G.A. van der Weijden

The Effect of Chlorhexidine Varnish on Root Caries: A Systematic Review

Objective: The aim of this study was to systematically review the present literature on the effect of chlorhexidine varnish (CHX-V) on root caries. Materials and Methods: The MEDLINE-PubMed, the Cochrane-CENTRAL and EMBASE databases were searched through December 2010 to identify any appropriate studies. Root caries incidence and root caries activity were selected as outcome variables. Results: An independent screening of the unique titles and abstracts of 24 MEDLINE-PubMed, 14 Cochrane-CENTRAL and 18 EMBASE papers resulted in 6 publications that met the eligibility criteria. Data extraction provided no conclusive evidence that the application of CHX-V is effective in patients when regular professional oral prophylaxis is performed. If effective, the 40% CHX-V was found to provide a benefit over a control or fluoride varnish. CHX-V at lower concentrations (1 and 10%) may provide protection against root caries in high-risk patients (such as geriatric and xerostomia patients) in the absence of regular professional oral prophylaxis. Conclusion: Within the limitations of this review, it may be concluded that in the absence of regular professional tooth cleaning and oral hygiene instructions, CHX-V may provide a beneficial effect in patients in need of special care. The strength of this recommendation is graded as ‘weak’.

Increased Salivary Fluoride Concentrations after Post-Brush Fluoride Rinsing Not Reflected in Dental Plaque

The aim of the present study was to assess fluoride concentrations in unstimulated saliva and buccal dental plaque 6 h after an oral hygiene procedure that consisted of brushing with an AmF/SnF2 dentifrice and different post-brush rinsing protocols: expectorating the excess of dentifrice foam and rinsing with tap water, expectorating only, or rinsing with 10 ml AmF/SnF2 mouthwash. The fluoride concentrations in plaque and saliva were increased after all three experimental protocols compared to F-free periods. The increase of the fluoride concentration in saliva was more pronounced after AmF/SnF2 mouthrinse as compared to rinsing with water and expectorating the excess of dentifrice foam. Such an effect was not seen in dental plaque. It is concluded that the potentially beneficial effect of not rinsing or fluoride rinsing after tooth brushing is not reflected in an increased fluoride concentration in newly formed dental plaque 6 h after brushing.

Long-term efficacy of a 0.07% cetylpyridinium chloride mouth rinse in relation to plaque and gingivitis : a 6-month randomized, vehicle-controlled clinical trial

OBJECTIVEnTo evaluate the effectiveness of 0.07% cetylpyridinium chloride (CPC) mouth rinse for reduction of gingival inflammation and inhibition of plaque compared to a vehicle control (VC) mouth rinse over a 6-month period.nnnMATERIALS & METHODSnParticipants (nxa0=xa062) used their randomly assigned product as adjunct to toothbrushing. Bleeding, plaque and staining scores were assessed at baseline, 3 and 6 months. Plaque and saliva samples were taken at each assessment monitoring possible shifts in the composition of the microbiota.nnnRESULTSnA significant difference (Pxa0=xa00.002) in favour of the CPC mouth rinse, with respect to plaque scores, was found. Bleeding scores at 6 months were not significantly different (Pxa0=xa00.089). However, when correcting for baseline values, a tendency towards a significant difference in bleeding scores at end trail was observed in favour of the CPC mouth rinse (Pxa0=xa00.061). Regarding staining at 3 and 6 months, a small but significant difference (8.6% and 10.4%, respectively) (Pxa0<xa00.0001) was observed with lower scores for the VC group. There was a significant reduction in total anaerobic count in the CPC group at 6 months (Pxa0<xa00.05). The ratio of aerobes/anaerobes was markedly increased at 3 months, especially in the CPC group. No further differences were observed between groups at 6 months.nnnCONCLUSIONSnThe use of 0.07% CPC mouth rinse was significantly more effective in reducing plaque scores than the vehicle control. Bleeding scores were not different at 6 months. The test product was well accepted and did not cause any serious clinical side effects or negatively affected the microbiota.

