- Email: [email protected]
Oral malodor
the patient referred to his or her primary care physician for consultation. The dentist should discuss with the physician the patient’s medical condition, cognitive status, disease prognosis, drug regimens, and modifications needed during dental treatment. PD patients face the challenge of adapting to their progressive disability. Any dental treatment plans should consider the patient’s current status and degree of intervention required. Restorative procedures should be completed during the initial stages of the disease. Considerations during these procedures include the patient’s reduced ability to tolerate long appointments and any lack of cooperation as a result of the disease. The dentist should discuss immediate as well as long-term treatment plans with the patient and/or family/responsible party to prevent future complications. PD patients can suffer muscle rigidity that challenges the maintenance of oral hygiene. Improved oral hygiene reduces the risk of not only oral diseases but also systemic conditions such as diabetes, infective endocarditis, and aspiration pneumonia. The patient should be educated and motivated to maintain good oral hygiene. Concerns with grip and overall dexterity increase with the progression of tremors and poor muscle coordination. Aids to achieve good hygiene include modified techniques for using the toothbrush, tooth paste, and floss. Toothbrushes with a wider grip are best; the brush can be fixed inside bike handlebar grips or tennis balls to increase surface area and promote better hygiene efforts. Power toothbrushes are especially useful, having a thicker handle, which improves the patient’s ability to grip the tool. In addition, the new versions have a timer with an on/off switch that keeps the patient on track for proper brushing for the right length of time. The best choice is a toothbrush with soft bristles and a small head so all corners of the mouth can be reached. Brushes should be replaced every 3 months or when the bristles start to fan out. Toothpaste pumps will dispense a fixed amount of toothpaste. Flossing is facilitated by floss holders and interproximal brushes to help the patient cleanse the mouth
more effectively. If the patient uses partial, fixed, or complete dentures, they should also receive regular cleansing. Tongue cleansing is needed because food particles can remain, especially in patients with PD-related xerostomia. Mouthwashes used by PD patients should be nonalcoholic and fluoridated to improve overall benefit with other hygiene aids. Combining fluoridated toothpaste with an antimicrobial mouth rinse is a useful, simple, quick, and noninvasive way to control and manage existing root caries lesions. The patient should also be educated in how to use all of these hygiene aids most effectively. Patients with reduced oral muscle control can be taught to dip a toothbrush in mouthwash before brushing or bend over the sink and rinse, both of which will reduce the incidence of uncontrolled swallowing. Patients who are having issues with memory and remembering details about how to brush and floss can post notes in the brushing area as reminders. The family can also be encouraged to remind patients about brushing and flossing.
Clinical Significance.—Providing complete dental care for PD patients is extremely important, especially with the increasing numbers of older patients dentists will be managing. Dentists who are well informed about the manifestations of PD, its direct and indirect effects on oral health, and modifications needed to achieve good oral care are in the best position to handle these challenging situations.
Grover S, Rhodus NL: Dental implications of Parkinson’s disease. Northwest Dent 90:13, 2011 Reprints not available
Periodontal Diseases Oral malodor Background.—Oral malodor (halitosis) is a multifactorial disease and requires a careful diagnostic and treatment plan. It is essential to identify the causative factors and perform proper measurements to determine the most
318
Dental Abstracts
appropriate treatment modality. Between 85% and 90% of oral malodor originates in the oral cavity, with the principal components being volatile sulfur compounds. These are produced through the putrefaction of proteins that contain
methionine or cysteine by oral anaerobic gram-negative organisms such as Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia. The amount of volatile sulfur compounds in mouth air and the extent of periodontal disease are correlated, which indicates these organisms can contribute to the production of volatile sulfur compounds. Tongue coating consists of bacteria, desquamated epithelial cells from the oral mucosa, leukocytes from periodontal pockets, and blood metabolites. It also contributes to the production of oral malodor in healthy persons, as well as those with periodontal disease. Based on these associations, it is reasonable to assume that periodontal treatment and the removal of tongue coating would improve oral malodor by reducing the number of pathogens present that produce the volatile sulfur compounds. Whether this approach is equally effective in reducing oral malodor in periodontitis and gingivitis patients was investigated. Methods.