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Periodontal Disease in Pregnancy. I. Prevalence and Severity
... Was performed for all patients with moderate gingivitis by two specialized periodontists. The intra oral clinical examination include; measurement the thickness of plaque according to plaque index PLI (Silness and Löe) (11) by using a straight sharp explorer and measure the amount of bacterial plaque for four surfaces of all the examined teeth and given a score from 0-3, a PLI grade 0 indicates no plaque, grade 1 indicate thin layer of plaque at the gingival margin which only detectable by scraping with a probe, grade 2 indicates moderate layer of plaque along gingival margin which visible by naked eye, grade 3 indicate abundant plaque along gingival margin and interdental spaces filled with plaque, while measurement the extent and severity of gingival inflammation according gingival index GI by (Löe and Silness) (12) and (Löe) (13) , inspection by naked eyes and by gentle probing through using periodontal probe for four gingival surfaces of the examined tooth (facial, lingual, mesial, and distal) and given a score from 0 to 3, grade 0 indicate normal gingiva, grade 1 indicate mild gingival inflammation, grade 2 indicates moderate gingival inflammation, and grade 3 indicates sever gingival inflammation, then the scores of the 4 areas of the tooth was totaled and divided by four to give a tooth score, then by adding the tooth scores together and dividing by the number of teeth examined and individual's GI score was obtained (12,13,14). ...
... Was performed for all patients with moderate gingivitis by two specialized periodontists. The intra oral clinical examination include; measurement the thickness of plaque according to plaque index PLI (Silness and Löe) (11) by using a straight sharp explorer and measure the amount of bacterial plaque for four surfaces of all the examined teeth and given a score from 0-3, a PLI grade 0 indicates no plaque, grade 1 indicate thin layer of plaque at the gingival margin which only detectable by scraping with a probe, grade 2 indicates moderate layer of plaque along gingival margin which visible by naked eye, grade 3 indicate abundant plaque along gingival margin and interdental spaces filled with plaque, while measurement the extent and severity of gingival inflammation according gingival index GI by (Löe and Silness) (12) and (Löe) (13) , inspection by naked eyes and by gentle probing through using periodontal probe for four gingival surfaces of the examined tooth (facial, lingual, mesial, and distal) and given a score from 0 to 3, grade 0 indicate normal gingiva, grade 1 indicate mild gingival inflammation, grade 2 indicates moderate gingival inflammation, and grade 3 indicates sever gingival inflammation, then the scores of the 4 areas of the tooth was totaled and divided by four to give a tooth score, then by adding the tooth scores together and dividing by the number of teeth examined and individual's GI score was obtained (12,13,14). ...
... indicates mild gingival inflammation, 1.1-2.0 indicates moderate gingival inflammation, and 2.1 to 3 indicates severe gingival inflammation (12,13,14) and finally measurement bleeding on probing BOP according to Ainamo and Bay (15) by using Wiliams periodontal probe and pass it gently along the inner surface wall of gingival sulcus and bleeding was noted after 30s as (-) absent or (+) present of bleeding. The selected teeth for clinical examination were Ramforjord's index teeth (16,21,24,36,41 and 44), all those clinical parameters were assessed before mouth rinse at baseline and after 3 and 7 days of rinsing with chlorhexidine or Punica I and II. ...
... The gingival index (GI) used in this study is based on the method proposed by Löe andSilness (1963/1964) [11]. The bleeding index (BI) used in this study was determined using the method developed by Ainamo and Bay (1975), which measures the occurrence of bleeding upon probing and determines the percentage of sites with bleeding [12]. ...
... The gingival index (GI) used in this study is based on the method proposed by Löe andSilness (1963/1964) [11]. The bleeding index (BI) used in this study was determined using the method developed by Ainamo and Bay (1975), which measures the occurrence of bleeding upon probing and determines the percentage of sites with bleeding [12]. ...
... The efficacy of probiotics may also be due to their ability to regulate the host immune response. Probiotics reduce the levels of pro-inflammatory cytokines, such as IL-1β and TNF-α, thus limiting local inflammation and promoting tissue healing [10][11][12][13][14][15]. These findings agree with the meta-analysis conducted by Martin-Cabezas et al. (2016), which concluded that probiotic therapy significantly improves the effectiveness of standard periodontal treatments [14]. ...
Background and Objectives: Periodontal inflammation, often linked to oral microbiota dysbiosis dominated by pathogenic bacteria, remains a significant challenge in periodontitis management. Traditional periodontal therapies primarily reduce the bacterial load but fail to restore the microbiota balance. Probiotics offer a promising therapeutic adjunct with their ability to enhance beneficial bacteria. This study investigates the effects of probiotics on the oral microbiota, inflammatory markers (IL-1β, TNF-α), and clinical parameters (gingival index, bleeding index, and periodontal pocket depth). Materials and Methods: In this pilot study, 80 patients with moderate-to-severe periodontitis were assigned to two groups. Group A received standard periodontal therapy (non-surgical periodontal therapy (NSPT)) with probiotic supplementation (Lactobacillus reuteri, 2 × 10⁹ CFU daily for 8 weeks), and Group B received standard treatment with a placebo. Microbiological changes were assessed via quantitative PCR, while inflammatory markers (IL-1β, TNF-α) were analyzed using ELISA. Clinical parameters, including the gingival index (GI), bleeding index (BI), and periodontal pocket depth (PPD), were measured at baseline (T0), 4 weeks (T1), and 8 weeks (T2) using standardized methods. Results: Probiotic therapy (Group A) significantly reduced the pathogenic bacteria and increased the beneficial bacteria levels compared to the placebo (p < 0.01). Inflammatory markers decreased by 37% (IL-1β) and 42% (TNF-α), while clinical parameters improved, with reductions in the gingival and bleeding indices (−1.5, −1.3) and a 2 mm decrease in the periodontal pocket depth (p < 0.01). Conclusions: Probiotics, as an adjunct to periodontal therapy, effectively restore the microbiota balance, reduce inflammation, and improve clinical outcomes in periodontitis.
... Modified Plaque Index (MPI), 4 Modified Sulcus Bleeding Index (MBI), 4 Probing Pocket Depth (PPD) were recorded at baseline for Group I and Group II, while Plaque Index (PI), 5 Gingival Index (GI) 6 and PPD were recorded at baseline for Group III, at each surface by using UNC 15 periodontal probe (PCP UNC 15; Hu-Friedy Manufacturing Co., Chicago, The same investigator assessed all clinical parameters during various recall visits. Calibration training was conducted over consecutive days, during which 10 volunteers were examined. ...
... Nil (see Figs. [1][2][3][4][5][6] ...
Background
Most studies have analyzed the presence of cytokines in Gingival crevicular fluid (GCF) in different periodontal diseases, but very limited studies have been conducted on Peri-implant crevicular fluid (PICF) in peri-implantitis.
Aim
The present study was conceptualized to explore the levels of Interleukin (IL)-1β and Interleukin (IL)-6 as a diagnostic marker in peri-implantitis.
Materials and methods
A total of 40 patients each having at least one dental implant were enrolled in the study. Clinical parameters were recorded around each implant and tooth nearest to it. Gingival crevicular fluid (GCF)/Peri-implant crevicular fluid (PICF) was collected to evaluate the concentration of IL‐1β and IL‐6. Conservative treatment was performed in peri-implantitis cases, 3 months after treatment their clinical parameters, IL-1β and IL-6 levels were recorded and compared with their pre-treatment values.
Results
Clinical parameters like Modified Plaque Index (MPI), Modified Bleeding Index (MBI) and Probing Pocket Depth (PPD) were statistically significantly higher in the peri-implantitis group as compared to the healthy implant group and healthy teeth group. IL-1β and IL-6 levels were also statistically significantly higher in the peri-implantitis group in comparison to healthy implants and healthy teeth group.
Conclusion
The study concludes that biomarkers in PICF can be used as a diagnostic tool to supplement the diagnosis of peri-implantitis along with the use of clinical parameters to make an early diagnosis of peri-implantitis possible.
... Using a periodontal probe, the depth (periodontal pocket) was measured by inserting it into at least three points on each tooth, and the average value was recorded. To assess the severity of gingivitis, the Plaque Index (PI) by Silness and Löe [30] and the Gingival Index (GI) by Löe and Silness [31] were used. ...
... Measurements taken with a periodontal probe during the study were recorded according to the Löe and Silness gingival index scoring system [31]. In cats with gingivitis caused by bacterial agents, the GI was measured as 1.90 ± 0.82 at the beginning of the application, 1.40 ± 0.69 on d 7, and 1.30 ± 0.48 on d 14. ...
