As dental professionals, we know that preventing gingivitis is the primary method of prevention against periodontitis. However, patients may also present with gingivitis, requiring treatment and improved home care. When a patient presents with gingivitis, we usually focus our efforts on mechanical plaque control, educating our patients on good oral hygiene habits and techniques. While we know that this is an essential part of treating gingivitis, there is growing support for an integrated chemical and manual approach.
It has long been accepted that mechanical plaque control methods, i.e., brushing and interdental cleaning, are effective in disrupting and eliminating oral biofilm on the dentition. However, according to a systematic review published in the Journal of Clinical Periodontology (JCP), such methods alone may be insufficient in preventing the development or recurrence of periodontal diseases in part of the population. The authors also noted several studies in which patients plaque levels returned to baseline levels following participation in oral hygiene studies or oral hygiene instructions. Possible explanations including limited use of interdental cleaning, limited time spent on oral hygiene and a failure to control biofilms other than dental plaque. However, they found that using oral health products, particularly mouth rinses containing agents for chemical plaque control, led to statistically significant improvements in gingival bleeding, inflammation and plaque indices.
That begs the question: why not use both chemical and mechanical plaque control methods?
Upon reviewing the evidence in support of adjunctive chemical plaque control agents, the European Federation of Periodontology (EFP) supports an integrated chemical and mechanical plaque control approach. The organization recommends that patients brush with a fluoride toothpaste supplemented with plaque control agents as a primary method of preventing periodontitis.
Your patients with gingivitis may also benefit from following their brushing with an anti-plaque mouth rinse. The 0.12% chlorhexidine gluconate formula is clinically proven to significantly reduce gingivitis, plaque and bleeding, and to support gingival healing. Both 0.12% chlorhexidine gluconate rinse available in the US and the 0.20% concentration available in the UK and some other countries are effective, with different amounts used to rinse depending on the concentration.
In the JCP systematic review, mouth rinses were found to be the most clinically effective method of delivery for chemical anti-plaque agents. The authors speculated that toothpastes may be more effective in real terms as they are more convenient, more widely used, and used alongside a mechanical plaque control method (the toothbrush). However, the evidence suggests that our gingivitis patients, especially those at higher risk, would benefit from the use of both a toothpaste and a mouth rinse.
Of course, we should absolutely continue to encourage mechanical plaque control as the first line of defense against periodontal diseases. That includes recommending the appropriate oral health tools, as well as coaching our patients on how to use them effectively. However, as the evidence shows, there is also a place for chemical adjuncts in the fight against periodontal disease.