Tooth brushing in just 10 seconds?
Automatic toothbrushing could have future potential, but still requires further technical developments to improve existing shortcomings with regard to customizsation for different jaw sizes and tooth positions, interdental spaces and choice of optimal brushing time.
When as well as possible is not good enough
Even when told to brush their teeth as well as possible, the quality of tooth brushing among young adults is poor; the main weaknesses are cleaning palatal/lingual surfaces and overall brushing technique.
Peri-implant mucositis – are chemical adjunctive therapies effective? Part 2!
Additional measures locally applied or taken systemically by the patient (e.g. antiseptics in the form of mouth-rinse solutions or probiotics) could have an additional positive effect in the treatment of peri-implant mucositis.
Prevention is the best treatment!
Optimal diabetes control, regular supportive implant therapy and augmentation of peri-implant soft tissue deficits have proven to be crucial features in primary prevention of peri-implant diseases.
Non-surgical peri-implantitis treatment – chemical cleaning ...?
Chemical additives for cleaning the implant surface as part of non-surgical peri-implantitis therapy may make sense, but there is a shortage of well-conducted studies with a sufficient number of patients and a long-enough follow-up period to really be able to recommend a specific method and/or a specific product.
Non-surgical peri-implantitis treatment – gold standard ...?
Due to a continuing lack of well-conducted clinical studies, it is still not possible, based on the evidence, to give a clear treatment guideline for mechanical cleaning as part of non-surgical peri-implantitis treatment.
Electric interdental cleaning – a good alternative …?
Electrically-powered interdental cleaning devices seem to have a comparable effectiveness to dental floss for gingivitis patients, but at the same time have the advantage that patients prefer them.
Peri-implant mucositis – are chemical adjunctive therapies effective?
Based on the evidence, it is not possible to recommend professionally administered chemical adjunctive therapies in the treatment of peri-implant mucositis; the products tested to date did not demonstrate any significant benefits in comparison with debridement alone.
Chewing gum as treatment …?
Chewing sugar-free xylitol chewing gum could have significantly positive effects in reducing gingival inflammation when used as an adjunct to traditional therapies for treating gingivitis (mechanical cleaning and optimisation of home oral hygiene), but further clinical studies are required in order to confirm this assumption.
Periodontal diagnosis made easy
Implementing the new classification for periodontal and peri-implant diseases takes time and is a question of experience and practice, but simple reference tools such as a flowchart can help with this process.
Oral hygiene helps even in difficult situations!
Oral health (gingivitis, periodontitis) influences the occurrence and the healing process of oral mucositis in patients with haematological disorders who are given high-dose chemotherapy.
Air polishing as an adjunct in non-surgical periodontal treatment …?
As part of non-surgical periodontal treatment, the additional use of air-polishing treatment could be beneficial for deep baseline probing pocket depths (≥ 5.5 mm) in particular.
Artificial intelligence in dental practice
The use of artificial intelligence with the aim of optimising home oral hygiene significantly improved the results in non-surgical periodontal therapy
Gingivitis treatment = happier and healthier patients!
Treating gingivitis is not only the most effective option for preventing the occurrence of periodontitis, but also leads to a reduction in systemic inflammatory markers, whilst also improving the patient’s quality of life in terms of oral health.
What is the situation with e-cigarettes and periodontal health?
Based on the available literature, the smoking of e-cigarettes seems to have a slightly less negative effect on periodontal health compared to traditional cigarettes.
Periodontitis & bowel disease – Is there a link?
Patients with inflammatory bowel disease have a higher risk of oral diseases (periodontitis and tooth loss) and these diseases appear in turn to increase the degree of activity of inflammatory bowel disease.
Lifelong supportive periodontitis treatment? Absolutely!
Periodontitis patients should always be integrated into supportive periodontitis treatment, as otherwise the rate of recurrence, and therefore a further episode of periodontal inflammation, is likely to be very high.
