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JADA Specialty Scan - Radiology
Periodontics - A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Does brushing with dentifrice help remove dental plaque?

Toothbrushing with a dentifrice does not provide an added effect for the mechanical removal of dental plaque, although researchers say that using dentifrice should be continued because it offers other benefits such as serving as a delivery system for fluoride and antimicrobials. The plaque removal findings are based on a new review of literature published in the December 2016 issue of the Journal of Clinical Periodontology.

Researchers retrieved 10 published studies from MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE, and other electronic databases. Each study addressed the question, “What is the efficacy of brushing with or without a dentifrice for the mechanical removal of plaque in healthy adults?” Eligible comparisons featured randomized controlled trials and controlled clinical trials with participants at least 18 years old and in good general health, and evaluated pre- and post-brushing plaque scores and compared tooth brushing with and without a dentifrice.

Two reviewers independently scored the methods of included studies to assess bias. Random allocation, defined inclusion/exclusion criteria, blinding to patient and examiner, balanced experimental groups, identical treatment between groups, and follow-up reporting indicated a low risk of bias. Studies that met 6 of these 7 criteria indicated a moderate risk of bias. The absence of 2 or more of these 7 criteria indicated a high risk of bias.

A descriptive data presentation was used for all studies. The number of participants in the control group was divided by the number of comparisons for studies that compared data with more than 1 other group. Each experiment was assigned a weight based on its sample size. All studies but one provided the name of the dentifrice.

An average of 49.2% of plaque was removed when brushing was performed with a dentifrice based on 577 single brushing exercises included in the studies. An average of 50.3% of plaque was removed when tooth brushing was performed without a dentifrice. Researchers found no statistically significant difference between the two interventions. The meta-analysis of post-brushing scores showed no significant difference between tooth brushing with or without a dentifrice.

Researchers noted that one reason for the negative influence of dentifrice on plaque removal could be the “sliding effect.” The effect suggests that presence of enough dentifrice could reduce the shear force of toothbrush filaments, causing them to slide over tooth surfaces instead of inducing a force that could loosen plaque at approximal sites.

“Toothbrushing is a complex process, and its efficacy is strongly influenced by the compliance and dexterity of the individual,” researchers noted. “The mechanical action provided by the use of the toothbrush appears to be the main factor in the plaque-removal process, and the major variable in this process is the person using the brush.”

Noting that the study did not evaluate other aspects of dentifrices such as remineralization and antimicrobial effects, researchers concluded that their use should be continued for other benefits, such as a delivery system for fluoride and antimicrobials.

Read the original article.


Consulting Editor: Tapan Koticha, BDS
Diplomate, American Board of Periodontology
Assistant Professor, Department of Periodontics,
Clinical Director, Graduate Periodontics
University of Oklahoma Health Sciences Center, College of Dentistry

Four- and six-implant maxillary overdentures in the anterior region compared

Bar-connected maxillary overdentures on 4 or 6 implants led to similar treatment outcomes, with high implant survival, limited loss of peri-implant marginal bone and high patient satisfaction. That’s the key finding of new research published in the December 2016 issue of the Journal of Clinical Periodontology.

Researchers designed their 5-year randomized controlled trial to measure treatment outcomes of maxillary overdentures by 4 or 6 dental implants in the maxillary anterior region. They chose 50 patients with functional problems with their maxillary denture, who had ample bone volume in the anterior region to place 4 or 6 implants.
Bone dimensions in the region between the bicuspids in the anterior area of the maxilla were at least 12 millimeters high and at least 5 mm wide to reach initial stability of the implant. Rotational panoramic radiographs, lateral cephalograms, and postero-anterior oblique radiographs were taken to assess the volume of the maxillary alveolar bone, the dimensions of the maxillary sinus, and the antero-posterior relationship of the maxilla to the mandible. The radiographs were also screened for sinus pathology.

Implants were placed at crestal bone level in predefined positions (positions 15, 13, 11, 21, 23, 25 in the 6 implants group, and positions 13, 11, 21, 23 in the 4 implants group) with the help of a surgical template following a submerged healing protocol. After a 3-month osseointegration period, second-stage surgery was performed and healing abutments were placed. The design of the overdentures was with full coverage of the alveolar process, but with limited palatal coverage.

Primary outcome measures were marginal bone-level alterations. Secondary outcome measures were implant survival, overdenture survival, and soft tissue conditions (plaque index, presence of calculus, gingiva index, sulcus bleeding index, and pocket probing depth). These parameters were scored at placement of the overdenture, and 1 year, and 5 years after loading. Patient satisfaction was also scored before treatment, and 1 year, and 5 years after loading.

