Library

Notes: Abstract This was a 2-part study. The purpose of the 1st part was to examine the relationship between brushing force and plaque removal efficacy comparing a regular manual toothbrush (M) with an electric toothbrush the Braun Oral-B Plak Control* (B). The study consisted of a single oral prophylaxis followed by 5 experiments which differed solely in respect to toothbrushing force. At baseline (after 24-h plaque accumulation), the amount of dental plaque was evaluated and subsequently, the subject's mouth was brushed by a dental hygienist. Brushing was carried out in a random split-mouth order. Either the 1st and 3rd quadrants or the 2nd and 4th quadrants were brushed with 1 toothbrush and the 2 remaining quadrants with the other. The available time for the brushing procedure was 2 min. After brushing, the amount of remaining dental plaque was assessed. The force used in experiment 1 through 5 was 100, 150, 200, 250, 300 g, respectively. The results show that when brushing force is increased, more plaque is removed with either of the two brushes. Except for the high brushing force (300 g), the electric toothbrush removed more plaque than the manual brush. The purpose of the 2nd part was to evaluate the habitual brushing force which individuals use with various toothbrushes. Besides a manual toothbrush (M), 3 electric toothbrushes were examined, the Rotadent® (R). Interplak® (I) and Braun® (B). 20 subjects were selected on the basis of being ‘good brushers” (plaque score at screening 〈25%). At baseline, each subject randomly received 1 of the 4 brushes. They were allowed a training period of 3 weeks at the end of which they were asked to abstain from brushing for at least 24 h. The plaque (Turesky modification of the Quigley & Hein) was scored, after which the subjects brushed their teeth (2 min) with the assigned toothbrush equipped with a strain gauge. A computer set–up measured (100 Hz) and calculated the mean brushing force. After brushing, the amount of remaining plaque was assessed. The design of the study was a 4-way cross-over. The results show that with a manual brush, considerably more force is used than with the electric brushes (R=96. 1 = 119. B= 146, M=273). No significant relation between brushing force and plaque removal was demonstrated for any of the brushes.

Notes: Abstract. The purpose of the present study was to compare the Braun Plak Control® (D7) and Philips HP 500® (MM) in their plaque removing efficacy. Furthermore the brushing force applied by the panellist on the brush-head with both these brushes was evaluated. For this study, 35 university students (non-dental) were selected. The study consisted of 3 experiments. Prior to each experiment, all subjects were asked to abstain from all oral hygiene procedures for at least 48 h. In Exp. I, the efficacy of toothbrushing was studied when one of the investigators brushed the teeth of the panellists. In Exp. II, the efficacy of the brushing was studied after the students had received a professional instruction. In Exp. III, the brushing force used during a single brushing exercise was evaluated. The available time for the brushing amounted to a total of 2 min per mouth. Dental plaque was evaluated by means of the Silness and Löe and Quigley and Hein plaque indices assessed at 6 sites per tooth. Results showed that both in Exp. I and Exp. II, the D7 removed significantly more plaque than the MM electric toothbrush. The plaque reduction assessed according to Silness and Löe in Exp. I was for the D7, 1.07 and for the MM, 0.78. In Exp. II, the reduction was 1.08 and 0.88, respectively. The results of Exp. III show that the mean brushing force was comparable for both brushes (D7=I73 g, MM=I75 g). All 35 subjects were allowed to choose one electric toothbrush as compensation for their participation. The majority (n=26) of subjects preferred the D7 to the MM. In conclusion, the results of the present study show that given a choice, there was a preference of the panellists for the D7. No difference in brushing force was observed between the 2 brushes. Evaluation of plaque removing efficacy showed that the Braun Plak Control® is more effective than the Philips HP 500®.

