Biomedical subjects

M F Timmerman

Publications and source records attributed to M F Timmerman.

At least 37 records · Page 2Linked to original sources

PubMed2005

The combined use of enamel matrix proteins and a tetracycline-coated expanded polytetrafluoroethylene barrier membrane in the treatment of intra-osseous defects.

OBJECTIVES: The purpose of this split-mouth study was to evaluate the clinical response of enamel matrix proteins (EMPs, Emdogain Gel in intra-osseous defects with or without a combined application of a tetracycline-coated expanded polytetrafluoroethylene barrier membrane (e-PTFE, Gore-Tex). METHODS: Twelve pairs of intra-osseous periodontal defects in 11 patients received the application of EMPs on the exposed root surface (EMP). One of the two defects received randomly, as an adjunct to EMP treatment, a tetracycline-coated e-PTFE membrane (MEMP). At baseline, 6- and 12-month probing pocket depth (PPD), clinical attachment level (CAL) and probing bone level (PBL) were measured. RESULTS: After 12 months, the EMP defects showed a significant mean PPD reduction of 2.86+/-0.75 mm, a mean gain in CAL of 1.28+/-2.04 mm, a mean PBL gain of 1.63+/-1.21 mm and a mean increase of recession (REC) of 1.56+/-2.30 mm. The MEMP defects showed a significant mean PPD reduction of 3.02+/-1.55 mm, a mean gain in CAL of 1.65+/-1.29 mm, a mean PBL gain of 1.58+/-1.92 mm and a mean increase of REC of 1.38+/-1.63 mm. Except for significantly more post-operative discomfort at the MEMP sites, no significant differences were found between EMP and MEMP defects. CONCLUSION: Within the limits of this study, it is concluded that in the treatment of intra-osseous defects with EMP, the adjunctive use of a tetracycline-coated e-PTFE membrane failed to show more gain of CAL and PBL.

Adolescent↗

PubMed2005

Sonic-powered toothbrushes and reversal of experimental gingivitis.

OBJECTIVE: To compare two sonic toothbrushes in relation to the reversal of experimental gingivitis. MATERIALS AND METHODS: Subjects refrained from brushing mandibular teeth for 21 days. During a 4-week treatment phase, the right or left side of the mouth was brushed with either the Sonic Complete (SC) or Sonicare Elite (SE) toothbrush as randomly allocated. Plaque and gingivitis were assessed on day 0, after 21 days of no oral hygiene and after 1, 2 and 4 weeks of brushing twice daily. RESULTS: Thirty-four subjects provided evaluable data. The experimentally induced gingivitis (EIG) resulted in higher bleeding and plaque scores compared with day 0. The mean plaque scores at day 21 changed from 3.09 to 1.30 for the SC, and from 3.02 to 1.21 for the SE. At the end of the treatment period, there was no significant difference between the two brushes. The mean bleeding scores changed from 1.87 (day 21) to 0.97 for the SC, and from 1.83 to 0.92 for the SE. For the assessments at 1, 2 and 4 weeks post-EIG, both brushes showed a significant decrease in bleeding scores. There were no statistically significant differences between brushes.

Adolescent↗

PubMed2004

Effect of a combination of amine/stannous fluoride dentifrice and mouthrinse in periodontal maintenance patients.

