Biomedical subjects

M F Timmerman

Publications and source records attributed to M F Timmerman.

At least 55 records · Page 3Linked to original sources

PubMed2002

Comparison of the bleeding on marginal probing index and the Eastman interdental bleeding index as indicators of gingivitis.

AIM: The purpose of the present study was to compare 2 indices, i.e., the Eastman interdental bleeding (EIB) index and the bleeding on marginal probing (BOMP) index. The comparison was made (a) in terms of the degree of bleeding provoked and the relationship with plaque in natural gingivitis and (b) for the ability of these 2 methods to detect differences between the development of experimental gingivitis in a control group and a group in which the development of gingival inflammation was suppressed by treatment. For the present studies, subjects were selected without interdental recession of the gingival tissues. METHODS EXPERIMENT 1: In this experiment, 43 subjects having established moderate gingivitis were assessed using a random splitmouth design (1st and 3rd/2nd and 4th quadrant). Plaque was scored on all approximal sites after which the BOMP index was assessed in one half of the mouth and the EIB index in the other. RESULTS EXPERIMENT 1: The BOMP index showed a bleeding score of 84% and the EIB index of 87%. The significant correlation between plaque and gingival bleeding for the BOMP index (0.55) was higher than for the EIB index (0.44). METHODS EXPERIMENT 2: For this experiment, 25 subjects participated in an experimental gingivitis trial of the lower jaw. At baseline, first the BOMP index and immediately thereafter the EIB index were assessed at all approximal sites. Experimental gingivitis (EG) was carried out in one randomly assigned quadrant and as a treatment modality only floss was used in the other (FL). RESULTS EXPERIMENT 2: In the EG quadrant, the BOMP index increased to 69% and the EIB index to 73%. Both indices showed a significant correlation with plaque; 0.60 and 0.64 respectively. In the FL quadrant, the BOMP index increased to 38% and the EIB index to 30%. No significant correlation between both gingivitis indices and the amount of plaque was present in the FL quadrant. CONCLUSION: The ability of the BOMP index and the EIB index to assess the level gingival inflammation appears to be comparable.

Dental Plaque↗

PubMed2002

How do data from deepest pocket per quadrant relate to full-mouth scores? Progression of untreated periodontal disease in young Indonesians.

BACKGROUND: When the subgingival presence of periodontal pathogens is studied in groups of patients or populations, mostly a number of the deepest sites is sampled. The mean clinical parameters of these deep sites are also frequently used as a the descriptor of the clinical situation of these subjects. It can be questioned, whether these 4 deep sites are capable of predicting a full-mouth situation. AIM: The purpose of the present retrospective study was to investigate to what extent the experienced progression of periodontitis as measured in the deepest approximal pocket in each quadrant reflects the disease progression at the approximal sites on a full-mouth level. METHODS: A data set of a 7-year longitudinal study of 158 young subjects (69 male, 89 female, 15-25 years of age at baseline) was used. Clinical assessments included plaque index (PI), pocket depth (PD) and attachment loss (AL) at baseline (1987) and follow-up (1994). Measurements were made at the approximal surfaces of all teeth. The deepest pocket in each quadrant was determined at follow-up. Changes of the clinical parameters between baseline and follow-up were calculated both as full-mouth mean scores as well as for these 4 deepest sites. A regression analysis was used to evaluate the relationship between full-mouth score and the 4 test sites. RESULTS: For disease progression between baseline and follow-up, significant correlation coefficients were observed between the 4-site and full-mouth mean changes (PD: 0.80, AL: 0.70, PI: 0.77). Regression coefficients were 0.51 for PD, 0.35 for AL and 0.55 for PI. The precision of the estimate for the full-mouth mean, as predicted by the 4-site mean, is determined by the residual standard deviation. This was for PD 0.31 mm, for AL 0.31 mm and for PI 0.29. Compared to the between-patient standard deviation of the full-mouth means, the residual standard deviations were high. CONCLUSION: In the present population, a reasonable to good correlation between full-mouth and 4-sites data was observed. However, the high residual standard deviation in the regression analysis illustrates the inaccuracy for the 4-sites data when used as a descriptive for changes in the periodontal condition on a full-mouth level. Data evaluating progression of periodontitis based on a limited number of diseased sites should be interpreted cautiously.

