Advances for periodontal disease preventionNews
Posted by: The Probe 7th March 2020
Despite continuous efforts both at national and international levels, periodontal disease remains one of the most prevalent diseases of mankind. The most common periodontal diseases are gingivitis and periodontitis, whose main characteristic is inflammation of the periodontium caused by plaque biofilms. It results in the progressive destruction of the tooth supporting apparatus, periodontal detachment and eventually tooth loss. Tooth loss can negatively affect function and aesthetics and impair speech, nutrition and quality of life. There is also robust evidence to associate periodontal disease with systemic diseases such as cardiovascular disease, diabetes, and adverse pregnancy outcomes. By helping patients to prevent periodontal disease there is the potential to lower the risk of serious dental complications as well as the devastating impact of its associated conditions.
The accumulation of plaque due to poor oral hygiene is one of the main contributing factors associated with periodontal disease. Plaque biofilm contains an elaborate community of bacteria along with various other compounds that stimulate an inflammatory response. Gingivitis is the precursor of periodontitis and represents the first manifestation of the inflammatory response to the accumulated biofilm. The gums often appear red or swollen and may bleed easily. However, if microbial biofilm is regularly disrupted with proper brushing and flossing at this stage, gingivitis is reversible.
If gingivitis is not addressed effectively, inflammation can spread and cause periodontitis, where the gums begin to pull away from the teeth, forming periodontal pockets which trap plaque and cause further infection. Treatment for periodontitis includes scaling and root planning (SRP) to remove the accumulation of calculus, bacterial plaque and bacterial toxins above and below the gingival margin. The root of the tooth is also smoothed to prevent plaque deposits and to allow healed tissue to reattach and periodontal pockets to reduce in depth. Fundamentally, effective and consistent oral hygiene practices are required to prevent further damage to the periodontal tissues.
As we advise patients, brushing twice a day with fluoride toothpaste is essential. Fluoride has antiplaque and anti-gingivitis effects and it reduces the proportion of bacteria in subgingival areas, which can help to promote gingival health.3 For some time both manual and powered toothbrushes were considered effective, provided that proper technique was used and that patients brushed for long enough. However, a Cochrane review in 2014 revealed that powered toothbrushes were statistically significantly more effective at reducing plaque and gingivitis than manual toothbrushing in the short term, although the long‐term benefits remained unclear. Interestingly, a 11-year cohort study into the long-term impact of a powered toothbrush on oral health was conducted in 2019. The results revealed that powered toothbrush usage has a long‐term protective effect on the oral health in terms of reduced probing depths, clinical attachments and number of teeth lost. Based on this, patients should be advised to use a powered toothbrush to help reduce the progression of periodontal disease.
It is well-known that toothbrushing alone cannot adequately clean all surfaces of the teeth. Bacteria and plaque deposits can accumulate easily between the teeth, at the gingival margin and in areas that are hard to reach with a toothbrush. As a result, daily flossing or interdental cleaning is a must.
String dental floss is often recommended by dental professionals, but patient compliance is poor. This is frequently attributed to a lack of motivation and difficulties using the floss. Those that do use dental floss for example, often use it incorrectly and fail to remove plaque from interdental surfaces sufficiently. Furthermore, researchers found poor quality evidence to suggest flossing in addition to toothbrushing reduces gingivitis compared to just brushing. They also reported weak and very unreliable evidence from ten studies that flossing plus toothbrushing may be associated with a small reduction in plaque at one and three months. Although some patients find interdental brushes somewhat easier to use, there is only low certainty evidence to suggest that interdental brushes may reduce plaque or gingivitis more than toothbrushing alone.
Conversely, the Waterpik® Water Flosser is clinically proven to be effective for removing plaque, and improving gingival health when compared to string floss or interdental brushes. Indeed, it has been shown to reduce gingivitis, bleeding, probing pocket depth, host inflammatory mediators and calculus, making it a valuable tool for performing an effective oral hygiene routine. Furthermore, Waterpik® has developed oral health products that combine the efficiency of the water flossing technology with the benefits of a powered toothbrush. The Waterpik® Complete Care range for instance, brings together a high-end oscillating or sonic toothbrush with a Water Flosser in one unit. For the ultimate in high quality innovation, there is also the Waterpik® Sonic-Fusion®, the world’s first ever flossing toothbrush. Here the clinically proven water flossing technology has been built into an advanced sonic toothbrush to enable patients to brush and floss simultaneously.
To manage and prevent periodontal disease, dental professionals provide high quality individualised oral health instruction. This can be combined with the use of products that enable patients to carry out improved oral hygiene practices easily, consistently and most importantly, effectively.
For more information on Waterpik® products please visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Asda, Costco UK, Boots and Superdrug online and in stores across the UK and Ireland.
 Tonetti MS. et al. Principles in prevention of periodontal diseases: Consensus report of group 1 of the 11th European Workshop on Periodontology on effective prevention of periodontal and peri-implant diseases. J Clin Periodontol. 2015 Apr;42 Suppl 16:S5-11. https://www.ncbi.nlm.nih.gov/pubmed/25639948 [Accessed 24th September 2019]
 Munoz-Carrillo J.L et al. Pathogenesis of Periodontal Disease. June 2019. Intech Open. Periodontal Disease – Diagnose Considerations. https://www.intechopen.com/online-first/pathogenesis-of-periodontal-disease [Accessed 24th September 2019]
 Nazir M.A. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim). 2017 Apr-Jun; 11(2): 72-80. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426403/ [Accessed 24th September 2019]
 Yaacob M. et al. Powered versus manual toothbrushing for oral health. Cochrane Systematic Review – Intervention. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No: CD002281.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002281.pub3/full [Accessed 24th September 2019]
 Pitchika V. et al. Long-term impact of powered toothbrush on oral health: 11-year cohort study. J Clin Periodontol. 2019 Jul; 46(7): 713–722. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619286/ [Accessed 24th September 2019]
 Sambunjak, D. et al. (2011). Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database of Systematic Reviews, Dec 2011;(12) Art. No: CD008829.
https://www.ncbi.nlm.nih.gov/pubmed/22161438 [Accessed 24th September 2019]
 Worthington H. V. et al. Home use of interdental cleaning devices, in addition to toothbrushing for preventing and controlling periodontal diseases and dental caries. Cochrane Database of Systematic Apr 2019; Issue 4. Art. No: CD012018. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012018.pub2/abstract [Accessed 24th September 2019]
 Goyal C.R. et al. Evaluation of the Plaque Removal Efficacy of a Water Flosser Compared to String Floss in Adults After a Single Use. J Clin Dent 2013; 24:37-42. https://www.ncbi.nlm.nih.gov/pubmed/24282867 [Accessed 24th September 2019]
 Barnes C.M. et al. Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent. 2005;16(3):71-7. https://www.ncbi.nlm.nih.gov/pubmed/16305005 [Accessed 24th September 2019]
 Goyal C.R. et al Comparison of water flosser and interdental brush on reduction of gingival bleeding and plaque: a randomized controlled pilot study. J Clin Dent 2016; 27: 23-26. https://www.ncbi.nlm.nih.gov/pubmed/28390208 [Accessed 24th September 2019]
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