- Email: [email protected]
Cognitive decline
Discussion.—The onset of aggressive periodontitis is apparently not caused by orthodontic therapy, although the two may occur in the same general time span. Decisions must be made by orthodontists concerning whether to proceed and what periodontal measures should be taken. Orthodontic treatment in the reported cases focused primarily on closing extraction spaces or repositioning incisors through the processes of intrusion, retraction, or uprighting. The periodontal treatments were designed to manage just the inflammatory disease and its effects.
Clinical Significance.—To manage orthodontic treatment and aggressive periodontitis, an interdisciplinary team, including a pedodontist, a periodontist, and an orthodontist, should be gathered. Periodontal health must be assessed, as well as the orthodontic patient’s ability to perform adequate oral hygiene before and during treatment. Both patients and their parents should be informed about the protocols that must be observed. In LAgP with periodontal pockets or bone loss occurring before orthodontic treatment begins, interceptive/ corrective periodontal therapy should be performed before undertaking orthodontic treatments. Severe cases may require revisiting the orthodontic treatment plan to reduce orthodontic forces that exacerbate the dentition involved with aggressive periodontitis. Longer intervals of orthodontic force activation are needed to permit periodontal ligament
recovery. If extractions are required, a 3month delay of orthodontic movement of adjacent teeth into an aggressive periodontitis extraction site after tooth removal may prevent re-involvement of the newly positioned teeth and permit proper bone healing. Continued frequent periodontal/pedodontic follow-up is required, including periodontal and radiographic evaluations every 3 months during orthodontic treatment. Removable rather than fixed retainers should be considered, although there is the drawback of requiring the patient’s cooperation. However, the removable appliances tend to positively influence plaque accumulation and negatively influence gingival inflammation. The clear vacuum-formed retainer has negligible gingival contact, decreases plaque accumulation and gingival irritation, and helps to maintain proper oral hygiene. Future research should investigate the relationship between aggressive periodontitis and the outcome of orthodontic treatment.
Hazan-Molina H, Levin L, Einy S, et al: Aggressive periodontitis diagnosed during or before orthodontic treatment. Acta Odontol Scand 71:1023-1031, 2013 Reprints available from D Aizenbud, Orthodontic and Craniofacial Dept, Rambam Health Care Campus, Haifa, PO Box 9602, 31096, Israel; fax: þ972 4 8339889; e-mail: aizenbud @ortho.co.il
Cognitive decline Background.—Cognitive ability declines with age and is predictive of adverse health outcomes. The specific effect of cognitive decline on oral health has included increased dental caries, fewer teeth, and poorer periodontal health compared to persons not suffering cognitive impairment. Even before dementia becomes apparent, cognitive decline may influence oral health, however, meaning that middle-aged adults whose cognitive impairment is in its early stages may be at risk for unfavorable dental health behaviors, plaque accumulation, or gingivitis. The possibility of this relationship was investigated. Methods.—Data came from the Atherosclerosis Risk in Communities (ARIC) study, in which cognitive function
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Dental Abstracts
was measured at two visits 6 years apart and oral health was assessed only at the later point. The three tests used to assess cognition were the Delayed Word Recall (DWR) test, the Digit Symbol Substitution (DSS) test, and the Word Fluency (WF) test. At the second visit, 10,050 participants responded to dental screening questions and 5878 dentate individuals underwent comprehensive oral evaluations. Cognitive change was assessed for its ability to predict oral health behaviors and conditions. Results.—At the second visit, approximately 90% of the participants were between ages 46 and 65 years. Women accounted for 55.5% of the sample, and 81.5% were white. Compared to the white members of the
sample, African Americans had poorer socioeconomic status, poorer general health status, poorer oral health status, and worse dental behaviors. Their prevalence of complete tooth loss was 18.2% compared to 11.3% for white participants. African American persons had fewer teeth, practiced poorer oral hygiene care, and made fewer dental visits than white persons. Eighty percent of the white respondents and a third of African American persons visited dentists on a regular basis. Ninety-eight percent of those who had no teeth and 46% of dentate individuals wore dentures. The change in cognitive ability over the 6 years was small, but greater among persons who were older and had low education level, low income, and more medical co-morbidities. A 1-unit increase in scores on the three cognition tests was associated with fewer teeth and higher odds of complete tooth loss. However, when all adjustments were made, no association was found between cognitive decline and number of teeth. A greater decline in DSS score was associated with not brushing teeth when all covariates were considered. A greater decline in WF score was associated with infrequent toothbrushing and greater plaque deposits regardless of adjustments. Even statistically significant relationships had odds ratios of 1.3 or less. Cognitive decline was not significantly associated with periodontitis scores, dental visits, or use of dental floss.
