Oral Health and Preventive Dentistry

Purpose: To assess the association of various factors including education level and oral health with type 2 diabetics’ awareness of periodontitis and periodontitis/diabetes relationship, and to evaluate the importance of integrated healthcare in this association. Materials and Methods: 288 type 2 diabetics were evaluated through a validated structured questionnaire about oral hygiene habits, access and attendance to dental treatment, the presence of periodontitis and previously received information of periodontitis and periodontitis/diabetes relationship. Descriptive data were explored and both simple and multiple logistic regressions were performed. Results: The average age of participants was 62.24 (±10.93) years, 81.6% were previously treated for periodontitis and approximately 70% have never received information on periodontitis and its relationship with diabetes. A higher chance of participants having previously received information regarding periodontitis was associated with more than 8 years of schooling, daily flossing habit, presence of periodontitis and prior treatment for periodontitis (p  Keywords: diabetes mellitus, periodontal diseases, health promotion, public health/community dentistry, primary healthcare

Purpose: The aim of the present research was to analyse the effects of two bleaching agents, on the enamel crystallography by means of X-ray diffraction. Material and Methods: Twelve human sound posterior teeth, were collected for the present study (n = 12) and from each tooth two enamel slabs were obtained and randomly assigned to one of two different bleaching protocols. The first protocol involved an in-office bleaching agent (hydrogen peroxide 37.5%/ SDI Polaoffice+), and the second an at-home whitening product (carbamide peroxide 16%/ PHILIPS Zoom! NiteWhite). X-ray diffraction readings were made before and after applying the treatments in order to analyse the peak intensity and crystal domain size. Additionally, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) were carried out to identify the composition correctly. Statistical analysis included repeated measures analysis of variance (p ≤ 0.05). Results: Peak intensity in spectra obtained by X-ray diffraction had a tendency to diminish, mostly in the at-home bleaching group. The analysed data approximate a decrease in the crystal domain size among the samples treated for longer periods of time. Statistical analysis depicted no statistically significant differences among the experimental groups (p ≥ 0.05). Conclusions: Crystal domain size had a tendency to decrease, mostly when the enamel was treated by bleaching gels that had to be applied by prolonged periods of time. Keywords: bleaching agent, enamel crystallography, X-ray diffraction

Purpose: To investigate the subgingival microbiological profiles of patients with periodontitis, to determine their stage and grade scores and to evaluate the differences in the microbiota among different stages and grades. Materials and Methods: Sixty-seven (n = 67) periodontitis patients were selected. Periodontitis staging and grading, following the 2018 classification system, were defined. Following a clinical examination, subgingival samples were taken from the deepest periodontal pocket of each quadrant for cultivation, identification and quantification. The prevalence, proportion and counts of nine selected periodontal pathogens were determined, and differences between periodontitis stages III and IV and grades B and C were assessed. Results: All nine cultivable periodontal bacteria were detected, of which the most prevalent was P. intermedia (91.0%) and the least prevalent were E. corrodens (9.0%) and C. ochracea (9.0%). The frequency of detection of the two main target pathogens, A. actinomycetemcomitans and P. gingivalis, was 41.8% and 76.1%, respectively. The prevalence (grade B: 80.6%, grade C: 55.6%, p = 0.035) and total counts (grade B: 19.8 colony forming units – CFU/ml-4 (1.9–52.8); grade C: 4.0 CFU/ml-4 (0.0–26.4); p = 0.022) of F. nucleatum were statistically significantly higher in grade B than in grade C periodontitis patients, whereas the counts of P. gingivalis and A. actinomycetemcomitans were similar between grades and stages. Conclusion: Our study suggests that relevant differences between the various grades of periodontitis exist only in the numbers of F. nucleatum. Prevalence and quantities of other cultivable species between different stages and grades of periodontitis seem to be similar. Keywords: periodontitis, stage, grade, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum

Purpose: The aim of this study was to verify how the prevalence of viridans-streptococci is changed by two appointments of professional prophylaxis and after the subgingival instrumentation via scaling and root planing (SRP). Material and Methods: Samples of the subgingival biofilm were collected from 19 individuals with periodontitis receiving two appointments of professional prophylaxis and SRP before and after the treatment procedures and the presence of viridans-streptococci was analysed by microbiological cultivation. Non-parametric statistical testing using Friedman/Wilcoxon tests and chi-square testing was used for statistical analysis. Results: No statistically significant changes over time were found for the mutans-group. The prevalence of Streptococcus mitis decreased after two appointments of professional prophylaxis (p = 0.013). The prevalence of S. mitis decreased again after SRP (p <0.001). The prevalence of Streptococcus anginosus decreased after two appointments of professional prophylaxis (p = 0.002). After SRP five positive results for S. anginosus were detected (p = 0.026). For Streptococcus oralis and Streptococcus gordonii tendencies to statistical significance were found. The number of positive results for S. oralis increased after the first appointment of professional oral prophylaxis (p = 0.055). The number of positive results for S. gordonii increased after the first appointment of professional oral prophylaxis (p = 0.055). Conclusion: The step-wise periodontal therapy influences the prevalence of viridans-streptococci, especially S. mitis and S. anginosus. No tremendous increase of streptococci especially related to the carious process occurs in the subgingival biofilm. Clinical Relevance: The study reveals knowledge on changes of the composition of the subgingival biofilm due to different steps of periodontal therapy. Keywords: periodontitis, professional dental prophylaxis, subgingival instrumentation, subgingival biofilm, viridans-streptococci

Purpose: Several studies demonstrated compromised oral health and periodontal diseases as risk factors for adverse pregnancy outcomes. However, consideration of oral health by pregnant women remains elusive. The aim of this study was to evaluate knowledge and behaviour of French pregnant women towards relationship between oral conditions and pregnancy outcomes and to evaluate influencing factors. Materials and Methods: A self-reported questionnaire was given to women between 1 and 3 days after delivery in three specialised clinics in France. The questionnaire aimed to evaluate demographic characteristics, self-perceived oral health, type of pregnancy follow-up and knowledge regarding oral conditions during pregnancy and risk of adverse pregnancy outcomes. A multivariate analysis was performed to evaluate correlation between knowledge and behaviour. Results: The questionnaire was completed by 212 women. Among them, 92% considered prevention of oral diseases during pregnancy important. Despite knowledge of potential negative influence of periodontal diseases on pregnancy outcomes, only 47% of pregnant women received dental diagnosis or treatment during pregnancy. Only 18% of the women discussed oral health consideration during pregnancy with health professional in charge of pregnancy follow-up. Interestingly, absence of dental consultation during pregnancy was associated with low rate of dental consultation prior to pregnancy (p < 0.01). Conclusions: Pregnant women were aware of the association between oral health and pregnancy and of need of prevention. However, consideration of importance of oral health was not adequate to the rate of dental consultation and seems to be influenced by individual dental follow-up habits prior to pregnancy. Clinical Relevance: Dental evaluation should be considered systematically during pregnancy follow-up. Keywords: oral health, questionnaire, prevention, risk factor

Purpose: To assess the effect of age on the mean percentage of bleeding on probing (BOP) during supportive periodontal therapy (SPT) in patients enrolled in SPT for at least 5 years. Materials and Methods: This study was performed as a retrospective analysis of data collected from SPT patients initially diagnosed with gingivitis or mild to severe periodontitis. Two groups of patients were selected: in group A, younger adults (age ≤ 35 years) were included while group B consisted of older SPT patients (age ≥ 65 years). BOP in the two groups was compared according to both disease severity and % compliance with SPT visits. Results: BOP in all patients (n = 236) was 19.2% (± 12.4). Group A (n = 110) presented mean BOP levels of 19.7% (± 11.8), while lower BOP levels of 18.7% (± 13.0) were found in group B (n = 126; p = 0.5272). Older patients demonstrating high % compliance had lower mean BOP levels (14.2% ± 9.5) than younger patients (18.0% ±  11.7; p = 0.0841). Similarly, BOP was lower in older patients with moderate (group B: 18.4% ± 12.1, group A: 19.3% ± 14.6, p = 0.0541) or severe periodontitis (group B: 22.4% ± 11.4, group A: 23.2% ±  14.0; p = 0.3440). In patients with moderate or severe periodontitis and higher % compliance with SPT, the mean BOP was statistically significantly lower in older patients than in younger patients (moderate: 14.4% ± 11.9 vs 19.4% ± 15.1, p  Keywords: bleeding on probing, elderly, compliance, supportive periodontal therapy

