Perio
Reports Vol. 22 No. 9 |
Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians.
Perio Reports research summaries will be included in each issue to keep you on the cutting edge
of dental hygiene science.
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Bisphosphonates and Osteonecrosis of the Jaws
Bisphosphonate drugs are given intravenously when
treating various cancers and their side effects. It is prescribed
orally for the treatment of osteoporosis. Bisphosphonates
preserve bone by inhibiting osteoclast function, inducing
apoptosis (programmed cell death) for osteoclasts and
inhibiting the differentiation of bone marrow cells into
osteoclasts. The half-life of intravenous bisphosphonate
drugs in bone is approximately 10 years, depending how
long the drug was administered.
Bisphosphonate-induced osteonecrosis of the jaws is
defined as an area of exposed bone that persists for more than
six weeks. Other symptoms may include pain, swelling, infection,
drainage, bone necrosis, bone fracture, fever and lymphadenopathy.
Osteonecrosis occurs most often in those given
intravenous bisphosphonate drugs. To a lesser extent, cases
have been reported for those taking oral bisphosphonates such
as Fosamax. Tooth extraction is the dental procedure most
likely to trigger alveolar bone destruction.
Treatment is unclear, but antibiotics are recommended to
curb potential infection. Due to the long half-life of bisphosphonate
drugs, discontinuing the drug is not likely to speed
healing of the osteonecrosis, nor is discontinuing the drug
before a problem exists thought to prevent osteonecrosis.
Prevention is the best approach—being sure the oral cavity is
healthy prior to beginning bisphosphonate drug therapy.
Clinical Implications: At least one month prior to beginning bisphosphonate treatment, particularly intravenously, patients should be examined by a dentist and receive any necessary dental work to assure a healthy oral condition.
Aldana-Gibaja, R., Traverso-Oviaga, C., Lui-Monteiro, A.:
The Link Between Treatment with Bisphosphonates and
Osteonecrosis of the Jaws. A Literature Review. J Int Acad Perio
12: 66-69, 2010. |
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Calcium Channel Blockers and
Gingival Hyperplasia
Gingival hyperplasia is caused by alterations in the
connective tissue resulting in overstimulation of fibroblasts
and overgrowth of gingival tissue. Drug-induced
hyperplasia occurs within the first three months of taking
a drug and begins with enlargement of interdental papilla.
Calcium channel blocker (CCB) drugs inhibit intercellular
uptake of calcium, which may affect fibroblasts or
reduce collagenase production, thus causing gingival
hyperplasia. CCBs are prescribed for the treatment of cardiovascular
diseases. Other drugs prescribed include
diuretics, beta blockers and renin-angiotensin systems
affecting drugs (RAS). These drugs have not been found to
cause gingival hyperplasia.
Researchers in the Netherlands evaluated medical
and dental charts from a large electronic database of
more than 800,000 patients. Subjects were selected
based on CCB prescriptions and also a report of
gingival hyperplasia by the physician and confirmed by
a dentist.
Of the 20,636 subjects taking CCB or RAS drugs, 103
patients were identified as having definitive gingival hyperplasia.
Cases of mild, asymptomatic gingival hyperplasia
were not identified in the medical charts. Gingival hyperplasia
was found to be dose- and time-dependent for
CCBs. Subjects taking the drug for several months and
those taking a higher dose were more likely to have a diagnosis
of gingival hyperplasia. Additionally, an association
was found between those taking anti-epileptic drugs and
gingival hyperplasia.
Clinical Implications: Patients taking calcium channel blockers may experience gingival hyperplasia occurring within the first month of drug use.
Kaur, G., Verhamme, K., Dieleman, J., Vanrolleghem, A., van Soest, E., Stricker, B., Sturkenboom, M.: Association Between Calcium Channel Blockers and Gingival Hyperplasia. J Clin Perio 37: 625-630, 2010. |
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Denture-induced Stomatitis
Nearly half of all denture wearers experience denture-induced
stomatitis (DIS), a redness and swelling where the
denture presses against oral tissues. DIS is seen with both full
and partial dentures, primarily in the maxilla and less frequently
on the mandible. DIS is
usually asymptomatic, and patients
may not even be aware of this condition
in their mouths.
A researcher in the College of
Dentistry at King Saud University
in Riyadh, Saudi Arabia evaluated
a total of 71 denture wearers.
Complete dentures were worn by 48
subjects and removable partial dentures
by 23 subjects. DIS was diagnosed
in 57 percent of subjects in the maxillary arch and 52
percent for the mandibular arch.
Using a questionnaire, patients were asked about denture
hygiene habits and denture wearing habits. The three choices for
denture cleaning were washing, brushing with paste and soaking
in a denture cleaner. The majority, 61 percent, reported washing
their dentures with water. Toothbrush with toothpaste was the
choice of 24 percent and 15 percent reported soaking their dentures
in denture cleaner. Lack of effective denture cleaning is a
risk factor for DIS and was found to be significantly linked to
DIS in this population.
Wearing dentures overnight is
also a risk factor for DIS and was
found in this study to be significantly
linked to the incidence of DIS.
Clinical Implications: Dentists and hygienists should provide cleaning instructions to patients with dentures. Ideally, dentures should be rinsed after meals whenever possible, and soaked in a non-bleaching denture cleaner overnight. Patients should also avoid wearing their dentures while sleeping.