Effects of various rinsing protocols after the use of amine fluoride/stannous fluoride toothpaste on the acid production of dental plaque and tongue flora

The aim of this clinical study was to evaluate the effect of various rinsing protocols on oral acid production 6 h after tooth brushing with an amine fluoride/stannous fluoride (AmF/SnF2) toothpaste. After a 14-day period of using F-free toothpaste, 30 participants followed three experimental protocols each, followed by F-free washout periods in a randomized crossover trial. They used AmF/SnF2 toothpaste twice daily for 1 week, and after brushing, they either rinsed with tap water, omitted the post-brush rinse, or rinsed with an AmF/SnF2 mouthwash. In the F-free washout periods, the participants brushed their teeth without further instructions. Six hours after the last brushing (± rinsing) of each period, subjects rinsed with 10 ml 10% sucrose solution for 2 min. A tongue film sample and a buccal plaque sample were taken 4 and 8 min after the sucrose challenge, respectively. Metabolic acid ions were determined by capillary electrophoresis. The results show that (1) omitting the post-brush water rinse did not reduce the production of lactic, acetic or minor acids in plaque, nor on the tongue, and that (2) the additional use of AmF/SnF2 mouthwash after brushing reduced the acid production in plaque and tongue samples for at least 6 h. The distributions of acids produced in the plaque or tongue samples were not statistically different between experimental periods. It is concluded that an increase in the antimetabolic effect of AmF/SnF2 toothpaste in between two daily brushing exercises is not achieved by omitting the post-brush water rinse. The additional use of AmF/SnF2 mouthwash after brushing is effective in reducing the acid metabolism in dental plaque and tongue flora.

Safety and efficacy of two manual toothbrushes

OBJECTIVEnThe purpose of this study was to test the efficacy and safety of a newly designed multi-level manual toothbrush (Profit-Haije-Brush) compared with a control flat-trimmed manual reference toothbrush from the American Dental Association (ADA).nnnMATERIAL AND METHODSnFor this study, 36 healthy subjects without previous experience in the use of the Profit-Haije-Brush (PHB) were selected. Subjects were given a period of 2 weeks to become familiar with both types of brushes and were instructed to use them on alternate days for 2 min twice daily. Prior to their visit, subjects refrained from all oral hygiene procedures for 48 h. Prebrushing plaque and gingival abrasion scores were assessed. Subsequently, two randomly chosen contra-lateral quadrants were brushed with one of both brushes and the other two quadrants with the alternate brush. Subjects were supervised during their 2-min brushing exercise. After brushing, plaque and gingival abrasion were re-assessed. A questionnaire was filled out to investigate the subjects attitudes towards both brushes.nnnRESULTSnThe overall mean prebrushing PI was 2.47 for the PHB and 2.44 for the ADA. The reduction in PI was 1.32 and 1.23 respectively (P < 0.05). With regard to gingival abrasion the overall mean prebrushing scores were 4.57 (PHB) and 5.34 (ADA). Post-brushing scores were 13.49 and 13.77 for the PHB and ADA respectively.nnnCONCLUSIONnStatistically, the multi-level PHB was significantly more efficacious than the flat-trimmed ADA. However, the difference is clinically considered small and the amount of remaining plaque was not significantly different between brushes. No greater potential to cause gingival abrasion to the oral tissues was observed.

A reproducible microcosm biofilm model of subgingival microbial communities

OBJECTIVEnTo develop a reproducible subgingival microcosm biofilm model.nnnMATERIAL AND METHODSnSubgingival plaque samples were collected from four deep pockets (probing pocket depth ≥6xa0mm) in each of seven patients with periodontitis and from shallow pockets (probing pocket depth ≤3xa0mm) in two periodontally healthy donors. An active attachment model and a peptone medium (Thompson et. al., Appl Environ Microbiol 2015;81:8307-8314) supplemented with 30% serum was used. Biofilms were harvested at 2 and 4xa0weeks. DNA of dead cells was blocked for amplification by propidium monoazide treatment. Composition was analyzed using 16S rRNA gene amplicon pyrosequencing. Similarities between the biofilm samples were assessed by non-metric multidimensional scaling using the Bray-Curtis similarity index and similarity percentage analysis. Data from duplicate experiments, different biofilm sources and different biofilm age were compared.nnnRESULTSnThe non-metric multidimensional scaling revealed a strong clustering by the inoculum source, the donor and their periodontal status. Statistically significant differences were found between the sources of inoculum (P=.0001) and biofilm age (P=.0016). Furthermore, periodontitis biofilms (P) were distinct in composition from health-derived biofilms (H) by genera: Porphyromonas (P=19%; H=0%), Filifactor (P=10%; H=0%), Anaeroglobus (P=3%; H=0%), Phocaeicola (P=1.5%; H=0%), Parvimonas (P=19%; H=14%), Fusobacterium (P=2%; H=26%), Peptostreptococcus (P=20%; H=30%), Veillonella (P=7%; H=8%) and 57 other genera. Similarity distances (Bray-Curtis) (mean 0.73, SD 0.15) and the Shannon diversity index (mean 2, SD 0.2) revealed no differences between duplicate experiments (P=.121).nnnCONCLUSIONnThis biofilm model allows reproducible production of complex subgingival microbial communities.