Notes: Abstract. The purpose of this study was to evaluate different methods of eliciting gingival bleeding as indicators of gingival inflammation in the experimental gingivitis model. Following a period of stringent oral hygiene, 103 dental students were scored for plaque and gingival bleeding assessed by 4 methods. From this group, 41 volunteers were randomly allocated to 2 treatment groups. Dental students with clean teeth and healthy gingivae were asked to abolish all mechanical tooth cleaning in the lower jaw for a period of 3-weeks. During the 21-day experimental period, chlorhexidine (Peridex®) or a placebo mouthrinse was applied to the lower jaw. Subjects brushed the upper jaw with a standard toothpaste. In principal, 2 different methods were employed to provoke bleeding: (1) at the marginal gingival tissue by running a probe along the soft tissue wall at the orifice of the pocket, and (2) by probing to the “bottom” of the pocket. Variations in the methods were based on angulation (AngBI, ParBI) of the probe in relation to the tooth surface and to the probing force (PPBI.25N, PPBI.757V). 1 randomly selected quadrant in the lower jaw was scored using the AngBI. The opposing quadrant was scored with a randomly-allocated bleeding index, either ParBI, PPBI.25N or PPBI.75N. The results of this study confirm earlier findings that the angulation of the probe determines the number of sites with bleeding observed. It also indicates that bleeding as elicited by probing to the bottom of the pocket is a poor indicator of early gingivitis. It is recommended that gingivitis should be assessed by probing the marginal gingiva.

Notes: Objectives: The purpose of this split-mouth study was to evaluate the clinical response of enamel matrix proteins (EMPs, Emdogain Gel®) in intra-osseous defects with or without a combined application of a tetracycline-coated expanded polytetrafluoroethylene barrier membrane (e-PTFE, Gore-Tex®).Methods: Twelve pairs of intra-osseous periodontal defects in 11 patients received the application of EMPs on the exposed root surface (EMP). One of the two defects received randomly, as an adjunct to EMP treatment, a tetracycline-coated e-PTFE membrane (MEMP). At baseline, 6- and 12-month probing pocket depth (PPD), clinical attachment level (CAL) and probing bone level (PBL) were measured.Results: After 12 months, the EMP defects showed a significant mean PPD reduction of 2.86±0.75 mm, a mean gain in CAL of 1.28±2.04 mm, a mean PBL gain of 1.63±1.21 mm and a mean increase of recession (REC) of 1.56±2.30 mm. The MEMP defects showed a significant mean PPD reduction of 3.02±1.55 mm, a mean gain in CAL of 1.65±1.29 mm, a mean PBL gain of 1.58±1.92 mm and a mean increase of REC of 1.38±1.63 mm. Except for significantly more post-operative discomfort at the MEMP sites, no significant differences were found between EMP and MEMP defects.Conclusion: Within the limits of this study, it is concluded that in the treatment of intra-osseous defects with EMP, the adjunctive use of a tetracycline-coated e-PTFE membrane failed to show more gain of CAL and PBL.

Notes: Objectives:  The study was designed to test the efficacy in plaque removal of three toothbrushes: two manual brushes, the Butler GUM 311® and the Dr Best X-Active®, and one electric toothbrush the Braun Oral-B 3D Plaque Remover (3D)®.Method:  The study was a split-mouth, single-blind, randomized clinical study consisting of three identical experiments testing three combinations of toothbrushes (experiment 1: 3D versus Butler; experiment 2: 3D versus Dr Best; experiment 3: Butler versus Dr Best), in which the teeth of the panellists were brushed by a dental hygienist. In a fourth experiment, the panellists brushed their own teeth (3D versus Dr Best). Thirty-five subjects participated in the study and received a professional prophylaxis prior to the first experiment. They were requested to refrain from brushing their teeth for 48 h prior to each experiment. Plaque was assessed according to the Silness & Löe plaque index at six sites per tooth. Next, the dental hygienist (experiments 1–3) or the panellist (experiment 4) brushed for 60 s with their first assigned brush in two randomly selected contralateral quadrants. Brushing was repeated (60 s) with the second brush in the opposing two contralateral quadrants. Prior to experiment 4, panellists were given two thorough hands-on professional instructions in the use of the 3D and the Dr Best toothbrushes.Results:  In experiment 1, the 3D showed a mean plaque reduction of 72% compared to 63% with the Butler (P〈0.01). In experiment 2, the 3D showed a mean plaque reduction of 79% and the Dr Best 76% (P〈0.05). In experiment 3, the Butler showed a mean plaque reduction of 81% and the Dr Best 85% (P=0.01). In the hands of the panellists (experiment 4), the 3D showed a mean plaque reduction of 88% and the Dr Best 84% (P〈0.05).Conclusions:  A 5-week training period with repeated hands-on instruction gives panellists the skill to perform brushing with efficacy comparable to that of professional brushing. In agreement with a previous study, the 3D was more effective than a flat-trimmed manual toothbrush (Van der Weijden et al. 1994). Brushing with the criss-cross resulted in small statistical differences with the 3D and the flat-trimmed manual toothbrush. The clinical relevance of these statistically significant results should be the subject of a longitudinal study.

