Perio Reports Vol. 26, No. 5
|Perio Reports provides easy-to-read research summaries on topics of specific
interest to clinicians. Perio Reports research summaries will be included in each
issue to keep you on the cutting edge of dental hygiene science.
|Mom’s Oral Health Predicts Infant’s Oral Health
Mothers share many health outcomes with their children.
This is due, in part, to shared genes, shared social environment
and shared health knowledge and attitudes.
Mothers also share oral bacteria with their children. Specific
strains can be identified in both mothers and their children.
Mothers with high salivary levels of mutans streptococci (MS)
are more likely to have children with MS colonization.
Mothers of children with caries are also more likely to have
high MS levels.
Researchers at several universities in California participated
in a long-term observational study of mothers and
their children. Mothers were entered into the study during
their second trimester of pregnancy in a community clinic
near the U.S./Mexico border. Mothers were 18 to 33 years
of age. Their saliva was tested for MS and lactobacillus (LB)
during pregnancy and at four, nine, 12, 24 and 36 months
postpartum. Clinical exams were also done at these times
plus a series of questions. The study included 243 motherchild
pairs from low-income, Mexican-American families.
All of the mothers had experienced dental caries. Nearly
60 percent of the mothers had untreated decay at all visits.
At 36 months, 34 percent of the children had caries.
Mothers with high levels of MS were likely to have children
with high MS levels as well. Mothers with high levels of MS
during the study were more likely to have children with
caries. Mothers with low levels of MS were more likely to
have caries-free children.
Clinical Implications: Mother’s oral health
and bacterial levels will predict early childhood
caries in their children.
Chaffee, B., Gansky, S., Weintraub, J., Featherstone, J., Ramos-Gomez, F.: Maternal
Oral Bacterial Levels Predict Early Childhood Caries Development. J Dent Res
93:(3) 238-244, 2014.
Lower Right Lingual Most Difficult Area to Clean
Several authors have reported that the area in the mouth
most likely to be missed with toothbrushing is the lower right
lingual. This area is also reported to have the highest levels of
plaque and gingivitis, compared to other areas of the mouth.
In a clinical practice, the hygienist noticed many patients
with problems brushing the mandibular right lingual surfaces.
These surfaces had more plaque and more inflammation
than other areas of the mouth. It was decided to change
the pattern of toothbrushing to begin in this area.
Ten patients with puffy, swollen lingual tissue were invited
to participate in this Action Research Project. An intraoral
camera was used to capture images of both the right and left
mandibular lingual tissues. These images were shared with the
patient and the difference between the sides was discussed.
Following their routine prophylaxis, they were given a new
toothbrush and instructed to brush the lower right inside surfaces
first, before brushing the rest of the teeth. They were
given a disposable mouth mirror and asked to evaluate the tissue
for any changes after brushing this way for two weeks. The
hygienist either telephoned or emailed, per patient request,
after two weeks to see if any difference was noted.
Of the ten patients who participated in this study,
six patients reported improvement in the tissue color and
no bleeding upon brushing or flossing. Three patients didn’t
notice any difference and one forgot the instructions and
didn’t make any changes to the brushing pattern.
Clinical Implications: Teaching patients to begin toothbrushing on the lower right lingual will effectively reduce
plaque and inflammation.
Rogers, C.: Would Starting Toothbrushing on the Lower Right Lingual Reduce Tissue Swelling from Inflammation? OHU Action Research 9A-13, 2014.
|Xylitol Baby Gel Used on a Denture Eliminated
Denture stomatitis is a common infection resulting in mild
inflammation and redness under the denture. It is due to leaving
the denture in the mouth rather than removing it during
sleep, poor oral hygiene and/or a compromised immune system.
In 90 percent of denture stomatitis cases, Candida albicans
is involved. Anti-fungal drugs are used but not always
effective in controlling these infections.
In this case study, an elderly man residing in a long-term
care facility suffered from severe denture stomatitis and angular
cheilitis. Because of the oral
ulcerations, he was unable
to wear his denture very
long, eating was difficult,
his mouth burned and he
lost his sense of taste. Antifungal
medications had not
remedied the situation.
The patient’s father was
a dentist who wanted to
find a solution to this problem.
The hygienist suggested
using xylitol off label
to control the infection.
There were no contraindications,
so the Spry Xylitol Tooth Gel was used five times daily
on the denture. After cleaning the denture, a small amount of
gel, the size of a nickel, was spread on the denture before inserting
it into the mouth. The gel was also used on the corners of
Within one week, the angular cheilitis was healed and
within two weeks, the oral ulcerations were gone, which allowed
the denture to be worn all day. The patient was pleased with the
outcome. The patient’s quality of life was positively impacted as
he was no longer in pain and could eat comfortably.
Clinical Implications: Spry Xylitol Tooth Gel is an effective
remedy for oral candidiasis associated with dentures.
