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Reduced Plaque Formation by the Chlormethyl Analog of Victamine C
... • Moderate gingival inflammation: ≥40% bleeding on marginal probing (BOMP) [6], and ≥30% Gingival Bleeding Index (GBI) [7]. • Inadequate plaque control (Turesky plaque index ≥ 1.5) [8]. • Patients should not have any orthodontic bands or removable prostheses. ...
... Dental plaque was assessed using a disclosing solution (PlacControl ® , Dentaid, Barcelona, Spain) with the Turesky et al. [8] modification of the Quigley and Hein index [13], scored at six sites per tooth. ...
... Appendix Clinical Indices. References [6,8,[13][14][15][16][17]29,30] are cited in the Supplementary Materials. Informed Consent Statement: Informed consent was obtained from all subjects involved in this study. ...
The aim of this study was to evaluate a newly formulated mouth rinse containing cymenol in patients undergoing supportive periodontal care in terms of safety (primary outcome) and the impact on dental biofilm and gingival inflammation (secondary outcomes). This research was designed as a pilot, controlled, randomized, parallel, triple-blinded, single-center, clinical trial of a 12-week duration. Adverse events and product perception were assessed by a questionnaire. Clinical, patient-reported outcomes (PROs), compliance, tooth staining, dentin hypersensitivity and microbiological variables were also evaluated. Student T, Mann–Whitney-U and Chi-square tests were applied. Thirty participants (15 per group) were included, randomized and followed for 12 weeks. No adverse events were reported. The questionnaire showed an overall rating of 7.2 (out of 10) in the experimental group and of 8.2 in the control group (p = 0.165) at 12 weeks. No statistically significant differences were observed in terms of gingival health, tooth staining, dentin hypersensitivity or microbiological outcomes between groups at baseline, 6- and 12-week visits. The adjuvant use of the new mouth rinse formulation proved to be as safe as the control product and no significant differences were observed in terms of clinical efficacy.
... The primary outcome of this study was to define if SRP therapy with the application of PRF membrane could enhance clinical results in terms of PPD reduction, CAL gain, the plaque index [28], the Gingival Index [29] and GR minimization compared with SRP therapy alone. ...
... Patients enrolled underwent a comprehensive intra-and extra-oral examination. A comprehensive periodontal examination was performed encompassing site-specific pre-and post-operative clinical parameters, such as the plaque index (PI) described by Turesky et al. [28], gingivitis index (GI) described by Loe and Silness [30], probing pocket depth (from the gingival margin to the base of the pocket), clinical attachment loss (CAL-from the cemento-enamel junction to the base of the pocket), and gingival recession (GR-from the gingival margin to the cemento-enamel junction), were measured at baseline and after six weeks post-operatively. ...
... The plaque index was used to assess the presence and the amount of plaque on the teeth that would be treated with the following scoring criteria [28]: 0 = Absence of microbial plaque; 1= Thin film of microbial plaque along free gingival margin; 2 = Moderate accumulation with plaque in sulcus; 3 = Large amount of plaque in sulcus or pocket along the free gingival margin. ...
This clinical trial investigated the efficacy of platelet-rich fibrin (PRF) as an adjunct to conventional scaling and root planing (SRP) in non-surgical periodontal therapy. In a split-mouth randomized controlled trial with 13 patients and 26 periodontal pocket sites, PRF was inserted in test group pockets alongside SRP, while control group pockets received SRP alone. Measurements at baseline and six weeks included probing pocket depths (PPDs), clinical attachment loss (CAL), gingival recession (GR), the plaque index, and the gingivitis index. The wound healing index was assessed at six weeks. The results show statistically significant improvements in the SRP+PRF group compared to SRP alone, demonstrating a better CAL gain (SRP+PRF group: 2.69 ± 0.63; SRP alone group: 4.15 ± 0.69—p-value: 0.001), PPD reduction (SRP+PRF group: 2.62 ± 0.65; SRP alone group: 3.85 ± 0.80—p-value: 0.001), and GR minimization (SRP+PRF group: 0.46 ± 0.62; SRP alone group: 0.81 ± 0.72—p-value: 0.21). The adjunctive use of PRF enhanced healing, reduced pocket depths, decreased tissue morbidity, and minimized gingival recession. This study concludes that PRF placement is effective in 5–6 mm pockets, potentially reducing the number of periodontal treatment sessions needed for pocket closure.
... Results of periodontal status The periodontal evaluation compared treatments with the indexes that categorized plaque index [6,[28][29][30][31], bleeding on probing [6,29,31,32], probing depth [29][30][31], and gingival recession [6,29]. Plaque index was recorded at four sites for the six anterior teeth except for Jamilian et al. [30] that used plaque index developed by Quigley and Hein and modified by Turesky et al. [36]. Robertsson and Mohlin [6] and Nordquist et al. [28] compared patients treated with orthodontic closure or with dental prosthesis, while De Marchi et al. [29], Schneider et al. [31] and Jamilian et al. [30] compared orthodontic closure with dental implant. ...
... Orthodontic procedures involve the mesial movement of adjacent teeth, maxillary first premolarand canine, to the canineand lateral incisor camouflaging [30]. According to dentists' and laypeoples' opinions [7,36,42,43] the reshaping of the maxillary canines has shown significant improvement in the aesthetics of individuals who choose space closure. Orthodontic treatment also demonstrated to have a positive psychological impact, as there was a significant improvement in self-esteem and social interaction of the individuals. ...
... All the authors used Loe and Silness [24] to mess up the gingival index. Bhor et al. [23], Bhattacharjee et al. [4], and Bajaj and Tandon [21] used the Silness and Loe [25] index to measure plaque scores, while Chainani et al. [22] used the Turesky modification of the Quigley and Hein plaque index [26], and Padiyar et al. [5] used the Narayan and Mendon index [27]. There were no dropouts in the studies reported by Bhor et al. [23] and Padiyar et al. [5], while deaths were reported in the rest of the studies [4,21,22]. ...
... Gingival index: Loe and Silness [24] Plaque Index: Narayan and Mendon index [26] Triphala and chlorhexidine both work to remove plaque and gingivitis, but Triphala and chlorhexidine both reduced plaque and gingival index scores by a lot more than the negative control (p < 0.001). There was no significant difference in the plaque and gingival index scores between Triphala and chlorhexidine. ...
Aim: The aim of this study was to evaluate and compare the efficacy of Triphala and chlorhexidine mouthwashes in reducing gingivitis and dental plaque in children. Methodology: A literature search was confined to the English language using MeSH terms conferring to PICO format in PubMed, Cochrane Library, and Ovid (SP), covering the period from January 1960 to August 2022. A search in Google Scholar and the grey literature and a hand search of references was performed to find additional data. Suitable studies were selected based on the predefined inclusion and exclusion criteria. Quality analysis of the selected studies was performed using the Cochrane Risk of Bias Tool for Randomized Controlled Trials. Results: Seven hundred and forty-seven articles were retrieved from three databases (PubMed, Cochrane Library, Ovid (SP), and other sources). Results: A total of 747 studies were retrieved from electronic databases and hand searches. After removing duplications, 519 were available; among them, 495 irrelevant citations were excluded with inclusion and exclusion criteria. Twenty-four citations were eligible for abstract screening, and fourteen citations were excluded including invitational studies, narrative reviews, animal studies, and studies that involved adults. Finally, studies for full texts were screened for eligibility for the research question, and then only five studies were available upon full-text phase analysis. The five studies involved 1740 children to evaluate the efficacy of Triphala and chlorhexidine mouthwashes in reducing gingivitis and dental plaque in children. Among them, one article showed low risk, three articles showed moderate risk, and one article showed high risk. Conclusion: While Triphala and chlorhexidine both reduce gingivitis, reports indicate that Triphala is less effective than chlorhexidine in improving plaque index scores. Further controlled studies are needed to confirm the effectiveness of Triphala mouthwash in children.
... This study included the case history records of systemically healthy patients between the ages of 20 and 40 years with gingivitis as diagnosed by clinical examination using a gingival index (GI) by Loe and Silness [10] with scores ≥ 1, PI scores ≥ 1 [11], who were prescribed TM or CHX mouthwash for a minimum of two months, without a history of periodontal therapy within the preceding six months, non-smokers, nontobacco chewers, and who had complete clinical records with a follow-up of two months. Incomplete records, records with a history of patients using antibiotics, steroids, hormonal therapy within the last six months, multiple missing teeth, periodontally compromised teeth, medically compromised patients, and individuals with disease severity necessitating periodontal therapy were excluded from the study. ...
... The patients in group 2 used 0.2% CHX mouthwash following the same instructions and methods as group 1. The following indices were assessed to evaluate the efficacy of two mouth rinses: PI by Turesky et al., who modified Quigley-Hein PI [11], and GI by Loe and Silness [10]. The baseline indices (PI and GI) were obtained from the patient's case history records (T0). ...
Introduction: Mouthwashes are highly efficacious chemical agents for managing plaque and gingivitis. The aim of the present study was to evaluate and compare the efficacy of turmeric (TM) and chlorhexidine (CHX) mouthwash as anti-plaque and anti-gingivitis agents.
Materials and methods: This retrospective, observational study was conducted on the clinical case records of 60 patients with gingival and plaque scores of ≥ 1, who were treated with TM mouthwash as group 1 and CHX mouthwash as group 2 for a period of two months. Indices such as plaque index (PI) and gingival index (GI) were noted at baseline (T0) and at the end of two months of mouthwash use (T1). The data were subjected to statistical analysis.
