Is oral hygiene performed by caregivers of children and adolescents with cerebral palsy effective?

Objective: To evaluate the effectiveness of oral hygiene performed by caregivers of children and adolescents with cerebral palsy (CP) during the moments before and after three months of oral health instructions. Methods: In a longitudinal study, 102 participants were joined in two groups: G1 (n=51) composed of children and adolescents (C/A) with CP and G2 (n=51), composed of their caregivers. Sociodemographic and oral hygiene habits were collected and evaluated using the Visible Plaque Index (VPI) and Gingival Bleeding Index (GBI), before and after oral hygiene orientation. The Qui-Squared, ANOVA 1, and tStudent tests were applied. P < 0,05. Results: The C/A group with pattern clinical CP tetraparesis, diparesis and hemiparesis were homogeneous in terms of gender (P = 0,07), however differed in age (P < 0,05), the youngest being diparetic. No difference was observed when comparing VPI and GBI before and after instructions in oral health for the three clinical types (P> 0,05). However, a reduction in the VPI and GBI indexes (P < 0,05) before and after, in each of the three clinical patterns. Most of the caregivers were female, married, with a high school degree, and they performed oral hygiene three times per day. The caregivers presented significant drops in VPI and GBI after receiving oral hygiene instructions. (P < 0,05). Conclusion: Oral hygiene instruction is fundamental for the caregivers of children and adolescents with cerebral palsy since it is an effective form of controlling health problems.

Management of endo perio lesion with class iii furcation defect –A case report

The primary aim of periodontal and endodontic therapy is to restore the lost periodontium and maintain the natural dentition. An ideal endodontic treatment involves removal of any infected pulp completely, preventing or minimizing any chances of reinfection, with proper irrigation and drying of canals, care to be taken not to break any file during cleaning and shaping of canals, proper obturation and not over or under filling of canals, proper sealing, proper restoration and an ideal crown placement. An ideal periodontal treatment involves scaling and root planing, proper reflection of flap to visualize the furcation areas, removal of diseased soft tissue surrounding the lesion and furcation areas and giving adequate oral hygiene instructions. Based on grade of furcation defects, suitable treatment modalities should be chosen. This case report aims at managing an endo-perio lesion involving class III furcation defect using tunneling technique.

A 10 Day Tooth Brushing Pilot Study- Report

A major dental problem in persons with mental retardation/developmental disabilities is poor dental hygiene resulting in poor plaque control which leads to gingivitis, periodontal disease and dental caries. The most obvious reason for poor oral hygiene of such persons is their inability to clean the oral cavity adequately. Caregivers face many challenges in providing good oral care for such individuals. The electric toothbrush has been shown to be effective in plaque removal and gingivitis in both healthy and disabled/ special needs people. They are more superior at removing plaque and reducing gingivitis in both short- and long-term clinical trials. This study assessed the effectiveness of using electric toothbrushes as a means of plaque control in a 10-day pilot program. It was implemented as part of a life skills program at a special needs school in South Auckland. A total of 11 children participated in the program. Informed consent was obtained from parents/caregivers prior to the study. Electric toothbrushes and toothpastes were provided by the author of the study along with and oral hygiene instructions to the teachers/caregivers. The study was evaluated by comparing photos of the teeth before and after the pilot study. Plaque disclosing tablets were used to aid this process as it dyes the plaque making it visible to the eyes. Evaluation /feedback forms were also completed by teachers/caregivers of the special needs unit to ascertain the efficacy of the program. The findings of the study showed that using electric toothbrushes improved both the general plaque distribution and boosted children’s motivation to brush their teeth. The conclusion drawn from this study indicates that while electric toothbrushes are effective at plaque control, a longer intervention period is postulated to obtain clinically significant results or see a significant change in behavior.

New Frontiers on Adjuvants Drug Strategies and Treatments in Periodontitis

Causes of the progression of periodontitis such as an imbalance between the immune response by the host by the release of inflammatory mediators in the response of the oral pathogenic dysbiotic biofilm have been identified. New insights on specific cell signaling pathways that appear during periodontitis have attracted the attention of researchers in the study of new personalised approaches for the treatment of periodontitis. The gold standard of non-surgical therapy of periodontitis involves the removal of supra and subgingival biofilm through professional scaling and root planing (SRP) and oral hygiene instructions. In order to improve periodontal clinical outcomes and overcome the limitations of traditional SRP, additional adjuvants have been developed in recent decades, including local or systemic antibiotics, antiseptics, probiotics, anti-inflammatory and anti-resorptive drugs and host modulation therapies. This review is aimed to update the current and recent evolution of therapies of management of periodontitis based on the adjunctive and target therapies. Moreover, we discuss the advances in host modulation of periodontitis and the impact of targeting epigenetic mechanisms approaches for a personalised therapeutic success in the management of periodontitis. In conclusion, the future goal in periodontology will be to combine and personalise the periodontal treatments to the colonising microbial profile and to the specific response of the individual patient.

