Involving patients in the treatment of periodontal diseases
UncategorisedPosted by: Dental Design 11th August 2023
Gum disease is one of the largest dangers to oral health. In fact, almost half of UK adults are affected by some level of irreversible periodontitis.[i] Patient awareness around the subject is fundamental, from understanding prevention and symptoms, to adhering to treatment protocols and advice. Dental professionals at all levels should provide their patients with the appropriate information to prevent or manage periodontal disease between appointments, so that care continues past the dental chair.
Patient awareness of gingival issues
As professionals know, gum disease develops over time and symptoms can be exacerbated by a lack of a daily care routine. Gingivitis is classified as an inflammation of the gingiva, resulting from a build-up of plaque or biofilm. When the infection progresses to affect the surrounding tissues and bones, the infection is reclassified as periodontitis. Extreme cases of periodontal disease can result in bad breath and a loss of teeth, which can have detrimental effects on general and mental health.[ii]
Studies have found that patient knowledge of the impact of gum disease is considerable, with nearly nine of out ten people recognising the issues it can present.[iii] Despite this, more than a third of people with symptoms could be unaware of the damage occurring in their own mouths. They may not even notice signs of an infection that has progressed from gingivitis to periodontitis, such as gingival recession.[iv]
The prevention of periodontal disease relies upon a patient performing daily toothbrushing and interdental cleaning. Dental professionals can only encourage a patient to carry out this regimen outside of their treatment. It therefore becomes a clinician’s responsibility to educate and motivate[v] and the patient’s duty to comply with recommendations.
Communicating a routine
Instilling a drive within a patient to play closer attention to their oral care routine is difficult. Behavioural obstacles that prevent a person’s oral health from positively progressing can be overcome by a unique patient-centred approach.[vi]
A patient-centred approach takes into account their aims, circumstances and preferences. Having an open conversation about treatments and recommended care provides patients with their own sense of agency, encouraging them to act upon plans made for their own routines.[vii] Engaging with a patient in a two-way discussion about the risks of periodontal disease has been found to increase the likelihood of action upon advice. This can result in an increase in interdental care when recommended, and in turn a reduction in plaque, alongside regular brushing.[viii]
The most effective approaches to improving oral care rely on a relationship of trust between patient and dentist. This can be achieved through effective interaction that is compassionate, informative, and open.[ix]
The right product for the patient
When advising patients on their oral care routine, it’s important to recommend the appropriate products. Understanding which solutions will effectively control plaque, whilst balancing other priorities in oral care, is important for preventing periodontal issues.
Fluorides are well known for their benefits of enhancing remineralisation of enamel, and reducing caries. However, studies based around stannous fluoride have found it has a pronounced effect on plaque reduction and anti-inflammatory action on the gingiva too,[x] in turn aiding the prevention of gingivitis. Stannous fluoride is now a common active ingredient in toothpastes, and is especially important in those combating gingivitis.
Cetylpyridinium Chloride (CPC) is an antimicrobial agent that is found in some mouthwashes. CPC’s strength is disturbing the maturation of dental plaque. In doing so, bacteria associated with gingivitis cannot build up. Formulations containing CPC have been successfully trialled, with promising results in preventing periodontal issues.[xi]
Long considered the “gold standard” anti-plaque agent,[xii] chlorhexidine (CHX) is 
incredibly effective when tackling gingivitis. CHX has been adopted in a variety of forms, from toothpastes and gels, to mouthwashes and sprays. At higher concentrations, CHX may be recommended for short term application for patients undergoing periodontal surgery.[xiii] It can be used alongside regular oral hygiene routines at a lower concentration for an extended period of time, and doing so significantly reduces plaque and risk of gingivitis in patients.[xiv] The long-term use of CHX should be carefully monitored by a practitioner and patient, to prevent potential concerns surrounding alterations of taste and discolouring.[xv]
Finding the correct products for patients looking to prevent periodontal diseases is important. When doing so, dentists should consider discussing the use of the Perio Plus+ range from Curaden. The Perio Plus+ mouthwashes, gel and toothpaste balance the gold standard CHX with the specially developed bioflavonoid CITROX® for powerful anti-microbial and anti-inflammatory benefits. Clinicians can tailor care to each patient’s needs with solutions that are made for short- and longer-term use, with products available containing CPC and fluorides, to reduce plaque and tackle tooth decay.