Results: Both groups were effective in reducing all indices from T0 to T1; however, group 2 was more effective than group 1 in reducing plaque scores at T1. The results were statistically significant (p<0.05), whereas there was no significant difference in the gingival scores at T1 between both groups (p>0.05). Multivariate analysis of variance (MANOVA) revealed no significant differences between the groups in gingival and plaque scores over time. Wilks’ Lambda test revealed that the treatment groups had a statistically significant impact on the overall treatment outcomes.
Conclusion: Although both CHX and TM mouthwashes were equally effective as anti-plaque and anti-gingivitis agents, TM mouthwash is recommended in cases where prolonged use is required, such as in orthodontic patients.
... Subjects had to possess at least 20 natural teeth with facial and lingual score-able surfaces; and be in good periodontal health with no more than five (5) periodontal pockets over 5 mm. Subjects with gingival index scores (Löe-Silness gingival index [23]) greater than or equal to (≥) 1.0 and plaque index scores (Turesky Modified Quigley and Hein plaque index [24,25]) greater than or equal to (≥) 1.5 were enrolled in the study. ...
... Dental plaque assessments were completed after all plaque were disclosed using a disclosing solution. The entire dentition was evaluated for dental plaque and plaque scored at the disto-, mid-, mesio-buccal and disto-, mid-, mesio-lingual surfaces of each tooth according to the criteria of the modified Quigley and Hein Index [24,25]. ...
Objective: This clinical investigation evaluated oral health improvements after the use of a novel zinc toothpaste in comparison to a control after 3 weeks and 6 weeks of use. Clinical assessments of gingivitis, bleeding and dental plaque evaluated oral health. Methods: Healthy adults meeting the study criteria (plaque index scores ≥ 1.5 and gingival index scores ≥ 1.0) were randomized into a treatment group with 74 participants assigned to the test and 73 participants assigned to the control groups. With the assigned toothpaste, subjects were instructed to brush at home twice a day for one minute. Subjects were evaluated clinically for gingivitis, plaque and bleeding at the baseline, employing 3-week and 6-week examinations. Results: All one hundred and forty-seven (147) subjects completed the 6-week study with no significant differences between groups at baseline (p > 0.05). The test demonstrated progressive improvements at the 3-week and 6-week evaluations as compared to the control (p < 0.001). In comparison to the control, the test demonstrated reductions of 13.4%, 17.0% and 55.3% for gingivitis, dental plaque and gingival bleeding, respectively, at the final visit (p < 0.001). Conclusions: Clinical improvements in gingivitis, dental plaque and gingival bleeding were registered in the group assigned the test toothpaste as compared to the control. The test toothpaste demonstrated statistically significant and progressively improving gingivitis, dental plaque and gingival bleeding scores that were all statistically significant versus the control at each post-treatment assessment.
... One study [20] measured the outcome using a full mouth Plaque Index (PI) score [21] and found that charcoal-infused toothbrushes were more effective in removing dental plaque than non-charcoal-infused brushes. However, the other study [19] used the Turesky-Gilmore-Glickman modification of the Quigley-Hein PI [22] and concluded that both types of brushes had similar effects on plaque removal. Due to the limited number of eligible studies using different outcome measures, a meta-analysis could not be conducted for this review. ...
... To measure the outcome of plaque removal, the included articles used the same time intervals (baseline, 3 weeks, and 6 weeks) but different plaque indices. The PI reported by Loe [21] was used in a study by Kini et al., [20], whereas Prusty et al., [19] utilized the Quigley-Hein PI [22]. In a recent study, four different plaque indices were investigated, which revealed that plaque accumulation was evaluated differently for each index and that they were not interchangeable [29]. ...
Background: This systematic review aimed to evaluate the available clinical evidence on the plaque removal effectiveness of charcoal-infused toothbrushes in comparison to non-charcoal brushes. Methods: An online search was conducted in major scientific databases. Inclusion criteria were experimental clinical trials conducted on participants aged 18 years or older that evaluated the plaque removal effectiveness of charcoal-infused toothbrushes compared to non-charcoal brushes, with no limitations on the language or publication date. Results: Out of 147 studies, 2 met the inclusion criteria. The Risk of Bias in the included articles was determined as "high". The findings were mixed regarding the plaque removal effectiveness. One of the studies showed higher efficacy for charcoal-infused toothbrushes. In contrast, the other study showed a similar effect for both types of brushes. The meta-analysis could not be performed due to the small number of eligible studies, with each utilizing different outcome measures. Conclusions: Within the context of this review, it is unclear whether charcoal-infused toothbrushes are better oral hygiene aids than non-charcoal brushes. Therefore, further research over a longer duration is needed to reach a conclusive statement. Healthcare professionals and the public should be cautious when recommending or utilizing such novel products that lack enough scientific support.
... Using a disclosing solution (1% neutral red) (YOUNG Dental, Missouri, U.S.A.), the maxillary right first molar (#16), maxillary left central incisor (#21), maxillary left first premolar (#24), and mandibular left first molar were identified. After staining the crown and cervical surfaces of the mandibular left first molar (#36), mandibular right central incisor (#41), and mandibular right first premolar (#44), plaque was assessed on the buccal and lingual surfaces of each tooth [15]. A score ranging from 0 to 5 was assigned to each part. ...
... answered 'I don't know at all.' And Regarding the willingness to try a smart toothbrush, the largest number of guardians(15, 68.2%) answered 'Strongly agree'. ...
Objective
Advances in mobile technology are helping with health management practices, and smart toothbrushes provide proper dental care by collecting and analyzing users’ toothbrushing data. The purpose of this study is to assess the effect of a telemonitoring device on oral hygiene management in individuals with intellectual or developmental disabilities and its role in promoting oral health.
Materials and methods
Participants were split into two groups: one initially using the telemonitoring device (telemonitoring device/manual toothbrush) and the other using it later (manual toothbrush/telemonitoring device), with a one-month washout period. The study compared plaque index, halitosis, changes in oral microbiota, and guardian questionnaire responses between the groups.
Results
In period 1, the QHI index score significantly decreased from 1.93 to 0.83 in the group using the remote monitoring device, compared to an increase from 1.75 to 2.01 in the manual toothbrush group. Additionally, toothbrushing frequency, time, and cooperation increased by 0.82 ± 0.60, 0.82 ± 1.16, and 1.09 ± 0.94, respectively, with initial telemonitoring device use. However, these measures decreased by -1.45 ± 0.68, -1.09 ± 0.70, and − 1.00 ± 1.00 after switching to a manual toothbrush, and decreased by -0.64 ± 0.67, -0.27 ± 1.19, and 0.09 ± 0.94 overall, respectively. However, there were no significant differences in oral microbiota between the groups at these different time points.
Conclusions
The study shows that telemonitoring devices effectively reduce plaque index and improve toothbrushing frequency, time, and cooperation. However, these benefits decrease after switching to a manual toothbrush. Follow-up is needed to assess satisfaction and compliance with telemonitoring device use.
Clinical relevance
Using telemonitoring devices in the oral health management of individuals with intellectual and developmental disabilities can improve their oral health quality.
... Clinical and radiographical examinations were performed to determine the periodontal conditions of volunteers who met the inclusion and exclusion criteria. Clinical periodontal indices included probing depth (PD), clinical attachment loss (CAL), the dichotomous scoring of bleeding on probing (BOP +/-), gingival index (GI) [26], and plaque index (PI) [27]. Clinical recordings were performed at six points (mesiobuccal, buccal, distobuccal, mesiopalatal/mesiolingual, palatal/lingual, and distopalatal/distolingual) of all teeth, except the 3rd molars, by a single investigator (C.Ö.) using a conventional periodontal probe (Williams, Hu-Friedy, Chicago, IL). ...
Objectives
Activin-A belongs to the transforming growth factor-beta superfamily and is a multifunctional cytokine that plays a role in inflammation, immune response, tissue repair and regeneration. Proinflammatory cytokine interleukin-1beta (IL-1β) can increase Activin-A expression in various cell types. This study aims to evaluate gingival crevicular fluid (GCF) and salivary Activin-A and IL-β levels in stage III periodontitis.
Materials and methods
23 patients with stage III periodontitis, 26 with gingivitis and 26 periodontally healthy individuals were included. Full-mouth clinical periodontal indices were recorded, unstimulated whole saliva and GCF samples were obtained, Activin-A and IL-1β total amounts were determined by ELISA. Statistical comparisons were performed using non-parametric tests. Receiver operating characteristics curve was used for estimating the area under the curve (AUC).
Results
Periodontitis group exhibited significantly lower GCF Activin-A levels but higher IL-1β levels than the periodontally healthy group (p < 0.05). Gingivitis group had similar GCF Activin-A and IL-1β levels to the periodontitis and periodontally healthy groups (p > 0.05). Salivary Activin-A and IL-1β concentrations were similar among study groups (p > 0.05). GCF Activin-A level showed an excellent diagnostic performance (an AUC value of 0.82 with 87% sensitivity) to discriminate periodontitis from periodontal health.
Conclusions
For the first time, this study demonstrated oral biofluid levels of Activin-A in periodontal health and diseases. Within the limits of the study, it might be suggested that diseased sites in periodontitis are associated with reduced Activin-A and increased IL-1β levels in GCF.
