Volume 9 • 2022 • Issue 3

The biggest takeaway for the research team? “I was surprised that the efficacy of some tools hadn’t been definitively proven,” he says. “Clinical trials are expensive, so there are some methods that I know from my experience as a clinician work well for patients, but they haven’t been scientifically explored. For example, the toothbrush has not been the subject of a well- designed randomized control trial.” Another obstacle was that periodontal disease doesn’t have a standard definition. “It’s not like hypertension, where it is defined by blood pressure over a certain number,” says Dr. Scannapieco. “In three different journal articles, periodontal disease may be described three different ways. There are different ways of measuring it. Pocket depth is not the same as clinical attachment level. And then the question is how many pockets constitute disease?” Despite these challenges, Dr. Scannapieco was happy with the results of the review. “As a periodontist, it’s helpful to be able to share simple things with my patients that they can do at home.” When talking to his patients, in plain language, Dr. Scannapieco tells them that periodontal disease is the result of the bacteria that stick to teeth, which causes inflammation of the gums. He tells them if they don’t remove the bacterial plaque every day, gums will get inflamed. “And how do you do that? Flossing, interdental brushes, toothbrushing and mouthwashes work pretty well when you use them all together,” he says. Dr. Scannapieco says that, on average, people spend just 30 seconds each day brushing their teeth. “I have to work with my patients to change that habit. Good home care takes between 3 and 5 minutes, twice a day.” For the patients who have taken his advice to heart, Dr. Scannapieco has been pleased to see maintenance of healthy mouths into old age. As a periodontist, it’s helpful to be able to share simple things with my patients, in plain language, that they can do at home. Their article 1 about their findings was published in the Journal of the International Academy of Periodontology . It explores the evidence of the efficacy at-home care tools, with advice about which ones can help patients maintain their oral health. Reference: 1. Volman EI, Stellrecht E, Scannapieco F. Proven primary prevention strategies for plaque-induced periodontal disease – an umbrella review. J Int Acad Periodontol . 2021 23(4): 350-67 Main Findings of Study • Methods of mechanical oral biofilm control found to be effective by systemic reviews: powered toothbrushes, oral irrigators, and interdental cleaning devices, especially interdental brushes. • Manual tooth brushing and powered tooth brushing were found to be equivalent. • Effective topical chemical interventions include chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC), and essential oils. Triclosan- containing dentifrice adds to the effectiveness of toothbrushing to reduce gingivitis. • There is only limited evidence for other interventions, including sodium benzoate, stannous fluoride, hexetidine, hydrogen peroxide, other natural compounds, 0.2% delmopinol, probiotics, anti‑inflammatory agents, dietary supplements, antioxidants, and smoking cessation. 40 | 2022 | Issue 3 SupportingYour Practice