AIM: The purpose of the present study was to evaluate the beneficial effect of using a dentifrice and mouthrinse containing amine fluoride (AmF) and stannous fluoride (SnF(2)) in a group of periodontal maintenance patients. Efficacy parameters were plaque, gingival inflammation, pocket depth and attachment loss. An additional parameter was development of stain. MATERIAL AND METHODS: In total, 80 patients who had been treated for moderate-to-severe periodontitis agreed to participate in this study. Subjects received supportive periodontal therapy at regular intervals of 3-4 months for at least a period of 1 year. The patients were randomly divided into two groups: (1). the test group used an AmF/SnF(2) dentifrice and mouthrinse and (2). the control group used a sodium fluoride (NaF)-containing dentifrice and mouthrinse. Clinical assessments were performed at baseline, 3, 6, 12, 18 and 24 months. RESULTS: The mean plaque index score after 3 months in the test group (0.24) was significantly lower than that in control group (0.34) (p<or=0.05), a difference that was maintained throughout the remainder of the study. In terms of bleeding on probing, at no point in time were significant differences between test and control group found. No significant differences were noted between the two groups, nor were there any significant changes in comparison with baseline values with respect to pocket depth and attachment level. At baseline, the mean percentage of sites with no staining was 98% for both the test and control groups. At all further assessments, the staining in both groups was elevated as compared with baseline. Smoking did not affect the outcome of the study. CONCLUSION: The combined use of an AmF/SnF(2) dentifrice and mouthrinse did not affect the parameters of inflammation (bleeding upon marginal probing and probing pocket depth), but it has shown to be more effective in terms of plaque reduction when compared with the use of an NaF dentifrice and mouthrinse in a group of periodontal patients placed under regular maintenance care.

Amines↗

PubMed2004

Plaque development in relation to the periodontal condition and bacterial load of the saliva.

AIM: To investigate the influence of the oral bacterial load on plaque development in various groups of periodontitis patients and in healthy subjects. MATERIAL AND METHODS: This study included subjects with a healthy periodontium, a healthy reduced periodontium after treatment, an inflamed reduced periodontium after treatment and untreated periodontitis. At the start of the study, subjects were instructed to rinse with 10 ml reduced transport fluid (RTF) for 10 s in order to evaluate the oral bacterial load. The microbiological evaluation included anaerobe culture and phase-contrast microscopy. Next, the amount of plaque and the clinical condition were evaluated. Thereafter, all supragingival plaque was removed and patients were instructed to refrain from all oral hygiene procedures for 19 h. Subsequently, the rinsing procedure and the evaluation of the amount of plaque were repeated. RESULTS: The amount of plaque that developed in 19 h was significantly higher in the untreated periodontitis group as compared with the two healthy groups. In case of an inflamed reduced periodontium, sites with deep pockets developed more plaque in 19 h than sites with shallow pockets. The number of bacteria present in the rinsing samples of the two inflamed groups was considerably higher than of the two periodontally healthy groups. A significant correlation was found between the bleeding index at intake and the plaque index at 19 h. No correlations were found between gingival recession and the bacterial counts at intake, and the plaque index at 19 h. CONCLUSION: The present findings support the concept that the periodontal condition is the dominating factor in relation to the rate of plaque formation. The number of bacteria present in the oral cavity as ascertained by means of a rinsing sample does not seem to play a role.

Adult↗

PubMed2004

Influence of a SLS-containing dentifrice on the anti-plaque efficacy of a chlorhexidine mouthrinse.

BACKGROUND: Chlorhexidine (CHX) and sodium lauryl sulphate (SLS), the most widely used detergent in dentifrice, may counteract. Consequently, studies about this interaction suggested that care is required when combining both these compounds, even when they are introduced separately into the oral cavity. The purpose of the present study was to investigate the effect of toothbrushing with a SLS-containing dentifrice in one jaw, on the plaque inhibition of a CHX mouthrinse in the opposite jaw during a 4-day study period. METHODS: The study was an examiner-blind, randomised two-cell, crossover design. It used a 4-day plaque accumulation model to compare two different oral hygiene regimens with a washout period of 17 days. Sixteen healthy volunteers were enrolled in the study and received a thorough dental prophylaxis at the beginning of each 4-day test period. One jaw (upper or lower) was randomly assigned as the "study" jaw. The opposite jaw was assigned as the "dentifrice" jaw and served only to introduce the effect of brushing with a dentifrice in the study model. Two oral hygiene regimens were evaluated. During one randomly assigned test period, the "dentifrice" jaw was treated by toothbrushing with a 1.5% SLS-containing dentifrice and rinsed together with the "study" jaw with 0.2% CHX, thus forming regimen 1. As a control during the other test period, both the "dentifrice" jaw and "study" jaw were only rinsed with 0.2% CHX, forming regimen 2. No other oral hygiene methods were allowed. After 4 days of undisturbed plaque accumulation, the amount of plaque was evaluated (Silness & Löe 1964). The "study" jaw was used to study the effect of the two regimens on the level of plaque accumulation at the end of the 4-day period. RESULTS: The overall plaque index was 0.36 for regimen 1 and 0.34 for regimen 2. There was no significant difference in plaque accumulation between the two regimens. CONCLUSIONS: Within the limitations of the present study design, it can be concluded that ordinary brushing with a 1.5% SLS-containing dentifrice (Colgate Bi-Fluor), followed by rinsing with water does not appear to reduce the level of plaque inhibition offered by a post-brushing CHX rinse.

