The efficacy and safety of an enzyme-containing lozenge for dental biofilm control-a randomized controlled pilot trial.

OBJECTIVES: To evaluate the effect of daily use of a multiple-enzyme lozenge on de novo plaque formation, on gingivitis development, and on the oral microbiome composition. METHODS: This trial with two parallel arms included 24 healthy adults allocated to the Active (n = 12) or Placebo (n = 12) group. Subjects consumed one lozenge three times daily for seven days, and no oral hygiene procedures were allowed. Differences in de novo plaque accumulation between a baseline period, and one and seven days of intervention were assessed by the Turesky-modification of the Quigley-and-Hein-Plaque-Index (TM-QHPI). The development of gingivitis after seven days of intervention was assessed by the Gingival Index (GI). Plaque and saliva samples were collected at baseline and after seven days of intervention, and evaluated by 16S rRNA gene sequencing. RESULTS: All subjects completed the study, and no adverse events were reported. After one day, the average TM-QHPI was significantly lower in the Active than in the Placebo group, as compared to baseline (p = 0.012). After 7 days, average TM-QHPI values did not differ significantly between groups (p = 0.37). GI values did not increase during the intervention period, with no difference between groups (p = 0.62). Bacterial richness increased in both plaque and saliva samples over a seven-day oral hygiene-free period, with a statistically significant difference for the saliva samples (p = 0.0495) between groups. CONCLUSIONS: A multiple-enzymes lozenge decreased the build-up of de novo plaque after one day and slowed down the process of species increment in saliva. The lozenge may be an adjunct to regular mechanical plaque removal. CLINICAL SIGNIFICANCE: Dental plaque is the main cause of caries, gingivitis, and periodontitis. The search for therapeutic adjuncts to mechanical plaque removal that have no harmful effects on the oral microbiome is important. Treatment with multiple plaque-matrix degrading enzymes is a promising non-biocidal approach to plaque control.

Efecto de talleres de técnica de cepillado monitoreados y supervisados con la técnica "ver-repetir" sobre higiene oral en niños con discapacidad auditiva

Introducción. La salud bucodental de poblaciones vulnerables como aquellas con discapacidad auditiva se enfrenta a barreras de salud por la falta de habilidad para la comunicación resultando en una alta prevalencia de caries, enfermedad periodontal y pérdida dentaria. Objetivo. Disminuir el Índice de O´Leary posterior a talleres de técnica de cepillado monitoreados y supervisados con la técnica "ver-repetir". Materiales y Métodos. Estudio de intervención en estudiantes de una escuela para personas con discapacidad auditiva de Asunción-Paraguay, durante el 2022-2023. Los participantes recibieron entrenamiento de cepillado con la técnica de Bass en modelos y maquetas previo a cada sesión de cepillado. En cada sesión se proveyó a cada participante de cepillo y pasta dental. Se instruyó a padres y maestros para fomentar la técnica en el hogar y en la escuela. Se estableció el Índice de O´Leary previa aplicación de una sustancia reveladora de placa bacteriana. Resultados. Participaron del estudio, 46 niñas y 25 varones entre 4 a 13 años; 12 con dentición temporaria, 41 mixta y 18 permanente. Se realizaron 11 sesiones, siendo 8 la mediana de participación. El índice de O´leary fue al inicio 81,86% ± 26,09% que se redujo significativamente a 11,69% ± 3,94%; en el 100% se redujo a menos de 25%. Los primeros molares permanentes inicialmente cariados fueron restaurados y permanecieron sin recidivas hasta el final. Conclusión. La cantidad de placa bacteriana oral en niños con discapacidad auditiva se puede mantener bajo control siguiendo estrategias de higiene que sean supervisadas y monitoreadas.

Introduction. The oral health of vulnerable populations such as the hearing-impaired face barriers due to lack of communication skills resulting in a high prevalence of caries, periodontal disease and tooth loss. Objective. To decrease O'Leary index after monitored and supervised brushing technique workshops with the "see-repeat" technique. Materials and Methods. Intervention study in students of a school for people with hearing disabilities in Asunción-Paraguay, during 2022-2023. The participants received brushing training with the Bass technique on models and mock-ups prior to each brushing session. In each session, each participant was provided with a toothbrush and toothpaste. Parents and teachers were instructed to promote the technique at home and at school. The O'Leary Index was established after applying a substance that reveals bacterial plaque. Results. 46 girls and 25 boys between 4 and 13 years old participated in the study; 12 with temporary teeth, 41 mixed and 18 permanent. 11 sessions were held, with a median participation of 8. The O'leary index was 81.86% ± 26.09% at the beginning, which was significantly reduced to 11.69% ± 3.94%; in 100% it was reduced to less than 25%. The initially decayed first permanent molars were restored and remained recurrence-free until the end. Conclusion. The amount of oral bacterial plaque in hearing impaired children can be kept under control by following hygiene strategies that are supervised and monitored.