The long-lasting effects of smoking on our implants …
Tobacco consumption has a lasting negative effect on the peri-implant tissue and leads to an increased risk of developing periimplantitis. This negative effect continues for years, even after an individual has successfully stopped smoking.
Tooth loss rate in Europe – what is the trend?
We always endeavour to improve the health of our patients’ teeth, but are we actually successful in achieving this? Has oral health in Europe actually improved in recent years/decades and are our patients actually losing fewer teeth?
Emdogain – can it help even without surgery …?
Emdogain is a product that consists of enamel matrix proteins and is obtained from porcine tooth germs. It has been successfully used in periodontal surgery for more than 20 years and, with the right indication and application, it can be used to achieve outstanding results including at least partial regeneration of periodontal defects.
Periodontitis doesn’t normally come alone!
As early as 2016 (Monsarrat et al. 2016), a study outlined a link between periodontitis and 57(!) systemic diseases, the most well-known of these being diabetes mellitus and cardiovascular diseases. Time and again, these links prompt a discussion about the need for positive cooperation between dentists and doctors in order to improve early diagnosis of specific systemic diseases.
Sensitive tooth cervix following periodontal therapy...
Experiencing cervical tooth sensitivity following periodontal therapy? Here’s what you can do about it! Non-surgical periodontal therapy can unfortunately entail a number of disadvantages, which are the sources of some complaints from our patients time and again. For example, they complain about the longer appearance of their teeth and/or about increased sensitivity of the exposed tooth cervix. Studies have shown that around 60 to 90% of our patients suffer from cervical tooth sensitivity in the period immediately following non-surgical periodontal therapy and that from a third up to a quarter of patients still suffer from cervical tooth sensitivity after 4 to 8 weeks (Lin et al. 2012).
When does it make sense to splint teeth?
Periodontitis and the related attachment loss inevitably lead to increased tooth mobility after a certain period of time. This increased tooth mobility often makes patients aware that “something is not right,” but for many patients it is also a very unpleasant side effect of periodontal disease and one which can make them feel as if they are losing their teeth.
Does periodontitis increase the risk of gestational diabetes
The links between diabetes mellitus and periodontitis are very well described and documented in the literature. A specific malfunction in the sugar metabolism can occur during pregnancy, which is referred to as gestational diabetes. In Austria, around 5–10% of all pregnant women are affected by gestational diabetes.
Interdental cleaning – by itself or with an “extra” component?
Every day we try to persuade our patients to brush their teeth twice a day and to brush the interdental spaces at least once a day as well. However, we all know how particularly difficult it is to persuade our patients to brush the interdental spaces, as this calls for a certain amount of skill on their part.
Can yoghurt reduce tooth loss ...?
Many beneficial effects on our health are attributed to the consumption of dairy products. Research indicates that there is a lower risk of diabetes mellitus, metabolic syndrome and cardiovascular disease. It also describes beneficial effects specifically for the oral cavity thanks to the consumption of dairy products. Certain studies, for example, showed that high and regular consumption of dairy products led to a lower risk of periodontitis.
Knowledge is motivation!
The key to success in periodontal treatment is the cooperation of the patient. If the patient fails to comply every day of their life with good and efficient oral hygiene at home and fails to attend recalls consistently, we will unfortunately fail despite all our efforts.
Can too much coffee lead to tooth loss …?
Coffee is clearly one of the world’s favourite drinks! For example, in 2019 around 160 million 60-kilo sacks of coffee were consumed worldwide, and Austria is also one of Europe’s biggest consumers of coffee. In Austria, annual consumption is around 162 litres or 7.2 kilos – this equates to an average of 2.6 cups of coffee per person per day!
Medium bristles – are they really a problem?
The discussion on soft, medium or hard bristled toothbrushes is not a new one, and yet new literature on the subject is appearing all the time, so it is something we are keen to address.
Successful treatment – does it make a difference?
The ‘new’, although also now almost five-year-old, classification for periodontal and peri-implant conditions included a definition for a successfully treated periodontitis patient for the first time.