Purpose: A previous clinical study showed that the prevalence of erosive toothwear in vegetarians is statistically significantly higher than in nonvegetarians, due to the consumption of vinegar and other acidic foodstuffs. To adequately inform patients, this study investigated the erosive potential of bottled salad dressings available in Switzerland and compared it with that of orange juice. Materials and Methods: One hundred enamel samples of bovine teeth were divided into ten groups. Samples were placed in 1 of 9 bottled salad dressings or orange juice (Granini) for 2 min. Afterwards, they were rinsed with Zürich tap water for 30 s, followed by abrasion with a toothbrush for 20 brush strokes and a toothpaste-saliva mixture. Erosive/abrasive enamel wear was determined with contact profilometry after 40 cycles. Results: The enamel wear (median/IQR) caused by Tradition Sauce Balsamique (9.5 µm/5.3 µm), M-Classic Dressing Italiano (10.9 µm/12.3 µm), Betty Bossi Balsamico Dressing (9.4 µm/4.5 µm) and Thomy Balsamico Vinaigrette Dressing (14.2 µm/6.5 µm) was statistically significantly higher than that caused by orange juice (2.4 µm/0.8 µm). Enamel wear caused by M-Classic Dressing French Joghurt (0.2 µm/0.2 µm) and Coop Qualité & Prix French Dressing (1.2 µm/1.0 µm) was statistically significantly lower compared to that of orange juice. Conclusions: The pure balsamico vinegar-based dressings (Italian type) showed a statistically significantly higher erosive potential than orange juice, whereas dressings containing calcium-rich products (enriched with milk and/or cream) (French-type) caused lower enamel wear than orange juice. The study shows that some bottled dressings have erosive potential even higher than orange juice and patients should be informed accordingly. Keywords: erosion, tooth wear, salad dressings

Purpose: The topical fluoride treatment of teeth can lead to a formation of CaF2-like material, which is considered to play a significant role in caries prevention. Different types of fluoride sources are applied. The aim of this study was to analyse the in vitro fluoridation effect of the lesser known organic fluoride compound nicomethanol hydrofluoride (NH) regarding fluoride accumulation and morphological changes on dental enamel surfaces. Materials and Methods: The fluoridation effect was investigated by scanning electron microscopy (SEM) and energy dispersive x-ray analysis (EDX) after treatment with fluoride solutions at a concentration of 1350 ppm F - and a pH value of 5.5. NH was tested against inorganic sodium fluoride (NaF) as reference. Fluoridation was done on pellicle-free and pellicle-covered enamel. Results: Formation of globular CaF2-like material was observed for both fluoride types. However, NH led to considerably higher calcium fluoride accumulation on the enamel surface as shown by both EDX and SEM. The globule diameters varied between 0.2 and 0.8 µm. Cross-sectional analysis revealed that the globular precipitates lay directly on the enamel surface; only the very surface-near volume was affected. No statistically significant difference of the fluoridation effect was measured with vs without saliva pre-treatment. Conclusion: The experiments showed a 6 times greater F - surface uptake on dental enamel with NH compared to sodium fluoride, thus suggesting an important role of NH during remineralization phases, fostering equilibrium between de- and remineralization. Keywords: amine fluorides, calcium fluoride precipitation, enamel, energy dispersive x-ray analysis, scanning electron microscopy

Purpose: Orthodontic treatment may introduce a risk to the integrity of enamel due to plaque accumulation and colonisation by oral microbes. This prospective cohort study observed the effect of fixed, self-ligating orthodontic appliances on saliva properties and oral microbial flora. Materials and Methods: Thirty adolescent patients were recruited (13 female, 17 male, mean age 13.97 ± 2.07 years). Saliva samples were collected before placement of fixed orthodontic appliances (T0), and 4 (T1) and 12 (T2) weeks later. Salivary pH, flow rate and buffering capacity were recorded. All saliva samples were cultured on agar plates for 2 days. Salivary prevalence of Neisseria spp., streptococci, Staphylococcus aureus, coagulase-negative staphylococci and Candida albicans were assessed. Results: High buffering capacity was reported in 21 patients at T0, 22 patients at T1 and in 28 patients at T2. Saliva flow rate also increased over time (7.08 ml/5 min at T0, 7.93 ml/5 min at T1 and 8.35 ml/5min at T2). Mean pH was 7.63 at T0, 7.67 at T1 and 7.78 at T2. There was no evidence that either pH or the number of colonies of any of the microbial species changed over time. Conclusion: The increased buffering capacity of saliva as well as the salivary flow rate after initial bonding might be protective against the development of dental caries. Current microbial findings indicate that initiation of orthodontic treatment may not be associated with significant changes in oral microbial flora. Keywords: microbial flora, orthodontics, saliva

Purpose: The aim of this study was to review the literature and chart the clinical studies that have focused on periodontal diseases and adverse pregnancy outcomes since 1996. Materials and Methods: Medline, Cinahl, and Cochrane databases were searched for original studies focused on pregnancy outcomes and periodontal status in humans. The most recent search was conducted on April 30, 2020. Results: Of the 633 articles identified, 232 articles (n = 119,774 participants) were selected for analysis. The majority of studies highlighted a statistically significant association between periodontal diseases and preterm birth (71 of 111 articles; 63.96%), low birth weight (46 of 64 articles; 71.87%), preterm low birth weight (29 of 49 articles; 59.18%), preeclampsia (31 of 45 articles; 68.89%) and other pregnancy complications, such as preterm, prelabor rupture of membranes (17 of 26 articles; 65.38%). Geographical analysis revealed that clinical studies were conducted in 51 countries, primarily in the United States (42 studies, 18.10%), Brazil (33 studies, 14.22%) and India (25 studies, 10.78%). Irrespective of geographical location, analysis showed various degrees of evidence of a relationship between periodontal diseases and adverse pregnancy outcomes. Conclusion: The majority of the studies found a statistically significant link between periodontal diseases and some complications of pregnancy. The strength of such a link varies according to type of study, type of variable and outcome measure selected. Keywords: periodontal diseases, pregnancy, adverse pregnancy outcomes, mapping

Purpose: To determine how the currently available techniques of scaling and root planing, used either alone or with additional polishing techniques, affect the substance thickness and surface roughness of enamel and cementum. Materials and Methods: After extraction, impacted third molars were prepared and subjected to air polishing with a nonabrasive powder, ultrasonic scaling, or hand instrumentation. All three techniques were performed alone and in combinations for a total of 9 treatment groups. The control group consisted of untreated surfaces. Optical microcoordination measurements were conducted to separately assess substance loss, mean roughness depth (Rz), and roughness average (Ra) on enamel and cementum. The Rz results were analysed using a t-test for paired samples. Results: Air polishing alone and with additional rubber-cup polishing using a paste were the only two approaches which caused no enamel loss. Both groups also entailed less cementum loss (≤ 20 μm) than any of the other seven groups, and both yielded the most favorable Rz results on enamel. Air polishing alone was the only group to reveal no significant change in Rz from untreated cementum (p = 0.999). The other 8 approaches statistically significantly reduced the surface roughness of cementum (p ≤ 0.017). Conclusion: Air polishing with a nonabrasive powder yielded the best hard-tissue preservation. Combining any of the scaling techniques with additional polishing was not beneficial; on the contrary, they caused even more abrasion of hard tissue on both enamel and cementum. Keywords: cementum, enamel, hand instruments, substance loss, surface roughness, ultrasonic air polishing

Purpose: Preschool children with early childhood caries (ECC) frequently exhibit extreme dental anxiety and fear, posing a considerable challenge to paediatric dentists for their treatment. The aim of this study was to evaluate the influence of silver diamine fluoride (SDF) treatment on the oral health-related quality of life (OHRQoL) of uncooperative preschool children using an Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS). Materials and Methods: A pre-validated A-ECOHIS was used to assess the sensitivity and responsiveness. Fiftyone children, uncooperative with conventional dental care, underwent SDF treatment; their mothers answered the A-ECOHIS before and 4 weeks after treatment. Based on the global transition rating (GTR), the mothers rated their child’s oral health condition following SDF treatment. Results: SDF effectively arrested caries after 4 weeks in all children. There was a statistically significant reduction in mean scores of the total A-ECOHIS, child impact scale and family impact scores at follow-up (Wilcoxon signedrank test; p ˂ 0.001). There were statistically significant changes in the mean GTR of children’s oral health. Conclusions: A-ECOHIS was sensitive and responsive to SDF treatment. SDF statistically significantly improved the OHRQoL of uncooperative preschool children. Keywords: children, dental caries, mothers, silver diamine fluoride, quality of life