Clinical relevance.
Reduced GCF Activin-A levels and the accompanying increase in IL-1β might be associated with diseased sites in stage III periodontitis.
... A comprehensive clinical examination and plaque registration were performed with visual observation and not using a periodontal probe (as the plaque accumulation needed to be intact for the following steps). The index used for the registration was the modified Quigley-Hein plaque index [16] (Table 1). A full-mouth plaque assessment was conducted in this study, with each tooth evaluated buccally and lingually. ...
Background/Objectives: The aim was to evaluate the agreement between plaque detection with an intraoral scanner system (IOS) and a conventional clinical method and to evaluate the inter-rater reliability for scoring 3D models with and without a disclosing agent. Methods: A total of 14 participants were recruited from the Department of Operative Dentistry, School of Dentistry, National and Kapodistrian University of Athens. Participants eligible for inclusion were adults with good general health and a minimum of 20 teeth. Participants were clinically examined with plaque assessment according to the modified Quigley–Hein plaque index before and after using a disclosing agent (GC-Tri Plaque ID-Gel, GC, Europe N.V). Before and after the application of the disclosing agent, all study participants were scanned using the IOS (TRIOS5, 3Shape TRIOS A/S). The clinical examiner and three additional examiners blinded to the clinical examination assessed plaque status on the acquired 3D models with and without disclosing agent using the same index to evaluate the inter-rater agreement. Intraclass coefficient correlation, one sample t-test, and Cronbach’s α for inter-rater reliability were calculated. Results: All methods showed moderate to strong correlations (Spearman’s rho ranging from 0.527 to 0.618), and Cronbach’s α ranged from 0.551 to 0.766. Conclusions: The level of agreement between conventional clinical registration and registration from 3D models was acceptable overall.
... In addition, many studies were conducted with rather low baseline levels of gingival inflammation, which weakens the benefit of dental floss [9,16]. Another point is, that many studies [14][15][16] use plaque indices such as the Turesky modified Quigley and Hein Index (T-QHI) [20], the Silness and Loe Plaque-Index [21] or the Rustogi modified Navy-Plaque-Index (RMNPI) [22]. These indices assess the entire smooth surface of a tooth and therefore have limited validity for separate plaque quantification of areas close to the interdental space. ...
Objectives
This study aimed to evaluate the effectiveness of an instruction-video, with and without additional hands-on instruction, in teaching young adults proper flossing performance.
Materials and Methods
This randomised intervention and observational study included 94 participants, 24 (23; 25) years, receiving an instruction-video with (group 1) or without additional hands-on instruction (group 2). The flossing performance was assessed by videotaping before instruction (T1), after instruction and one week of practice (T2), as well as after two weeks of practice (T3). Parameters of interest were number of interdental spaces reached, adaptation to mesial and distal surfaces, flossing technique, systematic approach and handling combined with self-assessment of flossing skills and time spent, assessed by questionnaires.
Results
Additional hands-on instruction did not lead to a significant improvement in any parameter compared to video-instruction alone. At T1, the participants reached many interdental spaces, but only two managed to floss their entire dentition correctly. After video instruction (T2), the participants reached more interdental spaces (p = 0.039) using a systematic approach and improved adaptation, technique and handling (p < 0.001 each). Parameters improved again at T3, resulting in 42 participants flossing their entire dentition correctly. After instruction participants found flossing less difficult, although they estimated it took more time.
Conclusion
Video-instruction significantly improved flossing performance, whereas hands-on instruction had no additional benefit. This indicates that video-instruction could be an effective and timesaving tool to improve flossing performance.
Clinical relevance
The results emphasize the importance of appropriate teaching-methods in dental prophylaxis and highlight the potential of video-instructions to improve interdental cleaning skills significantly.
... The plaque index was assessed according to Turesky et al. [9] modification of Quigley Hein Index: 0: ...
Objective
To determine the effect of Augmented Reality (AR) - based toothbrushing on oral hygiene practices among 6-8yrs old children of Mysuru City.
Material and Methods
A concurrent parallel examinerblinded study was conducted on 6-8yrs old children. The participants were divided into two groups: a) the Conventional brushing group and b) the AR-assisted brushing group. Oral hygiene parameters were assessed at the baseline. The conventional group was given a manual toothbrush. The AR-assisted group received a Colgate Magik toothbrush. Both groups were followed up for two weeks. The acceptance of using AR-assisted brushing was recorded via feedback. The pre-post comparison within the group was carried out using a paired t-test.
Results
An improvement in oral hygiene status with a significant reduction in the AR-assisted brushing group (p<0.0001) was observed. The percentage reduction in plaque and gingival bleeding scores was also higher in the AR-assisted brushing group.
Conclusion
Augmented reality guided toothbrushing is an effective method to teach positive oral hygiene behavior in children.
Keywords:
Computer Simulation; Toothbrushing; Oral Hygiene; Technology
... The plaque was scored according to the Turesky modification of the Quigley-Hein PLI, to record plaque coverage area, and the focus was to observe plaques near the gingival margin and interproximal plaques (Turesky, Gilmore, and Glickman 1970). PLI is the indicator used clinically to evaluate the Oral hygiene status and the effect after periodontal disease control. ...
Objectives
Gingivitis is the initial stage of periodontitis, one of the most common oral diseases and the primary cause of tooth loss. This study aims to evaluate the effect of toothpaste containing 2% zinc citrate on gingival health and the abundance of three bacteria related to gingivitis and periodontitis.
Methods and Materials
Eleven volunteers with the same oral health status were randomly assigned to the treatment (n = 5) and control (n = 6) groups. The control group used fluoride toothpaste, while the treatment group used fluoride toothpaste supplemented with 2% zinc citrate for 3 months. The plaque index, gingival index, and bleeding index were measured at baseline (0 day), 3 weeks, and 3 months. Dental plaque from four areas of the mouth (FDI criteria) was collected at the same timepoints. A total of 132 dental plaque samples were analyzed using quantitative PCR (qPCR) to monitor the abundance of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia.
Results
Toothpaste containing 2% zinc citrate significantly lowered the gingival index and reduced gum bleeding but did not affect the plaque index. It also reduced the total abundance of the three bacteria related to gingivitis and periodontitis in dental plaque over a long‐term period.
Conclusions
Toothpaste with 2% zinc citrate persistently improves gingival health and reduces the presence of gingivitis‐associated bacteria in dental plaque.
Trial Registration
Chinese Clinical Trial Registry (Clinical trial registration no.: ChiCTR1900020592) (09/01/2019).
... The patients in Group 2 used 0.2% CHX mouthwash following the same instructions and methods as Group 1. The following indices were assessed to evaluate the efficacy of two-mouth rinses: plaque index (PI) by Turesky et al., who modified Quigley-Hein PI [12], GI by Loe and Silness [10], stain index (SI) by Lobene [13], and halitosis index (HI) by Rosenberg and McCulloch [14]. The baseline indices (PI, GI, SI, and HI) were obtained from the patient's case history records (T0). ...
Introduction: Mouth rinse is a highly effective chemical solution for managing plaque and gingivitis. This study evaluated and compared the efficacy of chitosan (CH)-rich mouthwash with standard chlorhexidine (CHX) mouthwash in reducing gingivitis, plaque, halitosis, and stains.
Materials and methods: This retrospective, observational study was conducted on the clinical case records of 60 patients who were treated with CH mouthwash (formulated and dispensed from the department) as group 1 and CHX mouthwash as group 2 for at least three months. Indices such as the plaque index (PI), gingival index (GI), stain index (SI), and halitosis index (HI) were obtained at baseline (T0) and the end of three months of mouthwash use (T1) from the case records. The data were subjected to statistical analysis.
Results: Both groups effectively reduced all indices from T0 to T1; however, group 1 was more effective than group 2 in reducing gingival, plaque, and stain scores. The results were statistically significant (p<0.05) for all indices, and both groups were equally effective in reducing halitosis. Male sex showed a significant positive correlation with PI, GI, and SI, whereas female sex showed a positive correlation with PI and HI.
Conclusion: Based on the findings of the present study, it was concluded that the CH mouthwash was more effective in reducing plaque, gingival, and staining scores than the CHX mouthwash. Both types of mouthwash were equally effective in reducing halitosis scores.
... Oral hygiene assessment was performed using a previously modified plaque index (PI) [23]. PD, CAL, and BOP were assessed using a standardized periodontal probe (University of North Carolina-UNC-15) at six predetermined sites per tooth, covering all teeth except third molars. ...
This cross-sectional study aimed to evaluate the interplay between volatile sulfur compounds (VSC), biofilm, salivary parameters, and periodontal status in patients with and without periodontal disease. Sixty-four subjects diagnosed with periodontitis and 60 periodontally healthy individuals were included. Probing depth, clinical attachment level, bleeding on probing, tongue coating index, plaque index, number of teeth, spinnability of unstimulated whole saliva, and salivary flow rate were evaluated. The concentrations of VSC were quantified using a portable gas chromatograph. The mean differences in hydrogen sulfide, methyl mercaptan, salivary flow, spinnability, and plaque index did not exhibit statistically significant variances between the two groups. However, a pronounced tongue coating index and a diminished tooth count showed statistical significance in the periodontitis group (p = 0.039; p < 0.001). Unstimulated salivary flow rate less than 0.25 mL/min was statistically significant in the periodontitis group (p = 0.032). After controlling for confounding factors, bleeding on probing remained significant. A positive correlation between periodontal parameters and VSC concentration was found. An inverse correlation was also noted between the spinnability of saliva and tongue coating index (−0.34; p < 0.001). Salivary parameters may contribute to the formation of tongue coating and are correlated with periodontal status. Bleeding on probing, clinical attachment level, and probing depth were identified as potential contributors to VSC formation.