Lessons from the pandemic: continuity in treatment is important!
The Covid-19 pandemic has posed and continues to pose major challenges for all of us – this includes our patients and their compliance in terms of attending regular dental check-ups. For example, already during the first few months of the pandemic, patients proved to be far more reluctant to attend medical check-ups and appointments (Makiyama 2020). Now that the pandemic has continued for far longer than initially anticipated, however, it is important for us to encourage our patients to begin attending regular appointments for check-ups and treatment again.
Prognosis for teeth with through-and-through furcations
The optimal treatment result for periodontitis patients is for them to keep their own teeth in good condition for as long as possible. However, there are both patients and teeth with certain characteristics that make it significantly harder to actually achieve this objective!
AirFloss – a popular alternative …?
Interdental cleaning is not a favourite activity for most patients. Furthermore, based on a survey of 2000 representative Americans, it was found that almost a third of patients lie to their dentist when asked about their teeth-cleaning habits and, in particular, about the use of dental floss. Having said that, it is our responsibility to recommend the best tool for effective interdental cleaning for each of our patients – in terms of effective plaque removal, but also in terms of long-term compliance.
Air polishing as an adjunct to ultrasound?
According to the recently published S3 guidelines about treating patients with stage I–III periodontitis (Sanz 2020), the current evidence-based recommendation is to perform subgingival debridement as part of non-surgical periodontal treatment with hand instruments and/or (ultra)sound devices. But of course, the search continues to find options that will further improve the outcome of non-surgical periodontal treatment.
How often should we actually be cleaning our teeth?
We are used to telling our patients, ‘Clean your teeth twice daily!’. But where does this idea come from, and is it really necessary to brush twice daily? What would happen if we only brushed our teeth once every two days?
Which factors have affected dental status in the last two decades?
In Germany, cross-sectional studies of oral health are carried out at regular intervals (German Oral Health Study). Data from five cross-sectional studies are available thus far, and the sixth study is scheduled to take place between 2021 and 2023.
Can using mouth-rinse reduce the pain of periodontal treatment?
To achieve a high level of compliance among periodontitis patients in the maintenance phase of treatment, it is important to make this maintenance therapy, including professional mechanical plaque removal, as pleasant as possible. Unfortunately, however, patients often experience pain during cleaning with (ultra)sonic devices, which could reduce their compliance later on and, in particular, in the long term.
Stress results in poorer treatment outcomes!
In a previous article (‘Does periodontitis cause anxiety and depression?’) we explored the links between periodontal disease and mental illnesses and, based on a systematic review, it was shown that periodontitis increases the risk of both depression and anxiety disorder. This connection is thought to be bi-directional.
Regular tooth brushing reduces the risk of stroke!
‘Tooth brushing and risk of stroke’ – are the two really connected? This hypothesis is based on the following theory: Poor and insufficient oral hygiene can lead to gingivitis and, in turn, to periodontitis. In periodontitis, oral bacteria can enter the bloodstream, resulting in a local and systemic inflammatory reaction. This inflammatory reaction is accompanied by an increase in inflammatory markers, and it is this mechanism that could in turn increase the risk of having a stroke.
Does periodontitis cause anxiety and depression?
Are anxiety and depression caused by periodontitis? Or is periodontitis caused by anxiety and depression? According to the literature, the connection between periodontal disease and mental illness or mood disorders is probably bi-directional; this means that each illness can influence the other.
Covid-19 & oral symptoms
According to data from the World Health Organization (WHO), almost 110,000,000 people have tested positive for Covid-19 since the pandemic began in December 2019, and 2,435,000 of these cases have had a fatal outcome. On account of this huge outbreak, our professional and social lives have also changed over the past twelve months, in some cases massively.
Covid-19 & periodontitis
In the previous article we summarized the results of a systematic review about manifestations of oral symptoms in patients with a Covid-19 infection (see: Covid-19 & oral symptoms). Another fascinating study was recently published in the Journal of Clinical Periodontology. In this study, Marouf et al. (2021) investigated the possible influence of periodontitis on the progression of Covid-19 infections.
