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Oral Health & Preventive Dentistry Oct 2020Currently, there is no consensus on recommendations for manual toothbrushing techniques between dentists, oral health therapists and dental companies. The aim of this...
PURPOSE
Currently, there is no consensus on recommendations for manual toothbrushing techniques between dentists, oral health therapists and dental companies. The aim of this systematic review is to identify and assess the quality of evidence of the effectiveness of manual toothbrushing techniques in the existing literature.
METHODS
A broad search was conducted on the electronic databases Medline via Ovid, PubMed and EBSCO Dentistry & Oral Sciences. Included studies examined manual toothbrushing technique efficiency. Articles were assessed utilising the Cochrane Collaboration's tool for assessing risk of bias. Thirteen studies met the inclusion criteria and were included in this review. These included five randomised controlled trials (RCT), seven experimental non-randomised control studies and one in vitro study.
RESULTS
Of the 3190 articles identified, 40 were relevant to manual toothbrushing and 13 were included in the final review. Studies indicating statistically significantly superior plaque removal for a given technique were Bass (one), modified Bass (one), Charter's (two), Fones (two), scrub (two), roll (one), modified Stillman (one), toothpick method (one). Four studies exhibited no statistically significant difference in effectiveness of plaque removal. Unfortunately, considerable variation was found between studies, making a definitive conclusion impossible in terms of an ideal manual toothbrushing technique that would promote plaque removal and reduce gingivitis.
CONCLUSION
There is still insufficient evidence for suggesting that one toothbrushing method is more effective than another in plaque removal and reduction of gingivitis. Excessive variability in many aspects of the design and methodology of the selected studies hinder conclusions on an ideal manual toothbrushing technique. Experimental randomised controlled trials that follow the CONSORT guidelines are required to provide adequate-quality evidence and make any definitive conclusions on the relative effectiveness of manual toothbrushing techniques.
Topics: Dental Care; Dental Plaque; Gingivitis; Humans; Oral Health; Toothbrushing
PubMed: 33028052
DOI: 10.3290/j.ohpd.a45354 -
The Cochrane Database of Systematic... May 2019Periodontal (gum) disease and dental caries (tooth decay) are the most common causes of tooth loss; dental plaque plays a major role in the development of these...
BACKGROUND
Periodontal (gum) disease and dental caries (tooth decay) are the most common causes of tooth loss; dental plaque plays a major role in the development of these diseases. Effective oral hygiene involves removing dental plaque, for example, by regular toothbrushing. People with intellectual disabilities (ID) can have poor oral hygiene and oral health outcomes.
OBJECTIVES
To assess the effects (benefits and harms) of oral hygiene interventions, specifically the mechanical removal of plaque, for people with intellectual disabilities (ID).
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases to 4 February 2019: Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Register of Studies), MEDLINE Ovid, Embase Ovid and PsycINFO Ovid. ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. The Embase search was restricted by date due to the Cochrane Centralised Search Project, which makes available clinical trials indexed in Embase through CENTRAL. We handsearched specialist conference abstracts from the International Association of Disability and Oral Health (2006 to 2016).
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and some types of non-randomised studies (NRS) (non-RCTs, controlled before-after studies, interrupted time series studies and repeated measures studies) that evaluated oral hygiene interventions targeted at people with ID or their carers, or both. We used the definition of ID in the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). We defined oral hygiene as the mechanical removal of plaque. We excluded studies that evaluated chemical removal of plaque, or mechanical and chemical removal of plaque combined.
DATA COLLECTION AND ANALYSIS
At least two review authors independently screened search records, identified relevant studies, extracted data, assessed risk of bias and judged the certainty of the evidence according to GRADE criteria. We contacted study authors for additional information if required. We reported RCTs and NRSs separately.
