15 October 2021

Dental Check-Up Revisited

Welcome back. About 11 years ago, I released a blog post that became one of the blog’s most popular. In those years, I wrote mainly about me, and that post chronicled my dental history. (Yes, of course it was humorous, see Dental Check-Up Time.)

Simulated reconstruction of Warren’s dentist at work
from Dental Check-Up Time and Amazon).

It began when I was young, when one visited the dentist only if something was wrong. The likelihood of there being something wrong was much higher in those pre-fluoride, pre-flossing, pre-periodic cleaning, pre-sugarless gum, pre-soft-toothbrush days. And while there was Novocain, which is no longer the anesthetic of choice, it was used sparingly for the big stuff, like extractions.

I ended that post, noting how dentistry had evolved; the only pain on visiting a dentist nowadays is the bill. I also mentioned my dental epiphany. On my first visit to a new dentist some 25 years ago, I was shown the evil decay-causing micro-creatures that were sloshing around in my mouth. That night, I rushed out to buy an antiseptic mouthwash, and I’ve rinsed twice a day ever since. Evil or good, the micro-critters don’t stand a chance.

I was thrilled to see that my mouthwash made the cut in a recent study as one of the best approaches for dental care.  

That study by researchers affiliated with the University of Buffalo (one is now with the University of Rochester) identified the best, worst and unproven approaches for dental care.

Assessing Dental Care Approaches
The researchers’ ratings followed their search and assessment of published systematic reviews of self-administered interventions to prevent periodontal disease.

Lest the terms be unfamiliar, periodontal disease is mainly the result of infections and inflammation of the gums and bone surrounding and supporting the teeth. In its early stage, called gingivitis, the gums can become swollen and red and may bleed. In its more advanced form, called periodontitis, the gums can pull away from the teeth, bone can be lost and the teeth may loosen and even fall out. 

Periodontal disease progression (from https://medlineplus.gov/ency/imagepages/19942.htm).
Periodontitis is common but largely preventable. It's normally the result of poor oral hygiene.

OK. To speed you on your way, I’ll get right to the researchers’ findings. Be forewarned that relatively few interventions have been proven effective.

What’s Recommended, What’s Not?

Best: toothbrush; interdental brush; water pick; mouthwash containing chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC) or essential oils (e.g., Listerine).

Regular brushing (with periodic dental hygienist cleaning) controls dental plaque, the sticky, colorless or pale-yellow film of bacteria that forms on and between teeth, both above and below the gum line. Interdental brushes and water picks are effective for reducing gingivitis, as are mouthwashes based on CHS, CPC and essential oils.

Toothpicks, though not effective for gingivitis, are useful for monitoring gum health. Gently prodding gums and monitoring for bleeding can detect signs of gum disease.

Unproven: electric toothbrush, dental floss, probiotics, dietary supplements and many mouthwashes.

They may be easier to use, but electric toothbrushes are no better than properly used manual brushes for reducing plaque and gingivitis. Similarly, while flossing is essential for interdental cleaning (including removal of interdental plaque between tightly spaced teeth), its overall value for reducing plaque and gingivitis has not been shown.

Probiotics are a promising yet unproven strategy to prevent gum disease; but there’s little evidence that dietary supplements improve gum health or that mouthwashes containing tea tree oil, green tea, anti-inflammatory agents, hydrogen peroxide, sodium benzoate, stannous fluoride, hexetidine or delmopinol reduce gingivitis. There’s also insufficient evidence that professional plaque removal with a scraper (scaling) prevents gum disease.

Worst: toothpastes containing triclosan.

I used Colgate Total toothpaste for many years before seeing reports that triclosan, its main ingredient for controlling plaque and gingivitis, was a suspected carcinogen. More years passed before Colgate replaced triclosan with sodium fluoride.

Wrap Up
As forewarned, there are surprisingly few self-administered interventions proven to prevent gingivitis and periodontitis, which makes the researchers’ umbrella review even more valuable. I look forward to future updates and hope you agree.

Warren’s dental visit freebies--toothbrush, floss, interdental brush.
Thanks for stopping by.

Umbrella review of periodontal prevention strategies in Journal of International Academy of Periodontology: www.perioiap.org/publications/57-october-2021/256-proven-primary-prevention-strategies-for-plaque-induced-periodontal-disease-an-umbrella-review
Article on review on EurekAlert! website: www.eurekalert.org/news-releases/930042
Periodontal disease:

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