Notes: Background: Chlorhexidine (CHX) 0.2% solution is still “the leading oral antiseptic” for controlling gingivitis. Side effects, however, limit the acceptability to users and the long-term employment of a 0.2% CHX antiseptic in preventive dentistry. This stimulated the development of new formulations. The aim of the present study was to assess the effect on plaque inhibition and taste perception of two commercially available mouthrinses (0.12% CHX non-alcohol base with 0.05% cetyl pyridinium chloride (Cpc) versus 0.2% CHX alcohol base).Methods: The study was designed as a single-blind, randomized two group parallel experiment, to compare two different commercially available mouthrinses, during a 3-day plaque accumulation model. Forty healthy volunteers were enrolled in the study and received a thorough dental prophylaxis at the beginning of the test period. Over a 72-h experimental non-brushing period, during which subjects abstained from all forms of mechanical oral hygiene, one group (test) used a 15 ml alcohol free 0.12% CHX (=18 mg) mouthrinse on a Cpc base (Perioaid®, CHX⊕Cpc), twice daily for 30 s. The other group (control) used a 10 ml 0.2% CHX (=20 mg) mouthrinse on an 11.8% ethanol alcohol base (Corsodyl®, CHX⊕Alc), twice daily for 60 s. After 72 h of plaque formation, the amount of plaque was evaluated. By the use of visual analogue scale, the subjects were asked for their appreciation of the taste of the mouthrinse they had used.Results: The mean plaque index for the CHX⊕Cpc group was 0.97 and for the CHX⊕Alc group 0.78. After 72 h of non-brushing, there was no significant difference in plaque accumulation between the two groups. The answers to the questions (taste perception and after-taste) showed a statistically significant difference between the two groups. The mean visual analogue scale (VAS) scores for taste appreciation on a scale from very bad to very good taste (0–10) were 5.92 for the CHX⊕Cpc group and 4.10 for the CHX⊕Alc group (p=0.02). The mean visual analogue scale (VAS) scores for the after-taste on a scale from very short to very long (0–10) were 7.24 for the CHX⊕Cpc group and 5.38 for the CHX⊕Alc group.Conclusions: Within the limitations of the present study design, it can be concluded that rinsing with a 0.12% CHX mouthrinse on a non-alcohol base with 0.05% Cpc (Perio-Aid®) is not significantly different from rinsing with a 0.2% CHX mouthrinse on an alcohol base (Corsodyl®). It appears that the subjects appreciated the taste of the non-alcohol CHX solution better but the after-taste of the rinse remained longer in the mouth.