In cats, gingivitis treatment typically involves professional dental cleaning under anesthesia, pain management, and antibiotic administration to reduce inflammation. Considering the disadvantages of antibiotic administration, the necessity for alternative acute treatment protocols arises. It is believed that enhancing the antibacterial, anti–inflammatory, and local anesthetic effects of propolis with ozone could shorten the treatment duration, help reduce the risks associated with gingivitis, and also support the overall health of the cat. The study included 20 domestic cats diagnosed with the causative agent of gingivitis presented to private clinics. The cats included in the study were grouped based on bacterial agents (n=10; Female=4, Male=6) and viral agents (n=10; Female=5, Male=5). Propolis extracted with ozone–enriched oil was administered in spray form for 14 days (d). Before the application and on the 7 th and 14 th d of the treatment, the gingival indices of the cats were recorded, scored, saliva samples were collected, and photographs were taken. The levels of VEGF and TNF– α in saliva were determined using a cat-specific ELISA kit. When the data were evaluated, the application of ozone–enriched propolis demonstrated a statistically significant reducing effect on the levels of TNF–α in saliva in both groups (P<0.01). Salivary VEGF levels showed a significant increase during application, especially in gingivitis caused by bacterial agents (P<0.05). In the viral group, application was found to be more effective in increasing VEGF levels during the first 7 d. In gingivitis caused by bacterial agents, the gingival index (GI) and plaque index (PI) decreased compared to pre–treatment values (P<0.05). In gingivitis associated with viral agents, the decrease in the GI was statistically significant, while the decrease in the PI was found to be non– significant. In conclusion, this study demonstrated that the application of ozone–enriched propolis might be an alternative treatment option for cats with gingivitis.
... In terms of outcomes, most studies reported two clinical indicators of oral health: the gingival index (GI) and plaque index (PI) [63,64]. Five studies investigated the presence of oral pathogens in plaque or saliva samples [50,55,56,59,60], and one study reported saliva pH and lgA levels [61]. ...
... PI assesses the presence and thickness of plaque, while GI assesses gingiva swelling and bleeding. Both are rated on a scale from zero to three [63,64]. ...
Gingivitis and periodontitis are prevalent periodontal conditions associated with dysbiosis of the oral cavity, which leads to inflammation and bleeding of gums, loss of tooth attachment, and degradation of the underlying bone structure. The standard adjunctive treatment for periodontal conditions, chlorhexidine mouthwash, is effective but is associated with several side effects. Probiotics have been explored as an alternative solution that promotes oral health by restoring homeostasis in the oral cavity. This review presents a summary of clinical trials using the Darolac® (Oralis SB®) probiotic formulation (Lactobacillus acidophilus Rosell®-52, Lactobacillus rhamnosus Rosell®-11, Bifidobacterium longum Rosell®-175 and Saccharomyces boulardii CNCM I-1079) as a mouthwash to support the maintenance of oral health or the restoration of its balance. In reviewed studies, Darolac® is compared to a placebo or other common solutions for periodontal conditions, including chlorhexidine mouthwash. Studies show that Darolac® is as effective or even superior to other available solutions, which supports its use as an effective adjuvant to oral health. The effects of Darolac® on the reduction in oral pathogens and markers of oral dysbiosis are reviewed, and the association between periodontitis, inflammation, and systemic diseases, as well as their implications and the use of probiotics in the periodontal field, are discussed.
... GI was measured using the Loe and Silness GI [8], with scores ranging from 0 to 3: 0 -normal gingiva; 1mild inflammation with slight color change and slight edema, no bleeding on probing; 2 -moderate inflammation with redness, edema, and glazing, along with bleeding on probing; and 3 -severe inflammation with marked redness and edema, a tendency for spontaneous bleeding, and ulceration. ...
... The GI used was adapted from Loe and Silness [8]. There was a statistically significant difference in GI both between the groups and within the groups. ...
Introduction: The fluoride varnish and fluoride-releasing composites are being used in orthodontic patients to prevent white spot lesions (WSL). The study evaluates and compares the efficacy of these two on plaque accumulation, gingival health, and demineralization in vivo, as well as shear bond strength in vitro.
Methods: This study was conducted using 45 extracted premolars for the in vitro group and 45 patients for the in vivo group. Each group was further subdivided into three subgroups of 15 each. In the in vitro subgroups, bonding in Subgroup I (control group) was done using Transbond XT, Subgroup II (fluoride varnish group) involved the application of fluoride varnish using Fluor Protector, and Subgroup III (Transbond Plus Color Change Adhesive) was used for bonding. Shear bond strength was evaluated in the in vitro group using a universal testing machine. In the three in vivo subgroups, bonding was done similarly to the in vitro group. The efficacy was assessed in vivo using the plaque index (PI), gingival index (GI), and demineralization index at T0 (baseline), T1 (week 4), T2 (week 8), and T3 (week 12).
Results: The results demonstrated a statistically significant difference between the inter- and intragroup comparisons of the PI and GI, whereas the demineralization index group did not show any statistically significant difference, as indicated by ANOVA, Tukey’s test, and paired t-tests. The in vitro group showed statistically significant differences between the fluoride varnish group and both the control group and the fluoridated composite group.
Conclusion: Fluoride-releasing orthodontic composite and fluoridated varnish can be used to prevent plaque accumulation and demineralization and maintain gingival health during fixed orthodontic therapy.
... The oral examination was complete and performed on each sextant (17-14, 13-23, 24-27, 37-34, 33-43, 44-47) using mirrors, tweezers and Williams periodontal probe graduated from 1 to 15 mm. The peri-odontal indices estimated were: the Silness and Loe plaque index, the Green and Vermillon calculus index (direct assessment of oral hygiene), and the Loe and Silness gingival index [24][25][26]. Each index was stratified (scores 0, 1, 2, and 3) as presented in Periodontal examination: the methodology was described in one of our previous publications [7]. ...
... The oral examination was complete and performed on each sextant (17-14, 13-23, 24-27, 37-34, 33-43, 44-47) using mirrors, tweezers and Williams periodontal probe graduated from 1 to 15 mm. The periodontal indices estimated were: the Silness and Loe plaque index, the Green and Vermillon calculus index (direct assessment of oral hygiene), and the Loe and Silness gingival index [24][25][26]. Each index was stratified (scores 0, 1, 2, and 3) as presented in Supplementary Table 2. ...
Background
The relationship between serum uric acid level (SUA) and periodontal diseases (PD) is still controversial, and few studies have been carried out in population with no element of metabolic syndrome especially in sub-Saharan Africa. The aim of this study was to assess the relationship between PD and SUA in Cameroonian adults not suffering from metabolic syndrome.
Methods
We carried out a cross-sectional study including Cameroonians aged over 18 years recruited in the general population and free of metabolic syndrome elements. They were assessed for frequency of consumption of purine-rich foods, periodontal indices (plaque index, gingival index, calculus index, pocket depth and clinical loss of attachment), and SUA. The diagnosis of PD was based on the American Academy of Periodontology criteria revised in 2015, and hyperuricemia was defined for values exceeding 70 and 60mg/L in men and women respectively. Comparison of SUA means was performed with the ANOVA test. Association between hyperuricemia and PD were evaluated using Fischer's exact test. The threshold of significance was 0.05.
Results
One hundred and seventy-four participants were included (57.5% women, mean age 29 (10.39) years). The frequencies of PD were 75.9%, gingivitis (59.1%) and periodontitis (40.1%). Hyperuricemia was found in 20.45% of people with PD, with no difference in frequency comparing with those without PD. The frequency of consumption of purine-rich foods was similar in individuals with and without PD. Serum uric acid levels were not different in individuals with and without PD, and differed among periodontal indices only for calculus index, where SUA were higher in participants with the highest score (p=0.026). We found no association between hyperuricemia and PD.
Conclusion
In individuals without elements of metabolic syndrome, hyperuricemia affects one in five people with PD. There appears to be no link between SUA and overall periodontal status in this population. Further studies are needed to better understand the salivary interaction between uric acid and periodontium in our population.
... To assess the clinical periodontal status, the PPD, CAL, bleeding on probing index (BOP) (Ainamo & Bay, 1975) [17], gingival index (GI) (Löe & Silness, 1963) [18], and plaque index (PI) (Silness & Löe, 1964) [19] of all teeth of the patients were measured. PPD and CAL were assessed on six dental surfaces: mesiobuccal, distobuccal, midbuccal, mesiopalatal/mesiolingual, distopalatal/distolingual, and midpalatal/midlingual. ...
... To assess the clinical periodontal status, the PPD, CAL, bleeding on probing index (BOP) (Ainamo & Bay, 1975) [17], gingival index (GI) (Löe & Silness, 1963) [18], and plaque index (PI) (Silness & Löe, 1964) [19] of all teeth of the patients were measured. PPD and CAL were assessed on six dental surfaces: mesiobuccal, distobuccal, midbuccal, mesiopalatal/mesiolingual, distopalatal/distolingual, and midpalatal/midlingual. ...
Background
There is an increasing occurrence of periodontitis and metabolic syndrome (MetS), which is resulting in a decline in the overall quality of life. Both disorders can occur together since they are both linked to insulin resistance and systemic inflammation. However, evidence for a role of interleukin (IL)-20 in this comorbidity is very limited. This cross-sectional study aimed to comprehensively investigate, for the first time, the levels of RANKL/OPG, MMP-8 and OSI as well as the role of IL-20 in patients with MetS and periodontitis.
Methods
The study included a total of 80 individuals, divided into four groups: 20 individuals who were healthy both systemically and periodontally, 20 individuals who were systemically healthy but had periodontitis, 20 individuals who had MetS but were periodontally healthy, and 20 individuals who had both MetS and periodontitis. Periodontal clinical parameters (plaque index, gingival index, bleeding on probing, clinical attachment loss, probing pocket depth) were evaluated. Gingival crevicular fluid (GGF) and serum samples were collected and used for biochemical assays. Enzyme-linked immunosorbent assay was used to determine the levels of IL-20, receptor activator of nuclear factor kappa B ligand (RANKL)/osteoprotegerin (OPG), matrix metalloproteinase-8 (MMP-8) and oxidative stress index (OSI).
