With clinical dental practice keeping dentists busy, here is a snapshot of some recently published material to help you choose what may be most relevant to your work and therefore worth accessing in its entirety to find out more.
Mouthwash use and the prevention of plaque, gingivitis and caries (Boyle P et al, 2014)
This supplement found that quantitative assessment of data exploring mouthwash use and the risk of common oral conditions supports the use of mouthwash in preventing dental plaque, gingivitis and dental caries.
It was also suggested that over a period of less than three months, mouthwashes containing chlorhexidine are the most effective of the preparations considered, resulting in a reduction of both dental plaque and gingivitis. When used for six months or longer, essential oil mouthwashes equal or exceed the effect of chlorhexidine in controlling plaque and gingivitis as an adjunct to standard care.
In addition, a fluoridated mouthwash is a useful adjunct to fluoridated toothpaste in reducing caries in children.
Furthermore, it is concluded that “there are no major adverse effects” including that there is “no evidence of an increased risk of oral cancer among users of mouthwash containing alcohol”.
Principles of periodontology (Dentino A et al, 2013)
Dentino and colleagues (2013) present an overview of the principles of periodontology, considering its history,
classification, aetiology, pathogenesis, epidemiology and treatment modalities.
Among their findings, Dentino et al report: “Currently, periodontal
diseases are classified based upon clinically observed disease traits using radiographs and clinical examination: gingivitis; chronic periodontitis; aggressive periodontitis; periodontitis as manifestation of systemic diseases; necrotizing ulcerative periodontitis; abscesses of the periodontium; periodontitis associated with endodontic lesions; and developmental or acquired deformities and conditions. Advances in genomics, molecular science, and personalized
medicine may result in guidelines for unambiguous disease definition and diagnosis in the future.”
In terms of treatment the authors suggest: “The therapeutic efforts for controlling periodontal diseases focus on the removal of dental biofilm from the affected lesion, as active treatment centers on non-surgical mechanical debridement with antimicrobial and sometimes anti-inflammatory adjuncts. The surgical therapy aims at gaining access to the lesion and correcting unfavorable gingival⁄osseous contours to achieve a periodontal architecture that will provide for more efficient oral hygiene and periodontal maintenance. In addition, recent advances in tissue engineering have provided an efficient means to regenerate⁄repair periodontal defects, based upon principles of guided tissue regeneration and utilization of growth factors⁄biologic mediators. To maintain periodontal stability, these therapies must be supplemented by a longterm maintenance program (supportive periodontal therapy).”
Periodontitis: from microbial immune subversion to systemic inflammation (Hajishengallis G, 2015)
In this review, Hajishengallis: “… discusses the mechanisms of microbial immune subversion that tip the balance
from homeostasis to disease in oral or extra-oral sites.”
Exploring issues such as microbial synergy and dysbiosis and the subversion of host immune responses, Hajishengallis concluded: “Dysbiotic microbial communities in the periodontium resist immune elimination and create permissive conditions for growth in a nutritionally favourable inflammatory environment. The immune subversive and proinflammatory strategies that promote the fitness of periodontal bacteria not only cause collateral damage to the periodontium, but also have repercussions that link periodontitis to systemic afflictions. The virulence of individual periodontal pathogens is maximized in the context of a polymicrobial infection and its impact
on the host depends on genetic predisposition and environmental modifiers.”
“Hence, to better understand the mechanisms of the pathogenesis of periodontitis and associated systemic conditions, data from epidemiological and animal model studies need to be integrated with those from metatranscriptomic and metaproteomic approaches, as well as with data from whole-genome transcriptomic and proteomic analyses of tissue samples from healthy individuals and from patients with different stages of disease. This integration can offer insights into the dynamic nature of host–microorganism interactions in disease development and, moreover, can facilitate the formulation of novel hypotheses for further studies. More importantly, key findings from basic research need to be translated into clinical applications and inform the development of therapies that counteract the immune-subversive mechanisms of periodontal bacteria, thereby contributing to the treatment of periodontitis and associated systemic inflammatory disorders.”
Crevicular fluid biomarkers and periodontal disease progression (Kinney JS et al, 2014)
The aim of this research was to: “Assess the ability of a panel of gingival crevicular fluid (GCF) biomarkers as predictors of periodontal disease progression (PDP).”
