Primary prevention of periodontitis: managing gingivitis (original) (raw)

Journal of Clinical Periodontology, 2015

Abstract

Periodontitis is a ubiquitous and irreversible inflammatory condition and represents a significant public health burden. Severe periodontitis affects over 11% of adults, is a major case of tooth loss impacting negatively upon speech, nutrition, quality of life and self-esteem and has systemic inflammatory consequences. Periodontitis is treatable and treatment leads to reduced rates of tooth loss and improved quality of life. However, successful treatment necessitates behaviour change in patients to address lifestyle risk factors (e.g. smoking) and, most importantly, to attain and sustain high standards of daily plaque removal, life-long. Whilst mechanical plaque removal remains the bedrock of successful periodontal disease management, in high risk patients it appears that the critical threshold for plaque accumulation to trigger periodontitis is low, and such patients may benefit from adjunctive agents for primary prevention of periodontitis. The aims of this working group were to systematically review the evidence for primary prevention of periodontitis by preventing gingivitis via four approaches: 1) the efficacy of mechanical self-administered plaque control regimes; 2) the efficacy of self-administered interdental mechanical plaque control; 3) the efficacy of adjunctive chemical plaque control; 4) anti-inflammatory (sole or adjunctive) approaches. Two meta-reviews (mechanical plaque removal) and two traditional systematic reviews (chemical plaque control/anti-inflammatory agents) formed the basis of this consensus. Data support the belief that professionally administered plaque control significantly improves gingival inflammation and lowers plaque scores, with some evidence that re-enforcement of oral hygiene provides further benefit. Re-chargeable power tooth brushes provide small but statistically significant additional reductions in gingival inflammation and plaque levels. Flossing cannot be recommended other than for sites of gingival and periodontal health, where interdental brushes (IDBs) will not pass through the interproximal area without trauma. Otherwise, IDBs are the device of choice for interproximal plaque removal. Use of local or systemic anti-inflammatory agents in the management of gingivitis has no robust evidence base. We support the almost universal recommendations that all people should brush their teeth twice a day for at least 2 minutes with fluoridated dentifrice. Expert opinion is that for periodontitis patients 2 minutes is likely to be insufficient, especially when considering the need for additional use of interdental cleaning devices. In patients with gingivitis once daily interdental cleaning is recommended and the adjunctive use of chemical plaque control agents offers advantages in this group. This article is protected by copyright. All rights reserved.

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