Comparison of the effectiveness of two manual toothbrushes: Conventional design versus double-sided toothbrush design. A pilot study.

OBJECTIVES: Dental hygiene is the most effective method in the prevention of oral diseases. However, most patients do not use the recommended teeth brushing techniques and/or time brushing is insufficient. With this objective, modifications in conventional toothbrushes have been developed to deal with these findings. The aim of this study was to compare plaque removal effectiveness of a manual toothbrush with a modified head (MTMH) with a wrap-around design versus a conventional manual toothbrush. METHODS: This pilot prospective clinical study was designed according to STROBE guidelines. The patients suspended oral hygiene habits for 24 h (baseline). Subsequently, the teeth were brushed for 60 s. Both toothbrushes followed the same study procedure, separated by 1 month. Plaque-removing effectiveness was measured before and after tooth brushing using the modified O'Leary Plaque Index (PI). RESULTS: Seven patients were included in this pilot study. The mean age was 37.66 ± 10.68 years. PI mean differences between baseline and after brushing were 51.99% ± 16.43 for MTMH and 27.93 ± 6.85, for conventional toothbrush (p = 0.0013). After brushing, mean PI values were 18.36% ± 6.95%, and 37.61% ± 10.57% respectively (p < 0.001). CONCLUSION: Within the limitations of the present study, it can be concluded that the effectiveness of plaque removal by using MTMH is significantly higher than the conventional manual toothbrush.

Salivary immunoglobulin levels and periodontal indices in Brazilian children with and without type 1 diabetes

Abstract This cross-sectional study evaluated the association between salivary immunoglobulins, plaque index, and gingival index in Brazilian children with and without type 1 diabetes mellitus (DM1). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for the reporting of observational studies was followed. The DM1 group had 38 children, and an equal number of volunteers matched by sex and age were recruited as controls. Clinical examination was performed for plaque index and gingival index determination. Non-stimulated whole saliva was collected. Concentrations of IgA, IgG, and IgM were determined by ELISA test. Data were tested by the Kolmogorov-Smirnov, Mann-Whitney, and Spearman tests and a multiple linear regression model (p<0.05) was performed. Gingival index was higher in the Control (DM1: 0.16±0.17; Control: 0.24±0.23, p=0.040). In DM1, there was a correlation between IgA and age (rho=0.371, p=0.024), IgM and IgG (rho=0.459, p=0.007), and IgM and gingival index (rho=0.394, p=0.014). In DM1, multiple linear regression showed that age (p=0.041; β=0.363), gingival index (p=0.041; β=0.398), and plaque index (p=0.008; β=-0.506) were good predictors of IgA levels in saliva. Thus, IgA was the only researched immunoglobulin that was directly associated with plaque and gingival indices in Brazilian children with DM1, but not in control subjects.

A tangible prospect for the treatment of gingivitis using a potentially probiotic strain Lactobacillus plantarum MK06 isolated from traditional dairy products: a triple blind randomized clinical trial.

BACKGROUND: Frequent bacterial plaque buildup at the gingival margin and crevice can provoke an inflammatory reaction in gingival tissues which manifests as gingivitis. Probiotics could serve as a beneficial complementary therapy for treating gingival inflammation. The main aim of this research was to investigate the effect of the Lactobacillus plantarum MK06 probiotic strain on the treatment of gingivitis. METHODS: Patients with gingivitis, who were referred to a private clinic and were systematically healthy, were included in this randomized, triple-blind, placebo-controlled trial. They were instructed to use either placebo or Lactobacillus plantarum suspensions for one minute two times a day after tooth-brushing for four weeks. Then, the clinical parameters of gingivitis, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), and oral hygiene index (OHI-s), were measured in the first, second, and fourth weeks. A total of forty-two patients were randomly assigned to the experimental (n = 21) and control (n = 21) groups. The mean age of the experimental and control groups was 29.10 and 28.48, respectively. RESULTS: The mean scores of BOP, GI, PI, and OHI-s reduced over time in both the control and test groups. However, according to the Mann-Whitney test, the difference between the two groups was not significant at the same time intervals (P ≥ 0.05) and only GI showed a significant difference in the fourth week (GI-3, P = 0.006). Nevertheless, the experimental group experienced a higher overall reduction rate than the control group. The BOP, GI, PI, and OHI-s scores decreased by 0.081, 0.204, 0.186, and 0.172 times in the second week, respectively, resulting from the interaction of time and the intervention, which considerably diminished these indices. CONCLUSION: This study shows the potential of the probiotic Lactobacillus plantarum MK06 suspension as a promoting therapeutic adjuvant in the treatment of gingivitis.

Evaluation of the Effect of Maternal Education on Toddler Dental Plaque Removal Based on a Health Belief Model.