Mechanical biofilm management at home
Mechanical biofilm management at home is indispensable for preventing gingivitis and subsequent periodontitis. The German Society for Periodontology (DG Paro) recently published new guidelines on this topic: ‘Mechanical biofilm management at home for the prevention and treatment of gingivitis’
The long-lasting effects of smoking on our teeth …
How can we demonstrate to our patients exactly how bad smoking is for the teeth? We already tackled this topic in one of the first scientific articles and were able to provide a very vivid example (Smoking & periodontitis): ‘Smoking substantially reduces the ability of the periodontium to heal during periodontal treatment – it is thought that the healing capacity of a 50-year-old smoker’s periodontium roughly corresponds to that of an 86-year-old non-smoker’s periodontium – that is a difference of 36 years!’
Treating periodontal disease during pregnancy
Periodontitis and pregnancy – it’s something we deal with regularly in our day-to-day work. But what can we do? And – most importantly – what are we allowed to do?
Diabetes & periodontitis
Diabetes mellitus and periodontitis are two of the most common chronic diseases. Diabetes mellitus affects approximately 415 million people worldwide, and periodontitis affects as many as 750 million. Furthermore, these two diseases mutually affect each other, and periodontitis constitutes one of the main complications of diabetes. But what exactly is the current situation among patients with periodontitis and/or type 2 diabetes mellitus?
Periodontal treatment in patients with diabetes – what do you need to know?
We recently discussed the links between periodontitis and diabetes mellitus. But what do you need to watch out for when giving periodontal treatment to patients who also have diabetes?
The patient has their new implant-supported prosthesis – what now?
The patient has received their new implant-supported prosthesis, but our work is not done yet. Now we have to help the patient enjoy their new implant and crowns for as long as possible, a task that includes keeping the implant and surrounding tissue healthy and free from inflammation. To enable prompt recognition of any peri-implant disease that may subsequently occur, it is important to perform a ‘baseline examination’ after the patient has received their implant-supported prosthesis.
Smoking & periodontitis
Smoking and periodontitis – how bad is it really?
Taking good implant X-rays made easy!
To be able to diagnose peri-implant diseases correctly, it is helpful to have good-quality, informative X-rays. However, periapical bitewing X-rays of implants in particular can often turn out blurry. There is, however, one very simple rule you can follow to correct these images and to depict implant threads clearly and precisely, thus enabling exact determination of the patient’s bone level. Furthermore, this rule is easy to remember and, above all, can be implemented rapidly in daily clinical practice.
New classification scheme for periodontal diseases
In June 2018, as part of the EuroPerio 9 conference in Amsterdam, the long-awaited new classification scheme for periodontal and peri-implant diseases was presented publicly to dentists.
Classification of clinical periodontal health
For the first time, the new classification scheme for periodontal diseases, which was presented in June 2018, contains a definition of the concept of clinical periodontal health (Lang & Bartold, 2018).
Classification of gingivitis
The new classification continues to differentiate between plaque-induced gingivitis and non-plaque-induced gingival diseases (Chapple et al., 2018).
How to correctly diagnose peri-implant mucositis
Up to what point can an implant and its surrounding tissue be described as healthy? And at what point are caution and appropriate treatment required because the diagnosis of peri-implant mucositis already applies?
Probing of implants – what to consider
Regardless of whether you are treating a new patient or seeing an existing patient for a check-up, there is no doubt that implants (see article ‘The patient has their new implant-supported prosthesis – what now?’) need to be monitored right from the start, just as natural dentition does – and that includes measurement of pocket probing depths!
How to correctly diagnose peri-implantitis
The article ‘How to correctly diagnose peri-implant mucositis’ discussed the criteria for peri-implant health and peri-implant mucositis. But how can you tell that the patient’s condition has already reached an advanced stage – in other words, how can I correctly diagnose peri-implantitis?