Results
IL-20 levels measured in serum and GCF were statistically significantly highest in patients with MetS and periodontitis (p = 0.001). Significant positive correlation was observed between serum and GCF IL-20 values and periodontal parameters (p < 0.05). There was a positive correlation between RANKL and RANKL/OPG levels and IL-20 and clinical parameters (p < 0.05). OSI values were found to be increased in the presence of both periodontitis and MetS (p = 0.001) and were positively correlated with serum and GCF IL-20 (p < 0.05).
Conclusions
These data from the study suggest a correlation between IL-20 and both MetS and periodontitis. IL-20 may potentially worsen the condition of periodontal tissue by increasing both the oxidative stress levels, periodontal collagen degredation and the ratio of RANKL to OPG.
Trial registration
This study was registered on ClinicTrials.gov (NCT06092853), 2023-10-10, retrospectively registered.
... Participants had the ability to use a computer, smartphone, or tablet. Special needs students who had learning problems or disabilities reported by the homeroom teacher, participants who had a visible plaquer index (VPI) [16] and a gingival index (GI) [17] equal to zero were excluded. Only medium-sized public elementary schools that had a sound lab were included. ...
Background
Entertainment platforms have become more popular among children since the COVID-19 outbreak. The entertainment designed for education; “edutainment” could be a promising learning tool on oral health education (OHE). This study aimed to evaluate the effectiveness of edutainment use for OHE in school-age children.
Methods
A total of 210 students (age range 9.2–10.8 years) were included. The three-arm parallel randomized controlled trial was conducted in three schools, receiving the same contents of OHE with different learning methods; classroom learning (CL), edutainment in video-based learning with and without repetition at a three-month follow-up (EVBL and EVBL-R). The knowledge, behavior, behavioral intention score, and oral health (OH) status; visble plaue (VPI) and gingival index (GI) were evaluated at baseline, immediate post-intervention, 3, and 6 months. Differences within and between groups for knowledge scores and OH status were analyzed by repeated measures and one-way ANOVA, respectively, and for both behavior and behavioral intention scores, Friedman’s two-way analysis of variance and Kruskal-Wallis test were analyzed, respectively, at a significant level of 0.05.
Results
The knowledge score was significantly higher in CL for two out of three content domains (p = 0.01, p < 0.001) yet immediately improved within all groups (p < 0.001) with the range of 26.58–53.35% vs. 4.12–29.77% of both EVBLs. No significant difference was found in the behavior and behavioral intention scores among groups. EVBL and EVBL-R had significantly improved behavior scores throughout their follow-ups (p = 0.017, p = 0.006) with the range of 1.19–28.13% vs. 1.90-15.16% of CL and had a significant improvement for VPI (p < 0.001) or 32.5-57.08% vs. 36.45–38.79% of CL. There was no significant difference in GI, but it significantly improved only within the EVBL-R group after the repetition.
Conclusion
EVBL was comparable to the CL in encouraging positive behaviors, while the CL was preferable for providing core knowledge. EVBL was more applicable to how-to content, and the repetition at least every three months might be able to promote a better OH status.
Trial registration
The trial was registered in the Thai Clinical Trials Registry under the number TCTR20240816001 on 16/08/2024 (retrospective registration).
... Panoramic radiographs were examined, and a fullmouth clinical periodontal examination was performed. Periodontal parameters, including plaque index (PI), gingival index (GI), PD, CAL, and bleeding on probing (BOP -recorded 15 s after probing), were measured and documented [25]. These measurements were conducted using the Williams periodontal probe (Hu-Friedy, Chicago, IL). ...
Background
Periodontal diseases could cause halitosis and may impair taste and smell. While non-surgical periodontal therapy is known to reduce halitosis, its effects on taste and smell are less studied. This study aims to investigate the factors influencing self-perceived halitosis, taste, and smell, as well as the changes in these perceptions after periodontal therapy.
Methods
A total of 183 participants were divided into three groups: 61 patients with periodontitis, 61 with gingivitis, and 61 who were gingivally healthy. Periodontal parameters and self-perceived halitosis, taste, and smell were evaluated at baseline and four weeks after non-surgical periodontal treatment using a visual analog scale (VAS). Robust regression analysis was used to assess independent variables influencing baseline VAS ratings.
Results
The periodontitis group had the lowest taste perception and the highest self-perceived halitosis scores (p < 0.05). Taste perception was negatively associated with ≥ 4 mm pockets (p = 0.002). A positive relationship was also observed between the plaque index and self-perceived halitosis (p = 0.030). Post-treatment, taste perception improved significantly in all groups (p < 0.05), in parallel with improvements in periodontal parameters. Additionally, self-perceived halitosis showed a significant decrease (p < 0.05). The improvement in smell perception was statistically significant in the gingivally healthy and periodontitis groups (p < 0.05).
Conclusions
Periodontal disease may contribute to the development of chemosensory disorders. While the main goal of periodontal treatment is disease management, it can also improve taste and smell function. Oral hygiene practices play an essential role in the development of these improvements. However, further research is needed on the subject.
Trial registration
The study was registered as “Investigation of Halitosis, Taste, and Smell in Terms of Periodontal Condition Stated by Patients and Periodontal Diagnosis by Dentists, and Then Evaluation of Change Before and After Treatment” with the registration number NCT06063460 (13/09/2023) at https://www.clinicaltrials.gov Protocol Registration and Results System.
Clinical trial registration
This clinical trial was registered prior to participant recruitment on ClinicalTrials.gov (NCT06063460,13.09.2023).
... 4,8,9 Therefore, it can be generally assumed that pregnant women should accumulate bacterial plaque at the same rate as other women, especially if they practice good oral hygiene before and during conception. 10,11 However, both anecdotal and published evidence suggests an increasing prevalence of gingival inflammation associated with pregnancy especially in areas with pre-existing gingivitis. 4,8,9 Oral alterations in pregnancy are reported to be because of physiologic changes accompanied by fluctuations in estrogen and progesterone levels, which increase oral vasculature permeability and decrease host immunity, thereby increasing susceptibility to gingivitis. ...
Background: Skipping daily oral hygiene procedures will predispose one to plaque and calculus accumulation, thus resulting in poor oral hygiene. This should not be the case during pregnancy, except for some reported cases of women who do not follow thorough oral hygiene to avoid stimulating vomiting, especially during the first trimester. Objective: To assess some factors that influence oral hygiene status among selected pregnant women Methodology: Three hundred and forty-five pregnant women were assessed for their oral hygiene status during their third trimester. The same procedure was carried out three and a half months after childbirth. Possible contributory factors such as socioeconomic factors, rate of dental service utilization and frequency of daily toothbrushing were assessed using a questionnaire. The oral hygiene of respondents was assessed using the simplified oral hygiene index. The index was compared before and after childbirth using students t-test and statistical significance was inferred at p<0.05. Results: The majority of the respondents brush their teeth once daily (81.2%) and were in the low socioeconomic class (68.4%) with about a third being prima gravid (33.0%), but only a few (10.7%) have ever visited a dentist before. There was an improvement in the simplified oral hygiene index following childbirth, which was statistically significant. Conclusion: Though the majority of the contributory factors that were assessed in this study did not seem to significantly influence oral hygiene status during pregnancy, women of childbearing age still need to be adequately enlightened concerning the need to optimize their oral hygiene.
... The oral clinical examination in both groups applied indices such as the Silness & Löe Plaque Index (PI) to assess oral hygiene [11]. The gums were assessed using the Löe & Silness Gingival Index (GI) [12]. The Decayed, Missing, Filled Teeth (DMF-T) index was used to determine the prevalence of caries and the need for dental treatment [13], and the Thylstrup-Fejerskov (TF) index to establish the degree of fluorosis [14]. ...
Background
Certain bone diseases of congenital origin are associated with dental alterations and with oromaxillofacial (OMF) disorders. The objective of this study was to evaluate and compare the OMF alterations presented by patients affected by bone pathology with respect to a healthy population from the same geographical environment.
Material & methods
A cross-sectional study was carried out at Mount Meru Regional Referral Hospital and Kaloleni secondary school in Arusha, Tanzania. The patients with bone pathologies ( n = 60) were consecutively recruited from the hospital, while the controls ( n = 581) comprised a population of healthy students from the school, which was located in the same neighbourhood as the hospital. In the case group, the different bone pathologies were divided into two subgroups: (i) disorders in cellular metabolism (DCM); and (ii) disorders of bone growth/deformity (DGD). Musculoskeletal and oral clinical examinations were performed in both groups.
Results
The case group presented significantly higher values of moderate and severe inflammation on the Löe & Silness Gingival Index (GI 2: 65%, GI 3: 25%) than the control group ( p < 0.001), where mild inflammation predominated (GI 1: 88%). The case group also had higher scores for decayed, missing and filled teeth. Dental fluorosis was reported in 75.2% of controls and in only 26.6% of cases, the differences being clearly significant ( p < 0.001). Significant differences for fluorosis were also reported between the two subgroups ( p < 0.001), with a higher incidence for the DCM subgroup (43.8%). Twenty-two patients (36.7%) in the case group displayed clinical absence of teeth: the rate was significantly higher in the DGD subgroup ( n = 15, 50%) than in the DCM subgroup ( n = 8, 25%) ( p = 0.045). In relation to the type of dental occlusion, the group with bone pathology presented a significant predominance of Angle class II - III malocclusions ( p < 0.001). Craniofacial abnormalities were more frequent in the DGD subgroup, although the difference was not significant. The spine was normal in 41 patients (68.3%) and the differences between subgroups were not significant. Pathological fractures were significantly more frequent in the DGD subgroup (50% vs. 6.3%; p < 0.001). Assessing whether there was a relationship between malocclusion and skeletal deformities (spine and upper limb) in the case group, subjects with upper limb deformity ( n = 16) presented significant differences for inverted overjet ( p = 0.031).
