I received the following info on Friday. Periodontal disease is something the dental profession sees, diagnoses, and treats every day. As the profession learns more about the disease and ways to potentially treat it, we need science to lead the way. This is a long post, but that's because I also included the footnoted references for you to review as well. Here's the report:
NHANES data show that 42.2% of dentate US adults aged 30 years or older had some degree of periodontitis, while prevalence reached 59.8% among adults aged 65 or older
Following two days of work and discussion at Kenvue’s headquarters in New Jersey, a multidisciplinary group of US and international experts has made progress in defining recommendations tailored to the realities of oral healthcare in the United States, with a focus on strengthening prevention and management of periodontal diseases.
Held as part of the ‘Principles for Oral Health’ initiative, led by the SEPA Foundation and sponsored by LISTERINE, the meeting brought together specialists in periodontology, dental hygiene, research, and education from leading US and international academic institutions, including the University of Michigan, the University of California, San Francisco (UCSF), the University of Pennsylvania, Ohio State University, Texas A&M University, A.T. Still University, and Complutense University of Madrid.
“Bringing together this exceptional group of US and international experts reflects our conviction that prevention must sit at the heart of periodontal care. With more than four in ten American adults affected by periodontitis, translating rigorous science into practical, personalized guidance for the dental team has never been more important. Through ‘Principles for Oral Health’, LISTERINE and SEPA are proud to put science at the service of oral health professionals, and, ultimately, of their patients”, comment Smruti Nair, Medical Affairs Lead, Oral Care, Kenvue
A particularly significant challenge in the United States
The need to move toward risk-based preventive strategies is especially relevant given the high burden of periodontal disease in the United States. According to National Health and Nutrition Examination Survey (NHANES) data analyzed by Eke and colleagues, 42.2% of dentate US adults aged 30 years or older had some degree of periodontitis, while 7.8% had severe periodontitis. [1]
The same study reported an overall prevalence of periodontitis of 59.8% among adults aged 65 or older and 59.9% among people who reported having diabetes. Prevalence was also higher among men (50.2%) than women (34.6%) and among current smokers (62.4%) than nonsmokers (34.4%). [1]
These data underscore the importance of identifying groups with a higher burden of disease or greater difficulty maintaining adequate biofilm control, and of incorporating individual risk assessment into prevention strategies.
Gingivitis: an important prevention window
The prevention of periodontal disease begins with effective management of gingivitis, the reversible inflammatory condition of the gingiva that precedes periodontitis. Managing gingivitis therefore represents an important opportunity for intervention and prevention. [2,3,4]
Patient-performed oral hygiene, through toothbrushing and interdental cleaning, remains the cornerstone of gingivitis management and the prevention and management of periodontal diseases. However, even when patients receive appropriate instructions and brush for the recommended length of time, mechanical biofilm removal may be insufficient for part of the population.
What the evidence says about antiseptics
The scientific evidence reviewed supports the use of certain antiseptic agents and mouthrinses as adjuncts to mechanical oral-hygiene measures. Among the agents reviewed, essential oils, chlorhexidine, and cetylpyridinium chloride have shown the greatest efficacy in reducing dental biofilm and gingival inflammation when used in addition to mechanical control. [3,5]
Their role should be understood within a personalized, risk-based approach. These products should not be routinely recommended to the entire population; their use should be individualized according to the patient’s characteristics, clinical needs, and any difficulties in achieving adequate mechanical biofilm control. There is currently insufficient direct evidence to conclude that antiseptics used at home can, by themselves, prevent the onset of periodontitis. [3,4,5]
Prevention continues after periodontal treatment
Individualization is also particularly important for patients who have already received periodontitis treatment and are enrolled in periodontal maintenance programs. The available evidence points to additional benefits in terms of gingival inflammation and biofilm levels when certain antiseptics are used in addition to mechanical measures, especially in patients with local or systemic factors that make biofilm control more difficult. [6]
Secondary prevention—aimed at preventing disease recurrence—is therefore part of ongoing periodontal care. The goal is to maintain treatment outcomes over the long term and tailor oral-hygiene strategies to each patient’s circumstances.
Risk-based prevention: who may particularly benefit?
One of the main conclusions is that periodontal prevention should be tailored to each patient’s profile and needs. [2, 6] The experts consider it particularly important to identify the circumstances that may make daily biofilm control more difficult.
Local factors include difficulty accessing certain areas to clean them properly (as may occur in people with crowded teeth, restorations with overhanging margins, or certain orthodontic appliances), as well as anatomical features that encourage biofilm retention. Patients with extensive or complex prosthodontic restorations may also require specific consideration.
General factors include certain chronic diseases, particularly when diabetes is suboptimally controlled; frailty and advanced age; temporary or permanent limitations in manual dexterity; and low motivation to maintain appropriate oral-hygiene measures. Recovery after certain surgical procedures may also temporarily limit a patient’s ability to perform proper mechanical oral hygiene.
“Not all patients have the same ability to achieve effective biofilm control through mechanical measures. It is therefore essential to identify the circumstances that can make daily oral hygiene more difficult and assess when an adjunctive strategy may provide an additional benefit,” says Dr. Gustavo Ávila-Ortiz, co-leader of this project and Clinical Professor and Director of Graduate Periodontics, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry.
