Effects of interdental cleaning devices in preventing dental caries and periodontal diseases: a scoping review.

To identify and map existing evidence on the effectiveness of interdental cleaning devices in preventing dental caries and periodontal diseases, a scoping review was carried out by electronically searching PubMed, Scopus and Embase. Studies on interdental cleaning devices, written in English, and published from January 2008 up to April 2019 were included in the review. Of 1860 studies identified, six systematic reviews (SR) were included in the review. One SR each was on flossing, interdental brushes, wood sticks and oral irrigation. Of two SR on multitude of interdental cleaning devices, one assessed comparative efficacy while the other both the individual and comparative efficacy. All reviews had assessed the heterogeneity and the methodological quality of studies included, and performed data extraction and meta-analysis where appropriate. Evidence ranged from weak to moderate with very low- to low-certainty for the adjunctive benefit of these devices to control plaque and gingivitis. It warrants long-term studies with sufficient power and those assessing the impact of interdental cleaning on interproximal caries to corroborate such evidence. Available evidence on the efficacy of interdental cleaning devices suggests that dental practitioners recommend patient-specific interdental cleaning devices that enable patients to achieve a safe and high standard of interdental cleaning.

A scoping review of caries risk management protocols in Australia and New Zealand.

To identify and map the caries risk management protocols with multiple strategies, which were used in Australia and New Zealand and reported in the existing literature, a scoping review was carried out by electronically searching PubMed, Web of Science, Scopus, Embase and Dentistry and Oral Science. Studies on caries risk management protocols, written in English, limited to Australia and New Zealand and published up to March 2018 were included in the review. There was no restriction on participants' age. Of 257 studies identified, seven were included in the review. These seven studies were reported in Australia and all but six were based on the caries management system (CMS). There were two descriptive studies, one 3-year multicentre cluster randomized controlled trial (RCT), one 2 to 4-year post-RCT follow-up and two cost-effective evaluations based on Markov decision analytic models. While concentrating on assessing individual behavioural risk factors for dental caries, studies indicated that the CMS would be more cost-effective if its protocol was properly adhered to. Future studies on caries risk management protocols are suggested to consider both the individual characteristics and the social context of different population groups in view of enhancing the effectiveness of oral care.

Health behaviours and quality of life in independently living South Australians aged 75 years or older.

BACKGROUND: This study evaluated the associations between oral and general health behaviours, self-reported health and quality of life of adults aged 75 years or older living independently in South Australia. METHODS: A cross sectional study based on a self-report mailed questionnaire was conducted in 590 independently living adults aged 75 years or older. Self-ratings of oral health and general health were assessed using single-item global ratings. Quality of life was measured using the Oral Health Impact Profile and the EuroQol instrument for health utility. RESULTS: The overall response rate was 78%. The current analyses were restricted to 354 dentate older adults. Increasing age and being female were negatively associated with EuroQol scores. Good self-rated oral and general health were more prevalent in participants with higher social status who also had lower oral health impact and higher EuroQol scores. Good self-rated oral and general health were less prevalent while oral health impact was greater in participants who ate few fruits, vegetables or dairy products. CONCLUSIONS: Self-rated health and quality of life were poor in older adults with inadequate fruit/vegetables/dairy intake and lower social status. These findings suggest that nutrition and socioeconomic factors may be important to the oral and general health of adults aged 75 years or older.

Practice characteristics and service provision rates of dental hygienists in Australia.

INTRODUCTION: Dental hygienists (DHs) have been practising in Australia since the early 1970s. OBJECTIVE: This study describes the clinical activity of Australian DHs. METHODS: A questionnaire was mailed to members of two professional associations representing DHs. Practitioner characteristics, employment characteristics and clinical activity on a self-reported typical practice day were collected. The proportion of each service item of all services provided was estimated. Associations between practice characteristics and service provision were assessed by log-binomial regression models. RESULTS: Adjusted response rate was 60.6%. Of the DHs included in analysis (n=341), 80% were employed in general practice, and nearly all (96%) worked in the private sector. About half (53.7%) of all service provided were preventive services, and one-fourth (23.9%) were diagnostic. Service provision varied by practice and practitioner characteristics, with the largest variations observed by practice type. Unadjusted analysis showed that general practice DHs provided a higher mean number of periodontal instrumentation and coronal polishing (0.92 vs 0.26), fluoride applications (0.64 vs 0.08), oral examinations (0.51 vs 0.22) and intraoral radiographs (0.33 vs 0.07) per patient visit and a lower mean number of impressions (0.05 vs 0.17) and orthodontic services (0.02 vs 0.59) than specialist practice DHs. In adjusted analysis, rates of periodontal services also significantly varied by practice type; other associations persisted. CONCLUSION: Service provision of DHs varied by practice type. Practice activity was dominated by provision of preventive services while provision of periodontal treatments, fissure sealants and oral examinations was relatively limited indicating areas in which DHs are possibly underutilized.

