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BMC Oral Health Apr 2023Mouthwashes were convenient adjuncts to mechanical cleaning procedures. This review aimed to evaluate the efficacy of mouthwashes on oral microorganisms and gingivitis... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mouthwashes were convenient adjuncts to mechanical cleaning procedures. This review aimed to evaluate the efficacy of mouthwashes on oral microorganisms and gingivitis in orthodontic patients.
METHODS
By April 16, 2022, multiple databases and grey literature were searched based on the PICOS strategy. Randomized controlled trials in orthodontic patients evaluating the efficacy of mouthwashes with at least one microbial parameter and/or plaque- and/or gingival inflammation-related index were included. Relevant data were extracted, and the risk of bias was evaluated using Cochrane's tool. Individual mean and standard deviation of the outcomes in mouthwashes and placebos/blank controls were pooled to estimate the weighted mean differences (WMDs) and 95% confidence intervals (95%CIs). Sensitivity analysis, and certainty of evidence were evaluated.
RESULTS
Of 1684 articles, 32 studies satisfied the eligibility criteria, and nine were included for meta-analysis. Missing outcome data was the primary source of bias. Compared to blank controls, the short-term application of fluoride mouthwashes significantly reduced the colony counts of Mutans streptococci (MS), while the long-term application may not be effective. Compared to placebos or blank controls, Chlorhexidine mouthwashes significantly reduced the colony counts of multiple microorganisms in the short-term. Compared to placebos or blank controls, herbal mouthwashes showed the inhibitory effect of MS in the short-term, with some results lacking statistical significance. After meta-analysis, significant lower plaque- and gingival inflammation-related indexes were observed in the Chlorhexidine mouthwashes groups [Gingival Index: WMD = -0.45, 95%CI = -0.70 to -0.20 (placebos as control); WMD = -0.54, 95%CI = -0.96 to -0.13 (blank controls); Plaque Index: WMD = -0.70, 95%CI = -1.12 to -0.27 (blank controls)]. Significant lower gingival inflammation-related indexes were observed in the herbal mouthwashes groups [Gingival Index: WMD = -0.20, 95%CI = -0.32 to -0.09 (blank controls)].
CONCLUSIONS
The short-term application of fluoride mouthwashes may reduce the colony counts of cariogenic bacteria, but the long-term effect is not evident. Chlorhexidine may reduce the colony counts of multiple microorganisms in the short-term. Short-term application Chlorhexidine and herbal mouthwashes may effectively reduce plaque- and gingival inflammation-related indexes. However, the risk of bias, inconsistency, and imprecision in the included studies may reduce the certainty of the evidence.
Topics: Humans; Mouthwashes; Chlorhexidine; Fluorides; Gingivitis; Inflammation; Dental Plaque; Dental Plaque Index; Anti-Infective Agents, Local
PubMed: 37024817
DOI: 10.1186/s12903-023-02920-4 -
BMC Oral Health Aug 2023To analyse the available evidence regarding the incidence and severity of white spot lesions (WSLs), plaque accumulation and salivary caries-associated bacteria(SCB) in... (Meta-Analysis)
Meta-Analysis
White spot lesions, plaque accumulation and salivary caries-associated bacteria in clear aligners compared to fixed orthodontic treatment. A systematic review and meta- analysis.
OBJECTIVE
To analyse the available evidence regarding the incidence and severity of white spot lesions (WSLs), plaque accumulation and salivary caries-associated bacteria(SCB) in clear aligners (CA) verses conventional fixed (CF) orthodontic appliances.
METHODS
Electronic searches of MEDLINE, Scopus, Embase, Google Scholar, Clinical trial registry, OpenGrey and ProQuest were done for all relevant studies. Eligibility criteria were; Randomized Controlled Trials and Non-Randomized Studies that compared the incidence and severity of WSLs, plaque accumulation and SCB between CA and CF appliances in patients undergoing orthodontic treatment. The risk of bias(ROB) and certainty of evidence was assessed independently by two reviewers using Cochrane's ROB and GRADEpro, respectively. Standardized mean difference (SMD) was used to estimate the effect size using STATA 17 software.