Objectives: The objective of this study was to investigate the impact of an educational intervention, guided by the Health Belief Model (HBM), on promoting preventive behaviors among mothers to combat early childhood caries (ECC) in toddlers aged 12 to 18 months. Materials and Methods: This single-blind interventional study evaluated 92 toddlers between 12 to 18 months and their mothers, who were selected by stratified random sampling. Data regarding demographic and nutritional factors were collected using a questionnaire. The dental status of children was evaluated by clinical examination and measuring the plaque index (PI) of maxillary central incisors and the dmfs index. A pamphlet designed according to the HBM was used for oral hygiene instruction in both the intervention and control groups. All of the mothers in the intervention group received a music file to listen to when brushing their children's teeth. Data were analyzed using chi-square, Fisher exact, Mann-Whitney, and Wilcoxson tests. P<0.05 was considered significant. Results: No significant correlation was noted between the daily frequency of sugary substance intake and primary PI in the intervention or control group with/without dental plaque (P>0.05). In the intervention group, PI significantly decreased after the intervention compared to baseline (P<0.001). However, there was no significant change in PI after the intervention in the control group compared with baseline (P=0.1). Conclusion: The findings indicate that a combination of educational intervention and incentives, such as using age-appropriate music for toddlers, can significantly enhance mothers' effectiveness in removing dental plaque.

Clustering of children's oral diseases in families and villages in a rural setting in Egypt.

BACKGROUND: This study assessed the clustering of children' caries experience, plaque accumulation and gingival inflammation in families and villages in Northwestern Egypt and the factors related to the severity of these conditions. METHODS: This was a secondary analysis of a 2019 household survey of children in villages around Alexandria, Egypt. Clinical examination assessed primary and permanent teeth caries experience (dmft/ DMFT using the World Health Organization criteria), plaque accumulation (Plaque Index (PlI)) and gingival inflammation (Gingival Index (GI)). A child questionnaire assessed child's age, sex, the frequency of toothbrushing (at least twice daily versus less) and frequency of consuming eight types of sugary products (daily sugar consumption score, sum of sugary products consumed daily). Mothers' questionnaire assessed the number of children in the family, mother's education (at least high school versus less), at least twice daily toothbrushing and daily sugar consumption similar to the child. Multilevel regression analyses assessed clustering, calculated by the intraclass correlation coefficient (ICC) of the three conditions in families and villages. Regression estimates (B) and 95% confidence intervals (CIs) of individual and family factors were calculated. RESULTS: Complete data were available for 450 children (246 families, seven villages], mean = 9.9 years-old and 56% females. The mean caries experience score = 3.6, mean plaque index = 1.5 and mean gingival index = 1.2. Caries experience, plaque accumulation and gingival inflammation were not clustered in villages (ICC < 0.01) but clustered in families (ICC = 0.10, 0.44 and 0.29). Child factors significantly improved model fit for caries experience and gingivitis (p < 0.001) but not plaque accumulation (p = 0.90). Family factors did not improve any model fit (p > 0.05). Child's age was significantly associated with caries experience (B= -0.48, p < 0.001) and gingival inflammation (B = 0.032, p < 0.001). Children who brushed their teeth twice daily had significantly more caries experience (B = 1.04, p = 0.01). CONCLUSION: The three oral conditions were not clustered in villages but clustered in families. Plaque accumulation showed the greatest within-family clustering. Family factors were not associated with the three conditions and individual factors indicated the need for interventions to promote preventive behaviors and identify families at risk of oral conditions.

Effect of supragingival plaque control on recurrent periodontitis and clinical stability among individuals under periodontal maintenance therapy: 10-year follow-up.

BACKGROUND: The aim of this study was to evaluate the effect of supragingival plaque control on the recurrence of periodontitis (RP) and the achievement of a stable periodontal clinical endpoint after 10 years of periodontal maintenance therapy (PMT). METHODS: The present retrospective cohort study included 225 individuals in continuous PMT. The plaque index (PI) determining the oral hygiene (OH) status, periodontal clinical parameters, and other variables of interest were collected at three time points: T1 (prior to active periodontal therapy [APT]), T2 (after APT), and T3 (10 years after T2). According to PI records at T3, participants were categorized into: (1) good OH (GOH; PI ≤ 30%, n = 63); (2) fair OH (FOH; PI > 30% and ≤40%, n = 73); and (3) poor OH (POH; PI > 40%, n = 88). Data were analyzed using the chi-square and Student t tests, analysis of variance (ANOVA), and mediation and regression analyses. RESULTS: Significant differences in all periodontal clinical parameters between the GOH, FOH, and POH groups were observed at T3. The POH group exhibited higher mean bleeding on probing (BOP), periodontal probing depth (PD), and clinical attachment level (CAL), as well as higher tooth loss (POH > FOH > GOH; P < .001). There was an increased risk for RP in the FOH (odds ratio [OR] 2.02; CI, 1.10-4.38) and POH (OR 4.33; CI, 2.17-8.65) groups. Moreover, the FOH and POH groups had an approximately 2.5 and 6.0 times greater chance of not achieving a stable periodontal clinical endpoint, respectively. CONCLUSIONS: After 10 years of monitoring in PMT, individuals with higher PI scores (>30%) presented an unhealthier periodontal status, a higher risk for RP, and a lower chance of achieving ≤4 sites with PD ≥ 5 mm.