Adult↗

PubMed2004

Atmospheric contamination during ultrasonic scaling.

OBJECTIVE: The aim of this study was to determine the microbial atmospheric contamination during initial periodontal treatment using a piezoelectric ultrasonic scaler in combination with either high-volume evacuation (HVE) or conventional dental suction (CDS). METHODS: The study included 17 treatment sessions, consisting of a 40-min episode of continuous plaque and calculus removal using an ultrasonic unit (EMS). The treatment sessions were carried out in six patients with generalized adult periodontitis and ranged from two to four sessions per patient according to their needs. The use of HVE and CDS was randomly assigned over the sessions within each patient. Before each treatment, the operating room was not used for 15 h. To measure baseline microbial air pollution two Petri dishes containing blood agar were exposed for 10 min to the air. At the start of each treatment session, two Petri dishes were exposed for 5 min at a distance of 40 cm from the mouth of the patients. After 20 min, this procedure was repeated. At a distance of 150 cm, two Petri dishes were exposed for 20 min followed by exposure of two new Petri dishes for the rest of the session. The plates were cultured aerobically and anaerobically for 3 and 7 days, respectively. RESULTS: The mean colony forming units (CFU) before treatment never exceeded 0.6 colonies per plate. At 40 cm, the mean CFU, when considering a period of 40 min, was 8.0 for HVE and 17.0 for CDS. The mean CFU at 150 cm during this period was 8.1 with HVE and 10.3 with the CDS. With reference to the Air Microbial Index the operatory atmosphere was considered to be in a good condition during 40 min of continuous use of the ultrasonic scaler in combination with both HVE and CDS. CONCLUSION: Within the restrictions of this study, only limited atmospheric microbial contamination is produced when using a piezoelectric ultrasonic scaler.

Adult↗

PubMed2004

High and low brushing force in relation to efficacy and gingival abrasion.

OBJECTIVES: Does a high brushing force induce more gingival abrasion than a low (regular) brushing force? Furthermore, what is the effect of a low or high force on the efficacy? METHODS: Thirty-five non-dental students were selected. All received an appointment prior to which they abstained from oral hygiene for at least 48 h. At baseline the teeth and surrounding tissues were disclosed using Mira-2-Tone disclosing solution. Next, the examiner (PAV) evaluated the number of sites with gingival abrasion and the amount of dental plaque (Quigley & Hein) at 6 surfaces of each tooth. In the absence of this examiner, the subject's teeth were brushed by a hygienist (MP) using the Braun/Oral-B-D17 oscillating rotating toothbrush. Brushing was performed in two randomly selected contra-lateral quadrants for 60 s with either a low force (+/-1.5 N) or high force (+/-3.5 N) and in the opposing quadrants for 60 s with the alternative force. Visual feedback was given to control force. The brush was moved from the distal tooth to the central incisor perpendicular to the tooth surface with an angle of approximately 10-15 degrees towards the gingival margin. Next, the number of sites with abrasion and the remaining plaque were assessed again. RESULTS: The overall baseline gingival abrasion scores were 3.1 and 3.2 sites for high and low force, respectively, and increased to 5.0 and 5.9 sites respectively after brushing. There was no significant difference with respect to incidence of abrasion. At baseline, 48 h. plaque levels were 2.2. The reduction in plaque scores with the low force was 60% and with the high force 56%. This difference was significant. CONCLUSION: With the oscillating rotating power toothbrush (Braun/Oral-B D17) the use of high force (+/-3.5 N) is less efficacious as compared to a regular low force (+/-1.5 N) while the incidence of gingival abrasion sites was comparable.

