Evaluación de un protocolo de cepillado dental con aspiración en pacientes hospitalizados en la unidad de cuidados intensivos utilizando análisis de imagen y microbiología: estudio piloto / Evaluation of a dental brushing protocol with aspiration in patients hospitalized in an intensive care unit using image and microbiological analyzes: Pilot study

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Correlation between dental caries experience and the level of Streptococcus mutans and lactobacilli in saliva and carious teeth in a Yemeni adult population.

OBJECTIVE: This study aimed to determine the relative amounts of Streptococcus mutans (SM) and lactobacilli (LBs) and their relationship with dental caries among a Yemeni adult population. RESULTS: A positive correlation appeared between SM and LB counts from saliva and caries tissue samples and the decayed, missing and filled teeth (DMFT) score (p < 0.05). There was a significant correlation between SM and LBs in caries tissue (p < 0.05). However, there was no significant difference between SM and LBs isolated from saliva samples (p > 0.05). The number of SM and LBs in subjects with active caries was significantly higher than that in those without active caries (p < 0.05). There was no significant difference between the daily habits and SM and LB or DMFT scores (p > 0.05), except for a significant difference between brushing frequency and DMFT score (p < 0.05).

The Quality of Toothbrushing in Children with Intellectual Disabilities Enrolled in an Oral Health Promotion Programme: A Paired Study.

PURPOSE: To assess the quality of toothbrushing of children with intellectual disability (ID). MATERIALS AND METHODS: One hundred thirty-six children, 68 with ID (SG = study group) and 68 non-ID (CG = control group), were paired. Their caregivers completed a questionnaire about socioeconomic and demographic characteristics and another about oral hygiene habits. The toothbrushing technique and position adopted were documented and the duration of the procedure was measured. A modification of the Simplified Oral Hygiene Index (SM-OHI) was used to classify the quality of brushing as: adequate, when all the teeth had SM-OHI 0 or 1; or inadequate, when at least one tooth had SM-OHI 2 or 3. The Kolmogorov-Smirnov test was used to assess the normality of data distribution for age, duration of brushing and SM-OHI. Fisher's exact test and the chi-squared test were applied to assess the association between ID and oral hygiene habits or characteristics of toothbrushing. To compare the duration of brushing groups, the Mann-Whitney test was applied. Student's t-test for independent samples was applied to compare mean MS-OHI. RESULTS: Mothers were the main persons performing children's toothbrushing in SG. They reported a higher daily brushing frequency, longer toothbrushing duration of children in the SG, SG children had lower SM-OHI scores and were thus rated as having adequate toothbrushing, in contrast to the CG (p < 0.001, p < 0.001; p = 0.012; p < 0.001; p < 0.001, respectively). CONCLUSION: Toothbrushing provided by caregivers for ID children was more effective than toothbrushing carried out by non-ID children of the same age and gender.

Manual dexterity and dental biofilm accumulation in independent older adults without hand disabilities: A cross-sectional study.

BACKGROUND: This study investigated the relationship between manual dexterity and dental biofilm accumulation in independent older Koreans using Quantitative Light-Induced Fluorescence-Digital (QLF-D). METHODS: This cross-sectional study included 44 participants recruited from senior welfare facilities in South Korea and aged ≥65 years. Participants were surveyed using face-to-face structured interviews; manual dexterity was assessed using the Box and Blocks Test. To evaluate dental biofilm accumulation, the 528 surfaces of six index teeth were imaged using QLF-D and then quantified into Simple Plaque Scores (SPS) and ΔR20 values. The t-test and one-way analysis of variance were used to analyze differences in SPS and ΔR20 according to general characteristics and manual dexterity. RESULTS: Those who brushed their teeth ≤2 times per day had higher SPS and ΔR20 values on the lingual surface of tooth #24 than those who brushed ≥3 times per day (p < 0.05). The low manual dexterity group had higher SPS on lingual surfaces of teeth #12, #24, and #32, as well as higher ΔR20 values on the lingual surfaces of teeth #12, #24, #32, and #44 (p < 0.05) than the normal group. CONCLUSIONS: The low manual dexterity group had more dental biofilm-particularly on the lingual surfaces of teeth-and more mature biofilm than the normal group. These findings indicate that reduced manual dexterity could be a predictor of poor oral hygiene in independent older adults without hand disabilities. Therefore, we suggest manual dexterity be assessed in advance of dental biofilm assessment and tooth brushing instruction.