Adolescent↗

PubMed2002

Effectiveness of an electrically active brush in the removal of overnight plaque and treatment of gingivitis.

OBJECTIVES: The purpose of the present study was to evaluate the effect of an electrically active toothbrush on established plaque and gingivitis in a 7-month clinical trial. MATERIAL AND METHODS: For this study, 66 volunteers (non-dental University students) were selected on the basis of having moderate gingival inflammation. At baseline, plaque (Quigley & Hein), bleeding upon marginal probing and the Modified Gingival index were assessed on the vestibular, mesio-vestibular, disto-vestibular and lingual surfaces at four sites per tooth. Subjects were randomly divided among two groups; one group brushed with a control brush (Butler GUM 309) while the other used the electrically active test brush. After 2 weeks, 4 weeks, 4 months and 7 months the clinical indices were again recorded. At each assessment the participants received a new brush head for the electrically active brush (test group) or a new manual control toothbrush (control group). RESULTS: All baseline indices appeared to be well balanced. A mean Quigley & Hein plaque score of 1.98 and 2.13 was found in the control and test group, respectively. Little change was observed from baseline to 7 months. The mean bleeding upon marginal probing score at baseline was 0.62 for the control group and 0.59 for the test group. Little to no improvement was observed for the manual brush, whereas an increase in bleeding was observed in the test group in the course of this study. The mean percent reduction in plaque after 1 min of brushing varied throughout the study between 36% and 46%. No difference between the brushes was observed at any time point during the 7-month test period. CONCLUSION: No beneficial effect could be shown for the 'electrically active design feature' compared to a regular manual toothbrush control.

Adolescent↗

PubMed2002

A clinical comparison of three powered toothbrushes.

AIM: The purpose of the present study was to compare the ability of the Braun Oral-B 3D Excel power toothbrush (BPT), the Sonicare power toothbrush (SPT) and the Philips Sensiflex 2000 (HX 2550) power toothbrush (PPT) to control plaque and reduce experimentally induced gingivitis. MATERIALS AND METHODS: Two experiments were carried out in two different groups of subjects using a split-mouth design whereby the two halves of the mandible which had been allowed to develop gingivitis were brushed over a 4-week period with the test toothbrushes. Experiment 1 compared the BPT with the SPT (n = 35) and experiment 2 compared the BPT with the PPT (n = 32). The study used a run-in period of 2 weeks, which, together with the 3-week experimental gingivitis phase, represented the pretrial phase of the experiment. The purpose of this phase was two-fold: first, to enable the subjects to become acquainted with the two power brushes and for them to receive proper oral hygiene instruction, and, second, to develop a reasonable level of gingivitis on the mandible. Those subjects with at least 40% of sites exhibiting bleeding in each quadrant in the mandible at day 21 of the experimental gingivitis phase were allowed to continue with the trial. During the next 4 weeks (treatment phase) of each experiment, subjects were told to brush according to a split-mouth design, the right and left sides of the mouth being randomly allocated to a toothbrush. During this period, no rinsing with an antiseptic mouthwash or flossing was allowed and a standard toothpaste (Zendium(R)) was used. After 1, 2 and 4 weeks, the plaque index (Quigley & Hein) and the bleeding tendency on marginal probing were assessed in the mandible. RESULTS: Experiment 1 showed that the bleeding score was reduced from 1.63 to 1.12 at 4 weeks by the BPT and from 1.65 to 1.26 by the SPT. This reduction was more rapid and greater with the BPT (P < 0.05). The plaque index was reduced from 2.19 at day 21-1.03 at 4 weeks by the BPT, and from 2.18 to 1.20 by the SPT. The difference between the two toothbrushes was not significant. Experiment 2 showed that the bleeding score was reduced from 1.77 at day 21 to 1.07 at 4 weeks by the BPT and from 1.75 to 1.24 by the PPT. This reduction was more rapid and greater with the BPT (P < 0.05). There was no significant difference in plaque index at 4 weeks (BPT, 1.09; PPT, 0.95). Data from the questionnaire at the end of the study revealed that, in both experiments, most subjects preferred the BPT. CONCLUSIONS: The data from this study show that the design and action of the Braun Oral-B 3D Excel power toothbrush are more effective in resolving gingivitis than the Sonicare & the Philips Sensiflex 2000 power toothbrushes.

Attitude to Health↗

PubMed2002

A systematic review on the clinical efficacy of subgingival debridement in the treatment of chronic periodontitis.