Notes: Aim: This study was designed to test whether the approximal efficacy of a powered toothbrush (Braun Oral-B 3D Plaque Remover) can be improved when a pointed-shaped brush head (PBH) specifically designed for these approximal areas is used as compared with the standard cup-shaped brush head (CBH).Material and Methods: Forty non-dental students were included. They all received the powered toothbrush and two different brush heads (CBH+PBH). Instructions were given to use each brush head twice every day (2 min. with the CBH followed by 1 min. with the PBH). Two weeks later they received an appointment for the first experiment (Exp 1), prior to which they abstained from all oral hygiene procedures for 48 h. Plaque was assessed at 6 sites/tooth. Next, the dental hygienist brushed for 2 min. (30 s/quadrant) with the CBH. Plaque was scored again. Subsequently, the dental hygienist brushed the approximal areas for another minute: in two randomly selected contra-lateral quadrants for 30 s with the CBH and in the opposing quadrants for 30 s with the PBH. The next approximal plaque was scored a third time. After 2–3 weeks, Exp 2 was carried out comparable to Exp 1; only this time the panelists brushed themselves.Results: Exp 1 showed approximal plaque scores at the baseline of 1.70 and 1.72 and at post-brushing 0.21 and 0.26 for the CBH + PBH and CBH only, respectively (p〈0.05). The additional increase in approximal plaque reduction after 30 s of brushing with PBH was 22% and for the CBH 19% (p〈0.05). Exp 2 showed approximal plaque scores at baseline of 1.76 and 1.74 and post-brushing of 0.21 and 0.24 for the CBH+PBH and the CBH, respectively. The additional approximal plaque reduction of 30 s brushing with PBH was 19% and 18% with the CBH (no significant difference).Discussion/Conclusion: An additional 1 min. showed minor differences (1–3%) between brush heads. The effect of the 1 min. extra brushing (±18%) itself was much larger. It seems therefore beneficial to advise the patient to brush longer. A second different brush head may stimulate to do so.

Notes: Objectives: This study was designed to evaluate two factors possibly influencing incidence of gingival abrasion during toothbrushing: (1) the abrasiveness of a dentifrice and (2) the possible influence of feedback of oral sensory perception.Material and Methods: For this purpose, two separate, single blind, randomized clinical experiments were performed. The two groups of subjects were requested not to brush their teeth 48 h, prior to the experiments. After staining with disclosing solution gingival abrasion sites were recorded as small (〈inlineGraphic alt="leqslant R: less-than-or-eq, slant" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE652:les" location="les.gif"/〉5 mm) and large (〉5 mm), both before and after brushing. The dentifrice experiment was a split-mouth design, including 36 subjects, brushing their teeth in two randomly selected contra-lateral quadrants, either with or without dentifrice, whereas the remaining two quadrants were brushed, using the alternative choice. The sensory perception feedback experiment was a full-mouth design, including 43 subjects and two separate brushing exercises with use of dentifrice. The first brushing-exercise was performed by a dental hygienist, excluding the feedback of oral sensory perception of the brusher. After a 4 weeks period of familiarization to the manual toothbrush, subjects brushed themselves in the same random order as the hygienist, using a fresh brush, thus including oral sensory perception.Results: In the dentifrice experiment, the increment of small abrasion sites was 5.86 for brushing with and 5.75 without dentifrice. There was no statistically significant difference between brushing with and without dentifrice. Both with and without dentifrice, more small abrasions were found vestibular, (3.78 and 4.22, respectively) as compared with lingual (2.22 and 1.42, respectively) (p=0.027, p〈0.001). In the sensory perception feedback experiment, the increment in small gingival abrasion sites was larger for the subjects brushing themselves (8.86) as compared with the professional brushing (2.94, p 〈0.0001). Subjects caused more abrasion on the vestibular surfaces (6.28) as compared with the lingual (0.60, p=0.0001), where the professional did not show this difference (vestibular: 1.88, lingual: 1.30, p=0. 1388).Conclusions: No statistically significant difference in the incidence of gingival abrasion was found between brushing with dentifrice or without dentifrice. Neither did oral sensory perception seem to affect the incidence of gingival abrasion.

