PubMed · 4514669
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C L Wiedemann. 1973. Plaque control plus smoking control.. https://pubmed.ncbi.nlm.nih.gov/4514669/
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This survey investigated the association between the efficacy of plaque removal and toothbrushing forces during a normal brushing regime. The 94 subjects participating in this study were requested not to brush 24 h prior to the experiment. Panelists brushed for 1 min with a manual toothbrush. Before and after brushing, plaque was assessed using the Turesky modification of the Quigley & Hein plaque index. A second 1-min exercise of brushing was carried out to assess the toothbrushing force. The mean plaque reduction was 39%, with vestibular surfaces being cleaned most effective (69%) and the lingual surfaces the least (21%). The mean brushing force was 330 g. No correlation was observed between efficacy and brushing force (r=0.14, p=0.16). The relationship between pre- and post-brushing plaque was stronger (r=0.68, p<0.001). Multiple regression analysis entering squared values of force as an independent variable into the equation, indicated that the relation between efficacy and force was not linear. A curve could be fitted to the plot (p=0.0004), demonstrating that up to a certain level of force, an increase of force is associated with an increase in efficacy (r=0.33, p<0.01). Beyond this point, application of higher forces resulted in reduced efficacy (r=-0.49, p=0.03). As was calculated in this particular test this 'transition' level of force was 407.4 g. The absence of a correlation between brushing force and plaque removal efficacy suggests that in a 'user model' brushing situation, other factors than brushing force are of major influence on the amount of plaque removed.
Periodontitis, which is widespread in the adult population, is a persistent bacterial infection associated with Porphyromonas gingivalis. Gingival epithelial cells are among the first cells encountered by both P. gingivalis and commensal oral bacteria. The chemokine interleukin 8 (IL-8), a potent chemoattractant and activator of polymorphonuclear leukocytes, was secreted by gingival epithelial cells in response to components of the normal oral flora. In contrast, P. gingivalis was found to strongly inhibit IL-8 accumulation from gingival epithelial cells. Inhibition was associated with a decrease in mRNA for IL-8. Antagonism of IL-8 accumulation did not occur in KB cells, an epithelial cell line that does not support high levels of intracellular invasion by P. gingivalis. Furthermore, a noninvasive mutant of P. gingivalis was unable to antagonize IL-8 accumulation. Invasion-dependent destruction of the gingival IL-8 chemokine gradient at sites of P. gingivalis colonization (local chemokine paralysis) will severely impair mucosal defense and represents a novel mechanism for bacterial colonization of host tissue.
The orthodontist is in fact a periodontal-therapist since his aim is to move the teeth with and through the periodontal tissues. It is most important for the orthodontist to be able to determine at the initial clinical examination what are the various periodontal risk factors. When the pathology is obvious with inflammation, periodontal pockets, gingival hyperplasia, edema of the papillae, gingival recessions, the need for periodontal treatment is manifest. But many times, the periodontal evaluation is complicated by the presence of slight variations of the quality of the marginal tissue that represent a risk of developing periodontal defects during the orthodontic treatment. The aim of this presentation is to put forward the importance of the periodontal evaluation during the initial examination of the patient so that, if necessary, an adequate periodontal therapy can be initiated to stabilize the periodontal tissues and thus improves the esthetical outcome.