OBJECTIVE: The purpose of this study was to perform a systematic review of the literature and to evaluate, in patients with chronic periodontitis, what the effect is of subgingival debridement (SGD), in terms of bleeding on probing, pocket depth and probing attachment level. MATERIAL AND METHODS: An electronic search of the Cochrane Oral Health Group specialized register and MEDLINE were performed using specific search terms to identify studies assessing in patients with chronic periodontitis the effect of subgingival debridement with regard to clinical outcomes. This was performed on titles registered up to 2001. The only papers included were those which utilized data based on the patient as unit of observation. RESULTS: The searches identified 702 abstracts. Titles and abstracts were independently screened by two reviewers (G.A.W. & M.F.T.) to identify publications that met specific inclusion criteria. The agreement between the two reviewers was assessed. The kappa score for agreement was 0.80. Review of these abstracts resulted in 114 publications for detailed review. Finally, 26 papers which met the criteria of eligibility were independently selected by the two reviewers. The kappa score for agreement on this decision was 0.92. Disagreement regarding inclusion of both abstracts and full papers was resolved by discussion between the reviewers. No randomized controlled trials (RCT) could be retrieved that were specifically designed to answer the question formulated at the outset of this systematic review. From the 10 controlled studies, four provide a definitive 'yes' that SGD is effective with regard to clinical outcomes. In the one study where subgingival debridement was not supported by oral hygiene instruction, the paper provided a definitive 'no'. The weighted mean of attachment gain of SGD in pockets initially >or=5 mm was 0.64 mm as compared with 0.37 mm for supragingival plaque control only (SPC). The reduction of pocket depth was 0.59 mm and 1.18 mm for SPC and SGD, respectively. Of the 18 papers that provided only information on the effect of treatment as compared with the baseline values, eight showed SGD to be beneficial with regard to clinical attachment level change while the remaining 10 provided no such an analysis. The weighted mean of this effect was a 0.74-mm gain of attachment as a result of treatment in pockets initially >or= 4 mm. CONCLUSIONS: In patients with chronic periodontitis, subgingival debridement (in conjunction with supragingival plaque control) is an effective treatment in reducing probing pocket depth and improving the clinical attachment level. In fact it is more effective than supragingival plaque control alone.

Adult↗

PubMed2002

Parotid salivary S-IgA antibodies during experimental gingivitis in smokers and non-smokers.

Persons who smoke display a less pronounced increase of gingival bleeding in the experimental gingivitis model as compared with non-smokers. The aim of the present study was to investigate whether this could partly be explained by differences in levels of parotid total secretory IgA (S-IgA) or parotid S-IgA reactive with selected oral microorganisms. Parotid saliva samples were obtained from 11 smoking and 14 non-smoking volunteers, at baseline, after 5 and 14 days of full mouth experimental gingivitis. Output levels of total S-IgA and of specific S-IgA reactive with cell extracts from Actinobacillus actinomycetemcomitans, Actinomyces naeslundii, Campylobacter rectus, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Peptostreptococcus micros, Streptococcus gordonii and Streptococcus mutans were determined in the samples by means of ELISA. Smokers and non-smokers were found to have similar output levels (microg/min) of total S-IgA, and the values did not significantly change during the experimental gingivitis trial. Parotid salivary outputs (units/min) of the bacteria-specific S-IgA at baseline and at days 5 and 14, were not different between smokers and non-smokers; no changes were observed during the experimental gingivitis trial. The present observations indicate that total S-IgA and bacteria-specific S-IgA in saliva are not main factors that can explain the less pronounced increase of gingival bleeding in the experimental gingivitis model in smokers as compared with non-smokers.

Actinomyces↗

PubMed2002

[Reduction of stain, plaque and gingivitis by mouth rinsing with chlorhexidine and peroxyborate].

Aim of the present study was to investigate whether the use of an oxidising mouthrinse as an adjunct to chlorhexidine is efficacious in reducing stain, plaque and gingivitis. This study had a single-blind, 2-group parallel design, including a 14-day experimental non-brushing period during which 1 group (n = 14) used chlorhexidine alone (CHX) and the other (n = 14) used chlorhexidine in combination with an oxidising agent. Patients were randomly assigned to either group. The gingival condition was evaluated at baseline by means of bleeding on marginal probing. The examination after 14 days of rinsing included the evaluation of plaque, bleeding on marginal probing and stain (GMSI: gingival modification of the stain index). The results showed at day 14 a significant difference between the 2 groups for plaque and gingival bleeding. The proportion of stained surfaces was less in the CHX + PER-group (28%), than in the chlorhexidine group. The adjunctive use of an oxidising agent peroxyborate to chlorhexidine, proved to be superior to chlorhexidine alone with regard to the inhibition of plaque and development of gingivitis.