Implant survival was defined as the percentage of implants initially placed that was still present and not mobile at follow-up. Survival of maxillary overdentures was defined as the percentage of overdentures initially placed that was still present at follow-up. Patient satisfaction with their overdenture was assessed using a questionnaire that focused on complaints and consisted of 54 items divided into 6 scales.

A total of 46 of the 50 patients completed the 5-year evaluation. No implants failed in the 4 implants group, while 1 implant in the 6 implants group was lost during the osseointegration period. The 5-year survival rate of implants was 100% in the 4 implants group, 99.2% in the 6 implants group. The 5-year survival rate of overdentures was 100% in both groups. The mean loss of marginal bone between placement of the overdenture and the 5-year evaluation was 0.50 +/- 0.37 mm in the 4 implants group and 0.52 +/- 0.43 mm in the 6 implants group. Incidence of peri-implantitis after 5 years was 8.3% and 4.5% in the 4 and 6 implants groups, respectively. None of the outcome measures studied showed any significant differences between the groups. After 5 years, patients in both treatment groups continued to be very satisfied with their overdentures.

Read the original article.


Sneak peek: courses confirmed for the AAP 2017 Annual Meeting in Boston
Check out the recently confirmed sessions taking place at the 103rd Annual Meeting of the American Academy of Periodontology, held Sept. 9-12, 2017, in Boston.

For more information, visit or e-mail


Long-term effect of surface roughness, other factors on dental implant bone loss

Bone loss greater than 3 millimeters occurs in less than 5% of all implants after at least 5 years in function, and co-factors such as smoking or periodontal disease increase the risk for bone loss. Peri-implant bone loss around minimally rough implant systems is statistically less significant in comparison to the moderately rough and rough implant systems. Those findings are part of a systematic review and meta-analysis published online Nov. 15, 2016, in Clinical Implant Dentistry and Related Research.

Researchers designed the study to measure whether long-term peri-implant bone loss was affected by implant surface roughness and/or patient-related factors such as smoking and a history of periodontitis.

Researchers chose 87 papers that reported a mean bone loss on implant level over a 5- to 20-year follow-up. A total of 48 studies were designed as prospective and 39 were retrospective. A total of 53 studies described 10,533 originally placed implants from the three leading companies: Dentsply, Nobel Biocare and Straumann. A total of 9,136 implants remained at follow-up, for a dropout rate of 13.3%.

Information on probing depth and bleeding on probing was available in 40 and 49 of the included studies, respectively. A total of 27 papers reported peri-implantitis prevalence on implant level ranging between 0% and 39.7%. Only 19 of those 27 papers reported bleeding on probing, 16 reported probing depth, and 11 actually defined peri-implantitis.

From the 87 included papers and 123 study groups, the survival was reported in 79 papers and 107 study groups, and ranged between 73.4% and 100%. The implant survival rate was between 95% and 100% in 44% of the studies. In half of the studies, the implant survival rate ranged between 90% and 94.9%. The survival rate was below 90% in just 6% of the studies. The average weighted implant survival was 97.3% including all studies, and 96.4% for rough, 98.4% for moderately rough, and 97.6% for minimally rough.

In the total material, 49% of the implants lost more than 1 mm bone, 18% of the implants lost more than 2 mm, and 5% lost more than 3 mm bone. The proportion of implants losing above 2 mm bone is 14%, 18%, and 20% for minimally rough, moderately rough, and rough surfaces, respectively.

No statistically significant difference was observed between moderately rough and rough implant systems. The studies that compared implants with comparable design and different surface roughness, showed less average peri-implant bone loss around the less rough surfaces in the meta-analysis. The average weighted implant survival rate was 97.3% after 5 years or more of loading. The meta-analysis indicated that periodontal history and smoking habits yielded more bone loss. The authors, however, caution that the clinical impact of surface roughness on bone loss is limited in a majority of the papers included. This could be because of the multifactorial causes for bone loss and the heterogeneity of the studies.

Read the original article.


Less sleep, higher salivary glucose levels and gingivitis in children

Shorter sleep duration and higher salivary glucose levels are associated with increased gingival inflammation in children. That finding is part of a new study published in the November 2016 issue of the Journal of Dental Research.

In investigating sleep duration as a risk behavior for gingivitis, researchers investigated the longitudinal relationship between short sleep duration and salivary glucose levels in developing gingival inflammation in Kuwaiti children. Researchers used multi-level analysis to account for the clustering effect within schools across time and for variation among children.

