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Perio Reports

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Perio Reports  Vol. 24, No. 7
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.
Effectiveness of Subgingival Air Polishing

Air polishing is generally done supragingivally due to the abrasiveness of the sodium bicarbonate powder on root surfaces and general tissue trauma. The EMS company introduced a fine-grain glycine powder that can be used on root surfaces, restorative materials and soft tissue without noticeable damage. This new glycine powder allows air polishing to now reach subgingival areas, making it an alternative to hand instruments for biofilm removal at periodontal maintenance visits.

Researchers at the University of Washington compared subgingival plaque biofilm removal on 30 patients using either hand instruments or air polishing with EMS Air-Flow glycine powder. Patients had probing depths of 4-9mm on at least two teeth and detectable levels of Pg and Tf. Subgingival and oral bacterial samples were measured at baseline, day 10 and day 90.

Subgingival air polishing was done with a ne wly designed nozzle with three openings to effectively reach the entire subgingival area. Each tooth surface was treated for five seconds. Hand instrumentation was done with curettes and scalers following no time limit. Both groups rinsed with chlorhexidine twice daily for two weeks.

Clinically, there were no differences between the test and control groups at 90 days. Microbiologically, at 90 days, fewer patients in the air polishing group (73 percent) were positive for Pg compared to the hand instrumentation group (93 percent). Air polishing might provide a shift in subgingval bacterial population. With calculus removal it might be the entire group.

Clinical Implications: Subgingival air polishing with glycine powder might become the treatment of choice for perio maintenance visits.

Flemmig, T., Arushanov, D., Daubert, D., Rothen, M., Mueller, G., Leroux, B.: Randomized Controlled Trial Assessing Efficacy and Safety of Glycine Powder Air Polishing in Moderater-to-Deep Periodontal Pockets. J Perio 83:444-452, 2012.
Laser Used for Periodontal Maintenance

Supportive periodontal care (SPC) is an integral part of managing periodontal health. The goals of SPC are to stop progression of periodontal disease, prevent or reduce tooth loss and provide early screening for oral cancer and other oral conditions. Mechanical instrumentation during SPC is done with hand or power instruments or a combination of both. The Er:YAG laser has been designed as an alternative or adjunct to mechanical instrumentation.

Researchers in Germany conducted a multi-center research study including four German university research sites. The study began with 78 non-smoking patients, and 58 finished the 26-week study. Clinical and microbiological outcomes were measured comparing mechanical instrumentation and Er:YAG laser during SPC appointments. Subjects each had two single rooted teeth in the same arch with probing depths 5mm or deeper and bleeding upon probing. Baseline clinical and microbial measures were repeated at 13 weeks and 26 weeks.

Patients presented after complete periodontal debridement. One test tooth was treated with the KaVo Key Laser and the other was treated with the KaVo Sonicflex Sonic Scaler to remove plaque biofilm. Treatment time was set at 20 seconds per diseased surface for a maximum of two minutes per test tooth.

No significant differences were observed between the two groups at 13 or 26 weeks for probing depths, attachment levels or bleeding upon probing. Baseline attachment levels were 9mm average for both groups and at 26 weeks were 7.5mm for the laser and 8mm for the sonic scaler.

Clinical Implications: After calculus removal, the laser and the sonic scaler provide comparable outcomes.

Ratka-Krüger, P., Mahl, D., Deimling, D., Mönting, J., Jackmann, I., Al-Machot, E., Sculean, A., Berakdar, M., Jervøe-Storm, P., Braun, A.: Er:YAG Laser Treatment in Supportive Periodontal Therapy. J Clin Perio 39:483-489, 2012.
VSCs Linked to Periodontal Progression

Volatile Sulfur Compounds (VSCs) are gases released with the breakdown of proteins that can also be detected by their distinctive smells. VSCs associated with both bad breath and periodontal disease include hydrogen sulfide, methyl mercaptan and dimethyl sulfide. Tongue coating and periodontal disease release significant amounts of VSCs.

Researchers at Nigata University in Nagita, Japan followed a group of non-smoking, elderly Japanese over three years to determine if VSC scores were predictive of periodontal disease progression. Subjects were part of a larger study of 70-year-old Japanese examining the relationship between oral health and general health.

Dental examinations were completed at baseline and yearly for three years. Clinical attachment levels and bleeding upon probing were the key clinical indices monitored. VSC scores were also recorded. An interview was conducted to determine oral health and eating and drinking habits.

Subjects were divided into two groups, those examined before meals and those examined after meals. After meals VSC scores were lower than before meal scores. Those who showed evidence of greater than 3mm of attachment loss from baseline also showed higher VSC scores.

Those with the highest number of periodontal pockets measuring 6mm or more also had the highest VSC scores. The higher the number of teeth with periodontal disease, the higher the VSC scores. Reports of flossing, regular dental visits, alcohol consumption and frequency of toothbrushing did not impact VSC readings.

Clinical Implications: VSC levels might now be considered a risk factor for periodontal disease and become part of clinical records regularly collected to monitor periodontal disease progression.

