What characterizes effective tooth brushing of daily users of powered versus manual toothbrushes?

Background Recent data show comparable deficits in oral cleanliness after tooth brushing in habitual users of powered toothbrushes (PT) and manual toothbrushes (MT). The present analysis explores the origin of these deficits by relating aspects of the observed tooth brushing behaviour to plaque after tooth brushing. Methods Users of rotating-oscillating PT (N = 48) and of MT (N = 52) brushed their teeth the best they could while being filmed. Video analyses assessed brushing time, number of sextants brushed sufficiently long (7.5 s per surface; NSBSL), brushing of outer surfaces with closed jaws, and brushing movements. Correlation analyses examined the relationship between these parameters and plaque after brushing (Marginal Plaque Index (MPI); Turesky modification of Quigley Hein Index (TQHI)) and gingivitis (Papillary Bleeding Index (PBI)). Results In PT users, correlations between behaviour and MPI-scores were significant for the NSBSL (outer surfaces: rho = − 0.249; inner surfaces: rho = − 0.510) and brushing duration (outer surfaces: rho = − 0.399; inner surfaces: rho = − 0.509). In MT users, vertical movements on the outer surfaces were positively related to MPI (rho = 0.299). In contrast, circular movements correlated negatively with MPI in those who brushed all outer sextants sufficiently long (n = 47: rho = − 0.294). In both groups, PBI-scores on the inner surfaces were negatively correlated to NSBSL and brushing duration (rho = − 0.327 − rho = − 0.246). Conclusion NSBSL and brushing duration appear to play an important role for brushing effectiveness and gingival health in PT and MT users. Whether PT users apply brushing movements or not apparently does not affect the result. In MT users, circular movements seem to be more efficient than vertical movements on the outer surfaces.

ASSESSMENT OF LIPID METABOLISM IN PATIENTS WITH CORONARY ARTERY DISEASE AND GENERALIZED PERIODONTITIS

Introduction. It has been assumed that generalized periodontitis (GP) adversely affects the qualitative and quantitative composition of plasma lipids and lipoproteins. On the other hand, periodontal treatment and reduction of general periodontal pocket infection in patients with GP are associated with a decrease in total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C) and triglycerides (TG). The aim of the study was to conduct a comparative assessment of the state of lipid metabolism in patients with coronary artery disease (CAD) depending on the GP severity. Methods. The study included 101 patients (mean±SD age - 58.2 ± 8.3 years) with CAD and GP, 58 men (57.4%) and 43 women (42.6%). According to the severity of GP, study participants were divided into 3 groups: group I - patients with CAD and GP stage I (initial periodontitis), group II - patients with CAD and GP stage II (moderate periodontitis) and group III - patients with CAD and GP stage III and IV (severe periodontitis). The control group included 9 patients with CAD and clinical gingival health on an intact periodontium (mean±SD age - 56.3 ± 6.1 years), 5 men (55.6%) and 4 women (44.4%). The diagnosis of CAD and the results of lipid metabolism were obtained by analyzing the inpatient medical records. Results. It was revealed that the values of TC, LDL-C, very low-density lipoprotein-cholesterol (VLDL-C), TG and atherogenic coefficient (AC) were lower in the group of patients with CAD and clinical gingival health compared to the level of the corresponding indicators in the groups of patients with CAD and GP (p<0.05). In the analysis of lipid profile in patients with CAD and GP of varying severity, it was found that the average levels of TC, LDL-C, and AC in the subjects of group I were significantly lower compared to the corresponding indicators of groups II and III (p<0.05). There was no statistical difference in the values of lipid metabolism in groups II and III (p>0.05). No significant difference was found in high-density lipoprotein-cholesterol (HDL-C) levels between the comparison groups including the patients with CAD and clinical gingival health (p>0.05), as well as the gender characteristics of the analyzed indicators in the examined patients. Conclusions. Average levels of TC, LDL-C, and AC in patients with CAD and GP increase with increasing destructive-inflammatory changes in periodontal tissues, therefore, with the severity of GP indicating the progression of atherogenesis along with the increased inflammatory process in the periodontium

Arch Bar versus Titanium Mini-Plate Fixation in Anterior Segmental Osteotomy / Orthognathic Surgery (Cohort Clinical Study)

Aims and objectives: To compare the efficacy and outcome of arch bar versus plating fixation on the integrity of the osteomised segment. Materials And Methods: The study involved a total of 43 patients (86 jaws) undergoing upper (Wassmund) and lower (Kole) anterior segmental osteotomy from (2006-2013) in the Maxillofacial Department in Al-Salam Teaching Hospital/Mosul. The sample was divided into two groups, group A (43 jaws), the osteotomized segments fixed with the arch bar, while group B (43 jaws) fixed with mini-plates. The clinical evaluation includes the following criteria: pain, swelling, bleeding, wound healing, oral hygiene ,integrity of stabilization, relapse rate and duration of operation. Results: Clinical parameters as pain, swelling, and wound healing show no significant differences between groups; on the contrary, the bleeding scale and gingival health scale show very high significant differences in p-value. The integrity of stabilization immediately in operation reveals stable surgical correction in both groups. Still, one jaw from each group develops significant mobility (grade II) that necessitate the use of additional local types of fixation. Duration of operation: this manure could be operator skill dependent, in that most cases managed clinically in teaching hospitals necessitating some delayed time in operative work, but as a mean time overall patients in group A was 90 minutes, while in group B was 77 minutes. Conclusions: According to this study, we prefer to use an arch bar rather than manipulates for fixation of anterior segmental osteotomies. Key words: Arch Bar, Complication, Fixation, Miniplate, Osteotomy.