—The subjects included 102 periodontitis patients and 116 gingivitis patients who had oral malodor. The degree of malodor was measured using the organoleptic test and Oral Chroma. Subjects each completed a selfadministered questionnaire compiling demographic information and dental health behaviors. They also underwent an oral examination to document caries experience, plaque index, gingival index, pocket depth, clinical attachment level, and gingival bleeding on probing. Radiographs were obtained to confirm periodontal status. Tongue coating thickness was determined visually. The presence of pathogens in the tongue coating was evaluated using the N-benzoyl-DL-arginine-2-napthylamide (BANA) test. The subjects in each diagnostic group were randomly divided into two groups, P1 and P2 and G1 and G2. The 52 P1 subjects received periodontal treatment first, then tongue cleaning; the 59 P2 subjects received these treatments in the opposite order. The 58 G1 and 60 G2 subjects were also given these treatments in the two patterns. Oral malodor was determined after each treatment; oral examinations were also performed at that time. The periodontal group’s treatment consisted of oral hygiene instruction, scaling, tooth polishing, root planing, and/or removal of ill-fitting prostheses. The gingivitis group’s treatment involved oral hygiene instruction, scaling, and tooth polishing. The length of periodontal treatment depended on the severity of the periodontitis. Tongue cleaning was accomplished before tooth brushing each morning for 7 days. Oral malodor assessments and oral examinations were conducted on the eighth day. Results.—At baseline, all subjects reported brushing their teeth each morning, and 17.5% of the subjects said they cleaned their tongue every day after tooth brushing. The periodontitis group had significantly higher mean organoleptic, hydrogen sulfide, and methyl mercaptan scores and higher values on periodontal parameters than the
gingivitis group. However, the BANA test found no statistically significant differences between the groups. The mean values of periodontal parameters, plaque index, tongue coating score, and BANA test score were similar for the P1 and P2 groups. Statistically significant improvements were noted after periodontal treatment and tongue cleaning on most parameters. Plaque index, tongue coating score, and BANA test results were significantly reduced after periodontal treatment and tongue cleaning in both periodontal groups. In the G1 and G2 groups, most periodontal parameters significantly improved after periodontal treatment and tongue cleaning, with significant reductions in plaque index, tongue coating score, and BANA test score. Malodor parameters were significantly improved after periodontal treatment in the P1 and P2 groups, with lesser improvement after tongue cleaning. The situation was opposite in the gingivitis groups, with significantly improved malodor after tongue cleaning and lesser improvement after periodontal treatment. Discussion.—Although both groups benefitted from periodontal treatment and tongue cleaning with respect to oral malodor, they differed in respect to which treatment produced the greatest improvement. For the periodontitis groups, oral malodor was more effectively removed using periodontal treatment. For the gingivitis groups, oral malodor was more effectively addressed by tongue cleaning.
Clinical Significance.—The treatment of periodontal disease and tongue cleaning are highly dependent on the patient’s daily hygiene regimen. This also applies to the treatment of oral malodor. The importance of personal oral care for managing oral malodor cannot be overstated. Patients need to be educated about the causes of oral malodor and the fact that daily removal of the offending bacteria can prevent or at least lessen the problem. In addition, dentists should be able to fit the treatment to the patient—emphasizing periodontal treatment for periodontitis patients and tongue cleaning for gingivitis patients.
Pham TAV, Ueno M, Zaitsu T, et al: Clinical trial of oral malodor treatment in patients with periodontal disease. J Periodont Res 46:722729, 2011 Reprints available from M Ueno, Dept of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental Univ, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8549, Japan; fax: þ81 3 5803 0194; e-mail: [email protected]
Volume 57
Issue 6
2012
319
more effectively. If the patient uses partial, fixed, or complete dentures, they should also receive regular cleansing. Tongue cleansing is needed because food particles can remain, especially in patients with PD-related xerostomia. Mouthwashes used by PD patients should be nonalcoholic and fluoridated to improve overall benefit with other hygiene aids. Combining fluoridated toothpaste with an antimicrobial mouth rinse is a useful, simple, quick, and noninvasive way to control and manage existing root caries lesions. The patient should also be educated in how to use all of these hygiene aids most effectively. Patients with reduced oral muscle control can be taught to dip a toothbrush in mouthwash before brushing or bend over the sink and rinse, both of which will reduce the incidence of uncontrolled swallowing. Patients who are having issues with memory and remembering details about how to brush and floss can post notes in the brushing area as reminders. The family can also be encouraged to remind patients about brushing and flossing.
Clinical Significance.—Providing complete dental care for PD patients is extremely important, especially with the increasing numbers of older patients dentists will be managing. Dentists who are well informed about the manifestations of PD, its direct and indirect effects on oral health, and modifications needed to achieve good oral care are in the best position to handle these challenging situations.