Dental service provision by oral health therapists, dental hygienists and dental therapists in Australia: implications for workforce modelling.

OBJECTIVE: Dental service provision rates are necessary for workforce planning. This study estimates patient and service rates for oral health therapists (OHTs), dental hygienists (DHs) and dental therapists (DTs). To identify important variables for workforce modelling, variations in rates by practice characteristics were assessed. DESIGN: A cross-sectional self-complete mailed questionnaire collected demographic and employment characteristics, and clinical activity on a self-selected typical day of practice. SETTING: Private and public dental practices in Australia. PARTICIPANTS: Members of the two professional associations representing DHs, DTs and OHTs. METHODS: For each practitioner type, means and adjusted rate ratios of patients per hour, services per visit and preventive services per visit were estimated. Comparisons by practice characteristics were assessed by negative binomial regression models. RESULTS: Response rate was 60.6% (n = 1,083), 90.9% were employed of which 86.3% were working in clinical practice and completed the service log. Mean services per patient visit provided by OHTs, DHs and DTs were 3.7, 3.5 and 3.3 and mean preventive services per patient were 2.1, 2.1 and 1.8 respectively. For all three groups, adjusting for explanatory variables, the rate of preventive services per patient varied significantly by practice type (general or specialist) and by the proportion of child patients treated. CONCLUSION: Services rates varied by age distribution of patients and type of practice. If these factors were anticipated to vary over-time, then workforce planning models should consider accounting for the potential impact on capacity to supply services by these dental workforce groups.

Applied scope of practice of oral health therapists, dental hygienists and dental therapists.

BACKGROUND: Oral health therapists (OHTs) are an emerging workforce whose training incorporates the skills of dental hygienists (DHs) and dental therapists (DTs). There are concerns that OHTs are underutilized. This study compares the employment characteristics and applied practice scope of OHTs with those of DTs and DHs. METHODS: Members of two professional associations representing DHs, DTs and OHTs, were surveyed by mail. Data collected included demographic and employment characteristics and clinical activity on a typical practice day. Applied practice scope was described by calculating the proportion of practitioners that had provided ≥1 of a selected range of key services. Log binomial regression was used to compare OHTs to DTs and DHs. RESULTS: The response rate was 60.6% (n = 1083) and of these 90.9% were employed. Preventive services dominated service provision. The proportion of OHTs that provided fluoride applications (77%) was higher than the proportion of DTs (53%, p < 0.05), and was not significantly different from the proportion of DHs (70%). The proportion of OHTs that provided (48%) fissure sealants was lower than the proportion of DTs (70%) and substantially higher than the proportion of DHs (10%, p > 0.05). CONCLUSIONS: Overall, the applied practice scope of OHTs appeared to differ from DTs and DHs.

Associations with dental caries experience among a convenience sample of Aboriginal Australian adults.

BACKGROUND: Few studies have examined dental caries experience in Aboriginal adults. The objectives of this study were to describe the dental caries experience of some Aboriginal Australian adults residing in the Northern Territory, and to determine associations with dental caries experience. METHODS: A convenience sample of Aboriginal adults from Australia's Northern Territory was dentally examined. Self-reported oral health information was collected through a questionnaire. RESULTS: Data were available for 312 participants. The per cent of untreated decayed teeth (per cent DT >0) was 77.9 (95% CI 73.0 to 82.1), the mean DT was 3.0 (95% CI 2.6 to 3.4), the prevalence of any caries experience (the per cent DMFT >0) was 95.5 (95% CI 92.6 to 97.3) and the mean DMFT was 9.7 (95% CI 8.9 to 10.5). In multivariable analyses, unemployment and not brushing teeth the previous day were associated with the per cent DT >0. Problem-based dental attendance was associated with both the mean DT and the per cent DMFT >0. Older age, residing in the capital city, being non-incarcerated, last visiting a dentist <1 year ago and problem-based dental attendance were associated with the mean DMFT. CONCLUSIONS: Dental caries experience among this convenience sample of Aboriginal Australian adults was very high. Most factors associated with dental caries were social determinants or dental service access-related.

