Avi Zini

A 6‐month study of the effects of 0.3% triclosan/copolymer dentifrice on dental implants

AIM Supportive therapy to maintain dental implants is increasingly important. This study examined the effect of a 0.3% triclosan/2% copolymer dentifrice on oral biofilms and gingival inflammation (GI) on dental implants and peri-implant tissues. MATERIALS AND METHODS One hundred and twenty adults with a dental implant and contra-lateral tooth were enrolled in this 6 month, double-blind, two-treatment, parallel group study. Sixty subjects were randomly assigned to a triclosan/copolymer dentifrice test group and 60 subjects to a fluoride dentifrice control group and instructed to brush twice daily for 6 months. At baseline, 3, and 6 months, a calibrated dentist assessed dental plaque, GI and collected supragingival dental plaque for microbiological analysis. RESULTS Subjects in the triclosan/copolymer group demonstrated significantly lower levels of dental plaque, gingivitis, and bleeding on probing at 3 and 6 months at both the implant and contra-lateral tooth compared with the fluoride group (p<0.05). There were significantly fewer Gram-negative anaerobes in the triclosan/copolymer group (p<0.05) including >90% reductions in Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Eubacterium saburreum, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella melaninogenica, Solobacterium moorei, and Tannerella forsythia. CONCLUSIONS Twice daily use of a triclosan/copolymer dentifrice may enhance dental implant maintenance by reducing dental plaque and GI.

Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia

OBJECTIVES To examine associations between psychosocial profile (psychological distress and social support) and changing oral health status (dental caries and periodontal disease), among a group of immigrants from Ethiopia to Israel. METHODS Three hundred and forty immigrants, aged 18-75 years, with a mean age of 38.4±13.5 years, comprised the study population and were followed over a 5-year period. Dental caries was recorded employing the DMFT index. Periodontal health status was recorded employing the Community Periodontal Index (CPI). Participants were interviewed using a structured written questionnaire which included two validated psychosocial scales, for psychological distress and social support. Bivariate and multivariate analyses were performed. RESULTS Among subjects with psychological distress, the adjusted mean caries (DMFT) increment in 2004-2005, since baseline (1999-2000), was 3.52±0.19 when compared to 0.35±0.15 among subjects with no psychological distress (P<0.001). Correspondingly, the percentage of people with increased periodontal pockets was 40%, when compared to 7%, respectively (P<0.001). In multiple linear regression analysis employing the DMFT as a continuous variable, and in multiple logistic regression analysis employing the DMFT as a dichotomous variable (% caries versus % caries-free), the four variables that reached statistical significance as predictors of caries status were previous caries experience, psychological distress, social support, and age. Gender, income, and education were not significantly related to current caries prevalence. In a multiple logistic regression analysis, the three variables that reached statistical significance as predictors of periodontal disease (shallow and deep pockets) were previous periodontal disease experience, psychological distress, and age. Social support, gender, income, and education were not significantly associated with periodontal disease prevalence. CONCLUSIONS This study presents persuasive evidence that supports the role of psychological distress and social support as determinants of changing oral health levels, among a low socioeconomic, relatively homogenous immigrant minority population.

Periodontal health status and smoking among young adults

AIM Our aim was to evaluate the periodontal status and present smoking habits among a representative sample of young adult Israelis and to investigate possible associations. MATERIAL AND METHODS A representative sample of young adult Israelis was examined and interviewed on the day of release from compulsory military service. Collected data included demographic background (gender, education level, family size and fathers country of origin) and current smoking habits. Clinical examination included the recording of periodontal health status according to the Community Periodontal Index (CPI). RESULTS Seven thousand and fifty-six young adults were examined. Sixteen per cent were classified as CPI 0, 78% as CPI 1-2 and 6% as CPI 3-4. In total, 36% of the sample reported a current smoking habit. Periodontal status was significantly improved among non-smokers, females and children of fathers born in Israel or Western countries. CONCLUSION Only 7% of the participants demonstrated signs of periodontitis and most young adults did not smoke; a dose-response association was revealed between present smoking habits and periodontal disease.

The association between demographic and oral health-related quality of life factors and dental care attendance among underprivileged older people.

