Regimen-Based Plaque Control

Author : Dental Product Shopper
Published Date 12/30/2008
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Dental plaque prominently contributes to oral diseases. Inadequate oral hygiene, provisional restorations, orthodontic appliances, and other factors may exacerbate plaque accumulation. This, in turn, can readily compromise clinical outcomes, jeopardizing the appearance and function of esthetic-restorative dentistry. In my experience, plaque control is rarely addressed during esthetic-restorative lectures, and if so, typically follows one of two approaches: 1) reinforcing normal oral hygiene or 2) use of a chlorhexidine rinse during treatment. The former is often insufficient, as exemplified by only 20% of adults in one large study reporting at least once daily flossing. For the latter, chlorhexidine acceptability, side effects, and other factors can limit compliance and compromise long-term clinical outcomes.

Regimen-based oral hygiene can represent a simple and effective approach for plaque control, requiring little training to achieve high levels of adoption and long-term compliance. My perspective ?from the podium? is that this simple 3-part combination represents a new, easy-to-use standard for plaque control during and after estheticrestorative care.

Dental plaque prominently contributes to oral diseases. Inadequate oral hygiene, provisional restorations, orthodontic appliances, and other factors may exacerbate plaque accumulation. This, in turn, can readily compromise clinical outcomes, jeopardizing the appearance and function of esthetic-restorative dentistry. In my experience, plaque control is rarely addressed during esthetic-restorative lectures, and if so, typically follows one of two approaches: 1) reinforcing normal oral hygiene or 2) use of a chlorhexidine rinse during treatment. The former is often insufficient, as exemplified by only 20% of adults in one large study reporting at least once daily flossing. For the latter, chlorhexidine acceptability, side effects, and other factors can limit compliance and compromise long-term clinical outcomes.

Regimen-Based Oral Hygiene

Given the impact of plaque on clinical outcomes, our research group sought an approach that may allow for optimal plaque control both during and after estheticrestorative care. The hypothesis was that an easy-to-use regimen involving multiple, complementary mechanisms of action might yield superior plaque reduction. To facilitate compliance, we selected a simple 2-step approach involving 3 marketed products:

  • advanced brush design via power rotation-oscillation (Oral-B Vitality) or manual criss-cross bristle technologies (Oral-B CrossAction)
  • chemotherapeutic dentifrice with 0.454% stannous fluoride (Crest Pro-Health)
  • chemotherapeutic rinse with 0.07% cetylpyridinium chloride (Crest Pro-Health).

This approach combines mechanical and chemotherapeutic effects for plaque control. The brushes provide incremental plaque removal, and the rinse and dentifrice are bacteriocidal. After only 2 minutes of in-office instruction, all treatment is accomplished at home.
Plaque reductions have been considerable. One case involved an adolescent male undergoing orthodontia who experienced appreciable overnight plaque accumulation. Images were collected using a fluorescent dye to temporarily disclose plaque for standard digital photography and measurement. Before the regimen, fluorescent overnight plaque is clinically evident. After using the assigned regimen for 1 week, clinical response was impressive even before brushing, with little overnight plaque accumulation.

While case studies illustrate the potential benefit, clinicians should seek additional evidence from randomized controlled trials that directly compare the treatment head-to-head versus a positive or negative control. Such research is widely recognized as providing the highest form of single study evidence of efficacy and safety.

 

From the Podium

Regimen-based oral hygiene can represent a simple and effective approach for plaque control, requiring little training to achieve high levels of adoption and long-term compliance. My perspective ?from the podium? is that this simple 3-part combination represents a new, easy-to-use standard for plaque control during and after estheticrestorative care.

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