Classification of gingivitis
In June 2018, as part of the EuroPerio 9 conference in Amsterdam, the long-awaited new classification scheme for periodontal and peri-implant diseases was presented publicly to dentists.
The importance of an up-to-date medical history
It is important to fully update our patients’ general medical history and medication at regular intervals (at least once per year) – even for patients we have known ‘for years’.
Chemical biofilm management at home
Mechanical biofilm management should always be regarded as the basis for preventing periodontal diseases. It combines tooth brushing and interdental cleaning.
Periodontitis – is it a risk for peri-implantitis....?
Affecting approximately 750 million people, periodontitis is the sixth most common disease worldwide. Apart from caries, it is the most common cause of tooth loss. Consequently, periodontitis patients often ask their dentist about implant-supported dentures.
Use of antibiotics in periodontal treatment
In light of the growing problem of antimicrobial resistance, any use of antibiotics in dentistry should be given careful consideration, and antibiotics should only be administered if they can genuinely lead to a clinically significant improvement in treatment outcome. It is therefore important to develop guidelines on this topic that are based on the available literature, and just such a guideline was recently drawn up by the German Society of Periodontology (DG Paro): ‘Use of systemic antibiotics as an adjuvant to subgingival instrumentation as part of systematic periodontal treatment’
A residual pocket probing depth of 6 mm – is it a problem?
It is a situation we are all too familiar with: following the active phase of treatment, nearly all the patient’s teeth are now unaffected by increased pocket probing depths. However, there are still 1 or 2 places where the treatment goal has unfortunately not been achieved.
Periodontal maintenance therapy – how often do I need it?
A very common question after the active phase of periodontal therapy is how high the patient’s risk is of re-developing periodontal problems.
Interdental care – what is the best option?
Whether manual, sonic or electric, a toothbrush on its own is unfortunately insufficient to achieve perfect oral hygiene, because it is simply unable to penetrate the interdental spaces deeply enough. But what advice should we give to our patients?
No-one wants bad breath ...
Bad breath (halitosis) can be extremely unpleasant for those affected, and it is estimated that approximately one person in four struggles with persistent bad breath. A Belgian study (Quirynen 2009) investigated 2000 patients whose main concern was unpleasant bad breath. The study showed that the oral cavity was the source of bad breath in 75% of patients and thus fell within the dentist’s remit. Only 10% of cases had an extraoral cause, and 15% of participants had what is known as pseudohalitosis, where a patient is convinced they have bad breath even though it can be neither detected nor perceived by other people.
Air-polishing devices in periodontal treatment
Air polishing devices have become a firmly established part of periodontal treatment in recent years. But how efficient are they? What applications do they have? What should be considered when using them?
Air-polishing devices – are there any risks?
The previous article ‘Air-polishing devices in periodontal treatment’ has already discussed the effectiveness of air-polishing devices and the importance of using the right powder to avoid damaging the hard and soft tissues. But what else needs to be considered when using these devices?
Does periodontal treatment really pay off?
The previous report discussed a question that patients frequently ask: ‘will periodontal treatment really make me feel better?’ And, based on the literature, this question should be answered with a resounding ‘yes!’ However, personal well-being and oral-health-related quality of life are not the only issues – for many patients, financial considerations are also of primary concern, prompting the question: ‘does periodontal treatment really pay off?’
Will periodontal treatment really make me feel better?
From the patient’s point of view in particular, having treatment for periodontal disease can seem tedious and stressful. Patients find one fact hard to deal with in particular: periodontal disease is a chronic condition that requires a life-time follow-up (every 3 months in severe cases) to ensure the patient’s periodontal status remains stable after the active phase of treatment and during maintenance therapy. Inevitably we are asked the following question again and again: ‘will periodontal treatment really make me feel better?’
Using smart phones in prophylaxis
The use of smart phones for ‘mHealth’ (mobile health) in prophylaxis is becoming more and more fashionable – but what does it involve exactly?
Dentine hypersensitivity – what can be done?