... PD, BOP, GR, and CAL were measured at six sites [proximal, mesial, central, and distal on the buccal surface/lingual surface] for each tooth. PI was categorized into buccal-lingual for maxillary and mandibular teeth and scored on a 0-5 scale [28]. All clinical parameters were measured by the same examiner at visit 1 (screening) or 2 (baseline measurement) and visit 3 (after taking PMEC or placebo for 4 weeks) and 4 (after taking PMEC or placebo for 8 weeks). ...
This study investigated the efficacy and safety of a propolis–mangosteen extract complex (PMEC) on gingival health in patients with gingivitis and incipient periodontitis. A multicentered, randomized, double-blind, placebo-controlled trial involving 104 subjects receiving either PMEC or placebo for eight weeks was conducted. The primary focus was on the changes in inflammatory biomarkers from gingival crevicular fluid (GCF), with clinical parameters as secondary outcomes. The results revealed that the PMEC group showed a significantly reduced expression of all measured GCF biomarkers compared to the placebo group (p < 0.0001) at 8 weeks, including substantial reductions in IL-1β, PGE2, MMP-8, and MMP-9 levels compared to the baseline. While clinical parameters trended towards improvement in both groups, the intergroup differences were not statistically significant. No significant adverse events were reported, indicating a favorable safety profile. These findings suggest that PMEC consumption can attenuate gingival inflammation and mitigate periodontal tissue destruction by modulating key inflammatory mediators in gingival tissue. Although PMEC shows promise as a potential adjunctive therapy for supporting gingival health, the discrepancy between biomarker improvements and clinical outcomes warrants further investigation to fully elucidate its therapeutic potential in periodontal health management.
... A comprehensive clinical examination and plaque registration using the conventional methods was performed. The index used for the registration was the modified Quigley-Hein plaque index [14] ( Table 1). All teeth were given a score buccally and lingually. ...
The aim was to evaluate the agreement between plaque detection with intraoral scanner system (IOS) and a conventional clinical method and to evaluate the inter-rater reliability for scoring 3D models with and without a disclosing agent. 14 participants were recruited from the Department of Operative Dentistry, School of Dentistry, University name blinded to reviewers, it is completed after the reviewing process. Participants eligible for inclusion were adults with good general health and a minimum of 20 teeth. Participants were clinically examined with plaque assessment according to the modified Quigley-Hein plaque index before and after using a disclosing agent (GC-Tri Plaque ID-Gel, GC). Before and after the application of the disclosing agent, all study participants were scanned using the IOS (TRIOS5, 3Shape TRIOS A/S). The clinical examiner and additional three examiners blinded to the clinical examination assessed plaque status on the acquired 3D models with and without disclosing agent using the same index to evaluate the inter-rater agreement. Intraclass coefficient correlation, one sample t-test and Cronbach’s α for inter-rater reliability were calculated. All methods showed moderate to strong correlations (Spearman’s rho ranging from 0.527 to 0.618) and Cronbach’s α ranged from 0.551 to 0.766. Level of agreement between con-ventional clinical registration and registration from 3D models was acceptable overall.
... PD, BOP, GR, and CAL were measured at six sites [proximal, mesial, central, and distal on the buccal surface/lingual surface] for each tooth. PI was categorized into buccal-lingual for maxillary and mandibular teeth and scored on a 0-5 scale [28]. All clinical parameters were measured by the same examiner at visit 1 (screening) or 2 (baseline measurement) and visit 3 (after taking PMEC or placebo for 4 weeks) and 4 (after taking PMEC or placebo for 8 weeks). ...
This study investigated the efficacy and safety of a propolis mangosteen extract complex (PMEC) on gingival health in patients with gingivitis and incipient periodontitis. A multi-centered randomized, double-blind, placebo-controlled trial involving 104 subjects receiving either PMEC or placebo for eight weeks was conducted. The primary focus was on changes in inflammatory biomarkers from gingival crevicular fluid (GCF), with clinical parameters as secondary outcomes. Results revealed that the PMEC group showed significantly reduced expression of all measured GCF biomarkers compared to the placebo group (p<0.0001) at 8 weeks, including substantial reductions in IL-1β, PGE2, MMP-8, and MMP-9 levels compared to baseline. While clinical parameters trended towards improvement in both groups, inter-group differences were not statistically significant. No significant adverse events were reported, indicating a favorable safety profile. These findings suggest that PMEC consumption can attenuate gingival inflammation and mitigate periodontal tissue destruction by modulating key inflammatory mediators in gingival tissue. Although PMEC shows promise as a potential adjunctive therapy for supporting gingival health, the discrepancy between biomarker improvements and clinical outcomes warrants further investigation to fully elucidate its therapeutic potential in periodontal health management.
... The plaque on the teeth was visualized by Curaprox PCA 260 Two-Color Plaque Indicator Solution. To conduct a morphometric determination of the amount of dental plaque the plaque scores were recorded using the Quigley and Hein Plaque Index (QHI) as modified by Turesky et al. 13 . ...
This longitudinal survey aims to demonstrate improvement in oral hygiene among a group of youth with visual impairment (VI) achieved by repeated oral hygiene training, compare their progress with healthy peers (CG) and assess their oral health knowledge. In 100 VI (55♀, 45♂; ± 17.8 years) and 45 CG (23♀, 22♂; ± 17.2 years) oral hygiene training and a Quigley-Hein Plaque Index (QHI) rating were repeated six times at three-month intervals. The VI were divided into four subgroups according to the toothbrush hardness/type. A questionnaire was given to both groups. Appropriate statistical analyses were performed at 5% significance level. Both groups showed reduction in QHI, the VI had overall higher QHI values than CG. Use of an electric toothbrush in VI led to lower QHI in the last examination (p < 0.03). 69% of participants recommended dental specialists to improve communications by acquiring more illustrative aids. VI changed toothbrush less often (p < 0.02). A higher incidence of dental plaque was confirmed in VI compared to CG. After education and individual training, gradual plaque reduction has occurred in both groups. Using an electric toothbrush in VI resulted in better QHI outcomes. Repetitive preventive intervention in youth with VI helped them to adopt healthier oral hygiene habits.
This scoping review appraises the available literature that investigates oral health after bariatric surgery (BS). Forty-two records were included (33 original studies and 9 systematic reviews). Bariatric surgery had a negative impact on the oral health related quality of life (three out of six studies). Relatively few studies found improvement following BS, probing pocket depth (2/10), clinical attachment level (1/9), bleeding on probing (3/10) and plaque (3/8). Conversely, BS was negatively associated with the DMFT (4/6), tooth wear (4/6) and oral radiographic findings (1/1). There was conflicting evidence regarding salivary parameters. To conclude, the literature on oral health in bariatric surgery patients is continuously growing. Positive as well as negative associations between oral health parameters and bariatric surgery are observed.
Background
Dental calculus accumulation varies across individuals. While various factors contribute to its accumulation, the role of salivary composition remains underexplored. This study aims to compare individuals suffering from rapid rates of dental calculus formation rates with those having slow formation rates in terms of salivary electrochemical properties as well as its proteomic, metaproteomic and elemental composition.
Methods
A total of 26 patients with a history of dental calculus were recruited. Saliva samples were collected and evaluated for electrochemical properties as well as elemental, proteomic and metaproteomic composition. Patients were provided scaling treatment to remove all calculus. Six months after the dental cleaning patients were re‐assessed for the presence of dental calculus. Based on the dental calculus formation rate participants were categorised into slow (57.7%) and rapid calculus formers (42.3%) that were then assessed for differences in salivary composition.
Results
Rapid calculus formers exhibited a more neutral zeta‐potential and lower concentration of salivary calcium ions than their slow‐forming counterparts. Proteomic analysis identified 895 proteins across all samples. Of these, 38 proteins were exclusive to the rapid formation group, while 24 proteins were specific to the slow group. The rapid group demonstrated augmented pathways related to cell binding (e.g., cytoskeletal regulation by Rho GTPase and integrin signalling), inflammatory mediation (e.g., chemokine and cytokine signalling) and neurodegenerative disorders (e.g., 5‐Hydroxytryptamine degradation, Huntington's disease and Parkinson's disease) and significant enrichment in peptidase inhibitor activity. In contrast, the slow group demonstrated enrichment mainly in immune response. Metaproteomic analysis for salivary bacteria showed significant predominance of Streptococci in the rapid group and elevated levels of Rothia in the slow group.
Conclusion
The saliva of patients with rapid calculus formation rates differs from that of patients with slow rates of calculus formation in terms of electrochemical properties as well as proteomic, metaproteomic and elemental composition.
Objectives
To evaluate the efficacy of a toothpaste containing amine compound, 0.5% zinc lactate, and 1400 ppm F (NaF) in comparison to a regular fluoride toothpaste containing 1450 ppm F as MFP/NaF (negative control). Plaque and gingivitis indices were determined over a 6-month period.
