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Objective. The aim of this study was to evaluate the overall effects of herbal mouthwashes as supplements to daily oral hygiene on plaque and inflammation control compared with placebos and chlorhexidine (CHX) mouthwashes in the treatment of gingivitis. Methods. PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and grey literature databases were searched. Only randomised controlled trials (RCTs) comparing herbal mouthwashes with placebos or CHX in the daily oral hygiene of patient with gingivitis were included to compare the effect of different mouthwashes on plaque and inflammation control. Results. A total of 13 studies satisfied the eligibility criteria, and 11 studies were included in meta-analyses. Significant differences were observed in favour of herbal mouthwashes compared with placebos in both plaque- and inflammation-related indices (Quigley-Hein Plaque Index, QHPI: WMD = −0.61, 95% CI (−0.80, −0.42), P<0.001; Gingival Index, GI: −0.28 (−0.51, −0.06), P=0.01; Modified Gingival Index, MGI: −0.59 (−1.08, −0.11), P=0.02; Gingival Bleeding Index, GBI: −0.06 (−0.09, −0.04), P<0.001). No significant difference was found between herbal and CHX mouthwashes. Conclusions. Herbal mouthwashes have potential benefits in plaque and inflammation control as supplements to the daily oral hygiene of patients with gingivitis. Although no difference was observed between herbal and CHX mouthwashes in the selected studies, further high-quality RCTs are needed for more firm support before advising patients with gingivitis about whether they can use herbal mouthwashes to substitute for CHX mouthwashes or not (PROSPERO registration number: CRD42019122841).

Background Periodontitis is a polymicrobial, multifactorial infection that affects the supporting structures of teeth. Melatonin, a biomolecule with anti-inflammatory, antibacterial, and antioxidant properties, has demonstrated promising results in various medical fields, including dentistry. Objective This study aimed to evaluate the effectiveness of 1% (w/v) melatonin gel as an adjunct to Non-Surgical Periodontal Therapy (NSPT) in improving clinical periodontal parameters, reducing antimicrobial activity against Aggregatibacter actinomycetemcomitans and Prevotella intermedia , and increasing superoxide dismutase (SOD) levels in gingival crevicular fluid (GCF) among patients with stage II periodontitis. Methods A split-mouth randomized controlled trial was conducted on 24 periodontitis patients. Two sites per patient were randomly assigned: the test site underwent scaling and root planing (SRP) followed by intra pocket application of 1% melatonin gel, while the control site received SRP alone. Clinical parameters, including the Plaque Index (PI), Gingival Index (GI), Gingival Bleeding Index (GBI), Periodontal Pocket Depth (PPD), and Clinical Attachment Loss (CAL), were assessed at baseline, 1 month, and 3 months. Subgingival plaque samples and GCF were collected to evaluate microbial and biochemical changes. Results Both groups showed statistically significant improvements in clinical parameters from baseline to the 3rd month post-therapy. A quantitative reduction in Aggregatibacter actinomycetemcomitans and Prevotella intermedia was observed at both sites. Additionally, the test site exhibited a greater increase in SOD levels compared to the control site. Conclusion The adjunctive application of melatonin gel with SRP demonstrated enhanced antioxidant potential and improved clinical outcomes in patients with stage II periodontitis. Trial registration trial registry ISRCTN. Trial registration number ISRCTN40460432. Date of Registration: 22/10/2024. “Retrospectively registered”.

Objectives To compare the plaque reducing efficacy of oil pulling with sesame oil compared to distilled water in a randomized, controlled, examiner-blinded parallel group study. Materials and methods Forty probands without advanced periodontal disease of the University Hospital for Restorative Dentistry and Periodontology, Medical University of Innsbruck (Austria) were randomized allocated to test- (sesame oil) or control group (distilled water) and asked to pull daily in the morning for eight weeks with their allotted fluid for 15 min. Rustogi Modified Navy Plaque Index (RMNPI) and gingival bleeding index were assessed at baseline and after four and eight weeks. Plaque samples underwent microbiological analysis. Results Pulling with sesame oil was significantly more effective in reducing full mouth RMNPI compared to distilled water after eight weeks (median reduction 18.98% versus 10.49%; p  = 0.023), and was most pronounced in anterior, buccal, and lingual subscales. On approximal surfaces, significantly higher plaque reduction was found in the test group after four (24.07% versus 14.29%) and eight weeks (16.00% versus 5.36%) of intervention ( p  < 0.05). No significant changes in gingival index and mirobiological analysis could be detected. Conclusion Plaque reduction was statistically significantly higher with oil pulling than with distilled water, however, a study bias cannot be ruled out. Further high-quality trials are needed to understand the mechanisms and effectiveness of oil pulling, to finally clarify the evidence. Clinical relevance Oil pulling may be recommended as an adjuvant to mechanical dental cleaning. Individuals with keratosis may experience adverse effects. Trial registration ClinicalTrials.gov NCT06327841.