Data were collected from 6,316 10-year-old children in 2012 and again in 2014. Participants represented 138 public schools from the 6 governorates of Kuwait. Students enrolled in these schools represented all socioeconomic levels and ethnic groups among the Kuwaiti population but did not include non-Kuwaiti children.

Subject demographics, sleep evaluation interviews, saliva samples, oral examinations, nutrition interviews, and body weight measures were collected by 2 calibrated teams. Calibrated examiners conducted oral examination, self-reported sleep evaluation interviews, anthropomorphic measurements, and unstimulated whole saliva sample collection. Salivary glucose levels were measured by a florescent glucose oxidase method; values of salivary glucose ≥1.13 mg/dL (milligrams per deciliter) were defined as high glucose levels.

A total of 74% of the gingival sites were recorded as red during the first data collection period, while only 42% were recorded as red at the second visit. There was a substantial increase in the proportion of children with high salivary glucose levels at visit 2. Over the second year, each child obtained an average of 3 additional decayed and/or filled teeth. The outcome was the progression of the extent of gingival inflammation in children over time.

The main independent variables were the number of daily sleep hours and salivary glucose levels. Other explanatory variables and confounders assessed were governorate, dental caries and restorations, and obesity by waist circumference (adjusted for snacking and gender). Gingivitis increased over time in children who had shorter sleep duration. Children who had more decayed or filled teeth had more gingivitis. Researchers found no significant association between gingivitis and obesity. The level of gingivitis was different among the 6 governorates of Kuwait. Additionally, there was a strong clustering effect of the observations within schools and among children across time.

“We were able to detect a clustering effect within schools across time, suggesting that school context influenced the gingivitis outcome in Kuwaiti children,” researchers concluded. “Children in the same school are exposed to the same atmosphere, and they tend to influence one another.”
The authors also cautioned that the lack of measuring other explanatory variables such as oral hygiene habits, quantity of plaque, and socioeconomic status might limit the clinical application of the study results.

Read the original article.

The connection between gum disease and rheumatoid arthritis

AAP President Dr. Terrence Griffin talks to Everyday Health about the link between RA and gum disease and how treating one condition may improve the other. Click here to read more.




Marijuana use linked to increased gum disease risk

Researchers have found that frequent recreational cannabis use—including marijuana, hashish, and hash oil—may be associated with elevated risk of periodontal disease. Click here to learn more about the recent report published in the Journal of Periodontology.

Have your patients seen Gumblr?

As the online destination for Love The Gums You’re With, the AAP’s consumer awareness campaign, offers various creative and informative assets designed to educate the public on the value of gum health. With interactive quizzes, videos, articles, and an array of periodontal care tips, Gumblr is a fun way for patients to learn why it’s important to love their gums for life. Share it with your patients—


Clarity, examples and treatment options for your perio patients

“Periodontal Disease: Don’t Wait Until It Hurts” is an ADA brochure full of essential messages tailored for your patients. This all-in-one brochure covers periodontal disease from causes, warning signs, and methods of prevention to treatment, surgery, and post treatment instructions. Additionally, this brochure features vivid illustrations of probing, scaling and rot planing, and periodontal surgery, along with bone loss radiographs and “stages of perio” photos. 

“Periodontal Disease” is a 12-page booklet sold in packs of 50. The brochure is also available in Spanish or personalized versions. To order, call 1-800-947-4746 or go to Readers who use the code 17404E before February 3 can save 15% on all ADA Catalog products.


Available for download: clinical and scientific papers from the AAP
The American Academy of Periodontology has developed a suite of resources to be used as guidelines for dentists dealing with periodontal health issues. These resources include disease classifications, AAP-commissioned reviews, parameters of care, position papers, consensus papers/clinical recommendations, and Academy statements.

View and download these materials by clicking here.


What is Specialty Scan?

This is one in a series of quarterly newsletters updating dentists on selected specialties in dentistry. Information presented is aggregated and summarized from previously published materials, each item attributed to its publication of origin. This issue of JADA Specialty Scan focuses on Periodontics, the first in the series on this topic for 2017. Other Specialty Scan issues are devoted to endodontics, oral pathology, oral and maxillofacial radiology, orthodontics, pediatric dentistry, and prosthodontics. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. We welcome feedback on this and all Specialty Scan issues.

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Any statements of opinion or fact are those of the authors and do not necessarily reflect the views of the American Dental Association. Neither the ADA nor any of its subsidiaries have any financial interest in any products mentioned in this publication. Any reference to a product or service, whether in advertisements or otherwise, is not intended as an endorsement or as approval by the ADA or any of its affiliated organizations unless accompanied by an authorized statement that such approval or endorsement has been granted.

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