Adult↗

PubMed2001

Occurrence of Prevotella intermedia and Prevotella nigrescens in relation to gingivitis and gingival health.

AIM: The occurrence of Prevotella intermedia (Pi) and Prevotella nigrescens (Pn) in relation to natural gingivitis, gingival health and 14-day experimental gingivitis was investigated in 25 non-dental students. MATERIALS AND METHODS: Samples were taken from the dorsum of the tongue, the tonsils (or tonsillar area), and the supra- and subgingival plaque. RESULTS: The microbiological results show that 73% of the samples were positive for the bacterial species presumed to be Pi and/or Pn. In natural gingivitis, gingival health and in experimental gingivitis 25, 23 and 25 subjects were found to be positive for Pi and/or Pn, respectively. The results of the 889 isolates that were successfully purified and differentiated, show that almost all subjects were colonized with Pn whereas approximately half of the study population harboured Pi. These 2 species were isolated from both dental plaque and mucosal sites and were found to colonize the oral cavity simultaneously. CONCLUSION: In natural gingivitis, at the start and after 14 days of experimental gingivitis, Pn was the predominant micro-organism.

Adolescent↗

PubMed2001

Amoxicillin plus metronidazole in the treatment of adult periodontitis patients. A double-blind placebo-controlled study.

BACKGROUND, AIMS: The aim of this double-blind, parallel study was to evaluate the adjunctive effects of systemically administered amoxicillin and metronidazole in a group of adult periodontitis patients who also received supra- and subgingival debridement. METHODS: 49 patients with a diagnosis of generalised severe periodontitis participated in the study. Random assignment resulted in 26 patients in the placebo (P) group with a mean age of 40 years and 23 patients in the test (T) group which had a mean age of 45 years. Clinical measurements and microbiological assessments were taken at baseline and 3 months after completion of initial periodontal therapy with additional placebo or antibiotic treatment. Patients received coded study medication of either 375 mg amoxicillin in combination with 250 mg metronidazole or identical placebo tablets, every 8 hours for the following 7 days. RESULTS: At baseline, no statistically significant differences between groups were found for any of the clinical parameters. Except for the plaque, there was a significantly larger change in the bleeding, probing pocket depth (PPD) and clinical attachment level (CAL) in the T-group as compared to the P-group after therapy. The greatest reduction in PPD was found at sites with initial PPD of > or = 7 mm, 2.5 mm in the P-group and 3.2 mm in the T-group. The improvement in CAL was most pronounced in the PPD category > or = 7 mm and amounted to 1.5 mm and 2.0 mm in the P- and T-groups, respectively. No significant decrease was found in the number of patients positive for any of the test species in the P-group. The number of patients positive for Porphyromonas gingivalis, Bacteroides forsythus and Prevotella intermedia in the T-group showed a significant decrease. After therapy there was a significant difference between the P- and the T- group in the remaining number of patients positive for P. gingivalis, B. forsythus and Peptostreptococcus micros. 4 subgroups were created on the basis of the initial microbiological status for P. gingivalis positive (Pg-pos) and negative patients (Pg-neg) in the P- and the T-groups. The difference in reduction of PPD between Pg-pos and Pg-neg patients was particularly evident with respect to the changes in % of sites with a probing pocket depth > or = 5 mm. This % decreased from 45% at baseline to 23% after treatment in the Pg-pos placebo subgroup and decreased from 46% to 11% in the Pg-pos test subgroup (p < or = 0.005). In contrast, the changes in the proportions of sites with a probing pocket depth > or = 5 mm in the Pg-neg placebo and Pg-neg test subgroup were similar, from 43% at baseline to 18% after treatment versus 40% to 12% respectively. CONCLUSIONS: This study has shown that systemic usage of metronidazole and amoxicillin, when used in conjunction with initial periodontal treatment in adult periodontitis patients, achieves significantly better clinical and microbiological results than initial periodontal treatment alone. Moreover, this research suggests that especially patients diagnosed with P. gingivalis benefit from antibiotic treatment.

