Oral Health and Preventive Dentistry, 04/2014

Halitosis is the offensive or disagreeable odour that may emanate from the mouth. In 80%-90% of cases, bacterial activities especially on the dorsum of the tongue are implicated. Current studies on halitosis accessed from electronic databases were appraised in the light of prevalence, impact and control of halitosis. Halitosis has a worldwide occurrence with a prevalence range of 22% to 50%. Due to the associated social and psychological effects, it should be taken seriously in all affected patients. Oral healthcare professionals ought to be well informed, because their office(s) are usually the first points of call for the affected patients. Palabras clave: control, halitosis, prevalence, prevention

Purpose: Infective endocarditis (IE) in high-risk patients is a potentially severe complication which justifies the administration of antibiotics before invasive dental treatment. This literature review presents the current guidelines for antibiotic prophylaxis and discusses the controversial aspects related to the antibiotic administration for prevention of IE. Results: According to the guidelines of the American Heart Association, individuals who are at risk to develop IE following an invasive dental procedure still benefit from antibiotic prophylaxis. In contrast, the guidelines of the National Institute for Health and Clinical Excellence in England and Wales have recommended that prophylactic antibiotic treatment should no longer be performed in any at-risk patient. Bacteraemia following daily routines such as eating and toothbrushing may be a greater risk factor for the development of IE than the transient bacteraemia that follows an invasive dental procedure. However, a single administration of a penicillin derivate 30 to 60 minutes pre-operatively still represents the main prophylactic strategy to prevent bacteraemia. Conclusions: Presently, there is not enough evidence that supports and defines the administration of antibiotics to prevent IE. The authors suggest performing a risk-benefit evaluation in light of the available guidelines before a decision is made about administration. Palabras clave: antibiotic prophylaxis, bacteraemia, current guidelines, endocarditis

Hepatitis C virus (HCV) infection is a worldwide health problem, affecting over 130 million individuals. The virus is transmitted parenterally, making health care professionals a risk group for infection. For this reason it is important that dental health-care workers recognise the symptoms of the infection, which can be present in the oral cavities of hepatitis C-infected individuals. Moreover, dental health-care workers should know how to manage hepatitis C-infected individuals during dental treatment and the measures to prevent nosocomial spread of HCV. Thus, the purpose of this study was to perform a review of HCV epidemiology, natural history, transmission, diagnosis, treatment and prevention focusing on oral manifestations in and dental management strategies for HCV-infected individuals. Palabras clave: hepatitis C virus, dentistry, dental health workers, oral health

Purpose: To evaluate the effect of different maintenance recall intervals in patients with chronic periodontitis treated by full-mouth ultrasonic debridement. Materials and Methods: Twenty-eight patients participated in the study and were divided into two groups: group 1 (n = 14) underwent full-mouth ultrasonic debridement followed by monthly supportive periodontal therapy; group 2 (n = 14) underwent full-mouth ultrasonic debridement followed by supportive periodontal therapy delivered at 3-month intervals. Plaque index (PI), bleeding on probing (BOP), pocket probing depth (PD), gingival recession (GR) and clinical attachment level (CAL) were evaluated at baseline and after 3 and 6 months. Results: Subjects in group 1 had statistically signi cantly lower PI scores than did subjects in group 2 at six months. However, no differences in BOP, PPD, GR and CAL were observed between groups at any of the time points evaluated. Nonetheless, while full-mouth BOP and PPD scores progressively decreased over time in group 1, the same parameters were signi cantly reduced at 3 months in group 2, but remained stable thereafter. The proportion of moderate and deep pockets decreased progressively over time in the group of monthly recalls, while the proportion of moderate to deep sites decreased signi cantly in group 2 only at 3 months; no additional reductions were seen at 6 months. Conclusion: Supportive periodontal therapy both at one- and three-month intervals promotes short-term stability of clinical improvements obtained after full-mouth ultrasonic debridement in patients with chronic periodontitis. Palabras clave: periodontal therapy, periodontitis, ultrasonic debridement