MAIN RESULTS
We included 19 RCTs and 15 NRSs involving 1795 adults and children with ID and 354 carers. Interventions evaluated were: special manual toothbrushes, electric toothbrushes, oral hygiene training, scheduled dental visits plus supervised toothbrushing, discussion of clinical photographs showing plaque, varied frequency of toothbrushing, plaque-disclosing agents and individualised care plans. We categorised results as short (six weeks or less), medium (between six weeks and 12 months) and long term (more than 12 months).Most studies were small; all were at overall high or unclear risk of bias. None of the studies reported quality of life or dental caries. We present below the evidence available from RCTs (or NRS if the comparison had no RCTs) for gingival health (inflammation and plaque) and adverse effects, as well as knowledge and behaviour outcomes for the training studies.Very low-certainty evidence suggested a special manual toothbrush (the Superbrush) reduced gingival inflammation (GI), and possibly plaque, more than a conventional toothbrush in the medium term (GI: mean difference (MD) -12.40, 95% CI -24.31 to -0.49; plaque: MD -0.44, 95% CI -0.93 to 0.05; 1 RCT, 18 participants); brushing was carried out by the carers. In the short term, neither toothbrush showed superiority (GI: MD -0.10, 95% CI -0.77 to 0.57; plaque: MD 0.20, 95% CI -0.45 to 0.85; 1 RCT, 25 participants; low- to very low-certainty evidence).Moderate- and low-certainty evidence found no difference between electric and manual toothbrushes for reducing GI or plaque, respectively, in the medium term (GI: MD 0.02, 95% CI -0.06 to 0.09; plaque: standardised mean difference 0.29, 95% CI -0.07 to 0.65; 2 RCTs, 120 participants). Short-term findings were inconsistent (4 RCTs; low- to very low-certainty evidence).Low-certainty evidence suggested training carers in oral hygiene care had no detectable effect on levels of GI or plaque in the medium term (GI: MD -0.09, 95% CI -0.63 to 0.45; plaque: MD -0.07, 95% CI -0.26 to 0.13; 2 RCTs, 99 participants). Low-certainty evidence suggested oral hygiene knowledge of carers was better in the medium term after training (MD 0.69, 95% CI 0.31 to 1.06; 2 RCTs, 189 participants); this was not found in the short term, and results for changes in behaviour, attitude and self-efficacy were mixed.One RCT (10 participants) found that training people with ID in oral hygiene care reduced plaque but not GI in the short term (GI: MD -0.28, 95% CI -0.90 to 0.34; plaque: MD -0.47, 95% CI -0.92 to -0.02; very low-certainty evidence).One RCT (304 participants) found that scheduled dental recall visits (at 1-, 3- or 6-month intervals) plus supervised daily toothbrushing were more likely than usual care to reduce GI (pocketing but not bleeding) and plaque in the long term (low-certainty evidence).One RCT (29 participants) found that motivating people with ID about oral hygiene by discussing photographs of their teeth with plaque highlighted by a plaque-disclosing agent, did not reduce plaque in the medium term (very low-certainty evidence).One RCT (80 participants) found daily toothbrushing by dental students was more effective for reducing plaque in people with ID than once- or twice-weekly toothbrushing in the short term (low-certainty evidence).A benefit to gingival health was found by one NRS that evaluated toothpaste with a plaque-disclosing agent and one that evaluated individualised oral care plans (very low-certainty evidence).Most studies did not report adverse effects; of those that did, only one study considered them as a formal outcome. Some studies reported participant difficulties using the electric or special manual toothbrushes.
AUTHORS' CONCLUSIONS
Although some oral hygiene interventions for people with ID show benefits, the clinical importance of these benefits is unclear. The evidence is mainly low or very low certainty. Moderate-certainty evidence was available for only one finding: electric and manual toothbrushes were similarly effective for reducing gingival inflammation in people with ID in the medium term. Larger, higher-quality RCTs are recommended to endorse or refute the findings of this review. In the meantime, oral hygiene care and advice should be based on professional expertise and the needs and preferences of the individual with ID and their carers.
Topics: Dental Plaque; Humans; Intellectual Disability; Oral Health; Oral Hygiene; Periodontal Diseases; Toothbrushing
PubMed: 31149734
DOI: 10.1002/14651858.CD012628.pub2 -
Oral Health & Preventive Dentistry Jun 2022To summarise the available data on the effects of chlorhexidine (CHX) mouthwash in treating gingivitis during treatment with fixed orthodontic appliances. (Meta-Analysis)
Meta-Analysis
PURPOSE
To summarise the available data on the effects of chlorhexidine (CHX) mouthwash in treating gingivitis during treatment with fixed orthodontic appliances.
MATERIALS AND METHODS
Multiple electronic databases were searched up to December 7th, 2021. Only randomised controlled trials (RCTs) were eligible for inclusion. The quality of the included RCTs was assessed with the Cochrane risk of bias tool for randomised trials (RoB 2.0). After data extraction and risk of bias assessment, differences were recorded in several oral hygiene indices in time and mean percentage change in those indices using different antimicrobial solutions.