Adolescent↗

PubMed2004

The anti-plaque efficacy of a chlorhexidine mouthrinse used in combination with toothbrushing with dentifrice.

BACKGROUND: Although the efficacy of chlorhexidine (CHX) chemically can be affected by the presence of a sodium lauryl sulphate (SLS)-containing dentifrice in the oral cavity, previous data, collected without supervision, showed that the level of plaque inhibition offered by a 0.2% CHX post-brushing rinse in one jaw is not reduced under the influence of toothbrushing with a 1.5% SLS-containing dentifrice in the opposite jaw. OBJECTIVES: The aim of the present study was to investigate, during a 4-day supervised study period, the anti-plaque efficacy of a 0.2% CHX pre-brushing rinse in one jaw, under the influence of toothbrushing in the opposite jaw, either with a SLS-containing dentifrice or with a SLS-free dentifrice. Three different dentifrices were tested. Two of them contained SLS (Colgate Total & Aquafresh Natural Whitening), the other (Zendium) did not. METHODS: The study was an examiner blind, randomised 4-cell, crossover design. It used a 4-day plaque accumulation model to compare under supervision 4 different oral hygiene regimens with a washout period of at least one week. Thirty-five healthy volunteers were enrolled in the study and were randomly assigned to a sequence according to a 4 x 4 Latin square design. At the beginning of each 4-day test period, they received a thorough dental prophylaxis. Plaque was scored in one randomly assigned (upper or lower) jaw, called the study jaw. At the end of the 4-day period the study jaw was used to study the effect of the four regimens on the level of plaque accumulation. The opposite jaw was assigned as the dentifrice jaw and served only to introduce the effect of brushing with a dentifrice in the study model. Four oral hygiene regimens were designed. During the randomly assigned test periods, rinsing with 0.2% CHX and then brushing the dentifrice jaw was performed twice daily. In regimen 1, 2, and 3 the subjects used a dentifrice in the assigned dentifrice jaw being either a dentifrice with SLS (Colgate Total and Aquafresh Natural Whitening) or a SLS-free dentifrice (Zendium). Regimen 4 served as a control during witch subjects only rinsed with 0.2% CHX. No other oral hygiene methods were allowed. After 4 days of undisturbed plaque accumulation, the amount of plaque was evaluated (Lobene et al. 1982, Quigley & Hein 1962, Turesky et al. 1970 modifications). RESULTS: The overall plaque index for regimen 1, 2 and 3 was, respectively, 1.8, 1.8 and 1.9. For regimen 4, the overall plaque index was 1.9. There was no significant difference in plaque accumulation between the four regimens. CONCLUSIONS: Within the present study design, it can be concluded that the anti-plaque efficacy of a pre-brushing 0.2% CHX mouthrinse does not seem to be reduced under the influence of a normal toothbrushing exercise with a dentifrice after rinsing, whether the dentifrice contains SLS or not.

Adult↗

PubMed2004

Soft-tissue wound healing following periodontal surgery and Emdogain application.

OBJECTIVES: The aim of the present study was to examine, by clinical means and as patient perception of post-operative events, the effect of Emdogain (enamel matrix derivative (EMD)) on the healing of soft-tissue wounds following periodontal surgery in comparison to flap surgeries without application of EMD. MATERIAL AND METHODS: For this study, 22 subjects (nine female and 13 male) who were scheduled for periodontal flap surgery were selected. The mean age for all patients was 49.9 (SD 8.7) years (range, 32-67). Six women and five men were assigned to the test group and three women and eight men were assigned to the control group. All subjects were scheduled, after re-evaluation of the periodontal status 8 weeks after initial treatment, to undergo surgery of the soft tissues, because of existing of probing pocket depth (5 mm or more), on at least three teeth. At random, 11 patients were assigned to control treatment and 11 patients were placed in the test group. All underwent one periodontal flap surgery for the purpose of this study. A modified Widman flap was performed. Patients in the test group received an application of EMD underneath the mucoperiostal flaps and onto the exposed root surfaces. Clinical measurements were taken at four different points in time, at the time of surgery, 1, 4 and 8 weeks after surgery. All subjects filled out a questionnaire every day for the first 7 days following surgery to evaluate post-operative complaints. RESULTS: Of all parameters evaluated none showed a significant difference between the control and EMD groups, except for gingival swelling at the 1-week assessment, where the EMD group exhibited a higher swelling score. The questionnaire revealed that complaints of oozing of blood from the wound was twice more prevalent 1 day post-surgery in the control (n=6) as in the EMD group (n=3). CONCLUSION: This study shows that the early woundhealing of periodontal flap-surgeries in those sites treated with Emdogain is not different from control sites.