Oral health is a mediator for disease severity in patients with Behçet's disease: A multiple mediation analysis study.

OBJECTIVES: The aim of the study was to examine whether oral health as an infection focus could mediate disease course in patients with Behçet's disease (BD). METHODS: In the study, oral health of 194 BD patients was examined at baseline and follow-up periods. The reasons for last dental visits were recorded as tooth extraction or regular control visits/planned treatments at the end of follow-up period. The Behçet's disease severity score was calculated with higher scores indicating a more severe course. Mediation analysis was carried out to assess the effects of oral health on disease severity score at follow-up period in the study. RESULTS: Dental and periodontal indices were found to be higher at follow-up visit compared to those of baseline (P < 0.05). Disease severity score was found to be higher in males (5.3 ± 2.4) compared to females (4.4 ±2.5) in the whole group (P = 0.005). Moreover, patients having tooth extraction at their last dental visit and patients with dental caries had a more severe disease course (5.4 ± 2.4; 5.5 ± 2.5) compared to others (4.2 ± 2.3; 4.4 ± 2.4; P < 0.0001). In multiple mediation analysis, disease severity score was a dependent variable and was directly mediated by male gender (B = -0.8822, P = 0.0145) and indirectly mediated through the presence of dental caries (B = 0.9509 P = 0.0110) and need of tooth extraction (B = 0.8758, P = 0.0128). CONCLUSION: Both presence of dental caries and need of tooth extraction were observed to be effective mediators for a more severe disease course in BD. Therefore, better oral health should be aimed to eliminate microbial factors, which are a part of pathogenic processes.

Optimal frequency of tooth brushing in mechanically ventilated adults: Study protocol for a randomized controlled trial.

The optimal frequency of tooth brushing in the critically ill has not been experimentally determined. For mechanically ventilated patients, optimal frequency of tooth brushing is an important unresolved issue as there is little evidence to judge the benefits or associated risks of tooth brushing. Given this knowledge gap, the project's overall goal is to determine the optimal frequency of tooth brushing (once, twice, or three times daily) for mechanically ventilated adults. A prospective, randomized, experimental design is used. Specifically, 345 subjects, with 207 expected to complete the study, are randomly assigned within 36 hr of intubation to one of three groups (once, twice, or three times tooth brushing daily). Tooth brushing with a soft compact-head toothbrush takes approximately 2 min. Dental plaque assessment, gingival crevicular fluid (GCF) determination for IL-1ß, and data regarding healthcare-acquired infection (HAI) and clinical status are collected at baseline and daily in-hospital. The clinical impact of daily frequency of tooth brushing in relation to extent of dental plaque and inflammation reflected by GCF analysis will be compared by the three treatment arms. In addition, evaluation of safety for HAIs will be compared based on calculation of the number needed to harm. The trial will empirically determine the optimal frequency of tooth brushing in mechanically ventilated adults, balancing benefits and risks. This contribution is significant because it will have immediate impact on bedside nursing practice, and is a final component necessary for specific evidence-based guidelines for the common nursing intervention of oral care in mechanically ventilated adults.

An educational programme designed for the evaluation of effectiveness of two tooth brushing techniques in preschool children.

AIM: This study aimed to evaluate oral and dental health status of preschool children, to teach them two different brushing techniques, and to determine the effectiveness of such techniques. MATERIALS AND METHODS: One hundred sixty three healthy children from three preschools in Isparta (Turkey) that were willing to participate in the study were included. A questionnaire was distributed to the parents. All children were given an oral and dental health education. Examinations were done in the classrooms, and plaque index and dft-dfs values were recorded. In each preschool, the horizontal scrub technique was randomly taught to a group of children, and the Fones technique to other group, and children were asked to apply the technique taught. Plaque index scores were recorded again, measurements were repeated at 1 week, and 1, 3 and 6 months. Data were analysed statistically. RESULTS: The questionnaires showed children's and parents' inadequate oral hygiene behaviours. Plaque index values for both techniques decreased from baseline at 1 week, and 1, 3 and 6 months. Values at month 6 were closer to baseline. The horizontal scrub technique was applied more easily and it provided an effective decrease on plaque index scores. No statistically significant difference was found for dft and dfs values. CONCLUSION: The educational programme with regular repeated tooth brushing training presented significant improvements in the oral health behaviours. The horizontal scrub technique was deemed more suitable than the Fones technique for preschool children.