Exposed dentine often leads to painful teeth and causes a short sharp pain. If this pain occurs regularly, it can substantially impair the patient’s quality of life. The prevalence of dentine hypersensitivity varies according to the population being investigated; as an example, however, one study found it affected 40% of individuals aged 18 to 35 (West et al. 2013). Any treatment should ideally be easy to use, effective, rapid and long-lasting.
Diabetes screening at dental surgeries?
The bidirectional links between periodontitis and diabetes are undisputed, and a big problem associated with diabetes is the relatively high number of unreported cases. To improve this number and to identify patients with pre-diabetes and diabetes sooner, the potential role of the dental surgery has been discussed more and more in recent years.
Electric toothbrushes have a proven long-term effect
The effectiveness of electric toothbrushes is undisputed, and their safety when used correctly has also been proved over a period of at least 3 years (see also: ‘Can brushing your teeth be harmful...?’). This fact was also recently stressed in the new guidelines of the German Society for Periodontology (DG Paro; see also: ‘Mechanical biofilm management at home for the prevention and treatment of gingivitis’). And the last systematic Cochrane Review systematischen Cochrane Reviews (Yaacob et al. 2014) also concluded that electric toothbrushes reduce plaque and gingivitis by a statistically significantly greater amount than manual toothbrushes do. However, the following question remains: does this statistically significant benefit really lead to a better periodontal status and less tooth loss in the long term?
Untreated peri-implant mucositis …
We know what we should do after the patient has been fitted with their implant-support prosthesis, but if our approach is less than strict, what actually happens? What happen to patients who have peri-implant mucositis but are nonetheless not included in a regular follow-up programme?
Should dental floss be used before or after tooth brushing?
It is often very hard to persuade our patients to clean between their teeth. Patients are often still advised to use dental floss, despite the fact we know that in many cases floss is not their method of choice and, above all, is often rather unpopular.
Smoking also affects the maintenance phase
A previous article (Smoking & periodontitis ) explained the severe effects of smoking on the periodontium. But how does a smoker’s periodontium behave compared with a non-smoker’s periodontium during the periodontal maintenance phase after active periodontal treatment?
NIWOP – No Implantology Without Periodontology
Sowohl periimplantäre Mukositis als auch Periimplantitis sind leider häufig auftretende biologische Komplikationen rund um dentale Implantate. Bei fast jedem 2. beziehungsweise 4.Patienten/Patientin wird eine periimplantäre Mukositis beziehungsweise Periimplantitis diagnostiziert (Derks & Tomasi 2015)!
NIWOP – pretreatment = the right start!
Patient request: ‘I would like to replace my missing tooth – can I have an implant?' In addition to implantological information, such as the patient’s available bone, medications, underlying diseases etc., several other very important factors need to be clarified before this question can be answered. Above all, these include the patient’s periodontal condition, their compliance and their smoking status. These issues are included and summarized in the first phase of the NIWOP workflow NIWOP Workflow (NIWOP – No Implantology Without Periodontology - )“ under ‘Pretreatment’. Everyone working in prophylaxis plays a very important role during this phase.
Cleanability is a must!
Both when treating peri-implant diseases and after fitting a new implant-supported restoration, our top priority should always be to provide patients with instructions regarding home oral hygiene. However, there is one thing we must not forget: It must be possible for the patient to actually clean their implant-supported restoration!
Personalized prevention – the implications of general health factors
Whether preventative or curative, dental measures need to be individually tailored according to the risk factors identified for each patient. In this context, general health is significantly influenced by three risk factors.
A long-term study confirms that implant follow-ups do help
In line with phase 3 of the NIWOP approach (NIWOP [No Implantology without Periodontology] – consistent & long-term follow-up care) regular implant follow-up sessions should be planned and adhered after completing implant treatment. But what happens if the practitioner and/or patient does not adhere to this, and regular implant follow-up sessions do not take place?