SYSTEMIC AND LOCAL DELIVERY OF ANTIBIOTICS IN MANAGING PERIODONTAL DISEASES: AN UPDATE

The aim of this update was to evaluate the use of local and systemic antibiotics for the treatment of periodontal diseases. Due to the accumulation of bacteria in the form of dental plaque, the tissues and bone surrounding the teeth can become infected leading to periodontal diseases such as gingivitis and periodontitis. The main purpose of periodontal therapy is to eliminate or control the undesired effects of these bacteria present in the oral cavity in the form of biofilms. The use of antibiotics in conjunction with mechanical instrumentation has been suggested for the successful treatment of periodontal diseases. PubMed and google scholar databases were used to search through the past 30 years of literature using selected search criteria “Periodontal diseases*[TW] AND (gingivitis*[TW] OR periodontitis*[TW] OR antibiotics*[TW])” to identify articles/book chapters discussing polymerization shrinkage and possible solutions. In total, 46 articles/book chapters met the criteria for inclusion in the literature review. It can be concluded that the use of antibiotics is justified in cases with rapid signs and symptoms of destruction of periodontal tissues. Hence, antibiotics are suggested in cases of aggressive periodontitis, periodontal abscess, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis and periodontitis that do not respond well to mechanical instrumentation alone. However, antibiotics may cause side effects and the bacteria may develop resistance, therefore dentists should keep in mind the adverse effects and benefits while prescribing antibiotics. Moreover, antibiotics should always be given as an adjunct to mechanical instrumentation and oral hygiene instructions to achieve successful outcome.

Titanium Mesh Exposure After Bone Grafting: Treatment Approaches—A Systematic Review

Study Design: A systematic review according to PRISMA statement has been designed to answer the preliminary question: “ In titanium mesh exposures, is there a treatment alternative which leads to an increased graft maintenance?” and fill the PICO assessment out. Objective: To review studies published in the past 20 years (1999-2019) in which mesh exposure has occurred, detecting the suitable approaches to treat exposure allowing the graft maintenance. Methods: Initial search on PUBMED, SCOPUS, and COCHRANE databases resulted in 777 articles, and hand-searching identified 6 articles. After removing duplicates and unrelated articles, eligibility criteria were applied, and 31 studies were selected (randomized clinical trials, retrospective/prospective clinical trials, and case series). Results: A total of 677 surgical sites and 225 cases of mesh exposure were identified. Eleven treatments have been identified. Chlorhexidine was the primary approach in 46% of cases, followed by oral hygiene instructions and follow-up with 22.5% of occurrences. In 21% of clinical situations, titanium mesh removal was the treatment of choice, associated with other measures (i.e., antibiotic prescription). There seems to be a consensus in cases of infection. When this complication was associated with tissue dehiscence, the primary treatment was mesh removal. The same does not occur when the site needs to be cleaned for long-term periods. Conclusion: In 2 decades of use of titanium meshes, the available treatments do not seem to have evolved, and there is not enough data to establish a guideline.

C – reactive protein in saliva of non-smoking patients with periodontitis (a pilot study)

Introduction: C-reactive Protein (CRP) as an inflammatory biomarker can be easily determined in saliva, but the values of salivary CRP in periodontitis are not well-studied. The aim of this study was to analyze and determine the values of salivary CRP in non-smokers with periodontitis stage 3 or 4 before and after supragingival and subgingival full-mouth periodontal therapy.Methods: Standard periodontal parameters and saliva samples were collected in 12 non-smoking patients. Patients in the test group (n = 6) underwent supragingival and subgingival full-mouth periodontal therapy, and the control group (n = 6) received only supragingival full-mouth therapy. Both groups received the same oral hygiene instructions in addition to therapy. After 3 months, re-registration of periodontal parameters and re-sampling of saliva for analysis of salivary CRP were done for both groups.Results: Statistical analysis revealed large differences in the values of clinical periodontal parameters and CRP levels in the test group after therapy. Values of salivary CRP in the test and control groups were lower 3 months the therapy; however, the results were not statistically significant. The correlation of clinical periodontal parameters and salivary CRP varied in both groups.Conclusion: Our pilot study reveals decreased concentrations of salivary C-reactive protein in non-smoking patients following non-surgical periodontal therapy. Further studies are needed to prove the reliability of salivary CRP as a biomarker for periodontitis.