A fast and reliable method for semi-automated planimetric quantification of dental plaque in clinical trials.

AIM: To develop a simple and reproducible method for semi-automated planimetric quantification of dental plaque. MATERIALS AND METHODS: Plaque from 20 healthy volunteers was disclosed using erythrosine, and fluorescence images of the first incisors, first premolars, and first molars were recorded after 1, 7, and 14 days of de novo plaque formation. The planimetric plaque index (PPI) was determined using a semi-automated threshold-based image segmentation algorithm and compared with manually determined PPI and the Turesky modification of the Quigley-Hein plaque index (TM-QHPI). The decrease of tooth autofluorescence in plaque-covered areas was quantified as an index of plaque thickness (TI). Data were analysed by analysis of variance (ANOVA) and Pearson correlations. RESULTS: The high contrast between teeth, disclosed plaque, and soft tissues in fluorescence images allowed for a fast threshold-based image segmentation. Semi-automated PPI is strongly correlated with manual planimetry (r = 0.92; p < .001) and TM-QHPI recordings (r = 0.88; p < .001), and may exhibit a higher discriminatory power than TM-QHPI due to its continuous scale. TI values corresponded to optically perceived plaque thickness, and no differences were observed over time (p > .05, ANOVA). CONCLUSIONS: The proposed semi-automated planimetric analysis based on fluorescence images is a simple and efficient method for dental plaque quantification in multiple images with reduced human input.

Association of the self-reported socioeconomic and health status with untreated dental caries and the oral hygiene level in adult patients.

BACKGROUND: Dental caries is a multifactorial disease and its management requires a thorough analysis of its etiological factors. OBJECTIVES: The present study used a multivariate approach to investigate the associations of socioeconomic and health-related determinants with untreated tooth decay and level of oral hygiene in adult individuals. MATERIAL AND METHODS: A cross-sectional study involved 597 adult patients. Health and socioeconomic status were assessed using a self-administered structured questionnaire. The presence of decayed teeth was recorded clinically using the World Health Organization diagnostic thresholds. Oral hygiene level was estimated using the plaque index. Multiple linear regression analysis was used to explore the associations of socioeconomic and health-related variables with the number of decayed teeth and level of oral hygiene. RESULTS: Socioeconomic and health-related variables explained 34.1% of the observed variation in the number of decayed teeth (p < 0.001) and 19.2% of the observed variation in the plaque index (p < 0.001). Analysis revealed several significant associations for both decayed teeth and plaque index scores. Males had 2.3 more untreated decayed teeth than women and an increased plaque index score of 0.3 units (unique contributions of 6.6 and 4.2%, respectively). An increase in self-assessed household economic status decreased the average number of decayed teeth by 1.3 and the plaque level score by 0.13 (unique contributions of 3.13% and 1.46%, respectively). Smokers presented with 1.78 more decayed teeth than non-smokers (unique contribution of 2.1%) and an increase in the plaque index by 0.48 units (unique contribution of 8.5%). CONCLUSIONS: Untreated dental caries and dental plaque severity share the same socioeconomic and health-related determinants.

Visible Occlusal Plaque Index Predicting Caries Lesion Activity.

This study was undertaken to appraise the predictive validity of the Visible Occlusal Plaque Index (VOPI) in assessing occlusal caries lesion activity in adolescents. A total of 618 adolescents aged 10 to 15 y were examined at the beginning of the trial and 511 (82.7%) at the 2-y follow-up. Adolescents and parents answered questionnaires about demographics, oral health behavior, and family sociodemographic variables. The VOPI has a 4-point ordinal scale ranging from no plaque to heavy plaque. Molar teeth were assigned to group VOPI 0-1 (no/thin plaque; n = 2,539) and group VOPI 2-3 (thick/heavy plaque; n = 843). At baseline examination, occlusal surfaces at risk of transition (n = 3,382) were either sound (55%), inactive noncavitated lesions (21%), inactive cavitated lesions (1%), active noncavitated lesions (15%), or active cavitated lesions (7%). The relative risk (RR) for caries lesion transition was estimated. Sound occlusal surfaces with no or thin plaque were significantly more likely to remain sound (RR = 1.3; 95% confidence interval [CI]: 1.1-1.4) than those harboring thick or heavy plaque. Inactive noncavitated occlusal lesions presenting no or thin plaque were significantly less likely to progress to active noncavitated lesions (RR = 0.1; CI: 0.0-0.8) than their counterparts with thick or heavy plaque. Active noncavitated lesions harboring thick and heavy plaque had a significantly lowest chance of becoming sound (RR = 0.7; CI: 0.5-0.9) and a highest risk of remaining active (RR = 1.5; CI: 1.1-1.9). Stepwise logistic regression analyses were run according to surface status at baseline and showed that none of the nonclinical predictors were significant for the outcome. The presence of thick and heavy plaque on occlusal surfaces was a predictor for caries lesion development, progression and activity (P < 0.0001). In conclusion, besides being an additional clinical tool for oral hygiene assessment, the VOPI is a predictor for development, progression, and activity of occlusal caries lesion. This is of particular interest for assessment of occlusal lesions undergoing health-promoting transitions.