Adult↗

PubMed2004

Plaque removal by professional electric toothbrushing compared with professional polishing.

OBJECTIVES: This parallel examiner blind study was designed to compare the results of professional brushing with an electric toothbrush (ETB, Braun Oral-B 3D Excel) to a professional polish session. MATERIAL AND METHODS: For this study, 90 non-dental students were selected. All received a single oral prophylaxis where plaque and calculus were removed and the teeth were polished so that all subjects started with equally clean teeth. Approximately 4 weeks later the subjects received a new appointment prior to which they were asked to abstain from oral hygiene procedures for at least 48 h. At baseline the examiner (M.P.) evaluated the amount of dental plaque (Sillness & Löe) at six surfaces of each tooth. Subsequently, in the absence of this examiner, the subject's teeth were brushed or polished by a dental hygienist (Y.I.J.). Three groups were formed; the subjects in Group 1 received 10 min of polishing with a rubber cup/point using dentifrice as abrasive paste, in Group 2 subjects were brushed for 2 min with an ETB and dentifrice by the hygienist and in Group 3 brushing for 10 min was performed with an ETB and dentifrice. Care was taken to call upon the examiner always >10 min after her leaving the room so that she was unaware of the treatment. Electric brushing was carried out carefully following the contour of the teeth and turning the brush head separately in the direction of the mesial and distal aspect of each tooth in each approximal space. After finishing with the brushing/polishing, the examiner re-evaluated the amount of remaining dental plaque. RESULTS: The baseline plaque levels in Groups 1-3 were 1.54, 1.62 and 1.55, respectively. The reduction in plaque scores in Group 1 was 94.8% (+/-4.0), for Group 2 94.2% (+/-4.7) and for Group 3 99.4% (+/-0.5). The results in Group 3 were significantly better than in Groups 1 and 2. Explorative analysis revealed that these differences were due to a higher plaque removal from the approximal surfaces and molars. CONCLUSION: Two minutes of professional brushing with an ETB was as effective as 10 min of professional polishing. Whereas 10 min with an ETB was even more effective.

Dental Devices, Home Care↗

PubMed2004

Amine fluoride/stannous fluoride and incidence of root caries in periodontal maintenance patients. A 2 year evaluation.

AIM: The purpose of the present study was to evaluate in a group of periodontal maintenance patients, the effect of using a dentifrice and mouthrinse containing amine fluoride (AmF) and stannous fluoride (SnF2) as compared with a dentifrice and mouthrinse both containing sodium fluoride (NaF) with regard to their root caries experience. MATERIAL: In total, 80 patients who had been treated for moderate-to-severe periodontitis agreed to participate in this study. Subjects received supportive periodontal therapy at regular intervals of 3-4 months for at least a period of 1 year. The patients were randomly divided into two groups: (1) the test group used an AmF/SnF2 dentifrice and mouthrinse and (2) the control group used an NaF-containing dentifrice and mouthrinse. Root caries was recorded at four sites per tooth at baseline and 24 months. RESULTS: An increase in number of the exposed root surfaces was noted for both groups during the experimental period (p<0.05). The mean number of active caries lesions at baseline was 2.1 and 1.8 for the test group and control group, respectively. At 24 months, the corresponding values were 1.8 for the test and 2.2 for the control group. An increase of the mean number of restored surfaces was noted for the AmF/SnF2 group (from 7.3 to 13.4) and the control group (from 7.9 to 14.7) during the course of the study. This increase was found to be statistically significant for both groups in comparison with the baseline values (p< or =0.01). No statistically significant differences were noted between groups. Further analysis of the restored surfaces revealed that the major increase in number of the restorations was associated with restorations involving three to four root surfaces in the same tooth. Molars and premolars were the teeth receiving most new restorations. CONCLUSION: The present study did not detect a difference in terms of root caries development between the two groups. Root caries development is a common finding associated with surfaces developing recession in patients once treated for periodontal problems.