Conclusion
Patients with bone disease had worse oral health and more severe dental malocclusion than controls. The results presented here may help to raise awareness among orthopedic and pediatric professionals of abnormalities related to OMF conditions in childhood.
... The Total Mouth Periodontal Scoring system was used to assess gingivitis (measured as TMPS-G) and attachment loss (measured as TMPS-AT) resulting from periodontitis [28][29][30][31]. Gingivitis was measured on the Silness-Löe index of 0-3 [32]. Briefly, a 0 gingival index was applied for no visible gingival inflammation or bleeding upon probing; a 1 gingival index was applied for gingival erythema or edema with no bleeding upon probing; a 2 gingival index was applied for gingival erythema or edema with mild gingival bleeding upon probing; a gingival index of 3 was applied for gingival erythema/edema with spontaneous bleeding without probing. ...
Feline immunodeficiency virus (FIV) is the domestic cat analogue of HIV infection in humans. Both viruses induce oral disease in untreated individuals, with clinical signs that include gingivitis and periodontal lesions. Oral disease manifestations in HIV patients are abated by highly effective combination antiretroviral therapy (cART), though certain oral manifestations persist despite therapy. Microorganisms associated with oral cavity opportunistic infections in patients with HIV cause similar pathologies in cats. To further develop this model, we evaluated characteristics of feline oral health and the oral microbiome during experimental FIV infection over an 8-month period following cART. Using 16S rRNA sequencing, we evaluated gingival bacterial communities at four timepoints in uninfected and FIV-infected cats treated with either cART or placebo. Comprehensive oral examinations were also conducted by a veterinary dental specialist over the experimental period. Gingival inflammation was higher in FIV-infected cats treated with placebo compared to cART-treated cats and the controls at the study endpoint. Oral microbiome alpha diversity increased in all groups, while beta diversity differed among treatment groups, documenting a significant effect of cART therapy on microbiome community composition. This finding has not previously been reported, and indicates cART ameliorates immunodeficiency virus-associated oral disease via the preservation of oral mucosal microbiota. Further, this study illustrates the value of the FIV animal model for investigations of mechanistic associations and therapeutic interventions for HIV’s oral manifestations.
... The gingival index of Löe and Silness (Löe and Silness 1963) was used to assess inflammation of the marginal gingival tissues around six index teeth (if present: the most anterior molar tooth in each dental quadrant + right upper central incisor + left lower central incisor). ...
Objectives
This study was conducted to describe the dental visiting patterns and ascertain their associations with clinically assessed dental caries and periodontal disease levels of dentate Australian adults.
Materials and Methods
A three‐stage stratified probability sampling design was used to randomly select a cross‐section of Australians aged 15+ years. Self‐reported oral health and related information was obtained using questionnaire‐based interviews. Dental visiting patterns studied were usual frequency of dental visits, usual reason for dental visit, and use of a regular dentist. Oral examinations were conducted following a standardized protocol in public dental clinics. A total of 5022 dentate adults aged 15+ years who were interviewed and orally examined were included in the current analysis.
Results
Higher proportions of adults with lower education levels and no dental insurance usually visited for a dental problem, made dental visits less frequently, and did not use a regular dentist. Individuals who were usually visiting for a dental problem, making dental visits less frequently, and not using a regular dentist had higher levels of dental caries and periodontal diseases.
Conclusions
Dental visiting patterns of Australian adults were associated with their socioeconomic backgrounds. Usually visiting for a dental problem, making dental visits less frequently, and not using a regular dentist were more likely to be associated with higher levels of dental caries and periodontal diseases. These findings may help clinicians to recognize patients at increased risk for dental caries and periodontal diseases while apprising policy makers to plan and implement programs for dental service provision.
... Baseline periodontal treatments of the patients were performed. Plaque index (PI) (11), gingival index (GI) (12), probing pocket depth (PPD) (mm), clinical attachment level (CAL) (mm) were recorded before periodontal treatment. We prepared patients with total PI scores less than % 15for the surgical procedure (O'Leary et al 1972). ...
Objective: In this study, randomized clinical trial (RCT), the aim was to compare clinical periodontal data of subepithelial connective tissue graft (SCTG) group and SCGT+enamel matrix derivatives (EMD) group in terms of gained gingiva volume (GGV) and gained gingiva surface area (GGSA) by scanners of computer-aided design/computer-aided manufacturing (CAD/CAM) devices. Material and Methods: In this study, a total of 35 Miller class I-II gingival recession defects were involved (n=17 in SCTG group, n=18 in SCTG+EMD group). In addition to, periodontal clinical parameters, and three dimensional (3D) images were recorded by using CAD/CAM system before the treatment, at the 1st month and the 6th months after the treatment. The images were superimposed by using softwares and GGV, and GGSA were calculated. Results: There was no significant difference in terms of GGV and GGSA values at the 1st month and 6thmonths between SCTG+EMD and SCTG groups. Similarly, there was no significant difference in periodontal clinical parameters between groups. Conclusion: Images obtained from CAD/CAM system can be easily used in calculating GGV and GGSA data after the gingival recession treatment and in determining of the success of administered treatment. It is expected that the evaluation of the success of many therapeutic approaches for periodontal treatment will be carried out by using CAD/CAM system in the future.
... Among them, we collected data from patients older than 20 years, with more than 20 natural teeth and fewer than 5 dental implants, a history of panoramic radiographs, and full-mouth clinical parameter records for probing depth (PD), https://jpis.org 2/12 P r o v i s i o n a l P r o v i s i o n a l bleeding on probing (BOP; %), the modified sulcus bleeding index (mSBI) [16], the plaque index (PI) [17], the gingival index (GI) [18], gingival recession, and clinical attachment loss (CAL) were collected. The exclusion criteria encompassed patients with a history of systemic diseases that can influence the prognosis of periodontitis, heavy smokers (>10 cigarettes per day), and those who had already undergone treatment with scaling, other periodontal treatments, or antibiotics within 6 months of the oral examination. ...
... Dental caries severity was evaluated using the Decayed Missing Filled Surfaces (DMFS) according to WHO criteria [26]. In clinical periodontal examination, probing depth (PD) and interdental clinical attachment loss (CAL) [27], bleeding on probing (BOP) [28], gingival index (GI) [29] and plaque index (PI) [30] using Williams periodontal probe were evaluated and recorded. ...
Objectives
To evaluate the impact of oral health problems on oral health-related quality of life (OHRQoL) among female patients received Radioactive iodine (¹³¹I) therapy.
Materials and methods
This unmatched case-control study was conducted on 40 female patients (20 cancer free controls and 20 patients treated with ¹³¹I therapy). Data were collected via clinical examination, self reported questionnaire including the Oral Health Impact Profile-14 (OHIP-14), salivary tests, socio-demographic and behavioural characteristics. Data were analyzed using descriptive, bivariate and multivariate statistics.
Results
There were significant differences in the total number of decayed, missing and filled surfaces, stimulated and unstimulated salivary flow rates, and periodontal indices between the study and control groups in the unadjusted analysis. Age adjusted analysis revealed significant differences in the stimulated and unstimulated salivary flow rates, periodontal indices, physical pain domain scores between groups. No significant differences were observed between groups in the xerostomia severity and OHRQoL. In study group, the score for the OHIP-14 psychological discomfort domain was negatively correlated with both stimulated and unstimulated salivary flow rates. The total OHIP-14 score and its domain scores of physical pain and psychological disability were correlated positively with the severity of xerostomia, but negatively correlated with number of the repeated ¹³¹I therapy.
Conclusions
Due to xerostomia, patients reported worse OHRQoL in the domains of physical pain, psychological discomfort and disability. They had worse periodontal status and tooth brushing habits than healthy controls.
Clinical relevance
The findings of this study may provide a valuable insight on the oral health problems and needs of target group when planning a a team-based care.
... The plaque index was used to assess the amount of plaque on teeth with the aid of plaque-disclosing tablets 40 . The gingival index was used to assess the condition of the gingiva according to the following score 41 : 0 Normal gingiva with slight color change, and slight edema. There was no change in probing. ...
