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Perio Reports

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Perio Reports  Vol. 26, No. 9
Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians. Perio Reports research summaries will be included in each issue to keep you on the cutting edge of dental hygiene science.
Diabetes Linked to Increased Perio Severity

Type 2 diabetes mellitus (DM) belongs to a group of genetically diverse disorders affecting metabolism. Many research studies confirm a bi-directional link between DM and periodontitis. The prevalence of DM in the Middle East is nearly 15 percent of the population. This 2010 figure is expected to dramatically increase in the future. The goal of this study was to compare diabetes-related parameters with severe periodontal destruction.

Researchers at Kuwait University compared a group of 158 patients, 80 with DM and 78 healthy controls. A complete periodontal examination was provided for all subjects, measuring plaque scores, probing depths, attachment levels and bleeding upon probing scores. DM was determined from the medical history and from the most recent HbA1c levels. Subjects ranged in age from 30 to 68 years. Most of the DM patients were older.

DM patients had lower plaque scores, 59 compared to 70 in the control group but had similar bleeding upon probing scores, 40 versus 39. DM patients experienced more periodontal disease, with the number of sites with clinical attachment loss of 5mm or more averaging 26 per patient versus 13 in the control group. This converts to 19 percent of sites compared to 11 percent in the control group. Signs of severe periodontitis could be predictors of DM. There was a relationship between those with two or more complications from diabetes and clinical evidence of more severe periodontitis. Periodontal therapy and maintenance should be an important part of care provided for those with DM.

Clinical Implications: Patients with Type 2 diabetes are more likely to have signs of severe periodontitis.

Al-Khabbaz, A.: Type 2 Diabetes Mellitus and Periodontal Disease Severity. Oral Health Prev Dent 12:(1) 77-82, 2014.

Periodontal Disease Influences Low Birth Weight

Many studies link periodontal disease to preterm (born before 37 weeks), and low birth weight (less than 2,500 grams or 5 pounds, 8 ounces). It has been suggested that women with periodontal disease are seven times more likely to deliver a preterm, low birth weight baby. This can be extrapolated to suggest that 18 percent of preterm, low birth weight babies delivered may be due to periodontal disease in the mothers.

Researchers at the KLE University in Belgaum, India, evaluated 770 pregnant mothers receiving free medical care. Basic demographic information was collected along with childbirth history and a periodontal screening examination.

Within this group, 14 percent were periodontally healthy and 84 percent had signs of periodontitis. More of the women with little education had periodontitis. Educated women had less periodontal disease. The incidence of low birth weight increased in women with probing depths deeper than 5mm.

In India, many women chew areca nut, tobacco or pan. Pan is chewed after meals as a breath freshener, digestive and to color the lips red. Areca nut is considered carcinogenic, but is frequently chewed. In this group of mothers, 77 percent engaged in unhealthy nut or tobacco chewing habits. Increased levels of pocketing and bleeding upon probing were associated with these chewing habits.

These findings confirm a link between periodontal disease and low birth weight. Early periodontal screening may prove to be a cost effective way to identify women at risk of delivering a low birth weight baby.

Clinical Implications: Treat and prevent periodontal disease in pregnant women.

Kothiwale, S., Desai, B., Kothiwale, V., Gandhi, M., Konin, S.: Periodontal Disease as a Potential risk Factor for Low Birth Weight and Reduced Maternal Haemoglobin Levels. Oral Health Prev Dent 12:(1) 83-90, 2014.
Herbal Toothpaste Reduces Inflammation

Although the toothbrush is the most commonly used oral hygiene tool, not everyone is effective with it. Several studies reported that more than half the plaque remains after toothbrushing. This explains why gingivitis remains a problem for some, despite daily toothbrushing. For these cases, antimicrobial toothpastes are recommended. Herbs are used for their antimicrobial and antioxidant properties and have been added to oral care products, for example: chamomile, Echinacea, sage, and magnolia.

Researchers at the University of Gothenburg in Sweden compared a fluoride toothpaste with an herbal toothpaste. Both toothpastes were provided by Colgate in plain white tubes. Both toothpastes contained 1.5% sodium lauryl sulfate and sodium fluoride, 1100ppm. The test toothpaste additionally contained 0.3 percent magnolia extract from the magnolia tree. Subjects were also given a new Colgate toothbrush for every month of the study.

The six month study was completed by 94 subjects. Bleeding, gingivitis and plaque scores were recorded at baseline, three and six months. Both groups showed significant reductions in plaque and gingivitis scores from baseline to three months. Scores were also lower at six months, but not as significantly for both groups. This suggests the tendency for patients to be less compliant over time.

Plaque reductions were similar for both toothpastes but the test toothpaste showed slightly greater reduction in gingivitis sites that bled. The test toothpaste reduced the number of bleeding sites by 60 percent compared to 30 percent for the control toothpaste.

Clinical Implications: For patients with severe gingivitis, an herbal toothpaste may enhance the benefit of toothbrushing by reducing inflammation.

Hellström, M. Ramberg, P.: The Effect of a Dentifrice Containing Magnolia Extract on Established Plaque and Gingivitis in Man: A Six-Month Clinical Study. Int J Dent Hygiene 12(2): 96-102, 2014.

Introduction of the Water Flosser to Students

Hygienists and dentists are influenced significantly by their instructors. Students amass information verbatim. One example is the emphasis placed on string flossing as the primary source for plaque biofilm removal between the teeth, despite evidence that only 12 percent of Americans floss daily. Focusing on only one unsuccessful approach for interdental plaque removal limits the student's mindset, their problem solving approach, and is not conducive to reflective critical thinking or action. Providing students with alternative interdental cleaning methods, allows students to focus on the patient's individualized needs, preferences and capabilities.

A total of 98 dental hygiene students at three dental hygiene schools in California were introduced to the use of the Waterpik Aquarius Water Flosser as an alternative to string flossing. The purpose was to encourage students to be flexible and open to diverse philosophies and opinions and to develop reflective critical thinking when making recommendations to patients. They viewed a video presentation introducing the benefits and use of the Aquarius Water Flosser for plaque biofilm removal between the teeth. In addition, one student in each class tested the product themselves and as a demonstration in class, followed by discussion.

A questionnaire was completed prior to any discussion of the water flosser.

Students were also observed interacting with their patients in a clinic setting and role-playing. Students were observed asking open-ended questions and involving patients in the decision-making process. They did not simply repeat information verbatim. Students weighed the information from their educators and began drawing their own conclusions regarding how they would relay this learned information to their patients. Students assessed their patients and then offered choices depending on individualized needs, desires, and capabilities.

Clinical Implications: Involve patients in the decision about what interdental plaque removal tool would be best for them to use.

Clark, S.: Could the Waterpik Water Flosser be a Viable Alternative to String Flossing for Dental Hygiene Students to Offer Their Non-Compliant String Floss Patients? OHU Action Research Project, 1B-14, 2014.

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