Oral Health and Preventive Dentistry, 02/2004

The purpose of this retrospective cohort study was to evaluate the effect of smoking habits and patient compliance on the outcomes of supportive periodontal therapy (SPT) (tooth loss and residual pockets defined by probing depth of >= 5 mm) in a private practice situation. Eighty-seven patients, who completed active periodontal treatment and then followed an SPT program for at least 5 years, were recruited from the patient pool of a private dental practice. After active periodontal therapy and at the follow-up examination 5 - 11 years later, pocket probing depths (PPD) and tooth loss were assessed, and the patients were divided into 4 subgroups based on their smoking history: non-smokers (NS); occasional smokers (OS); moderate smokers (S); and heavy smokers (HS). The patient cohort was also divided into 4 subgroups based on patient compliance (mean delay from the scheduled recall sessions): fully compliant ( 1 week); compliant within 1 - 3 weeks; compliant within 3-6 weeks; and not compliant (> 6 weeks). The mean tooth loss per patient and year ranged from 0.11 - 0.18 in the various subgroups with no significant differences between them. After a mean observation period of 7.3 ± 1.5 years, the incidence of new sites with residual probing depth of >= 5 mm varied between 1.2% for the NS and 13.8% for the HS (p 0.05,), and between 3.2% for the compliant and 5.8% for the non-compliant patients. Smoking habits significantly influenced the treatment outcomes of SPT, while compliance was less influential regarding the incidence of new residual pockets during 7.3 years of SPT. Keywords: supportive periodontal therapy, SPT, compliance, smoking habits, tobacco, smoking, periodontal pockets, reinfection, maintenance, tooth loss

To assess the experience and attitudes of dental professionals towards smoking cessation and, in particular, to explore perceived barriers limiting their involvement in this area of practice. A combined quantitative and qualitative methodology was employed in South Essex, an area in South East England. In the first phase a questionnaire survey was conducted with all general dental practitioners on the South Essex Health Authority dental list to assess their current involvement in smoking cessation and their general attitudes to this area of clinical care. In the second phase, ten focus group interviews were conducted with dental teams to uncover in greater depth views towards smoking cessation and, in particular, the barriers preventing progress. A 60% response rate (n = 149) was achieved for the postal questionnaire and 52 dental team members participated in the focus groups. The questionnaire survey revealed that the majority of the sample reported asking their patients about smoking (90%) and recording this information in their clinical notes (75%). However, a relatively low number indicated active involvement in assisting smokers to stop (30%) or referring them for more detailed support (24%). The focus groups uncovered a range of fundamental barriers limiting greater involvement in smoking cessation. The key issues included a fatalistic and negative concept of prevention; perceived lack of relevance of smoking cessation to dentistry; patient hostility; and organizational factors within the practice setting. Future action to encourage the provision of smoking cessation in dental practices needs to address the range of barriers that currently limit involvement in this area of clinical practice. Keywords: smoking cessation, dentists, barriers

The aim of the study was to compare the effectiveness in plaque removal of a three-headed toothbrush with a conventional toothbrush in pre-school children. Twenty-nine children (aged 4 - 5 years) participated in this study. Fourteen children (group A) used a three-headed toothbrush, and 15 children (group B) used a conventional toothbrush for 3 months. At the initial visit, the children brushed their teeth with their regular toothbrush, and at the final visit with the type of toothbrush they had used for the past 3 months. Plaque was recorded at 48 surfaces (molars: vestibular, oral, occlusal; front teeth: vestibular, oral). Plaque reduction was assessed on anterior and posterior areas of the dentition, and on the different tooth surfaces in sextants (I = 55/54; II = 53/63; III = 64/65; IV = 74/75; V = 73/83; VI = 84/85). Statistical evaluation was performed using Wilcoxon signed rank and Mann-Whitney tests. In group A, the median number of surfaces with plaque was reduced significantly after 3 months (p 0.05). At final examination the number of surfaces with plaque in both groups differed significantly (p 0.05). Significant decreases in plaque scores were recorded at maxillary and mandibular posterior and mandibular anterior teeth in group A (p 0.05). The comparison of changes in plaque scores of both groups showed significant differences (p 0.05) on the occlusal surfaces of molars, except in sextant IV. Significant differences between the groups were also noted on all surfaces of the left side and on the occlusal surfaces of the right side of the mouth (p 0.05). This study indicates that the three-headed toothbrush could be an alternative to the conventional toothbrush. Keywords: pre-school children, oral hygiene, toothbrush