Periodontitis & cardiovascular diseases
The ‘Perio–Cardio Workshop 2019’ took place in February 2019. This workshop was organized by the World Heart Federation in collaboration with the European Federation of Periodontology
Orthodontic treatment of periodontitis patients – is such a thing possible ...?
Patients with periodontitis often suffer from the problem that loss of attachment has caused the position of their teeth to change – i.e. they have drifted, rotated and/or elongated. Flared anterior teeth with a gap between the central incisors is a very common finding among periodontitis patients. As a result, these patients very often ask about the possibility of getting the (usually unaesthetic) position of their teeth straightened – either before they undergo periodontal treatment, or at the latest after.
Is a manual or an electric toothbrush better during orthodontic treatment?
As mentioned in a previous article (article) one of the most important factors during orthodontic treatment is that the patient has a healthy, inflammation-free periodontium. This applies both to inherently periodontally healthy patients and to patients who have had successfully completed periodontal treatment.
Can probiotics be used in maintenance therapy?
The article ‘Probiotics in periodontal treatment – an overview’ took a first look at the potential role of probiotics in periodontal therapy. The review presented in that article was from 2016. Since then, however, several new studies on this topic have been published, one of which had an interesting approach: Can probiotics be used in maintenance therapy?
Mucositis & gingivitis – are they comparable?
Unfortunately, peri-implant diseases are an all too common part of our day-to-day work nowadays. Similar to gingivitis and periodontitis, the primary aetiological factor for developing peri-implant mucositis and peri-implantitis is the accumulation of oral biofilm. But how do the tissues respond to this bacterial load? Does the immune system also respond in a similar way?
Probiotics in periodontal treatment – an overview
The term ‘probiotics’ refers to a preparation that contains viable micro-organisms, such as species of lactobacilli and bifidobacteria, and is intended to have a positive effect on health.
Do air-polishing devices have any contraindications?
The use of air-polishing devices for the treatment of periodontal and peri-implant diseases is now part of daily routine at the dental surgery. When used for the right indications, they are regarded as safe and effective. In addition, patients often find them more pleasant than traditional methods.
Powders: moving it up a gear
Air-polishing has long been an integral component of prophylaxis and expands the treatment spectrum of a comprehensive preventative–curative workflow. By achieving the perfect balance of powder, handpiece and spray head, the supra- and subgingival area can be cleaned both thoroughly and gently. To help achieve an optimum patient outcome, it is therefore advisable to use systems that belong together.
S3 guideline – Subgingival instrumentation
In collaboration with the German Society for Periodontology (DGParo), in October 2019 the German Society for Dental, Oral and Maxillary Medicine (DGZMK) published a new S3 guideline on the topic of ‘Subgingival instrumentation’, which is now valid for five years. This new guideline primarily focuses on the following two main topics:
Some information about manual toothbrushes
Dagmar Else Slot is probably one of the most published dental hygienists, and her systematic reviews always make for interesting reading. This time she has published a review on the topic of the efficacy of manual toothbrushes, and this study also helps us to answer the question: Does it really make a difference whether I quickly brush my teeth for only one minute, or if I brush them for two?
Are all interdental brushes equal ...?
Interdental brushes are viewed as the tool of choice for patients with periodontitis. This is because for interdental attachment loss in particular, they are regarded as more effective than dental floss, for example. Most interdental brushes on the market are cylindrical in shape. However, a research group from Austria (Innsbruck Medical University) asked the valid question of whether this cylindrical shape truly is the ‘best’ for optimum cleaning efficacy (Schnabl 2019).
Interdental brush or oral irrigator?
In periodontal maintenance therapy, keeping our patients motivated is particularly important – in terms of both oral hygiene and attending appointments at the dental practice.
Oral hygiene – just get stuck in ...?
Anyone who works in prophylaxis is aware of the importance of oral hygiene home care, particularly if we want to treat our periodontitis patients successfully in the long term.
Do adjunctive therapies help in the treatment of gingivitis?