RESULTS
Fourteen studies were deemed eligible for inclusion, reporting on a total of 602 patients with an age range of 11-35 years. The experimental solution was a 0.06%, 0.12%, or 0.2% CHX mouthwash with the control either a placebo mouthwash or a selection from a variety of mouthwashes. Treatment duration varied from 1 day to almost 5 months and the follow-up period varied from 1 min to 5 months. Chlorhexidine mouthrinses led to reduced plaque accumulation and gingival inflammation during orthodontic treatment, while at the same time, some of the control group mouthrinses were deemed equally effective. No statistically significant difference was detected in the meta-analysis between CHX and mouthwashes with propolis/probiotics/herbs in terms of the gingival index at 3 to 4 weeks (mean difference 0.07, 95% CI: -0.18, 0.31, p = 0.59).
CONCLUSION
Chlorhexidine mouthwash in orthodontic patients successfully controls gingival inflammation and bleeding when compared to untreated controls, but is equally effective as other mouthrinses where various oral health indices are concerned.
Topics: Adolescent; Adult; Child; Chlorhexidine; Dental Plaque; Gingivitis; Humans; Inflammation; Mouthwashes; Young Adult
PubMed: 35762364
DOI: 10.3290/j.ohpd.b3170043 -
Journal of Clinical Periodontology Sep 2023Consumption of free sugars has been associated with chronic non-communicable diseases. The aim of the study was to investigate the effect of free-sugar consumption on... (Meta-Analysis)
Meta-Analysis Review
AIM
Consumption of free sugars has been associated with chronic non-communicable diseases. The aim of the study was to investigate the effect of free-sugar consumption on gingival inflammation using a systematic review and meta-analysis based on the PICO question 'What impact does the restriction of free sugars have on the inflammation of gingival tissue?'
MATERIALS AND METHODS
Literature review and analyses were based on the Cochrane Handbook for Systematic Reviews of Interventions. Controlled clinical studies reporting on free-sugar interventions and gingival inflammation were included. Risk of bias was performed with ROBINS-I and ROB-2, and effect sizes were estimated with robust variance meta-regressions.
RESULTS
Of the 1777 primarily identified studies, 1768 were excluded, and 9 studies with 209 participants with gingival inflammation measures were included. Six of these studies reported on the dental plaque scores of 113 participants. Restriction of free sugars, when compared with no such restriction, was associated with statistically significantly improved gingival health scores (standard mean difference [SMD] = -0.92; 95% confidence interval [CI]: -1.43 to -0.42, p < .004; I [heterogeneity] = 46.8) and a trend towards lower dental plaque scores (SMD = -0.61; 95% CI: -1.28 to 0.05, p < .07; I = 41.3). The observed improvement of gingival inflammation scores with restricted consumption of free sugar was robust against various statistical imputations. No meta-regression models were feasible because of the limited number of studies. The median publication year was 1982. Risk-of-bias analysis showed a moderate risk in all studies.
CONCLUSION
Restriction of free sugar was shown to be associated with reduced gingival inflammation. The systematic review was registered at PROSPERO (CRD 42020157914).
Topics: Humans; Dental Plaque; Sugars; Gingivitis; Inflammation; Dental Plaque Index
PubMed: 37246336
DOI: 10.1111/jcpe.13831 -
Journal of Periodontal Research Oct 2023To investigate the existence of any association between new putative periodontal pathogens and periodontitis. Two independent reviewers conducted electronic literature... (Meta-Analysis)
Meta-Analysis Review
To investigate the existence of any association between new putative periodontal pathogens and periodontitis. Two independent reviewers conducted electronic literature searches in the MEDLINE (PubMed), EMBASE, DOSS and Google Scholar databases as well as a manual search to identify eligible clinical studies prior to November 2022. Studies comparing the prevalence of microorganisms other than the already-known periodontal pathogens in subgingival plaque and/or saliva samples between subjects with periodontitis and subject with periodontal health were included. Meta-analyses were performed on data provided by the included studies. Fifty studies including a total of 2739 periodontitis subjects and 1747 subjects with periodontal health were included. The Archaea domain and 25 bacterial species (Anaeroglobus geminatus, Bacteroidales [G-2] bacterium HMT 274, Desulfobulbus sp. HMT 041, Dialister invisus, Dialister pneumosintes, Eubacterium brachy, Enterococcus faecalis, Eubacterium nodatum, Eubacterium saphenum, Filifactor alocis, Fretibacterium sp. HMT 360, Fretibacterium sp. HMT 362, Mogibacterium timidum, Peptoniphilaceae sp. HMT 113, Peptostreptococcus stomatis, Porphyromonas endodontalis, Slackia exigua, Streptococcus gordonii, Selenomonas sputigena, Treponema amylovorum, Treponema lecithinolyticum, Treponema maltophilum, Treponema medium, Treponema parvum and Treponema socranskii) were found to be statistically significantly associated with periodontitis. Network studies should be conducted to investigate the role of these newly identified periodontitis-associated microorganisms through interspecies interaction and host-microbe crosstalk analyses.