BackgroundConsidering the increasing number of elderly people, dementia has gained an important role in today’s society. Although the contributing factors for dementia have not been fully understood, chronic periodontitis (CP) seems to have a possible link to dementia.AimTo conduct a systematic review including meta-analysis in order to assess potential differences in clinical periodontal variables between patients with dementia and non-demented individuals.MethodsThe following focused question was evaluated: is periodontitis associated with dementia? Electronic searches in two databases, MEDLINE and EMBASE, were conducted. Meta-analysis was performed with the collected data in order to find a statistically significant difference in clinical periodontal variables between the group of dementia and the cognitive normal controls.ResultsForty-two articles remained for full text reading. Finally, seven articles met the inclusion criteria and only five studies provided data suitable for meta-analysis. Periodontal probing depth (PPD), bleeding on probing (BOP), gingival bleeding index (GBI), clinical attachment level (CAL), and plaque index (PI) were included as periodontal variables in the meta-analysis. Each variable revealed a statistically significant difference between the groups. In an attempt to reveal an overall difference between the periodontal variables in dementia patients and non-demented individuals, the chosen variables were transformed into units that resulted in a statistically significant overall difference (p < 0.00001).ConclusionThe current findings indicate that compared to systemically healthy individuals, demented patients show significantly worse clinical periodontal variables. However, further epidemiological studies including a high numbers of participants, the use of exact definitions both for dementia and chronic periodontitis and adjusted for cofounders is warranted.Clinical relevanceThese findings appear to support the putative link between CP and dementia. Consequently, the need for periodontal screening and treatment of elderly demented people should be emphasized.

Background Orthodontic treatment can cause traumatic ulcers within the first month due to friction and irritation. Curcumin, a turmeric extract, exhibits analgesic, anti-inflammatory, antibacterial, and wound-healing properties. This study investigated the effectiveness of curcumin mouthwash in preventing traumatic ulcers in fixed orthodontic patients during the first month of treatment. Methods In this double-blind, placebo-controlled, randomized clinical trial, 70 patients aged 12–30 years were assigned to curcumin or placebo mouthwash, used twice daily for 28 days after bracket cementation. Primary outcomes were (1) incidence and (2) duration of traumatic ulcers. Secondary outcomes included pain scores, ulcer sites, adverse effects, plaque index (PI), gingival index (GI), gingival bleeding index (GBI), and patient feedback. Data were analyzed using descriptive statistics and SPSS software. Results All 70 patients completed the trial, with 35 participants in the curcumin group (mean age 20.88 ± 4.87 years) and 35 in the placebo group (mean age 18.60 ± 4.20 years). No significant between-group differences were observed in the incidence or duration of traumatic ulcers ( p  > 0.05). Patients in the curcumin group reported significantly lower pain scores compared with those in the placebo group during the first and second weeks ( p  < 0.05), indicating an early analgesic effect; however, no significant differences were observed thereafter. The buccal mucosa was the most frequent ulcer site, and orthodontic wax use did not differ significantly between groups ( p  > 0.05). No adverse effects were reported in the curcumin group, and participants rated its smell as more pleasant. Baseline PI was lower in the curcumin group ( p  < 0.05), but no post-intervention differences were observed ( p  > 0.05). Within-group analyses showed a PI reduction in the placebo group and a GI reduction in the curcumin group (both p  < 0.05), while GBI remained unchanged. Conclusions Although ulcer prevention was not observed, curcumin mouthwash may serve as an adjunct for early pain relief in orthodontic patients. Trial registration ClinicalTrials.gov (Identifier: NCT05147376), registered on December 7, 2021. Available at: https://clinicaltrials.gov/study/NCT05147376 .