Comparative evaluation of the antimicrobial effects of probiotic milk and probiotic powder on the salivary Streptococcus mutans counts and the plaque scores in children aged 3-6 years: A randomized controlled trial.

BACKGROUND: Probiotics have been shown to have a positive influence on systemic and oral health. The prevention of dental caries and gingival diseases through the consumption of probiotics has been studied extensively. OBJECTIVES: The aim of this research was to determine the effects of a short-term intake of probiotic milk and powder on the salivary levels of Streptococcus mutans (S. mutans) and the plaque scores in children. MATERIAL AND METHODS: In this short-term study, 34 healthy 3-6-year-old children were randomly assigned to group A (control), group B (enKor­D) or group C (Yakult). The probiotics were taken for 7 days. To screen for the amount of S. mutans measured in colony-forming units per milliliter of saliva (CFU/mL), unstimulated saliva samples were collected and cultured on Mitis Salivarius Agar plates before and after the intervention. The plaque scores were also recorded at preand post-intervention visits. RESULTS: A statistically significant reduction of salivary S. mutans was recorded after the consumption of probiotic milk (Yakult®) and powder (enKor®-D) (p < 0.05), with the decrease being greater for the enKor­D group. However, only the consumption of Yakult decreased the plaque scores significantly (p < 0.05). CONCLUSIONS: A short-term use of Yakult and enKor­D can have a cariostatic effect by lowering oral microbial load in children with certain risk profiles. Further research is required to confirm this probiotic effect over a long-term period. Prior to prescribing or promoting Yakult or enKor­D as an adjunct caries prevention therapy for children, a thorough risk evaluation may be needed.

Effectiveness of orthodontic toothbrush versus conventional toothbrush on plaque and gingival index reduction: A systematic review and meta-analysis.

OBJECTIVE: In orthodontic patients submitted to oral hygiene instruction, what is the efficacy of orthodontic toothbrush (O-TB) versus conventional toothbrush (C-TB) on plaque and gingival index reduction in randomized and non-randomized controlled clinical trials? METHODS: Electronic database search was performed on PubMed, ClinicalTrials.gov, Cochrane Library and Google Scholar. Database research, study selection, data extraction and ROBINS-I and Risk of Bias Tool 2.0 analysis were conducted by two independently examiners in duplicate. Two different meta-analyses were performed for plaque index and gingival index, followed by the analysis of overall quality of the evidence using GRADE. RESULTS: A total of 158 studies were identified for screening; six articles were included in qualitative synthesis, and of those, three were subjected to a quantitative synthesis (meta-analysis). Three non-randomized studies presented an overall 'low', 'moderate' and 'high' risk of bias for each one of the articles, and the three randomized clinical trials presented 'low risk' for two articles and 'some concerns' quality for the other one. The overall strength of evidence was ranked 'very low' quality for plaque index and gingival index subgroups. CONCLUSIONS: Gingival bleeding is not modified by orthodontic design toothbrush, but there is circumstantial scientific evidence for recommending the use of an O-TB instead a C-TB based on the analysis of plaque index control. Although major plaque removal of the O-TB was validated by meta-analysis, this improvement is not completely clarified which calls for further clinical studies to assess the effects of using an O-TB compared with a C-TB.

Randomised methodology development study to investigate plaque removal efficacy of manual toothbrushes.