Adult↗

PubMed2001

Oscillating/rotating electric toothbrushes compared: plaque removal and gingival abrasion.

OBJECTIVES: This study was designed to test the efficacy in plaque removal and the potential for gingival abrasion of 3 electric toothbrushes. The established Braun Oral-B 'Ultra' plaque remover (D9), the Philips/Jordan HP 735, and the newly designed Braun Oral-B 3D Plaque Remover (3D). MATERIAL AND METHODS: This study was designed as a split-mouth, single blind, randomised clinical study consisting of 3 identical experiments with 3 combinations of toothbrushes (exp 1:3D-HP735, exp 2:D9-HP735, exp 3:D9-3D). 40 subjects were requested not to brush their teeth 48 h prior to each examination. At this visit, both the gums and teeth were disclosed for the assessment of baseline plaque and gingival abrasion. Abrasion sites were scored as small (< or = 5 mm) or large sites (> 5 mm). Plaque was assessed according to the Quigley & Hein index at 6 sites per tooth. The participants brushed 60 s with the 2 brushes, each brush in 2 randomly selected contra-lateral quadrants. RESULTS: The increase in number of small abrasions after brushing (exp. 1) was 1.2 versus 1.7 for 3D and HP735, respectively (ns); In exp. 2 the increase was 0.9 for both D9 and HP735. In exp. 3 the increase was 0.4 sites for both D9 and 3D. Comparison of the 3D and HP735 showed a mean plaque reduction of 67% and 54%, respectively (p<0.05); when the D9 and HP735 were compared, a mean plaque reduction of 70% and 58%, respectively, was found (p<0.05); a mean plaque reduction of 74% was found in the comparison of D9 and 3D. CONCLUSION: The results show that the potential gingival abrasion after brushing is comparable for all 3 electric toothbrushes. In addition the longer the subjects used the brushes the less abrasion occurred. Finally both 3D and D9 were more effective than the HP735 in removing plaque.

Analysis of Variance↗

PubMed2001

Untreated periodontal disease in Indonesian adolescents. Subgingival microbiota in relation to experienced progression of periodontitis.

BACKGROUND/AIMS: In an Indonesian population deprived of regular dental care, the experienced progression of disease between baseline (1987) and follow-up (1994) was investigated in relation to the composition of the subgingival microbiota at follow-up. At baseline the age ranged from 15 to 25 years. Clinical and microbiological evaluation was completed in 158 of the 167 subjects available at follow-up. METHODS: Plaque index (PI), pocket depth (PD), bleeding on probing (BOP), and attachment loss (AL) were scored at the approximal surfaces of all teeth and subgingival calculus on the approximal surfaces of the Ramfjord teeth only (number of sites with subgingival calculus: NSC). A pooled sample of the deepest pocket in each quadrant was evaluated using microbiological culture techniques. RESULTS: At baseline the mean values of the clinical parameters were AL=0.35 mm, PI=1.01, BOP=0.80 PD=3.25 mm and NSC=6.04 and at follow-up AL=0.75 mm, PI=1.16, BOP=1.19, PD=3.34 mm and NSC=5.85. All parameters except PD and NSC showed a statistically significant increase. At follow-up the prevalence of Actinobacillus actinomycetemcomitans was 40%, of Porphyromonas gingivalis 67%, of Prevotella intermedia 66%, of Fusobacterium nucleatum 79%, of Bacteroides forsythus 16%, of Campylobacter rectus 4%, and of P. micros 6%. No differences in clinical parameters were found between groups with or without these micro-organisms. In 129 subjects AL of > or =2 mm at > or =1 site was found. Logistic regression showed three significant odds-ratio's for experienced progressive periodontitis: Plaque index (12.2), gender (3.4) and Actinobacillus actinomycetemcomitans (2.9). CONCLUSIONS: The results of this retrospective study suggest that plaque is the most important parameter related to experienced disease progression, and that the presence of A. actinomycetemcomitans may be associated with increased chance of disease progression.

Adolescent↗

PubMed2001

Periodontitis in smokers and non-smokers: intra-oral distribution of pockets.