Materials and methods
In a randomized, double-blind, two-cell, parallel-group design on healthy adults from the Bangkok, Thailand area presenting with initial gingivitis (Löe-Silness gingival index ≥ 1) and visible plaque (Turesky Modification-Quigley-Hein index ≥ 1.5) were assigned test and negative control toothpastes and instructed to brush twice daily for two minutes.
Results
Site-level (N = 10,778) and subject-level (N = 92) data indicated that the test toothpaste increased the number of healthy sites and improved gum health as compared to the negative control toothpaste. For the test group, after 6 months, the average reduction for plaque, gingival index, and gingival severity was 31.2%, 32.3%, and 49.3%, respectively. Average reductions were greater in the test group than the negative control group across all measures.
Conclusions
The amine + zinc + fluoride toothpaste significantly improved measures of plaque (12× more effective) and gingivitis (5× more effective) in comparison to a standard fluoride toothpaste, suggesting that the novel formulation with antibacterial active ingredients amine and zinc facilitates more effective plaque removal, and promotes gingival health.
Clinical relevance
These results suggest that daily use of amine + zinc + fluoride toothpaste can provide a significant improvement in managing plaque accumulation and bleeding associated with gingival inflammation especially for patients experiencing gingivitis.
Clinical trial registration
NCT06563518 (registration date: August 19, 2024).
Background
This randomized double-blind, placebo-controlled clinical trial evaluated the effects of 2% OPTIMEALTH® OR toothpaste in regulating dental plaque microbiota and alleviating gingivitis.
Methods
Subjects were randomly assigned to the placebo group and test group. They were instructed to brush their teeth with placebo toothpaste (placebo group) or OPTIMEALTH® OR toothpaste (test group) for a continuous 4 weeks. Clinical indices of plaque index, gingival index, and bleeding on probe (%) were examined, and images of dental plaque staining were captured at baseline and after 2 and 4 weeks. The plaque microbiome was analyzed by 16s rDNA amplicon sequencing at baseline and after 4 weeks.
Results
Thirty-two participants with similar characteristics were recruited. After using OPTIMEALTH® OR toothpaste for 4 weeks, a decrease of 27.05% ( P < .01), 8.29% ( P > .05), and 47.44% ( P < .05) in plaque index, gingival index, and bleeding on probe (%) scores was observed compared to the baseline, respectively. The extent of decline in these indices is greater than that in the placebo group. A decrease in dental plaque could be observed after 2 and 4 weeks in the test group. The 16s rDNA sequencing results showed that the observed species index and Chao index, but not the Shannon index and beta diversity, were reduced significantly after using OPTIMEALTH® OR toothpaste for 4 weeks. In addition, compared with the placebo group, using OPTIMEALTH® OR toothpaste reduced the abundance of bacterial species such as Veillonella parvula and Prevotella denticola .
Conclusion
Brushing teeth with 2% OPTIMEALTH® OR-fortified toothpaste could effectively reduce dental plaque and regulate plaque microbiota.
Objective
Aim of this study was to critically appraise clinical evidence on the potential benefits of adjunctive use of superfoods green tea and turmeric as mouthrinse or local delivery agents in the treatment of periodontal disease.
Materials and methods
Electronic searches were performed in four databases for randomized trials from inception to February 2024 assessing the supplemental use of superfoods green tea and turmeric for gingivitis/periodontitis treatment. After duplicate study selection, data extraction, and risk-of-bias assessment with the RoB 2 tool, random-effects meta-analyses of Mean Differences (MD) or Standardized Mean Differences (SMD) with their 95% confidence intervals (CI) were performed.
Results
Nineteen studies (814 patients) were included, with 11 on gingivitis and 8 on periodontitis patients. No benefits were seen from the use of mouthwashes containing green tea extract or turmeric for gingivitis treatment, while green tea was associated with smaller Gingival Index (GI) reductions than chlorhexidine (5 studies; MD = 0.08; 95% CI = 0.01 to 0.14; P = 0.01). As far as periodontitis treatment is concerned, local supplementation with turmeric showed no benefits, whereas local supplementation with green tea extract was associated with improved treatment outcomes in terms of probing depth (4 studies; MD=-0.79; 95% CI=-1.29 to -0.29 mm; P = 0.002) and GI (3 studies; MD=-0.53; 95% CI=-1.01 to -0.05; P = 0.02) than the control group. However, the strength of evidence was moderate to very low due to bias, imprecision, and inconsistency.
Conclusion
Limited evidence indicates that supplemental use of green tea extract is associated with improved periodontal treatment outcomes. However, the strength of evidence is weak and further research is needed.
Clinical relevance
Green tea extract could be a natural adjunct to enhance periodontal treatment, without the potential side-effects of other adjuncts like chlorhexidine.
Aim
To evaluate risk indicators for gingival recessions (GRs) in the lower anterior teeth of orthodontic patients post treatment and during a retention period of at least 5 years, compared to non‐treated controls.
Material and Methods
Eighty‐nine orthodontically treated patients who were recession‐free before treatment were recruited. Demographic, cephalometric and occlusal records were retrieved before (T1) and after treatment (T2), and periodontal outcomes were clinically evaluated at least 5 years post retention (T3). Eighty‐eight non‐treated patients served as controls. Recession areas were digitally assessed and compared using t ‐test and chi‐square tests, and a multiple linear regression model was built.
Results
In the treated group, recession incidence was 11.24% at T2 and 67.42% at T3, all classified as type 1, class A (−). Among controls, recession prevalence was 15.91%, similar to the incidence at T2, but significantly lower than at T3. GR was most common in canines (1.85 mm ² ; 95% CI: 2.61–7.70; p < 0.005). Regression analysis identified higher incidence of recessions in female patients and in those with thin phenotype, high angle skeletal pattern, increased final inclination of lower incisors and greater probing depth.
Conclusions
GR incidence after orthodontic treatment was comparable to controls but increased significantly post retention. Several risk indicators may predict GR occurrence.
Background
A toothbrush device that telemonitors toothbrushing is a technologically advanced solution providing personalized feedback on toothbrushing habits and oral hygiene. These devices integrate smartphone apps to enhance oral health compliance through dental professional feedback.
Objective
This 6-month prospective randomized controlled trial aimed to compare the clinical effectiveness, defined as improved oral hygiene measured by plaque reduction and halitosis control, of an interactive telemonitoring toothbrush (ITT), an oscillating-rotating power toothbrush (ORT), and a manual toothbrush (MT).
Methods
Participants were recruited offline from the Department of Advanced General Dentistry at Yonsei University Dental Hospital, South Korea. A total of 150 participants were randomly assigned to 3 groups (50 participants each): (1) an ITT connected to a smartphone app providing real-time feedback and weekly dental professional reviews, (2) an ORT with smartphone-based guidance requiring participants to send weekly brushing records via screenshots, and (3) an MT with a brushing diary for review. Data collection occurred in clinical settings. Primary outcomes included plaque reduction measured using the Simple Hygiene Score (SHS), while secondary outcomes included plaque reduction measured using the Turesky modification of the Quigley-Hein plaque index (QHI), reductions in halitosis, and changes in oral microbiota. All outcomes were assessed at baseline and 1 month, 3 months, and 6 months.
Results
A total of 150 participants completed the study. Over 6 months, the SHS increased in the MT group (mean 3.16, SD 4.86 to mean 5.66, SD 5.20) but significantly decreased in the ITT group (mean 3.47, SD 5.50 to mean 2.27, SD 3.82; P=.004). Similarly, QHI decreased more in the ITT group (mean 1.79, SD 0.72 to mean 0.85, SD 0.63) than in the ORT (P<.001) and MT (P<.001) groups. Regarding microbiota, there were no significant differences in high-risk periodontal microbiota or the ratio of caries-risk to anticaries microbiota between the ITT and ORT groups. However, in the MT group, the ratio of caries-risk microbiota was significantly higher at the 3-month (P<.001) and 6-month (P=.005) recalls than at baseline and at the 3-month (P=.048) and 6-month (P=.03) recalls than at the 1-month recall. Poststudy questionnaires indicated that 45 of 50 ITT participants (92%) and 37 of 50 ORT participants (76%) reported improved brushing ability. The most effective feature in the ITT group was brushing training, while participants in the ORT group cited the brushing guide as most useful (P<.001). Satisfaction scores were higher in the ORT group (mean 7.90, SD 1.21) than in the ITT group (mean 7.15, SD 1.66; P=.004). The number of brushing events decreased significantly in the ORT group (P=.02), while brushing duration increased in the MT group (P=.01).
Conclusions
ITTs enable better oral hygiene management than MTs through dental professional feedback. However, further studies are needed to optimize feedback intervals and improve long-term adherence.
Trial Registration
Clinical Research Information Service (CRIS), Republic of Korea, KCT0009094; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26110&search_page=L
Background:
The persistence of dental plaque is attributable to the inaccessibility to all surfaces of the oral cavity. Thus, an integrated team designed an innovative toothbrush comprising a brush head assembly with an upper end and a lower end, and a handle rotatably configured with the lower end of the brush head assembly. The brush head is connected to the handle through a socket-ball joint, which allows the shank and the handle to rotate at any angle between 0° and 360° with respect to one another around an axis. Additionally, the brush head bends toward the handle, maintaining a bending angle of 15°.
Objectives:
The aim of the present randomized controlled trial (RCT) was to analyze and assess the effectiveness of a toothbrush with a rotatable shank in comparison to toothbrushes with flexible and straight handles with respect to supragingival plaque and gingival health outcomes. The secondary objective of the study was to evaluate the feedback of individuals who used the rotatable shank toothbrush.
