Periodontal Health

Since most patients fall short of ideal plaque control, dental hygienists should consider a regimen that will provide gingival health benefits even with suboptimal compliance.

Figure 6: Home-Care Product Options

Power toothbrushes can provide significantly better plaque removal than manual brushes. Marketed technologies include rotating, counterrotational, sonic, ultrasonic and oscillating-rotating toothbrushes. An independent, systematic review by the Cochrane Collaboration, an international organization providing systematic reviews of healthcare interventions to help professionals make data-based decisions, showed power toothbrushes with oscillating-rotating action removed plaque and reduced gingivitis more effectively than manual toothbrushes. No other power designs were as consistently superior to manual toothbrushes.36,37

Interproximal cleaning, including dental floss and interproximal cleaning devices (interproximal brushes, wooden plaque removers, etc.), are another essential aid for mechanical plaque removal in interproximal regions and just below the gingival margin. A recent study reported in the Journal of Periodontology demonstrated the benefits of flossing using a monofilament, shredresistant floss (Crest Glide) for reduction of bleeding among a population of fifty twin pairs in Brazil.38 Various interproximal aids, such as floss picks, floss holders, and interproximal brushes, are also available.

Chemotherapeutic dentifrices significantly inhibit plaque regrowth between brushings. Only two antiplaque/antigingivitis ingredients are currently marketed in common dentifrice brands, stannous fluoride (Crest Pro-Health)39-43 and triclosan (Colgate Total).44 However, only Crest Pro- Health with stannous fluoride also offers protection from sensitivity45-46 – a common condition reported to be even more prevalent among older patients and those with periodontal disease,47 in addition to its caries and gingival health benefits.43 This dentifrice also contains an advanced whitening and anticalculus agent, so patients get surface stain removal and calculus inhibition benefits unlike other stannous fluoride formulations that may cause transient stain.48-49

Chemotherapeutic rinses, available in prescription and over-the-counter versions, should also be considered as part of the home care regimen.50 Chlorhexidine is generally viewed as the gold standard, for its effectiveness and substantivity. The standard formulation (Peridex) contains 11 percent alcohol, but recently an alcohol-free version has been introduced (Sunstar Butler). Chlorhexidine is often limited to short-term use due to extrinsic stain and compliance challenges with taste. Over-the-counter chemotherapeutic rinses are a safe and effective option for long-term maintenance. Cetylpyridinium chloride (CPC) is a broad-spectrum antimicrobial available in an alcohol-free formulation (Crest Pro-Health Rinse), which may provide a more pleasant rinsing experience for patients whose oral tissues are sensitive to alcohol (e.g., xerostomics). Rinses containing essential oils (Listerine) and over 20 percent alcohol are also marketed over-the-counter. Both CPC and essentials oils have been shown to produce significant reductions in plaque and gingivitis.51- 52