Makino, Y., Yamaga, T., Yoshihara, A., Nohno, K., Miyazaki, H.: Association Between Volatile Sulfur Compounds and Periodontal Disease Progression in Elderly Non-Smokers. J Perio 83:635-643, 2012.
Adding Patient-centered Outcomes to Periodontal Therapy

The concept of patient-centered approaches to health care began in 1948 when the World Health Organization changed their focus from the absence of disease to the wellbeing of the patient. Clinical research focuses on measurable changes in probing depths, attachment levels and bleeding upon probing. More recently researchers have begun evaluating the impact of periodontal therapy from the patients’ perspective.

Researchers at the University of Hong Kong evaluated both clinical outcomes and patients’ perceptions immediately following non-surgical therapy and at three-month intervals for a year. A total of 60 nonsmoking Chinese adults between the ages of 35 and 65 with moderate to severe periodontal disease participated. In addition to the usual clinical indices, patients completed a 14-question oral health-related quality of life survey. Questions asked about chewing difficulty, trouble pronouncing words, eating comfort, having sore spots, feeling embarrassed, avoiding going out, unable to go to work, etc.

Experienced dental hygienists using local anesthesia provided non-surgical therapy over four to six visits completed within one month. Bleeding scores reduced from 86 percent to 32 percent. The overall mean probing depth reduced from 3.3mm to 1.8mm. The percentage of pockets 4mm or deeper was reduced from 31 percent to three percent.

The median quality of life scores began at 17, reducing gradually to 13 at the end of the year. The average score for a periodontally healthy person is 4.4.

Clinical Implications: The non-surgical periodontal therapy you provide your patients results in better oral health and also improvements in the quality of life they experience.

Wong, R., Ng, S., Corbet, E., Leung, W.: Non-Surgical Periodontal Therapy Improved Oral Health-Related Quality of Life. J Clin Perio 39:53-61, 2012.
XyliMelts Keep Mouth Moist Over Night

Xerostomia is caused by medications, CPAP use, radiation treatment and a variety of diseases. Lozenges, gels and sprays can manage daytime oral dryness, but not overnight dryness. XyliMelts are bi-layer tables with a vegetable gum adhesive on one side to allow the disc to adhere to either tooth surface or tissue. All the ingredients, including xylitol, will dissolve, providing oral lubrication.

Researchers at the University of Washington evaluated the effectiveness of XyliMelts in a group of 15 subjects with xerostomia. Subjects were instructed to apply one disc to the buccal surface of a maxillary first molar or gingiva, either right or left side after breakfast, lunch and dinner. Before bed, they were instructed to apply two discs, one on each side either on the buccal of the maxillary first molar of the adjacent gingiva. Subjects were asked to determine how long the XyliMelt disc lasted during the day and how their mouth felt each morning for one week.

Baseline stimulated salivary flow was measured and repeated after one week. No changes were evident for any of the subjects in their stimulated salivary flow. Secretion rates ranged from 0.004 to 0.074ml/minute. Average stimulated salivary flow rates equal 1ml/minute, so these scores are very low.

Oral wetness was measured using a visual analog scale of zero to 100. Baseline oral wetness scores recorded upon waking ranged from zero to 50. After one week, scores ranged from 32 to 92. Discomfort upon waking scores were reduced from 22-9

Clinical Implications: XyliMelts offer an overnight as well as daytime remedy for xerostomia.

Burgess, J., Lee, P.: XyliMelts Time-Release Adhering Discs for Night-Time Oral Dryness. Int J Dent Hygiene 10:118-121, 2012.
Probiotics Might be Helpful in Preventing Oral Disease

An estimated 100 trillion micro-organisms call the human body home. We ingest bacteria in the food we eat and the water we drink. Fermented foods also provide a source of micro-organisms: sausages, miso, tempeh, soy beverages, cheese, yogurt and other fermented milk products.

Probiotics are living micro-organisms that provide beneficial functions in the digestive tract and also in the mouth. The term probiotic was introduced in 1965 in an article in Science Magazine, despite having been advocated for several centuries before. Probiotic is the antonym or opposite of antibiotic.

Probiotics are live microbial food ingredients beneficial to health. Prebiotics are non-digestible food ingredients that selectively stimulate the growth of specific bacteria beneficial to health. A beneficial mixture of probiotics and prebiotics is called a synbiotic. Hydrogen peroxide is produced by some oral probiotics to eliminate the undesirable bacteria and as a side effect, whiten the teeth. The bacteria used in oral probiotics are not acid-producing species. Changing the balance of bacteria in the mouth with specific oral probiotics will also eliminate the bacteria releasing the volatile sulfur compounds associated with halitosis.

In the mouth, oral probiotics change the balance of the microflora to one favoring health and enamel mineralization, rather than disease and demineralization. There are four key properties of oral probiotics: 1) binding to dental surfaces, 2) production of antimicrobial substances against oral pathogens, 3) reduction of inflammatory response and 4) alteration of environmental conditions of the mouth. Oral probiotics are delivered to the mouth in gums and mints.

Clinical Implications: Oral probiotics can be an important part of oral health, prevention and fresh breath programs offered to patients.

VAnilkumar, K., Monisha, A.: Role of Friendly Bacteria in Oral Health - A Short Review. Oral Health Prev Dent 10:3-8,2012.
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