Purpose: Obesity and dental caries constitute an important public health problem worldwide. Special-needs children are at higher risk of developing dental caries and obesity because of their physical, neurological, or behavioural impairment or due to side effects of the medications they take. The present study was conducted to assess the association between dental caries and obesity among children with special health care needs in Taif City, Saudi Arabia. Materials and Methods: A descriptive cross-sectional study was conducted among 400 (220 girls and 180 boys) special-needs children. Body mass index (BMI) was determined by using height and weight measurements. Dental caries was recorded according to World Health Organization criteria. The association between caries and obesity was assessed using multivariable logistic regression analysis. Results: 289 (72.3%) children presented with caries with mean dmft and DMFT of 3.9 ± 2.7 and 4.8 ± 2.3, respectively. Regression analysis showed specials needs children were at a greater risk of having dental caries: 1.69 times (CI: 0.18–2.62, p < 0.05) greater with obesity; 2.01 (CI: 0.18–3.09, p < 0.05) times greater with sugar consumption; 2.21 times (CI: 1.27–4.12, p < 0.001) greater with cerebral palsy; and 2.27 (CI: 1.29–5.12, p < 0.001) times greater with intellectual disability. Conclusion: The present study showed a positive association between dental caries and obesity among children of special health care needs. Hence, a focused approach towards the common risk factors is essential to prevent both obesity and dental caries in special-needs children. Keywords: dental caries, obesity, special needs

Purpose: To identify the oral hygiene habits and denture hygiene status (e.g. sociodemographic characteristics, general health status) of complete denture wearers in Central Transylvania, Romania. Materials and Methods: This descriptive cross-sectional study was based on an original self-administered questionnaire. It included 162 patients who experienced complete tooth loss in one or both jaws and wore polymethylmethacrylate acrylic (PMMA) complete dentures. The exclusion criteria were partial dentures, dentures fabricated from materials other than PMMA, and the patient being unable to provide all the required information. The questionnaire solicited information regarding sociodemographic status, general health and oral hygiene-related habits. The dentures were clinically evaluated in order to assess denture hygiene. Results: Most respondents were completely edentulous (38.0% wore maxillary dentures, 10.6% mandibular dentures, while 51.6% had both), with an average age above 60, all wearing dentures. The clinical evaluation of the dentures revealed that 12.3% exhibited optimal hygiene status, 40.1% good, 32.7% unsatisfactory and 14.8% bad, with more women than men having well-cleaned dentures. Cleaning frequency was found to be 2–3 times per day for 54.3% of the patients, with 93.2% of the subjects using a toothbrush and 76.5% using toothpaste. Most of the participants felt at ease with the cleaning procedures. Only 30.9% of the respondents reported denture removal overnight. The results showed that the hygiene of the patients’ dentures was not correlated with their answers regarding oral hygiene habits. Conclusions: Competent oral health and denture hygiene promotion should be established, especially regarding nocturnal denture removal, denture hygiene methods, instruments and cleaning frequency. Keywords: complete dentures, denture cleaners, oral hygiene habits, nocturnal wear, stomatitis

Purpose: Psychosocial impacts on quality of life among adolescents with access to affordable dental care is not well documented. In addition, dental pain is accelerating towards a public health problem that needs immediate attention. The objective was to determine impacts on quality of life using the Oral Impacts on Daily Performances (OIDP) frequency scale and to determine prevalence of dental pain with its impact. Methods: A total of 288 students (mean age 15.72 ± 1.5) completed the survey instrument (sociodemographic variables, consumption of chocolates/candies, perceived need for dental care, history of dental pain in last 6 months and OIDP frequency scale) designed to measure subjective oral health indicators. Mean OIDP simple count scores were analysed using logistic regression and additive (ADD) scores for dental pain were compared using student’s t test. Results: The response rate was 96%. About 44.4% reported impacts affecting daily performances. About 11.4% consumed tobacco and 92.7% consumed forms of refined sugars. About 39% perceived a need for dental care and 32.3% experienced dental pain with problem in eating and cleaning teeth. Those not perceiving a need for dental care were more likely to have an impact (OR: 2.3; CI: 1.2–4.4). Males had higher OIDP ADD scores for dental pain than females (p = 0.015). Conclusion: Overall impact was less than 50%. Dental pain was reported among students with access to dental care with impacts on eating and cleaning of teeth. Oral health promotion needs to be reinforced by strengthening school community relationship. Keywords: adolescent, child, quality of life, school health services, dental care, dental pain

Purpose: To evaluate the effect of a full-mouth disinfection protocol (FMD) on periodontal parameters, glycaemic control and subgingival microbiota of periodontal patients with type 1 and type 2 diabetes, as well as those without diabetes. Materials and Methods: This study included 33 patients with periodontitis. Eleven of them were type 1 diabetes patients, 11 were type 2 diabetes patients, and 11 were non-diabetics. At baseline and 3 months after the FMD, the periodontal parameters of each patient were recorded, samples of capillary blood for the chairside assessment of HbA1c were taken, and plaque samples from the two deepest periodontal pockets were collected to test for the presence of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) and Treponema denticola (Td). Results: Bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL) and glycated haemoglobin (HbA1c) decreased statistically significantly (p  Keywords: diabetes mellitus, full-mouth disinfection, HbA1c, periodontitis, subgingival microbiota

Purpose: To evaluate the association between orthodontic treatment with fixed appliances and periodontal health during treatment by examining gingival inflammation indices and saliva properties. Materials and Methods: Thirty consecutive orthodontic patients, aged 11–18 years old, who were eligible for fixed orthodontic appliances, were included in the study. Plaque index (PI), gingival index (GI), salivary pH and flow rate were recorded at three timepoints: immediately before placement of orthodontic fixed appliances (T0), and 1 (T1) and 3 months (T2) after bonding. Results: The hypothesis that PI would remain constant across timepoints was rejected. PI increased over time (0 to 1 scale, T1-T0: mean diff. = 0.10, 95% CI = 0.03, 0.18, p = 0.01; T2-T0: mean diff. = 0.16, 95% CI = 0.08, 0.24, p < 0.001). On the other hand, GI changed statistically significantly over time (p = 0.05). Patients’ age was not a predictor for PI change (p = 0.93), but it was for GI (p = 0.01). As anticipated, average PI was found to be higher for the mandibular dentition by 0.10 (95% CI = 0.04, 0.16) and the labial surfaces of teeth of both jaws by 0.51 (95% CI = 0.45, 0.57). Conclusions: Within the framework of the current study, orthodontic treatment appeared to affect the periodontal health of patients, but the changes were clinically negligible and not consistently statistically significant. Keywords: fixed orthodontic appliances, gingival index, periodontal health, plaque index

Purpose: To compare clinical outcomes and oral fluid biomarkers in gingivitis subjects using an electric toothbrush/irrigator combination (test) or a manual toothbrush alone (control) over 8 weeks. Materials and Methods: Subjects were randomly assigned to two groups of n = 30. In both groups, toothbrushing was performed twice daily at home and no additional interdental cleaning aids were allowed. Plaque Index (PLI), Gingival Index (GI), whole saliva (WS), and gingival crevicular fluid (GCF) samples were collected at weeks 2, 4, and 8. Results: Subjects’ mean age was 23 years and 52% were female. Overall baseline means were 1.31 for PLI, 1.07 for GI, and 34.9 for number of bleeding sites. At every follow-up visit, both groups differed statistically significantly (p < 0.001) from baseline for all clinical parameters. The test group demonstrated statistically significantly (p < 0.001) greater reductions in GI vs the control group by 18% at week 2, 17% at week 4 and 24% at week 8. The test group also demonstrated statistically significantly (p < 0.002) greater reductions in the number of bleeding sites vs the control group by 33% at week 2, 34% at week 4 and 43% at week 8. Between-group comparisons for both WS and GCF revealed numerical trends for decreased levels of interleukin (IL)-1β in GCF after 4 and 8 weeks, but these were not statistically significant. Conclusion: In subjects using the electric toothbrush/irrigator combination, increased clinical improvements may be found accompanied by similarly improved trends for oral fluid biomarkers such as IL-1β. Keywords: gingival crevicular fluid, gingivitis, prevention, toothbrushing

Purpose: To investigate the relationship between periodontal parameters and lipid profiles. Subjects and Methods: A total of 48 subjects with dyslipidemia, consisting of 33 subjects who did not receive lipid-lowering medication (NLM) and 15 subjects who did receive lipid-lowering medication (LM) were enrolled in this cross-sectional study. Sixteen systemically healthy subjects were recruited as controls. The plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were measured. The levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels were determined. The variables related to high cholesterol levels, including age, gender, waist circumference, and body mass index (BMI), were evaluated. Results: The LM group had a statistically significantly higher CAL in comparison with either the control or the NLM groups. TG was statistically significantly correlated with PD (ρ = 0.398, p = 0.001) and CAL (ρ = 0.349, p = 0.005). HDL-C was negatively correlated with PI (ρ = -0.371, p = 0.003), GI (ρ = -0.284, p = 0.025), and PD (ρ = -0.289, p = 0.023). The stepwise multiple regression analysis showed that BMI was statistically significantly associated with percentage of sites with BOP (β = 0.367, p = 0.003) and PD (β = 0.392, p = 0.002). CAL was statistically significantly influenced by age (β = 0.496, p  Keywords: body mass index, dyslipidemia, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, periodontal disease

