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Periodontics: Oral Health and Wellness I. Understanding Periodontal Health, Recognizing Disease States and Choices in Treatment Strategies

Course Number: 50

Plaque Control Procedures and Products

The nature and severity of chronic periodontitis is a result of the interactions between microbial factors and a susceptible host. Pathogenic bacteria in the gingival sulcus or periodontal pocket are necessary for periodontitis to occur, but bacteria alone are only part of the picture. It is well known that the body's local and systemic response to bacteria and their toxins determines the extent and severity of the disease. Controlling pathogenic bacterial colonization minimizes the host response. That is best accomplished by routine brushing, flossing and otherwise disrupting plaque and biofilm. For more information on biofilm, please refer to the course:12

Routine plaque control is the most reliable strategy in the prevention of bone and soft tissue destruction and attachment loss that occurs with periodontal disease. One of the most important services the dental professional can provide is assistance with improved daily plaque control by the patient. The chances for plaque control improvement are increased when products with efficacy supported by the best available scientific evidence are recommended. Twice daily use of an effective toothbrush is critical to ensure efficient plaque removal. In a systematic review by the Cochrane Collaboration, power toothbrushes with rotation-oscillation motion were found to be better than manual toothbrushes at removing plaque and reducing gingival inflammation. No other powered designs were as consistently superior to manual toothbrushes.22 In a separate Cochrane review comparing power brush technologies, rotation-oscillation toothbrushes were found to reduce plaque and gingivitis more than those with side-to-side (sonic) action in the short term (4 to 12 weeks).23 Another way to ensure adequate plaque control is use of chemotherapeutic agents to inhibit plaque regrowth. Dentifrices containing stabilized stannous fluoride or triclosan and oral rinses with bioavilable CPC or essential oils have been shown to reduce plaque and gingivitis. Published studies indicate dentifrice with stabilized stannous fluoride offer greater plaque control and gingival health advantages relative to other over-the-counter therapeutic dentifrices. Attaining routine plaque control by the patient is a very important factor in periodontal therapy. Some of the long-term success of surgical therapies can be attributed to increased access to sites that have been adversely affected by periodontal disease; giving the opportunity for better plaque control by the patient.