Oral care at home can only be delivered with your supportNews
Posted by: The Probe 17th August 2020
All your patients – from the orally healthy to those most at risk of dental disease – need to be empowered to practice good dental hygiene, every day. The importance of ongoing home management has never been more relevant, as people are understanding that their own choices and behaviours are essential for long-term optimal oral health.
But patients need support. The market is crowded, and there are mixed messages from the mainstream media about what people should and shouldn’t do to keep their mouth clean and avoid issues like caries, halitosis and discoloured, unattractive teeth.
That’s why a strong, consistent message must come from the dental practice, to cut through any confusion about what to do and use. The aim is to give patients a practical foundation for home care, which can extend the length of time between visits, as far as is recommended.
Brushing is the main tenant of daily oral hygiene. For most people, it’s instant gratification, as their mouth will immediately feel cleaner and fresher after, improving confidence. We are advised to brush twice a day, but in situations when a boost is needed – before an interview, or a date – patients will often reach for their toothbrush for an extra clean. Technique must be recapped at every routine appointment, or when circumstances change – for example, if they have started wearing an orthodontic appliance. The correct brush must be recommended too.
Interdental brushing has become more popular as most patients find it easier to master than string floss, with guidance. Again, there is an element of gratification here, when irritating food deposits simply slide out. This is the gold-standard – but many of you will see patients for whom just “regular” brushing can be uncomfortable. So, for another or an additional way to optimise a daily hygiene routine, mouth rinse may be recommended.
The obstacles to a rinse
There is an issue of a crowded marketplace here too, but an added layer is that many patients will have their own obstacles to any advice that they should use mouth rinse. Some brands are so highly-flavoured that the taste becomes unpleasant rather than refreshing; it can linger too and inhibit the flavour of anything consumed for a long time after. Even when their trusted dentist is advocating mouth rinse, many patients will ask if, because of things they’ve read, it’s not merely a superfluous addition that won’t deliver the benefits it promises (articles with a questioning tone appeared in the consumer press as recently as March). An opinion piece published in the BDJ in 2012 explored the “lack of high-quality evidence to support guidance for post-tooth brushing rinsing behaviours” [i] – essentially, do dentists know what to tell their patients, regarding the regular use of mouth rinse?
Alcohol is a component of many market-leading rinses available in every supermarket or high-street chemist, which can cause a dry mouth, with persistent or overuse. Also present in “conventional” products is chlorhexidine (CHX) which, although clinically proven to reduce bacteria/plaque and encourages healing, can lead to unpleasant side effects, including disturbances to taste.[ii] On the most fundamental level, some conventional mouth rinses simply look “unnatural”. The interest in products containing natural ingredients has grown massively and is set to grow further as more of us are determined to buy more mindfully.
For patients with acute dental problems, and those who are at a higher risk of developing oral disease, there are natural and highly effective mouth rinses available for support. Under the guidance and direction of their dental practitioner they can be recommended to use Perio Plus+ mouth rinses, which are alcohol-free and contain a component of CHX which has been improved with the addition of CITROX®. CITROX® is a natural bioflavonoid extracted from bitter oranges and has antimicrobial, antioxidant and anti-inflammatory properties; the joint performance of CHX and CITROX® offers powerful protection against a variety of diseases, including caries and periodontitis.
Good oral care at home needs the ongoing support of the dental team, to check cleaning technique and recommend the right products and behaviours. Preventive care is a conversation, a collaboration and patients must be instructed in using the highest-quality adjuncts, preferably based on natural ingredients.
[i] Pitts, N., Duckworth, R., Marsh, P. et al. Post-brushing rinsing for the control of dental caries: exploration of the available evidence to establish what advice we should give our patients. Br Dent J 212, 315–320 (2012). https://doi.org/10.1038/sj.bdj.2012.260 (accessed April 2020).
[ii] Laugisch, O., Ramseier, C. A., Salvi, G. E., Hägi, T. T., Bürgin, W., Eick, S. and Sculean, A. (2016) Effects of two different post-surgical protocols including either 0.05% chlorhexidine herbal extract or 0.1% chlorhexidine on post-surgical plaque control, early wound healing and patient acceptance following standard periodontal surgery and implant placement. Clin Oral Investig. 20 (8): 2175-2183.
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