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Perio Reports Trisha E. O'Hehir, RDH, BS, Editorial Director, Hygienetown Magazine

More by this author (282)
Perio Reports  Vol. 20 No. 6
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.
Xylitol chewing gums reduce caries rates

This is a Classic Study, published a number of years ago and still referenced by authors today.

Caries is a bacterial disease that can affect quality of life and consumes considerable health care resources. Despite widespread use of fluoride in many forms, caries remains a staggering public health and economic burden.

Researchers have suggested that chewing gum stimulates saliva, which should help reduce the incidence of caries. This was the first study designed to compare, side-by-side, several chewing gum formulations.

Researchers from the University of Michigan compared nine treatment groups among fourth graders in Belize, Central America. The study included the 19 public schools in Belize City and lasted 40 months. The nine test groups were:
  1. no gum control
  2. sugar stick gum five-times daily
  3. sorbitol pellet gum five-times daily
  4. 45 percent xylitol/30 percent sorbitol pellet gum five-times daily
  5. 15 percent xylitol/45 percent sorbitol pellet gum five-times daily
  6. 60 percent xylitol stick gum three times daily
  7. 60 percent xylitol stick gum five-times daily
  8. 65 percent xylitol pellet gum three-times daily
  9. 65 percent xylitol pellet gum five-times daily
Gum chewing was supervised while at school and gum and instructions were given for weekends, holidays and vacations.

One of four dentists examined each child at baseline, 16, 28 and 40 months. The sugar gum resulted in a slight increase in caries compared to the control group. All the sorbitol and xylitol gums showed various levels of anticaries effects. The most effective gum for caries prevention was the xylitol-sweetened gum chewed five times daily.

Clinical Implications: Encourage patients to chew 100 percent xylitol sweetened chewing gum five times per day to achieve the greatest anticaries benefit of xylitol.
Mäkinen, K., Bennett, C., Hujoel, P., Isokangas, P., Isotupa, K., Pape, H., Mäkinen, P.: Xylitol Chewing Gums and Caries Rates: A 40-Month Study. J Dent Research 74: 1904-1913, 1995.
Low-level laser enhances tissue healing

Lasers are being used more in dentistry, primarily for cutting hard and soft tissues, pocket debridement, detoxification of root surfaces and bacterial elimination. Low-level lasers, which don't cut tissue, are used for biostimulation to enhance healing. Low-level lasers stimulate cell metabolism and speed up cell repair.

Researchers at Cukurova University in Turkey used a low-level laser following gingivectomy procedures to measure the effects on healing. Three weeks after scaling and root planing, patients underwent periodontal surgery to reduce bulky tissue, in either the maxillary or mandibular anterior region (six teeth minimum). Low-level laser treatment was provided to one side of the surgical site for five minutes. The laser treatment was repeated daily for the next seven days. Prior to laser treatment, the area was swabbed with a two stage disclosing solution that stained as yet unhealed epithelium.

Laser treatment resulted in slightly faster healing, 18 to 21 days vs. 19 to 24 days. The authors suggest that laser treatment on half the surgical site may have enhanced healing on the non-laser treated side by triggering systemic aspects of healing.

Clinical Implications: We might see more low-level lasers in the future, used to enhance tissue healing.

Ozcelik, O., Haytac, M., Kunin, A., Seydaoglu, G.: Improved Wound Healing by Low-Level Laser Irradiation After Gingivectomy Operations: A Controlled Clinical Pilot Study. J Clin Perio 35: 250-254, 2008.
New treatment for lichen planus

Lichen planus is a chronic inflammatory disorder affecting either skin or oral mucosal tissue. Skin lesions occur generally around wrist and ankle areas, are mild and resolve within two years. Oral lichen planus (OLP) is a longer lasting, chronic condition with acute outbreaks of pain and burning, which interferes with quality of life. OLP affects women more often than men and is generally seen in people over 40 years of age. Three types of OLP have been identified: white, hyperkerototic, which is often asymptomatic; red, erythematous with mild to moderate symptoms; and yellow or errosive/ulcerative which has persistent symptoms.

Researchers at the University of Verona in Italy compared a 0.05 percent corticosteroid ointment (clobetasol or Temovate) to a test ointment made with one percent tacrolimus, an injectable drug recently replacing cyclosporine for organ transplant patients. OLP lesions in the test subjects were confirmed with biopsy. Blood samples were taken at baseline and following the six-week study. Clobetasol ointment was used by 16 subjects and tacrolimus ointment by another 16 subjects. A burning sensation was reported the first two days for nine of the subjects using the tacrolimus ointment. The ointments were placed four times daily for four weeks. Evaluations were done at baseline, four and six weeks.

Both groups reported reduced pain, burning and lesion size. The tacrolimus group reported significantly greater reductions. Forty-four percent of the tacrolimus group was completely free from pain at six weeks. Despite improvement in the clobetasol group, none of the subjects were completely pain free at the end of the study.

Clinical Implications: We might see a new ointment for oral lichen planus in the near future.