Healing of toothbrush-induced abrasions to keratinized mucosa of the palate in humans: A pilot study

BACKGROUND AND OBJECTIVEnTo the best of our knowledge, the healing time for toothbrush-induced gingival abrasions in humans has not yet been explored. The aim of this study was to evaluate the time needed to heal for toothbrush-induced abrasions of the keratinized mucosa of the palate.nnnMATERIAL AND METHODSnIn patients without, with mild periodontitis or with periodontitis, gingival abrasion lesions were induced at the keratinized mucosa of the palate by brushing up to 2xa0minutes. Healing as observed clinically was followed via calibrated digital photographs of the lesion after staining, every 24xa0hours until the lesion had resolved. In patients without or with only mild periodontitis, the healing time of lesions caused by 30xa0seconds and 1xa0minute of brushing was also recorded.nnnRESULTSnThirty-one participants (11 without or with mild periodontitis, 20 with periodontitis) met the inclusion criteria. In patients without or with mild periodontitis, the lesions induced by brushing for 2xa0minutes diminished by 48.7% of their original surface area within 24xa0hours. In patients with periodontitis the respective outcome was 45.4% (Pxa0=xa0.87). Abrasions caused by 2xa0minutes of brushing needed more than 24xa0hours to heal completely. When decreasing the time exposed to trauma, fewer lesions were visible at baseline and the time needed to heal decreased. The subgroup of smokers was too small to evaluate any effect.nnnCONCLUSIONnThe longer the exposure time of the keratinized mucosa of the palate to trauma, the more lesions were visible, the larger the abrasions were and the more time they needed to heal completely. More studies are needed to investigate the role of smoking, gingival biotype and to link these findings with gingival recessions.

Supportive periodontal treatment: Pocket depth changes and tooth loss

AIMnThe purpose of this retrospective study was to determine the results of 10xa0years of supportive periodontal treatment(SPT) following active periodontal therapy(APT). Probing pocket depth(PPD), bleeding on probing(BOP), tooth loss(TL)and the effects of two patient-related factors, smoking and gender were evaluated.nnnMETHODSnThis retrospective study examined patients who underwent APT and SPT for adult periodontitis. Analyses were conducted using site-, tooth- and patient-level information. Mean values were calculated, and parametric and nonparametric analyses were conducted as appropriate to assess the results of APT and SPT.nnnRESULTSnThere was a significant improvement in BOP and PPD after APT. After 10xa0years, 9.3% of the patients adhered to the SPT protocol. The improvement in BOP and PPD was maintained, with no additional improvement in the clinical parameters at the 10-year follow-up. Furthermore, differences between non-smokers and smokers were found. After the 10-year follow-up, smokers had a significantly higher percentage of sites with a PPD of 4xa0mm or higher; the mean PPD was also significantly higher in smokers. A significant difference was also found between males and females during SPT for the percentage of sites with BOP and the percentage of sites with a PPD≥6xa0mm. A minority of patients(18.5%) did not lose teeth, and it was found that molars are the teeth most likely to be lost. The mean number of teeth lost was 2.6 during 10-year follow-up.nnnCONCLUSIONnThis study indicates that with regard to bleeding on probing and probing pocket depth, patients receiving supportive periodontal treatment maintain their periodontal condition. However, in this group of adherent maintenance patients, tooth loss was most prevalent for molar teeth.

31 Parodontale aandoeningen bij kinderen en jonge volwassenen

Al in 1938 waarschuwde McCall de tandheelkundige professie dat vrijwel alle vormen van parodontitis bij volwassenen terug te voeren zijn tot in de jeugd. In de afgelopen decennia is deze waarschuwing keer op keer herhaald, zonder dat ze veel effect sorteerde. De parodontale toestand van kinderen en jonge volwassenen was en bleef onbelangrijk, mede doordat de toestand van het parodontium bij volwassenen betrekkelijk weinig aandacht kreeg. Wat de aandacht voor volwassenen betreft, is er in de geindustrialiseerde wereld in de afgelopen 25 jaar een aanzienlijke verandering opgetreden. Hopelijk zal deze kentering ook tot gevolg hebben dat er in de toekomst meer aandacht wordt besteed aan het parodontium van kinderen.