Purpose: To compare the effectiveness of conventional and game-based oral health education on the oral health-related knowledge and oral hygiene status among 5- to 10-year-old schoolchildren. Materials and Methods: A total of 120 children aged 5 to 10 years were divided into 2 groups. Each group had 30 children aged 5 to 7 years and 30 children aged 8 to 10 years. A pretest evaluation of their knowledge regarding oral health and the estimation of Debris Index-Simplified (DI-S) was carried out. Children in group A were given oral health education through flash cards once daily for 7 days. Children in group B were educated through the play method (i.e. snakes and ladders game combined with flash cards). The evaluations regarding oral hygiene and DI-S were recorded on post-intervention day 1 and 3 months after the intervention. Results: In group B, high knowledge scores of 14.6 and 14.47 were obtained by the 5- to 7-year-olds and 8- to 10-yearolds, respectively, on post-intervention day 1. The lowest mean percentage difference of 8.9 was seen in 5- to 7-yearold children of group A after 3 months. In group B (5-7 and 8-10) and group A (8-10) there was a significant increase in good oral hygiene scores and a significant decrease in fair and poor debris scores on post-intervention day 1 and at the 3-month follow-up. Conclusion: The knowledge scores of both the younger and older groups of children increased considerably when the game-based teaching intervention was used. Hence, it can be an effective aid for teaching basic oral health concepts to children. Palabras clave: game-based teaching, intervention, oral health

Purpose: To assess the impact of empowerment (health coaching, HC) on toothbrushing self-efficacy (TBSE) and toothbrushing frequency (TB) and their effects on diabetes management (HbA1c, physical activity) and quality of life in comparison to health education (HE) among patients with diabetes type 2 (DM2). Materials and Methods: The data (HbA1c [glycated haemoglobin], TB, physical activity, TBSE, quality of life) were collected at baseline and at post-intervention at outpatient clinics of two hospitals in Istanbul, Turkey. Participants were allocated randomly to HC (n = 77) and HE (n = 109) groups. Results: At baseline, there were no statistical differences between HC and HE groups in terms of all measures (P > 0.05). At post-intervention, there was improvement in oral health- and diabetes-related variables in the HC group, whereas only TBSE and TB slightly improved in the HE group (P 0.05). At post-intervention among patients brushing their teeth at least once a day, HC group patients were more likely to be physically active and to have high self-efficacy than those in HE group (P 0.01). TBSE was correlated with favourable HbA1c levels ( 6.5%) in the HC group and quality of life (P 0.05) in both groups. Conclusion: The findings show that HC-based empowerment towards improving self-efficacy is more effective at improving toothbrushing behaviour than is HE and that interaction contributes significantly to diabetes management in terms of reduced HbA1c, increased physical activity and quality of life. TBSE can be a practical starting point for empowerment and toothbrushing can be used as an effective and practical behaviour to observe personal success in diabetes management. Palabras clave: diabetes type II, health coaching, quality of life, toothbrushing, toothbrushing self-efficacy

Purpose: To test the ability of several social-cognitive models to explain current behaviour and to predict intentions to engage in three different health behaviours (toothbrushing, flossing and mouthrinsing). Materials and Methods: Constructs from the health belief model (HBM), theory of reasoned action (TRA), theory of planned behaviour (TPB) and the motivational process of the health action process approach (HAPA) were measured simultaneously in an undergraduate student sample of 172 first-year medical students. Results: Regarding toothbrushing, the TRA, TPB, HBM (without the inclusion of self-efficacy SE), HBM+SE and HAPA predictor models explained 7.4%, 22.7%, 10%, 10.2% and 10.1%, respectively, of the variance in behaviour and 7.5%, 25.6%, 12.1%, 17.5% and 17.2%, respectively, in intention. Regarding dental flossing, the TRA, TPB, HBM, HBM+SE and HAPA predictor models explained 39%, 50.6, 24.1%, 25.4% and 27.7%, respectively, of the variance in behaviour and 39.4%, 52.7%, 33.7%, 35.9% and 43.2%, respectively, in intention. Regarding mouthrinsing, the TRA, TPB, HBM, HBM+SE and HAPA predictor models explained 43.9%, 45.1%, 20%, 29% and 36%, respectively, of the variance in behaviour and 58%, 59.3%, 49.2%, 59.8% and 66.2%, respectively, in intention. The individual significant predictors for current behaviour were attitudes, barriers and outcome expectancy. Conclusion: Our findings revealed that the theory of planned behaviours and the health action process approach were the best predictor of intentions to engage in both behaviours. Palabras clave: dental flossing, mouthrinsing, self-efficacy, theory planned behaviour, toothbrushing

