Message Boards
Today's Active Topics Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Perio Reports

View Comments (2)

Perio Reports  Vol. 25, No. 11
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.
NHANES Report on the Prevalence of Perio in Adults

The National Health and Nutrition Examination Sur vey (NHANES) is a large-scale study first completed in 1960- 1962 and repeated several times since then, with the most recent report covering 2009 and 2010. One area of investigation within this large scale study is the prevalence and incidence of periodontal disease in adults. In past surveys, only partial-mouth probings were done. This is the first to report six probing sites per tooth for all teeth in the mouth.

Dental hygienists working in mobile clinics examined 3,743 patients across 50 states and the District of Columbia. This sample represents 137.1 million civilian, non-institutionalized American adults.

Definitions of periodontitis for this study included severe with two or more interproximal sites with 6mm or more of attachment loss (AL) and one or more sites with 5mm or more of probing depth (PD), moderate was two or more interproximal sites with 4mm or more of AL and two or more sites with 5mm or more of PD, and mild was two or more interproximal sites with 3mm or more of AL and two or more sites with 4mm or more of probing depth.

The prevalence of periodontitis in this group was 47.2 percent representing 64.7 million people. Reports for disease severity were: 8.7 percent with mild, 30 percent with moderate and 8.5 percent with severe. In adults 64 years or older the prevalence of periodontitis was 70.1 percent. Periodontitis was highest in men and Mexican Americans.

Clinical Implications: Periodontitis remains a significant public health problem, especially among the aging population.

Eke, P., Dye, B., Wei, L., Thornton-Evans, G., Genco, R.: The Prevalence of Periodontitis in the United States: 2009 and 2010. J Dent Res 91(10): 914-920, 2012.

Periodontal Disease Significantly Underestimated

Past NHANES studies suggested a decline in periodontitis based on partial-mouth probings. Previous partial-mouth probings presented biased data that did not accurately represent the extent of periodontal disease in this country.

In past studies, only two random quadrants were evaluated and only two sites per tooth measured: mesial-buccal and mid-buccal. In one of the studies they used three sites, including the distal-buccal site. This data led to a prevalence rate for periodontitis of 19.5 percent with two sites per tooth or 27.1 percent with three sites per tooth compared to the 2009-2010 figure of 47.2 percent, based on full-mouth data.

Prior to the current study results, a decrease was reported over a 15-year period. Attachment levels of 6mm or more were reported to drop from 8.4 percent to 5.3 percent. Compare the 5.3 percent reported in 1999-2004 to the current level of 25.5 percent reported for attachment loss of 6mm more and the bias of partial-mouth probing in previous study results is clear. Had the latest data been collected with partial probings, there would have been nearly a five-fold underestimation of periodontal disease prevalence.

Socio-demographic patterns remain the same from past to current NHANES findings. Periodontitis is more prevalent in men, smokers, people below the poverty line and those with the lowest education. Mexican Americans are now more affected than Non-Hispanic Blacks.

Clinical Implications: Periodontitis has been underestimated by 50 percent with new figures suggesting that nearly 50 percent of the population has some periodontal disease and 70 percent of those over 65 years of age are affected.

Papapanou, P.: The Prevalence of Periodontitis in the US: Forget What You Were Told. J Dent Res 91(10): 907-908, 2012.
Manual Toothbrushing Removes Less than 50 Percent of Plaque

Toothbrushing is generally accepted as the most common practice to reduce oral plaque biofilm. Despite the introduction of a variety of toothbrush designs and bristle configurations, no one toothbrush design has been found to be superior for plaque removal. Personal preference for one brush over another is how people decide which brush to use. Enthusiastic brushing is not however synonymous with effective plaque removal. Most people are able to remove approximately 50 percent of plaque with a one-minute brushing. This means people are generally not very good toothbrushers and live their lives with considerable plaque on their teeth. A systematic review was needed to determine the effectiveness of manual toothbrushing.

Researchers at University of Amsterdam in the Netherlands evaluated all available studies to determine the effect of manual toothbrushing on plaque removal. A total of 59 papers with 212 brushing experiments were evaluated. A total of 10,806 subjects participated in these studies. The outcome analyzed from each of these studies was the percentage of reduction in plaque from before to after the brushing exercise.

Overall, the manual toothbrush provides a 42 percent reduction in plaque scores. The reduction is 30 percent when the Quigley and Hein plaque index is used and 50 percent when the Navy plaque index is used. Sub-analysis revealed that various bristle designs reduced plaque scores 24 to 61 percent. Toothbrushing time also impacted plaque removal. For studies brushing for one minute, the mean plaque reduction was 27 percent and increased to 41 percent with two minutes of brushing.

Clinical Implications: Toothbrushing doesn’t remove as much plaque as you might expect.

Slot, D., Wiggelinkhuizen, L., Rosema, N., Van der Weijden, G.: The Efficacy of Manual Toothbrush Following a Brushing Exercise: A Systematic Review. Int J Dent Hygiene 10: 187-197, 2012.