Retention is crucial in orthodontics, aiming to preserve treatment outcomes and enhance patient satisfaction with permanent fixed retainers. However, a removable retainer may be needed with fixed retainers to prevent unwanted changes. An eight-unit extended fixed retainer is proposed to eliminate the need for a removable retainer, addressing the undesired changes associated with six-unit fixed retainers. The impact of extended retainers on periodontium and quality of life remains unexplored. This study evaluates the periodontal response and patient-reported quality of life with an eight-unit maxillary fixed retainer. A single-arm prospective clinical trial with only twenty-eight test group patients (6 males, 22 females) who finished active orthodontic treatment were recruited. The mean age was (19.8 ± 4.5 years). This research was approved by the institutional review board of the Faculty of Dentistry, Alexandria University (IORG:0008839, No-0479-8/2022). The registration date of this study was (5/06/2023). An eight-unit maxillary fixed retainer was bonded to the palatal surface of the maxillary incisors, canines, and first or second premolars directly after debonding the brackets. The periodontal assessment and quality of life were carried out through clinical examination and valid questionnaires and the patients were followed up for 12 months. The periodontal response improved significantly at 1-year follow-up. The Probing depth, Gingival index, Plaque index, Bleeding index, and mobility index were significantly lower in these patients. Quality of life was assessed by the OHIP-14. The mean score decreased by -1.86 (SD = 4.19), and the acceptance of the orthodontic appliance scale score increased by 0.68 (SD = 0.86), which was significant with a p-value < 0.001. For 12 months of follow-up, an eight-unit maxillary retainer did not adversely affect the periodontal ligaments. meets patients’ expectations and maintains a high quality of life.
... -Modified plaque and gingiva index [20,21]. ...
Purpose
To retrospectively evaluate the outcome of implant-supported or combined tooth-implant-supported prostheses retained by electroplated double-crowns after 1–12 years.
Methods
Twenty-five patients were retrospectively examined in a private dental practice in Hamburg, Germany. All had been rehabilitated with a removable prosthesis retained by electroplated double-crowns, for at least one year. Fifteen patients had implant-supported prostheses and 10 had combined tooth-implant-supported prostheses in the maxilla or the mandible. Biological and technical complications were recorded at the clinical examination and extracted from the patient records. Kaplan–Meier implant and tooth survival rates were calculated. Potential risk factors for severe complications were identified. Oral health-related quality of life (OHRQoL) was measured by a short version of the Oral Health Impact Profile (OHIP) questionnaire. Patients reported subjective chewing function using a visual analogue scale.
Results
Kaplan–Meier survival rates were 100% for natural abutments and 90.9% for implants after 11.8 years (p = 0.54). Two implants in two patients were lost at 8 and 9 years due to peri-implantitis in the "solely implant" group. The most common complications were decementation of primary crowns and wear of the prosthetic teeth. The mean OHIP score for the group “tooth-implant-supported” was 5.2 ± 5.0, whereas the mean score for the "solely implant" group was 1.7 ± 2.9 (p = 0.039). Patients rated their subjective masticatory function very high with an average score of 9.4 ± 0.8 out of a possible 10.
Conclusions
Implant-supported or combined tooth-implant-supported prostheses retained by electroplated double-crowns are a viable method of treatment with a satisfactory outcome. Maintenance has been manageable and patients have reported very good subjective chewing function after several years of function.
Graphical Abstract
... Mechanistically, metatranscriptomic and proteomic analysis reveals that oral commensal bacteria downregulate metabolic genes while pathogens thrive under the same conditions by upregulating virulence genes such as lipopolysaccharides, flagella and capsule; thus gaining space and resources over commensal streptococci (Shah et al., 2017). Such perturbations were reported to promote increased gingivitis (Löe and Silness, 1963;Kumar et al., 2011). Cigarette smoke modulates the oral microbiota by affecting salivary cytokine content. ...
Introduction: Electronic cigarette (ECIG) use or vaping has become popular globally. While the question "Is vaping safer than smoking?" continues, it is becoming clearer that one of the most dangerous components of E-liquids are the flavorings. Since the oral cavity is the first anatomical site to be assaulted by ECIG aerosol, the aim of this study is to test the hypothesis that flavored ECIG aerosols or E-liquids pose a more detrimental effect on the growth of commensal oral streptococcal bacteria compared to flavorless aerosols or E-liquids. Methods: Kirby Bauer assays and 24-h planktonic growth curves were used to compare the effects of flavorless vs. flavored (tobacco, menthol, cinnamon, strawberry and blueberry) ECIG-generated aerosols and E-liquids on the growth of four common strains of oral commensal bacteria (Streptococcus gordonii, Streptococcus intermedius, Streptococcus mitis and Streptococcus oralis). Results: Kirby Bauer assays revealed inhibition of growth for all bacteria tested when exposed to 100% menthol, cinnamon or strawberry flavors. In contrast, 5% flavor in E-liquid had no effect. When exposed to 100 puffs of ECIG-generated aerosol ± flavors (≈ 0.05% flavor in brain heart infusion media) or an equivalent amount of E-liquid ± flavors, twenty-four hour planktonic growth curves indicated no effect on growth for all streptococci tested. Subsequent twenty-four hour planktonic growth curves testing the effects of E-liquid ± flavors (0.0625, 0.125, 0.25, 0.3125, 0.625, and 1.25% flavor in brain heart infusion media) revealed dose-dependent inhibition of growth, particularly for menthol, cinnamon and strawberry), for all bacteria tested. Conclusion: These results support the hypothesis that flavored E-liquids are more detrimental to the growth of oral commensal bacteria than unflavored E-liquids. The streptococci tested in this study are early colonizers and part of the foundation of oral biofilms and dental plaque. Disturbances in the composition and growth of these primary Frontiers in Physiology | www.frontiersin.org 1 November 2020 | Volume 11 | Article 585416 Fischman et al. Flavored E-Liquids and Oral Streptococci colonizers is crucial to the development of a healthy dental plaque and host-bacteria interactions. E-liquids and their aerosols containing flavoring agents alter the growth of these bacteria. Such perturbations of pioneering oral communities pose a potential risk to the health of the oral cavity and, ultimately, health in general.
... The severity of gingival inflammation was recorded by assessing the gingival index (GI), which was developed by Loe H and Silness J in 1963 [15]. This index assesses the severity of gingivitis and its location in four possible areas by examining all surfaces of all teeth. ...
... • Presence of at least 20 ...
Chlorhexidine (CHX) is the most commonly used mouthwash with proven antiplaque and antibacterial activity. The aim is to evaluate the effect of vitamin C (VitC) in CHX mouthwash on plaque accumulation and gingivitis, and to compare it with CHX alone mouthwash and antiseptic phenol-containing mouthwashes. This study conducted as a multicenter, randomized, controlled, double-blind, parallel design clinical study. Sixty patients were included, randomly divided into three groups. 1. Antiseptic phenol agent (P, Phenol), 2. Antiseptic bisbiguanide agent CHX-only (CHX) and 3. Antiseptic bisbiguanide agent CHX + VitC mouthwash (CHX + VitC). The study assessed oral hygiene and periodontal health status, followed by scaling and root planning (SRP) and subsequent polishing. After using the mouthwash for 60 s twice daily along 14 days, patients recalled for evaluation of plaque index (PI), gingival index (GI), bleeding on probing (BOP) and staining. One-way analysis of variance (ANOVA) was used to compare the differences formed between groups and Tukey multiple comparison analysis was used to determine groups that showed the differences. Statistical significance was determined using a p-value threshold of 0.05. There were no significant differences between the groups regarding baseline PI, GI and BOP (p > 0.05). Changes at 14th day in PI, GI and BOP in all groups were similar and no significant differences were observed (p > 0.05). Regarding ‘all surfaces’, staining density of two mouthwashes containing CHX was significantly higher than that of P mouthwash. CHX, CHX + VitC, and P mouthwashes appeared to exhibit comparable effects as oral hygiene adjuncts to periodontal mechanical treatment, with the exception of staining, which was more noticeable in the CHX groups compared to the P group. Adding vitamin C did not enhance the effects of CHx alone.
... Two trained and calibrated examiners (L.S., G.C.L.S.A.) conducted the clinical examination procedures. Before study initiation, both examiners received training on Löe and Silness gingival index 27 and Silness and Löe plaque index. 28 The examination focused on identifying gingival bleeding sites on the vestibular side of the maxillary anterior sextant, three sites per tooth (mesiobuccal, buccal, distobuccal), using a periodontal probe. ...
Background
Gingivitis, a widely prevalent oral health condition, affects up to 80% of the population. Traditional assessment methods for gingivitis rely heavily on subjective clinical evaluation. This study seeks to explore the efficacy of interpreting the color metrics from intraoral scans to objectively differentiate between healthy and inflamed gingiva.
Methods
This study used the percentage of bleeding on probing (BOP%) as the clinical reference standard. Intraoral scans, obtained before and after gingivitis treatment using a scanner, were analyzed through a custom MATLAB script to quantify HSV (hue, saturation, value) and CIELAB (Commission Internationale de l'Eclairage L*a*b*) color coordinates. The region of interest was a 2‐mm‐wide gingival strip along the buccal margin of the maxillary anterior teeth. Linear regression analysis was performed to evaluate the relationship between photometric outcomes and continuous, dichotomous, and categorical BOP data. Diagnostic accuracy was assessed using the area under the receiver operating characteristic (ROC) curve (AUC), as well as sensitivity and specificity measures.
Results
The analysis included clinical and digital color data from 110 scans, adhering to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. The multilevel linear regression analysis underscored a significant correlation between the BOP% and digital color metrics, specifically the CIELAB a* (red‐green chroma), CIELAB b* (yellow‐blue chroma), and color saturation, with AUC performances of 70%, 79.5%, and 80.8%, respectively.
