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Perio Reports

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Perio Reports  Vol. 25, No. 4
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.
Air Polishing to Replace Subgingival Instrumentation

Air polishing in the past used a bicarbonate of soda powder that was effective for plaque and stain removal, but damaging for the tissues. Today, glycine powder is available for air polishing that can be used with a new tip to polish subgingivally, reaching into both shallow and deep pockets.

Researchers at the University of Washington in Seattle, Washington, compared full-mouth Glycine Powder Air Polishing (GPAP) to traditional scaling and root planing with curettes plus rubber cup polishing. All patients had undergone initial periodontal therapy prior to this study.

Subjects were all found positive for intra-oral levels of P. gingivalis and T. forsythia. Probing depths ranged from 4mm to 9mm. Patients were instructed to rinse twice daily with 0.12 chlorhexidine mouthrinse for two weeks following treatment. Microbial and clinical indices were repeated at day 10 and day 90.

At all time points, the patients receiving the subgingival GPAP had lower total viable bacterial counts in the moderate- to-deep pockets compared to those receiving instrumentation with curettes and rubber cup polishing. Patients found both treatment approaches comfortable. Air polishing with glycine power in subgingival pockets is more effective than using curettes to shift the oral flora from one conducive to infection to one more conducive to periodontal health.

Clinical Implications: Despite our tradition of instrumenting all subgingival areas during a perio maintenance visit, these findings suggest that air polishing with glycine power in the subgingival areas just might be able to replace subgingival instrumentation with curettes.

Flemming, T., Arushanov, D., Daubert, D., Rothen, M., Mueller, G., Leroux, B.: Randomized controlled trial assessing efficacy and safety of glycine powder air polishing in moderate-to-deep periodontal pockets. J Perio 83:(4)444-452, 2012.

Lasers Used in Supportive Perio Therapy, No Added Value

Laser therapy shows promise for bactericidal and detoxification effects. Lasers remove granulation tissue, plaque and calculus without harming tooth root surfaces. The Nd:YAG laser is often used as part of non-surgical therapy. It may be advantageous to use a laser in non-responding pockets encountered during periodontal supportive therapy.

Researchers at the University of Amsterdam in the Netherlands compared periodontal maintenance therapy with and without the adjunctive use of an Nd:YAG water-cooled laser. A total of 30 subjects who had been seen for regular periodontal maintenance care and still had 5mm probing depths with bleeding were included in the study. Each subject had an average of 11 treatable sites. After baseline data collection, all received supragingival and subgingival instrumentation and oral hygiene instructions. Following this treatment, subjects were randomly assigned to either laser treatment or no further treatment. Laser treatment was applied subgingivally against the tissue for no more than 60 seconds per site.

Subjects were instructed to rinse twice daily with 0.12 percent chlorhexidine mouthrinse for two weeks and were given a questionnaire to complete at home that evening and mail back the following day. Questions about pain, bleeding and medication needed were included.

At six months subjects returned for clinical examination. No differences were observed between the groups. No added benefit was provided by the laser therapy for probing depths or bleeding. The laser treated group reported more pain, bleeding and swelling. Both groups improved significantly.

Clinical Implications: Laser treatment might not provide added benefit to supportive therapy.

Slot, D., Timmerman, M., Versteeg, P., van der Velden, U., van der Weijden, F.: Adjunctive Clinical Effect of a Water-Cooled Nd:YAG Laser in a Periodontal Maintenance Care Programme: A Randomized Controlled Trial. J Clin Perio 39: 1159-1165, 2012.
Herbal Toothpaste Comparable to Fluoride Toothpaste

Despite disease starting between the teeth, toothbrushing is still the primary approach to plaque biofilm control. Mechanical and chemical means are used to control bacterial biofilm. Plant-based herbs have been used for centuries as medicinal remedies and are both economical and have fewer side effects than current pharmaceutical options. Several foodbased substances have been used in toothpastes over the years, including: myrrh, chamomile, Echinacea, sage, rhatany, essential oils, peppermint, ginger, cloves, tea tree oil, coriander, lemon and spearmint.

In India, Himalaya Dental Cream is a new herbal toothpaste now available. Public health researchers in Belgaum, India compared Colgate fluoride toothpaste and the Himalaya Dental Cream in a group of 55 young women. The women, ages 18 to 25 years, resided in a working women's hostel in Belgaum, India. Researchers evaluated plaque and gingivitis scores over six weeks, with scores recorded at baseline, three and six weeks.

Half the women brushed with Colgate fluoride toothpaste and the other half brushed with Himalaya Dental Cream which contains several herbal ingredients. All subjects were instructed in a circular toothbrushing method and asked to refrain from using other dental aids including mouthwash and dental floss.

Both groups showed significant reductions in plaque and gingivitis at each of the three exam time points. When asked to complete a questionnaire at the end, both groups reported they liked the color, taste and smell of their assigned toothpaste.

Clinical Implications: More herbal and alternative toothpaste brands are becoming available. Recommend toothpaste based on ingredients you and the patient want.

Hebbal, M., Ankola, A., Sharma, R., Johri, S.: Effectiveness of Herbal and Fluoridated Toothpaste on Plaque and Gingival Scores Among Residents of a Working Women's Hostel - A Randomized Controlled Trial. Oral Health Prev Dent 10: 389-395, 2013.