Background Orthodontic treatment presents challenges with plaque accumulation around brackets, archwires, and elastics, leading to retained plaque and gingival inflammation. Conventional toothbrushing may not be enough, requiring additional oral hygiene aids like interproximal brushes, dental flosses, and water flossers. Limited research exists on comparing water flossing and interdental flossing in orthodontic patients. Therefore, this study aims to assess their effectiveness in maintaining oral hygiene during active orthodontic treatment. Methods A single-blind, randomized, parallel clinical study recruited orthodontic patients with full-mouth brackets and archwires. Thirty participants were randomly assigned to either water jet flossing or interdental flossing groups. All participants were instructed to brush twice daily with a provided toothbrush and toothpaste and use the assigned intervention once daily at night. Clinical measures, including the Gingival Bleeding Index (BI), Plaque Index (PI), and Gingival Index (GI), were recorded at baseline and day 14. Descriptive statistics and statistical tests were performed using SPSS software. Results The water jet flossing group demonstrated a slightly higher, albeit non-significant, benefit in plaque removal (median difference of 6.79%%, P  = 0.279) and bleeding reduction (median difference of 5.21%%, P  = 0.172) compared to the interdental flossing group after two weeks. Both groups showed significant reductions in gingival bleeding index and plaque index from baseline to the 2-week follow-up. The interdental flossing group had median mean percentage differences of 16.13%% (plaque index) and 23.57% (gingival bleeding index), while the water jet flossing group had median percentage differences of 21.87% (plaque index) and 32.29% (gingival bleeding index). No significant changes in gingival index grades were observed in either group. Conclusion Both water jet flossing and interdental flossing were effective in reducing plaque accumulation and gingival bleeding among orthodontic patients. While no significant differences were found between the two methods, water jet flossing showed a potential advantage. Further research is needed to validate its effectiveness, assess long-term impact, and understand its benefits for orthodontic patients.

Objective The objective was to evaluate the remineralization effects of fluoride varnish (Clinpro White varnish), self-assembling peptide (Curodont™ Repair) and their combined use on WSL after orthodontic treatment. Materials and methods Thirty-two subjects, aged of 10–18 (mean age 13.91 ± 2.92) with 107 post-orthodontic WSL were included in the study. Subjects were divided into four groups as control, tricalcium phosphate (TCP) containing fluoride varnish (Clinpro White varnish) group, self-assembling P11-4 peptides (Curodont™ Repair) group and combined application of the two products. At the beginning, each subjects’ caries risk profile was assessed by evaluating diet cariogenicity, plaque index, gingival bleeding index and stimulated salivary flow rate. Before the application of the remineralization agents, WSL baseline demineralization values were determined with QLF Inspektor™ Pro, laser fluorescence using DIAGNOdent and color values were measured by Vita EasyShade. Remineralization data were obtained by measuring ΔF, ΔQ, and lesion area with QLF. The aesthetic improvement after the remineralization process was evaluated with a spectrophotometer at six weeks, three and six months. Results No statistically significant differences were found between the groups in terms of criteria determining patients’ caries risk profiles, DIAGNOdent data, and plaque index scores ( p  > 0.05). Intra-group evaluation following remineralization revealed statistically significant increases in ΔF and ΔQ with a decrease in lesion area for the fluoride varnish group at six months, for the peptide group at three months, and for the combined application group at three and six months ( p  < 0.05). In inter-group comparisons, ΔF and ΔQ values were found to be statistically significant only in the fluoride group at six months compared to the other groups ( p  < 0.05). While the L* value decreased significantly in all groups at six months, a statistically significant difference in ΔE* values was observed only in the control group between three and six months. Conclusion Fluoride varnish with TCP showed highest remineralization at 6 months, and the remineralization was positively affected in the short term (three months) after the use of self-assembling P11-4 peptides and their combined application. Clinical relevance Remineralization obtained after single application of agents tested in six months in-vivo showed parallel results. In an attempt to trigger subsurface remineralization, the combined use of fluoride with self-assembling peptides as biomimetic remineralization agent needs further evaluation.

