Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians. Perio Reports research summaries will be included each month to keep you on the cutting edge of dental hygiene science.

The oral cavity is a reservoir for gastric ulcer bacteria

Stomach ulcers and, to some extent, gastric carcinoma are associated with Helicobacter pylori, a Gram-negative, spiral-shaped bacteria. Antibiotics plus antimicrobials and drugs to reduce gastric pH will successfully treat 80-90% of H pylori gastric infections. In some cases, reinfection does occur. The oral cavity is one site considered to harbor H pylori and contribute to reinfection. H pylori have been found in saliva, supra and subgingival plaque, on the tongue and on tissue irritations.

Researchers at the University of São Paulo, Brazil evaluated 30 patients, half with gingivitis and half with chronic adult periodontitis who were being treated for gastric infection. All of the subjects underwent an upper digestive endoscopy that confirmed the presence of H pylori. All of them were prescribed the triple therapy of lansoprazole, 30 mg; amoxicillin, 1 g; and clarithromycin, 500 mg twice daily for seven days. Three months later, patients underwent another endoscopy and oral testing for H pylori in saliva, supra- and subgingival plaque and on the tongue.

Three subjects or 10% remained positive for gastric H pylori when evaluated with endoscopy after treatment. The triple therapy was effective in eradicating gastric H pylori in 90% of the subjects, but not in eliminating H pylori from the oral cavity. After the triple therapy, 60% (18 patients) still harbored H pylori in the oral cavity. Only four patients who were positive for oral H pylori at baseline were negative for oral H pylori after treatment. The oral cavity provides a reservoir for these bacteria and the potential for reinfection.

Clinical Implications: Patients receiving antibiotics for gastric ulcers should also consider periodontal therapy, as oral bacterial biofilm is a reservoir for H pylori.

Gebara, E., Faria, C., Pannuti, C., Chehter, L., Mayer, M., Lima, L.: Persistence of Helicobacter Pylori in the Oral Cavity after Systemic Eradication Therapy. J Clin Perio 33: 329-333, 2006.

Probing requires technique, not just the right probe

The periodontal probe remains the most important diagnostic tool in determining disease presence, progression and healing. Both manual and automated probes are used today, with no clear gold standard. Researchers in the Netherlands compared four probes on 12 maintenance patients to determine which provided accurate reproducibility. The first molars were measured at six points per tooth, for a total of 288 measurements. Probing was done twice the first time, 30 minutes apart and then again a week later.

The two most common probes tested were the Florida Probe and a manual probe from Hu-Friedy. The Jonker Probe from the Netherlands and the Brodontic Probe from the UK were also tested. The tapered tine of the Florida Probe is 0.4 mm in diameter at the tip, enlarging to 0.5 mm at the 5 mm mark and 0.6 at the 10 mm mark. The tapered tine of the other probes is slightly larger, with a 0.5 mm diameter at the tip, enlarging to 0.6 mm at the 5 mm mark and 0.7 at the 10 mm mark. The three pressure sensitive probes were set to the manufacturer’s recommended pressure.

Half the sites measured 4 mm or more. The average interproximal probing depth with the manual probe was 4.6 mm and bleeding upon probing was found at 23% of these sites. The Brodontic Probe also produced a similar average interproximal score of 4.6 mm. The mean interproximal probing depth recorded with the Florida Probe was 3.9 mm and with the Jonkers Probe it was 3.8 mm. Average buccal and lingual measurements ranged from 2.2 to 2.7 mm, with the manual probe average being 2.6 mm.

Differences were observed in probe readings, due to probing technique. In some instances, measurements ranged from 0 to 3.5 mm, which means that the probe tip didn’t even enter the sulcus. This was explained to be the result of the pressure set with automated probe being too low and the probe tine being too large. The Jonkers Probe was used at a lower pressure setting than the other automated probes, resulting in some readings of zero.

The design of the Florida and Jonkers probes make them difficult to access distal lingual sites, which may explain why measurements were not reproduced as accurately as with the manual and Brodontic probes.

Clinical Implications: Based on these findings, the authors suggest the most reproducible readings will be found with either a manual probe or the Brodontic Probe.

Barendreegt, D., Van der Velden, U., Timmerman, M., van der Weijden, G.: Comparison Of Two Automated Periodontal Probes And Two Probes With A Conventional Readout In Periodontal Maintenance Patients. J Clin Perio 33: 276-282, 2006.

Is rinsing with SLS slurry the same as brushing with SLS toothpaste?

Sodium lauryl sulphate (SLS) is a detergent used in toothpaste that was found to reduce the plaque inhibition effects of chlorhexidine. Studies to confirm this theory used a slurry of toothpaste containing SLS as a mouthrinse rather than as a toothpaste. Since that time, recommendations to patients included a warning to separate toothbrushing and CHX rinsing by at least 30 minutes and preferably two hours. This was suggested to avoid reducing the antimicrobial effect of CHX.

Researchers at the Academic Centre for Dentistry Amsterdam wondered if rinsing with an SLS slurry was in fact the same as brushing with a toothpaste containing SLS. They designed a study to measure the effect on plaque accumulation over four days of rinsing with an SLS slurry or toothbrushing with an SLS toothpaste prior to rinsing with CHX. Using CHX alone was the positive control.

One jaw was randomly assigned to be the “test” jaw and the other the “toothbrushing” jaw for the group brushing. The test jaw was monitored for plaque accumulation. All subjects received a two-part prophylaxis at baseline. The first clinician used disclosing solution and removed all supragingival plaque and calculus using a sonic scaler and polishing. Then the second clinician repeated the process, to remove any remaining deposit. For the next four days, subjects used their assigned rinses and/or toothpaste twice daily under supervision of two dental assistants. Subjects refrained from using any other oral hygiene product during the test period.

Group 1 used only a CHX rinse. Group 2 rinsed with a SLS slurry followed by the CHX rinse. Group 3 brushed the assigned jaw with an SLS toothpaste and manual toothbrush, followed by the CHX rinse. Only one jaw per subject was evaluated for plaque accumulation.

After four days, plaque scores in the assigned jaw were 1.17 for CHX alone, 1.62 for the SLS slurry plus CHX, and 1.14 for toothpaste plus CHX. Based on these findings, using an SLS containing toothpaste prior to rinsing with CHX shouldn’t reduce the antimicrobial effects of the rinse.

Clinical Implications: Patients should still experience the antimicrobial effects of CHX when they brush first with an SLS toothpaste.

Van Strydonck, D., Timmerman, M., Van der Velden, U., Van der Weijden, G.: Chlorhexidine Mouthrinse in Combination with an SLS-Containing Dentifrice and a Dentifrice Slurry. J Clin Perio 33: 340-344, 2006.