Periodontitis is thought to affect around 10% of the world’s population, with some level of irreversible periodontitis affecting nearly half of UK adults.[i]
Although the disease is most common in those aged between 60 and 64,i anyone with poor oral hygiene habits can develop it. Gingival tissue is delicate and can be easily disrupted by certain behaviours, including smoking, drinking and a poor diet. As you well know, some form of daily interdental cleaning is essential to keep the interproximal area of the teeth free from bacteria and food debris, but not all patients follow this advice faithfully, if at all.
Therefore, education in the importance of gingival health is vital to keep the nation’s oral cavity free from disease. There are also various other areas of health that can be affected by poor gingival health, providing further incentive to help patients take control of their dental hygiene habits.
The villain of dentistry
The battle against dental plaque is never-ending. As you are aware, this sticky substance clings to all surfaces within the mouth, meaning that its continual removal is paramount. Despite the havoc that plaque can cause in the mouth, studies have suggested that, under favourable conditions, periodontal pathogens can also “disseminate and colonise distant organs.”[ii] Once this happens, the oral bacterium may trigger disease within those organs. For instance, back in 1986, a study suggested that chronic inflammation, including periodontitis, could be a risk factor for a stroke,[iii] and further studies have attempted to establish that link. [iv] More recently, associations have been made to the dissemination of periodontal pathogens and COVID-19, whereby the periodontal bacteria enter the lower respiratory tract and create a suitable environment for a severe COVID-19 lung infection.ii Furthermore, P. gingivalis, one key microorganism implicated in periodontal disease pathogenesis, has been identified in the brain tissue of a patient with Alzheimer’s disease.[v]
How do we fight it?
Previously, traditional air polishing was more cosmetic in nature, focusing on removing stains along the gingival margin with sodium bicarbonate powder. Nowadays, air polishing is used as a swift and comprehensive solution for the removal of biofilm. New materials used in air polishing, such as erythritol powder or glycine, are around 14-25 microns, compared to sodium bicarbonate which is 75-microns.[vi]
Glycine has around one-fifth of the abrasiveness when compared to sodium bicarbonate, but according to research, it can remove biofilm from a root surface within five seconds.[vii] Treatments that are effective in removing plaque and staining, but are gentle on the soft and hard tissues within the mouth, are ideal and it has been proven that air polishing with glycine powder is a satisfactory method of plaque and stain removal.vii Encouraging patients to attend regular dental appointments is vital, so they can experience a deep, professional clean to prevent the development of gingival complications. But patient compliance is of an even greater importance, as it is not recommended for patients to rely solely on a professional clean. So what can patients do at home?
Appliances such as interdental brushes are a useful alternative if patients struggle with conventional flossing. Their efficacy in reducing plaque levels has been noted in studies,[viii] and, anecdotally, some patients may find them easier to handle. Similarly, pre-threaded floss might be a more useful option too, as they come pre-cut and provide more solid handling than traditional floss. A water flosser is another alternative that has been proven time and time again to be effective in disrupting plaque and removing debris. Water flossers can also be used in conjunction with antimicrobial solutions and cleaning agents, that can penetrate deep into the sulcus and interproximal regions.[ix] For patients with limited dexterity, or orthodontic appliances, water flossers have demonstrated their efficacy in studies.[x]
A professionally-clean feeling
By recommending a water flosser to your patients, they’ll be able to experience a professionally-clean feeling at home. Why not recommend the Waterpik® Whitening Water Flosser, for a mini air polish that patients can do at home?
The Waterpik® Whitening Water Flosser has been designed to not only keep the gingiva healthy, but to provide gentle whitening too. This solution is clinically proven to be up to 50% more effective for improving gum health vs. string floss,[xi] and removes up to 99.9% of plaque from treated areas.[xii] This model is available with four whitening tips and also comes with a one-month supply of whitening tablets, designed to leave patients with a refreshingly clean and brighter smile. For an easy-to-use solution from the world’s number one water flosser brand, recommend the Waterpik® Whitening Water Flosser today.
The benefits of controlling plaque extend far beyond the oral cavity. By equipping your patients with relevant guidance and high-quality solutions, you can ensure that they have the tools they need to protect their gingiva and their health.
For more information on Waterpik® Water Flosser products visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Costco UK, Argos, Boots, Superdrug and Tesco online and in stores across the UK and Ireland.
Join the 3,000+ dental teams who have already benefitted from a professional Waterpik® Lunch & Learn. Book your free session for 1 hour of verifiable CPD and a free Waterpik® Water Flosser – available either face to face or as a webinar – at www.waterpik.co.uk/professional/lunch-learn/
Author:
Andrea Hammond is a Dental Hygienist and Waterpik Professional Educator. Andrea has worked in dentistry since 1996, first qualifying as a dental nurse in 1998 – the same year in which she secured a place on the very first dental therapy cohort at the Eastman Dental Hospital. Following this, she was awarded diplomas in both dental hygiene and dental therapy in the year 2000, and became an active member of the GDC fitness to practice panel since 2015. Today, she continues to share knowledge as a Professional Educator for Waterpik and be deeply involved in the industry as a Regional Group Representative for the British Society of Dental Hygiene and Therapy (BSDHT).