Oral health behaviours and perceptions reported by Indigenous Australians living in Darwin, Northern Territory.

OBJECTIVE: To describe the reported oral health behaviours and perceptions of Indigenous Australians living in Darwin, Northern Territory and to compare those with estimates for Darwin and Australia derived from the National Survey of Adult Oral Health (NSAOH). PARTICIPANTS: A total of 181 Indigenous Australians aged 22 years and over living in Darwin, participating in screening for a wider randomised clinical trial, were included. METHOD: Information on socio-demographic characteristics, oral health status including oral health behaviours and perceptions was collected using a questionnaire. Differences between the Darwin study (DS) participants and Australians in NSAOH were made based on non-overlapping 95% confidence intervals. RESULTS: Almost 72% of DS participants had last seen a dentist over a year earlier, compared to 47% and 39% of NSAOH Darwin and Australian participants, respectively. A higher proportion of DS participants usually visited a dentist because of a problem than NSAOH Darwin and NSAOH Australian participants. A higher proportion of DS participants had avoided or delayed a dental visit because of cost than NSAOH participants. Over three times as many DS participants rated their oral health as fair/poor compared to NSAOH participants. A higher proportion of DS participants had perceived gum disease and one or more symptoms of gum disease than NSAOH participants. A higher proportion of DS participants experienced toothache, felt uncomfortable about appearance of their mouth and avoided eating because of oral problems than NSAOH participants. CONCLUSIONS: A higher proportion of Indigenous Australians living in Darwin presented with non-optimal oral health behaviours and perceptions compared with both the Darwin and Australian general populations.

Influence of family structure on dental caries experience of preschool children in Sri Lanka.

BACKGROUND: The prevalence of dental caries in preschool children has not been declining in the recent past. A growing body of research suggests that social and behavioural factors may play a considerable role in the aetiology of dental caries. AIMS: The objective of this study was to determine the relationship between the family structure and dental caries experience in preschool children. METHODS: A descriptive cross-sectional study was carried out in children aged 3-5 years in Wattala Divisional Secretariat area in Colombo district of Sri Lanka. An interviewer-administered questionnaire was used to obtain information from the parents on family structure including the size, birth rank, age spacing between the next oldest and youngest sibling and age of parent at birth of the subject. The dental caries status of the children was assessed using WHO standard criteria for primary teeth. RESULTS: Family size, birth rank, age difference between the subject and next oldest sibling and parent's age at birth of the subject were significantly associated with the dental caries experience of the preschool children at bivariate level. In a stepwise multiple linear regression analysis family size, birth rank and the parent's age at birth of the child remained statistically significant. CONCLUSION: The present findings suggest that family structure might significantly affect the caries experience of preschool children.

Dentine hypersensitivity in a private practice patient population in Australia.

Although dentine hypersensitivity (DH) has been widely investigated, studies based on randomly selected general practice populations are scarce. This study aimed to examine the intra-oral distribution of DH and its association with age, sex, symptoms, stimuli, pre-disposing factors and management strategies in a private practice patient population in Australia. A randomly selected sample of 800 Australian private dental practice dentists was invited to participate in a questionnaire-based survey. A log diary about the total number of patients seen during a typical week in practice and the details of patients with DH were recorded. The details included teeth and sites involved with DH and the age and sex of people affected, symptoms, stimuli, pre-disposing factors and management strategies. The prevalence of DH was 9·1% among patients seen over the typical week with 2·3 teeth/person and 1·2 surfaces/tooth affected. Women (60·7%) were more affected than men (39·3%) whilst 30- to 49 -year-olds (48·8%) were the most common among those affected. Premolars (36·5%) and buccal surfaces (54·8%), respectively, were the most commonly affected teeth and tooth sites. Although cold stimulation (80·1%) was the commonest stimulus, dietary acid was the only stimulus that was significantly associated with DH. Gingival recession and erosion emerged as significant pre-disposing factors, whereas using desensitising toothpastes was the most important management strategy. The findings suggested that dietary acid, gingival recession and erosion were significantly associated with DH, while desensitising toothpastes was the key management strategy used for DH in this patient population.