RESULTS
A total of 14 studies met the eligibility criteria, and eight were suitable for meta-analysis. The qualitative results showed lower incidence and severity of WSLs, plaque accumulation, and SCB in CA group compared to CF appliances. The pooled results showed significantly lower plaque accumulation(SMD - 1.58;95%CI:-2.57,0.58;p = 0.002) in CA compared to CF appliances.
CONCLUSIONS
A moderate-quality evidence reveals less plaque accumulation and less SCB in CA, which might be related to the reduced incidence and severity of WSLs associated with CA when compared with CF appliances. However, the results of the present study should be interpreted with caution given the high ROB among some of the included studies as well as the marked heterogeneity across the studies.
CLINICAL RELEVANCE
For patients who can be treated with either CA or CF appliances, CA may be a better choice concerning oral health.
REGISTRATION
Open Science Framework (DOI: https://doi.org/10.17605/osf.io/kcpvb ).
Topics: Humans; Dental Caries Susceptibility; Bacteria; Dental Caries; Dental Plaque; Orthodontic Appliances, Removable
PubMed: 37635207
DOI: 10.1186/s12903-023-03257-8 -
BMC Oral Health Sep 2019This systematic scoping review aimed to identify changes in biomarkers of microbiological, immunological and biochemical origin during experimental gingivitis (EG)...
BACKGROUND
This systematic scoping review aimed to identify changes in biomarkers of microbiological, immunological and biochemical origin during experimental gingivitis (EG) studies that might indicate resistance and resilience.
METHODS
The term 'experimental gingivitis' was run in PubMed from inception to April 11th, 2018. From the 411 studies retrieved, 22 studies were included for this review.
RESULTS
Studies reporting data on biomarker changes during and after full mouth EG trial were included. Two studies reported findings on changes in biomarkers of microbiological, 12 on immunological and eight on biochemical origin. Changes were reported in the induction phase, and occasionally in the resolution phase. The microbiological composition of both supragingival and subgingival dental plaque changed over the course of EG to a more pathogenic direction, but showed a shift back to a more normal composition. This indicates resilience of the oral microbiome. For immunological biomarkers, it was challenging to retrieve a robust pattern of changes across multiple studies. IL-1β and IL-6 in saliva and in gingival crevicular fluid increased during induction phase and returned in the resolution phase below baseline values. The biochemical parameters cystatin-SN, cystatin-S and lactoferrin in saliva were increased at the end of induction phase, however also here no clear pattern emerged based on all available studies.
CONCLUSIONS
More research is needed to investigate which microbiological, immunological, and biochemical biomarkers can be useful for future investigations into the resistance and resilience of the oral cavity to experimental gingivitis.
Topics: Adolescent; Adult; Aged; Animals; Child; Dental Plaque; Female; Gingival Crevicular Fluid; Gingivitis; Humans; Male; Microbiota; Periodontal Index; Vascular Endothelial Growth Factor A; Young Adult
PubMed: 31511002
DOI: 10.1186/s12903-019-0889-z -
BMC Oral Health Jul 2020This systematic review of randomized clinical trials aimed to evaluate the available evidence regarding the efficacy of propolis-based mouthwash on dental plaque and...
BACKGROUND
This systematic review of randomized clinical trials aimed to evaluate the available evidence regarding the efficacy of propolis-based mouthwash on dental plaque and gingival inflammation.
METHODS
PubMed, Scopus, and Web of Science databases were searched up to November 2019. Clinical trials that evaluated the efficacy of propolis mouthwashes compared with chlorhexidine (CHX) were included. The primary outcomes comprised dental plaque and/or gingival inflammation. Two authors assessed the risk of bias using the Cochrane tool. Due to marked heterogeneity of the available data, studies were assessed qualitatively, and no metaanalysis was performed.
RESULTS
Nine clinical trials, comprising 333 subjects, fulfilled the eligibility criteria. Most of the included studies showed high risk of bias. Overall, propolis mouthwashes showed good efficacy on plaque and gingivitis in all of the included studies. Out of the eight studies that reported on plaque index, 5 studies found equal efficacy of propolis and CHX in reducing plaque, two studies found superior efficacy in favor of CHX, while one study found superior efficacy in favor of propolis. Six studies assessed gingival inflammation outcome, four of which reported better results with propolis, while two studies reported comparable results.