Corrocher, G., et al: Comparative Effect of Tacrolimus 0.1% Ointment and Clobetasol, 0.05% Ointment in Patients with Oral Lichen Planus. J Clin Perio 35: 244-249, 2008.
Chlorhexidine used with an ultrasonic scaler
Transient bacteremia occurs following subgingival instrumentation. Increases in inflammatory mediators are also evident in the blood stream. In people with moderate to advanced periodontal disease, chewing can force endotoxins into the circulating blood stream. Subgingival instrumentation can injure the sulcular lining, allowing whole bacteria to enter the blood stream.

Chlorhexidine (CHX) is sometimes used as a pretreatment mouthrinse and also as the lavage for power scalers. Not all research shows that using CHX for power scaler lavage reduces bacteremia. Researchers at King's College in London, used a 0.02 percent CHX solution in a Dentsply Dual Select irrigation unit in conjunction with a Bobcat ultrasonic scaler on 18 periodontally involved patients. The CHX lavage was used on one side of the mouth and the other side was treated with the power scaler using a saline lavage.
An indwelling cannula was inserted into the ante cubital fossa of the arm and blood samples were drawn at baseline, and five and 120 minutes after instrumentation began. Each patient was treated twice, first for quadrants on the right side and then for quadrants on the left side. Treatment was randomly assigned to each half of the mouth.

Interleukin 6 (IL6) and lipopolysaccharide (LPS) were measured in the circulating blood, with no differences noted between treatment groups. There was a slight increase at five minutes and a more significant increase at two hours.

Clinical Implications: CHX power scaler lavage did not alter IL6 or LPS levels in the blood following subgingival instrumentation.

Lee, M., Ide, M., Coward, P., Wilson, R.: Effect of Ultrasonic Debridement Using a Chlorhexidine Irrigant on Circulating Levels of Lipopolysaccharides and Inteleukin-6. J Clin Perio 35: 415-419, 2008.
Allergies are inversely related to periodontal disease
Recently published research shows that adults with periodontal disease are less prone to allergies and asthma than those who are periodontally healthy. The same researchers who reported these findings about a group of residents in Northern Germany, then evaluated a group in the same geographic area with type-1 diabetes. Those with diabetes are at greater risk of periodontal disease, so it was hypothesized that they would then experience less risk for respiratory allergies.

A total of 170 patients between 17 and 80 years of age were evaluated. All had type-1 diabetes. Clinical examinations included both restorative and periodontal data. A computer-aided personal interview was used to collect information about medical history, habits, socioeconomic status, hayfever, house dust mite allergies, and asthma.
Twenty-two subjects or 13 percent of the group had respiratory allergies. The previously published study on non-diabetics revealed 15.4 percent with respiratory allergies. It is believed that the presence of periodontal disease provides a protective effect against the development of respiratory allergies. No relationship was discovered between restorative findings and respiratory allergies.

Clinical Implications: There is an inverse relationship between periodontal disease and respiratory allergies. As attachment loss increases, the risk of allergies decreases. Despite these findings, allowing periodontal disease to develop is not the best way to prevent allergies.

Friedrich, N., Kocher, T., Wallaschofski, H., Schwahn, C., Lüdemann, J., Kerner, W., Völzke, H.: Inverse Association Between Periodontitis and Respiratory Allergies in Patients with Type 1 Diabetes Mellitus. J Clin Perio 35: 305-310, 2008.
Alcohol consumption and oral health

Smoking and diabetes are the most important risk factors for periodontal disease. Now lifestyle factors are proposed as factors to explain the severity of periodontal disease in some people. Alcohol consumption is considered a lifestyle factor with a risk-modifying effect. Studies report conflicting effects of alcohol on periodontal disease levels. Some report a correlation while others report no correlation.

Researchers in Sweden reported that 90 percent of males and 80 percent of females use alcohol and 18 percent of men and five percent of women consume harmful levels. To determine if alcohol consumption has detrimental effects on oral health, adults in the county of Stockholm were surveyed. Clinical and interview data were collected in 1970 and 1990. A total of 477 adults completed all phases of the study. Alcohol consumption information was reported for the frequency, volume and kind of alcoholic beverage (beer, wine, hard liquor) consumed. Calculations were then made to determine the individual's consumption in centiliters (one one-hundredth of a liter) of pure alcohol. The subjects were then divided into two groups, those who consumed five or less centiliters (cl) of pure alcohol each day and those who consumed more than five cl per day.

Those consuming more than five cl per day visited the dentist and dental hygienist significantly more irregularly than the other group. This group also had more missing teeth, more plaque, more calculus, more carious lesions and more apical lesions. However, the high alcohol intake group did not have significantly more periodontal disease as measured by bone loss and attachment loss.

Clinical Implications: Alcohol consumption does have an impact on oral health, but according to the findings in this study, there is no direct link to increased periodontal disease.

YJansson, L.: Association Between Alcohol Consumption and Dental Health. J Clin Perio 35: 379-384, 2008.
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