Perio Reports Vol. 25, No. 8 |
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.
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Parafunctional Habits Linked to TMD in Teens
Temporomandibular dysfunction or TMD is characterized
by three symptoms: pain, joint noises and difficulty
opening the mouth. Parafunctional habits are linked to
TMD. These include nail biting, clenching, grinding, lip or
object biting and gum chewing.
Researchers at two universities in Sao Paulo, Brazil,
surveyed 244 adolescents enrolled in elementary and high
school in the city of Sao Roque in the state of Sao Paulo,
Brazil, regarding harmful habits and TMD signs and symptoms.
The children ranged in age from 10 to 20 years. All the
questions on the survey were yes/no design. Children were
asked about parafunctional habits (listed above) and signs
and symptoms of TMD: headache, joint noise, difficulty or
pain upon chewing, tired feeling in the face, "locked" jaw,
facial pain and difficultly opening the mouth. The screening
questionnaire was developed by the American Academy of
Orofacial Pain. Identification of three or more signs of TMD
indicates need for a definitive diagnosis of TMD.
Headache was the most common symptom, reported by
41 percent. Noise in the joint was reported by 25 percent
and 14 percent reported difficulty talking or chewing. Facial
fatigue was reported by 10 percent, and nine percent
reported experiencing "locked" jaw.
At least one harmful oral habit was reported by 16 percent,
two by 20 percent, three by 39 percent and no oral
habits by 25 percent. There was a significant correlation
between the number of harmful oral habits and the number
of TMD symptoms.
Clinical Implications: Evaluate teens for
parafunctional habits as they are linked
to TMD.
Motta, L., Guedes, C., DeSantis, T., Fernandes, K., Mesquita-Ferrari, R.,
Bussadori, S.: Association Between Parafunctional Habits and Signs and
Symptoms of Temporomandibular Dysfunction Among Adolescents. Oral
Health Prev Dent 11:3-7, 2013.
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Does Light Enhance Whitening?
Researchers report conflicting results when comparing
tooth whitening with and without the use of an intensifying
light. Some show that the light helps to whiten teeth while
others show it has no effect.
Researchers in the division of dental hygiene at Ohio
State University in Columbus, Ohio, compared whitening
with and without the use of the Zoom light from Discus
Dental, a division of Philips. The study included 49 patients
whose teeth were whitened using a 25 percent hydrogen peroxide
gel, Discus
Zoom 2.
For each patient, the gingiva was isolated using a light-cured
resin dam, Discus Liquidam. The whitening gel was placed on
the maxillary and mandibular anterior teeth at a thickness of
2mm. The gel was placed on the right or left half (depending on
random assignment) and the sodium arc light positioned
directly in front of the mouth for 15 minutes. The gel was then
removed with high volume evacuation and new gel was applied.
This process was repeated for three 15-minute whitening sessions.
The opposite sides of the arches were then treated with
three 15-minute whitening sessions without the light. Patients
were seen at one week and two weeks to take the shade and get
their feedback on whitening and sensitivity.
At one week, the maxillary teeth whitened using the light
were found to be a lighter shade. At two weeks, there was no
difference. Patients saw no difference at any time. Very little
sensitivity was reported.
Clinical Implications: When whitening with 25 percent hydrogen peroxide the light will only produce a lighter tooth
shade for one week.
Henry, R., Bauchmoyer, S., Moore, W., Rashid, R.: The Effect of Light on Tooth Whitening: A Split-Mouth Design. Int J Dent Hygiene 11:151-154, 2013.
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Vitamin D Found Beneficial for Periodontal Health
Although gingivitis and periodontitis are both caused by
the toxic waste products of oral bacteria, the immune system
plays a significant role in the health or breakdown of the
connective tissue and bone. A good diet and in some cases,
dietary supplements can enhance the immune system.
Vitamin D might be helpful in controlling the inflammation
associated with gingivitis and periodontitis. The upper limit
recommended by the U.S. Food and Nutrition Board is
2,000IU. Researchers suggest this limit could be safely raised
by 10 times.
Researchers at the Dental College in Dharwad Karnataka,
India tested three vitamin D dosages in a group of 88
patients in a randomized, placebo controlled trial. The
three-month study included four groups, each receiving a
dietary supplement. Three groups received vitamin D in various
dosages: 2,000IU, 1,000IU and 500IU. The fourth
group was given a placebo. At 30-day intervals, all the subjects
were seen for a blood draw to determine vitamin D levels
and a gingival index.
As anticipated there was no change in the blood level of
vitamin D in the placebo group. Blood levels of vitamin D
in the three test groups were elevated corresponding to the
supplement dosage. The higher vitamin D dose revealed a
correspondingly higher blood serum level.
The gingival index also revealed a dose-dependent
change, with the higher dose leading to greater reduction
sooner compared to the lower doses.
Clinical Implications: Vitamin D is a safe and effective
anti-inflammatory supplement when given in a dose of
2,000IU per day.
Hiremath, V., Rao, C., Naik, V., Prasad, K.: Anti-Inflammatory Effect of Vitamin D on Gingivitis: A
Dose-Response Randomized Control Trial. Oral Health Prev Dent 11:61-69, 2013.