CONCLUSIONS
The results suggest that propolis-based mouthwashes have potential benefits in reducing plaque and gingival inflammation. However, methodological limitations along with small sample sizes in some of the included studies weaken the strength of the evidence. Therefore, further well-designed clinical trials with large sample sizes and adequate follow-up period are recommended to discern the efficacy of propolis mouthwash on plaque and gingivitis.
Topics: Anti-Infective Agents, Local; Chlorhexidine; Cross-Over Studies; Dental Plaque; Dental Plaque Index; Double-Blind Method; Gingivitis; Humans; Inflammation; Mouthwashes; Propolis; Single-Blind Method
PubMed: 32650754
DOI: 10.1186/s12903-020-01185-5 -
Journal of Dentistry Dec 2020People with Cystic Fibrosis (PWCF) may be presumed to be at lower risk of periodontal disease due to long term antibiotic use but this has not been comprehensively... (Review)
Review
INTRODUCTION AND OBJECTIVES
People with Cystic Fibrosis (PWCF) may be presumed to be at lower risk of periodontal disease due to long term antibiotic use but this has not been comprehensively investigated. The oral hygiene and periodontal status of PWCF in comparison to the general population is not well established. The objective of this systematic review was to critically evaluate the literature on periodontal and oral hygiene status in PWCF to see if this group are at increased risk of periodontal disease (gingivitis or periodontitis).
DATA SOURCES
5 databases were searched: Scopus, MEDLINE, Embase, Cochrane Library and Web of Science.
STUDY SELECTION
The search resulted in 614 publications from databases with one more publication identified by searching bibliographies. 13 studies were included in the qualitative analysis.
CONCLUSIONS
The majority of studies showed better oral hygiene, with lower levels of gingivitis and plaque among people with Cystic Fibrosis (PWCF) than controls. Interestingly, despite this, many studies showed that PWCF had higher levels of dental calculus. Three studies found there was no difference in Oral Hygiene between PWCF and controls. One study found that PWCF aged between 6 and 9.5 years had increased levels of clinical gingivitis, and one study showed that PWCF with gingivitis had more bleeding on probing than people without CF. The vast majority of PWCF examined were children- only five studies included people over 18 years, and only one looked exclusively at adults. There is a need for further study into the periodontal health of PWCF- particularly those over the age of 18.
CLINICAL SIGNIFICANCE
There are currently no guidelines referring to oral care in PWCF. Studies have suggested that the oral cavity acts as a reservoir of bacteria which may colonise the lungs. If PWCF are at increased risk of periodontal disease, they should attend for regular screenings to facilitate early detection.
Topics: Adult; Child; Cystic Fibrosis; Dental Plaque; Gingivitis; Humans; Middle Aged; Oral Health; Oral Hygiene; Periodontal Diseases
PubMed: 33129998
DOI: 10.1016/j.jdent.2020.103509 -
International Journal of Dental Hygiene Feb 2023To establish the efficacy of oscillating-rotating power toothbrush (OR-PTB) compared to high-frequency sonic power toothbrush (HFS-PTB) on improving parameters of plaque... (Meta-Analysis)
Meta-Analysis Review
The efficacy of an oscillating-rotating power toothbrush compared to a high-frequency sonic power toothbrush on parameters of dental plaque and gingival inflammation: A systematic review and meta-analysis.
AIM
To establish the efficacy of oscillating-rotating power toothbrush (OR-PTB) compared to high-frequency sonic power toothbrush (HFS-PTB) on improving parameters of plaque and gingival inflammation. Safety and participants' preference were secondary interests.
MATERIALS AND METHODS
MEDLINE-PubMed and Cochrane-CENTRAL databases were searched, up to April 2021. Inclusion criteria were (randomized)controlled clinical trials that evaluated healthy humans brushing with an OR-PTB compared to a HFS-PTB. Evaluation for a minimum of 4 weeks, of one or more of the following parameters: plaque index scores (PI), bleeding scores (BS), number of bleeding sites (NoB) and gingival index scores (GI).