Topics: Humans; Bacteria; Periodontitis; Dental Plaque; Bacteroides; Eubacterium
PubMed: 37572051
DOI: 10.1111/jre.13173 -
European Review For Medical and... Apr 2015Chlorhexidine (CHX) is one of the most widely used antiseptic, especially in dentistry. At low concentrations CHX is bacteriostatic and at high concentrations acts... (Review)
Review
OBJECTIVES
Chlorhexidine (CHX) is one of the most widely used antiseptic, especially in dentistry. At low concentrations CHX is bacteriostatic and at high concentrations acts bactericidal causing cell death by cytolysis. In this study, we performed a systematic review of pharmaco-biological activity and application of CHX.
MATERIALS AND METHODS
Articles for inclusion in this review were retrieved from online databases PubMed/Medline. The selected papers were included in the present manuscript according to their relevance for the topic.
RESULTS
Totally 75 papers were enrolled in this research. CHX has strong biocidal activity against Gram-positive bacteria and weaker activity against Gram-negative bacteria. It is also active against yeasts, some dermatophytes and some lipophilic viruses. The most widely application CHX has found in dentistry and antisepsis. Numerous studies have confirmed the beneficial effects of CHX in reducing of plaque accumulation, in tooth caries, gingivitis, periodontitis and in alveolar osteitis. Unfortunately, CHX exhibits cytotoxic activity on human cells, can cause colorization of teeth and fillings, and its activity depends on the pH of the environment and the presence of organic substances.
CONCLUSIONS
CHX play a valuable role in the dentistry and antisepsis. However, it can also cause side effects, limiting its application time.
Topics: Anti-Infective Agents, Local; Antisepsis; Biological Availability; Chlorhexidine; Dental Plaque; Humans
PubMed: 25912596
DOI: No ID Found -
Journal of Clinical Periodontology Apr 2015What is the effect of mechanical inter-dental plaque removal in addition to toothbrushing, on managing gingivitis using various formats of inter-dental self-care in... (Review)
Review
FOCUSED QUESTION
What is the effect of mechanical inter-dental plaque removal in addition to toothbrushing, on managing gingivitis using various formats of inter-dental self-care in adults based on evidence gathered from existing systematic reviews?
MATERIAL & METHODS
Three Internet sources were searched by a strategy designed to include systematic reviews on inter-dental cleaning devices. Plaque and gingivitis scores were the primary parameters of interest. Characteristics of selected papers were extracted. The potential risk of bias was estimated and the acquired evidence was graded.
RESULTS
Screening of 395 papers resulted in six systematic reviews. Two papers evaluated the efficacy of dental floss, two of inter-dental brushes (IDB), one of woodsticks and one of the oral irrigator. Weak evidence of unclear or small magnitude was retrieved that supported dental floss, woodsticks and the oral irrigator to reduce gingivitis in addition to toothbrushing. No concomitant evidence for an effect on plaque emerged. There is moderate evidence that IDBs in combination with toothbrushing reduce both plaque and gingivitis.
CONCLUSION
Evidence suggests that inter-dental cleaning with IDBs is the most effective method for inter-dental plaque removal. The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal. All investigated devices for inter-dental self-care seem to support the management of gingivitis, however, to a varying extend.
Topics: Dental Devices, Home Care; Dental Plaque; Dental Plaque Index; Gingivitis; Humans; Periodontal Index; Self Care; Toothbrushing; Treatment Outcome
PubMed: 25581718
DOI: 10.1111/jcpe.12363 -
Phytotherapy Research : PTR Feb 2018This is a systematic review of clinical and laboratory studies evaluating the effect of Melaleuca alternifolia on periodontopathogens, dental plaque, gingivitis,... (Review)
Review
This is a systematic review of clinical and laboratory studies evaluating the effect of Melaleuca alternifolia on periodontopathogens, dental plaque, gingivitis, periodontitis, and inflammatory responses. The PubMed, Cochrane, Web of science, Bireme, Lilacs, Prospero, Open Grey, and Clinical Trials databases were searched to identify potentially eligible studies through October 2016. Of 1,654 potentially eligible studies, 25 were included in the systematic review. Their methodology was evaluated through the Cochrane Handbook for clinical studies and the GRADE system for in vivo/in vitro studies. Although clinical studies must be interpreted with caution due to methodological limitations, laboratory studies have found promising results. In vitro evidences showed that M. alternifolia has bactericidal and bacteriostatic effects against the most prevalent periodontopathogens. Clinical studies found comparable effects to chlorhexidine 0.12% in reducing gingival inflammation, although the antiplaque effect was lower. M. alternifolia also showed antioxidant properties, which are beneficial to the host, allied to the reduction on immune-inflammatory responses to pathogens. This systematic review suggests that the M. alternifolia has potential anti-inflammatory and antimicrobial properties, which can be easily applied to the periodontal tissues. However, further clinical trials are needed to elucidate the clinical relevance of its application.
