Perio Reports Vol. 26, No. 7 |
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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More Interest in Fresh Breath than Oral Health
Despite scientific evidence to prevent both caries and periodontal
disease, the incidence remains high. According to the
American Academy of Periodontology, 47 percent of Americans
have some form of periodontal disease. Dental hygienists focus on
the importance of oral health as they provide regular oral hygiene
instructions. In spite of repeated instructions, the incidence of
periodontal disease, even in clinical practice, remains high.
Repackaging of the oral hygiene message was undertaken
by an RDH to determine if using an emotional hook was more
effective than focusing on science and logic. Patients are not
generally motivated to prevent periodontal disease, but they
spend over $3 billion dollars on mouth rinse each year. The
majority of patients do not floss or clean between their teeth on
a daily basis.
For this study, 60 patients participated. When asked if they
wanted information to prevent periodontal disease to have fresh
breath, 78 percent chose fresh breath over oral health. When
information was presented about cleaning between the teeth,
with a variety of interdental tools, patients were receptive when
it was linked to having fresher breath. Surprisingly, patients had
little understanding of the oral or systemic link and did not
understand the role bacteria play in the mouth.
Switching from the scientific educational approach about
periodontal disease, bleeding gums and tooth loss to providing
patients with ways to keep their breath clean all day resulted in
better compliance with daily interdental cleaning. The end result
was the same: good oral health; but the motivation was fresh
breath, not oral health.
Clinical Implications: Linking interdental cleaning
with fresh breath leads to better patient compliance
with daily oral hygiene.
LaDolce-O’Brien, D.: By Altering My Oral Hygiene Presentation, Will My Patients be
More Receptive to Improving Their Oral Health? OHU Action Research 10A-13, 2014.
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Cochrane Review of Triclosan/Copolymer Toothpaste: Colgate Total
The Cochrane Collaboration reviewed 30 research studies
to determine the long-term benefits of Colgate Total toothpaste
compared to a standard fluoride toothpaste. Only randomized,
controlled trials were included in the review. A total
of 14,835 subjects were included in the 30 published research
papers reviewed for this report.
Plaque measurements were compared in most studies after
six months. Colgate Total, the only triclosan/copolymer toothpaste
tested, showed a 0.5 reduction in plaque using a plaque
score of zero to five. This was determined to represent a 22 percent
reduction in plaque compared to the fluoride toothpaste
group. After six to nine months, gingivitis scores were reduced
by 0.3 in the Total group for scores of zero to three. This also
represented a 22 percent reduction compared to the fluoride
toothpaste group.
Regarding periodontitis, no difference was seen between
the Colgate Total toothpaste and the fluoride toothpaste for
attachment loss figures after three years of use. For caries incidence,
there was a slight reduction in the Colgate Total group,
with five percent fewer decayed, missing and filled surfaces
(DMFS) after 24 to 36 months.
Adverse effects were not specifically evaluated, but 22 of
the 30 studies reported no adverse effects caused by either
toothpaste.
The clinical relevance of these findings was not determined
for this review paper.
Clinical Implications: Colgate Total toothpaste containing triclosan, a copolymer and fluoride appears to be safe and effective.
Riley, P., Lamont, T.: Triclosan/Copolymer Containing Toothpastes for Oral Health. The Cochrane Library Published Online, 5, Dec, 2013.
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Fluoride Varnish Reduces Dentinal Hypersensitivity
The incidence of dentinal hypersensitivity varies between eight
to 35 percent, depending on the study. Many products are available
to treat sensitivity, but there is no gold-standard product that
works for all patients. Approaches being used today include:
dentin bonding agents, pro-argin technology, amorphous calcium
phosphate (ACP), tricalcium phosphate (TCP) and lasers.
Fluoride varnish is used for caries prevention, but it was first
introduced and accepted by the FDA as a product to reduce sensitivity.
In this small action research project, four patients, ages 28
to 71 years of age, with dentinal hypersensitivity were treated with
5% sodium fluoride varnish. The varnish was applied at the end of
the dental hygiene visit. Subjects were tested weekly for sensitivity
to touch, air, cold and tooth brushing at baseline for four weeks.
All of the test subjects experienced relief to some degree. Some of
the subjects experienced more relief than others.
To address the issue of incomplete reversal of the sensitivity,
another product was introduced, a polishing paste using pro-argin
technology. This was applied with a rubber cup at slow speed for
three seconds on the affected area. This was done at the start of the
dental hygiene visit, leading to a comfortable appointment for
both patient and hygienist. This application resulted in immediate
blocking of the dentinal tubules and therefore immediate relief
from sensitivity. The combination of these two approaches to
dentinal hypersensitivity may provide more long term
sensitivity relief.
Clinical Implications: Both fluoride varnish and pro-argin
polishing paste relieve dentinal hypersensitivity.
Papadakas, M.: Applying Fluoride Varnish to Reduce Dentinal Hypersensitivity. OHU Action Research 12A-
13, 2014.
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Oral Health Behaviors for Nine-Year-Olds
Elementary schools are the ideal place to
implement oral health instructions that will
impact the future habit of the children. Parents,
especially mothers, play a crucial role in establishing
oral health habits for their children.
This three month study included 338 children,
all 9 year olds. Two test groups and one
control group were formed. Students were
enrolled from 12 elementary schools in Iran,
including six schools for girls and six schools for
boys. Baseline examination included a clinical
exam and questions of the children about who
influenced their oral hygiene practices and about
their last dental visit.
The two intervention groups included a
classwork group and a parent guided group. The
control group received no intervention. The
classwork group used puzzles to convey oral
health messages about daily toothbrushing and
use of fluoride toothpaste. The parents were
given a pamphlet about daily toothbrushing and
the use of fluoride toothpaste. They were also
encouraged to limit sugary snacks and to model
good behavior to their children.
Nearly 90 percent of children reported that
their parents were their main source of oral
health information. Two-thirds, or 68 percent,
reported visiting the dentist within the past year.
Girls more often than boys visited the dentist.
At baseline, all the boys expect two had
bleeding gums. After three months, 60 percent of
those in the two intervention groups and 32 percent
of controls had improved gingival health
(Hawthorne Effect).
Clinical Implications: Improvement in oral health
results from an oral health message presented by
either the health counselor or the parent.
Saied-Moallemi, Z., Murtomaa, H., Virtanen, J.: Change in Conceptions of
Iranian Pre-Adolescents’ Oral Health After a School-Based Programme: Challenge
for Boys. Oral Health Prev Dent 12:(1) 21-28, 2014.
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