Dentine hypersensitivity - Australian dentists' perspective.

BACKGROUND: Dentine hypersensitivity is a frequent clinical presentation though inadequately comprehended by dentists. The objective of this study was to describe Australian dentists' perception on the occurrence, predisposing factors, triggers, diagnosis and management of dentine hypersensitivity. METHODS: Eight hundred dentists were randomly selected using the Australian Dental Association membership list and invited to participate in a questionnaire-based survey. RESULTS: Out of 295 responding dentists, 284 private practitioners were included in the final analysis. Most dentists perceived that the occurrence of dentine hypersensitivity was <20% and commonest among 30-49 year olds. According to them, abrasion and gingival recession were the main predisposing factors whilst cold stimuli were the commonest trigger. A differential diagnosis-based approach was adopted by a majority to diagnose dentine hypersensitivity although routine screening was resorted to by a few. Most dentists were aware of the current mechanisms underlying dentine hypersensitivity whereas the majority perceived that ongoing predisposing factors was the main reason for dentine tubules to remain exposed. The commonest management strategy employed by most dentists was to prescribe desensitizing agents for home use. CONCLUSIONS: Australian dentists' perception of dentine hypersensitivity is generally consistent with the current scientific consensus on this subject.

Relationship between bleeding on probing and periodontal disease progression in community-dwelling older adults.

OBJECTIVE: The main objective of this study was to determine the relationship between bleeding on probing (BOP) and periodontal disease progression in community-dwelling older adults. METHODS: A 3-year longitudinal study was carried out in 229 non-smoking healthy older adults aged 70 years. Using pressure-controlled periodontal probes, BOP, pocket depth and attachment level at 13,289 sites were measured annually. Periodontal disease progression was defined as an increase in attachment loss of >or=3 mm from the baseline to the final examination. The backward stepwise logistic regression analysis was performed to assess the relationship between the total number of sites with BOP in the four examinations and periodontal progression. RESULTS: Logistic regression analysis showed that the odds ratios of BOP frequency for periodontal disease progression ranged from 1.4 to 6.2 after controlling for pocket depth >or=4 mm at baseline, number of missing teeth, jaw type and tooth site. CONCLUSION: Increasing frequencies of bleeding might increase the probability of periodontal disease progression in community-dwelling older adults.

Serum vitamin C-periodontal relationship in community-dwelling elderly Japanese.

OBJECTIVE: To determine the relationship between serum vitamin C and periodontitis as estimated by clinical attachment loss (CAL) in community-dwelling elderly Japanese. MATERIAL AND METHODS: This analysis was confined to 413 Niigata citizens aged 70 years in whom the data for serum vitamin C and CAL were available. High-pressure liquid chromatography method was used to ascertain the serum vitamin C levels while CAL was assessed on six sites of all teeth present including third molars by means of pressure-sensitive probes. Other variables included gender, smoking, toothbrushing frequency, number of teeth present and random blood sugar levels. RESULTS: Serum vitamin C concentration was inversely related to CAL (r=-0.23, p<0.00005) at bivariate level. Multiple linear regression analysis showed that CAL was 4% greater in subjects with lower serum vitamin C levels than in subjects with higher serum vitamin C levels notwithstanding smoking, diabetes, oral hygiene, gender or number of teeth present. CONCLUSION: The findings suggested that serum vitamin C might have relatively weak but a statistically significant relationship with periodontitis in this elderly population.

Factors associated with severe periodontitis in rural Cambodia.