One hundred subjects took part in a 12-month longitudinal study. They were divided into four groups in line with their periodontal status. Bi-monthly, GCF, clinical parameters and saliva were collected. For the first six months
the participants received no periodontal treatment; however, such treatment was provided after six months. Participants then continued on for a further six months.
The results were as follows: “With the exception of GCF C-reactive protein, all biomarkers were significantly higher
in the PDP group compared to stable patients. Clustering analysis showed highest sensitivity levels when biofilm
pathogens and GCF biomarkers were combined with clinical measures, 74 per cent (95 per cent CI = 61, 86).”
This led Kinney and colleagues to conclude: “Signature of GCF fluidderived biomarkers combined with pathogens and clinical measures provides a sensitive measure for discrimination of PDP.”
Powered/electric toothbrushes compared to manual toothbrushes for maintaining oral health (Yaacob M et al, 2014)
“Authors from the Cochrane Oral Health Group carried out this review of existing studies and the evidence is current up to 23 January 2014. It includes 56 studies published from 1964 to 2011 in which 5068 participants were randomised to receive either a powered toothbrush or a manual toothbrush. Majority of the studies included adults, and over 50 per cent of the studies used a type of powered toothbrush that had a rotation oscillation mode of action (where the brush head rotates in one direction and then the other).”
Yaacob and colleagues (2014) found: “The evidence produced shows benefits in using a powered toothbrush when compared with a manual toothbrush. There was an 11 per cent reduction in plaque at one to three months of use,
and a 21 per cent reduction in plaque when assessed after three months of use. For gingivitis, there was a six per
cent reduction at one to three months of use and an 11 per cent reduction when assessed after three months of use. The benefits of this for long-term dental health are unclear.”
In addition, it was concluded that: “Few studies reported on side effects; any reported side effects were localised and only temporary.”
However, it is important to note that the authors of this report found costs, reliability and side effects to have been
inconsistently reported.
Developing pathways for oral care in elders: evidence-based interventions for dental caries prevention in dentate
elders (Ghezzi EM, 2014)
As increasing numbers of people maintain their teeth for longer, dental caries is becoming a greater challenge for older people.
Searching for a low-cost but effective product to tackle this problem, Ghezzi (2014) evaluated: “…evidence based
interventions for dentate elders, specifically the adjunct therapies of fluoride, chlorhexidine, xylitol, casein phosphopeptide-amorphous calcium phosphate, ozone, and herbal liquorice.”
She found that: “Fluoride interventions have demonstrated prevention and remineralization of dental caries in elders. Systematic reviews of the literature are unable to establish definitive conclusions regarding the effectiveness of other adjunct therapies in dental caries prevention.”
In conclusion, the author wrote: “Research priorities for dental caries prevention must include dentate elders. New strategies for research of the effectiveness of therapies to reduce dental caries include the development and evaluation of combinations of therapeutic interventions and dental caries management by risk assessment. There is need to provide clinical evidence that scientifically based dental caries risk assessment with corresponding aggressive preventive measures (i.e. targeted antibacterial and fluoride therapy based on salivary microbial and fluoride levels) and conservative restorations would result in reduced dental caries increment. To achieve compliance and efficacy, consumer products and homecare procedures need to be developed and become more accessible. Studies in patients at risk for dental caries and vulnerable groups are needed to increase knowledge and self-care practices by communicating preventive health messages and increasing motivation.”
Accuracy of diagnosing occlusal caries using enhanced digital images (Kositbowornchai S et al, 2014)
In 2014, Kositbowornchai and colleagues compared the accuracy of detecting occlusal caries lesions on original images versus digitally images enhanced. After taking each original radiograph, one researcher manipulated images for sharpness, zoom (full resolution) and brown pseudocolour.
The authors wrote: “Conventional radiography has been a boon in the detection of dental caries, but a diagnostic sensitivity between 0.40 and 0.60 begs improvement. The introduction of digital imaging in the mid-1990s proved a significant advance for radiographic diagnosis. While the diagnostic accuracy of digital systems is comparable with that of dental films, a major advantage of digital system is the possibility to alter the display options for image interpretation.”
Kositbowornchai et al further considered: “Whether or not, and how much, image enhancement can improve actual diagnostic potential is debatable, so it needs careful study. Our aim was to evaluate the in vitro diagnostic accuracy of occlusal caries detection with four different digital imaging modes: original image, sharpness filter, zoom and pseudocolour.”