With the appropriate products and good communication with a patient, it’s possible to create an effective oral care routine that minimises the risks of periodontal diseases for a lifetime.
For more details, please visit www.perioplus.com/uk
[i] Gov.UK, Chapter 5: Periodontal Diseases, (2021) Link: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-5-periodontal-diseases#fn:5 [Accessed April 2023]
[ii] Kisely, S. (2016). No mental health without oral health. The Canadian Journal of Psychiatry, 61(5), 277-282.
[iii] Yılmaz, M., Oduncuoğlu, B. F., & Nişancı Yılmaz, M. N. (2020). Evaluation of patients’ perception of gingival recession, its impact on oral health-related quality of life, and acceptance of treatment plan. Acta Odontologica Scandinavica, 78(6), 454-462.
[iv] Yılmaz, M., Oduncuoğlu, B. F., & Nişancı Yılmaz, M. N. (2020). Evaluation of patients’ perception of gingival recession, its impact on oral health-related quality of life, and acceptance of treatment plan. Acta Odontologica Scandinavica, 78(6), 454-462.
[v] Jönsson, B., & Abrahamsson, K. H. (2020). Overcoming behavioral obstacles to prevent periodontal disease: Behavioral change techniques and self‐performed periodontal infection control. Periodontology 2000, 84(1), 134-144.
[vi] Scannapieco, F. A., & Gershovich, E. (2020). The prevention of periodontal disease—An overview. Periodontology 2000, 84(1), 9-13
[vii] Tomaselli, G., Buttigieg, S. C., Rosano, A., Cassar, M., & Grima, G. (2020). Person-centered care from a relational ethics perspective for the delivery of high quality and safe healthcare: a scoping review. Frontiers in public health, 8, 44.
[viii] Asimakopoulou, K., Nolan, M., McCarthy, C., & Newton, J. T. (2019). The effect of risk communication on periodontal treatment outcomes: A randomized controlled trial. Journal of Periodontology, 90(9), 948-956.
[ix] Yuan, S., Freeman, R., Hill, K., Newton, T., & Humphris, G. (2020). Communication, trust and dental anxiety: a person-centred approach for dental attendance behaviours. Dentistry Journal, 8(4), 118.
[x] Sensabaugh, C., & Sagel, M. E. (2009). Stannous fluoride dentifrice with sodium hexametaphosphate: review of laboratory, clinical and practice-based data. American Dental Hygienists’ Association, 83(2), 70-78.
[xi] Rajendiran, M., Trivedi, H. M., Chen, D., Gajendrareddy, P., & Chen, L. (2021). Recent development of active ingredients in mouthwashes and toothpastes for periodontal diseases. Molecules, 26(7), 2001.
[xii] Varoni, E., Tarce, M., Lodi, G., & Carrassi, A. (2012). Chlorhexidine (CHX) in dentistry: state of the art. Minerva Stomatol, 61(9), 399-419.
[xiii] Vyas, T., Bhatt, G., Gaur, A., Sharma, C., Sharma, A., & Nagi, R. (2021). Chemical plaque control-A brief review. Journal of Family Medicine and Primary Care, 10(4), 1562.
[xiv] Van Strydonck, D. A., Slot, D. E., Van der Velden, U., & Van der Weijden, F. (2012). Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. Journal of clinical periodontology, 39(11), 1042-1055.
[xv] Rajendiran, M., Trivedi, H. M., Chen, D., Gajendrareddy, P., & Chen, L. (2021). Recent development of active ingredients in mouthwashes and toothpastes for periodontal diseases. Molecules, 26(7), 2001.
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