Discussion.—Even small reductions in cognitive function can be associated with some oral health behaviors. The relationship may not be causal, however, and periodontal disease is not among the oral health issues related to cognitive functional decline.
Clinical Significance.—Intuitively it seems plausible that a decline in cognitive function will lead to poor oral health. This study documents a modest association between cognitive decline and less frequent toothbrushing, plaque deposits, and a higher chance of edentulism. Other oral behaviors or conditions appeared to be unaffected by the small decline noted over a 6-year period. Further tests are needed to investigate causation and other influences on this trend.
Naorungroj S, Slade GD, Beck JD, et al: Cognitive decline and oral health in middle-aged adults in the ARIC Study. J Dent Res 92:795-801, 2013 Reprints available from S Naorungroj; e-mail: [email protected] or [email protected]
Tooth brushing frequency Background.—Plaque-induced gingivitis is the most common oral disease in dentate persons and the most common type of periodontal disease. Gingivitis is implicated as a precursor of periodontitis, so preventing gingivitis may indirectly prevent periodontitis and loss of tooth support. The principal method used to prevent gingivitis is the regular removal of plaque from all tooth surfaces via tooth brushing. The American Dental Association (ADA) recommends that brushing be performed twice a day. The relationship between the frequency of mechanical plaque removal and the gingival status of persons with a maximum of 5% of sites with gingival bleeding at baseline and no evidence of periodontitis was investigated. Methods.—The 52 patients were randomly assigned to perform the mechanical removal of plaque (MRP) every 12, 24, 48, or 72 hours. At baseline and after 15 and 30 days of following their assigned regimen, patients underwent
measurements of their plaque index (PII) and gingival index (GI). Differences within and between groups were noted and evaluated statistically. Results.—At baseline, none of the indices differed significantly between groups. PII was constant in the 12-hr group, but the other groups had increases in PII over the course of 15 days, then their levels stabilized. Mean GI did not change over the 30-day period of analysis in the 12-hr and 24-hr groups but increased significantly in the 48-hr and 72-hr groups. Subjects in the 12-hr group had significantly lower GI than those in the 72-hr group. The four groups had changes in mean GI over the course of 30 days of 0.11, 0.16, 0.35, and 0.30 for the 12-, 24-, 48-, and 72-hr groups, respectively. The reductions in mean percentage of healthy sites (GI = 0) were 8.8%, 13%, 26.8%, and 27.5%, respectively, in the 12-, 24-, 48-, and 72-hr groups. The additional sites developed visual inflammation or bleeding on probing. The 48-hr and 72-hr groups had
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Clinical Significance.—To manage orthodontic treatment and aggressive periodontitis, an interdisciplinary team, including a pedodontist, a periodontist, and an orthodontist, should be gathered. Periodontal health must be assessed, as well as the orthodontic patient’s ability to perform adequate oral hygiene before and during treatment. Both patients and their parents should be informed about the protocols that must be observed. In LAgP with periodontal pockets or bone loss occurring before orthodontic treatment begins, interceptive/ corrective periodontal therapy should be performed before undertaking orthodontic treatments. Severe cases may require revisiting the orthodontic treatment plan to reduce orthodontic forces that exacerbate the dentition involved with aggressive periodontitis. Longer intervals of orthodontic force activation are needed to permit periodontal ligament
recovery. If extractions are required, a 3month delay of orthodontic movement of adjacent teeth into an aggressive periodontitis extraction site after tooth removal may prevent re-involvement of the newly positioned teeth and permit proper bone healing. Continued frequent periodontal/pedodontic follow-up is required, including periodontal and radiographic evaluations every 3 months during orthodontic treatment. Removable rather than fixed retainers should be considered, although there is the drawback of requiring the patient’s cooperation. However, the removable appliances tend to positively influence plaque accumulation and negatively influence gingival inflammation. The clear vacuum-formed retainer has negligible gingival contact, decreases plaque accumulation and gingival irritation, and helps to maintain proper oral hygiene. Future research should investigate the relationship between aggressive periodontitis and the outcome of orthodontic treatment.