This study aimed to evaluate the effect of flossing on the presence of plaque and gingivitis in school students undertaking supervised oral hygiene. Thirty-three non-users of dental floss were selected from a larger panel. The study had a preliminary phase of 21 days, followed by two experimental phases of 21 days, separated by an interval of 21 days. The study was crossover and blind with two experimental groups. The addition of flossing to brushing was assigned to one group in each phase. Instructions in brushing and flossing were provided at the beginning, with re-instruction twice a week. The Visible Plaque Index (VPI) and the Gingival Bleeding Index (GBI) were determined at start and end of each phase. The medians were analyzed using the Wilcoxon and Mann-Whitney tests. In the first phase, the median interproximal GBI reduced from 62.1% to 17.9% with flossing, and from 59.3% to 22.2% without flossing. In the second phase, the median percentage of bleeding also reduced from 31.9% to 17.3% without flossing, and from 26.0% to 8.9% with flossing. The change in percentage was significant in both phases but similar for both groups. Similar results were observed in sites with VPI and sites where VPI and GBI were present. Free sites responded similarly to the interproximal sites. A regimen of brushing produced significant reductions in the presence of VPI and GBI both at free and interproximal sites; the inclusion of flossing into the regime did not represent significant improvements with respect to VPI and GBI. Keywords: dental floss, oral hygiene, brushing, gingivitis

To determine differences in interproximal plaque mass and fluoride retention with different modes of toothbrushing and flossing. Forty-seven subjects in good health used four treatments in a four-period, randomized, crossover design: 1) manual brushing only; 2) manual brushing and daily flossing; 3) electric brushing using a rotational oscillation toothbrush; and 4) electric brushing using a sonic toothbrush. Subjects used a standard sodium fluoride dentifrice during the eight-day experimental periods and a fluoride-free dentifrice during the seven-day washout periods between treatments. Interproximal plaque samples were taken on Day 1 and on Day 8, weighed, and analyzed for fluoride content. The amount of interproximal plaque was lowest with sonic brushing, which left 43-65% less plaque than all other treatments. Manual brushing and flossing yielded less plaque than manual brushing alone and rotational oscillation brushing. Differences were statistically significant (p 0.05) for treatment; there was no time effect on plaque mass. For fluoride retention, at Day 1 sonic brushing gave at least 54% more fluoride in the interproximal plaque than all other treatments, which was significant. All treatments demonstrated a significant increase in fluoride concentration with time except manual brushing and flossing, which showed a significant decrease. At Day 8, the fluoride concentration was significantly higher for sonic brushing than for manual brushing or rotational oscillation brushing by over 40%, and all treatments exhibited significantly greater fluoride than the manual brushing and flossing combination. The mode of toothbrushing may impact the amount of plaque retained interproximally and its fluoride concentration. Keywords: Plaque mass, fluoride, retention, interproximal, electric toothbrush, sonic toothbrush

Variations in decision-making about restorative treatments have been demonstrated among dentists in several countries. This study sought to assess the restorative treatment philosophies based on a representative sample of French dentists. A sample (n = 2000) was randomly extracted from a national list (n = 42,000). Each dentist received a questionnaire, illustrations of carious conditions, and a reply-paid envelope. The questionnaire assessed the stage of lesion progression at which the respondents considered restorative treatment appropriate, their choice of restorative technique and dental material. For all questions, an imaginary 20-year-old patient with low caries activity was described. After one reminder, the response rate was 40%. Almost half of the respondents would restore an occlusal lesion confined to enamel and 88% would have prepared a cavity for a proximal lesion at the amelo-dentinal junction. The majority of the respondents would not use the Black concepts for cavity preparation. Their preferred restorative material was composite. Answers indicated a tendency towards early restorative intervention and showed large variations between the treatment decisions of French dentists. Keywords: dental caries, diagnosis, treatment decision, restoration

A multicenter, double-blind, randomized, placebo-controlled clinical trial was conducted to determine the efficacy of an experimental dentifrice on the prevention of recurrent aphthous stomatitis (RAS). A 3-month pretrial period was used to self-record data pertaining to the frequency, ulcer size, duration, and pain associated with ulcers. Thirty-six participants, who reported at least 3 RAS episodes or 30 days with RAS during the pretrial period, completed the study. Following a stratified randomization for age, sex and disease severity, the participants received the experimental dentifrice (T) or the placebo (C). The test period comprised 3 months of self-evaluation of number of ulcers, size and location. Pain related to RAS was estimated by the use of a Visual Analogue Scale (VAS). Symptoms were found to decrease in both groups when the pretrial and test periods were compared, although no statistical difference was reached in the C group. A statistically significant difference between the two time periods was obtained for the T group concerning the number of days with ulcers (p 0.025) and VAS (p 0.010). Of more clinical importance was the observation that 50% of the patients in the T group reported a more than 50% reduction in days with ulcers compared to 17% in the C group. The dentifrice may be used as a treatment strategy for a subgroup of patients with RAS in view of the low adverse effects and the benefit of using a treatment modality that is a part of daily routines. Keywords: aphthae, RAS, dentifrice, prevention, controlled-study

Brown tumor associated with hyperparathyroidism secondary to chronic renal failure has been increasingly documented of late. This intraosseous giant cell lesion is indistinguishable from a central giant cell granuloma and is considered as an unusual local complication of renal osteodystrophy. This report presents a case of a maxillary brown tumor in an uremic, non-hemodialysis patient with secondary hyperparathyroidism. The radiographic, biochemical, and histopathological examinations are reported and the possible pathogenesis is also discussed. Keywords: brown tumor, secondary hyperparathyroidism, chronic renal failure