Purpose: To evaluate the positive effects of a CPC-, GK2-, and TXA-based (CPC/GK2/TXA) mouthwash after implant placement. Materials and Methods: Twenty patients (n = 20) who underwent posterior implant-placement surgery were randomly and evenly allocated to the study or the placebo group. After the mouthwash was used 3x/day for 7 to 10 days postoperatively, sutures were analysed by counting the colony-forming units (CFU) for total aerobes, total G [-] anaerobes, total enterobacteria and total H. influenzae, followed by Real-Time PCR of bacterial-specific DNAs of A. actinomycetemcomitans, P. gingivalis, T. forsythia, T. denticola, P. intermedia, P. micra, F. nucleatum, C. rectus, and E. corrodens. In vitro resistance of P. gingivalis, S. aureus, and P. aeruginosa was analysed. The compatibility of the mouthwash with Straumann SLA implant surfaces was evaluated by scanning electron microscopy (SEM). Results: Sixteen patients (n = 16) completed the trial. A statistically significantly greater number of CFU was found in the placebo group for almost all species, especially for total G [-] anaerobes. No statistically significant in vitro resistance was found for P. gingivalis, S. aureus, and P. aeruginosa. SEM revealed no surface alteration after exposure to the mouthwash. Conclusion: The use of a CPC/GK2/TXA mouthwash inhibited propagation of the bacteria extracted from the post-surgical sutures after implant placement. Keywords: antibacterial agents, biofilms, implantology, microbiology, periodontology

Purpose: This study aimed to obtain the oral health-related factors of patients with intellectual and developmental disabilities (IDD) from family caregivers and to relate caregiver-perceived risk factors to dental treatment needs of patients. Materials and Methods: A total of 120 dyads of patients (mean [SD] age = 29.1 [8.4] years) and their family caregivers (mean [SD] age = 56.5 [9.5] years) were included. Data were obtained from self-administered questionnaires by caregivers and oral examinations by a dentist. Oral health conditions of patients were analysed in different age groups using paired t-tests. Caregiver-perceived oral health conditions of patients and dentist-assessed caries and periodontal disease were compared using Pearson’s chi-squared and Fisher’s exact tests. Relationships between patient factors and treatment needs were analysed using multiple logistic regression. Results: Tooth pain, chewing difficulty, and reasons for the last dental visit were associated with high numbers of decayed teeth (DT) (p  Keywords: caregiver, caries, DMFT, intellectual disability, oral health, periodontal index

Purpose: Analgesics (painkillers) are one of the most widely used medications to reduce and control pain. The objective of this study was to investigate the self-medication with analgesics (narcotic or non-narcotic) in controlling odontogenic pain in patients visiting dental offices, dental clinics, and the dental school of Kerman. Materials and Methods: This was a descriptive-analytic study, conducted in 2018. The study sample included patients referring to dental offices, dental clinics and the dental school of Kerman. After obtaining informed consent, a questionnaire consisting of demographic data and questions regarding the consumption of different types of analgesics for relieving and controlling odontogenic pain and their impact on patients was given by the researcher to the respondents. The patients were asked to complete and return the forms. The questionnaire consisted of three categories of questions, including demographic data, pain characteristics (severity, aggravating factors, relieving factors, etc) and the drug used to relieve the pain. Pain severity was measured using a visual analogue scale (VAS). Mann-Whitney and chi-squared tests were used for statistical analysis in SPSS. Results: This study included 230 males and 351 females (male:female ratio = 0.66) in the age range of 18 to 71 years old (38.21 ± 7.45). 2.6% of respondents were illiterate and 11.3% of respondents were unemployed. The mean value of pain intensity was 6.21 ± 1.11 on a scale of 1 to 10. The types of drugs used for pain relief included 71.8% analgesics, 12.1% complementary medicines and 16.1% antibiotics. The most commonly used medication was NSAIDS, followed by acetaminophen codeine. In this study, the fourth most common medication consumed by patients as an analgesic was amoxicillin. Moreover, it showed that 44.3% (257 individuals) of study participants had used analgesics as self-medication to relieve odontogenic pain, of which 46.08% were males (N = 107) and 42.68% were females (N = 150). The gender of respondents, level of education, and occupation were significantly associated with the consumption of opioid drugs (p = 0.023, p = 0.041, p = 0.011, respectively). Consumption of opioid medications was not statistically significantly correlated with pain intensity (p = 0.115). Conclusion: The factors affecting the appropriate use of medications are social, economic, cultural, and flaws in the health-care system of a society. This study showed that the medications used to reduce pain included analgesics, traditional drugs, and antibiotics. The rate of self-medication was higher among men and among those having a higher level of education. Keywords: analgesic, dentistry, narcotic, odontogenic pain, self-medication

Purpose: In 2017, Saudi Arabia introduced a 120% tax on energy drinks and a 50% tax on soft drinks. The impact of this policy on the consumption of sugar-sweetened beverages (SSB) among schoolchildren is not known in this country. The present study evaluated the impact of the excise tax on SSB consumption in the tri-city metropolitan area of Dammam-Khobar-Dhahran, Eastern Province, Saudi Arabia. Materials and Methods: A repeated cross-sectional design was used to examine the difference between pre- and post-tax SSBs consumption among schoolchildren (12–14 years old) in Dammam-Khobar-Dhahran cities. A beverage-consumption frequency questionnaire was completed by 453 participants before the tax implementation and 334 participants after the tax implementation. The tax on soft drinks was increased by 50% and on energy drinks by 120%. Pre-tax data were collected in May 2017 and post-tax data in April 2018. Results: The proportion of participants who consumed energy drinks was 46.1% (95% CI: 42-51) before tax implementation, decreasing to 38.4% (95% CI: 33-44) after tax implementation, a reduction of nearly 8%. 92.5% (95% CI: 90-95) of the participants consumed soft drinks before tax implementation and 94.6% (95% CI: 92-97) did so after tax implementation, an increase of about 2%. Conclusions: The study showed no statistically significant impact of tax implementation on the consumption of energy drinks and soft drinks in this sample of children. Keywords: energy drinks, sugar consumption, sugar-sweetened beverages, sugar tax

Purpose: A novel anhydrous toothpaste formulation has been developed containing the anti-dentinal hypersensitivity (DH) ingredient stannous fluoride (SnF2). Materials and Methods: This randomised, controlled, examiner-blind, parallel-group, stratified (by baseline Schiff sensitivity score) study compared efficacy of an experimental ‘Test’ toothpaste (n = 67) containing 0.454% SnF2, 0.072% sodium fluoride and 5% sodium tripolyphosphate (all percentages w/w) with a negative ‘Control’ 0.76% sodium monofluorophosphate toothpaste (n = 68) in relieving DH in healthy Chinese adults. After 4–6 weeks acclimatisation, DH was assessed at baseline and following 4 and 8 weeks’ twice-daily brushing by response to evaporative (air) (Schiff sensitivity score) and tactile (Yeaple probe) stimuli. An analysis of covariance model was used (factor: treatment group; covariate: baseline Schiff sensitivity score). Results: Both Test and Control toothpastes statistically significantly reduced Schiff sensitivity score from baseline after 8 weeks’ use; the Test toothpaste also statistically significantly reduced the score after 4 weeks’ use (all p < 0.001). The Test toothpaste reduction was statistically significantly superior to the Control toothpaste reduction at both timepoints (p < 0.001). Percentage differences in treatment effects between Test and Control groups were 24.1% at 4 weeks and 31.7% at 8 weeks. Tactile threshold scores for both treatments statistically significantly increased from baseline at both timepoints (all p < 0.001); however, there were no statistically significant differences between Test and Control groups. Both toothpastes were well-tolerated with no adverse events reported. Conclusion: The Test toothpaste containing 0.454% SnF2 reduced DH statistically significantly more than the Control as evaluated by the Schiff sensitivity score, but not by tactile threshold. Keywords: dentifrices, dentin hypersensitivity, randomised controlled trial, tin fluorides