AIM: The purpose of the present study was to establish retrospectively whether the disease severity differs between smokers and non-smokers. METHODS: The study population consisted of 183 periodontitis patients, 79 smokers and 104 non-smokers. These subjects had been referred by general dentists to the Clinic for Periodontology, Utrecht, because of periodontal problems and were selected on the basis of the clinical diagnosis: adult periodontitis. The proportion of bleeding sites and the intra-oral distribution of probing pocket depth was evaluated. RESULTS: No statistically-significant differences between smokers (SM) and non-smokers (NSM) were found regarding the mean % of sites that bled upon probing (SM=76%, NSM=72%). Overall differences in the prevalence of probing depths > or =5 mm between smokers and non-smokers were found (SM=44%, NSM=34%). The proportion of sites with a probing pocket depth of > or =5 mm was consistently higher in smokers in the anterior, premolar and molar regions. The data also show that in the upper jaw at the anterior and premolar teeth, the largest differences are found between smokers and non-smokers. Smokers have more sites with a pocket depth > or =5 mm, especially on the lingual surfaces of these teeth. CONCLUSIONS: The present study indicates that cigarette smoking is a factor associated with deeper periodontal pockets and an intra-oral distribution that is suggestive of a local effect.

Adult↗

PubMed2001

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

BACKGROUND: Recent studies show that subjects with natural gingivitis or periodontitis have elevated levels of salivary cystatins compared to periodontally healthy individuals. Increased glandular output of cystatins in inflammatory conditions suggests an active, most likely protective, rôle for these proteins in inflammatory processes. Furthermore, it has been shown that the development of gingival inflammation is suppressed in smokers during experimental gingivitis. AIMS: The purpose of the present study was to investigate whether (i) the levels of salivary cystatins in natural gingivitis are related to smoking status, and (ii) to study whether experimentally induced gingivitis is associated with changes in salivary cystatin levels, in both smokers and non-smokers. MATERIAL AND METHODS: Whole saliva samples were taken in relation to natural gingivitis, gingival health and 14-day experimental gingivitis in 25 non-dental students (14 non-smokers and 11 smokers). The salivary flowrate was determined. Samples were analyzed for levels of protein, cystatin and cystatin-C. RESULTS: Salivary flow and protein concentrations in cleared human whole saliva samples of non-smokers and smokers were not different from each other at any timepoint during the trial. With regard to cystatins, the results showed that in the state of natural gingivitis cystatin activity is lower in smokers as compared to non-smokers. In smokers, the resolution of natural gingivitis to the state of gingival health did not result in a change of cystatin activity and levels of cystatin C. At the end of the 14-day experimental gingivitis period, smokers showed a decrease in cystatin activity and cystatin C as well as lower outputs of cystatin activity and cystatin C. CONCLUSION: Smoking is associated with lower cystatin activity and output of cystatin C during gingival inflammation.

Adolescent↗

PubMed2000

Stain, plaque and gingivitis reduction by combining chlorhexidine and peroxyborate.

BACKGROUND: Previous studies have shown that using an oxidising agent in addition to chlorhexidine reduces staining. AIM: The purpose of the present study was to investigate whether, compared to chlorhexidine alone, the use of an oxidising mouthrinse as an adjunct to chlorhexidine is efficacious in reducing stain, plaque and gingivitis. METHOD: This study had a single-blind, 2-group parallel design, including a 14-day experimental non-brushing period during which 1 group (n= 14) used chlorhexidine alone (CHX) (chlorhexidine mouthrinse, 0.12% Oral-B laboratories, Ireland), and the other (n= 14) used chlorhexidine in combination with an oxidising agent (sodiumperborate-monohydrate-Bocasan, Oral-B laboratories, Ireland). Patients were randomly assigned to either group. All participants received a scaling and polishing before the start of the trial. No oral hygiene instructions were given. Since, at the start of the experiment, all stain and plaque were removed, only the gingival condition was evaluated at baseline by means of bleeding on marginal probing. The examination after 14 days of rinsing included the evaluation of plaque, bleeding on marginal probing and stain (GMSI: gingival modification of the stain index). RESULTS: The results showed at day 14, a significant difference between the 2 groups for plaque (CHX: 0.18, CHX+PER: 0.08, p=0.03) and gingival bleeding (CHX: 0.38, CHX+PER: 0.21, p<0.001). The proportion of stained surfaces was less in the CHX+PER group (28%), than in the chlorhexidine group (48%) (p=0.04). CONCLUSIONS: In conclusion, the adjunctive use of an oxidising agent peroxyborate to chlorhexidine, proved to be superior to chlorhexidine alone with regard to the inhibition of plaque and development of gingivitis. In addition, the proportion of stained surfaces was significantly less when adding the oxidising mouthrinse to chlorhexidine.

