MASTER OF DENTAL SURGERY IN ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS
DATE OF ADMISSION TO COURSE
31- 05 - 2012
TITLE OF THE TOPIC
“ EFFECTS OF AMINE FLUORIDE AND PROBIOTIC MOUTHWASH ON LEVELS OF PORPHYROMONAS
GINGIVALIS IN ORTHODONTIC PATIENTS AND ITS QUANTITATIVE DETECTION USING REAL TIME – PCR.”
BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the study:
Dental plaque is a highly complex organization in a biofilm structure that provides nutrients and protection for periodontopathic bacteria.2 Ample evidence indicates Porphyromonas gingivalis as a putative periodontal pathogen in subgingival dental plaque and it is implicated as an indicator of periodontal disease. Gingival changes and oral bacteria in plaque have been studied during orthodontic treatment in adolescents and young adults.6 But there is a paucity of research to describe the needs for controlling P. gingivalis in orthodontic patients using chemical plaque control such as mouthwash. Probiotics are live micro-organisms administered orally, may benefit oral health by preventing the growth of harmful microbiota or by modulating mucosal immunity in the oral cavity.5
Hence, prime objective of the study is to compare the microbial changes in levels of P.gingivalis during orthodontic treatment and effect of amine fluoride mouthwash (AMFLOR-group pharma) and probiotic on P.gingivalis using real time PCR.1
6.2 Review of Literature:
Andrea Amezquita Naranjo et al (2006) conducted an in vivo study on changes in the subgingival microbiota and periodontal parameters before and 3 months after bracket placement. They cultured the samples and analysed them for periodontopathic and super-infecting bacteria. Authors concluded that bracket placement influences the accumulation of plaque and the colonization of important periodontopathic and superinfecting bacteria, resulting in more inflammation and bleeding. There was an increase in levels of Porphyromonas gingivalis, Prevotella intermedia/Prevotella nigrescens, Tannerella forsythia, and Fusobacterium species in the experimental group after bracket placement compared with the control group.2
Ristic M et al (2008) conducted a prospective study to analyze the effects of fixed orthodontic appliances on subgingival microflora. They concluded that fixed orthodontic appliances cause plaque accumulation around bands and brackets and the therapy with fixed appliances may transitionally increase the growth of periodontopathogenic bacteria and consequently result in gingival inflammatory response but without destructive effect on deep periodontal tissues.3
Sule Kavaloglu Cildir et al (2009) conducted a double-blind study to evaluate levels of salivary mutans streptococci in orthodontic patients during daily consumption of yoghurt containing probiotic bifidobacteria. They concluded that statistically significant reduction of salivary mutans streptococci was recorded after probiotic yoghurt consumption which was in contrast to the control yoghurt. 4
Melinda Madléna et al (2012) conducted a pilot study on effects of amine and stannous fluorides on plaque accumulation and gingival health in orthodontic patients treated with fixed appliances. They concluded that the use of AmF/SnF2-containing products resulted in beneficial clinical effects on plaque accumulation and gingival health after placement of fixed orthodontic appliances.7
Sang-Ho Kim et al (2012) conducted an in vivo study to evaluate the microbiologic changes in subgingival plaque before and during the early period of orthodontic treatment using the polymerase chain reaction (PCR) method. They concluded that the placement of orthodontic appliances affects the subgingival microbiofilm composition even during the early period of orthodontic treatment thus increasing the prevalence of periodontopathogens, especially in the molar region.8
6.3 OBJECTIVES OF THE STUDY:
To compare the quantity of Porphyromonas gingivalis in patients before and during fixed orthodontic treatment.
To compare the effect of amine fluoride containing mouthwash (Amflor- Group Pharma) on Porphyromonas gingivalis during fixed orthodontic treatment.
To compare the effect of probiotic on Porphyromonas gingivalis during fixed orthodontic treatment.
To compare the efficacy of Amflor and Probiotic in controlling Porphyromonas gingivalis.
MATERIALS AND METHODS :
7.1 Source of data:
The sample for present study will include 30 patients with need of fixed orthodontic treatment, reporting to Department of Orthodontics and Dentofacial Orthopaedics, Sri Hasanamba Dental College and Hospital, Hassan.