An analytical cross-sectional study was conducted with 812 subjects aged 35-74 years in Prek Russey commune, Cambodia to detect some factors associated with severe periodontitis. Four calibrated examiners employed Community Periodontal Index (CPI) to ascertain periodontal pocket depth (PD) and loss of epithelial attachment (LA). A questionnaire was used to obtain tobacco and alcohol consumption habits. One hundred (12.3%) subjects had one or more sextants with > or =4 mm PD and > or =6 mm LA (severe periodontitis). Smoking, tobacco chewing and age were significantly associated with severe periodontitis in bivariate analysis while only age and quantified smoking remained significant in a logistic regression analysis. The impact of quantified smoking on severe periodontitis was almost negligible [OR: 1.0006 (95% CI: 1.0001, 1.001)] compared to that of age [OR ranged from 8.3 at 45-54 years to 22 at 65-74 years (95% CI: 3.1, 62.3)]. Nevertheless, both age and quantified smoking can be considered as factors associated with severe periodontitis in rural Cambodians.

Socio-demographic risk indicators for tooth mortality in rural Sri Lankans.

To explore the socio-demographic factors associated with tooth loss in rural inhabitants of Sri Lanka, a random sample of 2178 males aged 20-60 years was selected using multi-stage cluster sampling procedure. The number of missing and present teeth was recorded excluding third molars and the subjects were interviewed to elicit socio-demographic information as well as oral hygiene and tobacco consumption habits. The mean number of teeth lost in the sample was 5.17 +/- 5.43. Tooth loss increased significantly with age. Sinhalese had significantly fewer lost teeth (5.05 +/- 5.38) compared to Tamils (6.54 +/- 6.18) and Muslims (6.02 +/- 5.21) whereas education, income, oral hygiene practices and tobacco use were significantly associated with tooth loss in the bivariate analysis. A forward stepwise multiple regression analysis revealed that age, Muslim ethnicity and quantified tobacco use were positively associated with tooth loss while better socio-economic conditions and good oral hygiene habits were negatively linked with tooth mortality independent of other factors. Age, Muslim ethnicity, quantified tobacco use, income, education, brushing frequency and substance used for cleaning had significantly affected tooth loss. Quantified tobacco use and oral hygiene may be regarded as modifiable socio-demographic risk indicators associated with tooth mortality in Sri Lankans.

Fifth-year hemodynamic performance of the prima stentless aortic valve.

BACKGROUND: The medium-term hemodynamic performance of stentless valves has not been widely reported, particularly in comparison with in vitro studies. Therefore, we have assessed prospectively the hemodynamics of the Edwards Prima valve in its fifth year after implantation in the aortic position, and compared the results with those at 1 month after implantation and also with in vitro data. METHODS: Thirty-five patients (age, 77 +/- 6 years; 19 men) were prospectively studied by Doppler echocardiography at 1 month and 52 +/- 8 months after implantation of a Prima stentless valve. Valve hemodynamics were assessed by measuring the mean pressure gradient, mean valve resistance, and effective orifice area. Left ventricular systolic function was quantified by ejection fraction, the degree of hypertrophy by ventricular mass index, and the ratio of ventricular wall thickness to cavity radius as a measure of ventricular geometry. RESULTS: With a mean valve size of 24.6 +/- 2.2 mm in the fifth year after implantation, the mean pressure gradient was 6.2 +/- 3.5 mm Hg, the mean valve resistance, 29 +/- 16 dyne x s(-1) x cm(-5)), and the effective orifice area was 2.05 +/- 0.50 cm2. Compared with 1 month after operation, there was a 47% decrease in mean valve resistance (p = 0.002) and a 39% increase in effective orifice area (p = 0.001). Furthermore, both effective orifice area and mean valve resistance in the fifth year did not differ from their in vitro counterparts, whereas the left ventricular ejection fraction (0.64 +/- 0.14), the left ventricular mass index (119 +/- 49 g/m2), and the ratio of ventricular wall thickness to cavity radius (0.44 +/- 0.13) were within the normal range. CONCLUSIONS: This study suggests that the Prima valve is a reliable stentless aortic bioprosthesis. This is supported by a favorable medium-term clinical outcome, durable hemodynamic performance, and normal mean values of left ventricular ejection fraction and mass index in the fifth year after implantation.

Time-related hemodynamic changes after aortic replacement with the freestyle stentless xenograft.