[i] GOV.UK. (n.d.). Chapter 5: Periodontal diseases. [online] Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-5-periodontal-diseases#:~:text=Some%20level%20of%20irreversible%20periodontitis [Accessed 28 Jul. 2022].
[ii] Aquino-Martinez, R. and Hernández-Vigueras, S. (2021). Severe COVID-19 Lung Infection in Older People and Periodontitis. Journal of Clinical Medicine, [online] 10(2), p.279. Available at: https://www.mdpi.com/2077-0383/10/2/279/htm [Accessed 29 Jul. 2022].
[iii] Syrjänen, J., Valtonen, V.V., Livanainen, M., Hovi, T., Malkamäki, M. and Mäkelä, P.H. (2009). Association between cerebral infarction and increased serum bacterial antibody levels in young adults. Acta Neurologica Scandinavica, [online] 73(3), pp.273–278. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0404.1986.tb03275.x [Accessed 29 Jul. 2022].
[iv] Sfyroeras, G.S., Roussas, N., Saleptsis, V.G., Argyriou, C. and Giannoukas, A.D. (2012b). Association between periodontal disease and stroke. Journal of Vascular Surgery, [online] 55(4), pp.1178–1184. Available at: https://www.sciencedirect.com/science/article/pii/S0741521411023251 [Accessed 29 Jul. 2022].
[v] Dominy, S.S., Lynch, C., Ermini, F., Benedyk, M., Marczyk, A., Konradi, A., Nguyen, M., Haditsch, U., Raha, D., Griffin, C., Holsinger, L.J., Arastu-Kapur, S., Kaba, S., Lee, A., Ryder, M.I., Potempa, B., Mydel, P., Hellvard, A., Adamowicz, K. and Hasturk, H. (2019). Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. Science advances, [online] 5(1), p.eaau3333. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30746447 [Accessed 29 Jul. 2022].
[vi] Cecchini-259, J. (2019). Biofilm Conquered: Glycine Powder To The Rescue! [online] Oral Health Group. Available at: https://www.oralhealthgroup.com/features/biofilm-conquered-glycine-powder-to-the-rescue/ [Accessed 29 Jul. 2022].
[vii] Gambhir, R., Kaur, A., Bhardwaj, A., Kansil, S., Kaur, R. and Kaur, S. (2021). Efficacy evaluation of rubber cup and air polishing techniques using glycine in plaque and stain removal – A clinical trial. Journal of Family Medicine and Primary Care, [online] 10(2), p.636. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138352/ [Accessed 29 Jul. 2022].
[viii] Gennai, S., Nisi, M., Perić, M., Marhl, U., Izzetti, R., Tonelli, M., Petrini, M. and Graziani, F. (2022). Interdental plaque reduction after the use of different devices in patients with periodontitis and interdental recession: A randomized clinical trial. International Journal of Dental Hygiene. [online] Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/idh.12578 [Accessed 29 Jul. 2022].
[ix] annalsofdentalspecialty.net.in. (n.d.). Dental Misconceptions In Social Media Accounts: Youtube And Instagram Applications Among Fluoride Toxicity, Bleaching And, Waterjet – Annals of Dental Specialty. [online] Available at: https://annalsofdentalspecialty.net.in/article/dental-misconceptions-in-social-media-accounts-youtube-and-instagram-applications-among-fluoride-to-ndzof3golib99yz [Accessed 29 Jul. 2022].
[x] Abdellatif, H., Alnaeimi, N., Alruwais, H., Aldajan, R. and Hebbal, M.I. (2021). Comparison between water flosser and regular floss in the efficacy of plaque removal in patients after single use. The Saudi Dental Journal, [online] 33(5), pp.256–259. Available at: https://pubmed.ncbi.nlm.nih.gov/34194188/ [Accessed 29 Jul. 2022].
[xi] Comparison of Irrigation to Floss as an Adjunct to Toothbrushing: Effect on Bleeding, Gingivitis, and Supragingival Plaque. Barnes CM, et al. J Clin Dent, 2005; 16(3): 71-77. Study conducted at the University of Nebraska Medical Center, College of Dentistry, Lincoln, Nebraska.
[xii] Biofilm Removal with a Dental Water Jet – Gorur A, Lyle DM, Schaudinn C, Costerton JW. Compend Contin Ed Dent 2009; 30 (Suppl 1):1 – 6.