Aim:  In order to identify whether demographic and oral health‐related quality of life factors are associated with dental care attendance among an underprivileged older population, a comparison was performed between people who have and have not attended dental care.

Oxygen deprivation affects the antimicrobial action of LL-37 as determined by microplate real-time kinetic measurements under anaerobic conditions.

Some agents, including Escherichia coli and group A Streptococcus pyogenes cause infections in oxygen depleted sites. LL-37 is a human host defence peptide shown previously to play an important role in controlling infections caused by these bacteria. However, the effect of oxygen levels on the antimicrobial activity of LL-37 remains obscure. In order to test the effect of oxygen (or lack thereof) on LL-37s activity against E. coli and S. pyogenes, a method for adapting commonly used microtiter plates for real-time growth-kinetic (and growth-inhibition) measurements under anaerobic conditions was developed. Using the proposed method, anaerobic conditions were attained in the microplate within 30 min and were maintained for at least five days. Anaerobiosis was further confirmed by comparing the growth of two anaerobic oral species (Porphyromonas gingivalis and Fusobacterium nucleatum) in anaerobic compartments of microtiter plates versus aerobic ones. Both species grew only in the anaerobic compartments of the plates as indicated by the growth curves generated. The sensitivities of E. coli and S. pyogenes to LL-37 were tested under anaerobic conditions and compared to those in aerobic ones. The oxygen facultative E. coli grew to a higher density under aerobic conditions and its sensitivity to LL-37 was increased under anaerobiosis. The microaerophilic pathogen S. pyogenes grew faster and to a higher density under anaerobic conditions and was much more resistant to LL-37 under oxygen deprivation. Our results suggest that resistance to antimicrobial agents of microbes infecting anaerobic-microaerophilic sites should be tested under oxygen-restricted conditions.

Psychological distress and self-perception of oral health status among an immigrant population from Ethiopia.

Objectives. To examine the association between psychological distress (PD) and perception of oral health status among a group of Ethiopian immigrants compared to the ‘gold standard’ of clinical diagnosis. Design. Three hundred and forty Ethiopian immigrants, aged 18 years or more, were interviewed using a version of the Self-Reporting Questionnaire (World Health Organization) for the assessment of psychological status and perceived dental and periodontal health status. Clinical data for dental and periodontal health status were used as the ‘gold standard’ against the self-perceived assessment scores among the PD and no psychological distress (NPD) groups. These were compared for sensitivity and specificity. Results. One hundred and thirty-five subjects (40%) presented PD. Seventy-eight percent of the PD subjects reported a negative dental health status, as compared to 42% of the NPD subjects. Seventy-three percent of the PD subjects reported a negative periodontal health status, as compared to 44% of the NPD subjects (p<0.001). The sensitivity for self-perceived dental health status among the PD subjects was found to be 0.78 and the specificity was found to be 0.40, as compared to 0.59 and 0.69, respectively, among the NPD subjects (p<0.001). The sensitivity for self-perceived periodontal health status among the PD subjects was found to be 0.78 and the specificity was found to be 0.40, as compared to 0.59 and 0.58, respectively, among the NPD subjects (p<0.001). Conclusion. Results demonstrate that PD may modify self-perception of health status. Self-perceived health and disease should be an integral element in the continuum of professional clinical health assessment and subsequent health care planning. The relevance of PD is evident in this immigrant ethnic group and should be considered and further studied in other at-risk minority communities.

Incidence of Cholesterol in Periapical Biopsies among Adolescent and Elderly Patients