Adult↗

PubMed2004

The effect of periodontal treatment on the salivary bacterial load and early plaque formation.

AIM: The purpose of the present study was to investigate in periodontitis patients the relationship between the number of bacteria in the saliva and the amount of de novo plaque formation before and after treatment. METHODS: At baseline, before any treatment was provided, patients rinsed with 10 ml sterile saline. After professional tooth cleaning the patients were instructed to abolish all tooth cleaning procedures for the subsequent 24 h. After this period, the rinsing procedure was repeated and the amount of de novo plaque was assessed. Three months after the initial periodontal therapy was completed the experiment was repeated. The microbiological evaluation of the rinsing samples was carried out by means of phase contrast microscopy and anaerobic culturing. RESULTS: After treatment the amount of de novo plaque was less compared to before treatment, 0.40 and 0.65 respectively. Both before and after treatment more de novo plaque was present at sites with inflammation than at healthy sites. In order to evaluate the contribution of the numbers of salivary bacteria to the amount of de novo plaque formation an analysis was carried out for healthy sites. This analysis included only healthy sites as determined before treatment and the same sites after treatment. The results showed a significant reduction in the de novo plaque formation after treatment (0.49 before and 0.22 after treatment). Phase contrast microscopic evaluation showed that the number of bacteria in the rinsing samples after treatment was less than before treatment. After treatment also a reduction was found in the prevalence of Prevotella intermedia, Tannerella forsythensis and Peptostreptococcus micros in the rinsing samples. CONCLUSION: The present study confirms the observation in the literature that the periodontal condition is of major importance in the rate of de novo plaque formation. In addition, the results suggest that the number of bacteria in the saliva may play a role.

Adult↗

PubMed2004

The plaque-removing efficacy of a finger brush (I-Brush).

OBJECTIVE: The purpose of the present study was to test the effectiveness of a finger toothbrush (I-Brush) in removing plaque compared with a flat-trimmed manual toothbrush. MATERIAL AND METHODS: For this study, 37 subjects were selected, without previous experience of the use of the I-Brush. Each subject received a finger brush (I-Brush), a manual toothbrush (Butler GUM 311), two written brushing instructions for both types of brushes, and a brush calendar. Subjects were given a period of 3 weeks to become familiar with the two types of brushes. During this period, the subjects were instructed to use the two types of brushes on alternate days. The brush calendar helped as a reminder and served to ensure compliance. No instructions regarding brushing time or frequency of brushing were given to the subjects, except that they should conform to their usual oral habits. After 3 weeks, all subjects were asked to abstain from oral hygiene procedures for 48 h prior to the experiment. In this experiment, the amount of dental plaque was scored by a trained examiner. The examiner (N.A.M.R.) used the modified Silness & Loe (1964) plaque index at six sites per tooth. After scoring, each subject received a new finger brush and a new manual toothbrush. The subjects brushed according to a split mouth protocol. Two contra-lateral quadrants were chosen randomly and were brushed with one randomly chosen brush and the two opposing contra-lateral quadrants with the alternate brush. The brushing was performed under supervision in front of a mirror. The available time for brushing was 2 min. for the entire dentition. Finally, the remaining plaque was scored again. RESULTS: The overall reduction in plaque was 79% for the manual toothbrush and 62% for the finger brush. The plaque removing efficacy of the finger brush was poorest at the approximal vestibular surfaces (55% plaque reduction) compared with the manual toothbrush (77% plaque reduction). CONCLUSION: The plaque reduction of the finger brush is not an acceptable alternative to the use of a regular manual toothbrush.

Adult↗

PubMed2003

Effect of smoking and periodontal treatment on the subgingival microflora.