Dry Brushing Mandibular Lingual Surfaces First

Standard toothbrushing instructions focus on bristle placement and toothbrush movement, not where to start brushing. Mandibular lingual surfaces have the highest levels of both calculus and gingivitis, but this area is often the last to be brushed, if at all. Many clinicians followed their common sense instincts and recommended that patients brush mandibular lingual surfaces first. Individuals reported success with this approach, but no research was available to confirm these findings.

To test this theory, 29 dental hygienists were invited to participate in a pilot study to measure the effects of lingual brushing first on calculus and bleeding. They invited patients with heavy lingual calculus to participate in the study. Since all were busy clinicians, data collection was limited to mandibular lingual surfaces, measuring calculus and bleeding upon probing. A total of 126 patients participated in the study. Dental hygienists instructed the patients to begin brushing on the lingual surfaces of the mandibular arch. They were told to brush dry, no water and no toothpaste. They followed their regular brushing technique, brushing until all the teeth in the mouth felt clean and tasted clean. At that point, they rinsed their toothbrush, added toothpaste and brushed again to deliver the toothpaste to the tooth surfaces. They were seen again at six months.

Analysis of the data revealed a 55 percent reduction in bleeding on the mandibular lingual surfaces and a 58 percent reduction in calculus. When analyzing data from just the mandibular anterior teeth, the reduction in calculus was 63 percent. Patients reported brushing longer and more evenly throughout their mouths.

Clinical Implications: Teach patients to dry brush mandibular lingual surfaces first to achieve longer time brushing and more thorough plaque removal.

O'Hehir, T., Suvan, J.: Dry Brushing Lingual Surfaces First. JADA 129:614, 1998.
Dental Floss Provides No Benefit over Toothbrushing Alone

Dental flossing is encouraged and recommended daily by dentists and dental hygienists. Dental professionals believe, based on common sense, that dental floss is effective. However, the research doesn’t bear this out. Some studies show no benefit when flossing is added to toothbrushing.

Researchers at the University of Applied Sciences in Amsterdam, the Netherlands, performed a Cochrane Review to see how brushing alone compared to brushing and flossing. Of the 187 studies they evaluated, 11 met the criteria for inclusion in the review process. They were controlled, clinical trials lasting at least four weeks on subjects 18 years of age and older. Many of the studies showed no benefit from flossing on either plaque levels or gingivitis. The data from these studies was extracted and evaluated by way of a meta-analysis to determine the effect of daily dental floss use on plaque and gingivitis levels.

While individual studies may show some benefit when flossing is used without toothbrushing, this systematic review of dental floss research showed no beneficial effect when dental flossing was added to toothbrushing. Two of the studies included involved dental students with more than average knowledge of proper brushing and flossing technique. However, even with that advantage over the general population, no benefit from flossing was demonstrated. Dental floss is no longer the first choice for interdental control of plaque and gingivitis.

Clinical Implications: Clinicians must decide on an individual basis what the best interdental tool is for each patient. The scientific evidence does not support recommending dental floss to every patient.

Berchier, C., Slot, D., Haps, S., Van der Weijden, G.: The Efficacy of Dental Floss in Addition to a Toothbrush on Plaque and Parameters of Gingival Inflammation: A Systematic Review. Int J Dent Hygiene 6: 265-279, 2008.

Fluoride Toothpaste Reduces Caries 23 Percent

Fluoride toothpastes have been used since the 1950s in the United States and are widely used and recommended today. A review of the randomized, controlled trials comparing toothpastes of varying fluoride concentrations was undertaken as a Cochrane Review. The studies reviewed were published between 1955 and 2009 in the U.S. and the U.K. The minimum study length was 12 months and the longest study was seven years. Analysis focused on the data closest to the three-year mark. Study participants were children up to the age of 16.

A total of 75 papers covering 83 independent trials were included in the review. Fluoride concentrations of 440/500/550ppm showed no beneficial effect when compared to a placebo toothpaste for caries reduction. Toothpastes with fluoride concentrations of 1000/1055/ 1100/1250ppm demonstrated a 23 percent effect when compared to a placebo. Higher concentrations proved greater benefit. This figure is called the “prevented fraction” and is calculated by taking into account the effect of both the test and placebo group averages for caries reduction. This figure is considered a more accurate representation of the preventive effect of the fluoridated toothpastes.

Analysis was also done on the potential for dental fluorosis in children under the age of six years when any topical fluoride was used. No significant association was found between the frequency of brushing with fluoride toothpaste or the fluoride concentration on dental fluorosis.

Clinical Implications: Fluoride toothpaste has the potential to provide a caries reduction benefit of 23 percent. Additional approaches and interventions are needed to achieve 100 percent caries prevention.

Wong, M., Clarkson, J., Glenny, A., Lo, E., Marinho, V., Tsang, B., Walsh, T., Worthington, H.: Cochrane Reviews on the Benefits/Risks of Fluoride Toothpastes. J Dent Res 90(5):573-579, 2011.
Sponsors
Site Menu
Message Boards Articles Continuing Education Podcasts Blogs Classifieds News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2024 Hygienetown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450