RESULTS
Thirty two publications involving 38 comparisons were included after the independent screening. The descriptive analysis showed that in 54% of the comparisons, a significant difference in favour of the OR-PTB was found for PI, BS and GI scores. The Quigley and Hein index showed a significant difference of means (DiffM) between the end scores (DiffM 0.13, 95% CI [0.05;0.21] p < 0.001), as well as for the Rustogi-modified Navy index (DiffM 0.01, 95% CI [0.01;0.03] p = 0.002). This is in line with the meta-analysis for BS (DiffM 0.09, 95% CI [0.03;0.14] p = 0.003), for which the results were in favour of the OR-PTB and considered potentially clinically relevant. NoB showed a significant difference in favour of the OR-PTB for the end scores (DiffM 3.61, 95% CI [2.63;4.58] p < 0.00001). No difference in safety was indicated, 78% of participants preferred the OR-PTB.
CONCLUSION
For patients to maintain good plaque control and improve gingival health, there is a small but significant difference based on longer-term studies between OR-PTB and HFS-PTB. This difference is potentially clinically relevant.
Topics: Humans; Dental Plaque; Equipment Design; Single-Blind Method; Toothbrushing; Gingivitis; Dental Plaque Index; Inflammation
PubMed: 35535635
DOI: 10.1111/idh.12597 -
The Journal of Clinical Pediatric... Mar 2023This paper systematically evaluate the effects of probiotics on preventing caries in preschool children. The present systematic review was conducted following the... (Meta-Analysis)
Meta-Analysis
This paper systematically evaluate the effects of probiotics on preventing caries in preschool children. The present systematic review was conducted following the Transparent Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recorded in the International prospective register of systematic reviews (PROSPERO) database (registration no: CRD42022325286). Literature were screened from PubMed, Embase, Web of Sciences, China National Knowledge Infrastructure (CNKI), Wanfang and other databases from inception to April 2022 to identify randomized controlled trials on the clinical efficacies of probiotics in preventing dental caries in preschool children and extract relevant data. The meta-analysis was performed using the RevMan5.4 software and the Stata16. Cochrane handbook was used to assess the risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADEprofiler 3.6) was used to determine the evidence quality. A total of 17 randomized controlled trials were eligible, of which two trials had certain levels of bias and 15 had a low risk of bias. Evidence quality assessment showed that the included trials were of medium quality. The meta-analysis results showed that was associated with a reduced incidence ( = 0.005) and progression ( < 0.001) of caries in preschool children. Probiotics could reduce the number of high-level Streptococcus mutans in saliva ( 0.00001) but could not reduce the number of Streptococcus mutans in dental plaque nor the amount of Lactobacillus in the saliva and dental plaque. Current evidence shows that probiotics could prevent caries in preschool children, but was more effective in preventing caries than others. Although probiotics could reduce high levels of Streptococcus mutans in saliva, they could not reduce the amount of Lactobacillus in saliva and dental plaque.
Topics: Humans; Child, Preschool; Dental Caries; Dental Plaque; Dental Caries Susceptibility; Streptococcus mutans; Lactobacillus; Probiotics
PubMed: 36890746
DOI: 10.22514/jocpd.2023.014 -
International Journal of Environmental... Jun 2022This systematic review aimed to compare the efficacy of herbal agents with ethylene diamine tetraacetic acid (EDTA) in removing the smear layer during root canal... (Review)
Review
This systematic review aimed to compare the efficacy of herbal agents with ethylene diamine tetraacetic acid (EDTA) in removing the smear layer during root canal instrumentation. The research question in the present study was to assess: "Is there a significant difference in reducing smear layer comparing EDTA and herbal agents?" Electronic databases (PubMed, Scopus, and Web of Science) were searched from their start dates to April 2022 using strict inclusion and exclusion criteria, and reviewed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Only in vitro studies comparing herbal agents with EDTA were included in the current systematic review. Two reviewers independently assessed the included articles. A total of 625 articles were obtained from an electronic database. Eighteen papers were included for review of the full text, out of which, ten papers were excluded because they did not meet the inclusion criteria. Finally, eight articles were included in the systematic review. The present systematic review considered only in vitro studies; hence, the result cannot be completely translated to strict clinical conditions. The results of the present systematic review have shown that extract, and neem show better smear layer removal compared to other herbal agents, whereas they showed reduced smear layer removal when compared with EDTA. Although, it was seen that most of the included studies did not report a high quality of evidence. Hence, the present systematic review concludes that herbal agents have reported to show inferior smear layer removal when compared to EDTA. Thus, as far as herbal based alternatives are concerned, there is no highest level of evidence to state its real benefit when used as a chelating root canal irrigant.