Purpose: To evaluate the comprehensive effects of photobiomodulation (PBM) therapy on teeth after active orthodontic treatment. Materials and Methods: This systematic review was conducted according to the PRISMA guidelines. Six databases were electronically searched and screened for eligible human and animal studies published up to August 2020. The risk of bias was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions and Systematic Review Centre for Laboratory Experiment Tool. Two independent reviewers performed all procedures in duplicate. Any disagreement was resolved by discussion or consultation with a third reviewer. Results: A total of 395 records were identified from the initial search up to August 2020. Following screening, 16 full-text articles were reviewed for eligibility (κ > 0.90), and ultimately 9 studies (3 clinical studies and 6 animal studies) were included in this review. The key outcomes observed were ‘tooth position maintenance’ and ‘root resorption rehabilitation’. Two controlled clinical trials and two animal studies supported the preventive effects of PBM therapy on the relapse of post-orthodontic tooth positions, while the other two animal studies reported opposing findings. Regarding root resorption, all evidence supported the rehabilitation potential using PBM therapy for teeth that had undergone orthodontic tooth movement. There was a high risk of bias among studies, except for one randomised controlled trial. Due to the substantial heterogeneity among studies in terms of their types, participants, designs, PBM therapy settings and variables of interest, it was not possible to conduct a meta-analysis; therefore, a qualitative synthesis is presented. Conclusion: The quality of evidence for PBM therapy contributing to the maintenance of tooth position or improved dental health after orthodontic treatment remains low. There is considerable controversy over the effects of PBM therapy on orthodontic relapse. However, the use of PBM therapy after orthodontic treatment has promising effects for root resorption rehabilitation and is generally recommended. Keywords: orthodontic retention, orthodontically induced inflammatory root resorption, photobiomodulation therapy, systematic review

Purpose: To develop an evidence-based Clinical Practice Guideline (CPG) on caries management for the Malaysian population using the ADAPTE trans-contextual adaptation framework. Materials and Methods: A systematic search was conducted to identify all CPGs related to caries management on guideline repository websites and other platforms. The search findings were screened and the quality of the identified guidelines was evaluated using the AGREE II tool. The currency and the content of the recommendations were assessed by multidisciplinary experts for local adaptation. Results: Following an extensive assessment, six high-quality CPGs were selected for adaptation. Subsequent to the content assessment, the multidisciplinary experts agreed to adopt 24 recommendations, adapt 55, and exclude two recommendations. The adaptation process generated 21 recommendations for caries management in Malaysia. The formulation of the final evidence-based recommendations for caries management in Malaysia was based on the feedback given by the external reviewers. Conclusion: The use of the trans-contextual adaptation process is feasible for the development of local guidelines when there are scarce resources and insufficient local evidence. The involvement of the multidisciplinary experts ensures the comprehensiveness of the CPG in terms of its quality and validity and subsequently promotes adherence and ownership of the CPG at the local settings. Keywords: adaptation, ADAPTE, caries management, clinical practice guidelines, evidence-based

Purpose: To assess the effectiveness of a 40% miswak compared to a 0.12% chlorhexidine mouthwash. Materials and Methods: A total of 60 patients aged 20-55 years who attended the Periodontics Clinics at the College of Dentistry, Al-Iraqia University, Baghdad, Iraq, were allocated into 2 groups to use either 40% miswak mouthwash or 0.12% chlorhexidine gluconate Kin Gingival (Laboratorios KIN) twice daily for 2 months. Gingival, bleeding, and plaque indices were assessed. Results: There were statistically significant differences between the effectiveness of miswak and chlorhexidine mouthwashes in terms of gingivitis. The means of gingival, bleeding, and plaque indices using miswak mouthwash were 1.2, 0.4, and 0.53, respectively, i.e. indicating lower effectiveness, than when 0.12% chlorhexidine mouthwash was used (0.87, 0.43, 0.23, respectively). Conclusion: Miswak mouthwash is a good oral hygiene agent especially for long-term use even if its efficacy is lower than chlorhexidine mouthwash. Keywords: chlorhexidine, gingivitis, miswak, mouthwash, oral health

Purpose: This systematic review addressed flap designs in endodontic surgery which can have an impact on the Oral Health Related Quality of Life (OHRQoL). Materials and Methods: Four electronic databases were searched (PubMed, Cochrane Library, Web of Science, and Scopus) to identify all studies up to November 2019 that investigated the effect of flap designs on gingival recession and quality of life among healthy adults. Results: The initial search identified 2701 references. Ten studies were included in this systematic review; two were randomised clinical trials and eight were non-randomised clinical trials. Studies showed that sulcular incision increases the risk of gingival recession and decreases OHRQoL. Two studies were included in the meta-analysis in relation to gingival recession. The pooled results demonstrated that submarginal incision showed a decreased weighted mean difference in gingival recession by 0.31 mm (95% CI: 0.12 – 0.51) (p = 0.002) compared to sulcular incision. Conclusion: Sulcular incision flap unfavourably affect the level of gingiva and OHRQoL. All nonrandomised studies had a statistically significant bias and the sample sizes in all studies were relatively small. More gingival recession and lower OHRQoL were associated with sulcular incision. Additional investigations are warranted to provide more evidence. Keywords: flap incision, gingival recession, oral health quality of life, surgical endodontic treatment, systematic review

Purpose: To determine the oral health status among adult employees in Kuwait. Materials and Methods: This cross-sectional study was performed on a convenience sample (n = 1294) of adult employees. Their ages ranged from 19 to 77 years (mean 36.2). Six trained and calibrated dentists examined them using a mouth mirror and a WHO ball-tip probe. Caries was scored using WHO diagnostic criteria. The debris index simplified (DI-S) score was used to assess oral hygiene status. Results: Overall, the mean DMFT in the adults was 10.3. The DMFT increased from 7.8 for the age group 19–24 years to 10.7 at 35–44 years and 18.9 at 65–77 years (p < 0.001). Females had slightly higher caries experience (DMFT) (11.0) than did males (10.1) (p = 0.021), and Kuwaitis (11.1) more than non-Kuwaitis (8.9) (p < 0.001). The proportion of caries-free adults was 28%. In multivariate analysis, adults with poor oral hygiene (OR=1.5; 95% CI=1.2-2.1), those with an intermediate-school (grades 6 to 9) or lower level of education (OR=2.6; 95% CI=1.4-4.7), Kuwaitis (OR=1.3; 95% CI=1.0-1.7), those with oral pain (OR=1.4; 95% CI=1.0-1.8), and those needing urgent dental care (OR=4.6; 95% CI=2.6-8.0) were statistically significantly associated with caries risk. About 19.6% of these adults had good, 36.1% fair and 44.4% had poor oral hygiene. Nearly one-third (32.9%) of adults had perceived oral pain at the time of examination. Conclusion: Implementing oral health programs is needed and efforts should be made to promote oral hygiene practices in workplaces among adults in Kuwait. Keywords: adult employees, dental caries, Kuwait, oral health, oral hygiene, oral pain

Purpose: Systemic inflammation is characteristic for the pathogenesis of Alzheimer’s disease (AD) and is responsible for the accumulation of its disease-specific Tau-protein and β-amyloid plaques. Studies focusing on an association with periodontitis showed worse periodontal conditions in patients with dementia, but until now, no study has investigated the differences between AD and other forms of dementia (noAD/DEM). Expecting severe periodontal disease in AD, the aim of this pilot-study was to compare the periodontal and dental status in patients with either AD or noAD/DEM. Materials and Methods: Twenty patients recently diagnosed with AD and 20 with noAD/DEM between the ages of 50 and 70 years were recruited at the Department of Neurology, University Hospital, Münster, Germany and clinically examined at the Department of Periodontology, School of Dental Medicine, Münster, Germany. Neuropsychological testing, levels of Tau-protein and β-amyloid in serum and liquor were used to distinguish between both groups. Dental and periodontal parameters such as clinical attachment loss (CAL), probing pocket depth (PPD), bleeding-on-probing (BOP), radiographic bone loss, full-mouth plaque score (FMPS), and missing and restored teeth were recorded. Results: Periodontitis was diagnosed in all patients. Patients with AD presented mean BOP of 54.7 ± 31.1% and radiographic bone loss of 42.5 ± 25.3%; the mean BOP of those with noAD/DEM was 52.0 ± 23.7% and radiographic bone loss was 40.9 ± 32.3%. There was also no statistically significant difference regarding other periodontal and dental parameters. Conclusions: Both patients with AD and noAD/DEM had periodontal disease. Consequently, patients with all forms of dementia (AD/other) need special dental care to improve periodontal and oral health. Keywords: Alzheimer’s disease, dementia, dental care, oral health, periodontal disease

