Oral Health and Preventive Dentistry, 01/2003

The subject risk assessment may estimate the risk for susceptibility for progression of periodontal disease. It consists of an assessment of the level of infection (full mouth bleeding scores), the prevalence of residual periodontal pockets, tooth loss, an estimation of the loss of periodontal support in relation to the patient's age, an evaluation of the systemic conditions of the patient and finally, an evaluation of environmental and behavioral factors such as smoking. All these factors should be contemplated and evaluated together. A functional diagram may help the clinician in determining the risk for disease progression on the subject level. This may be useful in customizing the frequency and content of SPT visits. Keywords: periodontitis, maintenance, recurrent periodontitis, risk assessment, risk evaluation, periodontal infection, reinfection, bleeding on probing, residual pockets, bone loss, smoking

Multi-factorial risk models have been proposed to enhance the ability to predict risk for the progression of treated chronic periodontitis. to study if the outcomes of supportive periodontal therapy (SPT) based on a multi-factorial periodontal risk assessment are influenced by IL-1 gene polymorphism (IP) status. Information about the IP and smoking status, clinical periodontal conditions and age related bone level measurements were used to calculate a peridontal risk assessment model (PRA). The surface area of this diagram was calculated for 224 subjects who had participated in an SPT program over four years. Baseline and 4-year follow-up data were studied in relation to the IP status. Positive IP tests were obtained for 80/224 (35.7%) of the subjects. At baseline the mean PRA for the IP positive group was 79.9 units, which at year four had increased to 81.3 units (mean diff: 1.4 units, S.D. 16.5, p0.45, 95% CI: 2.3 to 5.1). At baseline and year four the mean PRA for the IP negative group was 44.2 and 38.6 units, respectively. This difference was statistically significant (mean diff: 5.6, S.D. 16.1, p0.001, 95% CI: 3.0 to 8.3). Independent t-tests confirmed that the IP status was significantly associated with a less favorable change in PRA over the four-year period (PRA difference: 7.04, t=3.01, p0.003, 95% CI: 2.4 to 11.65). Bleeding on probing, and probing depth values alone did not differ between positive and negative IP status. Regression analysis demonstrated that the best-fit model for change in PRA included bleeding on probing at baseline, IP status, proportional alveolar bone loss in relation to the age, and gender. The PRA allowed the assessment of the outcomes of SPT therapy. Subjects with positive IP did not respond to individualized SPT as favorably as did IP negative subjects. Keywords: periodontal risk assessment, bleeding on probing, alveolar bone height, multi-functional risk model, interleukin-1 polymorphism, supportive periodontal therapy

The aim of this study was to evaluate the effect of subgingival irrigation with propolis extract by clinical and microbiological parameters. Twenty patients diagnosed with chronic periodontitis presenting three non-adjacent teeth with deep pockets were selected. After scaling and root planing, the selected periodontal sites were submitted to one of the following treatments: irrigation with a hydro alcoholic solution of propolis extract twice/week for two weeks (group A); irrigation with a placebo twice/week for two weeks (group B); or no additional treatment (C). Subgingival plaque sampling and scaling and root planing were performed two weeks after clinical data recording. Two weeks later irrigation procedures were started (Baseline). Microbiological and clinical data were collected at baseline, and after 4, 6 and 24 weeks. A decrease in total viable counts of anaerobic bacteria (p=0.007), an increase in the proportion of sites with low levels (= 103 cfu/mL) of Porphyromonas gingivalis (p=0.005), and a decrease in the number of sites with detectable presence of yeasts (p=0.000) were observed in group A sites when compared to group B and C sites. Propolis treatment did not lead to an increase in organisms such as coagulase positive Staphylococci and Pseudomonas spp. 24 weeks after treatment there was an increased proportion of sites showing probing depth (PD) = 3 mm in Group A sites. Subgingival irrigation with propolis extract as an adjuvant to periodontal treatment was more effective than conventional treatment both by clinical and microbiological parameters. Keywords: propolis, bacteria, periodontitis, irrigation, periodontal pocket

To evaluate the long-term effect upon oral health knowledge and reported behavior of a comprehensive and a less comprehensive preventive program given to 13-16-year-old children 5 years after the termination of the programs. 186 Brazilian schoolchildren, randomly assigned to two test groups and a control group were originally enrolled in a 3-year preventive program. The comprehensive program included active participation of the students and their parents. The time resources invested in this program were approximately 5 times that of the less comprehensive program, which mainly consisted of instruction in oral hygiene procedures. At the end of the program, a questionnaire was filled in by the participants showing a significant effect upon both knowledge and reported behavior of both programs; the comprehensive program displaying the better results. Five years later, the same variables were re-examined through a structured telephone interview with 103 of the original participants. Significant differences in knowledge among the three groups were still observed, but not in reported behavior. In all groups the reported daily users of dental floss increased with time and the number of daily in-between-meal consumers of sugar decreased. Females reported more frequent daily use of dental floss than did males five years after the termination of the program, but this was not evident immediately after the experimental period. After 5 years, the correlation between knowledge and reported behavior was no longer significant. Other factors than knowledge are of importance for behavior, and favorable behavior in early adulthood may be achieved independent of implementation of programs for teenagers. Keywords: oral health education, adolescents