Notes: Background/aims: In an Indonesian population deprived of regular dental care, the experienced progression of disease between baseline (1987) and follow-up (1994) was investigated in relation to the composition of the subgingival microbiota at follow-up. At baseline the age ranged from 15 to 25 years. Clinical and microbiological evaluation was completed in 158 of the 167 subjects available at follow-up.Methods: Plaque index (PI), pocket depth (PD), bleeding on probing (BOP), and attachment loss (AL) were scored at the approximal surfaces of all teeth and subgingival calculus on the approximal surfaces of the Ramfjord teeth only (number of sites with subgingival calculus: NSC). A pooled sample of the deepest pocket in each quadrant was evaluated using microbiological culture techniques.Results: At baseline the mean values of the clinical parameters were AL=0.35 mm, PI=1.01, BOP=0.80 PD=3.25 mm and NSC=6.04 and at follow-up AL=0.75 mm, PI=1.16, BOP=1.19, PD=3.34 mm and NSC=5.85. All parameters except PD and NSC showed a statistically significant increase. At follow-up the prevalence of Actinobacillus actinomycetemcomitans was 40%, of Porphyromonas gingivalis 67%, of Prevotella intermedia 66%, of Fusobacterium nucleatum 79%, of Bacteroides forsythus 16%, of Campylobacter rectus 4%, and of P. micros 6%. No differences in clinical parameters were found between groups with or without these micro-organisms. In 129 subjects AL of 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280703:ges" location="ges.gif"/〉2 mm at 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280703:ges" location="ges.gif"/〉1 site was found. Logistic regression showed three significant odds-ratio’s for experienced progressive periodontitis: Plaque index (12.2), gender (3.4) and Actinobacillus actinomycetemcomitans (2.9).Conclusions: The results of this retrospective study suggest that plaque is the most important parameter related to experienced disease progression, and that the presence of A. actinomycetemcomitans may be associated with increased chance of disease progression.

Notes: Abstract Background, aims: The aim of this double-blind, parallel study was to evaluate the adjunctive effects of systemically administered amoxicillin and metronidazole in a group of adult periodontitis patients who also received supra- and subgingival debridement.Methods: 49 patients with a diagnosis of generalised severe periodontitis participated in the study. Random assignment resulted in 26 patients in the placebo (P) group with a mean age of 40 years and 23 patients in the test (T) group which had a mean age of 45 years. Clinical measurements and microbiological assessments were taken at baseline and 3 months after completion of initial periodontal therapy with additional placebo or antibiotic treatment. Patients received coded study medication of either 375 mg amoxicillin in combination with 250 mg metronidazole or identical placebo tablets, every 8 hours for the following 7 days.Results: At baseline, no statistically significant differences between groups were found for any of the clinical parameters. Except for the plaque, there was a significantly larger change in the bleeding, probing pocket depth (PPD) and clinical attachment level (CAL) in the T-group as compared to the P-group after therapy. The greatest reduction in PPD was found at sites with initial PPD of 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280402:ges" location="ges.gif"/〉7 mm, 2.5 mm in the P-group and 3.2 mm in the T-group. The improvement in CAL was most pronounced in the PPD category 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280402:ges" location="ges.gif"/〉7 mm and amounted to 1.5 mm and 2.0 mm in the P- and T-groups, respectively. No significant decrease was found in the number of patients positive for any of the test species in the P-group. The number of patients positive for Porphyromonas gingivalis, Bacteroides forsythus and Prevotella intermedia in the T-group showed a significant decrease. After therapy there was a significant difference between the P- and the T- group in the remaining number of patients positive for P. gingivalis, B. forsythus and Peptostreptococcus micros. 4 subgroups were created on the basis of the initial microbiological status for P. gingivalis positive (Pg-pos) and negative patients (Pg-neg) in the P- and the T-groups. The difference in reduction of PPD between Pg-pos and Pg-neg patients was particularly evident with respect to the changes in % of sites with a probing pocket depth 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280402:ges" location="ges.gif"/〉5 mm. This % decreased from 45% at baseline to 23% after treatment in the Pg-pos placebo subgroup and decreased from 46% to 11% in the Pg-pos test subgroup (p〈inlineGraphic alt="leqslant R: less-than-or-eq, slant" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280402:les" location="les.gif"/〉0.005). In contrast, the changes in the proportions of sites with a probing pocket depth 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03036979:JCPE280402:ges" location="ges.gif"/〉5 mm in the Pg-neg placebo and Pg-neg test subgroup were similar, from 43% at baseline to 18% after treatment versus 40% to 12%, respectively.Conclusions: This study has shown that systemic usage of metronidazole and amoxicillin, when used in conjunction with initial periodontal treatment in adult periodontitis patients, achieves significantly better clinical and microbiological results than initial periodontal treatment alone. Moreover, this research suggests that especially patients diagnosed with P. gingivalis benefit from antibiotic treatment.