Preventive support for patient protection

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  Posted by: Dental Design      10th September 2019

As the poor dental health of children in the UK continues to occupy the headlines, renewed efforts have been implemented to instil good oral hygiene habits in young people from an early age. Of course, there is no better time than childhood, when an effective oral hygiene routine can be taught and continued throughout adulthood, so that problems such as dental caries and periodontal disease can hopefully be avoided. However, it is vital to reinforce oral health instructions and support patients at all stages of life in order to help them to maintain the health of their teeth and gums, even in old age.

Age has been associated with tooth loss and the dental care of older adults was largely directed towards the replacement of teeth for many years. More recently however, there has been a reduction in tooth loss among adults[1]and there is a new generation of older people with a greater need for restorative dental services as well as preventive support to increase natural tooth retention and preservation.[2]

Alongside this, there has been significant growth in the global dental implant market[3]and it is estimated that worldwide, over 12 million dental implants are placed annually.[4]Dental implants are considered a safe and convenient method for replacing the teeth. They feel and function like natural teeth and also preserve the structure and appearance of the face by stimulating the natural renewal process of the bone beneath the replaced tooth.[5]Surgical and prosthetic innovation as well as digital technology and material developments have evolved rapidly to refine dental implant therapy and high survival rates above 95 per cent have been reported.[6]However, thenumber of patients presenting with peri-implant diseases is continually increasing[7],[8] and it remainscrucial to carefully monitor the condition of dental implants and the oral health of implant patients to prevent and control disease.

According to the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions, the key to distinguishing between peri-implant health and disease is bleeding or suppuration on probing (BoP) along with bone loss assessed in radiographs. Peri-implant mucositis typically features an inflammatory lesion in the soft tissues surrounding an implant along with the main clinical characteristics of bleeding on gentle probing with no bone loss. It is assumed that peri-implant mucositisprecedesperi-implantitis and can resolve if effective plaque control procedures and supportive therapy are reintroduced. However, peri-implantitis may develop quickly in the absence of improved oral hygiene and regular professional maintenance. Peri-implantitis is characterised by clinical signs of inflammation in the peri-implant mucosa, BoP, recession of the mucosal margin and the progressive loss of supporting bone.[9]

Peri-implantitis is a plaque-associated condition and primary prevention is key. Indeed, managing peri-implant mucositis can prevent the onset of peri-implantitis and regular maintenance underpinned with education and oral hygiene instructions tailored to the patient’s needs is essential to prevent disease development or recurrence. A reduction of inflammation can be achieved with professionally administered plaque removal (mechanical debridement) and, patient performed plaque control using a manual or powered toothbrush has been suggested as an effective preventive measure.7 Nevertheless, bushing alone only cleans the exposed implant surfaces and to achieve successful plaque control and ensure future peri-implant health, patients should be taught how to effectively clean all parts of the implant and prosthesis as well as the inter-implant areas. In addition, dental professionals should guide patients to the most suitable devices to use in order to avoid causing trauma to the peri-implant tissues.[10]

To help patients to achieve optimum implant and oral hygiene levels, dental professionals can confidently recommend the Waterpik® Water Flosser along with the Plaque Seeker® Tip, which has been specifically designed to gently access and clean stubborn plaque around implants and hard to reach areas. As an adjunct to tooth brushing water flossing offers patients a quick, easy and effective way to remove plaque biofilm that is unequivocally safe to use.[11]Certainly, the Waterpik® Water Flosser and Plaque Seeker® Tip has been shown to be 2X as effective as string floss for improving gingival health around implants.[12]

In the same way that inadequate oral hygiene and lack of dental visits increases the risk of periodontitis,[13]there is strong evidence to indicate that patients that have poor plaque control skills and, no regular maintenance care after implant therapy are at increased risk of developing peri-implantitis.[14] Consequently, it is important to continually reinforce oral health messages and offer individual preventive support in order to protect patients of all ages from the devastating effects of oral diseases.


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[1]World Health Organisation. The World Oral Health Report 2003. Continuous improvement of oral health in the 21stcentury – the approach of the WHO Global Oral Health Programme.

[Accessed 7thMay 209]

[2]Gagliardi D.I et al. Impact of dentalcare on oral health-related quality of life and treatment goals among elderly adults. Australian Dental Journal. March 2008: 53 (1) 26-33.

[3]GlobalData. Dental implant market projected to reach $5.9bn by 2028. November 2018.[Accessed 7thMay 2019]

[4]Klinge B. et al. Peri-implant diseases. European Journal of Oral Sciences, Oct 2018: 126(S1) 88-94.

[Accessed 7thMay 2019]

[5]European Federation of Periodontoloy (EFP). Dental Implants.[Accessed 7thMay 2019]

[6]Juodzbalys G. Implant Treatment Method’s Evolution: Pure Science Guided or Wild Darwin’s Evolution. J Oral Maxillofac Res. 2017 Oct-Dec; 8(4): e1. 7thMay 2019]

[7]Jepsen, S., Berglundh, T., Genco, R., et al. (2015). Primary prevention of peri-implantitis: Managing peri-implant mucositis. Journal of Clinical Periodontology, 42, S152-S157.

[8]Lee C.T. et al. Prevalences of peri-implantitis and peri-implant mucositis: systematic review and meta-analysis.J Dent. 2017 Jul;62:1-12.[Accessed 7thMay 2019]

[9]Berglundh T. EFP New classification of periodontal and peri-implant diseases. 04. Peri-implant health, peri-implant mucositis and peri-implantitis. Guidance for clinicians. Published March 2019.[Accessed 7th May 2019]

[10]Kripal K. et al. Supportive periodontal therapy for dental implant patients. Form Peridontololgy and Dental Implantology, editied by Jane Manakil, IntechOpen, November [Accessed 7th May 2019]

[11]JolkovskyD.L. et al. Safety of water flosser: a literature review. Compend Contin Educ Dent. 2015 Feb;36(2):146-9.[Accessed 8thMay 2019]

[12]Magnuson B. et al. Comparision of the effect of two interdental cleaning devices around implants on the reduction of bleeding: a 30 day randomized clinical trial. Compend Contin Educ Dent. 2013 Nov-Dec;34 Spec No 8:2-7.

[Accessed 8thMay 2019]

[13]Lertpimonchai A. et al. The association between oral hygiene and periodontitis: a systematic review and meta-analysis. Int Dent J. 2017 Dec; 67(6): 332–343.[Accessed 8thMay 2019]

[14]Schwarz F. et al. Peri-implantitis. J Clin Periodontol. 2018 Jun;45 Suppl 20:S246-S266.[Accessed 8thMay 2019]



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