OBJECTIVES: This study aimed to evaluate plaque removal efficacy of toothbrushes to guide clinical model development. METHODS: This single-centre, randomised, controlled, examiner-blind, method development study included 80 healthy participants. Over 28 days, participants brushed twice-daily using a fluoride toothpaste and one of four marketed toothbrushes: Toothbrushes A (compact head) and B (regular head): medium-hard; flat trim; end-rounded bristles; Toothbrush C: medium-hard; end-rounded bristles; silky, tapered filaments; compact head; Toothbrush D: soft; tapered filaments; compact head. Supra-gingival plaque removal was evaluated immediately after single brushing events (Days 0, 7, 28, at study centre) and following 7- and 28-days' home use via Rustogi modified Navy Plaque Index (RPI) and Turesky modified Quigley Hein Plaque Index (TPI). RESULTS: All toothbrushes provided significant plaque removal after single-brushing events with change from Day 0 pre-brushing scores on RPI ranging from -0.10 to -0.16 (p<.0001) and on TPI ranging from -0.61 to -0.89 (p<.0001). Toothbrushes A and B showed significant (p<.05) pre-brushing RPI/TPI plaque reductions after 7- (-0.04/-0.06, respectively for RPI; -0.16/-0.20, respectively for TPI) and 28-days (-0.04/-0.03, respectively for RPI; -0.20/-0.11, respectively for TPI) use versus Day 0 pre-brushing (except Toothbrush B, Day 28, non-significant TPI). There were no significant differences with Toothbrush C. Toothbrush D TPI was significantly lower at both timepoints versus Day 0 pre-brushing (p<.05). Study toothbrushes were generally well-tolerated. CONCLUSION: The observations from this study showed how various aspects of a study design could impact toothbrushes performance. These data will inform the design of future clinical studies of plaque removal efficacy using manual toothbrushes. CLINICAL SIGNIFICANCE STATEMENT: Regular effective oral hygiene can help prevent and treat gingivitis, principally via twice-daily mechanical cleaning with a toothbrush. Data generated from this methodology development study will help to identify the key aspects which impact toothbrushes' performance and understand which one would be more suitable to answer questions of scientific interest. This study provides useful information for the design of future clinical trials to assess plaque removal efficacy of manual toothbrushes and generate results to inform clinical recommendations.

Efficacy of minocycline hydrochloride ointment combined with metronidazole film in the treatment of periodontitis and their effects on C-reactive protein and elastase levels in gingival crevicular fluid / 中国基层医药

Objective:To investigate the efficacy of minocycline hydrochloride ointment combined with metronidazole film in the treatment of periodontitis and their effects on C-reactive protein and elastase levels in the gingival crevicular fluid.Methods:76 patients with periodontitis who received treatment in Jiaxing Hospital of Traditional Chinese Medicine from May 2019 to January 2020 were included in this study. They were randomly allocated to undergo treatment with metronidazole film (control group, n = 38) or minocycline hydrochloride ointment plus metronidazole film (observation group, n = 38) for 4 weeks. We compared clinical efficacy, periodontal system examination indexes (gingival index, periodontal probing pocket depth, gingival bleeding index, plaque index, loss of attachment), gingival crevicular fluid biochemical markers (C-reactive protein, elastase in the pellet, elastase in the supernatant) measured before and after treatment, the incidence of adverse reactions, and the recurrence rate within half a year after treatment between the two groups. Results:The total response rate was significantly higher in the observation group than in the control group [97.37% (37/38) vs. 78.95% (30/38), χ2 = 6.17 , P < 0.05]. Gingival index, periodontal probing pocket depth, gingival bleeding index, plaque index, and loss of attachment measured after treatment were significantly lower in the observation group than in the control group (all P < 0.001). C-reactive protein, elastase in the pellet, and elastase in the supernatant measured after treatment were (5.31 ± 1.19) μg/L, (0.70 ± 0.20) Abs/mL, (0.48 ± 0.19) Abs/mL respectively in the observation group, which were significantly lower than those in the control group [(7.92 ± 1.27) μg/L, (1.15 ± 0.52) Abs/mL, (1.12 ± 0.31) Abs/mL, t = 9.24, 4.97, 10.85, all P < 0.001]. The recurrence rate within half a year in the observation group was significantly lower than that in the control group [2.63% (1/38) vs. 20% (6/38), χ2 = 3.93, P < 0.05]. There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Minocycline hydrochloride ointment combined with metronidazole film is safe and effective in the treatment of periodontitis. The combined therapy help downregulate the levels of C-reactive protein, elastase in the pellet, elastase in the supernatant of the gingival crevicular fluid, alleviate inflammation, improve the periodontal status, and reduce the recurrence rate.

Oral health status of patients infected with human immunodeficiency virus and related factors, Iran: a cross-sectional study.

