Aging, Systemic Disease and Oral Health: Implications for Women Worldwide (Part I)
Course Number: 302
Mechanical Removal of Plaque Biofilm
Mechanical Removal of Plaque Biofilm
Controlling plaque biofilm interdentally is vital to good oral health. We know that plaque biofilm accumulation is a significant factor in the development of periodontal and peri-implant disease. The 2017 periodontal disease classification system developed cooperatively by the American Academy of Periodontology (AAP) and European Federation of Periodontology.81 The updated classification system uses four stages and three grades to describe disease status. The stages are based on the severity of the disease as established by the loss of the interdental clinical attachment, radiographic loss of bone, and/or loss of teeth, difficulty of management, and extent or dissemination of disease measured.
Power toothbrushes– Many power toothbrush technologies can provide more effective plaque removal than manual brushes. Certain power toothbrush models have compliance-enhancing features such as timers and multiple brushing modes. Power brush technologies available today include rotating, counter-rotational, sonic, ultrasonic, and oscillating-rotating. Results from an independent systematic review by the Cochrane Collaboration 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.82,83 In addition, there are new products available that are fully automated with individualized mouth pieces. One cleans the upper and lower arch in 10 seconds simultaneously.84 Another product, Proclaim, claims to provide consistent, effective at-home oral care in just 7 seconds a day.85 Each user has their own Proclaim mouthpiece, created from an intraoral scan, with up to 60 jets placed interproximally, both lingual and facial surfaces. According to the study, subjects who were assigned to the Fresh + Manual Toothbrushing group showed significantly greater reductions in gingival inflammation, gingival bleeding, plaque accumulation, BOP, and pocket depth measurements than those in the MTB and floss + MTB groups.85 Other “brushes” of this type have come and gone, with some still making a debut on Amazon or other websites.86
Interdental cleaning must be individualized in order to ensure compliance with our suggestions. Methods include: floss; a rubber tip; an interdental brush; an oral irrigator; or wooden sticks. Compliance with regular flossing has been far less than ideal. The routine use of dental floss has been shown to be in a range of daily use among adults ranging from 10% to as high as 30%.87 A 2015 study concluded that inter-dental cleaning with interdental brushes is the most effective method for inter-dental plaque removal.88 The majority of available studies in this meta-review did not demonstrate that flossing is generally effective in plaque removal. A Cochrane Database of Systematic Reviews recently summarized the research on interdental biofilm control devices for self-care that impact periodontal disease and caries. The authors warned there were weaknesses in most studies and found that generalizing to all populations challenging.89 The general conclusion was that the use of dental floss or interdental brushes, in addition to toothbrushing, may reduce gingivitis or plaque, or both, more than toothbrushing alone.
Chemotherapeutic Inhibition of Plaque Biofilm
Chemotherapeutic dentifrices containing stannous fluoride are used to inhibit plaque regrowth between brushings and to reduce gingival inflammation and bleeding.90 Stannous fluoride also offers protection from sensitivity91, a common condition reported to be even more prevalent among older patients and those with periodontal disease92, in addition to its caries and gingival health benefits.93 The latest stannous fluoride dentifrice technologies include; Crest Pro-Health Gum Detoxify™ and Colgate Total SF™.
Chemotherapeutic rinses are another important home care product often recommended in either prescription or over-the-counter versions.94 Dental professionals generally view chlorhexidine — now available in alcohol and alcohol-free forms — as the gold standard due to its efficacy and substantivity. However, its use is often limited to short-term use due to extrinsic stain and compliance challenges with taste. Other safe and effective options for long-term maintenance are over-the-counter chemotherapeutic rinses Cetylpyridinium chloride (CPC) is a broad spectrum antimicrobial available in an alcohol-free formulation. The alcohol-free form may provide a more pleasurable rinsing experience for patients with soft tissue sensitive to alcohol. Essential oils rinses containing alcohol are also available over-the-counter. Research demonstrates significant reductions in plaque and gingivitis for CPC and essential oils rinses when formulated appropriately.95,96 A recent study on an essential oil mothrinse showed that, at 6 months, subjects had nearly 5 times more plaque-free sites versus mechanical method subjects, and over 2 times more healthy gingival sites vs mechanical methods as well.96