Establishing dental hygiene education in Germany: current facts and future perspectives.

As there is a marked need to increase the number of dental hygienists (DHs) working in German dental practices, efforts are being made to establish dental hygiene education in accordance with international standards. However, as current German legislation does not envisage a perennial full-time training programme, dental hygiene education may currently be provided within a modular concept only. The basic qualification for enrollment in a modular hygienist training programme of this kind is accredited vocational training as a dental assistant (DA), followed by board-certified continuing education as an oral prophylaxis assistant. Thus, the current system of advanced training for qualification as a DH is subject to at least 6 years' work experience in the field of dentistry. A 950-h full-time advanced training course, meeting all the requirements of this concept, was established by the Westphalia-Lippe Dental Association in cooperation with the University of Münster. The curriculum underlying this programme was outlined considering the recommendations for dental hygiene education issued by the European Federation of Periodontology, although reduced in standards to comply with current German legislation. In addition, the recommendations for American Dental Hygiene education by the American Dental Association were used as a guide for programme development. The contents and implementation of the Münster Dental Hygienist Curriculum may allow the professional competence generated during practical work experience to be linked with international requirements of dental hygiene education.link_to_subscribed_fulltex

Combined systemic and local antimicrobial therapy of periodontal disease in Papillon-Lefèvre syndrome: A report of 4 cases

4 patients, 2 pairs of siblings, suffering from Papillon-Lefèvre syndrome were treated for periodontal disease. Following extraction of hopeless teeth, the children received scaling and adjunctive systemic antibiotics (metronidazole and amoxicillin for 7 to 10 days). In addition, they performed supragingival pulsated jet irrigation with 0.06% chlorhexidine digluconate 1X daily. In 2 siblings, A. actinomycetemcomitans was suppressed subgingivally below detectable levels, pocket probing depths were reduced to 4 mm or less, and plaque and bleeding indices were low. No further disease progression was seen over a 3-year-period. Another female patient also showed clinical improvement and suppression of subgingival A. actinomycetemcomitans and B. forsythus up to the 9-month-follow-up, while her sister showed further attachment loss over the course of 4 years. The present case reports indicated that in some patients suffering from Papillon-Lefèvre syndrome periodontal disease may be arrested by means of (i) oral hygiene instruction, (ii) extraction of severely diseased teeth, (iii) scaling, (iv) systemic antibiotics and (v) long-term antimicrobial irrigation. © Munksgaard, 1999.link_to_subscribed_fulltex

In-dental-office screening for diabetes mellitus using gingival crevicular blood

Background: Diabetes mellitus (DM) is undiagnosed in approximately 1/2 of the patients actually suffering from the disease. In addition, the prevalence of DM is more than 2X as high in patients with periodontitis when compared to periodontally healthy subjects. Thus, a high number of patients with periodontitis may have undiagnosed DM. Aim: The purpose of this pilot study was to evaluate, whether blood oozing from gingival tissues during routine periodontal examination can be used for determining glucose levels. 32 non-diabetic and 13 diabetic patients with moderate to severe periodontitis were enrolled and subjected to routine clinical periodontal examination. Periodontal pocket probing was performed using a standard force. Blood oozing from gingival tissues of anterior teeth following periodontal pocket probing was collected with the stick of a glucose self-monitoring device (Elite® 2000, Bayer Diagnostics GmbH, Munich). As control, fingerstick capillary blood was taken. Statistical analysis was performed by Pearson's correlation coefficient. Results: The patient blood glucose levels ranged from 3.57 mmol/l to 18.01 mmol/ l and the values of blood samples taken from gingiva or finger tip showed a very high intrapatient correlation (r=0.98; p<0.0001). Conclusion: The results suggested that blood oozing during routine periodontal examination may be used for diabetes mellitus screening in a dental office setting. Copyright © Munksgaard 2002.link_to_subscribed_fulltex

Working Parameters of a Magnetostrictive Ultrasonic Scaler Influencing Root Substance Removal in Vitro