Conclusion
Digital color analysis of intraoral scans has demonstrated a range of performance from acceptable to excellent in distinguishing sites with BOP. This innovative approach presents a promising tool for dentists and researchers in the accurate diagnosis, screening, and management of gingivitis.
Plain Language Summary
Our study focuses on finding a better way to detect gingivitis, a common gum disease affecting many people. Traditional methods rely on the dentist's visual inspection, which can be subjective. We explored the use of color measurements from digital intraoral scans to objectively identify healthy versus inflamed gums. We analyzed 110 scans from 55 participants, examining the color differences in the gums before and after treatment. By measuring specific color values, we achieved up to 80.8% accuracy in distinguishing between healthy and inflamed gums. This method could offer a more reliable tool for dentists and researchers to diagnose and manage gingivitis, leading to better oral health outcomes.
... Periodontal disease was recorded when the participant had at least one site with a score of 3 or 4, meaning a loss of bone attachment. The condition of the gums (gingivitis) was determined using the Löe and Silness Gingival Index (GI-index) [13]: six index teeth (teeth 16, 12, 24, 32, 36, and 44) were examined with a probe, and each tooth surface was assigned a score of 0-3. A score was calculated for each tooth, and then an overall average score of 0-3 was given for each participant. ...
Background
A large number of older people depend on others for help with their daily personal care, including oral health care. Nursing home and elder-care staff often face challenges identifying older people, who are exposed to or at an increased risk of oral diseases. Thus, the aim of this study was to identify risk factors that non-dental care staff can use to identify older people at risk of oral diseases and poor oral hygiene.
Methods
In this cross-sectional study, the oral health and risk factors for poor oral health were determined for 217 care dependent older people living in two nursing homes and a rehabilitation centre or receiving home care in two Danish municipalities. The outcome variables for oral disease i.e. caries, periodontitis, and gingivitis, and oral hygiene, i.e. plaque and calculus, were assessed using standardised oral examinations. Risk factors for oral diseases and poor oral hygiene were assessed based on a questionnaire concerning (1) background information, (2) health status, (3) social support, (4) oral health behaviours, and (5) self-reported oral health. The associations between oral health and risk factors were investigated using logistic regression analyses.
Results
In general, older people with different living arrangements had quite similarly distributed risk factors. The oral examinations showed that 54.5% had oral diseases, and 14.8% had poor oral hygiene. Not seeing a dentist regularly was significantly associated with having oral diseases (Odds Ratio, 2.87; CI, 1.53–5.39) and poor oral hygiene (OR, 4.50; CI, 1.83–11.05). A significant association was found between the presence of an oral disease and adversely affected quality of life (OR, 2.65; CI, 1.42–4.95), especially due to challenges eating (OR, 3.76; CI, 1.64–8.60) and/or smiling and showing teeth (OR, 3.64; CI, 1.27–10.42). A significant association was also found between poor oral hygiene and taking psychotropic drugs (OR, 2.61; CI, 1.08–6.30).
Conclusion
Questions regarding the use of the dental care system and oral health problems could be used by nondental care staff in conversations with older people to determine their risk of oral diseases and poor oral hygiene.
... The periodontal status of the subjects was determined by recording gingival index (GI) [12], plaque index (PI) [13], pocket depth (PD) [14] and periotest values [15]. Clinical periodontal measurements were performed using a UNC-15 periodontal probe (Hu-Friedy, USA). ...
The purpose of this study was to determine the levels of IL-17, Bcl-3 and IκBζ gene expression in the gingival crevicular fluid (GCF) of psoriatic and healthy individuals and to compare the clinical periodontal parameters in the patient and control groups. A total of 10 psoriasis patients and 2 healthy patients in the control group were included in the analysis for IL-17, Bcl-3, and IκBζ gene expression in the GCF. Periodontal health, gingival index, plaque index, and mobility (using a periotest device) levels were compared between the groups. While considering the down-expressed patients, the expression level of the Bcl-3 gene showed the most variability among the genes studied in psoriasis disease. IL-17 gene expression levels were significantly higher and up-regulated in all patients compared to the control group. In addition, when comparing IL-17 with Bcl-3, IL-17 gene expression was notably high in all patients except patients 4, 9 and 10. The highest expression levels of the IκBζ gene were observed in the patient sample, except for patients 7 and 8. While plaque index, gingival index, and pocket depth parameters were higher in the psoriasis group, there was no significant difference between the two groups (p = 0.257, p = 0.390, p = 0.240, respectively). In the periotest (mobility) parameter, while the mean value was higher in the psoriasis group significantly (p = 0.030), clinically mean values of two groups were in the same grade according to Miller mobility index. The IκBζ gene showed notable high expression levels in psoriasis patients. It was concluded that psoriasis may be associated with periodontitis.
Clinical Trial Registration Number
NCT06408454–05/06/2024.
Name of the Trial Register
Interleukin- 17 (IL-17), Bcl-3, and NF-kappa-B Inhibitor Zeta (IκBζ) Expression Levels in the Psoriasis Patients.
... It was designed to assess gingival condition, clearly distinguishing between the quality of the gum (the severity of the lesion) and the location (quantity) in relation to the four areas (buccal, mesial, distal, lingual) that make up the total circumference of the marginal gum [35]. This index does not consider the depth of periodontal pockets, degrees of bone loss, or any other quantitative changes in the periodontium. ...
Introduction: Periodontitis is a chronic inflammatory disease associated with dysbiotic plaque biofilms, characterized by clinical attachment loss (CAL) and alveolar bone loss, which negatively impacts quality of life. There are several treatment approaches, including surgical methods and the use of antibiotics, but limitations and bacterial resistance have led to the search for more effective alternatives. Probiotics may inhibit the recolonization of periodontopathogens through direct and indirect mechanisms. However, evidence regarding their efficacy in the treatment of periodontitis is still inconclusive due to the diversity of methodologies in the studies. Objective: Review the existing literature to evaluate the benefits of probiotics as adjuncts in non-surgical periodontal therapy. Materials and Methods: A search was conducted in electronic databases (PubMed) up to September 2024 for randomized controlled trials (RCTs) comparing scaling and root planing (SRP) combined with probiotics versus SRP alone or with placebo. The outcome variables evaluated included clinical periodontal parameters, immunological and microbiological monitoring. Results: Twelve RCTs were included that evaluated clinical periodontal, microbiological, and immunological parameters. Five demonstrated effectiveness in improving clinical periodontal parameters, four showed a reduction in periodontal pathogens, and three found improvements in the immune response of patients using probiotics as adjuncts to scaling and root planing (SRP). Conclusions: Studies indicate that probiotic supplementation could improve clinical, microbiological, and immunological parameters in patients with periodontal disease. However, the effectiveness of these probiotics varies depending on the formulation, method of administration, duration of treatment, and type of periodontal disease. Long-term randomized controlled trials (RCTs) are needed to confirm the efficacy of probiotics as adjuncts in periodontal treatment and to assess their impact on health over time.
... A preoperative periodontal examination was conducted by a single-blinded experienced periodontist (N.K.), including recording the baseline measurements of the Silness and Löe PI, 23 as well as the Löe and Silness GI of the Ramfjord's teeth to monitor the patient's oral hygiene at the dentition level. 24 Then, for the mandibular first molar, PI and BOP within 10 s after probing were scored and averaged at six points of the abutment. 25 PD was also measured at the same sites utilizing the University of North Carolina-15 (UNC-15) periodontal probe (UNC #15, Hu-Friedy, Chicago, Illinois, USA). ...
Purpose
To examine the impact of placing plain and impregnated retraction cords for two different retraction times on the postoperative gingival margin level and periodontal health.
Materials and Methods
A total of 40 endodontically treated mandibular first molars were selected and randomly allocated into four groups ( n = 10/group); A: plain retraction cord for 10 min, B: plain retraction cord, 20 min, C: impregnated (25% aluminum chloride (AlCl 3 ) retraction cord, 10 min, D: impregnated retraction cord (25% AlCl 3 ), 20 min. Intraoral digital scans were acquired, and periodontal parameters (Plaque index [PI], Bleeding on probing [BOP], and probing depth [PD]) were assessed at baseline, 7 days, and 28 days after retraction. The digital scans were superimposed to measure the change in the mid‐buccal gingival margin level. Statistical differences between groups at the threetime points were tested using one‐way ANOVA and Chi‐square tests ( α = 0.05).
Results
AlCl 3 ‐impregnated retraction cord for 20 min resulted in a statistically significant change in gingival margin level than limiting its application to 10 min or using plain cords at the three‐time points ( p < 0.05) with 88 ± 4 µm gingival recession after 28 days. The assessed periodontal parameters only showed a significant difference between groups in BOP after 7 days of retraction ( p = 0.0009); however, all parameters returned to normal after 28 days with no significant difference between groups ( p > 0.05).
Conclusions
To avoid transient gingival inflammation or permanent gingival recession, no matter how small, the retraction time of AlCl 3 ‐impregnated cords should be limited to no more than 10 min.
... For characterization of the periodontal condition, the periodontal probing depth (PPD) was measured from the gingival margin to the base of the clinical pocket using a UNC probe 15 (HU-Friedy, Milano, Italy) [42,43]. The plaque index (PI) (Sillness-Löe) [44] and gingival index (GI) (Löe-Sillness) [45] were also recorded. The PI, GI, and PPD were re-evaluated 3 months after the completion of complex dental treatments. ...