Purpose: To use and evaluate two methods for measuring gingival thickness (GT) at mandibular incisors of orthodontic patients and compare their performance in assessing periodontal anatomy through soft tissue thickness. Materials and Methods: The sample consisted of 40 consecutive adult orthodontic patients. GT was measured just before bracket placement at both central mandibular incisors, mid-facially on the buccal aspect, 2 mm apically to the free gingival margin with two methods: clinically with an ultrasound device (USD) and radiographically with cone-beam computed tomography (CBCT). Results: CBCT measurements were consistently higher than USD measurements, with the difference ranging from 0.13 mm to 0.21 mm. No statistically significant difference was noted between the repeated CBCT measurements at the right central incisor (bias = 0.05 mm; 95% CI = -0.01, 0.11; p = 0.104). Although the respective results for the left incisor statistically indicated that the measurements were not exactly replicated, the magnitude of the point estimate was small and not clinically significant (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014). Small differences between CBCT measurements made by the 2 examiners at the left central incisor (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014) were detected. However, this difference was minor and also not clinically significant. The respective analysis on the right incisor showed no statistically significant difference (bias = 0.05 mm; 95% CI = -0.01, 0.11; p = 0.246). Conclusions: Based on reproducibility, CBCT imaging for gingival thickness assessment proved to be as reliable as ultrasound determination. However, CBCT consistently yielded higher values, albeit at a marginal level, than did the ultrasound device. Keywords: cone-beam CT, gingival phenotype, periodontal tissue, ultrasound

Purpose: The coronavirus disease 2019 (COVID-19) pandemic is a major public health crisis worldwide and it also has generated new challenges for dentistry. The aim of this study was to evaluate the knowledge and attitudes of the parents of pediatric patients about dental treatment during the COVID-19 pandemic through a questionnaire. Materials and Methods: A structured questionnaire consisting of 15 multiple-choice questions and demographic information about the knowledge and attitudes of parents regarding dental treatment during the COVID-19 outbreak was used for the study. The participants were parents of pediatric patients (aged 8–14 years) who visited for a routine orthodontic examination at the department of orthodontics. Results: A total of 250 participants responded to the questionnaire. The findings indicate that more than 95% of parents had information about the transmission paths of the virus, took COVID-19 seriously, and told their children about this disease. 34% of the parents thought that dental clinics were more dangerous than other social areas, and 39.2% thought their children could be infected by medical instruments during dental treatment. A statistically significant difference was observed between educational levels in the answers given about the transmission paths of the virus, the danger of dental clinics in terms of the virus, the permitted dental treatment procedures, and the personal protective equipment of the dentist (p < 0.05). Conclusion: Although most parents have information about COVID-19, there are differences in the knowledge and attitudes of parents during the pandemic period according to their educational level. Keywords: COVID-19, pediatric dentistry, cross-infection control, dental treatment

Purpose: To explore potential caries risk indicators in 3- to 5-year-old children, and develop a simple risk-score model to screen the children at high risk of caries with decayed, filled, and missing teeth (dmft) > 2. Materials and Methods: A cross-sectional study involving 2746 children 3 to 5 years of age was conducted in Sichuan province. Children were examined for dmft index, and sociodemographic and behavioural factors were acquried through a questionnaire completed by their caregivers. A prediction model was developed by backward multivariate logistic regression, and its overfitting degree was examined with 5-fold cross-validation. A simple risk-score model was derived to screen the children with dmft > 2 at high risk of caries with the β regression coefficient obtained from the multivariate regression model. Results: A child’s oral health status was identified as the highest risk indicator with a β regression coefficient of 1.093. The mean area under curve (AUC) from the 5-fold cross-validation was 0.7408 (95% CI: 72.21%, 75.95%), with a bias of only ca 1%. This result allowed us to eliminate substantial overfitting of the prediction model. The AUC of the risk scoring system was 0.7455 (95% CI: 72.70%, 76.40%), which indicated good screenability. Conclusions: This risk score model has the advantages of simplicity, low cost and relatively high accuracy, and is suitable for use in developing countries, especially for primary screening for high risk of caries. It shows that certain child behaviours and parental attitude play an important role in dental caries among preschool children. Keywords: children, dental caries, epidemiology, high risk, risk score model

Purpose: To analyse the taste function in a pool of untreated patients with oral lichen planus (OLP) with tongue lesions (n = 35) and without tongue lesions (n = 36) and to compare it to healthy subjects (n = 36). Materials and Methods: Firstly, the subjective overall taste ability and impairment of the sensations of ‘sweet’, ‘sour’, ‘salty’ and ‘bitter’ were recorded in all three groups. Secondly, taste function was tested in all included subjects using the standardised ‘Taste Strips’ test. Results: Data showed a statistically statistically significant difference in overall taste perception between OLP patients with tongue lesions and control subjects (p = 0.027) for the tested taste function. The sensation of ‘sour’ showed the most pronounced difference (p = 0.08). The subjective taste perception and that of individual taste qualities did not differ statistically significantly between the three groups, and the correlation between subjective and objective taste perception was low. There was also a low correlation between taste scores and the presence of lesions on different areas of the tongue. Conclusion: For patients with OLP experiencing a loss in appetite, a formal taste examination and subsequent counselling should be considered. Keywords: mucocutaneous disorders, oral lichen planus, taste/taste physiology, tongue

Purpose: The objective of this cross-sectional study was to evaluate the relationship between ABO blood groups and periodontal diseases. Materials and Methods: Four hundred sixteen subjects (223 females, 193 males) were recruited according to the eligibility criteria. Periodontal examination was performed, including full-mouth plaque index (PI), bleeding on probing (BOP), clinical attachment level (CAL), and interproximal bone loss (IBL). ABO blood group patterns were determined based on self-reports, confirmed by medical records. The chi-squared test was done to evaluate the data (p < 0.05). Results: Out of the 416 subjects, 52.2% were blood group O, whereas 27.8% were blood group A. 46.8% of patients with blood group O had gingivitis and 49.6% had periodontitis. 31.2% of patients with blood group A had gingivitis,while 29.5% had periodontitis. The blood group with the lowest percentage among patients with gingivitis was AB, with a rate of 6.2%; in this blood group, 8.1% had periodontitis. Conclusions: There is no association between periodontal diseases and ABO blood group types. Keywords: ABO blood-group system, genetic, gingivitis, periodontitis, Rh-Hr blood-group system

Purpose: Grape-seed extract (GSE) contains polyphenols that readily adhere to proteins and modify the acquired enamel pellicle (AEP). The first step in biofilm formation is bacterial adhesion to the AEP-covered enamel. The aim of this in vitro study was to test whether AEP modification with GSE, fluoride (F-), or their combination (GSE+F-) modulates bacterial adhesion, biofilm metabolism and composition, or cariogenic demineralisation of the enamel. Materials and Methods: The study comprised 3 parts: 1) single-strain Streptococcus gordonii species, 2) a five-species biofilm model, or 3) biofilm (re-)formation using the five-species biofilm model after removal of initial biofilm with toothbrushing. Human whole-mouth stimulated saliva was used to form an AEP on human enamel specimens. The AEP was incubated in water (control), or modified with GSE, F-, or GSE+F-. Bacterial adhesion, biofilm diversity, metabolic activity, biofilm mass, and cariogenic demineralisation (surface hardness) of enamel were assessed after incubation in bacterial broths after 4 h or 22 h. Differences between groups were analysed with one-way ANOVA and post-hoc Bonferroni tests. Results: GSE and GSE+F- statistically significantly decreased single-strain S. gordonii adhesion, but had no relevant influence when the five-species biofilm model was used. In the biofilm (re-)formation model, GSE reduced bacterial adhesion compared to GSE+F-, while F- caused less cariogenic demineralisation than was found in the control group. Conclusion: AEP modified with GSE retards S. gordonii adhesion, but it does not influence the formation, metabolism and composition of a cariogenic multi-species biofilm. Keywords: biofilms, caries, dental pellicle, enamel, fluoride, grape-seed extract, pellicle modification

Purpose: To assess the impact of nonsurgical periodontal treatment, performed by undergraduate dental students, on oral health-related quality of life of patients with periodontitis. Materials and Methods: An observational, prospective, single-arm cohort study with pre‑post test involving 31 undergraduate dental students was performed. A complete periodontal examination was performed before and after receiving nonsurgical periodontal treatment. The main independent clinical variables assessed were the degree of periodontal inflammation and the number of teeth with periodontitis. Oral health-related quality of life was assessed before and after treatment through the Oral Impacts on Daily Performances (OIDP) questionnaire. The association between the extent of periodontal treatment (measured as number of treated teeth) and final OIDP score was assessed, adjusting for age, sex, and baseline OIDP, in a multiple regression model. Results: Thirty-four patients were enrolled and treated by the undergraduate students. The mean OIDP value (global absolute score), representing the severity and frequency of the impacts, decreased from 26.2 to 12 after treatment. The mean percentage of impact, representing the number dimensions affected by oral health (global percent score), was reduced from 13% to 6%. However, no association between the number of treated teeth and post-treatment OIDP score was observed after adjusting for age, sex, and baseline OIDP score. Conclusion: Nonsurgical periodontal treatment performed by undergraduate dental students improved the oral health-related quality of life of periodontal patients, although no statistically significant association was found between the extent of periodontal treatment and the final OIDP score. Keywords: dental, oral health, periodontal debridement, periodontitis, students, quality of life