Payne, J.: Is Xylitol an Effective Anti Fungal Treatment for Oral Candida Infections? OHU Action Research
Reducing Mandibular Lingual
Despite repeated oral hygiene instructions,
patients return time after time with moderate to
heavy supragingival calculus accumulating on the
lingual of the lower anterior teeth. Two solutions
have been presented to reduce plaque biofilm and
the resulting supragingival calculus formation.
The biofilm can be mechanically removed with
dry toothbrushing on the lingual surfaces first.
Blocking biofilm formation with xylitol use three
to five times daily will also prevent supragingival
Six patients with moderate to heavy supragingival
calculus formation on the lingual of the
lower anterior teeth were invited to participate in
the study. The two with the heaviest deposit were
instructed to dry brush the mandibular lingual
surfaces first, before brushing the rest of the
mouth. They were then instructed to add toothpaste
and repeat the brushing. They were also
given 100 percent xylitol-sweetened gum and
mints and told to use them after meals and snacks,
five times daily. The second two patients were
asked to follow the xylitol protocol and follow
their regular oral hygiene. The last two patients
were instructed in the dry toothbrushing technique.
Subjects were examined two weeks later.
Both dry toothbrushing lingual surfaces first
and xylitol use five times daily effectively reduced
the supragingival calculus formation. Xylitol was
slightly more effective and easier to use, thus compliance
was better. One of the patients wasn’t
properly placing the toothbrush on the lower lingual
surfaces to effectively remove the plaque. His
technique was corrected and upon further evaluation
two weeks later, the biofilm and calculus were
Clinical Implications: Both dry brushing and
xylitol can prevent biofilm formation and the
resulting supragingival calculus formation.
Anguiano, E.: Can Dry Brushing and the Use of Xylitol Mints and Chewing Gum Help
Reduce Supragingival Calculus Deposits? Action Research 9A-13, 2014.
|Baking Soda Elevates pH and Reduces Inflammation
Baking soda (sodium bicarbonate) has long been
suggested for toothbrushing and as a tooth whitener.
Actress Julia Roberts reports following her grandfather’s
advice to brush with baking soda for a brighter
smile. Sodium bicarbonate dates back to ancient
Egypt. The ability of baking soda to neutralize acids
makes it an inexpensive
home remedy for full body
issues as well as the prevention
of dental disease.
Ten patients ranging
in age from 20 to 60 years
participated in the study
with baking soda. At baseline
they were screened for
hypertension, salivary flow, salivary pH, gingival tissue
appearance and bleeding.
They were instructed to brush daily with baking
soda instead of toothpaste. They were to put half a
teaspoon of baking soda into the palm of their hand,
wet their toothbrush with water and scoop up the
baking soda with the bristles and brush their teeth.
They were also asked to add a teaspoon of baking
soda to a glass of water to make a mouth rinse. After
rinsing, they were to spit out the baking soda water
mix and not rinse with water. They were given pH
strips and asked to record the pH of their saliva
upon waking up each morning and to record it on
the form provided.
Patients returned one to two weeks later. The
group showed reduced pH scores over the test period
and also reduced bleeding and signs of gingivitis.
Patients reported their mouths felt cleaner.
Clinical Implications: Baking soda is an inexpensive
and readily available product for elevating
salivary pH and reducing inflammation.
McKenzie, S.: Will Sodium Bicarbonate Change the pH Levels of Saliva and Reduce Gingival
Inflammation? Action Research 9A-13, 2014.
Blood Test Screening for Diabetes
in the Dental Office
Many people have diabetes and don’t know it. According
to the CDC, in 2010, 25.8 million people or 8.3 percent of
the U.S. population had diabetes. Within this number, the
undiagnosed cases account for 7 million or 21 percent of
those with diabetes. Early treatment is essential to preventing
serious complications including kidney failure, blindness,
heart disease and stroke. Periodontal disease is also a risk factor
for those with diabetes. Screening for diabetes in the dental
office may provide an opportunity for early intervention.
Researchers at the University of Buffalo in New York
screened patients for signs of diabetes in 11 general and periodontal
practices and one community clinic in Providence,
Rhode Island. Patients were asked a series of diabetes risk
questions and given an HbA1c finger stick blood test. Scores
of 5.7-6.4 indicate pre-diabetes, 6.5 or greater indicates diabetes.
Patients with scores of 5.7 and higher were referred by
the dentist to their physician for a definitive diagnosis. A
total of 1,022 people 45 years and older participated in the
study. Half of those tested at the community center were at
high risk for diabetes, compared to one-quarter in private
dental practices. Community clinic patients were more likely
to follow up with their physician than those seen in private
dental office. Twenty-two percent of those referred by the
dental office actually went to the physician compared to 79
percent from the community clinic.
Clinical Implications: It is feasible to screen for diabetes and pre-diabetes with the HbA1c finger stick blood test.
Follow-through on the referral to a physician may be a problem.
Genco, R., Schifferle, R., Dunfor, R., Falkner, K., Hsu, W., Balukjian, J.: Screening for Diabetes Mellitus in Dental Practices. JADA 145:(1) 57-64, 2014.