BACKGROUND: Human immunodeficiency virus (HIV) continues to be a major global issue. HIV-infected patients commonly experience oral health problems. This study aimed to assess oral health status of the patients and its related factors in Shiraz, Iran. METHODS: In this cross-sectional study, by using simple random sampling, 250 HIV-infected patients were selected from Shiraz Voluntary Counseling and Testing Center in 2019. Patients' decayed, missing, and filled tooth (DMFT) index, plaque index (PI), and community periodontal index (CPI) were determined. Associations between patients' characteristics and the above-mentioned indices were examined by using Pearson correlation, one-way ANOVA, chi-square, and independent sample T test. The effect of possible confounding factors was controlled by using multiple linear regression and logistic models. RESULTS: Of the 222 participants, 111 (50%) had 15 or more missing teeth and 79 (35.6%) were edentulous. Their mean (SD) DMFT and PI were 20.71 (10.74) and 1.11 (0.79), respectively. About 40% of them had healthy gingiva. DMFT (p < 0.001), PI (p < 0.001), and CPI (p = 0.002) were significantly worse in men than women. The patients' DMFT and edentulous status were significantly associated with their age (both p < 0.001) and duration of disease (p = 0.001 and p = 0.008, respectively). Unemployed patients had the worst DMFT, PI, and CPI (all p < 0.001) and the highest percentage of edentulous individuals (p = 0.003). All examined indices were significantly worse in cigarette smokers, alcoholics, addicts, and patients with a previous history of imprisonment (all p < 0.001). The odds ratio of being edentulous was 5.74 times in addicted patients than in non-addicted ones (p < 0.001). The odds increased 0.11 with every year that the patients' age increased (p < 0.001). Multiple linear regression models also showed that the addicted patients had significantly more scores in DMFT index, PI, and CPI (all p < 0.001). CONCLUSIONS: Overall, oral health status of the HIV-infected patients was unsatisfactory. Therefore, effective interventional programs are needed for prevention and early treatment of dental problems among this population, especially for more vulnerable groups such as older men with low socioeconomic status, and those with high-risk behaviors.

Análisis Comparativo de la Eficacia, Comodidad y Seguridad del Cepillo Eléctrico Oscilante-Rotatorio Oral-B en Pacientes Portadores de Ortodoncia Fija: Un Ensayo Clínico Aleatorizado

RESUMEN: La higiene oral es fundamental en pacientes en tratamiento de ortodoncia. Actualmente hay una oferta amplia de cepillos eléctricos con este fin. El objetivo del presente estudio, fue determinar la eficacia y la comodidad del cep illo eléctrico Oral-B® Professional Care 500 en pacientes portadores de ortodoncia. Se realizó un ensayo clínico, randomizado, doble ciego, unicéntrico, con una muestra de 90 pacientes, divididos en dos grupos: 45 pacientes utilizaron cepillo eléctrico y 45 sujetos utilizaron cepillos manuales durante 90 días. Se determinó la efectividad con los índices O'leary, índice de placa de bracket e índice de Eastman al inicio, a los 30 y a los 90 días de uso de los cepillos y se evaluó la comodidad del cepillo eléctrico mediante una encuesta de satisfacción al término del estudio. Al analizar los datos, se observó una disminución significativa en los índices de O'leary y de placa de bracket en ambos grupos,mientras que se observó una disminución significativa en el índice de Eastman sólo en el grupo que utilizó el cepillo eléctrico. El resultado de la encuesta, indica qu e, en opinión de los participantes del estudio, el cepillo eléctrico es cómodo, fácil de usar y recomendable para pacientes con aparatología fija. En conclusión, el cepillo eléctrico Oral-B® Professional Care 500 resultó ser efectivo y cómodo al ser usado por pacientes portadores de ortodoncia fija y puede ser recomendado para este tipo de pacientes.

ABSTRACT: Oral hygiene is essential in patients undergoing orthodontic treatment. Currently there is a wide offer of electric brushes for this purpose. The objective of this study is to determine the efficacy and comfort of the Oral-B® Professional Care 500 electric toothbrush in orthodontic wearers. A double-blind, single-center clinical trial was carried out, in which the sample was 90 patients, these were randomized into two groups: 45 patients with electric toothbrush treatment and 45 subjects with manual toothbrush treatment. The effectiveness was determined with the O'leary indexes, the bracket plate index and the Eastman index. For the evaluation of comfort, a survey was used. Statistical analysis was performed with the Shapiro-Wilks test and the Mann-Whitney U test, in which a significant decrease was found in the O'leary index and bracket plate index in the group that used the electro-oscillating brush rotary and a greater decrease in the Eastman index was observed in the same group. In conclusion, the electric toothbrush is comfortable and easy to use, recommended for patients with fixed appliances.

The effectiveness of apple, sugar-free chewing gum, Rolly Brush® and tooth brushing in the reduction of plaque index: Crossover randomized clinical trial

Background: The implementation of the self-cleaning practice is of fundamental importance for the maintenance of oral health and to remove the human dental biofilm which is considered the main etiological factor for the development of caries and periodontal diseases. Objective: This study aimed to evaluate the use of chewing gum, Rolly Brush® and apples as forms of mechanical control and removal of the dental biofilm in the absence of brushing. Materials and Methods: Eighteen volunteers were submitted to plaque index evaluation after a period of 24 hours of no oral hygiene. Then, they would use one of the methods: chewing gum, Rolly Brush®, apple or tooth brushing, chosen by a draw, for one minute, and then, plaque index was evaluated again. This stage was repeated until all participants were submitted to all selected methods, in periods of 24 hours each. Results: Dental brushing was more effective when compared to each of the other methods applied and there was a statistically significant reduction of dental plaque index after apllying all methods of cleaning in all groups. Conclusion: Chewing gum, Rolly Brush® and apple may be used as auxiliary to dental brushing or when such method is impossible to be performed. Clinicaltrials.gov: number of protocol NCT 03.601.585.

