Patient self-care of periodontal pocket infections
Managing periodontal disease can be a very complex task. Multiple factors come into play and as dental professionals, we need to be able to assess these factors and recommend treatment and home care that will be effective at maintaining a healthy periodontium. In an article published in Periodontology 2000, the authors take a deep dive into exploring all the necessary aspects of the very important role of patient self-care in the maintenance and control of periodontal pocket infections.1
Mechanical removal of biofilm is the most utilized method, primarily using a toothbrush. I think it is safe to assume most of the population uses a toothbrush, albeit not as often as recommended. Studies have provided evidence that toothbrushing is effective for supragingival biofilm removal, however, it has limited effects on subgingival biofilm.
Antiseptic rinses have long been used as an adjunctive to mechanical biofilm removal. Recommendations for antiseptic rinses are based on the idea that the rinse will reach subgingival areas contributing to the control of biofilm. Unfortunately, research indicates that it is very difficult for the antiseptic rinse to reach the target site. If by chance the rinse does reach the target site, it is often unable to maintain a high enough concentration to affect the biofilm.
Chlorhexidine has long been considered the “gold standard” of antiseptic mouth rinses. It is important to note that it is very effective when controlling supragingival biofilm yet is inactivated by blood and serum. Of course, blood and serum are increased in inflamed periodontal pockets. There has been the concern associated with healing and cytotoxicity on human fibroblasts. This cytotoxicity was observed in vitro and has not been shown to interfere with healing in vivo.
Another promising antibacterial agent, receiving a lot of attention in the areas of endodontics and periodontics, is sodium hypochlorite. Future studies may lead us to utilize sodium hypochlorite more regularly when trying to maintain periodontal pockets.
Antiseptic rinses, even considering the above-listed shortcomings, may be a great adjunctive and should be considered for patients with disabilities and limited dexterity. It should not be used as a treatment to kill periodontal microorganisms that harbor in periodontal pockets, but more as a treatment to reduce supragingival biofilm formation.
Interdental cleaning is wildly important in the management of periodontal pockets and biofilm formation. There is weak evidence that flossing, wood sticks, and oral irrigators reduce gingivitis, however, interdental brushes have been shown to reduce biofilm formation and gingivitis. It is important to assess the individual patient’s needs as well as with which interdental tool they will be most compliant.
The most important factors in maintaining effective treatment and long-term preservation of the dentition is a combination of patient self-care and professional maintenance therapy. Continued motivation and support from clinicians can help patients make positive self-care changes. Motivating patients to change their habits may require the use of some psychological models, including interviewing the patient and behavior modification. Consider yourself a personal trainer for better oral health.
After reading the article, do you see ways you could change your approach to better serve your patients? How do you encourage behavior changes, such as compliance with interdental cleaning tools? Are you recommending antiseptic rinses, if so, are patients receptive and compliant in the use of these rinses?
- Nicole Birgit Arweiler, Thorsten M Auschill, Anton Sculean. Periodontol 2000. Feb 2018; 76(1): 164-179.
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