Contemporary Practices for Mechanical Oral Hygiene to Prevent Periodontal Disease
There is no question that the accumulation of dental plaque leads to gingivitis, which can then progress to periodontal disease. Management of plaque is a key element in preventing periodontal disease. In a review article published in 2020 in the journal Periodontology 2000, the authors reviewed multiple studies on different techniques and tools for mechanical oral hygiene to determine which technique and/or tool is most effective.1
Manual toothbrushes have been used for years, the meta-review and systematic reviews included in the article indicate an average plaque score reduction when using a manual toothbrush. With cross-angled bristle tuft designs performing better than flat or multilevel tuft designs. Oscillating-rotating powered toothbrushes show a higher reduction in plaque index scores when compared to manual toothbrushes. Additionally, sonic powered toothbrushes show a statistically significant greater reduction in plaque compared with manual toothbrushes.
Dentifrice does not appear to provide any benefits when compared to brushing alone when comparing plaque management. However, dentifrice should be recommended as it is a major source of fluoride, anti-inflammatory agents, and desensitizing agents. Some reviews have indicated the absence of fluoride shows the “preventative effect of personal oral hygiene is questionable.” Interestingly, the studies included found baking soda provides an additional effect on plaque reduction and may improve gingival parameters.
According to the meta-review and two systematic reviews included in this article, there is weak evidence to support the addition of dental floss as an effective technique for reducing gingivitis when compared to brushing alone. This does not necessarily mean flossing is entirely ineffective, flossing is technique specific and may need to be tailored to each patient. Interdental brushes were determined to be the most effective method for removing interdental plaque in several reviews. With further studies indicating that cylindrical shaped interdental brushes were more effective than conical interdental brushes. However, oral irrigators showed great potential in removing plaque and performed better than interdental brushes in several reviews.
Most importantly, when deciding on a device to recommend the patients dexterity, as well as the clinicians own personal experience with the success of implementing such tools and techniques should be taken into consideration. Each patient is different and may require different tools and techniques to achieve optimal oral health. Adverse events associated with toothbrushing include recession, traumatic injury, aspiration, and temporary bacteremia.
The authors conclude by stating, “Evidence related to contemporary practices for mechanical oral hygiene to prevent periodontal disease mainly relies on studies with gingivitis patients. General recommendations concerning the ideal oral hygiene devices and procedures are still inconclusive. However, generally established recommendations should be maintained, as these are anchored in patients’ minds. In order to improve the level of oral hygiene and primary approach most likely remains an individually tailored instruction to a systematic oral hygiene procedure.”
What products do you recommend to your patients for mechanical management of plaque? Have you found any specific tool accepted more readily by your patients? Do you tailor oral hygiene instructions and recommendations to each patient? Which product have you seen the most improvement in regard to your patients oral health?
- Sälzer S, Graetz C, Dörfer CE, Slot DE, Van der Weijden FA. Contemporary practices for mechanical oral hygiene to prevent periodontal disease. Periodontol 2000. 2020;84(1):35-44. doi:10.1111/prd.12332