Baby Tooth Wipes as Effective as Toothbrushing

Early childhood caries is a significant problem today that requires early intervention to disrupt and remove bacterial biofilm on babies' teeth. Mothers and caregivers provide daily oral hygiene, generally using a toothbrush, a finger-adapted toothbrush or wet gauze. Several tooth wipes are now available. A company in Brazil developed one of which contains xylitol, sorbitol and chamomile.

Researchers in Brazil compared the new baby tooth wipes to toothbrushing and cleaning with wet gauze in two groups of babies cared for by either their mother or a caregiver. Babies ranged in age from eight to 15 months and only had anterior teeth. The babies were all considered high risk, as they were given sweet drinks in bottles with no oral hygiene afterward.

The study design began with baseline biofilm scores using disclosing solution followed by a rubber cup polishing and four days of normal oral hygiene. The next two days no oral hygiene was performed followed by initial biofilm score and seven days of one of the three oral hygiene approaches: toothbrush, gauze or tooth wipe followed by the final biofilm score. Each of the 50 babies participated in all three approaches with a rubber cup polishing between.

Mothers removed 84 percent of biofilm compared to 45 percent removed by caregivers. Baby tooth wipes were as effective as a toothbrush and were better tolerated by babies.

Clinical Implications: Encourage parents and caregivers of babies to use baby tooth wipes after feeding and before putting the baby to sleep since this is easier and better accepted by the babies.

Abanto, J., Rezende, K., Carvalho, T., Correa, F., Viela, T., Bönecker, M., Salete, M., Correa, N.: Effectiveness of Tooth Wipes in Removing Babies' Dental Biofilm. Oral Health Prev Dent 10: 319- 326, 2012.
Malocclusion is Associated with Oral Habits

According to the World Health Organization, malocclusion ranks third – after caries and periodontal disease – in oral health priorities. Malocclusion is not a disease but is a group of deviations from normal tooth position. Most malocclusions are caused by acquired habits, including a soft diet, harmful oral habits and mouth breathing. Left untreated, malocclusion can cause both physiologic and social problems for the individual.

Researchers at Estadual Paulista University in Aracatuba, Brazil evaluated 1,385 children, ages five to six years, who were students in 56 public schools in Sao Paulo, Brazil. Ten dentists and 10 assistants were trained to clinically evaluate occlusion for this study.

Pacifier use was reported in 44 percent of children, bottle use by 86 percent and digit sucking by 18 percent. Tooth crowding was found in 10 percent of the children and four percent had tooth rotation. Harmful habits were associated with moderate to severe overjet in 22 percent of children. Posterior crossbite was found in 15 percent of children, which is lower than other studies reporting 29 percent in this age group.

Occlusion in these children was classified as Class I in 75 percent and Class II in 19 percent. Eight percent showed edge-to-edge occlusion and two percent had anterior cross bite. Short to high overbite was found in 44 percent of children.

Orthodontics is part of the Brazilian health care system and more prevention should be included to address the impact of harmful habits and mouth breathing on development of malocclusion.

Clinical Implications: Check children early for signs of malocclusion and harmful oral habits.

Santos, R., Nayme, J., Garbin, A., Saliba, N., Garbin, C., Moimaz, S.: Prevalence of Malocclusion and Related Oral Habits in 5 to 6-Year Old Children. Oral Health Prev Dent 10: 311-318, 2012.

Malocclusion Rates Remain High in Japanese Girls

Recognizing malocclusion helps determine future orthodontic needs. In large-scale studies of more than 500 adolescents, the prevalence varies from 48 percent to 90 percent. Factors influencing these variations include age, race, ethnicity and social class. Most studies show an overall prevalence of more than 50 percent malocclusion.

Over the past 40 years researchers at Osaka University in Japan have evaluated malocclusion using the same criteria in students at the same schools. The current study evaluated 2,378 schoolgirls in seventh and 10th grades studying in several private high schools. Those who were found to need orthodontic treatment were classified as having malocclusion.

Malocclusion was found in 56 percent of seventh graders and 55 percent of 10th graders. These numbers are similar to those reported in several studies of the same population over the past 40 years. Findings were similar for both class groups in these areas: maxillary protrusion, 9.4 percent and 7.8 percent; cross-bite 0.6 percent and 1.3 percent; edge-to-edge bite 4.1 percent and 1.2 percent; open-bite 0.6 percent and 1.2 percent; crowding 19.1 percent and 20.1 percent. The only difference was found in the deep-bite category with 8.4 percent of seventh graders reported to have a deep-bite and 5.8 percent of 10th graders. The lower score for 10th graders was explained by changes due to eruption of permanent molars in the older girls.

The popularity of early intervention orthodontics in Japan might explain lower rates for anterior cross-bite and edge-to-edge bite.

Clinical Implications: Malocclusion is an ongoing problem that requires recognition and early intervention and treatment.

Uematsu, S., Yoshida, C., Takada, K.: Proportions of Malocclusions in Japanese Female Adolescents over the Last 40 Years. Oral Health Prev Dent 10: 373-377, 2012
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