Material and methods:
Three toothbrushes - one with a rotatable shank, one with a flexible handle and one with a straight handle - were compared in terms of efficacy in plaque and gingivitis control at 3 clinical centers (a multicenter trial). A total of 270 patients, aged 18-65 years, were included in the study. The collected data was analyzed and compared using the analysis of variance (ANOVA) with Tukey's post hoc test.
Results:
All groups demonstrated improvement in gingival health and a reduction in the plaque index (PI) scores. Nonetheless, the improvement was more pronounced in the group that used the toothbrush with a rotatable shank.
Conclusions:
The enhanced plaque removal and improved gingival health at all surfaces achieved with the rotatable shank toothbrush are ascribable to the incorporation of 2 features: the ability to rotate the toothbrush neck along its axis; and an inclination that facilitates access to all surfaces.
Aim
Compliance with plaque control measures in open interdental spaces, an essential element in management of periodontitis, is reported to be poor. Mobile health (mHealth) approach is an effective approach for behavior change. This study aimed to assess the effectiveness of mHealth in improving plaque control in type 2 embrasures.
Methods
Stage II or III, grade B periodontitis patients ( n = 76) with type 2 embrasures were enrolled. Phase I therapy was provided in both groups. In the control group, interdental brushing instructions were given only at baseline and follow‐up appointments. In the test group, interdental brushing was also reinforced by regular text messages for 3 months. Clinical parameters including plaque index (PI), papillary bleeding index (PBI), probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), bleeding on probing (BOP), and interdental papillary height (IPH) were measured at baseline, 1, 3, and 6 months.
Results
Intergroup comparison from baseline to 6 months showed a statistically significant difference ( p < 0.05) between groups in all parameters with more reduction in mean values in test group. Intergroup comparison from 3 to 6 months showed a statistically significant difference ( p < 0.05) in mean values of PI, PBI, GI, PPD, CAL, and IPH with higher reduction in test group. Intragroup comparison from 3 to 6 months showed statistically significant reduction in mean values in PI, PBI, PPD, CAL, and IPH only in test group ( p < 0.05).
Conclusion
Cue to action through mobile text messages effectively augments compliance with the use of interdental brush, improves plaque control, and manages stage II or stage III periodontitis following subgingival instrumentation.
Trial Registration
ClinicalTrials.gov identifier: NCT05565404
To assess the impact of the picture exchange communication system (PECS) on oral hygiene motivation and practices in healthy children aged five to seven years.
A total of 160 healthy children aged five to seven years were included in this study. At the first visit, the participants’ guardians were asked to answer a questionnaire focussing on the sociodemographic, and the oral hygiene habits of the participants. All participants received a clinical examination to assess their dental caries experience using the ICDAS score, gingival condition using the gingival index (GI), and the amount of accumulated dental plaque using the Turesky Modification of the Quigley–Hein Plaque Index (TQHI), followed by comprehensive explanation of the proper oral hygiene protocol. The participants were randomly divided into two equal groups; the PECS group and the control group. The participants were re-assessed after 6 months. The collected data were statistically analysed using the Statistical Package for Social Sciences (SPSS) software version 23 at a p-value ≤ 0.05.
By the end of the follow-up period, the PECS group reported significantly greater adherence to regular tooth brushing (p = 0.006) with a frequency higher than twice per day (p < 0.000) and no need for parental motivation (p < 0.001), and had significantly lower mean GI and TQHI scores (p < 0.000). Most of the participants’ guardians reported that the PECS cards were useful for use and that they would continue to use them 66/76 (86%).
The PECS was found to be effective in motivating children to adhere to proper tooth-brushing practices, as reflected by improvements in their oral health status and gingival condition.
Objectives
The effective control of dental plaque is crucial for oral health, given that pathogenic bacteria in plaque are the primary cause of dental caries. Current antimicrobial agents, although effective, disrupt the oral microbiome and lead to oral dysbiosis, hindering efforts to curb dental caries. Novel antimicrobial peptides offer a promising solution due to their selective bactericidal activity against cariogenic bacteria. This study explores the initial safety and efficacy of KSL‐W formulated into chewing gum through a Phase 1 and 2a clinical trial.
Methods
The combined trial, approved by the FDA, follows a double‐blind, randomized, placebo‐controlled design. Phase 1 assessed safety with single doses (2−100 mg), whereas Phase 2a explored both safety and proof of concept in reducing oral bacteria with multiple doses (4−75 mg). Besides adverse events (Phase 1), outcome measures included whole‐mouth plaque and gingival index scores and bleeding on probing (Phase 2a).
Results
KSL‐W demonstrated safety in both phases, with no severe adverse events. The proof‐of‐concept analysis revealed a decrease in plaque and gingival inflammation, particularly at doses ≥ 20 mg. The 30 mg dose appeared to yield optimal effects without any adverse reactions in subjects.
Conclusions
Results from this study indicate that KSL‐W is safe for use in humans and provides initial evidence of its potential efficacy in reducing plaque and gingival inflammation. Further research is essential to determine optimal usage and ultimate safety, and to assess its potential in diverse populations.
Trial Registration
The trial is registered with the FDA (Trial Registration Number: NCT01877421). The clinical trials were registered in the clinicaltrials.gov database under the title “Safety and Tolerability of Antiplaque Chewing Gum in a Gingivitis Population” and the identifier number is NCT01877421. The URL for accessing the study in clinicaltrials.gov is https://clinicaltrials.gov/study/NCT01877421?intr=Antiplaque%20chewing&rank=1.
Background
The aim of the study is to evaluate the effectiveness of different toothbrushes in reducing gingival inflammation and dental biofilm removal in gingivitis patients with fixed orthodontic appliances.
Methods
Following baseline clinical assessments, including the Turesky modification of the Quigley-Hein plaque index (TQHI), gingival index (GI), bleeding on probing (BOP), and probing pocket depth (PPD), all patients received nonsurgical periodontal therapy. Patients were then randomly assigned to one of three groups: conventional toothbrush (C-TB), orthodontic toothbrush (O-TB), or single-tufted toothbrush (ST-TB). Each group received tailored oral hygiene instructions based on their assigned toothbrush type. Clinical assessments were repeated and recorded in the first week, sixth week, and third month.
Results
Thirty-six patients with a mean age of 23.14 ± 3.86 (18–32 years) participated in the study. All groups with twelve patients each demonstrated significant improvements in clinical parameters compared to baseline. In the sixth week, the O-TB and ST-TB groups showed significantly greater improvements in TQHI and BOP scores compared to the C-TB group (p < 0.05). By the third month, the ST-TB group maintained significantly lower TQHI and BOP scores, while the O-TB group’s scores became similar to those of the C-TB group. ST-TB and C-TB groups had significantly lower GI scores than the O-TB group in all time points. Although the effectiveness of ST-TB was significantly higher than that of other toothbrushes, all toothbrushes demonstrated lower efficacy in the posterior region.
Conclusions
The ST-TB was shown to be more effective in reducing gingival inflammation over three months, while it demonstrated similar efficacy to the O-TB in dental biofilm removal. Further research is necessary to substantiate these findings and to demonstrate the efficacy of this approach in promoting periodontal tissue health in patients with fixed orthodontic appliances.
Trial registration
This study was registered with the National Library of Medicine Clinical Trials Registry Platform on 19/07/2024 as NCT06510179.
Purpose
This study evaluated the therapeutic efficacy of combining Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser with subgingival curettage and root planing (SRP) in generalised stage III/grade C periodontitis patients and its effects on cytokine dynamics and microbial community.
Materials and Methods
Fifteen patients diagnosed with stage III/grade C periodontitis were included in the cohort. The right and left sides of the mouth were randomly assigned either the conventional SRP (control) group or the SRP supplemented with Nd:YAG laser group (experimental group, 160 mJ, 4 W) in a split-mouth design. Clinical periodontal indices were recorded at baseline and at the 6-week follow-up post-treatment. ELISA was utilised to measure IL-1β and TNF-α levels in gingival crevicular fluid. The subgingival microbiota’s composition and variations were characterised using 16S rDNA amplicon sequencing, while quantitative real-time polymerase chain reaction (qRT-PCR) was employed to analyse the changes in the red-complex bacteria in subgingival plaque.
Results
The SRP+Nd group exhibited a statistically significant reduction in record probing depth (PD) and bleeding on probing (BOP) compared to the SRP group after treatment (p<0.05). The SRP+Nd group showed a markedly lower IL-1β level than the SRP group (p<0.05). Furthermore, there was no statistically significant difference in the dominant subgingival microbiota composition and level of the red-complex bacteria between the two groups (p>0.05).
Conclusion
The adjunctive use of Nd:YAG laser with SRP demonstrates promising short-term therapeutic benefits for patients with extensive stage III/grade C periodontitis. Both SRP as a standalone treatment and its combination with Nd:YAG laser effectively facilitate a transition in the dominant bacterial community from periodontitis-associated to periodontal health-associated microbiota.
Background
This prospective study aims to investigate the comparative effects of clear aligners (CA) and traditional removable appliances (RA) on the cariogenic risk of patients in mixed dentition, focusing on the oral microbiome.
