investigation of the association between low-dose aspirinintake and periodontal attachment level (PAL) was under-taken to explore the possibility of using aspirin at these dos-ages as therapy for chronic periodontal diseases.

Methods.—One hundred sixty-two subjects taking low-dose (75 mg and 150 mg) aspirin therapy for at least 6months formed the study group; 146 subjects not taking as-pirin served as controls. All participants had various peri-odontal parameters recorded during an oral clinicalexamination, including the oral hygiene index simplified(OHI-S), bleeding index (BI), and clinical attachment loss(CAL). The results were compared between the groups.

Results.—None of the periodontal parameters differedsignificantly between the subjects taking 75-mg and 150-mgdoses of aspirin. Mean OHI-S was 2.83 for controls and 2.69for the study group, which was not a significant difference.MeanBIwas 79.58 in the study group,whichwas significantlyhigher than the 65.22 in controls. Mean CAL was significantlyhigher in controls (2.35) than in the study group (1.86).

Duration of aspirin use and BI showed a positive corre-lation, but CAL showed a statistically significant negativecorrelation with duration of aspirin use. Neither durationnor dose of aspirin significantly predicted CAL. OHI-S wasa significant predictor for CAL.

Discussion.—Aspirin is a preventive for various chronicdiseases with inflammatory etiologies. The findings in thisstudy indicate that periodontal status measured as CAL is

significantly better when aspirin is used regularly thanwhen it is not used. Further confirmation using a large sam-ple size in amulticenter prospective cohort study is needed.

Clinical Significance.—Before undertakingan aspirin regimen to reduce the rate of attach-ment loss, further investigation is needed. Anumber of parameters remain to be clarified,such as effects exerted by the number of miss-ing teeth in subjects, dietary influences, andlipid profiles. It must also be rememberedthat aspirin has serious side effects whenused in high doses, including gastrointestinalproblems, bleeding disorders, and hypersensi-tivity. Because this was a cross-sectional study,it represents a ‘‘snapshot’’ of aspirin’s effective-ness; a prospective cohort study would yieldinformation that would better guide the useof aspirin for its oral anti-inflammatoryproperties.

Faizuddin M, Tarannum F, Korla N, et al: Association between long-term aspirin use and periodontal attachment level in humans:a cross-sectional investigation. Austral Dent J 57:45-50, 2012

Reprints available from F Tarannum, 79/13, 5th Cross, PillannaGarden, 1st stage, Bangalore 560084, India; e-mail:dr_fouzta@indiatimes.com

Preventative DentistryBruxism and occlusion

Background.—Bruxism is commonly considered to becausally related to deviations in dental occlusion and artic-ulation. Therefore its treatment was focused on reshapingthe bite to achieve an occlusion and articulation free of de-viations and interferences. Because bruxism managementefforts are not always effective, dentists are also open toother causes of bruxism. The current evidence supportinga link between bruxism and the bite was reviewed.

Methods.—A search of PubMed identified 93 English-language articles, of which 46 were deemed acceptablefor the current study. These papers tended to fall into twocategories: dealing with possible associations betweenbruxism and aspects of occlusion or dealing with the possi-ble mediating role of occlusion between bruxism and itsconsequences, which includes tooth wear, loss of periodon-tal tissues, and temporomandibular pain and dysfunction.

Results.—With respect to interactions between brux-ism and the bite, no evidence supports occlusal interfer-ences or factors related to the anatomy of the orofacialskeleton playing a role in causing bruxism. Studies indicatea growing awareness that other factors, including psychoso-cial and behavioral aspects, plan an important role in theetiology of bruxism.

Considering studies focused on the bite mediating be-tween bruxism and its consequences, no evidence existsfor such a role. Most dentists agree that bruxism has adverseeffects, including tooth wear, loss of periodontal tissues,and temporomandibular pain and dysfunction. Amongthe aspects of tooth wear that have been studied are attri-tion, which is the mechanical wear resulting from mastica-tion or parafunction on contacting surfaces of the tooth,and abfraction, which is cervical tooth wear in the shape

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of a V. Attrition occurs with tooth grinding and clenching.However, abfraction is a controversial topic, with some con-sidering it a hypothetical phenomenon only. No unequivo-cal evidence supports periodontal breakdown as a result ofbruxism. In addition, the few papers that have explored themediating role of occlusion in a causal relationship betweenbruxism and temporomandibular disorders have producednegative or poorly understood outcomes.