Topics: Acetic Acid; Chelating Agents; Edetic Acid; Ethylenes; Humans; Microscopy, Electron, Scanning; Root Canal Preparation; Smear Layer; Sodium Hypochlorite
PubMed: 35682452
DOI: 10.3390/ijerph19116870 -
International Dental Journal Feb 2024Denture plaque, a biofilm that develops on denture surfaces, could contribute to many oral and systemic afflictions. Hence, a quantitative assessment of denture plaque... (Review)
Review
Denture plaque, a biofilm that develops on denture surfaces, could contribute to many oral and systemic afflictions. Hence, a quantitative assessment of denture plaque is important to evaluate the denture hygiene of denture wearers, particularly to prevent plaque biofilm-associated diseases. The aim of this systematic review, therefore, was to review and summarize the visual denture hygiene assessment methods using denture plaque indices and with planimetries published in the literature. English language studies published up to March 2022 in four electronic databases, PubMed, Medline, Embase, and Cochrane Library, were searched, followed by a manual search of Google Scholar by two assessors. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) whenever possible. Details of the visual assessment methods, including the types of denture assessed, its materials and its surfaces, as well as the use of a disclosing agent, were the main outcomes. Of 492 screened studies, 74 were included per the inclusion and exclusion criteria. Of these, 60 studies utilized various denture plaque indices while 18 used planimetries. 43 out of 60 studies with indices and 17 out of 18 studies with planimetries used disclosing agents for visual evaluation of plaque. A total of 21 indices were described in the included studies, of which seven graded a divided denture surface, while the remainder graded entire denture surface. Of the 18 planimetric assessments, one study quantified squares of the disclosed plaques on denture images, 16 studies quantified such pixels with computer programs, and a single study quantified points, pixels, and contour of plaque areas. In summary, denture plaque indices appear to be popular in denture plaque assessment due to their simplicity. Computerized planimetric assessment, though more time-consuming, provides a more accurate assessment of plaque load as it is less prone to subjectivity and assessor errors.
Topics: Humans; Oral Hygiene; Dental Plaque; Biofilms; Dental Plaque Index; Dentures
PubMed: 37479594
DOI: 10.1016/j.identj.2023.06.010 -
International Journal of Dental Hygiene Feb 2022This study aimed to establish the efficacy of a rubber bristles interdental cleaner (RBIC) as an adjunct to toothbrushing (TB) compared to that of the adjuvant use of... (Meta-Analysis)
Meta-Analysis Review
AIM
This study aimed to establish the efficacy of a rubber bristles interdental cleaner (RBIC) as an adjunct to toothbrushing (TB) compared to that of the adjuvant use of other interdental cleaning devices and TB alone on plaque and gingivitis parameters. Additionally, the safety aspects and panellists' appreciation were evaluated.
MATERIALS AND METHODS
Databases were searched for randomized controlled clinical trials (RCTs) evaluating plaque (PI), bleeding (BS), and gingival index (GI) scores, safety assessments, and participants' appreciation. Extracted data were summarized in a descriptive and, if possible, a meta-analysis.
RESULTS
The search retrieved 142 unique papers; six studies with 10 comparisons were included in a descriptive analysis. Five RCTs compared RBICs with interdental brushes (IDBs), four with dental floss (DF) and one with manual TB only. No comparisons to wood sticks were retrieved. Using an RBIC resulted in no difference in plaque scores compared to DF and IDBs. For overall bleeding scores, no difference was found. Two studies analysing the accessible sites separately found RBICs to be more favourable than DF and IDBs. Conversely, one study evaluating the efficacy of RBICs compared to IDBs, according to the GI scores, showed that IDBs achieved significantly greater reduction. Moreover, RBICs caused fewer gingival abrasions and were preferred by the study participants.
CONCLUSION
Based on a descriptive and a meta-analysis of the available literature, it is synthesized that in gingivitis patients, a weak to very weak certainty exists that a RBIC is indicated for gingivitis and plaque reduction. The evidence supports user safety and participants' preferences.
Topics: Dental Devices, Home Care; Dental Plaque; Dental Plaque Index; Gingivitis; Humans; Rubber; Toothbrushing
PubMed: 33630360
DOI: 10.1111/idh.12492