Adult↗

PubMed2000

A laboratory and clinical investigation comparing 2 oscillating/rotating electric toothbrushes.

BACKGROUND/AIMS: The purpose of the study was to investigate the efficacy of plaque removal by 2 different toothbrushes in a laboratory model and in a clinical study. METHOD: The 2 brushes used were the Philips/Jordan HP 735 and the Braun Oral-B Ultra Plaque Remover (D9). Both were compared in a laboratory study (using a robot system) and a short-term clinical study. For the laboratory study, plaque substitute was applied to the artificial teeth of ten typodonts, which were cleaned by a robot for 2 min. The remaining plaque substitute was measured on buccal and lingual/palatal surfaces, as well as gumline and interproximal sites, using a computerized vision system. The clinical study included 23 non-dental students. All subjects received a single oral prophylaxis and were asked not to brush their teeth for 48 h prior to their appointment. After the amount of plaque had been evaluated at 6 sites per tooth, subjects brushed in a random split-mouth order with the 2 electric toothbrushes, after which the amount of plaque was re-evaluated. RESULTS: The results of the laboratory study showed that, for all surfaces combined, the mean removal of plaque substitute for both brushes was the same. However, at the vestibular and the approximal vestibular surfaces, the reduction in plaque substitute was significantly higher (p<0.01) with the Braun toothbrush compared to the Philips. In the clinical study, the mean overall plaque reduction for the Braun toothbrush (74%) was significantly higher than for the Philips (66%). Further analysis revealed that the significant difference in favour of the Braun brush was mainly due to plaque removal from the approximal vestibular and the approximal lingual sites. CONCLUSIONS: In conclusion, both the laboratory and clinical study show that the Braun Oral-B Ultra Plaque Remover (D9) is more effective than the Philips/Jordan HP 735. Both study models indicate that this difference is greatest on the approximal vestibular surfaces.

Adult↗

PubMed2000

Untreated periodontal disease in Indonesian adolescents. Longitudinal clinical data and prospective clinical and microbiological risk assessment.

BACKGROUND, AIMS: In order to investigate the r le of various putative clinical and microbiological risk markers, a longitudinal study was initiated in a young population deprived of regular dental care. In 1987 all inhabitants in the age range 15-25 years living in a village with approximately 2,000 inhabitants at a tea estate on Western Java, Indonesia, were examined clinically and microbiologically. In total, 167 subjects of the original group of 255 adolescents were re-examined in 1994. The material presented in this paper describes the clinical periodontal condition at baseline (1987) and at follow-up (1994), 7 years later. Furthermore, the relationship between progression of the disease and baseline clinical and microbiological data was assessed. METHODS: Plaque index (PI), bleeding on probing (BOP), pocket depth (PD), and attachment loss (AL) were scored at the approximal surfaces of the vestibular aspects of all teeth. The number of approximal surfaces of the Ramfjord teeth showing subgingival calculus was recorded. At baseline, the dorsum of the tongue, the buccal gingiva in the upper jaw, the saliva and the deepest bleeding pocket without clinical loss of attachment were sampled for microbiological examination with phase contrast microscopy and indirect immunofluorescence. RESULTS: Mean values at baseline and at follow-up were PI: 1.01 and 1.15, BOP: 0.80 and 1.16, PD 3.26 mm and 3.32 mm, AL: 0.33 mm and 0.73 mm, respectively. All parameters except PD showed a statistically significant increase over the 7-year period. The prevalence of the studied bacteria irrespective of the sample site was: A. actinomycetemcomitans 53%, P. gingivalis 88%, P. intermedia 100%, spirochetes 89% and motile micro-organisms 100%. At the full mouth level, logistic regression showed significant odds ratios for progressive disease with age (1.15), subgingival calculus (1.20) and subgingival presence of A. actinomycetemcomitans (4.61). Presence of any of the selected micro-organisms on the mucous membranes was not related with progressive disease. In order to study local factors to explain local disease activity, each subject was characterized using the sampled pocket, which was the deepest bleeding pocket without LA at baseline, as a single response site per patient. In this constrained design, the main statistical factors associated with progressive disease were presence of motile micro-organisms and the plaque score. CONCLUSIONS: This study identified 3 main risk markers for disease progression at the full mouth level: age, amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans.