THIS STUDY ASSESSED DEFECT DEPTH and volume resulting from root instrumentation using a magnetostrictive ultrasonic scaler with a slim scaling tip (P 12) in vitro. Combinations of the following working parameters were analyzed: lateral forces of 0.5 N, 1 N, and 2 N; tip angulations of 0°, 45°, and 90°; power settings of low, medium, and high; and instrumentation time of 10, 20, 40, and 80 seconds. Defects were quantified using a 3-dimensional optical laser scanner. Lateral force had the greatest influence on defect volume compared to tip angulation and power setting (β-weights 0.53±0.04, 0.17±0.04, and 0.19±0.04, respectively). Lateral force and tip angulation had similar effects on defect depth, but both effects were greater compared to power setting (β-weights 0.43±0.04, 0.49±0.04, and 0.19±0.04, respectively). The various combinations of the assessed working parameters showed synergistic effects resulting in a wide range of defect depths (14.1±1.7 μm to 410.5±51.1 μm) and volumes (0.0084±0.0057 mm 3 to 1.3±0.079 mm 3). Severe root damage (defect depth >50 μm) at 40 seconds instrumentation time occurred under most combinations of lateral force, angulation, and power settings. The only exceptions were combinations of: 1) 0° angulation, 0.5 N and 1 N lateral force at any power setting and 2) 45° angulation, 0.5 N lateral force at low and medium power setting. The efficacy of the assessed magnetostrictive ultrasonic scaler may be adapted to the various clinical needs by adjusting the lateral force, tip angulation, and power setting.link_to_subscribed_fulltex

Subgingival plaque removal in buccal and lingual sites using a novel low abrasive air-polishing powder

Aim of the Study: This study was aimed at assessing the efficacy of subgingival plaque removal in buccal and lingual sites during supportive periodontal therapy (SPT) using a novel low abrasive air-polishing powder. Material and Methods: In 27 SPT patients, subgingival debridement was performed using the novel air-polishing powder (test) and hand instruments (positive control) in a randomized split mouth design. Before and immediately after treatment, subgingival plaque samples were taken from two teeth with pockets of 3-5 mm depth in both groups. To assess the influence of plaque sampling on the microflora, samples were also taken twice from two untreated teeth (negative control). The mean reduction in total colony forming units (CFU) was assessed by anaerobic culture. The patients' perception of treatment was assessed by a visual analog score (VAS). Therapy and plaque sampling were repeated after a 3-month interval. Results: Test treatment resulted in a significantly greater reduction in mean CFU than positive control treatment (log 1.7±0.98 and log 0.61±0.79 respectively; p<0.05). Following both treatments, the CFU reduction was significantly greater compared to negative control treatment (log 0.06±0.49; p<0.05). In addition, test treatment was perceived as significantly more pleasant than hand instrumentation (p<0.05). Conclusion: The novel low abrasive air-polishing powder is superior to curettes in removing subgingival plaque from pockets of 3-5 mm depth in supportive periodontal therapy and offers greater patient comfort.link_to_subscribed_fulltex

The effect of working parameters on root substance removal using a piezoelectric ultrasonic scaler in vitro

This study assessed defect depth and volume resulting from root instrumentation using a piezoelectric ultrasonic scaler with a slim scaling tip in vitro. Combinations of the following working parameters were analyzed: lateral forces of 0.5 N, 1 N, and 2 N; tip angulations of O°, 45°, and 90°; power settings of low, medium and high; and instrumentation time of 10 s, 20 s, 40 s, and 80 s. Defects were quantified using a 3D optical laser scanner. Overall, lateral force had the greatest influence on defect volume compared to instrument power setting and tip angulation (β-weights 0.49±0.04, 0.25±0.04, and 0.14±0.04, respectively). The effects on defect depth were highest for tip angulation followed by lateral force and instrument power setting (β-weights 0.48±0.04, 0.34±0.04, and 0.25±0.04, respectively). Interestingly, at all power settings, the highest defect volume and depth by far were found after combining 45° tip angulation with 2 N of lateral force. The efficacy of the assessed piezoelectric ultrasonic scaler may be adapted to the various clinical needs by adjusting the lateral force, tip angulation, and power setting. To prevent severe root damage it is crucial to use the assessed scaler at a tip angulation of close to 0°. © Munksgaard, 1998.link_to_subscribed_fulltex

Root defects following air polishing: An in vitro study on the effects of working parameters

Aim: Air-polishing devices (APDs) are highly effective in removing plaque and extrinsic staining. Their application on root surfaces, however, may result in clinically relevant substance removal, limiting the use in patients with periodontitis, where denuded root surfaces are frequently found. Therefore, the purpose of the study was to assess the influence of different working parameters on root damage and to identify those minimizing root damage. Material and methods: Defect depth and defect volume after instrumentation of roots with an APD (Dentsply Prophy-Jet®) using conventional NaHCO 3 powder at instrumentation times of 5, 10 and 20s, combinations of low, medium and high powder and water settings, distances of 2, 4 and 6 mm, and angulations of 45° and 90° were quantified laseroptically. A total of 297 roots were instrumented and parameter combinations were performed in triplicate. The influence of each working parameter on substance loss was determined by multiple regression analysis. Results: Time had the greatest influence on defect volume and depth (β-weights 0.6 and 0.57, respectively), when compared with powder setting (β-weights 0.49 and 0.3) and water setting (β-weights 0.28 and 0.3). Variations in distance affected defect depth (β-weight 0.44), but not volume (β-weight 0.04). No major differences were found at 45° and 90°. Various parameter combinations led to maximal defect depths of 473.5 ± 26.2 μm within 20s. Conclusion: Root damage varies among combinations of working parameters. Using the APD with the assessed NaHCO3 powder, all parameter combinations led to substantial root damage. Thus, APDs using NaHCO3 may not be safely utilized on exposed root surfaces.link_to_subscribed_fulltex