Amine Fluoride mouthwash (Amflor, Group Pharma)
Tris buffer solution.
Real time PCR machine.
7.2 Method of collection of data:
The sample for present study will include 30 patients with need of fixed orthodontic treatment, reporting to Department of Orthodontics and Dentofacial Orthopaedics, Sri Hasanamba Dental College and Hospital; Hassan will be selected fulfilling the following inclusion criteria.
Patients with age between 15-35yrs.
Patients indicated for Pre adjusted edge wise appliance - 022 MBT prescription.
Use of any antibiotic or hormone during the study.
Pregnant or lactating women.
Presence of large prosthetic restorations.
Gross carious lesion.
Patient on any other fluoride therapy.
Patient allergic to milk or milk products.
All participants will be given brief information about the purpose of the study and written consent will be taken before undertaking the study.
Probiotic (powder form) will be mixed in normal saline and used as a mouth wash according to the manufacturer’s instructions.
Patients will be equally divided into three groups:
GROUP A: Patients using Amine Fluoride mouthwash (Amflor)
GROUP B: Patients using Probiotic mouthwash
GROUP C: Control group(patient undergoing therapy with normal cleansing aids)
During the treatment, all the 3 groups will be advised to brush twice in a day(once morning and once night time) using Colgate tooth paste and Group A patients will be advised to swish fluoridated mouth wash (AMFLOR) and Group B patients with probiotic mouthwash for 60 seconds before expectorating, once in the morning after brushing.
No other oral hygiene aid will be recommended.
After gently removing supragingival plaque, subgingival plaque samples will be collected by inserting a sterile dental curette into the bottom of the gingival crevice around 31, 32, 41, and 42.
Samples will be collected using the same method at two different intervals for each patient,
T0 – Before the start of orthodontic treatment
T1 – 6 months after the beginning of fixed orthodontic treatment
Subgingival plaque samples collected will be transferred to Laboratory within 48 hrs for REAL TIME- PCR analysis in Tris- buffer solution to maintain the integrity of bacterial DNA.
P.gingivalis will be quantitatively analyzed in all the three groups using this technique.
Statistical Analysis :
The sample will be statistically analyzed using SPSS software.
7.3. Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
LIST OF REFERENCES:
Matto J, Saarela M, Alaluusua S, Oja V, Somer H, Asikainen S. Detection of Porphyromonas gingivalisfrom Saliva by PCR by Using a Simple Sample-Processing Method. J. CLIN. MICROBIOL.1998 Jan; 36(1):157–160
Naranjo A, Triviño M, Jaramillo A, Betancourth A, Botero J.Changes in the subgingival microbiota and periodontal parameters before and 3 months after bracket placement.Am J Orthod Dentofacial Orthop 2006;130:275.e17-275.e22
Ristic M,Vlahovic SM,Sasic M,Zelic O. Effects of fixed orthodontic appliances on subgingival microflora.Int J Dent Hyg.2008 May;6(2):129-136.
Cildir S, Germec D, Sandalli N, Ozdemir F, Arun T, Twetman S, Caglar E. Reduction of salivary mutans streptococci in orthodontic patients during daily consumption of yoghurt containing probiotic bacteria.Eur J Orthod 2009;31:407–411
Koduganti RR, Sandeep N, Guduguntla S, Gorthi VSS.Probiotics and prebiotics in periodontal therapy.Indian journal of Dental Research 2011;22(2):324-330
Liu H, Sun J, Dong Y, Hui Lu, Zhou H, Hansen B, Song X.Periodontal health and relative quantity of subgingival Porphyromonas gingivalis during orthodontic treatment.Angle Orthod. 2011;81:609–615
Madlena M, Banoczy J, Gotz G, Marton S, Kaán M, Nagy G. Effects of Amine and Stannous Fluorides on Plaque Accumulation and Gingival Health in Orthodontic Patients Treated With Fixed Appliances: A Pilot Study. Oral health and dental management. 2012 Jun;11(2):57-61
Kim S, Choi D, Insan Jang, Cha B K, Brinkmann P, Song J. Microbiologic changes in subgingival plaque before and during the early period of orthodontic treatment. Angle Orthod. 2012;82:254–260