Improving plaque management for gum health
This article explores why improving a patient’s plaque management is so critical when it comes to improving and maintaining gum health.
Brought to you by Johnson & Johnson Ltd., the makers of LISTERINE®.
Figures suggest that 83% of dentate adults show some evidence of gum disease (that is bleeding, calculus, periodontal pocketing of 4mm or more),1 indicating that there remains an unmet need in managing periodontal disease.
Plaque bacteria is considered a major cause of gum disease.2 It is defined by the Oxford Dictionary of Dentistry as: ‘A biofilm consisting of an organized bacterial community, salivary mucins and proteins adhering to tooth surfaces, restorations, and prosthetic appliances. Plaque forms by attachment of bacteria to the outer surface of the pellicle, predominantly in stagnation areas not having the benefit of the self-cleansing actions of the oral cavity.’3
According to the Group B consensus report of the 5th European Workshop in Periodontology, gingivitis and periodontitis are a ‘continuum’ of the same inflammatory disease.However, gingivitis will not always progress to periodontitis: ‘The weight of the evidence indicates that the prevention of gingival inflammation prevents periodontitis’.4
The Group further noted that, ‘Currently oral plaque biofilm disruption is the most effective way to treat and prevent both conditions [gingivitis and periodontitis]’.4
However, the mechanical routine of brushing and interdental cleaning is often insufficient to control gum disease in the majority of people,5 and part of this is the result of a lack of patient compliance.6
Boyle and colleagues (2014) added to this picture, writing: ‘Dental plaque is the main cause of oral diseases and can be removed mechanically by ‘effective’ brushing and flossing. However, a very large proportion of plaque on teeth is left behind by most individuals and soft tissues largely untouched mechanical means of plaque control.’7
What more can be done?
In 2015, Working Group 2 of the 11th European Workshop in Periodontology suggested that a third step may be needed, stating: ‘… where improvements in plaque control are required, adjunctive use of antiplaque chemical agents may be considered. In this scenario, mouth rinses may offer greater efficacy but require an additional action to the mechanical oral hygiene regime.’8
Building on this idea, Figuero and colleagues (2019) conducted a systematic review and meta-analysis exploring the adjunctive use of 11 different mouth rinse formulations.9
They concluded that adjunctive antiseptics in mouthwash provide statistically significant reductions in plaque compared to mechanical plaque control alone at six months.9
They also came to the conclusion that, ‘… despite the high variability in the number of studies comparing each active agent and the different risks of bias, CHX [chlorhexidine] and EOs [essential oils], in mouthrinses appeared to be the most effective active agents for plaque … control.’9
In addition, the Figuero and colleagues’ (2019) outcomes add to the pre-existing evidence base presented by Araujo and colleagues (2015), which was the first meta-analysis to demonstrate the clinically significant, site-specific benefit of adjunctive essential oil mouthwash in people within a 6-month period (that is, between dental visits).10
The analysis revealed that 36.9% of subjects using mechanical methods with essential oil-containing mouthwash experienced at least 50% plaque-free sites after 6 months, compared to just 5.5% of subjects using mechanical methods alone.10
Bridging the mechanical cleaning gap
With all of this in mind, Johnson & Johnson Ltd. have two products in its LISTERINE® range that help to support patients’ gum health – LISTERINE® Total Care and LISTERINE® Advanced Defence Gum Treatment.
It has been demonstrated that when used as an adjunct to mechanical cleaning, LISTERINE® Total Care, an essential oil mouthwash, manages plaque levels, to help prevent gingivitis.7
LISTERINE® Advanced Defence Gum Treatment is a twice-daily mouthwash clinically proven to treat gingivitis as an adjunct to mechanical cleaning.11
It is formulated with unique LAE (Ethyl Lauroyl Arginate) technology that forms a physical coating on the pellicle to prevent bacteria attaching, and so interrupts biofilm formation. When used after brushing, it helps to treat gingivitis as demonstrated by the reduction of bleeding by 50.9% (p<0.001) in just 4 weeks.11
With LISTERINE® Advanced Defence Gum Treatment clinically proven to interrupt the plaque colonisation process,11 this may offer a viable option in terms of supporting patients’ gum health.
1. Adult Dental Health Survey 2009. The Health and Social Care Information Centre, 2011.
2. Page RC, Kornman KS. The pathogenesis of human periodontitis: an introduction. Periodontol 2000. 1997; 14:9-11.
3. Ireland R (ed). Oxford Dictionary of Dentistry. Oxford University Press, 2010: p274
4. Kinane DF, Attström R. Advances in the pathogenesis of periodontitis. Group B consensus report of the fifth European Workshop in Periodontology. J Clin Periodontol. 2005; 32(Suppl. 6):130-1315. Sharma N et al. Adjunctive benefit of essential oil-containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly: a six-month study. J Am Dent Assoc. 2004;135:496-504
6. Low SB. Managing the difficult periodontal patient. Inside Dent.2005; 2(5). https://www.aegisdentalnetwork.com/id/2006/06/periodontics-managing-the-difficult-periodontal-patient. Accessed 16 October 2020
7. Boyle et al. Mouthwash use and the prevention of plaque, gingivitis and caries. Head Neck O Dis. 2014; 20(1):1-76.
8. Chapple ILC et al. Primary prevention of periodontitis: managing gingivitis. Clin Periodontol. 2015; 42 (Suppl. 16): S71-S76
9. Figuero E et al. Efficacy of adjunctive therapies in patients with gingival inflammation. A
systematic review and meta-analysis. https://doi.org/10.1111/jcpe.13244; 23 December 2019
10. Araujo MWB et al. Meta-analysis of the effect of an essential oil-containing mouthrinse on gingivitis and plaque. JADA2015;146(8):610-622
11. Gallob JT et al. A randomized trial of ethyl lauroyl arginate-containing mouthrinse in the control of gingivitis. J Clin Periodontol.2015;42:740-747
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