Expression of circulating cell-free nucleic acids around miniscrew implant during orthodontic tooth movement—a prospective study

Objectives Literature shows that the expression of various biomarkers in peri-miniscrew crevicular fluid (PMICF) is related to the stability of miniscrew implants (MSIs). The present study investigated the role and alterations in levels of circulating cell-free nucleic acids (cfNAs) in PMICF before and after orthodontic loading. Material and methods This prospective study consisted of forty-six MSIs placed between the second premolar and first molar in the maxillary and mandibular arches. Direct loading was done after 3 weeks of MSI insertion with nickel-titanium closed coil spring exerting a force of 200 g. The PMICF sample was collected at various time intervals, and the level of cfNA was determined. Clinical parameters, including implant mobility and gingival health, were also assessed. Pre-loading and post-loading parameters were assessed using Wilcoxon’s rank-sum test. Results Among 46 MSIs, 36 were stable during the study and 10 MSIs showed peri-implant inflammation and increased mobility. There was a significant rise in the cfNA concentration 24 h after implant insertion (0.4 ± 0.86 ng/μl). The level of cfNAs significantly decreased over 3 weeks and reached the baseline level (0.2 ± 0.31 ng/μl). There was also a significant rise in the levels of cfNA (0.8 ± 0.70 ng/μl) at 24 h after loading MSIs, which gradually decreased to 0.2 ± 0.24 ng/μl after 63 days. The expression of cfNAs was on the average 0.32 units more in the cases with failed implants (P = 0.05). Conclusions cfNA levels in PMICF showed an upward trend 24 h after MSI insertion and 24 h after orthodontic loading. The expression of cfNA was more in cases with failed MSIs. Hence, the cfNAs can be considered as a prognostic biomarker of MSI stability.

Surgical Techniques for Correcting Aberrant Frenal Attachment: A Clinical Review

Frenum is a fold of mucous membrane, usually with enclosed muscle fibers, which attaches the lips and cheeks to the alveolar mucosa and/or gingival and underlying periosteum. Different types of frenal attachments have been observed and classified. Frenum with abnormal attachments may lead to mucogingival problems while hampering gingival health, as they cause an interference in the plaque control or may create a muscle pull. This condition may require management that can be usually performed with frenectomy and frenotomy procedures. Frenectomy is the complete removal of the frenum, while frenotomy is the incision and relocation of the frenal attachment. The present article is a compilation and review of a series of clinical cases of frenal excision through different surgical approaches.

Effectiveness of oral health education intervention among 12–15-year-old school children in Dharan, Nepal: a randomized controlled trial

Background School-aged adolescents are in particular need of preventive program to ensure positive long-term oral health and hygiene. The objective of this study was to assess the effectiveness of an oral health education (OHE) intervention on oral hygiene knowledge, attitude and practices (KAP), plaque control and gingival health among 12–15 years old school children in Dharan sub-metropolitan city, Nepal. Methods A randomized controlled trial was conducted with parallel study groups, comprising 12–15-year-old school children, 120 in each group. OHE was given to the experimental group at baseline, third and sixth months and to the control group after completion of the study. Interview of the participants were done using a 23-item questionnaire for assessment of oral hygiene KAP. For each question, correct answer was scored as 1 and wrong answer was scored zero. An overall composite score was then created, by adding the individual scores. Oral examination was done using mouth mirror and WHO probe to record Turesky–Gilmore–Glickman modification of the Quigley-Hein plaque index, Gingival index and Dentition status and treatment needs. Analysis was done using chi-square test for categorical data and independent t test, Mann–Whitney U test, repeated measures ANOVA and post hoc Tukey’s test for quantitative data. The level of significance was set at P < 0.05. Results There was 54.58% improvement in overall oral hygiene KAP in experimental group (P = 0.001) whereas no improvement was seen in control group at the end of the study. The mean plaque score was improved by 57.67% (P = 0.001) in experimental group in comparison to 4.56% in control group. Gingival index was improved by 49.90% (P = 0.001) in experimental group in comparison to 0.7% in control group. Caries experience was increased in both groups but no significant difference was seen. Conclusions The study concluded that oral health education was effective in improving oral hygiene KAP, plaque control and gingival health. Trial registration The trial was retrospectively registered with Clinical Trial Registry India (CTRI) with identifier no. CTRI/2018/05/013985, registered on 05/21/2018. (http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=23651&EncHid=&modid=&compid=%27,%2723651det%27). Institutional Review Committee, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal provided the ethical approval (Ref. No.: 292/074/075-IRC).

The Relationship between Iron Deficiency Anemia and Dental caries

Background Iron deficiency anemia and dental caries are among the most prevalent diseases in some developing countries. However, few studies have been conducted to assess the association between Iron deficiency anemia (IDA) and early childhood caries (ECC). Objectives The aim of the study was to assess the association between IDA and ECC. Methods 40 children with proved iron deficiency anemia (using iron profile panel done initially) and another 40 healthy age and sex-matched children were examined by one trained and calibrated dentist where the oral status of all enrolled children was assessed in terms of the Decayed, Missing, Filled (DMF) index and gingival health using Gingival index of Loe and Sillness. Results Children with anemia had a significantly higher DMF index (4.37±4.44) than children without anemia (0.50±0.90) (P &lt; 0.001). It was found that there was a negative significant correlation between DMF index and the presence of anemia (r= -0.60, P &lt; 0.001), hemoglobin level (r= -0.454, P &lt; 0.001) and MCH level (r= -0.380, P = 0.001). The multiple regression model statistically significantly predicted DMF index (P = 0.001), (R2=0.34) and only the presence of anemia was found to add significantly to the model (P = 0.027). Conclusion Children with iron deficiency anemia have increased risk for development of dental caries than children without anemia. Any children with significant dental caries should be investigated for IDA and anemia should be treated if present.