Managing periodontal disease can be a difficult task for many dental hygienists as patients are often non-compliant with home care. Mechanical removal of plaque is the cornerstone to periodontal maintenance programs. Providing patients with devices to assist in proper plaque removal may be an option to overcome this obstacle. N a systematic review published in August 2019 in the Journal of Clinical Periodontology; the authors aimed to synthesize the “available clinical evidence concerning efficacy of mechanical oral hygiene devices in periodontal maintenance patients.”1
Choosing the most appropriate dental hygiene product can be difficult as there are so many on the market today. Though the task may be difficult and, in some cases, daunting, it is essential to provide patients with the best available product recommendations to support their efforts to manage periodontal disease.
Toothbrushes have multiple designs that claim to be superior due to bristle placement, length and stiffness. This review search found no studies that compared different manual toothbrush types. On the other hand, research comparing power toothbrushes and manual toothbrushes was more readily available. Interestingly, though power toothbrushes were found to be more effective at managing gingivitis, there was no difference between manual and power toothbrushes on effectiveness of plaque index and gingivitis in periodontal maintenance patients. However, periodontal patients with low compliance may still benefit from a power toothbrush.
Choosing an interdental cleaning device should be based on patient needs. There are multiple systematic reviews assessing efficacy different interdental cleaning devices. A recent meta-analysis published in 2018 and cited in this study quantitively evaluated interdental devices. The global ranking in this meta-analysis found interdental brushes and oral irrigators ranked high for reducing gingival bleeding, while toothpicks and floss ranked last. Though evidence supports interdental brushes and oral irrigators as options, flossing is still the most widely recommended device for interdental plaque removal. Dental flossing is often difficult, technique specific, and time consuming. There is weak evidence in favor of dental flossing as an adjunctive to brushing in reducing gingival inflammation. Therefore, if clinicians default to recommending flossing hey must take the time to thoroughly explain and evaluate the patients ability and understanding regarding proper flossing technique.
The authors note multiple limitations including and most importantly performance bias. This is a concern because blinding is not possible in studies designed to assess self-care. Other limitations noted included scarcity of evidence, studies that included oral hygiene products that re no longer available, and the lack of a minimum duration.
The authors conclude by stating, “Due to the scarcity of studies that met the inclusion criteria for each of the oral hygiene devices and the low certainty of the resultant evidence, no strong “evidence-based” conclusion can be drawn concerning any specific oral hygiene device for patient self-care in periodontal maintenance. Only for IDBs as adjuvant to toothbrushing a small but significant effect on PI was found although this emerges from indirect evidence. There appears to be an urgent need for studies evaluating self-care protocols in periodontal maintenance patients.”
What devices do you recommend to your periodontal maintenance patients? Do you still recommend flossing as a first choice for interdental cleaning? Would you consider changing recommendations in light of new evidence?
- Slot, D. E., Valkenburg, C., & Van der Weijden, G. (2020). Mechanical plaque removal of periodontal maintenance patients: A systematic review and network meta-analysis. Journal of clinical periodontology, 47 Suppl 22, 107–124. https://doi.org/10.1111/jcpe.13275