Methods
25 children were included and assigned into CA and RA groups. Supragingival plaque and saliva samples were collected, and clinical parameters including Decay-missing-filled teeth index (DMFT), Plaque Index (PI) and Gorelick Index (GI) were recorded before treatment (T0) and after 6-month follow-up (T1). DNA was extracted from supragingival plaque and saliva and analyzed via 16S rDNA gene sequencing.
Results
Clinical parameters showed no statistically significant difference between groups at each time point or within group over time (p > 0.05). In both RA and CA groups, saliva exhibited significantly higher alpha diversity compared to supragingival plaque at T1, as indicated by the significantly higher Chao1 and Shannon indexes (p < 0.05). Regarding beta diversity, significant difference was observed in saliva and supragingival plaque samples between T0 and T1 within group RA (p < 0.05, Adonis), whereas no such significance was noted in the CA group (p > 0.05, Adonis). At the genus level, Lactobacillus exhibited a statistically significant increase in saliva and supragingival plaque of group RA from T0 to T1 (p < 0.05), and an increasing trend in the group CA without statistical significance (p > 0.05). At T1, Lactobacillus levels were comparable between groups, whereas species-level analysis revealed distinct cariogenic species.
Conclusion
Both clear aligners and traditional removable appliances resulted in elevated cariogenic risk of patients in mixed dentition at the microbial level. Distinct alterations in cariogenic species were observed to be induced by various orthodontic appliances.
Purpose:
This study investigates the effects of daily consumption of a probiotic ayran drink on gingival inflammation and the development of experimental gingivitis.
Materials and methods:
This randomised, double-blind, placebo-controlled trial involved 54 volunteer students. The participants were randomly assigned to two groups: the control group received regular ayran for 42 days, while the test group received probiotic enriched ayran (including Lactobacillus acidophilus and Bifidobacterium bifidum) for 42 days twice a day. After 42 days, mechanical plaque control was stopped for 5 days. The plaque index (PI), gingival index (GI), probing bleeding (BOP), and probing depth (PPD) were measured at baseline, day 42, and day 47. At the same time, gingival crevicular fluid was taken for matrix metalloproteinase-8 examination.
Results:
The mean scores of BOP, GI, PI, and MMP-8 levels increases in both groups following the 5-day experimental gingivitis period compared to baseline and day 42. Patients using probiotic ayran had significantly less PI, GI, BOP scores and MPP-8 values (p = 0.002; p 0.001; p 0.001; p = 0.001; p = 0.001, respectively) at day 47 compared to the control group. No statistically significant differences in probing pocket depth (PPD) were observed at any time point.
Conclusion:
The present study suggests that daily consumption of a probiotic ayran drink containing Lactobacillus acidophilus and Bifidobacterium bifidum statistically significantly lowers clinical and immunological markers of gingival inflammation.
Background
The presence of dental caries impacts on children’s daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae.
Objectives
To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils.
Design
A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations.
Setting
Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school.
Participants
Pupils aged 11–13 years at recruitment, who have their own mobile telephone.
Interventions
Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils’ mobile phones about toothbrushing, compared with routine education.
Main outcome measures
Primary outcome: presence of at least one treated or untreated carious lesion using D ICDAS4–6 MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of D ICDAS4–6 MFT; presence and number of D ICDAS1–6 MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children).
Results
Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05).
The intervention had higher incremental mean costs (£1.02, 95% confidence interval −1.29 to 3.23) and lower incremental mean quality-adjusted life-years (−0.003, 95% confidence interval −0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging.
The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution.
Conclusions
Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility.
Trial registration
This trial is registered as ISRCTN12139369.
Funding
This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/166/08) and is published in full in Health Technology Assessment ; Vol. 28, No. 52. See the NIHR Funding and Awards website for further award information.
Aim
The primary aim was to systematically assess the available literature on the effect of an essential oils mouthwash without alcohol (EOalc−) compared to an essential oils mouthwash with alcohol (EOalc+) on plaque scores and parameters of gingival health. The secondary aim was to evaluate user appreciation.
Materials and Methods
The MEDLINE‐PubMed and Cochrane‐CENTRAL databases were searched to identify eligible studies published up to and including March 2024. Papers comparing the effectiveness of EOalc− and EOalc+ were included. The quality was assessed. A descriptive analysis and a meta‐analysis were performed.
Results
After screening, seven papers were found to be eligible. The descriptive analysis demonstrates a significant difference in plaque scores in favour of EOalc+. This is confirmed by the meta‐analyses of plaque scores in non‐brushing and brushing studies (DiffM = 0.40; 95% CI [0.27; 0.53], p < 0.00001 and DiffM = 0.05; 95% CI [0.01; 0.10], p = 0.01, respectively). This finding is also supported by the sub‐analysis of brands. The meta‐analyses of bleeding and gingival scores in brushing studies did not show significant differences between products. For user appreciation, the difference found was for taste perception in favour of EOalc− (DiffM = 1.63; 95% CI [0.72; 2.55], p = 0.0004).
Conclusion
When an EO‐mouthwash is used in non‐brushing or brushing situations, with small to moderate certainty, EOalc− provided less effect regarding plaque control than EOalc+. For bleeding and gingival index there is weak certainty for no difference. In terms of the taste perception EOalc− seems more appreciated.
Introduction
The efficacy of infiltration versus inferior alveolar nerve block (IANB) injection techniques during periodontal flap surgery in the mandible is crucial for optimising patient care. This comparative study aims to evaluate the pain management, ease of administration and clinical outcomes associated with both anaesthetic methods. Infiltration anaesthesia involves localised administration, targeting specific sites, whereas IANB provides a broader anaesthetic effect by numbing the entire mandibular nerve. Understanding the advantages and limitations of each technique will enhance procedural efficiency and patient comfort. This research contributes valuable insights into best practices for periodontal surgeries.
Materials and Methods
Twenty-five subjects who required periodontal flap surgery were included in the study to treat chronic periodontitis in the mandibular jaw. The surgery was performed under local infiltration of an anaesthetic agent on one side of the jaw and by an IANB on the other side. Pain perception was evaluated using the Visual Analogue Scale (VAS) score at various intervals during periodontal flap surgery. The effect of anaesthesia between the two techniques was compared and evaluated by analysis of variance using IBM Corp. IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows [Version 25]. Armonk, New York, USA. IBM Corp; 2017.
Results
Analysis determined the onset, duration and termination of anaesthesia induced by infiltration and the IANB technique. The onset and duration of anaesthesia by both techniques were comparable. The pain perception evaluated using the VAS score while using both anaesthesia techniques was also comparable.
Conclusion
Infiltration anaesthesia can be used as an alternative to overcome the disadvantages and complications of IANB for periodontal surgery in the mandibular jaw.
Background
Pit-and-fissure sealants, particularly the resin-based type, are widely used as the most efficient technique for preventing caries on the occlusal surfaces of permanent molars. School-based dental sealant (SBDS) program is a system where sealants are applied to the children in their schools with the primary aim to certify and safeguard the permanent molars that are sealed at the earliest after eruption.
Aim
The aim of this study was to evaluate the retention and effectiveness of SBDS Programs in Lucknow, UP.
Materials and Methods
A split-mouth randomized controlled trial was conducted among 6-year-old school-going children of Lucknow, UP. The study was carried out by a single trained and calibrated investigator who recorded the dentition status. The investigator interviewed the participants using a pro forma and examined the subjects included in the study. The sealant was applied to one tooth in the pair of fully erupted permanent first molars, and no treatment was done on the other side.
Results
The proportion of total retention after 1½ years was significantly higher in mandibular as compared with maxillary molars ( Z = 2.04; P = 0.04). The risk of having caries was 3.52 times more among children with no treatment as compared to children with treatment (odds ratio [OR] – 3.52 [1.01, 13.11]; P = 0.04; statistically significant). The association between survival rate of sealant and International Caries Detection and Assessment System codes (0 and 1–2) as well as that between retention of sealant and caries status was statistically significant ( P < 0.01 and 0.00001, respectively). The risk of having caries was 1.28 times more among males as compared to females (OR – 1.28 [0.38, 4.24]; P = 0.06), 1.61 times for sugar exposure (OR – 1.61 [0.53, 6.19]; P = 0.53; nonsignificant).
Conclusion
Sealant application proved to be an efficient method in preventing dental caries development; hence, SBDS programs, wherein the sealants were placed at school, were highly efficacious and acceptable in the vulnerable populace.
Background
The meaning of the toothbrushing technique for the effectivity of toothbrushing in terms of plaque removal and parameters of gingivitis is unknown. This systematic review and network meta-analysis (NMA) aimed to synthesize evidence from randomized controlled trials (RCTs).
Methods
We searched MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials, and the Web of Science for RCTs that compared any self-applied manual toothbrushing technique to any other technique or control and assessed plaque after toothbrushing and gingivitis. Where intervention effects were recorded repeatedly, the last post-intervention assessment was treated as the primary outcome date (POD), and the assessment closest to the intervention as the secondary outcome date (SOD). Age restrictions were not imposed. Participants with fixed orthodontic appliances were excluded. The evidence was evaluated using the Confidence in Network Meta-Analyses (CINeMA) approach, which is based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results
Thirteen publications, including 15 studies, were identified. Ten studies assessing the Fones, Bass, and Scrub techniques provided data eligible for the NMA. The confidence rating of the evidence varied from very low to high in the case of plaque, and from very low to low in the case of gingivitis. Regarding PODs, Fones probably reduces plaque slightly compared with no training; the evidence is very uncertain that Fones may have little to no effect on gingivitis. Bass may result in little to no difference in plaque; the evidence that Bass may result in a slight increase in gingivitis is very uncertain. The evidence is very uncertain that Scrub may result in little to no difference in plaque at the SOD (no POD-data available) and that it may result in a slight increase in gingivitis.