Online Oral Hygiene Instructions for Orthodontic Patients in Malaysian Population

Fixed orthodontic appliances causes plaque accumulation, which leads to the formation of dental caries and gingivitis. Therefore, concise oral hygiene instructions (OHI) is necessary to avoid the occurrence of these diseases. Massive Open Online Course (MOOC) ensures interactive learning to improve knowledge retention. MOOC transfers the responsibility of learning OHI to the patients with remote guidance from the clinician, thus reduces clinical time. This research aimed to develop the MOOC learning content on OHI in orthodontic practice. The secondary aim was to assess the overall analytics data among learners enrolled for the completion rate and time taken to complete the MOOC. The ADDIE principles which were, "Analyse, Design, Develop, Implement and Evaluate", were used to develop the MOOC. The contents were based on a published pamphlet of OHI from the Ministry of Health, Malaysia. The MOOC was pre-tested, and content was improved based on the feedback from users and experts. The MOOC named “Penjagaan Kebersihan Pendakap Gigi” utilises the Bahasa Melayu language to educate learners regarding oral care with orthodontic appliances. Sixty-two learners joined the MOOC, with 77.4% achieving a high rate of completion of the MOOC learning content. There were forty-six female learners (74.2%), while male learners comprised sixteen (25.8%). The median (interquartile range) time taken to complete MOOC learning content were 31.50 minutes, (13.00 minutes to 55.50 minutes). This shows that MOOC could be an alternative platform to instruct patients on OHI with fixed appliances. MOOC can potentially reduce clinical time to teach OHI to patients.

Daily Tasks and Willingness to Work of Dental Hygienists in Nursing Facilities Using Japanese Dental Hygienists’ Survey 2019

Oral health care by dental hygienists contributes to the maintenance of nutritional and general health for older people in nursing facilities. This study aimed to investigate daily tasks and willingness to work among dental hygienists working in nursing facilities in Japan. In 2019, using a self-administered questionnaire, a postal cross-sectional survey was conducted among members of the Japanese Dental Hygienists’ Association. Questionnaires were distributed to all 16,722 Association members (responses, n = 8932; return rate, 53.4%). We analysed data from 368 dental hygienists currently working in nursing facilities. Item response theory and correspondence analyses were performed. In total, >90% of dental hygienists undertook oral examinations and provided oral hygiene instructions to residents and facility staff. In contrast, the implementation rate of tasks related to interprofessional collaboration was relatively low (approximately 50%), and 72.6% of dental hygienists indicated that they wanted to continue working in nursing facilities. Their willingness to work was closely associated with work involving interprofessional collaboration. Our study findings showed that dental hygienists’ work content in nursing facilities was diverse, but that there was variation in implemented tasks. Willingness to continue working in nursing facilities was associated with interprofessional collaboration among dental hygienists.

Virtual reality in oral hygiene instruction: an innovative and effective method (Preprint)

BACKGROUND Currently, oral health issues have been increasingly addressed, virtual reality (VR), being used as an aid in the health area. However, there is little evidence of the use of VR in preventing oral health. OBJECTIVE To evaluate the effectiveness of VR in oral hygiene education. METHODS Three hundred students, aged 9 to 12 years old received instructions in oral hygiene by immersion in VR and they opined about the performed activies. Chi--square and Fisher's exact tests were applied, with a significance level of 5%. RESULTS The participants' perception of oral hygiene showed no statistically significant difference (p=0.550). There was an increase in the use of dental floss (p=<0.0001), in tongue brushing (p=<0.0001), and in tooth brushing (p=<0.0001). The drawings performed by the participants demonstrated drawings related to oral hygiene and the messages were positive regarding the project. CONCLUSIONS The use of VR in oral hygiene instructions was effective. Most participants increased the frequency of tooth and tonghe brushing, of the use of dental floss, and made drawings related to oral hygiene.