Products for Plaque Control
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. There is a new periodontal disease classification system developed cooperatively by the American Academy of Periodontology (AAP) and European Federation of Periodontology.73 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.74,75 In addition, there are now products in clinical trials, soon to be available, that are fully automated with individualized mouth pieces. One cleans the upper and lower arch in 7 seconds simultaneously,76 and the other cleans one full arch at a time with pressure driven cycles and perfectly placed nylon bristles, about 45 seconds each.77
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%.78 A 2015 study concluded that inter-dental cleaning with interdental brushes is the most effective method for inter-dental plaque removal.79 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.80 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 either stannous fluoride or triclosan, are used to inhibit plaque regrowth between brushings and to reduce gingival inflammation and bleeding. However, only stannous fluoride also offers protection from sensitivity81,82– a common condition reported to be even more prevalent among older patients and those with periodontal disease83 – in addition to its caries and gingival health benefits.84 The latest stannous fluoride dentifrice technology (Crest® Pro-Health™) contains stabilized stannous fluoride and a whitening, anticalculus agent.
Chemotherapeutic rinses are another important home care product often recommended in either prescription or over-the-counter versions.85 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.86,87