Objective Assess whether the independent variables (IV) such as number of MIH-affected molars, MIH severity, past caries experience, visible plaque index (VPI), gingival bleeding index (GBI), age, and gender affect the presence of caries lesion (DMF_s) in first permanent molars, considering or not atypical restoration in MIH-affected molars as a previous caries lesion. Methods A sample of 476 schoolchildren, aged 6–10 years, were evaluated for MIH and caries diagnosis, using the Severity Scoring System (MIH-SSS) and the International Caries Detection and Assessment System (ICDAS), respectively. From the ICDAS, the DF-s/ D-s and df-s were calculated. The Zero‐inflated Negative Binomial Regression was used to evaluate the impact of the IV on the dependent variable, considering or not the restorative component in MIH-affected molars. Results When the presence of caries was evaluated with the restorative component, age, MIH severity and past caries experience had a significant impact on the dependent variable (R 2  = 0.176). Without the restorative component in MIH-affected molars, only age and past caries experience were statistically significant (R 2  = 0.167). Conclusion Since in the case of MIH teeth restoration may be attributed to post-eruptive breakdown rather than previous caries lesions, in the present study MIH did not influence the presence of caries lesions in the MIH-affected molars showing that restoration is not an adequate parameter for measuring the historical occurrence of caries. Clinical relevance The first permanent molars may not necessarily be at an increased risk of caries due to MIH if the etiological factors for caries development are effectively managed.

Introducción: las personas que experimentan Ansiedad al tratamiento Dental (AD) pueden evitar las citas odontológicas e incluso posponer los tratamientos, incluyendo el tratamiento periodontal. El objetivo de este estudio fue 1) determinar la AD en pacientes con periodontitis antes del primer paso y después del segundo paso del tratamiento de la periodontitis (tratamiento periodontal no quirúrgico) y 2) recopilar características sociodemográficas y clínicas de la población estudiada. Métodos: se invitó a participar a pacientes con periodontitis que nunca habían recibido instrumentación subgingival, que asistían a la Clínica de Periodoncia de la Facultad de Odontología de la Universidad de Costa Rica. Del expediente electrónico se obtuvo la siguiente información: estadio periodontal, Índice de Placa (PI) e Índice de Sangrado Gingival (ISG). Se aplicó un cuestionario antes del primer paso y después del segundo paso del tratamiento de la periodontitis. Los datos recolectados incluyeron: factores sociodemográficos, hábitos de tabaquismo, condición de exfumador, dolor y la Escala de Ansiedad Dental de Corah Modificada (MDAS). Resultados: 51 pacientes completaron el estudio, 19 hombres y 32 mujeres, con un promedio de edad de 46 ± 11,16 años. La mayoría de los participantes refirió haber terminado la enseñanza media (37,3%). En cuanto al hábito de fumado, el 46% de los participantes eran no fumadores. De los no fumadores, el 7,8% eran exfumadores. El dolor máximo del paciente en el último mes disminuyó después de completar el segundo paso del tratamiento de la periodontitis (p=0,002). El diagnóstico periodontal más prevalente fue el Estadio III seguido del Estadio II. El PI medio fue del 61,4 % y el GBI medio fue del 39,5 %. El miedo al sonido de los instrumentos rotatorios y los raspadores ultrasónicos mejoró después del tratamiento periodontal. La AD se redujo en comparación con el valor inicial, según la puntuación total del MDAS y para todas las subpuntuaciones del MDAS. Conclusión: la autopercepción de la AD mejoró en el trascurso del tratamiento periodontal en nuestro entorno clínico.

Objectives Simplifying interdental space cleaning is a constantly discussed topic. The present study aimed to compare the cleansing efficacy of an oral irrigator with that of dental flossing in adolescent patients with fixed braces after four weeks of home-use. Materials and methods The study design is a randomized, single-blinded cross-over study. Following a twenty-eight-day period of product utilization in a home setting, a comparative analysis was conducted on hygiene indices, the Rustogi Modified Navy Plaque Index (RMNPI) and the Gingival Bleeding Index (GBI), between the test group (oral irrigator) and the control group (dental floss). Results Seventeen adolescent individuals completed the study. After 28 days of cleaning with the oral irrigator, RMNPI was 58.81% (55.31–66.47) compared to 59.46% (52.68–68.67) with dental floss ( p  = 0.070). Subgroup analyses did not indicate the superiority of either method. GBI after the test phase with the oral irrigator was 28.93% (23.21–33.97) and insignificantly higher compared to 26.40% (21.01–31.41) achieved with dental floss ( p  = 0.1585). Conclusions Neither of the two products demonstrated statistically significant superiority in terms of cleaning efficacy. Therefore, no recommendation can be made in favor of one over the other. It was found that the high initial hygiene indices for fixed orthodontic appliances could be improved through increased awareness and precise instruction. Clinical relevance For adolescent patients who struggle to use interdental brushes an oral irrigator may be suggested as a simple alternative in hard-to-reach areas, such as those around a fixed dental appliance.