Background: Patients with hyperlipidemia are of interest because of the possible interplay between chronic local dental infections and hyperlipidemia. This interventional clinical study aimed to evaluate the oral health status of hyperlipidemic patients receiving lipid-lowering therapy for at least 6 months and the effects of non-surgical and surgical dental treatments on serum C-reactive protein (CRP) levels and lipid markers. Methods: Twenty-eight patients with controlled hyperlipidemia and 18 healthy controls were enrolled in the study. All participants underwent dental examinations (clinical evaluation, X-ray imaging, and microbial analysis of subgingival and supragingival plaque samples) at baseline. Hyperlipidemic patients received periodontal, endodontic, and dentoalveolar surgical treatments. Serum CRP and lipid parameters were assessed at baseline, 1 week, and 3 months, while subgingival and supragingival plaque samples were analyzed at baseline and 3 months after completing dental treatments. Results: At the 3-month follow-up, clinical periodontal characteristics, including the plaque index, gingival index, and periodontal probing depth, improved significantly (p < 0.05). A significant shift in microflora was observed in both subgingival and supragingival plaque samples (p < 0.05), alongside improvements in periodontal values and a significant reduction in serum CRP levels (p < 0.05). Serum cholesterol levels decreased significantly, while moderate improvements in serum triglycerides, low-density lipoprotein, and high-density lipoprotein levels were observed but were not statistically significant (p > 0.05). Conclusions: Treating local dental inflammation is associated with a significant decrease in CRP and cholesterol levels and may serve as beneficial adjunct therapy alongside lipid-lowering therapy in patients with hyperlipidemia.
... gingival inflammation; (2.0-3.0)-severe gingival inflammation (28). The collected data were coded, and a statistical analysis was carried out by using Microsoft Excel 2010 and Jamovi Version 2.4 Analysis of the data was carried out by frequency distributions and descriptive statistics (chi-square test, Fisher's exact test, Mann-Whitney U test). ...
... The clinical and biochemical parameters were recorded at baseline (before SRP and gel placement), 15th day, and 30th day after gel placement. Clinical parameters were plaque index (PI) by Silness and Loe [10], measured using a two-tone disclosing solution (AlphaPlac®); gingival index (GI) by Silness and Loe [11]; probing pocket depth (PPD), measured using a UNC-15 periodontal probe; and clinical attachment level (CAL), measured using a customized occlusal stent from the lower border of the stent to the base of the pocket. The biochemical parameter was PGE2 levels, measured using an ELISA kit (Elabscience® Co. Ltd., USCN, Wuhan). ...
... Clinical measures such as the papillary bleeding index (PBI) (11) , gingival index (GI) (12) and plaque index (PI) (13) were evaluated. The primary investigator gathered data, which had been repeated on days; zero to four weeks later. ...
... Full-mouth Gingival Index (FMGI)- [23]. ...
Chlorhexidine is widely regarded as a gold standard antiplaque agent, and it is used commonly in periodontal patients. However, due to its side effects, a suitable alternative agent has been searched for several years. The present study compared the efficacy of a novel, oxygen-releasing, natural mouthwash Blue ® m (Bluem Europe, Zwolle, The Netherlands) with chlorhexidine in patients with gingivitis. A total of 50 patients were selected and randomly divided into two groups who received a baseline scaling by a trained periodontist. The test group received Blue ® m mouthwash as an adjunct for 2 weeks, whereas the control group received chlorhexidine mouthwash for 2 weeks. The primary outcomes of the Full-Mouth Gingival Index, Full-Mouth Plaque Index, and a percentage of the bleeding sites were recorded at the baseline. The same parameters were recorded after 2 weeks and 1 month from the baseline. Both the study and control groups exhibited equal efficacy in terms of reduction in the gingival index and bleeding percentage, both at 2 weeks and 1 month post scaling. However, the Blue ® m group displayed statistically significant reduction in plaque index at 1 month as compared with chlorhexidine. As per the objectives of the study, it can be concluded that Blue ® m reported a better antiplaque efficacy compared with chlorhexidine.
... The remaining three studies [30,32,35] treated and collected the microbiological and clinical peri-implant parameters of all periimplantitis sites treated. The Plaque Index (PI) [37] was recorded by assigning a dichotomous value to the absence (0) or presence (1) of plaque to calculate the percentage of treated peri-implantitis sites with the presence of plaque. ...
Objectives: This systematic review evaluated concomitant trends in microbial (total biofilm load and pre-dominant pathogens’ counts) and clinical, radiographic, and crevicular variations following (any) peri-implantitis treatment in partially vs. totally edentulous, systemically healthy, non-smoking adults and compared them to peri-implant mucositis treated sites. Methods: The study protocol, compliant with the PRISMA statement, was registered on PROSPERO (CRD42024514521). Findings from six randomized controlled trials (RCTs), evaluated through the ROBINS-2 tool, were qualitatively synthesized. Results: No data concerning total edentulism and treated peri-implant mucositis sites were retrieved from the included RCTs. Instead, as expected, in the partially edentulous subjects, peri-implantitis treatments effectively provided biofilm control, although Plaque Index (PI) tended to increase again over time. Notably, Bleeding on Probing (BoP) rose slightly after treatment but decreased markedly by three months, indicating, at least, a partial resolution of the infective-inflammatory process. Probing Depth (PD) showed a slower but consistent improvement throughout. Despite a return of PI levels by twelve months, BoP and PD continued to improve, underscoring the successful long-term outcomes of peri-implantitis treatment. Over time, variations in PI did not consistently reflect changes in predominant pathogenic species, especially at the 1-month follow-up; BoP aligned with predominant pathogens rather than total microbial biofilm load at the 1- and 3-month follow-ups, and PD did the same at the 3- and 6-month follow-ups, likely affecting peri-implantitis-associated microbiota. No data concerning crevicular parameters were retrieved in the included RCTs, and the extracted radiographic outcomes were not comparable. Conclusions: The impact of the microbial variations after peri-implantitis treatment on peri-implant clinical parameters highlight the critical role of dysbiosis, rather than total microbial load, in influencing inflammation and tissue destruction, emphasizing the need for targeted approaches to manage persistent pathogens and improve treatment efficacy.
... The following clinical parameters were evaluated: Probing depth (PD), gingival bleeding on probing index (BOP) and plaque index (PI) [ 14 ] . ...
Cigarette smoking is a risk factor for several diseases, and recent evidence strongly suggests an adverse effect on periodontal health. Nevertheless, the nature of the relationship between smoking and periodontal disease is not clear. Smoking causes defects in neutrophil function, impairs inflammatory and immune responses to periodontal pathogens, and exerts both systemic and local effects. Aims. This study aimed to assess periodontal health of smoker and nonsmoker under graduated dental students and to determine the possible factor of smoking and its effect on periodontal health. . In this study, 118 dental student participants (males only) between 18—25 years from 450 male under graduated dental student fit to the criteria of our research, were divided in two groups,61 smoker student and 57 non-smoker students. Demographic data, smoking status, and clinical periodontal parameter including plaque index (PI), pocket depth (PD), tooth mobility and bleeding on probing (BOP) indices were determined for each participant. . Smokers had a slightly higher PI (0.803±0.483) than that of nonsmokers (0.609±0.397, p=0.018). BOP and pocket depth tend to be greater in smokers (BOP=0.14±0.10 and PD=0.97±1.90 mm) than nonsmoker (BOP=0.13±0.09 and PD=0.72±1.57 mm). The greater percentage of students had started smoking due to friends’ influence (72%). There is a positive correlation between PD and PI for smokers (p=0.046). Also there is a positive correlation between BOP and PD for non-smokers with statistically significant difference (p=0.01). Moreover, there is a positive correlation between BOP and PD and PI for smokers (p=0.026) and there is a positive correlation between PI and BOP and PD for non-smokers with high statistically significant difference (p=0.0001). . The students having friends who are smoker are the most important factors associated with smoking, furthermore the percentage of bleeding is low since the fact that smoking effect the bleed vessel and cause vasoconstriction, finally Longitudinal trials need to be performed in order to obtain more conclusive result regarding the effect of smoking in periodontal disease.
... At surgery, plaque index PI (Silness & Löe) (17) and gingival index GI (Löe & Silness) (18) were evaluated in the surgical area. Following local anaesthesia and prior to flap reflection, the distance between the coronal edge of the MSC and the gingival margin (SGM0) was recorded using the MSC at the experimental teeth requiring crown lengthening: This measurement was made at 4 sites (mid-buccal, mid-lingual/palatal and mid-interproximal) at all experimental teeth using a calibrated periodontal probe and rounded to the nearest 0.5 mm. ...
Aplikimi standard i një vlere mesatare prej 2.04 mm për gjerësinë biologjike është demonstruar të rezultojë në sasi jo të vazhdueshme të zgjatjes së dhëmbit pas procedurës së zgjatjes së kurorës (CLP). BW është zëvendësuar kohët e fundit nga lartësia e indeve gingivale sulkulare (SGT) që përfshin BW dhe thellësinë sulkulare. Pyetjes nëse dimensioni SGT i vendosur në rigjenerimin e indeve pas operacionit, nuk është dukshëm i ndryshëm nga dimensioni para-kirurgjikal, nuk i është përgjigjur plotësisht. Objektivat: Qëllimet e këtij studimi klinik janë realizuar që të krahasojnë lartësinë paraoperative dhe 24-javëshe të SGT në anën bukale, linguale/palatale dhe ndërvepruese pas CLP kirurgjikale dhe të vlerësojnë ndryshimet e përkohshme në nivelin margjinal të gingivës nga dita pas operacionit në 24 javë kohë shërimi.
