Premium
Primary prevention of periodontitis: managing gingivitis
Author(s) -
Chapple Iain L. C.,
Van der Weijden Fridus,
Doerfer Christof,
Herrera David,
Shapira Lior,
Polak David,
Madianos Phoebus,
Louropoulou Anna,
Machtei Eli,
Donos Nikos,
Greenwell Henry,
Van Winkelhoff Ari J.,
Eren Kuru Bahar,
Arweiler Nicole,
Teughels Wim,
Aimetti Mario,
Molina Ana,
Montero Eduardo,
Graziani Filippo
Publication year - 2015
Publication title -
journal of clinical periodontology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.456
H-Index - 151
eISSN - 1600-051X
pISSN - 0303-6979
DOI - 10.1111/jcpe.12366
Subject(s) - gingivitis , medicine , periodontitis , oral hygiene , tooth loss , dentistry , dental plaque , quality of life (healthcare) , intensive care medicine , oral health , nursing
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 cause of tooth loss impacting negatively upon speech, nutrition, quality of life and self‐esteem, and has systemic inflammatory consequences. Periodontitis is preventable 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, lifelong. While 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. Aim 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 inter‐dental mechanical plaque control; 3) the efficacy of adjunctive chemical plaque control; and 4) anti‐inflammatory (sole or adjunctive) approaches. Methods Two meta‐reviews (mechanical plaque removal) and two traditional systematic reviews (chemical plaque control/anti‐inflammatory agents) formed the basis of this consensus. Results Data support the belief that professionally administered plaque control significantly improves gingival inflammation and lowers plaque scores, with some evidence that reinforcement of oral hygiene provides further benefit. Re‐chargeable power toothbrushes 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 inter‐dental brushes ( IDB s) will not pass through the interproximal area without trauma. Otherwise, IDB s 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 min. with fluoridated dentifrice. Expert opinion is that for periodontitis patients 2 min. is likely to be insufficient, especially when considering the need for additional use of inter‐dental cleaning devices. In patients with gingivitis once daily inter‐dental cleaning is recommended and the adjunctive use of chemical plaque control agents offers advantages in this group.