Safety and efficiency of novel sonic scaler tips in vitro

Background: The aim of the study was to evaluate a novel sonic scaler tip for subgingival root surface instrumentation combining high efficiency in calculus removal with minimized risk of root damage through subgingival debridement. Methods: A metal sonic scaler tip with a paddle-like working end covered with spheroid convexities of 0.8 mm diameter and 0.3 mm height was designed from the aspect of optimized adaptation to the root anatomy (tip-end dimension: 3.0 x 1.5 x 0.6 mm). Using a customary sonic scaler tip as control, instrument efficiency was quantified by measuring the time needed to completely remove calculus on extracted teeth (n = 52) under standardized conditions. To quantify the amount of calculus removed, the mean calculus area per tooth was measured on photographs taken before instrumentation. The tips safety was evaluated instrumenting calculus-free root surfaces in vitro (n = 18, lateral forces 0.5, 1, 2N, 20 s instrumentation time, tip angulation 0°) with subsequent laser-optical determination of resulting root substance loss. Results: Debridement efficiency was significantly higher for the novel tip (0. 78 ± 0.81 mm2/s completely debrided) than for the conventional tip (0.42 ± 0.33 mm2) (Mann-Whitney test, p < 0.05). Concerning instrument safety, the novel tip caused significantly less root substance loss than the conventional tip. Conclusion: The novel scaler tip appears to be significantly more efficient in calculus removal and less damaging to the root surface than the assessed conventional tip.link_to_subscribed_fulltex

Assessment of root curvature and distance using computed tomography.

The safety and efficacy of subgingival root surface instrumentation may be enhanced by optimized adaptation between instrument and treated surface. Thus, detailed knowledge of root geometry may allow advances in instrument design. The aim of this study was therefore to measure root radii of various tooth types as well as distances between tooth roots using computed tomography. Two hundred sixteen teeth in eight patients were studied, with cross sections of teeth at the level of the cemento-enamel junction (CEJ) being regarded as ellipses. The maximum radii of ellipses were calculated and averaged for each tooth surface within various tooth groups. In addition, the spacing between roots at CEJ level and 5 mm below the CEJ was measured. Mean radii varied from 1.09+/-0.50 mm (lower incisor, lingual) to 13.7+/-0.96 mm (upper molar, mesial). Radii of 1 mm to 6 mm were most frequently found at buccal, palatal, and lingual surfaces, whereas the majority of radii were between 2 mm and 11 mm at mesial and distal sites. Root distance varied between 1.04+/-0.49 mm (lower incisors, CEJ level) and 2.81+/-1.70 mm (lower molars, 5 mm below CEJ). The curvature of an instrument for root surface instrumentation should correspond to a radius of at least 11 mm to achieve maximum adaptation to the treated surface, and the width of the working end should be less than 1 mm to allow sufficient interdental instrumentation.link_to_subscribed_fulltex

In vitro evaluation of novel low abrasive air polishing powders

Aim of the study: Though efficient in stain and plaque removal, air polishing is highly abrasive on root cementum or dentin even if working parameters are adjusted to minimize damage. As abrasiveness is also influenced by the physical properties of the powders used, the aim of the study was to evaluate the safety of novel low abrasive air polishing powders in vitro. Material and methods: Using four novel air polishing powders (A, B, C and D) and a standard sodium bicarbonate (NaHCO3) powder, roots of 126 extracted teeth were air polished under standardized conditions at various working parameter combinations (distance: 2mm, 4mm and 6mm; powder and water setting: low, medium and high) at an angulation of 90° for 20s. Instrumentation was performed in triplicate; resulting root defects were quantified laser-optically. Results: Mean defect depths after application of powders A, B, C and D were significantly lower than with standard powder (A: 17.9 ± 10.9 μm, B: 48.2 ± 32.7 μm, C: 92.5 ± 51.9 μm, D: 33.9 ± 19.6 μm, NaHCO3: 163.1 ± 71.1 μm) (Kruskal-Wallis test). Among the experimental powders, D was transported most reliably in the air polishing unit and allowed complete removal of disclosed plaque as assessed on freshly extracted teeth. Conclusion: The novel air polishing powder D is of low abrasiveness to root cementum and dentin while being effective in removing dental plaque. Thus, it may be useful for safe and efficient plaque removal on exposed root surfaces.link_to_subscribed_fulltex