So now we know that the new model of periodontal disease is called polymicrobial synergy and dysbiosis (PSD). We also know some of the details of the mechanism of periodontal disease development and progression, but what does this mean on a clinical level? How should we modify our approach to the disease to exploit the research conclusions and, as always, enhance the level of care we provide for our patients?
What other recommendations should we be making? First and foremost, a power toothbrush. There is no comparison between the bacterial reduction achieved by a power versus a manual toothbrush. (1, 2, 3) Further, interdental brushes (IDB) are far more effective than dental floss, according to 2015 research. (4) IDBs should be used wherever they fit into our patients’ care regimens. Have patients use floss only where the contacts are too tight for IDBs. Make sure your patients have tongue cleaner and antibacterial rinses for daily use. We must be making all of these home-care recommendations with considerable urgency, since we are battling all of the bugs in the mouth—not just a select few.
My next blog post will offer further thoughts and recommendations for the brave new world of periodontal disease.
1. Ward M, Argosino K, Jenkins W, et al. Comparison of gingivitis and plaque reduction over time by Philips Sonicare FlexCare Platinum and a manual toothbrush. Philips Oral Healthcare website. https://www.usa.philips.com/c-dam/b2c/category-pages/personal-care/POHC/resource-library-docs/Comparison-of-gingivitis-and-plaque-reduction-over-time-by-Philips-Sonicare-FlexCare-Platinum-and-a-manual-toothbrush.pdf. Published 2012. Updated 2015. Accessed May 17, 2016.
2. Yaacob M, Worthington HV, Deacon SA, et al. Powered versus manual toothbrushing for oral health. Cochrane Database of Systematic Reviews. 2014;6:CD002281. doi: 10.1002/14651858.CD002281.pub3.
3. Kurtz B, et al. A randomized clinical trial comparing plaque removal efficacy of an oscillating-rotating power toothbrush to a manual toothbrush by multiple examiners. Int J Dent Hyg. 2016;5. doi: 10.1111/idh.12225. [Epub ahead of print].
4. Chapple IL, Van der Weijden F, Doerfer C, Herrera D, Shapira L, Polak D, et al. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol. 2015;42 Suppl 16:S71–6. doi: 10.1111/jcpe.12366.