Following examination of 400 images of 100 extracted third molars by four observers who did not have prior knowledge of any caries distributions, it was concluded: “…this in vitro study has demonstrated that three types of
enhanced digital images performed similarly to the non-enhanced images in the detection of occlusal caries.”
Cochrane fluoride reviews: an overview of the evidence on caries prevention with fluoride treatments (Marinho VCC, 2014)
Author Marinho (2014) wrote: “This paper provides a concise overview of the evidence compiled in the Cochrane
fluoride reviews, which form the basis of the international evidence base for fluoride use in caries prevention; it describes the key resources, highlighting their main methodological features, main findings and conclusions (for practice and research), as well as their use in clinical practice guidelines.”
Following Marinho’s research into the Cochrane fluoride reviews, she concluded: “The Cochrane reviews on the effects of toothpastes, mouth rinses, gels and varnishes have clearly confirmed the relative effectiveness of these fluoride treatment modalities. Estimates of the effectiveness of caries prevention have become much more precise (narrower confidence intervals) and causes of differences in effectiveness among treatments have been formally indicated. As these Cochrane fluoride reviews undergo updating with evidence from new trials being incorporated into the existing reviews, the precision of the estimates of caries-preventive effects are likely to increase slightly, although no changes in conclusions are likely to occur.”
Treatment modalities for dentine hypersensitivity (Gillam DG, 2014)
Written to provide dental professionals with information on in-practice and at-home care to help address tooth sensitivity, this piece has the creation of a workable maintenance programme at its heart.
Having reviewed the available literature, Gillam (2014) concluded: “For the dental professional to successfully manage DH [dentine hypersensitivity] and to enable their patients to have an improved quality of life, it is essential not only to correctly diagnose the condition but also to initiate a simple yet practical management strategy. This should be based on a stepwise approach, incorporating preventative and management strategies, in order to identify and eliminate any predisposing factors, in particular erosive factors (e.g. dietary acids) prior to offering any treatment to the patient. Treatment should be subsequently based on the extent and severity of the problem, for example, if the patient has severe discomfort limited to one or two teeth, then an in-office procedure would be the first treatment option of choice. If the patient’s discomfort is initially of a generalised mild disposition, then it would be appropriate for an at-home product to be provided; however, if the discomfort is not resolved by this method after a few weeks, then it would be appropriate for the dental professional to re-examine the patient and treat as necessary with an in-office procedure. It would be prudent for the dental professional to recognise that there is no one ideal treatment modality when treating DH and there may be occasions when a combination of at-home and in-office treatment may be appropriate to resolve the problem and provide the patient with an improvement in their quality of life.”
The Dentine Hypersensitivity Experience Questionnaire: a longitudinal validation study (Baker SR et al, 2014)
The aim of this article was: “To validate the Dentine Hypersensitivity Experience Questionnaire in terms of responsiveness to change and to determine the minimally important difference.”
The Dentine Hypersensitivity Experience Questionnaire (DHEQ) used comprised 34 questions covering the issues of functional restrictions, coping, social impact, emotional impact and identity.
Having followed participants over eight and 12-week periods, Baker and colleagues (2014) reported: “These findings indicate that the DHEQ is valuable for use in longitudinal evaluation of people with DH. Interestingly, the coping domain showed the greatest change – compatible with these items being transient or amenable to change (e.g. warming certain foods or drinks; avoiding cold drinks). In contrast, the identity and social domains were least
responsive perhaps because they are less likely to change over the short-term (e.g. makes me feel old; damaged).”
Practically speaking, the authors suggest that: “The study provides a comprehensive psychometric evaluation of the DHEQ. It offers clinicians, trial lists and researchers a tool to understand and quantify the experience of DH in everyday life and the effects of treatment from the person perspective.”
At the heart of success
As stated by the General Dental Council: “Keeping skills and knowledge up to date throughout your career is at the heart of what it means to be a dental professional.”
“Continuing Professional Development (CPD) can support dentists and dental care professionals in maintaining and updating their skills, knowledge and behaviour throughout their working life. It may also contribute to the delivery of good quality care and service provision, that patients and the public trust is safe and the best it can be.”
Knowing how pressed for time dentists and their teams are performing their clinical work, this article offers a time-saving lead to help meet the dental professional’s desire to keep their skills and knowledge current.
References available on request.
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