BACKGROUND: The effect of smoking on the prevalence of periodontal pathogens after periodontal treatment is still not clear. Some studies found no effect of the smoking status on the prevalence of periodontal pathogens after therapy, whereas others did. The aim of this retrospective study was to investigate the influence of smoking on the treatment of periodontitis and the composition of the subgingival microflora. METHOD: The study included 59 periodontitis patients (mean age 41.5 years): 30 smokers and 29 nonsmokers. The treatment consisted of initial periodontal therapy and, if necessary, surgery and/or antibiotics. Clinical and microbiological data were obtained before and after treatment at the deepest site in each quadrant. A pooled sample was analysed for the presence of Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotalla intermedia (Pi), Bacteroides forsythus (Bf), Fusobacterium nucleatum (Fn) and Peptostreptococcus micros (Pm). RESULTS: For smokers and nonsmokers a significant improvement of the clinical condition was found after treatment. A decrease could be assessed for bleeding on probing (smokers: 0.46; nonsmokers: 0.52) and probing pocket depth (PPD) (smokers: 1.64 mm; nonsmokers: 2.09 mm). Furthermore, both groups showed gain of attachment (smokers: 0.68 mm; nonsmokers: 1.46 mm). No significant difference in bleeding on probing and PPD reduction was found between smokers and nonsmokers. In contrast, nonsmokers showed significantly more gain of attachment than smokers. The microbiological results revealed no differences in the prevalence of the various bacteria between smokers and nonsmokers before treatment. After treatment in nonsmokers, a significant decrease was found in the prevalence of Aa (11-3), Pg (17-7), Pi (27-11), Bf (27-11), Fn (28-20) and Pm (27-17). In smokers, a significant decrease could be shown only for the prevalence of Pg (15-5). CONCLUSIONS: Nonsmokers showed more gain of attachment and a greater decrease in the prevalence of periodontal bacteria as compared to smokers. The phenomenon that among smokers, more patients remain culture positive for periodontal pathogens after therapy, may contribute to the often observed unfavourable treatment results in smoker periodontitis patients.

Adult↗

PubMed2003

Plaque removal with a novel manual toothbrush (X-Active) and the Braun Oral-B 3D Plaque Remover.

OBJECTIVES: The study was designed to test the efficacy in plaque removal of three toothbrushes: two manual brushes, the Butler GUM 311 and the Dr Best X-Active, and one electric toothbrush the Braun Oral-B 3D Plaque Remover (3D). METHOD: The study was a split-mouth, single-blind, randomized clinical study consisting of three identical experiments testing three combinations of toothbrushes (experiment 1: 3D versus Butler; experiment 2: 3D versus Dr Best; experiment 3: Butler versus Dr Best), in which the teeth of the panellists were brushed by a dental hygienist. In a fourth experiment, the panellists brushed their own teeth (3D versus Dr Best). Thirty-five subjects participated in the study and received a professional prophylaxis prior to the first experiment. They were requested to refrain from brushing their teeth for 48 h prior to each experiment. Plaque was assessed according to the Silness & Löe plaque index at six sites per tooth. Next, the dental hygienist (experiments 1-3) or the panellist (experiment 4) brushed for 60 s with their first assigned brush in two randomly selected contralateral quadrants. Brushing was repeated (60 s) with the second brush in the opposing two contralateral quadrants. Prior to experiment 4, panellists were given two thorough hands-on professional instructions in the use of the 3D and the Dr Best toothbrushes. RESULTS: In experiment 1, the 3D showed a mean plaque reduction of 72% compared to 63% with the Butler (P<0.01). In experiment 2, the 3D showed a mean plaque reduction of 79% and the Dr Best 76% (P<0.05). In experiment 3, the Butler showed a mean plaque reduction of 81% and the Dr Best 85% (P=0.01). In the hands of the panellists (experiment 4), the 3D showed a mean plaque reduction of 88% and the Dr Best 84% (P<0.05). CONCLUSIONS: A 5-week training period with repeated hands-on instruction gives panellists the skill to perform brushing with efficacy comparable to that of professional brushing. In agreement with a previous study, the 3D was more effective than a flat-trimmed manual toothbrush (Van der Weijden et al. 1994). Brushing with the criss-cross resulted in small statistical differences with the 3D and the flat-trimmed manual toothbrush. The clinical relevance of these statistically significant results should be the subject of a longitudinal study.