Purpose: Pigmentation of gingiva is an aesthetic problem. Until now, various methods have been introduced for removal of gingival pigmentation. The purpose of this study was to compare bur abrasion and CO2 laser methods in removing gingival pigmentation. Materials and Methods: Twelve patients aged 20–40 years old with the chief complaint of physiologic gingival pigmentation participated in this study. For these patients, gingival depigmentation was performed using two treatment modalities including bur abrasion and CO2 laser in a split-mouth design. Gingival depigmentation was performed in the right half of the anterior maxillary and mandibular sextants using bur abrasion method by means of diamond bur on a high-speed headpiece with vigorous water irrigation and the left half of the anterior maxillary and mandibular sextants using a CO2 laser. CO2 laser was set at: peak power 252 watts, repeat time 20 ms and pulse duration 200 microsecond which was used in a non-contact position. The area of pigmentation was calculated via gridlines in the Microsoft Paint software 1 and 6 months after the procedure. Gingival recession was also determined before, and at 1 and 6 months after the procedure. Results: The area of gingival pigmentation was not statistically significantly different between the two treatment modalities before the procedure (p = 0.452), 1 month (p = 0.443) and 6 months after the procedure (p = 0.202). There was no statistically significant difference in the variance of pigmented area at different times in the two methods. In both CO2 laser and bur abrasion methods, the mean area of pigmentation was statistically significantly different in the follow-up period (p < 0/001), in a way that the change in the area of pigmentation was statistically significant 1 month after treatment (p <0.001) and also 6 months after treatment (p < 0.001) compared to before. The change in the area of pigmentation between 1 and 6 months after treatment was not statistically significant in both CO2 laser (p = 0.157) and bur abrasion method (p = 0.150). No increase in gingival recession was observed in any of the patients. Conclusion: Both treatment modalities can effectively treat gingival pigmentation. No increase in gingival recession was observed. Conventional method and CO2 laser were not statistically significantly different during a follow-up period of 1 and 6 months. Keywords: laser, bur abrasion, gingival depigmentation, pigmentation, CO2

Purpose: To study the practices of general dentists, periodontists and dental hygienists who are members of the European Federation of Periodontology, regarding oral hygiene education, plaque control assessment, recommended dental and interdental hygiene tools, and antimicrobial agents. Materials and Methods: A web-based survey was sent to 13,622 members of the European Federation of Periodontology (EFP) through its 29 national member societies. It targeted general dentists (GD), specialists in periodontology (DSP) and dental hygienists (DH). Data were collected between 24 April and 17 May 2015. A data-driven statistical analysis was conducted and differences between professions were explored. Results: A total of 2076 answers were collected. Only the 2009 answers originating from GD, DSP and DH were analysed (67 answers originated from other professions and were excluded). Among those 2009 respondents, 43.2% were DSP and 37.2% were GD. Overall, DH, DSP and GD reported spending 17.1 minutes for the initial teaching of OH, with differences between professions (p < 0.0001). DH, GD and DSP exhibited differences in the type of toothbrushes they recommend (p < 0.0001). DSP recommended electric and manual toothbrushes (TB) equally. DH predominantly recommended electric TB (56.8%). Overall, 95% of DH, DSP and GD recommended interdental brushes, with no statistically significant differences between professions. Low concentration chlorhexidine was considered the most relevant antimicrobial agent for daily oral care of periodontitis patients. Half of GD prescribed antimicrobial mouthrinses for long-term use in 70%–100% of their patients with periodontitis. Conclusion: EFP-affiliated practitioners allocate a significant amount of time to educating patients on oral health. Their practices are mostly in line with the current scientific evidence. Some discrepancies were found between the different professions. Similar surveys could be conducted over time to monitor the evolution of practices. Keywords: dental hygienist, oral hygiene, patient education as topic, periodontal diseases, periodontists, surveys and questionnaires

Purpose: To assess how current COVID-19 restrictions regarding elective dental procedures influence patients’ self-reported oral health care needs at a University Hospital in Germany. Materials and Methods: Patients with COVID-19 induced cancellation of elective treatment appointments previously scheduled for the period March 16th to April 30th 2020 were contacted by telephone and questioned about the occurrence of oral health problems, pain, self-reported treatment needs, and the use of emergency dental services. Data were analysed retrospectively. Results: Information on 370 patients aged between 1 and 91 years was included. 16.2% (n = 60) of patients reported having experienced an oral health problem for which they requested timely dental treatment. Within this group, the most frequent complaints were pain or tooth hypersensitivity (42.4%, n = 26), insufficient restorations (28.8%, n = 17) and gingival or periodontal problems (23.7%, n = 14). Associations between the type of treatment pending and the report of an oral health problem were considerable for patients awaiting treatment under full anesthesia, surgical procedures and endodontic treatment (p = 0.001; 0.003 and 0.048, respectively). Problems were reported most frequently in these treatment groups, ranging from 27.7% to 100%, compared to 12.6% among patients scheduled for routine check-ups. Overall, 8.6% (n = 32) were experiencing pain, of whom 5 patients experienced constant pain. However, only 1.9% (n = 7) of patients made use of emergency dental services. Conclusions: The results suggest that while the postponement of routine check-ups is justifiable during emergency situations, the long-term cancellation of surgical and endodontic therapies must be viewed critically. Keywords: COVID-19, oral health, pandemics

Purpose: To determine the impact of the brushing protocol on dentin wear by comparing continuous to intermittent brushing, with the same total time of brushing. Materials and Methods: Dentin specimens (n = 120) were evently distributed into six groups (A–F). The samples were brushed with slurries of different relative dentin abrasivity (RDA): Groups A+B (Sident 2480-1; RDA 85), groups C+D (Zeodent 113; RDA 67), and groups E+F (Zeodent 103; RDA 174). Groups A+C+E were brushed continuously (25 min) with one slurry preparation, while groups B+D+F were brushed intermittently (25 x 1 min) with a renewal of the slurry after each sequence. Dentin wear was determined using surface profilometry and statistically analysed with ANOVA and post-hoc tests. Results: Neither the mode of brushing (p = 0.72) nor the interaction (p = 0.18) of the brushing mode with the type of abrasive particles had a significant influence on the abrasive dentin wear. Only the type of abrasive particles had a statistically significant influence on abrasive dentin wear (p < 0.001). Conclusion: The mode of brushing (continuously or intermittently) has no influence on abrasive dentin wear. Keywords: brushing, continuously, dentin wear, intermittently

Purpose: To assess the knowledge, attitude and perception of dentists (dental students, dental school graduates/interns, postgraduate dentists) of the role of robotics (R) and artificial intelligence (AI) in oral health and preventive dentistry. The null hypothesis was that dentists would not be aware of R and AI use in dentistry and would not be ready to accept them in oral health and preventive dentistry for dental care management and training. Materials and Methods: This was an observational cross-sectional study in which data was collected from a representative population in Saudi Arabia. 570 participants answered 26 closed-ended questions. The questionnaire’s validity and reliability were evaluated for vetting and remarks. The questionnaire collected demographic data of participants and their knowledge, perception and attitude about R and AI. Questions were to be answered with ‘yes’, ‘no’ and ‘I don’t know’. Descriptive statistical analysis was performed using the control chart technique and the chi-squared test, with statistical significance set at p < 0.05. Results: The majority of the participants (n = 313; 54.6%) were males. Dental students, dentist school graduates/interns, and postgraduate dentists comprised of 58.8%, 18.2%, and 23.0% respectively. Most of the respondents gave affirmative answers for knowledge, attitude and perception of R and AI (58.3%, 67.4%, and 60.3%, respectively). Participants agreed that R and AI is beneficial in dentistry and would provide better results. Most (83.3%) would be willing to be treated using R/AI and would recommend (84.5%) treatment with R/AI, as shown in the control chart by affirmative answers. These were significantly above the overall affirmative answers, as the corresponding point lies above 95% UCL (upper confidence limit). Conclusion: Most dentists were unacquainted with R and AI. Dentists had a positive attitude towards R/AI, but due to inadequate knowledge and understanding, its use and applications were very limited. There is significant need in the near future to increase awareness of this concept, as it may increase treatment efficiency and effectiveness. Keywords: artificial intelligence, digital dentistry, oral health, questionnaire, robotics, survey