From a theoretical point of view, caries can be prevented by perfect oral hygiene and sugar abstinence. However, practice has shown that this approach is successful in individual cases only. For the whole population, effective caries prevention is still not realistic without the use of fluoride in various forms. The use of different fluoride preparations increases its efficacy. On the other hand, correct dosage is important to prevent the risk of dental fluorosis. Most of the European scientific dental associations no longer recommend the use of fluoride supplements, such as fluoride tablets or drops, as a standard procedure in caries prevention. This is due to the increasing evidence that the effect of fluoride is mainly the result of chemical reactions on the tooth surface. Therefore, fluoridated toothpastes, gels, varnishes, and rinses are more in focus. Besides this, fluoridated water and fluoridated salt are still important. Although they have a systemic effect, the efficacy of these fluoride applications results from local processes. Keywords: Fluoride, Caries

The aim was to evaluate the effect of maternal use of chewing gums containing xylitol, chlorhexidine/xylitol or fluoride on the prevalence of mutans streptococci (MS) in the mothers' 18-month-old offsprings. After screening 416 women with newborn babies, 173 mothers with high counts of salivary MS were randomly assigned into three experimental chewing gum groups containing A) xylitol, B) chlorhexidine/xylitol and C) sodium fluoride. Mothers with low or medium MS counts formed a reference group D without any intervention. The participants in the experimental groups were instructed to chew one gum for 5 minutes, three times a day. The chewing was initiated when the child was 6 months old and terminated one year later. The outcome measure was MS colonization in mothers' 18-month-old infants. Bacterial sampling and cultivation was carried out with the Strip mutans technique. The MS prevalence was 10%, 16%, and 28% in groups A, B, and C respectively. In the reference group D, 10% of the infants harbored MS. The difference between group C and groups A and B was statistically significant (p0.05). The colonization levels in groups A and B were similar to those obtained in children of mothers with low MS counts (group D). Maternal consumption of xylitol- and chlorhexidine/xylitol-containing chewing gums significantly reduced the mother-child transmission of salivary mutans streptococci. Keywords: chlorhexidine, fluoride, infants, mutans streptococci (MS), xylitol

The concept "Minimally Invasive Dentistry" can be defined as maximal preservation of healthy dental structures. Within cariology, this concept includes the use of all available information and techniques ranging from accurate diagnosis of caries, caries risk assessment and prevention, to technical procedures in repairing restorations. Dentists are currently spending more than half their time replacing old restorations. The main reasons for restoration failures are secondary caries and fractures, factors that are generally not addressed in the technical process of replacing a restoration. Prevailing concepts on minimally invasive dentistry seem to be "product or technique-motivated", challenging one technique or product with another, rather than focusing on a general concept. New knowledge of caries progression rates has also led to substantial modification of restorative intervention thresholds and further handling of the disease. New diagnostic tools for caries lesion detection, caries risk assessment and focused preventive treatments have decreased the need for early restorative interventions. In parallel to this, new techniques for cutting teeth and removing decay have evolved. This paper focuses on describing minimally invasive dentistry in cariology from a conceptual perspective, relating to clinical caries diagnosis, restorative intervention thresholds and operative procedures, with special reference to survival of tunnel and slot restorations and to repair vs. replacement of defective restorations. Keywords: minimally invasive dentistry, caries diagnolis, caries removal systems, restoration survival, restoration repair, secondary repair

To investigate changes in presentation of oral mucosal lesions in patients with HIV/AIDS attending a dedicated oral medicine clinic over a nine year period. 358 Patients with HIV/AIDS attending a dedicated oral medicine clinic, contained within a genitourinary medicine clinic. Data was collected prospectively for all patients attending the oral medicine clinic, and entered into a database. Lesions were recorded according to the EEC-WHO diagnostic criteria 1991/1993. In 358 patients with 542 lesions, over 54% of the lesions belong within one of the five categories of ulcers, warts, candidiasis, OHL and Kaposi's sarcoma. The major differences in the presentation of the lesions over time were between the ulcers and the warts, but in this series the introduction of HAART did not make a statistical difference. There has been a large reduction in the presentation of oral ulcers, and there appears to be a relative increase in viral papillomata, and a decrease of other mucosal diseases over the period of study. Many of the warts biopsied showed dysplastic changes, and continued follow-up of these patients will be important to determine whether these patients are at increased risk for developing oral squamous carcinoma. Also, proposals are put forward suggesting a need for alteration of the three groups of HIV/AIDS lesions classification suggested by the EEC-WHO consensus. Keywords: HIV, cross sectional study, oral medicine, oral lesions, HPV, oral ulcers