Grover S, Rhodus NL: Dental implications of Parkinson’s disease. Northwest Dent 90:13, 2011 Reprints not available
Periodontal Diseases Oral malodor Background.—Oral malodor (halitosis) is a multifactorial disease and requires a careful diagnostic and treatment plan. It is essential to identify the causative factors and perform proper measurements to determine the most
318
Dental Abstracts
appropriate treatment modality. Between 85% and 90% of oral malodor originates in the oral cavity, with the principal components being volatile sulfur compounds. These are produced through the putrefaction of proteins that contain
methionine or cysteine by oral anaerobic gram-negative organisms such as Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia. The amount of volatile sulfur compounds in mouth air and the extent of periodontal disease are correlated, which indicates these organisms can contribute to the production of volatile sulfur compounds. Tongue coating consists of bacteria, desquamated epithelial cells from the oral mucosa, leukocytes from periodontal pockets, and blood metabolites. It also contributes to the production of oral malodor in healthy persons, as well as those with periodontal disease. Based on these associations, it is reasonable to assume that periodontal treatment and the removal of tongue coating would improve oral malodor by reducing the number of pathogens present that produce the volatile sulfur compounds. Whether this approach is equally effective in reducing oral malodor in periodontitis and gingivitis patients was investigated. Methods.—The subjects included 102 periodontitis patients and 116 gingivitis patients who had oral malodor. The degree of malodor was measured using the organoleptic test and Oral Chroma. Subjects each completed a selfadministered questionnaire compiling demographic information and dental health behaviors. They also underwent an oral examination to document caries experience, plaque index, gingival index, pocket depth, clinical attachment level, and gingival bleeding on probing. Radiographs were obtained to confirm periodontal status. Tongue coating thickness was determined visually. The presence of pathogens in the tongue coating was evaluated using the N-benzoyl-DL-arginine-2-napthylamide (BANA) test. The subjects in each diagnostic group were randomly divided into two groups, P1 and P2 and G1 and G2. The 52 P1 subjects received periodontal treatment first, then tongue cleaning; the 59 P2 subjects received these treatments in the opposite order. The 58 G1 and 60 G2 subjects were also given these treatments in the two patterns. Oral malodor was determined after each treatment; oral examinations were also performed at that time. The periodontal group’s treatment consisted of oral hygiene instruction, scaling, tooth polishing, root planing, and/or removal of ill-fitting prostheses. The gingivitis group’s treatment involved oral hygiene instruction, scaling, and tooth polishing. The length of periodontal treatment depended on the severity of the periodontitis. Tongue cleaning was accomplished before tooth brushing each morning for 7 days. Oral malodor assessments and oral examinations were conducted on the eighth day. Results.—At baseline, all subjects reported brushing their teeth each morning, and 17.5% of the subjects said they cleaned their tongue every day after tooth brushing. The periodontitis group had significantly higher mean organoleptic, hydrogen sulfide, and methyl mercaptan scores and higher values on periodontal parameters than the
gingivitis group. However, the BANA test found no statistically significant differences between the groups. The mean values of periodontal parameters, plaque index, tongue coating score, and BANA test score were similar for the P1 and P2 groups. Statistically significant improvements were noted after periodontal treatment and tongue cleaning on most parameters. Plaque index, tongue coating score, and BANA test results were significantly reduced after periodontal treatment and tongue cleaning in both periodontal groups. In the G1 and G2 groups, most periodontal parameters significantly improved after periodontal treatment and tongue cleaning, with significant reductions in plaque index, tongue coating score, and BANA test score. Malodor parameters were significantly improved after periodontal treatment in the P1 and P2 groups, with lesser improvement after tongue cleaning. The situation was opposite in the gingivitis groups, with significantly improved malodor after tongue cleaning and lesser improvement after periodontal treatment. Discussion.—Although both groups benefitted from periodontal treatment and tongue cleaning with respect to oral malodor, they differed in respect to which treatment produced the greatest improvement. For the periodontitis groups, oral malodor was more effectively removed using periodontal treatment. For the gingivitis groups, oral malodor was more effectively addressed by tongue cleaning.
Clinical Significance.—The treatment of periodontal disease and tongue cleaning are highly dependent on the patient’s daily hygiene regimen. This also applies to the treatment of oral malodor. The importance of personal oral care for managing oral malodor cannot be overstated. Patients need to be educated about the causes of oral malodor and the fact that daily removal of the offending bacteria can prevent or at least lessen the problem. In addition, dentists should be able to fit the treatment to the patient—emphasizing periodontal treatment for periodontitis patients and tongue cleaning for gingivitis patients.
Pham TAV, Ueno M, Zaitsu T, et al: Clinical trial of oral malodor treatment in patients with periodontal disease. J Periodont Res 46:722729, 2011 Reprints available from M Ueno, Dept of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental Univ, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8549, Japan; fax: þ81 3 5803 0194; e-mail: [email protected]
Volume 57
Issue 6
2012
319