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Curcumin Spice Mouthrinse Reduces
Gingival Inflammation
The gold standard mouthrinse for treating gingivitis
is chlorhexidine. The side effects of staining and taste
alteration make compliance with product use difficult.
Patients today are asking for natural products rather than
synthetic chemicals. Curcumin is derived from the root
of a spice with anti-inflammatory, antioxidant, antimicrobial
and antibacterial properties that can be used in
a mouthrinse. Curcumin is one of the substances in the
spice turmeric and gives it the yellow color.
Researchers at Rangoonwala Dental College in
Puna, India, compared a mouthrinse made with curcumin
to a 0.2 percent chlorhexidine mouthrinse in
patients with gingivitis. Three groups of 10 patients each
received scaling and root planing at baseline. The control
group received no mouthrinse. One test group was given
chlorhexidine 0.2 percent and the other test group was
given a 20 percent curcumin mouthrinse. Both rinse
groups were instructed to rinse twice daily for one
minute and to do the rinsing 10 minutes after brushing.
At days seven, 14 and 21, subjects were examined
and plaque and gingival indices were recorded. On day
seven, all three groups showed significant improvement
in the gingival index. On days 14 and 21, the two rinse
groups had lower scores than the control group. Plaque
scores reduced to the same degree for all three groups.
The curcumin mouthrinse may be a natural alternative
to chlorhexidine. Longer-term studies are needed to
confirm this finding.
Clinical Implications: It would be interesting to
find that a spice - curcumin (turmeric) - may possess
the anti-inflammatory properties capable of
controlling gingivitis.
Muglikar, S., Patil, K., Shivswami, S., Hegde, R.: Efficacy of Curcumin in the Treatment of
Chronic Gingivitis: A Pilot Study. Oral Health Prev Dent 11:81-89-6, 2013.
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One Session of Motivational Interviewing Not Enough
Motivational interviewing is a "collaborative,
person-centered form of guiding to elicit and
strengthen motivation for change." Motivational
interviewing engages people by asking them how
healthy they want to be and what they are willing to
do for oral hygiene and periodontal maintenance.
Traditional oral health education is typically a lecture
with instructions. Motivational interviewing
originated in the addiction field and is now being
used to achieve behavior change related to obesity,
physical fitness, mental health, glycemic control
and smoking cessation.
Researchers at University of Missouri in Kansas
City, Missouri, compared traditional oral health education
alone to traditional oral health education plus
a short 15-minute motivational interviewing session
in a group of 53 periodontal maintenance patients.
These patients had bleeding on probing scores of 40
percent or at least two interproximal sites with probing
scores of 5mm or more.
Patients underwent a regular periodontal maintenance
visit with oral hygiene education. All subjects
completed four questionnaires evaluating knowledge
and motivation. One week later, half the group
returned for the individualized motivational interview
session provided by an experienced non-dental
counselor. Clinical indices and questionnaires were
repeated at six and 12 weeks.
No differences were observed between the groups
for clinical indices or the knowledge and motivation
questionnaires. Perhaps if the motivational interviewing
had been part of the oral health education it
might have had an impact on motivation.
Clinical Implications: A separate motivational
interviewing session provided no added benefit
over traditional oral health education in a group
of periodontal maintenance patients being seen in
a university clinic.
Brand, V., Bray, K., MacNeill, S., Catley, D., Williams, K.: Impact of Single-Session
Motivational Interviewing on Clinical Outcomes Following Periodontal Maintenance
Therapy. Int J Dent Hygiene 11: 134-141, 2013.
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Prevention Education Varies Between Dentists
and Hygienists
Dental education is focused on repairing the damage of
dental disease with little emphasis on prevention compared
to the education of dental hygienists which focuses primarily
on prevention of dental disease. In the United Kingdom, the
National Health Service has focused on treatment rather
than prevention or quality in the past. Revised contracts
between the government and dentists will likely change the
reward system to focus on prevention and quality as well.
Education of dentists should include prevention.
Researchers at Cardiff University in Wales, U.K., used a
questionnaire to compare attitudes toward prevention
between dental undergraduates and hygienists and therapists.
A 28-item questionnaire was sent to 121 fourth- and
fifth-year dental students and 38 hygiene/therapy students.
The return rate was 62 percent with a similar return rate for
each group.
In the U.K., the Department of Health provides a toolkit
of prevention information it expects to be delivered to
adults. The four essential aspects are brushing twice daily
with fluoridated toothpaste, minimum of 1,350ppm fluoride
in the toothpaste, brush last thing at night and one
other time and spit out after brushing but don't rinse.
All the hygiene/therapy students found their education
adequately covered prevention, compared to 63 percent of
dental students. Dental students placed less emphasis on oral
health and would generally provide education only as needed
or only at the first visit. Hygienists/therapists who are educated
differently, reported they would provide oral hygiene
education much more frequently.
Clinical Implications: Dentists should rely on dental hygienists to provide prevention education to their patients.
Morgan, M., Verkroost, S., Hunter, L.: Evidence-Based Prevention: A Comparison of Oral Hygiene Advice Given by Dental and Dental Care Professional Students. Int J Dent Hygiene 11:121-125, 2013.
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