Situations in which mechanical oral hygiene may be limited
The recommendations also address certain clinical situations in which mechanical biofilm control may be temporarily compromised. During specific phases of periodontal treatment, chlorhexidine may be considered for limited periods as an adjunct to subgingival mechanical instrumentation in selected cases. [6] After certain surgical procedures, when the patient cannot adequately clean the treated area, certain mouthrinses may help control biofilm and promote favorable healing conditions. [7,8]
“The value of antiseptics does not lie in replacing toothbrushing or interdental cleaning, but in their ability to provide additional support for controlling biofilm and gingival inflammation in certain patients and clinical situations,” notes Dr. Ana Molina, Associate Professor of Periodontology, Faculty of Dentistry, Complutense University of Madrid, and co-leader of the project.
When should special precautions be taken?
Individualization also involves identifying situations in which special caution is required. The experts note that children under six and people who cannot adequately control swallowing should avoid mouthrinses to prevent accidental ingestion. The safety of these agents has not been sufficiently studied in pregnant or breastfeeding women; local regulations and the advice of the relevant healthcare professionals should therefore be followed.
More personalized prevention
The recommendations developed in New Jersey thus reinforce a central principle of ‘Principles for Oral Health’: the need to incorporate individual risk assessment into periodontal prevention. The available evidence makes it possible to identify situations in which certain adjunctive strategies may provide an additional benefit, but their use should always be integrated into an approach built on mechanical biofilm control, patient education, and professional follow-up.
The work carried out in the United States represents another step in the development of ‘Principles for Oral Health,’ an international initiative whose purpose is to translate scientific evidence and clinical practice guideline recommendations into a useful, practical framework for US oral-health professionals.
Expert panel
- Ana Molina: Associate Professor of Periodontology, Department of Clinical Dental Specialties, Faculty of Dentistry, Complutense University of Madrid (UCM).
- Gustavo Ávila-Ortiz: Clinical Professor and Director of Graduate Periodontics, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry. Editor-in-Chief, The International Journal of Periodontics and Restorative Dentistry.
- Elena Figuero: Associate Professor in Periodontology and Secretary of the Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid (UCM). Coordinator, ETEP Research Group. Director, Research Methodology in Dentistry Programme, SEPA. EFP Workshop Committee Chair.
- David Herrera: Dean of the Faculty of Dentistry, Complutense University of Madrid (UCM); Co-Director, Master’s Programme in Periodontology. EFP Workshop Committee Secretary.
- Effie Ioannidou: Professor and Chair, Department of Orofacial Sciences, University of California, San Francisco (UCSF). Editor-in-Chief, Journal of Periodontology and Clinical Advances in Periodontics. President, AADOCR.
- Paul A. Levi, Jr., DMD: Professor, Harvard School of Dental Medicine, Tufts University School of Dental Medicine, Universitat Internacional de Catalunya (Barcelona).
- Carlos Parra: Clinical Associate Professor and Program Director, Postgraduate Periodontics, Texas A&M University College of Dentistry, Dallas, Texas.
- Danielle Rulli, DHSc, MS, RDH, FNAP: Associate Professor and Director, Graduate Dental Hygiene Program, Ohio State University College of Dentistry.
- Ann Spolarich, RDH, PhD, FSCDH: Professor, Course Director of Pharmacology and Assistant Dean for Research, Arizona School of Dentistry & Oral Health (ASDOH), A.T. Still University.
- Flavia Teles: Professor, University of Pennsylvania School of Dental Medicine. Editorial Board member, Journal of Periodontology. Member, Task Force on Design and Analysis in Oral Health Research.
References
1. Eke PI, Thornton-Evans GO, Wei L, et al. Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009–2014. J Am Dent Assoc. 2018;149(7):576–588.e6. doi:10.1016/j.adaj.2018.04.023.
2. Chapple IL, Van der Weijden F, Doerfer C, et al. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol. 2015;42 Suppl 16:S71-S76. doi:10.1111/jcpe.12366.
3. Figuero E, Herrera D, Tobias A, et al. Efficacy of adjunctive anti-plaque chemical agents in managing gingivitis: a systematic review and network meta-analyses. J Clin Periodontol. 2019;46(7):723–739. doi:10.1111/jcpe.13127.
4. Serrano J, Escribano M, Roldan S, et al. Efficacy of adjunctive anti-plaque chemical agents in managing gingivitis: a systematic review and meta-analysis. J Clin Periodontol. 2015;42(Suppl 16):S106–138. doi:10.1111/jcpe.12331
5. Escribano M, Figuero E, Martin C, et al. Efficacy of adjunctive anti-plaque chemical agents: a systematic review and network meta-analyses of the Turesky modification of the Quigley and Hein plaque index. J Clin Periodontol. 2016;43(12):1059–1073. doi:10.1111/jcpe.12616.
6.Sanz M, Herrera D, Kebschull M, et al. Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22):4–60. doi:10.1111/jcpe.13290.
7. Chye RML, Perrotti V, Piattelli A, et al. Effectiveness of Different Commercial Chlorhexidine-Based Mouthwashes After Periodontal and Implant Surgery: A Systematic Review. Implant Dent. 2019;28(1):74-85. doi:10.1097/ID.0000000000000854.
8. Solderer A, Kaufmann M, Hofer D, et al. Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review. Clin Oral Investig. 2019;23(1):21-32. doi:10.1007/s00784-018-2761-y.
No comments:
Post a Comment