[Integrating the touch-screen into oral health prevention programs for people with cognitive disabilities: An exploratory study in children]. / Intégration de la tablette tactile dans les programmes de prévention bucco-dentaire destinés aux personnes en situation de handicap cognitif : étude exploratoire chez l'enfant.

BACKGROUND: The oral diseases of people with disabilities are the same as those observed in the general population but occur earlier and more intensely. Primary prevention, especially toothbrushing, is at the forefront of the appropriate management of these patients. The aim of this study is to evaluate the use of a digital application on iPad® as mediator for learning toothbrushing in children with disabilities. METHODS: Twelve children from a care-center were included in this preliminary study. A training program for toothbrushing was conducted, using a visual activity schedule on iPad®. Quotation grids enabled to assess the initial situation and the program efficacy over an 11-month period. RESULTS: The children progressed over time in their autonomy and in their compliance during toothbrushing. Wilcoxon's analysis showed that these progresses were significant, although some steps remained more difficult to achieve. Three months after the end of the program, the children maintained their skills. CONCLUSIONS: The integration of the iPad® as a support for visual pedagogy and learning is useful in a dental context, for children with cognitive disabilities.

Supervised toothbrushing programs in primary schools and early childhood settings: A scoping review.

OBJECTIVE: In this article we report the findings of a scoping review that aimed to identify and summarise the range of programs and guidelines available for toothbrushing programs in schools and early childhood settings. Dental caries is one of the most common preventable diseases affecting children worldwide. Untreated caries can impact on child health and wellbeing, development, socialisation and school attendance. Supervised toothbrushing programs in schools and other early childhood settings can be effective in improving the oral health of young children. There is limited understanding of the salient issues to consider when developing such programs or how they are best implemented in real world settings. METHODS: A scoping review methodology was utilised to provide a summary of the guidelines and programs available. Key search terms were developed, mapped and utilised to identify guidelines and programs across 6 databases and key search engines. RESULTS: We located 26 programs and guidelines that met the inclusion and exclusion criteria for the review. These were collated and summarised across key countries and critical aspects of program development and implementation were identified. Toothbrush type and storage, toothpaste strength and method of dispensing, toothbrush storage, staff training and parental consent are key considerations that varied widely. CONCLUSIONS AND RECOMMENDATIONS: Guidelines for supervised toothbrushing programs vary within and across countries due to differences in water fluoridation and availability of low fluoride toothpastes. The results of this review provide critical information to be considered when establishing and implementing toothbrushing programs in these settings.

The Bleeding on Brushing Index: a novel index in preventive dentistry.

BACKGROUND: The aim of this study was to evaluate the suitability of a dichotomous index, based on a special interdental brushing tool, to detect initial pathological processes in interproximal areas. Furthermore, different techniques of interdental hygiene were compared. METHODS: Participants (n = 108) were instructed to clean their teeth using the Bass technique and were randomly assigned to three groups according to the type of interdental cleaning used: group A, use of interdental brushes; group B, no interdental hygiene (the control group); and group C, use of dental floss. Approximal Plaque Index (API), Plaque Index (PI), modified Sulcus Bleeding Index (mSBI) and the Bleeding on Brushing Index (BOB) were measured at baseline, and after 2 (t1) and 4 (t2) weeks. Statistical analysis was performed using the Wilcoxon test and the Mann-Whitney U-test. RESULTS: One-hundred and six participants completed the study. The BOB decreased significantly in all groups (P < 0.001) with the most pronounced reduction being recorded for group A (baseline: 49.3 ± 23.0%; 4 weeks: 5.1 ± 6.9%). Also, the mSBI (P < 0.001) decreased significantly in all groups during the study. The API appeared to be less affected by the oral hygiene than other indices. The highest correlation was observed between BOB and mSBI (r = 0.785, P < 0.001). CONCLUSION: The BOB is a valuable complement for the existing array of indices in preventive dentistry, and is able to detect potential pathological processes in interproximal spaces. Additionally, this study suggests that interdental hygiene with individually selected brushes is superior to flossing. CLINICAL RELEVANCE: With the BOB, gingival inflammation can be demonstrated to patients, which could increase compliance.