Hazan-Molina H, Levin L, Einy S, et al: Aggressive periodontitis diagnosed during or before orthodontic treatment. Acta Odontol Scand 71:1023-1031, 2013 Reprints available from D Aizenbud, Orthodontic and Craniofacial Dept, Rambam Health Care Campus, Haifa, PO Box 9602, 31096, Israel; fax: þ972 4 8339889; e-mail: aizenbud @ortho.co.il
Cognitive decline Background.—Cognitive ability declines with age and is predictive of adverse health outcomes. The specific effect of cognitive decline on oral health has included increased dental caries, fewer teeth, and poorer periodontal health compared to persons not suffering cognitive impairment. Even before dementia becomes apparent, cognitive decline may influence oral health, however, meaning that middle-aged adults whose cognitive impairment is in its early stages may be at risk for unfavorable dental health behaviors, plaque accumulation, or gingivitis. The possibility of this relationship was investigated. Methods.—Data came from the Atherosclerosis Risk in Communities (ARIC) study, in which cognitive function
102
Dental Abstracts
was measured at two visits 6 years apart and oral health was assessed only at the later point. The three tests used to assess cognition were the Delayed Word Recall (DWR) test, the Digit Symbol Substitution (DSS) test, and the Word Fluency (WF) test. At the second visit, 10,050 participants responded to dental screening questions and 5878 dentate individuals underwent comprehensive oral evaluations. Cognitive change was assessed for its ability to predict oral health behaviors and conditions. Results.—At the second visit, approximately 90% of the participants were between ages 46 and 65 years. Women accounted for 55.5% of the sample, and 81.5% were white. Compared to the white members of the
sample, African Americans had poorer socioeconomic status, poorer general health status, poorer oral health status, and worse dental behaviors. Their prevalence of complete tooth loss was 18.2% compared to 11.3% for white participants. African American persons had fewer teeth, practiced poorer oral hygiene care, and made fewer dental visits than white persons. Eighty percent of the white respondents and a third of African American persons visited dentists on a regular basis. Ninety-eight percent of those who had no teeth and 46% of dentate individuals wore dentures. The change in cognitive ability over the 6 years was small, but greater among persons who were older and had low education level, low income, and more medical co-morbidities. A 1-unit increase in scores on the three cognition tests was associated with fewer teeth and higher odds of complete tooth loss. However, when all adjustments were made, no association was found between cognitive decline and number of teeth. A greater decline in DSS score was associated with not brushing teeth when all covariates were considered. A greater decline in WF score was associated with infrequent toothbrushing and greater plaque deposits regardless of adjustments. Even statistically significant relationships had odds ratios of 1.3 or less. Cognitive decline was not significantly associated with periodontitis scores, dental visits, or use of dental floss.
Discussion.—Even small reductions in cognitive function can be associated with some oral health behaviors. The relationship may not be causal, however, and periodontal disease is not among the oral health issues related to cognitive functional decline.
Clinical Significance.—Intuitively it seems plausible that a decline in cognitive function will lead to poor oral health. This study documents a modest association between cognitive decline and less frequent toothbrushing, plaque deposits, and a higher chance of edentulism. Other oral behaviors or conditions appeared to be unaffected by the small decline noted over a 6-year period. Further tests are needed to investigate causation and other influences on this trend.
Naorungroj S, Slade GD, Beck JD, et al: Cognitive decline and oral health in middle-aged adults in the ARIC Study. J Dent Res 92:795-801, 2013 Reprints available from S Naorungroj; e-mail: [email protected] or [email protected]
Tooth brushing frequency Background.—Plaque-induced gingivitis is the most common oral disease in dentate persons and the most common type of periodontal disease. Gingivitis is implicated as a precursor of periodontitis, so preventing gingivitis may indirectly prevent periodontitis and loss of tooth support. The principal method used to prevent gingivitis is the regular removal of plaque from all tooth surfaces via tooth brushing. The American Dental Association (ADA) recommends that brushing be performed twice a day. The relationship between the frequency of mechanical plaque removal and the gingival status of persons with a maximum of 5% of sites with gingival bleeding at baseline and no evidence of periodontitis was investigated. Methods.—The 52 patients were randomly assigned to perform the mechanical removal of plaque (MRP) every 12, 24, 48, or 72 hours. At baseline and after 15 and 30 days of following their assigned regimen, patients underwent
measurements of their plaque index (PII) and gingival index (GI). Differences within and between groups were noted and evaluated statistically. Results.—At baseline, none of the indices differed significantly between groups. PII was constant in the 12-hr group, but the other groups had increases in PII over the course of 15 days, then their levels stabilized. Mean GI did not change over the 30-day period of analysis in the 12-hr and 24-hr groups but increased significantly in the 48-hr and 72-hr groups. Subjects in the 12-hr group had significantly lower GI than those in the 72-hr group. The four groups had changes in mean GI over the course of 30 days of 0.11, 0.16, 0.35, and 0.30 for the 12-, 24-, 48-, and 72-hr groups, respectively. The reductions in mean percentage of healthy sites (GI = 0) were 8.8%, 13%, 26.8%, and 27.5%, respectively, in the 12-, 24-, 48-, and 72-hr groups. The additional sites developed visual inflammation or bleeding on probing. The 48-hr and 72-hr groups had
Volume 59
Issue 2
2014
103