Fundamento: A implementação da prática de autolimpeza é de fundamental importância para a manutenção da saúde bucal e remoção do biofilme dental humano que é considerado o principal fator etiológico para o desenvolvimento de cáries e doenças periodontais. Objetivo: Este estudo teve como objetivo avaliar a utilização de goma de mascar, Rolly Brush® e maçã como formas de controle mecânico e remoção do biofilme dental na ausência de escovação. Materiais e Métodos: Dezoito voluntários foram submetidos à avaliação do índice de placa após um período de 24 horas sem higiene bucal. Em seguida, utilizariam um dos métodos: goma de mascar, Rolly Brush®, ingerir uma maçã e escovar os dentes, escolhida por sorteio, por um minuto, e então, o índice de placa era novamente avaliado. Essa etapa foi repetida até que todos os participantes fossem submetidos a todos os métodos selecionados, em períodos de 24 horas cada. Resultados: A escovação dentária foi mais eficaz quando comparada a cada um dos outros métodos aplicados e houve redução estatisticamente significativa do índice de placa dentária após a aplicação do método de limpeza em todos os grupos. Conclusão: Goma de mascar, Rolly Brush® e maçã podem ser utilizados como auxiliares da escovação dentária ou quando tal método for impossível de ser realizado. Clinicaltrials.gov: Número do protocolo NCT 03.601.585.

Effect of interdental brush design on plaque during nonsurgical periodontal therapy.

OBJECTIVE: The aim of this randomized controlled trial was to evaluate the interproximal cleaning efficacy of waist-shaped compared with straight soft interdental brushes in patients undergoing nonsurgical periodontal therapy. MATERIALS AND METHODS: Ten patients diagnosed with periodontitis stage II or III were scheduled for nonsurgical periodontal therapy. Baseline plaque control record (PCR), modified approximal plaque index (API), papillary bleeding index (PBI), probing pocket depth (PPD), and bleeding on probing (BOP) were evaluated. Four interdental spaces of equal sizes were determined, and baseline plaque indices (PI) were assessed on eight surfaces of the respective adjacent teeth, resulting in 640 measuring positions. Interdental brushes with a straight or waist-shaped design were randomly allocated to the right or left side, and patients received oral hygiene instructions. Follow-up measurements including PCR, API, PBI, and site-specific PI were performed during initial nonsurgical periodontal therapy sessions and reevaluation which was undertaken 8 weeks afterwards. RESULTS: PCR, API, and PBI decreased significantly compared with baseline at each time point (p < 0.001). PPD (waist-shaped, baseline 4 mm (range, 2-9 mm) vs. reevaluation 3 mm (range, 1-6 mm); p < 0.001; straight, baseline 4 mm (range, 2-10) vs. reevaluation 3 mm (range, 1-6) mm; p < 0.001) and BOP (p = 0.008) showed significant reduction in both groups. Sub-analysis of site-specific areas including line angles and interproximal areas revealed no significant reduction of plaque during the observation period between both brush designs. No difference between straight and waist-shaped brushes regarding PPD or BOP decrease was found. CONCLUSION: The efficacy of both interdental brush designs concerning plaque control in patients undergoing nonsurgical periodontal therapy was similar. CLINICAL RELEVANCE: The use of interdental brushes is essential for biofilm removal in patients during initial periodontal therapy, regardless of brush design. CLINICAL TRIAL REGISTRATION: ISRCTNregistry (#ISRCTN24498365), http://www.isrctn.com/ISRCTN24498365.

Effect of a motivational video on flossing behaviour: A pilot study.

OBJECTIVES: Motivational interviews used for health behavioural change requires several sessions and expert consultations. A practical method is needed to promote oral hygiene habits. The aim of the study was to develop a video as a new motivational intervention method combining several health behaviour change theories to improve flossing behaviour. METHODS: A questionnaire about individual psychosocial characteristics was conducted to 30 volunteer dental patients. Plaque index (PI) scores were calculated and a video about flossing was shown the patients. The second PI measurements were performed after 2 months. The video including flossing instructions and expressions of performers acting dental patients was produced to test as a motivational method. Cues used in the video were generated according to health behaviour change theories and models under the supervision of an expert team. Content validity ratio (CVR) and content validity index (I-CVI) of the video and reliability of the questionnaire was determined. First and second PI scores were compared to assess the effect of the video. Correlation between answers of the questionnaire and PI changes were tested. RESULTS: The average I-CVIs of the video was 0.93, CVR of video items was 1, I-CVIs of 5 items was 80% and of 10 was 100%. Cronbach's alpha of the questionnaire was 0.93. PI scores significantly decreased after 2 months (p < 0.001). CONCLUSION: A single session motivational intervention via a video based on health psychological models and theories was efficacious in improving oral hygiene and flossing behaviour in the short term.