BACKGROUND: The Freestyle valve is a porcine aortic root fixed with net zero pressure across the cusps and treated with the anticalcification agent alpha-aminooleic acid. We evaluated the hemodynamic function of this stentless valve. METHODS: We implanted the valve into 80 consecutive patients scheduled to receive a bioprosthesis. Sixty-nine patients were more than 70 years old and 14 had calcified aortic sinuses. The "cylinder within a cylinder" implantation technique was used. Twenty-seven patients received coronary grafts, and 3 had mitral repair. All patients were studied echocardiographically during week 1 and 41 were studied at 6 months. RESULTS: Median ischemic time for isolated aortic valve replacement was 44 minutes. There were four hospital deaths, none valve related. No patient had more than trivial aortic regurgitation. Mean systolic gradients for valve sizes 21 to 25 mm fell significantly with time (p < or = 0.05) due to remodeling of the porcine root and early regression of left ventricular hypertrophy. Late hemodynamic function was equivalent to an aortic homograft. CONCLUSIONS: The Freestyle valve is easily implanted and has excellent hemodynamics. Transvalvular gradients decrease progressively.

Aortic valve replacement with the freestyle stentless xenograft.

We performed aortic valve replacement with the Free-style stentless xenograft in 55 consecutive patients requiring a bioprosthesis. Thirty-four were male and 21 female, and all were in New York Heart Association class III to V. Ages ranged from 44 to 87 years (median, 74 years). Fifteen patients required coronary bypass grafts. One required mitral valve replacement (after attempted repair) and another needed repair of both the mitral and tricuspid valves. Four were reoperations. Implantation involved two-thirds transection at the aortic sinotubular junction and insertion of the xenograft cylinder into the aortic sinuses. Ischemic times ranged from 34 to 58 minutes for isolated aortic valve replacement and up to 79 minutes for aortic plus mitral valve replacement. Two patients died in the hospital of left ventricular failure. Survivors underwent echocardiographic assessment of systolic gradients. The mean gradients for valve sizes of 21, 23, 25, and 27 cm were 13, 10, 8, and 6.5 mm Hg, respectively. No patient had more than trivial regurgitation. One died late of left ventricular failure. The Free-style stentless xenograft is user friendly and can be employed in a calcified root. The "cylinder within a cylinder" method is simple and reproducible and avoids aortic regurgitation. Follow-up has shown excellent hemodynamic function and decreasing gradients.

Comparison of implantation techniques using freestyle stentless porcine aortic valve.

Stentless porcine aortic valves demonstrate superior hemodynamic performance when compared with their stented counterparts. The technical considerations for implanting these valves can be demanding. The Medtronic Freestyle aortic root bioprosthesis resembles an allograft, has zero-pressure-fixed leaflets treated with an antimineralization agent, and can be implanted using a variety of techniques. In this study of that valve, total root replacement (TRR) was compared with a partial scallop aortic inclusion technique (PSI). Implications were performed in 75 patients (49 PSI and 26 TRR). There were no significant differences with respect to age, sex, or incidence of concomitant procedures. Mean aortic cross-clamp times were significantly less in the PSI group than in the TRR group (51.8 +/- 11.7 minutes versus 125.5 +/- 19.7 minutes; p = 0.0001). At discharge, mean systolic gradients seen on color-flow Doppler echocardiography were less in the TRR group than in the PSI group (6.17 +/- 3.66 versus 10.01 +/- 4.83 mm Hg; p = 0.014). Discharge echocardiography revealed trivial valve regurgitation in 8.3% of the TRR group and in 41.7% of the PSI group (p = 0.004). No patient experienced any significant valvular regurgitation on discharge echocardiography. We conclude that early experience with the Medtronic Freestyle aortic root bioprosthesis shows excellent short-term function regardless of implantation technique. Shorter cross-clamp times, comparable with those of stented valve procedures, occurred with PSI implantation. We anticipate that effects on long-term durability will be beneficial.

Atypical ventricular tachycardia and syncope with left coronary artery origin from the right coronary sinus.

An 18 year old man suddenly lost consciousness while jogging. The ambulance crew documented atypical ventricular tachycardia and an episode of ventricular fibrillation. Coronary angiography showed the left main coronary artery arising from the right sinus of Valsalva. Subsequent surgical coronary revascularisation was successful.