Adolescent↗

PubMed1999

Prevalence and serotyping of Porphyromonas gingivalis in an Indonesian population.

In this study, the prevalence and serotype distribution of Porphyromonas gingivalis in an Indonesian population (n=158) is described. The relationship between subgingival P. gingivalis and periodontal attachment loss was investigated. The serotype distribution and periodontal parameters were studied. Serotyping was also used to study person-to-person transmission between siblings and between spouses. Approximately 50% of the subjects had periodontal attachment loss > or =3 mm at 1 or more recorded sites. The population was divided into 2 subgroups based on the presence or absence of P. gingivalis. No differences in plaque index, pocket depth, clinical attachment loss, bleeding upon probing, % of sites with > or =3 mm clinical attachment loss and % of sites with probing pocket depth > or =5 mm, were observed between both sub-populations. All known 6 capsular serotypes were found in the study population, with the exception of the K1 type. Detection of 1 of the known P. gingivalis serotypes was not related with the amount of clinical attachment loss. In 3 out of 29 sibships with more than one member positive for P. gingivalis, an identical P. gingivalis serotype was found. None of the 15 couples in the study shared an identical P. gingivalis serotype, indicating that transmission is probably not a common phenomenon in this population.

Adolescent↗

PubMed1999

Clinical and microbiological effects of initial periodontal therapy in conjunction with amoxicillin and clavulanic acid in patients with adult periodontitis. A randomised double-blind, placebo-controlled study.

The aim of the present study was to investigate the clinical and microbiological effects of initial periodontal therapy in conjunction with systemic amoxicillin plus clavulanic acid in adult periodontitis patients using a double-blind, parallel-group, and placebo-controlled protocol. 21 patients with a clinical diagnosis of generalised adult periodontitis were recruited. Clinical measurements and microbiological assessments were carried out at baseline, 3, and 12 months post-treatment. Approximately 6 weeks after initial periodontal treatment (3-6 h), patients were randomly assigned to receive coded study medication of 500 mg amoxicillin plus 125 mg clavulanic acid (Augmentin) or placebo, every 8 h for 10 days. Patients returned for follow-up visits 3, 6, 9, and 12 months after completion of the medication. The mean plaque index (PI) at baseline was 1.1 for placebo group and 0.9 for the test group. At 3 months, the PI had dropped to 0.3 in both groups, and was maintained during the rest of the study. The changes in bleeding on probing (BOP) and gingival index (GI) in the course of the study were similar in both groups. The mean whole mouth probing pocket depth (PPD) in the placebo group was 3.8 mm at baseline and 3.9 mm in the test group. A mean reduction of 1.0 mm in the placebo group and 0.9 mm in the test group was observed during the first 3 months. No further reduction in PPD was noticed during the study period in either group. There was no statistically significant difference in the PPD reduction between the 2 groups. The change in clinical attachment level (CAL) from baseline to 3 months amounted to 0.5 mm in both groups. Between 3 and 12 months, the CAL changed in neither group. In both groups, treatment resulted in a decrease in the number of spirochetes and motile rods in positive patients, but no significant differences between either group were noted in any of the dark field microscopy observations. At baseline, 1 patient in the placebo group and 2 patients in the test group were culture positive for Actinobacillus actinomycetemcomitans (Aa). After therapy, Aa was not detectable in the placebo group and 1 patient remained positive in the test group. In the placebo group, the number of patients positive for Porphyromonas gingivalis (Pg) decreased from 7 to 2 after therapy. In the test group, the 4 patients positive for Pg at baseline remained positive after therapy. In both groups, all subjects were positive for Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn) at baseline. At 12 months, all subjects had detectable subgingival Fn. 9 out of the 11 placebo and 8 of the 10 test patients remained positive for Pi. There were no differences in detection frequency of Peptostreptococcus micros (Pm) and Bacteroides forsythus (Bf) in both groups between baseline, 3, and 12 months post-treatment. The findings demonstrated that, in comparison to placebo, systemic amoxicillin plus clavulanic acid provided no additional clinical and microbiological effects in the treatment of adult periodontitis patients.

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