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Perio Reports

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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.
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.

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.
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.

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.
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.

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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