Chemical biofilm management at home
PD Dr. Kristina Bertl, PhD MSc MBA
Mechanical biofilm management should always be regarded as the basis for preventing periodontal diseases. It combines tooth brushing and interdental cleaning.
If chemical products (mouth-rinse solutions) are used as an adjunct, they should improve the success of mechanical oral hygiene. The German Society of Periodontology (DG Paro) recently published a new guideline on this topic: ‘Chemical biofilm management at home for the prevention and treatment of gingivitis’
Mouth-rinse solutions for preventing gingivitis
The additional use of chemical antimicrobial substances in mouth-rinse solutions as an adjunct to mechanical cleaning can lead to a reduction in dental biofilm and can thus be recommended to prevent gingivitis. Based on the literature currently available, it is not possible to make an assessment regarding specific formulations or concentrations. Nonetheless, the greatest effects have been observed for mouth-rinse solutions containing essential oils or chlorhexidine (and triclosan/copolymer).
Mouth-rinse solutions for treating gingivitis
Antimicrobial mouth-rinse solutions containing the active substances amine fluoride/tin fluoride, essential oils, cetylpyridinium chloride, chlorhexidine and triclosan/copolymer had a statistically significant effect on reducing gingivitis compared with mechanical cleaning alone. However, comparison of the different active substances revealed that the effects differed in size. The greatest effects were achieved by mouth-rinse solutions containing essential oils or chlorhexidine and triclosan/copolymer.
Application in daily dental practice
Antimicrobial mouth-rinse solutions should be used in situations where a substantial short-term (approximately 2–4 weeks) reduction in bacterial count is required and where mechanical biofilm management is not possible (e.g. in post-operative aftercare). In such situations, rinse solutions that contain chlorhexidine at a concentration of 0.1% and higher should be used.
The following at-risk groups can use antimicrobial mouth-rinse solutions as an adjunct to their daily mechanical oral hygiene measures to prevent gingivitis:
- Patients who require special support and have an impaired ability to cope with everyday life (e.g. people in need of care).
- Patients with physical or mental impairments who are unable to achieve effective mechanical biofilm management.
- Patients on specific medications (e.g. during/after chemotherapy and/or radiotherapy).
- Patients with mechanically hard-to-access areas that preclude effective mechanical biofilm management.
In these cases, mouth-rinse solutions containing the following active substances can be recommended: amine fluoride/tin fluoride, essential oils, cetylpyridinium chloride, chlorhexidine <0.1%. Depending on the individual’s situation, a local application of mouth-rinse solution (e.g. with interdental brushes) can be considered.