Purpose: To assess the levels of dental anxiety among patients anticipating dental treatments in dental clinics/hospitals of Ranga Reddy district. Materials and Methods: A cross-sectional study was conducted among a representative sample of 1200 subjects (at least 18 years old) in dental clinics/hospitals which were selected from a list obtained through systematic random sampling. The data were collected using a pre-tested and calibrated questionnaire consisting of the Modified Corah Dental Anxiety Scale (MDAS) to assess anxiety levels. Results: The majority (52.4%) of subjects showed a low level of anxiety. Females (11.44 ± 4.41) were found to have higher mean MDAS scores than males, and the highest mean MDAS scores were found among 18- to 34-year-olds (11.28 ± 4.67) (P 0.05). Significant differences were found among subjects anticipating different treatments, with higher MDAS scores for extraction (11.25 ± 5.4), followed by examination, root canal treatment, gum surgery, scaling, restoration and others, e.g. orthodontic treatment, restoration with crowns, bridges and dentures (7.79 ± 3.80). The highest mean MDAS scores were found among subjects who were apprehensive due to 'past difficult experience in dental treatments', followed by 'drill' and 'injection', with the lowest scores among subjects indicating 'other reasons' (7.82 ± 3.84). Conclusion: The present data show that anxiety levels are higher in patients who have to undergo extractions than those who must be fitted with dentures. Thus, dental health care providers should pay more attention to patients' anxiety levels associated with different types of treatment. Palabras clave: dental anxiety, dental treatments, modified dental anxiety scale

Purpose: This in vitro study was designed to assess the effectiveness of three oral rinses on bacterial adherence to epithelial cells and hydroxyapatite surfaces. The role of oral rinses on the detachment of bacteria from biofilm was also evaluated. Materials and Methods: The efficacy of three oral rinses, Acclean, Noplak and Prevention were tested against a wide range of oral bacteria. Oral rinse antimicrobial activity was determined by an MTT assay for bacterial viability, by live/ dead staining and by measuring the bacterial metabolic activity using an XTT assay. Results: The two oral rinses that contained 0.12% chlorhexidine had the greatest antibacterial activity on both planktonic and bio lm-grown organisms when compared to the Prevention oral rinse. Conclusion: Both Acclean and Noplak were extremely effective in lowering the number of bacteria attached to buccal epithelial cells and pelllicles. In addition, these two oral rinses were also effective against the biofilm bacteria. Palabras clave: chlorhexidine, bacterial viability, biofilm, dental plaque, oral rinse, zinc chloride

Purpose: To evaluate the effects of fluoride varnish vs a combination of chlorhexidine-thymol varnish plus a gel containing chlorhexidine and fluoride on oral hygiene and caries prevention in disabled children. Materials and Methods: Ninety patients aged 3-17 years who were treated under general anaesthesia were randomly assigned into three groups as follows: group 1: Fluor Protector (0.1% fluoride varnish); group 2: Cervitec Plus (1% chlorhexidine- 1% thymol varnish) + Cervitec Gel (0.2% chlorhexidine-0.2% sodium fluoride); group 3: control (toothbrushing only). Mutans streptococci (MS) and lactobacilli (LB) levels, visible plaque index (VPI) and gingival bleeding index (GBI) were evaluated at four stages: T0, before general anaesthesia; T1, one month after treatment; T2, six months after treatment; T3, twelve months after treatment. The data were evaluated using Kruskal-Wallis and Mann-Whitney U-tests (P 0.05). Results: Groups 1 and 2 showed significantly lower scores than group 3 for all parameters at T1 and T2. No statistically significant difference was detected among any of the the groups at T3 (P > 0.05). Conclusion: The use of materials that include both fluoride and chlorhexidine as routine treatment of children with disability may increase the success of restorations by improving oral hygiene, reduce the need for future restorative treatments and thus the need for general anaesthesia. Palabras clave: antibacterial effect, children with disability, chlorhexidine, fluoride, general anaesthesia