INTRODUCTION Cholesterol clefts are common histologic findings in periapical biopsies; they have a reported incidence in periapical periodontitis of up to 44%. Cholesterol crystals are also recognized in advanced atherosclerotic plaques in humans. Male sex, genetic abnormalities, and age have been associated with advanced atherosclerotic lesions. Among these nonmodifiable risk factors, age is the most dominant. The aim of the study was to evaluate if age is also linked to cholesterol deposition in periapical periodontitis. METHODS The database of biopsy reports obtained between 2006 and 2009 was searched for specimens diagnosed as radicular cysts or periapical granulomas. Only data relating to biopsies obtained from adolescent (13-21 years old) and elderly (over 60 years old) patients were selected. The biopsies were examined by a pathologist under a light microscope (Zeiss, Jena, Germany) at magnifications of 40×-200×. The available material was scanned for the presence of cholesterol clefts and foamy cells in radicular cysts and granulomas. RESULTS A total of 41 specimens were collected in the adolescent group and 48 specimens in the elderly group over a 4-year period. A higher incidence of cholesterol was found in the elderly group compared with that in the adolescent group (odds ratio = 6.857). CONCLUSIONS The highly significant incidence of cholesterol deposits in periapical biopsies among elderly patients may be a possible cause for the lack of repair. The mechanism for cholesterol accumulation is probably similar to the process leading to atherosclerosis and coronary artery disease. Statin administration may be advantageous for the treatment of persistent lesions. A clinician should be aware of the risk for persistent lesions after endodontic treatment in elderly patients.

Dental Students’ Attitudes and Behavior Toward Smoking Cessation as Part of Their Professional Education

Background: Dental professionals have a major role in promoting tobacco use cessation (TUC). Purpose: The objective is to assess dental students’ knowledge, attitudes, behavior, and perception regarding their potential expected role. Methods: Self-administered anonymous questionnaires were used for all students of the Jerusalem Dental Medicine School. Results: Among 275 responding students, 17% reported smoking. Most students reported asking patients about smoking, counseling against smoking, and advising to quit. Only a minority reported providing antismoking educational material, suggesting nicotine replacements, and arranging follow-ups. Most students did not consider a list of suggested potential obstacles (lack of resources, not their role, etc.) as true barriers. Analysis by stage of studies revealed significant differences in reported TUC strategies and positive attitudes and decreases in perceived potential obstacles. Conclusions: These results indicate specific and practical areas for promoting antismoking intervention. Dental schools need to emphasize their role in preparing the next generation with a clear dedication toward TUC.

Oral health status among long-term hospitalized adults: a cross sectional study.

Background. Many Long-Term Care (LTC) institutionalized patients are the most frail and functionally dependent among the geriatric population and have significant oral health disparities.They often suffer from dental neglect due to limited access to appropriate professional dental care. These patients have chronic health situations and are treated with medications, which increase their risk of oral diseases. Despite the growth in elderly population in Israel, there is insufficient data regarding their oral health status and treatment needs. Objective. To describe the oral health status of the LTC hospitalized adults in a geriatric and psychiatric hospital in Israel. Methods. Data was recorded from LTC hospitalized adults with a physical and/or mental disabilities in a cross-sectional research design, which included general health anamnesis and clinical oral examination. Variables included gender, medicines, oral hygiene (OH), using dentures, number of caries lesions and residual teeth. Univariate analyses included Pearson χ2 and t-test analyses. Multivariate analyses included logistic and linear regressions while the outcome variables were categorical OH index and number of carious cavitations, number of residual teeth and carious teeth percentage. Results. 153 participants were included in the study with a mean age of 65.03 ± 18.67 years. 31.3% of the patients were edentulous, and only 14% had partial or full dentures. Females had a significantly higher number of caries cavitation than males (P = 0.044). The number of caries cavitation was higher among patients with poor OH (P < 0.001) and when taking Clonazepam (P = 0.018). Number of residual teeth was higher in the fair OH group (P < 0.001). Carious teeth percentage was higher among the poor OH group (P < 0.001).

Social Determinants and Oral Health: An Update

This review presents the most recent studies and evidence on the social determinants of oral health. Oral disease is associated with an array of structural determinants (income, goods, and services). It is also associated with daily living conditions, and social gradients have been reported for dental caries, periodontal disease, oral cancer, and tooth loss. Current understanding of these interconnections have prompted the development of a new approach for oral health promotion, which recognizes that the behaviors accounting for the most important noncommunicable diseases contribute to oral diseases as well. Oral diseases and issues such as poor access to dental care and low oral health literacy levels are social, political, behavioral, and medical in nature. These conditions will only be controlled by the promotion of initiatives that prioritize the improvement in the social determinants of health as a backbone structure for the development of healthy enabling environments.