Conclusion
There is limited evidence regarding the effects of toothbrushing techniques on plaque after brushing or gingivitis.
Objective
To assess the effect of the toothbrush handle on video-observed toothbrushing behaviour and toothbrushing effectiveness.
Methods
This is a randomized counterbalanced cross-over study. N = 50 university students and employees brushed their teeth at two occasions, one week apart, using either a commercial ergonomically designed manual toothbrush (MT) or Brushalyze V1 (BV1), a manual toothbrush with a thick cylindrical handle without any specific ergonomic features. Brushing behaviour was video-analysed. Plaque was assessed at the second occasion immediately after brushing. Participants also rated their self-perceived oral cleanliness and directly compared the two brushes regarding their handling and compared them to the brushed they used at home.
Results
The study participants found the BV1 significantly more cumbersome than the M1 or their brush at home. (p < 0.05). However, correlation analyses revealed a strong consistency of brushing behavior with the two brushes (0.71 < r < 0.91). Means differed only slightly (all d < 0.36). These differences became statistically significant only for the brushing time at inner surfaces (d = 0.31 p = 0.03) and horizontal movements at inner surfaces (d = 0.35, p = 0.02). Plaque levels at the gingival margins did not differ while slightly more plaque persisted at the more coronal aspects of the crown after brushing with BV1 (d = 0.592; p 0.042).
Discussion
The results of the study indicate that the brushing handle does not play a major role in brushing behavior or brushing effectiveness.
This narrative review addresses conventional diagnostic criteria used in clinical practice to discriminate between periodontal health, gingivitis, and periodontitis. Visual examination of the color and texture of the periodontal tissues, assessment of plaque deposits, periodontal probing assessments, and diagnostic imaging enable the collation of information to make a periodontal diagnosis, followed by an appropriate treatment plan. The periodontal probe is an essential diagnostic tool to assess probing pocket depth, clinical attachment level, bleeding on probing, and the degree of furcation involvement at multirooted teeth. When clinical signs and symptoms of periodontitis are identified, diagnostic imaging enables evaluation of the level and extent of bone destruction and bone defect morphology. The diagnostic process requires clinicians who are trained to evaluate, record, and interpret these measures. This narrative review focuses on conventional clinical diagnostic parameters which, despite their limitations, are considered the current standard of care.
Context
Periodontal disease is commonly found among pregnant women. Viruses may play a key role in the etiology of periodontal disease through a variety of mechanisms that work alone or in tandem. Many researchers have explored the possible role of herpes viruses in periodontal disease, but extremely limited studies have evaluated the effect of pregnancy on herpes viruses in women with periodontal disease.
Aims and Objectives
To study the effect of pregnancy on herpes simplex virus-1, Epstein–Barr virus (EBV), and human cytomegalovirus in women with periodontal disease and to evaluate the presence of herpes viruses within the saliva of pregnant and nonpregnant women with periodontal disease.
Settings and Design
The study design involves a cross-sectional analytical study.
Materials and Methods
The study consisted of 50 females aged between 18 and 35 years. Group I comprised pregnant women at any gestational age with periodontal disease and Group II comprised nonpregnant women with periodontal disease. The clinical parameters assessed were plaque index, gingival index, bleeding on probing, probing pocket depth, and clinical attachment loss. Nonstimulated whole saliva was utilized for the detection of three herpes viruses by multiplex polymerase chain reaction.
Statistical Analysis Used
The categorical variables and research parameters were compared using the Chi-squared test and the Student's t -test.
Results
Both groups tested positive for the three herpes viruses, but only a significant increase was observed in EBV in Group I participants on the intergroup comparison.
Conclusions
The presence of EBV in the saliva of women with periodontal disease was found to be more likely during pregnancy.
Background
The rich diversity of microorganisms in the oral cavity plays an important role in the maintenance of oral health and development of detrimental oral health conditions. Beyond commonly used qualitative microbiome metrics, such as relative proportions or diversity, both the species-level identification and quantification of bacteria are key to understanding clinical disease associations. This study reports the first-time application of an absolute quantitative microbiome analysis using spiked DNA standards and shotgun metagenome sequencing to assess the efficacy and safety of product intervention on dental plaque microbiome.
Methods
In this parallel-group, randomized clinical trial, essential oil mouthrinses, including LISTERINE® Cool Mint Antiseptic (LCM), an alcohol-containing prototype mouthrinse (ACPM), and an alcohol-free prototype mouthrinse (AFPM), were compared against a hydroalcohol control rinse on clinical parameters and the oral microbiome of subjects with moderate gingivitis. To enable a sensitive and clinically meaningful measure of bacterial abundances, species were categorized according to their associations with oral conditions based on published literature and quantified using known amounts of spiked DNA standards.
Results
Multivariate analysis showed that both LCM and ACPM shifted the dysbiotic microbiome composition of subjects with gingivitis to a healthier state after 4 weeks of twice-daily use, resembling the composition of subjects with clinically healthy oral conditions recruited for observational reference comparison at baseline. The essential oil-containing mouthrinses evaluated in this study showed statistically significant reductions in clinical gingivitis and plaque measurements when compared to the hydroalcohol control rinse after 6 weeks of use.
Conclusions
By establishing a novel quantitative method for microbiome analysis, this study sheds light on the mechanisms of LCM mouthrinse efficacy on oral microbial ecology, demonstrating that repeated usage non-selectively resets a gingivitis-like oral microbiome toward that of a healthy oral cavity.
Trial registration
The trial was registered on ClinicalTrials.gov on 10/06/2021. The registration number is NCT04921371.
Background
Translational microbiome research using next-generation DNA sequencing is challenging due to the semi-qualitative nature of relative abundance data. A novel method for quantitative analysis was applied in this 12-week clinical trial to understand the mechanical vs. chemotherapeutic actions of brushing, flossing, and mouthrinsing against the supragingival dental plaque microbiome. Enumeration of viable bacteria using vPCR was also applied on supragingival plaque for validation and on subgingival plaque to evaluate interventional effects below the gingival margin.
Methods
Subjects with gingivitis were enrolled in a single center, examiner-blind, virtually supervised, parallel group controlled clinical trial. Subjects with gingivitis were randomized into brushing only (B); brushing and flossing (BF); brushing and rinsing with Listerine® Cool Mint® Antiseptic (BA); brushing and rinsing with Listerine® Cool Mint® Zero (BZ); or brushing, flossing, and rinsing with Listerine® Cool Mint® Zero (BFZ). All subjects brushed twice daily for 1 min with a sodium monofluorophosphate toothpaste and a soft-bristled toothbrush. Subjects who flossed used unflavored waxed dental floss once daily. Subjects assigned to mouthrinses rinsed twice daily. Plaque specimens were collected at the baseline visit and after 4 and 12 weeks of intervention. Bacterial cell number quantification was achieved by adding reference amounts of DNA controls to plaque samples prior to DNA extraction, followed by shallow shotgun metagenome sequencing.
Results
286 subjects completed the trial. The metagenomic data for supragingival plaque showed significant reductions in Shannon-Weaver diversity, species richness, and total and categorical bacterial abundances (commensal, gingivitis, and malodor) after 4 and 12 weeks for the BA, BZ, and BFZ groups compared to the B group, while no significant differences were observed between the B and BF groups. Supragingival plaque vPCR further validated these results, and subgingival plaque vPCR demonstrated significant efficacy for the BFZ intervention only.
Conclusions
This publication reports on a successful application of a quantitative method of microbiome analysis in a clinical trial demonstrating the sustained and superior efficacy of essential oil mouthrinses at controlling dental plaque compared to mechanical methods. The quantitative microbiological data in this trial also reinforce the safety and mechanism of action of EO mouthrinses against plaque microbial ecology and highlights the importance of elevating EO mouthrinsing as an integral part of an oral hygiene regimen.
Trial registration
The trial was registered on ClinicalTrials.gov on 31/10/2022. The registration number is NCT05600231.
During a 5 day period without oral hygiene, 4 groups each consisting of 3 subjects with healthy gingivae, rinsed their mouths with solutions of tetracycline, vancomycin, polymyxin B or distilled water. Gingival plaque accumulated rapidly in the group rinsing with water, while tetracycline, and to a lesser degree vancomycin and polymyxin B inhibited plaque formation. Clinical gingivitis was not observed in any of the participants, but gingival exudate and leukocyte emigration were noted and seen to increase during the experimental period, especially in the water group. Rinsing with antibiotics inhibited these signs of subclinical inflammation to varying degrees. The bacterial composition of the gingival plaque changed in the water group during the experimental period towards a higher percentage of gram-negative bacteria, following the pattern observed in previous investigations. Tetracycline markedly reduced the numbers of gingival plaque organisms, while polymyxin B favored a proliferation of gram-positive cocci and short rods and depressed gram-negative bacteria. Rinsing with vancomycin resulted in a pronounced shift towards an almost pure gram-negative plaque flora. It is concluded that local administration of antibiotics with a limited spectrum may be useful for the study of the pathogenicity of the different components of the gingival microbial flora.