Topics: Anti-Bacterial Agents; Dental Plaque; Humans; Melaleuca; Periodontal Diseases
PubMed: 29235165
DOI: 10.1002/ptr.5974 -
International Journal of Dental Hygiene Feb 2022The purpose of the present systematic review and meta-analysis was to assess the available evidence regarding the efficacy of curcumin mouthwashes on plaque and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The purpose of the present systematic review and meta-analysis was to assess the available evidence regarding the efficacy of curcumin mouthwashes on plaque and gingivitis.
METHODS
A comprehensive online search of multiple databases (PubMed, Scopus, Web of Science, and Google Scholar) was performed to identify all relevant studies published up to August 2020, using the following keywords: curcumin, turmeric, gingivitis, periodontal health, and plaque control. All clinical trials that compared the efficacy of curcumin mouthwash with chlorhexidine in controlling dental plaque and gingivitis were included. Data were analysed using Review Manager (RevMan) 5.3 software. The risk of bias was evaluated by two independent reviewers using the Cochrane assessment tool.
RESULTS
Six randomized clinical trials (comprising 320 subjects) fulfilled the eligibility criteria. Five studies showed a high risk of bias and only one study showed a low risk of bias. The pooled data of the six included studies revealed comparable efficacy of curcumin and chlorhexidine in reducing dental plaque (I = 91%; standardized mean difference [SMD]: 0.27, 95% CI: -0.53, 1.07, p = 0. 51) and gingival inflammation (I = 40%; SMD: -0.13, 95% CI: -0.35, 0.09, p = 0.24), with no statistically significant differences between the two groups.
CONCLUSION
The results suggest that curcumin mouthwashes have promising anti-plaque and anti-gingivitis properties. Further clinical trials with adequate sample sizes and standardized methodologies are required to discern the efficacy of curcumin mouthwash in reducing plaque and gingivitis.
Topics: Anti-Infective Agents, Local; Chlorhexidine; Curcumin; Dental Plaque; Dental Plaque Index; Gingivitis; Humans; Mouthwashes
PubMed: 34013606
DOI: 10.1111/idh.12518 -
Advances in Nutrition (Bethesda, Md.) Nov 2015The aim of this systematic review was to identify and summarize evidence of the association between anthropometric measurements and periodontal status in children and... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review was to identify and summarize evidence of the association between anthropometric measurements and periodontal status in children and adolescents. We searched PubMed, Institute for Scientific Information Web of Knowledge, Cochrane Library, and 7 additional databases, following the guidance of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, up to December 2014. Observational studies reporting data on the association between anthropometric measurements and periodontal diseases in 2-18-y-old participants were included. An initial search identified 4191 papers; 278 potentially effective studies (k = 0.82) and 16 effective studies (k = 0.83) were included after screening. The mean quality of evidence among the studies was 20.3, according to the Strengthening the Reporting of Observational studies in Epidemiology checklist (k = 0.79). Meta-analyses showed that obesity (measured by body mass index) was significantly associated with visible plaque index (OR: 4.75; 95% CI: 2.42, 9.34), bleeding on probing (OR: 5.41; 95% CI: 2.75, 10.63), subgingival calculus (OR: 3.07; 95% CI: 1.10, 8.62), probing depth (OR: 14.15; 95% CI: 5.10, 39.25) and flow rate of salivary secretion (standardized mean difference: -0.89; 95% CI: -1.18, -0.61). However, various results were reported in the effective studies that were not included in meta-analyses. In conclusion, obesity is associated with some signs of periodontal disease in children and adolescents. Further studies with a comprehensive prospective cohort design and more potential variables are recommended.
Topics: Adolescent; Anthropometry; Body Mass Index; Child; Child, Preschool; Dental Plaque; Energy Intake; Gingivitis; Humans; Inflammation; Obesity; Periodontal Diseases; Periodontal Index; Salivation
PubMed: 26567204
DOI: 10.3945/an.115.010017