Sadig, W.: The Denture Hygiene, Denture Stomatitis and Role of the Dental Hygienist. Inter J Dent Hygiene 8: 227-231, 2010. |
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Toothbrush with Extended Reach Bristles
Toothbrushes are the primary tool for oral hygiene,
despite the fact that disease occurs most often between the
teeth. Only 10 percent of people regularly clean between their
teeth, so toothbrushes are being designed to achieve better
interproximal plaque removal. One of these new designs is the
Aquafresh Between Teeth brush. In addition to the standard,
rounded end, same-length bristles, there are fine, tapered bristle
filaments that are four millimeters longer to reach between
the teeth.
Researchers at the GlaxoSmithKline Consumer Health
Care Company in Buehl, Germany compared the Aquafresh
Between Teeth brush to the Oral-B CrossAction brush with
X-angled, dual-length bristles and the Oral-B Indicator
multi-tufted brush. Laboratory testing followed a method
shown to accurately predict clinical outcomes. Laboratory
studies are done prior to clinical studies, as they are less
expensive and can provide useful information to justify
human clinical trials.
Six brushes of each type were tested four times, for a total of 24
tests per brush type. Brushes were tested for 15 seconds with two
strokes per second. Brushes were positioned at a 90-degree angle to
the simulated anterior and posterior teeth, since this is the way the
majority of people brush, despite being taught to use a 45-degree
angle. Brushes were tested in both vertical and horizontal motions.
The AquaFresh extended reach bristles were more effective
in removing simulated plaque from interproximal surfaces on
the laboratory model.
Clinical
Implications: Look for clinical studies in the future exploring the potential for innovative manual toothbrush designs to remove interproximal plaque.
Stiller, S., Bosma, M., Shi, X., Spirgel, C., Yankell, S.:
Interproximal Access Efficacy of Three Manual Toothbrushes with
Extended, X-Angled or Flat Multitufted Bristles. Int J Dent
Hygiene 8: 244-248, 2010. |
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Interdental Brushes Better than Floss
The toothbrush is successful at removing plaque on facial, lingual and occlusal surfaces,
but not very effective on interproximal surfaces. Dental floss, wood sticks, picks,
rubber tip stimulators, oral irrigation and interdental brushes are used to reach plaque on
interproximal surfaces.
Researchers at the Department of Periodontology, Academic Centre for Dentistry
Amsterdam in the Netherlands reviewed research evaluating the effectiveness of interdental
brushes compared to manual tooth
brushing alone, and compared to other interdental
aids, including floss and wooden sticks.
Of the 234 abstracts and articles found on this
topic, nine full text articles were found that
were similar enough to each other to warrant
comparison. This elimination process is how
systematic reviews are done. Until researchers
follow similar protocols, using like-indices,
only a few studies will qualify for standardized
comparisons.
Each of these studies were at least four
weeks in length; a few were 12 weeks. A wide
variety of interdental brushes were tested from
several companies. Conclusions found interdental
brushes more effective for plaque
removal interproximally than a manual toothbrush
or dental floss. Interdental brushes also
reduced pocket probing depths more effectively
than dental floss.
The authors suggest a triangular-shaped interdental
brush, following the form of commonly
used interdental wooden sticks, may provide better
adaptation in interdental spaces, and thus
result in greater tissue healing. They also point
out the importance of selecting products specific
to each patient based on patient preference,
ability to use and willingness to comply with
daily use.
Clinical Implications: Interdental brushes are an appropriate choice for interproximal plaque removal, when space allows.
Slot, D., Dörfer, C., Van der Weijden, G.: The Efficacy of Interdental Brushes on Plaque and Parameters of Periodontal Inflammation: A Systematic Review. Int J Dent Hygiene 8: 253- 264, 2010. |
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RDHs Providing Oral Hygiene for Hospitalized Patients
Aspiration pneumonia is a serious disease of the elderly and those
hospitalized. Oral bacterial biofilm is responsible for some of these respiratory
infections. Prevention of these infections can be accomplished
with proper oral care. Unfortunately, those most in need of good oral
hygiene are left on their own to clean their mouths each day.
Researchers at Saitama Medical University in Saitama, Japan compared
professional oral hygiene provided by dental hygienists to brushing
and rinsing as instructed by a nurse. The 40 subjects were all
inpatients at the Department of Respiratory Medicine in the university
hospital. All subjects were instructed by a nurse to brush and rinse with
povidone iodine both morning and evening. Half the subjects were randomly
assigned to receive 15 minutes of professional oral hygiene
instructions from a dental hygienist with follow-up visits every two to
three days. Hospital stays for both groups averaged several weeks.
Plaque scores for both groups were similar at baseline. Plaque scores
for the control group remained at 66 percent on day five and the day of
hospital discharge. Those receiving professional dental hygiene instructions
had a plaque score of 46 percent on day five and 30 percent on the
day of hospital discharge. According to a short questionnaire, oral
health attitudes and behaviors improved in the treated group compared
to the control group.
Clinical
Implications: The most effective oral care for hospitalized
patients is provided by dental hygienists, rather than expecting
patients to effectively clean their mouths themselves.
Sato, T., Abe, T., Ichikawa, M., Fukushima, Y., Nakamoto, N., Koshikiya,
N., Kobayashi, A., Yoda, T.: A Randomized Controlled Trial Assessing the
Effectiveness of Professional Oral Care by Dental Hygienists. Int J Dent
Hygiene 6: 63-67, 2010. |
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