Purpose: It is hypothesised that systemic calcitonin delivery with adjunct local platelet-rich fibrin (PRF) therapy is more effective in augmenting osseointegration than calcitonin delivery alone under experimental osteoporosis conditions. The primary objective of the present experiment was to assess the effect of systemic calcitonin delivery with and without adjunct local PRF therapy on osseointegration in ovariectomised osteoporotic rabbits. Materials and Methods: Thirty female bilaterally ovariectomized rabbits were used. The animals were fed a low-calcium diet to establish a model for osteoporosis. In each animal, 2 implants were bilaterally placed in tibia. The animals were randomly divided equally into 3 groups. In group 1, no treatment was offered (control group). In groups 2 and 3, the animals received intramuscular injections of calcitonin without and with local PRF delivery prior to implant placement, respectively. All animals were euthanised at 12 weeks, and osseointegration was assessed as the gap widths between the bone and implant surface in the cervical, middle and apical third using scanning electron microscopy and energy-dispersive x-ray spectroscopy. The bone-to-implant contact (BIC) was also measured. p < 0.05 was defined as statistically significant. Results: Gap widths in the cervical (p < 0.001), middle (p < 0.001) and apical third (p < 0.001) were statistically significantly higher in group 1 than groups 2 and 3. Gap widths in the cervical (p < 0.001), middle (p < 0.001) and apical third (p < 0.001) were significantly higher in group 3 than group 2. The mean BIC was statistically significantly higher in the cervical (p < 0.001), middle (p < 0.001) and apical third (p < 0.001) in group 3 compared with groups 2 and 3. Conclusions: When used as an adjunct to calcitonin, PRF enhanced osseointegration in an experimental osteoporosis model. However, further well-designed studies with inclusion of additional groups (treatment with PRF alone) are needed. Keywords: calcitonin, gap junctions, osseointegration, osteoporosis, platelet rich fibrin

Purpose: To assess factors related to the prevalence of dental caries among adolescent schoolchildren attending marginalised schools in the West Bank area of Palestine. Materials and Methods: A cross-sectional study was conducted in schools participating in the School Support Program (SSP). Fifty schools identified as marginalised by the SSP were stratified by district, student gender and grade level to select a random sample of 20 schools. Students in the 6th and 9th grades were screened by senior dental students to collect data about their weight, height, gingival health and caries experience. In addition, a structured in-person questionnaire was used to collect data about students’ oral hygiene practices, dietary habits, mother’s education and father’s employment. Results: In total, 1282 students completed interviews and clinical screenings. The mean number of Decayed, Missing and Filled Teeth (DMFT) was 6.4 ± 4.4. Sixty-four percent had moderate gingivitis and 73% had fair oral hygiene. ‘Recent visit to the dentist’ was associated with mother’s level of education (X2 = 22.06, p < 0.001) and father’s employment (X2 = 24.02, p < 0.001). The final regression model showed that grade (β = 0.31, p < 0.001), gender (β = 0.06, p < 0.03), recent visit to the dentist (β = −0.06, p < 0.03) and drinking fresh juices (β = −0.05, p < 0.05) were statistically significant in explaining the high level of caries in this sample. Conclusions: This study indicates that Palestinian adolescents in marginalised governmental schools suffer the highest burden of dental disease and are disproportionally impacted when compared to other same-age students in the region. A high burden of disease was directly associated with unfavourable dietary habits, poor oral hygiene practices and challenges to accessing dental care services, and was indirectly associated with father’s employment and mother’s level of education. Keywords: adolescents, body mass index, dental caries, dietary habits, DMFT

Purpose: To investigate the practices, knowledge and opinions of French dental students (FDSs) in various domains of minimal intervention (MI) in cariology. Materials and Methods: A cross-sectional, questionnaire-based study was conducted in spring 2018 among all fifth-year French dental students (FDSs) from the 16 French dental schools. The present article focuses on restorative management. Statistical analyses (descriptive, chi-squared) were performed. Results: The response rate was 84.5%. Overall, 97.4% of respondents would have operatively intervened for proximal and 83% for occlusal carious lesions, respectively, while non-or micro-invasive intervention would have been possible. Interestingly, 15% would completely open the occlusal fissures. For both occlusal and proximal lesions requiring a restoration, composite resin was indicated by over 95% of the respondents. In a clinical case, 51.6% of FDSs who rightly diagnosed an enamel carious lesion would operatively intervene. When FDSs could not diagnose the type of carious lesions, a high proportion of invasive actions were also reported (40%). FDSs who read scientific articles were more likely to consider the high importance of not filling sound teeth unnecessarily (p = 0.033). Conclusion: FDSs do not have sufficient awareness of MI guidelines regarding occlusal and proximal restorative thresholds. Efforts are required in dental schools to teach FDSs to postpone invasive/restorative strategies to later stages of carious progression. There is a need to strengthen prevention techniques and non-invasive options in the teaching of MI in cariology. Keywords: carious lesions, dental education, dental students, minimal intervention, restorative threshold

Purpose: To estimate the prevalence and correlates of self-rated oral health (SROH) among adults in a national population-based survey in Sudan. Materials and Methods: Nationally representative data were analysed from the cross-sectional 2016 Sudan STEPS survey. In all, 7722 18- to 69-year-old individuals (median age 31 years) were assessed with questions on SROH, physical measurements, and medical conditions. Results: The prevalence of poor SROH was 8.0%, with 12.4% among females and 4.4% among males. In multivariable logistic regression analysis, ages 50-69 years, higher household income, urban residence, pain in the teeth/mouth, impaired Oral Health Related Quality of Life, dental visit, having overweight or obesity and elevated total cholesterol were positively associated with poor SROH, and male sex, primary or less education and having 20 or more natural teeth were negatively associated with poor SROH. In addition, in the unadjusted analysis, having dentures, hypertension, diabetes, stroke, or heart attack were positively associated with SROH, and engaging in moderate or high physical activity were negatively associated with poor SROH. Conclusions: Almost one in ten participants reported poor SROH. Several factors associated with poor SROH were found that can aid in designing programmes to improve SROH in Sudan. Keywords: adults, health variables, oral conditions, self-rated oral health, Sudan

Purpose: To investigate the effect of cancer treatment on the worsening of dental caries and periodontal disease. Materials and Methods: Fifty-three adult cancer patients who underwent panoramic radiography before cancer treatment and 1–2 years later were enrolled in this study. They received professional oral care, including oral hygiene instruction, scaling and root planing, professional mechanical tooth cleaning, and dental treatment or extraction of any tooth with the source of infection. Age, sex, smoking habit, probing pocket depth, alveolar bone loss, oral hygiene, number of teeth, leukocytes, haemoglobin, and albumin counts, cancer treatment, the administration of immunosuppressants, worsening of dental caries, and alveolar bone loss after 1–2 years were examined. Factors related to the worsening of dental caries and alveolar bone loss were analysed using logistic regression analysis. Results: Dental caries and periodontal disease worsened in 20.8% of the patients. Smoking habit and chemotherapy were independent risk factors for the worsening of dental caries, while alveolar bone loss greater than 1/3 and chemotherapy were independent risk factors related to worsening periodontal disease. Conclusion: Anticancer drug treatment is an exacerbating factor for dental caries and periodontal disease. Keywords: chemotherapy, periodontal disease, perioperative oral management, radiotherapy, risk factor

Purpose: Tongue coating is one of the primary causes of halitosis and some diseases such as aspiration pneumonia. However, to date, an effective method for reducing the bacterial count of tongue coating has not been established. We conducted a randomised-controlled study to compare the efficacy of three types of disinfectants approved for oral use in Japan in reducing the bacterial count of tongue coating. Materials and Methods: Thirty-two participants were randomly assigned to the following four groups according to the solution used: 1. benzethonium chloride; 2. povidone iodine; 3. hydrogen peroxide; 4. tap water (control group). Tongue cleaning with the three test disinfectants and water was performed using a toothbrush, and the bacterial count on the tongue dorsum before and after tongue cleaning was measured using the Rapid Oral Bacteria Quantification System. Results: The bacterial count decreased statistically significantly after tongue brushing using povidone iodine and hydrogen peroxide solutions (both p = 0.012), but not after brushing using 0.2% benzethonium chloride and tap water. Conclusion: Tongue brushing with povidone iodine or hydrogen peroxide was the most effective method for reducing the bacterial count of tongue coating. Keywords: benzethonium chloride, disinfection, hydrogen peroxide, povidone iodine, tongue coating