(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)
BEYOND brushing your teeth with a basic toothbrush, very little oral health tools prevent gum disease.
This is the conclusion of a new study conducted at the University at Buffalo (UB) and published in the October issue of the Journal of the International Academy of Periodontology.
The research separates fact from fiction on what oral hygiene tools actually prevent gum disease.
The answer is important. Afterall, gum disease affects nearly half of adults 30 and older. And that’s just in the United States, according to the U.S. Centers for Disease Control and Prevention.
All other oral hygiene interventions are only supported by insufficient evidence, says Dr. Frank Scannapieco, a dentist and the principal investigator of the research. He is also the chair and professor of oral biology in the UB School of Dental Medicine.
The co-researchers are Dr. Eva Volman, first author, UB alumna and resident dentist at the Eastman Institute for Oral Health; and Elizabeth Stellrecht, interim head of health sciences library services at UB.
The research findings will help dental practitioners and the public identify best practices for preventing gum disease, Dr. Scannapieco says.
The proven tools, according to the study: basic toothbrush; interdental brush; water pick; chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC) and essential oil mouth rinses.
The toothbrush is the reliable daily oral hygiene tool that helps control dental plaque, says Dr. Scannapieco. Interdental brushes and water picks covers hard-to-reach places (for example, areas in between teeth). They perform better than other interdental oral hygiene devices at reducing gingivitis, and both should be used in combination with daily tooth brushing to prevent gum disease.
Mouth rinses based on CHX, CPC, and essential oils are also effective at significantly reducing plaque and gingivitis.
Toothpicks also help, useful for monitoring gum health, says Dr. Scannapieco. Gently prod the gums with a toothpick to see if there is bleeding, a sign of gum disease.
Triclosan toothpastes and mouth rinses significantly reduced plaque and gingivitis. However, according to the study, the compound is linked to the development of various types of cancers and reproductive defects. (Triclosan has been removed from most popular toothpastes in America.)
The unproven: powered toothbrushes, dental floss, probiotics, dietary supplements and numerous mouth rinses.
Electric-powered toothbrushes are no more effective at reducing plaque and gingivitis than a basic toothbrush, according to the research. There is little evidence to indicate that dental floss is effective in reducing plaque and gingivitis, the UB study shows.
Flossing, however, has its uses, according to Dr. Scannapieco.
“While there are few studies available that specifically examined toothbrushes or floss alone, both are still essential. Floss is especially useful to remove interdental plaque for people who have tight space between their teeth. Floss also likely reduces the risk for cavities that form between the teeth.”
The research found insufficient evidence that mouthwashes based on tea tree oil, green tea, anti-inflammatory agents, hydrogen peroxide, sodium benzoate, stannous fluoride, hexetidine or delmopinol reduce gingivitis.
The use of probiotics, although promising as a preventive strategy against gum disease, is also unproven, the research states.
The researchers found little evidence that supports the claim that dietary supplements improve gum health. The investigators also found insufficient evidence that professional plaque removal (known as scaling, the process of removing plaque with a scraper) prevents gum disease.
“Patients can be confident that the oral care tools and practices supported by research, as described in the paper, will prevent the initiation and progression of periodontal (gum) disease if they are performed regularly and properly,” he says.
“It is my hope that this piece consolidates the relevant evidence in a way that is comprehensive, readable and uniquely helpful to all oral health professionals as well as patients,” says Dr. Volman.
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Dr. Joseph D. Lim is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; and Honorary Life Member of the Thai Association of Dental Implantology. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He was Assistant Professor at the National University, 2018; and Associate Professor, University of Makati, 2018. For questions on dental health, e-mail limdentalcenter@gmail.com./PN