Adolescent↗

PubMed2003

Salivary cystatin activity and cystatin C in experimental gingivitis in non-smokers.

BACKGROUND: Subjects with natural gingivitis and periodontitis have elevated levels of salivary cystatins compared to periodontally healthy individuals. Experimental gingivitis studies, however, have yielded conflicting results. AIM: The present study investigated whether experimentally induced gingivitis is associated with changes in salivary cystatin levels. MATERIAL & METHODS: Plaque scores, bleeding indexes and whole saliva samples of 35 non-smoking young adults were collected at the start and at the end of an experimental gingivitis trial, and 3 weeks after resuming oral hygiene. The saliva samples were assayed for protein concentrations, cystatin activity and cystatin C concentration. RESULTS: During experimental gingivitis, plaque and bleeding scores increased significantly in all subjects and subsequently decreased significantly after reinstalment of oral hygiene procedures. No significant changes were observed for the protein concentration, cystatin activity and cystatin C concentration. No significant relation could be established between these salivary parameters and bleeding on marginal probing. CONCLUSION: The present study confirms earlier results from Lie et al. (2001) that no significant changes occur in salivary cystatin activity and cystatin C concentration during and after experimental gingivitis.

Adolescent↗

PubMed2003

Factors influencing referral for specialist endodontic treatment amongst a group of Dutch general practitioners.

AIM: To analyse the need for endodontic referral amongst a group of Dutch general practitioners and to examine the current referral patterns and factors influencing the decision to refer. METHODOLOGY: A questionnaire was designed to investigate the perceived need for endodontic referral, the factors that influenced the decision process, the specialist to whom the case was referred and the frequency of referring. The questionnaires were distributed amongst 500 dentists attending a scientific meeting of the Netherlands Society for Endodontology (NVvE) and to 83 members of 10 study groups responding to a request in a newsletter. These groups were chosen to represent those dentists who possessed a similar degree of general dental knowledge and were acquainted with the requirements that endodontic treatment should meet. RESULTS: The response rate was 41%. Of the respondents, 93% felt the need to refer cases to specialists. The majority of dentists preferred to refer to an endodontist rather than an oral surgeon. The major factors considered to be important or very important (37 and 54%, respectively) for endodontic referral were the presence of an obstruction in the canal, followed by the presence of a perforation or resorption (43 and 34%, respectively) and persistent signs and/or symptoms (39 and 32%, respectively). NVvE members referred significantly less to oral surgeons than nonmembers. CONCLUSIONS: Amongst a group of Dutch general practitioners there is a substantial perceived need for referring endodontic cases to specialists.

Decision Making↗

PubMed2003

An evaluation of the usefulness of two endodontic case assessment forms by general dentists.

AIM: To evaluate the use of two forms to assess the risks and difficulty of root-canal treatment. METHODOLOGY: Two criterion-based forms, containing 15 and 16 items, respectively, were distributed to 83 general dentists to evaluate the potential difficulty of root-canal treatment. The participants were asked to assess the difficulty of 15 endodontic cases using the Dutch Endodontic Treatment Index (DETI) and the Endodontic Treatment Classification (ETC) forms. A questionnaire was also provided to evaluate the time needed to complete the two forms, their ease of use, the clarity and/or appropriateness of the criteria and any other comments. The outcomes of the assessment were compared with the assessment of each case as carried out by the authors. RESULTS: The response rate was 53%. The DETI was an easy and rapid way to differentiate between uncomplicated and complicated cases. In 13 of the 15 cases, 88-100% of the dentists scored the cases in agreement with the authors. Use of the ETC form was more complicated, as a result of the larger number of variables. However, most respondents recognized the complicated cases, and 91% found the ETC form valuable to help in assessing the difficulty of endodontic cases. CONCLUSIONS: These two forms may help general practitioners to assess the difficulty of endodontic problems and to decide whether to treat the case or to refer it to a specialist.

Decision Making↗