Discussion.—The evidence indicates growing agree-ment that it is not how the occlusion appears but how onecopes with certain types of occlusion that leads to bruxism.

16

Clinical Significance.—Both dental profes-sionals and bruxing patients tend to blameocclusal and morphologic factors for causing

2 Dental Abstracts

bruxism. However, the evidence does not sup-port this position. Rather than continue to acton this assumption, further research shouldinvestigate other possibilities to gather the evi-dence needed to guide clinical practice.

Lobbezoo F, Ahlberg J, Manfredini D, et al: Are bruxism and the bitecausally related? J Oral Rehabil 39:489-501, 2012

Reprints available from F Lobbezoo, Dept of Oral Kinesiology,Academic Ctr for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan3004, 1081 LA, Amsterdam, The Netherlands; e-mail:f.lobbezoo@acta.nl

Fluoride toothpaste knowledge, attitudes, and behaviors

Background.—Although dental caries has been declin-ing in recent decades, signs now indicate a global increasein this disease, possibly because of the worldwide changein lifestyle toward an increased consumption of sugar. Useof fluoride toothpaste twice a day is the most effectivemethod for preventing caries, but modifying factors includetoothbrushing frequency, fluoride concentration in thetoothpaste, amount of toothpaste used, brushing time,and water rinsing after brushing. Toothbrushing practicesare strongly influenced by a person’s lifestyle and social be-havior. In addition, oral health care education can increaseindividuals’ knowledge, improve attitudes toward oralhealth, and create better behavior patterns. The knowl-edge, attitudes, and behaviors with respect to fluoridetoothpaste and brushing habits among adolescents, adults,and the elderly were evaluated.

Methods.—Questionnaires were sent to 3200 persons intwo municipalities in Sweden. Sixty-three percent (2023 per-sons) returned the questionnaires. Respondents were di-vided into age groups as follows: 15-16, 31-35, 61-65, and76-80 years of age. Their responses were analyzed to deter-mine the knowledge, attitudes, and behaviors of this popula-tionwith respect tooral hygieneand toothbrushingpractices.

Results.—The highest percentages of responders werein the 61-65-year old group and the 76-80-year-old group.Most of the respondents identified the major role of fluo-ride as strengthening the teeth. Few respondents believedthat toothpaste was the most important tool for avoidingcaries. Most had received no instructions about how to

use toothpaste. Dental personnel were cited as the majorinstructors when respondents had been trained in tooth-paste use.

Nearly all respondents in all age groups believed brush-ing was very important, as was brushing with toothpaste.The three oldest age groups chose their toothpaste basedmainly on taste, whereas teenagers reported using what-ever toothpaste was available at home. The majority of re-spondents stated that healthy teeth were the mostimportant goal, followed by a lack of cavities, but a thirdof adolescents believed white teeth were important. Manyrespondents reported their oral health was good.

Two thirds or more of respondents in all age groupsbrushed their teeth twice a day, but older participants weremore likely to brush just once a day. The usual brushing pat-tern was after breakfast and before going to bed, but olderrespondents tended to brush before breakfast and after din-ner. Seventy-four percent of respondents who brushed oncea day did so before going to bed. Most respondents did noteat, drink, or take medicines after brushing their teeth, but27% said they did have some intake. Over 50% brushed theirteeth formore than 2min, andmost used 1 cmof toothpasteon a regular toothbrush. The youngest respondents tendedto use more toothpaste. The majority of persons who usedan electric toothbrush put toothpaste on the brush justonce. The majority of all persons dipped the brush in waterduring brushing. Older respondents reported dippingmoreoften andusedmorewater when rinsing after brushing com-pared to younger respondents.