treatment. The results of the oral malodor test were compared between the two groups. RESULTS: The results of the study found that oral malodor scores obtained by an organoleptic method was more severe in the second group than the first group, and statistical differences were found between the two groups (P < 0.001). CONCLUSION: These results revealed that accumulation of bacterial plaque on the tongue is an important factor for oral malodor in the adolescents. Oral malodor levels were significantly reduced after cleaning the surface of the tongue. Thus, tongue care shouldn't be neglected in order to avoid oral malodor.

Influence of different periodontal curette grips on the outcome of mechanical non-surgical therapy.

AIM: To determine to whether successful scaling and root planing (SRP) depends upon the grip used on the periodontal curette. METHODS: The hand grips used by dentists for holding periodontal curettes were examined and the dentists were allocated to one of two matched groups, one in which they used a modified pen grip, the other in which they did not. Using a split-mouth technique, patients scheduled for SRP had one quadrant treated by a dentist from each group. Instrument application force was recorded as were periodontal measures at operation and 3-months later. RESULTS: During scaling, forces reached a mean of 0.77N in dentists using a curette with a non-pen grip and 0.54N in those using a pen grip and during root planing, 0.93N and 0.64N respectively. These forces were statistically significantly different between the two groups. Pocket depth reduction in teeth treated by the two groups was similar but attachment levels were statistically significantly different. CONCLUSIONS: Instrument grip had a significant effect on response to SRP, suggesting that dentists using a modified pen grip achieved better clinical results.

Effects of zinc treatment in patients with recurrent aphthous stomatitis.

The purpose of this study was to assess the effects of systemic zinc sulfate in the treatment of recurrent aphthous stomatitis (RAS) by atomic absorption spectrophotometry. The study was carried out on 40 patients with RAS. The first group consisted of 20 subjects with RAS who were administered zinc sulfate (220 mg) once per day for one month. In the second group, there were 20 subjects with RAS who were administered placebo (saccharose). Results showed that the levels of serum zinc before treatment were under the normal value in the 42.5% percent of the patients with RAS. Saliva ALP, serum zinc, serum albumin, and serum alkaline phosphates activity for group II were significantly lower than those for group I after treatment (p < 0.01). After 1 month of zinc therapy the aphthae reduced and did not reappear for 3 months. The empirical use of systemic zinc sulfate supplementation in the treatment of RAS is recommend.

Clinical response to experimental forces and non-surgical therapy of teeth with various alveolar bone loss.

Firm lateral force is necessary for the thorough removal of calculus during scaling and root planning (SRP) with hand instruments. However, this firm lateral force should be applied to root surfaces without considering the tooth's loss of supporting tissues. The purpose of the present study was two-fold: firstly, to evaluate the initial pain response of periodontally diseased non-molar teeth with two different levels of alveolar bone loss (ABL) to experimental lateral and vertical pull forces; and secondly, to examine the clinical response of these teeth to non-surgical therapy. Twenty patients with chronic periodontitis were specifically selected in two groups according to the level of ABL at non-molar teeth. Group I consisted of 10 patients who have 141 non-molar teeth with a radiographic evidence of 40-65% ABL. Group II consisted of 10 patients who have 132 non-molar teeth with a radiographic evidence of > or =70% ABL. All patients were systemically healthy, free of pain, and reported no current medication usage. Starting from 0 and gradually increasing an experimental lateral force with digital force gauge, and also an experimental vertical pull force with mechanical force gauge were applied to each tooth and measured. As a result of a single experimental force applied to each non-molar tooth, the initial pain response emerged in the patients was determined by means of electronic bell system used by patients themselves. Each patient was treated with SRP using specific hand instruments under local anesthesia. Plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL) and periotest values (PV scores) were compared in both groups at initial and at month 3. A mean experimental lateral force of 24.6 N and a mean experimental vertical pull force of 48.3 N caused initial pain response in group I. Initial pain response occurred with a mean experimental lateral force of 5.3 N and a mean experimental vertical pull force of 19.4 N in group II. Only group I showed statistically significant decrease in PI, GI, PD and a significant attachment gain at month 3 (P < 0.05). There was a decrease of 6 PV in group I at month 3 (P < 0.05), whereas an increase of 4 PV was observed in group II (P > 0.05). This study showed that lateral and vertical forces required for effective SRP do not cause any problem in the group with 40-65% ABL. However, they may cause trauma in the group with approximately 70% ABL. Thus, the results suggest that the degree of healing would be different in the group with > or =70% ABL and in the group with 40-65% ABL.

Right- and left-handed dentists in periodontal therapy.

The purpose of this study was to determine whether successful dental therapy (scaling and root planing) depends upon handedness of dentists in right-handed dental chairs (units) Participants were 28 voluntary dentists (14 female and 14 male, ranging in age from 26 to 34 years). Patients (7 female and 7 male with a mean age of 39.6 years) had advanced periodontitis. Handedness was assessed using the Turkish version of the Edinburgh Handedness Inventory. There were two equal groups of dentists: left-handers (7 female, 7 male) and right-handers (7 female, 7 male). Initial examination of patients was performed using a pressure-controlled periodontal probe. During scaling and root planing, the negative interstroke forces were recorded using a piezo-electric receiver, an electronic transducer, and an analogue writer. The results showed that during scaling, mean negative forces reached a mean of 0.74 N in left-handed dentists and 0.52 N in right-handed dentists. During root planing, these forces were 0.86 N in left-handed dentists, and 0.63 N in right-handed dentists. These differences were statistically significant. The right-handed dentists were more successful than the left-handed dentists at scaling and root planing, provided that both of them used the same right-sided dental chairs. The importance of handedness of the dentists was accentuated in dental practice.

Right- and left-handed dentists using right- and left-sided dental chairs in treatment of calculus.

The aim of the present study was to evaluate the association of hand preference of dentists and the position of dental chairs in treatment of dental calculus. The dentists were last-class students from the School of Dentistry (Erzurum, Turkey). They were directed to dental chairs designed for right- and left-handers (right-sided and left-sided chairs) to remove calculus from the lower anterior teeth in volunteer patients having similar amounts of calculus, which was measured by Calculus index (CI). The right-handed dentists were more successful in right-sided (traditional) chairs than left-sided chairs; the left-handed dentists were more successful on left-sided chairs than right-sided chairs. The highest posttreatment CI (lowest success) was due to the right-handed dentists on the left-sided chairs. The lowest posttreatment CI (highest success) belonged to the left-handers working on the left-sided chairs. The left-handed dentists were better than right-handed dentists in the treatment of the mesial and distal surfaces of teeth, whereas the right-handers were successful only in the treatment of the distal parts of teeth. These results were explained by a better coordination between right and left hands and with higher skill in both hands in left-handers than right-handers.