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Recommendations from the European Federation of Periodontology

June 15, 2015
Should you still be telling your patients to floss? Read more as Maria Perno Goldie brings back the latest news and recommendations from Europerio8.

According to the European Federation of Periodontology (EFP), science is at the heart of periodontology recommendations and therapy. “25 Years of Periodontology,” a presentation at EuroPerio8, provided a European viewpoint on the critical developments in periodontology since the late 20th century, the current position in research and teaching, what the future of periodontal therapy might entail. It was a comprehensive overview of the evolution of European periodontology. This article will share some information about the EFP and EuroPerio8 recommendations, based on the 2014 XI European Workshop on Periodontology.

The EFP, in partnership with Oral-B, launched a public campaign to prevent gingival bleeding and periodontal diseases. (1) The campaign includes the launch of a dedicated website, a webinar with some of the Workshop’s top periodontists, and the production of specially designed communication materials. The campaign is based on the recommendations of the 2014 XI European Workshop on Periodontology. (2) This Workshop brought together leading periodontal and medical researchers, who came to a consensus on the effective prevention of periodontal and peri-implant diseases. The website will publish information and educational content aimed at both professional and nonprofessional visitors, and will be launched the end of June 2015. (3) The site will feature a webinar in October 2015 featuring the chairmen of the XI European Workshop on Periodontology’s four working groups.

The guidelines that this initiative endorses are based on clinical and scientific evidence from worldwide research studies over numerous years on plaque removal methods, oral hygiene products, lifestyle factors, and other critical elements that influence the effective prevention of periodontal and peri-implant diseases.

A significant recommendation is to understand and tell patients about the risks of bleeding gingival tissue. The members of the Workshop support the use of interdental brushing rather than flossing—a novel idea! They emphasized that self-performed dental hygiene, while important, may not assure periodontal health. The experts concluded that flossing cannot be recommended due to lack of evidence, other than for areas where interdental brushes will not go through the interproximal area without causing trauma. (4)

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It is stressed that patients must seek professional advice and treatment in addition to self-care. It was also stated that peri-implantitis is an “emerging public health issue” and warns that bleeding gingival tissue may be a symptom of disease. Professional biofilm and calculus removal is essential to prevent plaque-induced periodontal disease. However, there is a lack of consensus on how to maintain dental implants. (4)

Examples of power brushes.

Another of the Workshop's conclusions that will have an influence in the oral health community is that studies of plaque biofilm removal have confirmed that power brushes are more effective than manual brushes. (5) Additional research is needed before evidence-based advice concerning the comparative performance of the different powered toothbrushes can be given by health care professionals to the public. (5)

In addition, there was evidence that certain ingredients in some toothpastes can reduce pain in patients with dentin hypersensitivity. (6) Toothpastes and mouth rinses were shown to lower gingival inflammation and prevent plaque accumulation when used in addition to mechanical brushing. Dentifrices containing arginine, calcium sodium phosphosilicate, stannous fluoride, and strontium have shown an effect on pain reduction. (6) Also, professionally applied prophylaxis pastes containing arginine and calcium sodium phosphosilicate have shown efficacy. Mouth rinses and dentifrices made with chlorhexidine-, cetylpyridinium chloride-, and zinc-based active ingredients have a significant beneficial effect on oral malodor. (6)

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Prevention is also the best way to deal with periodontal disease. As always, positive lifestyle factors are central to oral health, and the campaign based on the Workshop’s conclusions will encourage professionals to do more to support behavioral changes in their patients, especially with regard to tobacco cessation.

For more on the EuroPerio8 meeting and to view the movie The Sound of Periodontitis: The patient's view of gum disease, visit the meeting website.

Notes and references
1. EFP and Oral-B partner to generate awareness on how to prevent gum bleeding [news release]. Madrid, Spain: European Foundation of Periodontology; June 4, 2015.
2. Tonetti MS, Chapple IL, Jepsen S, Sanz M. Primary and secondary prevention of periodontal and peri-implant diseases: Introduction to, and objectives of the 11th European Workshop on Periodontology consensus conference. J Clin Periodontol. 2015;42(suppl 16):S1-4. doi: 10.1111/jcpe.12382.
3. In late June 2015, the website will be available at
4. Sälzer S, Slot DE, Van der Weijden FA, Dörfer CE. Efficacy of inter-dental mechanical plaque control in managing gingivitis–a meta-review. J Clin Periodontol. 2015;42(suppl 16):S92–S105. doi: 10.1111/jcpe.12363.
5. Van der Weijden FA, Slot DE. Efficacy of homecare regimens for mechanical plaque removal in managing gingivitis: a meta review. J Clin Periodontol. 2015;42(suppl. 16):S77–S91. doi: 10.1111/jcpe.12359.
6. Sanz M, Bäumer AB, Buduneli N, et al. Effect of professional mechanical plaque removal on secondary prevention of periodontitis and the complications of gingival and periodontal preventive measures: consensus report of group 4 of the 11th European Workshop on Periodontology on effective prevention of periodontal and peri-implant diseases. J Clin Periodontol. 2015;42(suppl 16):S214–S220. doi 10.1111/jcpe.12367.

Maria Perno Goldie, RDH, MS, is editorial director of RDH eVillage FOCUS.