... Assessments of plaque levels and gingival inflammation were made at 4 sites per tooth (buccal, lingual, mesial and distal) using an explorer. Individual oral hygiene status was recorded using the Plaque Index (PI), and gingival inflammatory status was assessed by means of the Gingival Index (GI) [16,17]. The final PI and GI scores were calculated by dividing the summed scores of individual sites, quantified on a 4-grade scale (from 0 = no plaque/no inflammation to 3 = abundant plaque/severe inflammation), by the number of examined sites. ...
Objectives
The aim of the present study was to evaluate salivary gland function and oral health status in Osteogenesis imperfecta (OI) children, comparing to a control group, and to investigate the possible influence of bisphosphonate (BP) treatment.
Materials and methods
Patients aged 8–15 years with any OI molecularly confirmed and gender-matched healthy control were consecutively recruited at the Section of Pediatric Dentistry (Dental School-University of Turin). Comprehensive dental examinations were conducted to evaluate carious lesions, plaque and gingival index, stimulated saliva flow rate, pH, and buffer capacity.
Results
A total al of 22 OI patients (mean age: 10.7 ± 2.4 years) and 22 age- and gender-matched healthy controls (mean age: 10.3 ± 2.3 years) were consecutively enrolled. In OI patients reduced saliva quality and quantity and poor oral health, were observed compared to healthy peers. OI subjects exhibited significantly lower stimulated salivary flow rates (SFR; P < 0.001), higher gingival inflammatory status (P = 0.003) and carious experience in both the deciduous (P = 0.038) and permanent dentition (P = 0.005) Stratifying data based on BP assumption, statistically significant differences in resting (P = 0.024) and stimulated SFR (P = 0.019) were observed as compared to OI subjects not using BP drugs.
Conclusions
Pediatric OI patients show reduced SFR and poor oral health, highlighting the need for regular screenings and early salivary management.
Clinical relevance
Impairment of salivary gland function is suggested by these preliminary data in pediatric patients with OI.
Background/Objectives: The nature, diameter, and cross-section of orthodontic archwires affect tooth movement and the surrounding alveolar bone. Researchers have explored different features of archwires to optimize treatment outcomes. In this context, this study aimed to evaluate the properties of the I-arch for its effects on alveolar bone height, dehiscence, fenestration, and treatment duration. Methods: Forty patients (eight males, and thirty-two females; mean age: 20.97 ± 2.41 years) with dental crowding ≤ 6 mm and Class I malocclusion were treated without extractions. They were randomly divided into two groups: the experimental group (EG, n = 20), treated with the I-arch, and the control group (CG, n = 20), treated with traditional archwires of the MBT technique. Two CBCT scans were taken for each patient, one before treatment (T0) and one after leveling (T2). The studied teeth were upper and lower centrals, canines, and second premolars. The treatment duration was measured across three periods: T0–T1, T1–T2, and T0–T2. Results: Alveolar bone resorption, dehiscence, and fenestration were lower in the EG. Total treatment duration (T0–T2) was similar between groups, but the first period (T0–T1) was significantly shorter in the EG (p < 0.05). Conclusions: The I-arch resulted in fewer side effects on alveolar bone height during leveling and alignment.
Objective
Peri-implant diseases (peri-implant mucositis and peri-implantitis) are inflammatory conditions that affect the peri-implant tissues and are induced by microbial biofilms (dental plaque) formed around the implant. Removal of biofilm is the fundamental step in managing peri-implant diseases. Interdental cleaning aids such as interdental brush, unitufted brush, or oral irrigation along with regular toothbrushing are recommended for effective plaque control around implants. The present systematic review aims to evaluate the efficacy of home use of oral irrigators compared to other plaque control methods for managing peri-implant diseases.
Method
This systematic review has been prepared using the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) checklist. Five databases were searched using the following keywords: “Peri-implantitis” OR Periimplantitis OR “Peri-implant disease” OR “Peri-implant Mucositis” AND “Oral irrigation” OR “Oral Irrigator” OR Waterpik OR “Interdental irrigation” OR “Oral Spray” OR “Oral Irrigants”.
Results
Oral irrigator along with mechanical brushing was found to be more effective than mechanical brushing alone in reducing the plaque index (PI), gingival index (GI), and bleeding on probing (BOP). No statistically significant difference in improvement in quality of life and patient satisfaction with regard to comfort and ease of use was noted upon using mechanical toothbrushing alone and an oral irrigator. Implant sites where an oral irrigator was used showed more reduction in BOP (81.8% vs 33.35%) compared to sites where the floss was used (P = 0.0018). The levels of the red and orange complex bacteria in the peri-implant biofilm were lower with the use of an oral irrigator than with toothbrushing alone.
Conclusion
Oral irrigators along with toothbrushing were found to be more effective in removing microbial plaque around implants and controlling peri-implant inflammation compared to mechanical brushing alone. The reduction in BOP was better with the use of oral irrigation compared to floss and interdental brush.
The association between phenytoin-induced gingival hyperplasia (PIGH) and five major periodontopathic bacteria was investigated by real-time PCR in 12 subjects (30.6±7.95 years of age) with severe motor and intellectual disabilities. The subjects had not received antibiotics or periodontal therapy within three months. A healthy gingival site or a site with the lowest gingival hyperplasia score (minimum site), and a site with the maximum score of gingival hyperplasia (maximum site) on each subject were selected for investigation. The clinical parameters were measured after microbial sampling.
The following results were obtained :
1. The detection rates of both Treponema denticola and Porphyromonas gingivalis were 75% (9/12) at the maximum sites, and that of Tannerella forsythia was 33.3% (4/12). The detection rate of Prevotella intermedia was 58.3% (7/12), but no significant correlation was observed between this bacterium and the other types of bacteria in quantitative analysis.
2. The detection rate of P. gingivalis with typeⅡ fimA was 25% (1/4) at the minimum sites, and 83.3% (5/6) at the maximum sites.
3. The samples were divided into three groups ; namely, those with no detection of P. gingivalis at either the minimum sites or the maximum sites, no detection at the minimum sites but detection at the maximum sites, and detection at both sites.
In conclusion, 1) the detection rates of T. denticola and P. gingivalis were the highest at the maximum sites. In particular, the detection rate of P. gingivalis with typeⅡ fimA was high in the present study, and 2) the subgingival microflora was diverse because of the diverse severity of gingival inflammation associated with PIGH.
A BSTRACT
Background
The prevalence of metabolic syndrome (MeS) is increasing due to modern lifestyles, making it essential to explore its connection with conditions like periodontitis, particularly in pregnant women. This study aims to evaluate the periodontal parameters health of pregnant women with metabolic syndrome.
Material and Methods
The study included 144 pregnant women aged 18–34 with MeS. Demographic data collected encompassed age, nutrition, medical history, and oral health practices. Dental exams assessed the gingival index, plaque index, bleeding on probing, probing depth, and clinical attachment loss, classifying participants into mild, moderate, and severe periodontitis. Blood glucose, triglycerides, HDL cholesterol, systolic and diastolic blood pressure, waist circumference, and BMI were measured to analyze the relationship between the number of MeS components and periodontal disease severity using a Chi-square test. A P value of less than 0.05 was considered statistically significant.
Results
Gingivitis was present in 33.3% of the subjects, whereas severe periodontitis was in 20.8%. Nonetheless, there was no discernible correlation ( P > 0.05) between periodontal disease severity and MeS risk variables.
Conclusion
The majority of subjects had gingivitis, although all patients with MeS exhibited periodontal disease to some degree. However, there is still debate over whether or whether an increased presence of MeS components is associated with more severe periodontal disease, particularly during pregnancy.
A BSTRACT
Background
Although there are quite a number of studies on the impacts of periodontal therapeutic management on pregnant females, literature on the impact of supragingival scaling on pregnant females with metabolic syndrome (MS) is wanting. The present investigation was meticulously formulated to ascertain the clinical ramifications of supragingival scaling in pregnant individuals diagnosed with MS.
Material and Methods
An intervention study was conducted on 47 pregnant females. The gingival index (GI), plaque index, bleeding on probing, probing depth, and clinical attachment level were among the periodontal parameters evaluated. By the end of 20–21 weeks of pregnancy, all participants had received scaling and polishing at the baseline appointment, along with advice on dental hygiene. Periodontal parameters were gathered again during a follow-up appointment 8 weeks post treatment. A 5% threshold for statistical significance was set, and paired t -test and chi-square test were applied for comparison.
Results
Lower levels of PI, GI, and BOP 8 weeks post supragingival scaling were noted than at the baseline. The results obtained were statistically significant ( P < 0.001) All patients with severe periodontitis (n = 14) before supragingival scaling shifted to milder forms of the disease. Similarly, moderate periodontitis was seen in 20 patients before the start of the study, and after the intervention, it was reduced to 16 patients.
Conclusion
In summary, supragingival scaling lowers the incidence of periodontal disease in pregnant MS females. High-risk pregnant women who receive scaling treatment and instruction on oral hygiene on a regular basis have better oral health, which in turn improves the health of their unborn child.
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.
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