Decreased frequency and duration of tooth brushing is a risk factor for endothelial dysfunction.

BACKGROUND: Periodontal disease is associated with endothelial dysfunction, leading to cardiovascular disease. The effect of detailed tooth brushing behavior, not only frequency but also duration of tooth brushing, on endothelial function is unclear. The purpose of this study was to evaluate the relationships of detailed methods of tooth brushing with vascular function. METHODS: We evaluated flow-mediated vasodilation (FMD), nitroglycerine-induced vasodilation, and frequency and duration of tooth brushing in 896 subjects. We divided the subjects into three groups according to the frequency and duration of tooth brushing: low frequency and short duration group (

Effect of Frequency of Brushing Teeth on Plaque and Calculus Accumulation, and Gingivitis in Dogs.

The efficacy of brushing the teeth of beagle dogs in a randomized, controlled, blinded study design using a clearly-defined brushing technique was evaluated for 4 brushing frequencies: brushing daily, brushing every other day, brushing weekly and brushing every other week, compared with no brushing in a control group of dogs. All dogs were fed a standard dry kibble diet during the study. Standard plaque, calculus, and gingivitis indices were used to score the teeth. A 'clean tooth' model was used. No gingival or non-gingival lacerations or other signs of injury to oral tissues were found at the end of the 28 day trial period. Brushing more frequently had greater effectiveness in retarding accumulation of plaque and calculus, and reducing the severity of pre-existing gingivitis. Brushing daily or every other day produced statistically significant improved results compared with brushing weekly or every other week. Based on the results of this study, daily brushing is recommended.

Integrating oral health into pediatric nursing practice: Caring for kids where they live.

PURPOSE: The purpose was to identify the factors influencing pediatric oral health and describe the Caring for Kids Where They Live program. CONCLUSIONS: In North America, the burden of pediatric oral disease is significant. Despite evidence to this effect, oral health is an often-neglected aspect of pediatric nursing care. The Caring for Kids Where They Live program has successfully integrated oral health into pediatric nursing care as evidenced by increased accessibility of health care, pathways for care, and disease prevention. PRACTICE IMPLICATIONS: Pediatric nurses can address oral health disparities by integrating an oral health assessment tool as well as interprofessional follow-up and referral processes in practice.

[Structural changes of toothbrush bristles by brushing in patients with dental implants].

Lack of proper oral hygiene practices can lead to treatment failure in patients with implant-retained restorations. Structural changes of toothbrush bristles were studied using scanning electron microscopy and correlated with cleaning efficiency which was assessed at baseline and after 3 months of use of various toothbrushes types in 146 patients with implant-retained restorations. Oral hygiene was valued according to several indices (Approximal Plaque-Index (API), the Turesky index (PI), a modified superstructure plaque index Silness-Loe (PLIsk). Ultrasound toothbrush provided the best and the most efficient cleaning outcome in patients with implant-retained restorations. Scanning electron microscopy proved ultrasonic toothbrush bristles to be more resistant to abrasion during the three-month use.

[Various toothpastes efficiency in children living in orphan institutions].

Oral hygiene in children living in orphan institutions is inadequate. Clinical and remineralising effect of various toothpastes was investigated in orphan children. This paper compares the results of toothpastes with fluoride, calcium and calcium-fluoride complex: "Brilard Professional. Best Friends", "Brilard Calcium ion", "The Tooth Fairy. Fluoride", "New Pearl. Calcium". Significant improvement of hygiene indices and reduction of periodontal inflammation was determined. The study proved the method of controlled tooth brushing to be highly effective in institutions for orphans.