Another topic that was discussed as part of the Perio Workshop 2019 was the efficacy of chemical adjunctive therapies in the treatment of gingivitis. Of course, this is not a ‘new’ topic, and several reviews on this subject already exist; this time, however, two new issues were tackled:
Determining patients’ caries risk – what makes sense?
The main diseases we are confronted with in dentistry are caries and periodontal conditions. Although the results of the fifth German Oral Health Study show a positive trend for the two diseases, effective prevention of both must nonetheless be our primary goal. We discussed the options for caries prophylaxis in a previous article (‘Update on caries prophylaxis’). The current article is intended to provide an overview of the tests for determining patients’ caries risk.
What are the desired endpoints after periodontal treatment?
In addition to evaluating treatment methods, the following topic was also discussed at the Perio Workshop 2019: ‘What are we actually trying to achieve with periodontal treatment – from a practitioner’s perspective, but above all from a patient’s perspective?’
Adjunctive therapies in non-surgical periodontal treatment I
Another topic that was discussed as part of the Perio Workshops 2019 was the effectiveness of local and systemic adjunctive therapies or medications in non-surgical periodontal treatment.
Adjunctive therapies in non-surgical periodontal treatment II
In the recently presented systematic review by Donos et al. (‘Adjunctive therapies in non-surgical periodontal treatment I’), local and systemic adjunctive therapies were discussed in the context of non-surgical periodontal treatment. However, as part of the Perio Workshop 2019, the possibilities offered by local antibiotics were also assessed.
Adjunctive therapies in non-surgical periodontal treatment III
Following Part I (local and systemic non-antibiotic adjunctive therapies) and Part II (local antibiotics and antiseptics) about adjunctive therapies in non-surgical periodontal treatment, Part III now goes on to look at the results from the Perio Workshop 2019 regarding the effects of using systemic antibiotics as part of non-surgical periodontal treatment.
Subgingival instrumentation – Part II
Effective instrumentation of the root surface is an indispensable part of treating patients with periodontitis. In Part I of the topic ‘subgingival instrumentation’ based on the results of the Perio Workshop 2019, the effectiveness of ‘standard techniques’ [(ultra)sonic instruments, hand instruments or a combination of the two] was described. Part II of this topic will now focus on newer approaches, such as laser Technology and photodynamic therapy, as supplements to mechanical cleaning.
Protection from aerosols – S1 guideline of the German Society for Dental, Oral and Maxillary Medicine
Since the outbreak of the pandemic and the resulting global spread of SARS-CoV-2, aerosol-generating activities have been a hot topic of discussion in dentistry. How should we handle them? How can we best protect our patients and ourselves? What measures should we take in daily clinical practice?
Does using an intelligent toothbrush make for healthy gums?
In a previous article (Using smart phones in prophylaxis) we discussed the possible advantages of mHealth, the use of mobile electronic devices in healthcare, for dentistry. Tonetti et. al have just published a new study on this topic in the Journal of Clinical Periodontology, about the use of an intelligent electric toothbrush in combination with a mobile app.
Personalized prevention – case-oriented needs adaptation
A patient-oriented tailoring of preventative measures seems to be next logical step to counter the complexity of oral diseases for the future. Although existing strategies – for example, caring for periodontitis patients by means of supportive periodontitis treatment (SPT) – can stabilize the treatment outcome of an individual disease, their integration in a case-specific and needs-oriented preventative approach is lacking.
Peri-implant disease risk assessment
The ‘spider web diagram’ devised by Bern University is intended to help clinicians assess the individual risk profile of patients with periodontitis. You can find more information about this in a previous article (Periodontal maintenance therapy – how often do I need it?). But does such a thing also exist for implant patients? As of this year, the answer is: yes, it does – the Implant Disease Risk Assessment.
Dementia and periodontitis …?
The principal symptom of dementia is a worsening of cognitive capabilities. This can impact short-term memory, ability to think and/or motor skills, for example, and those affected lose the skills they once had.
Do lifestyle changes make for a healthier periodontium?
Periodontitis is an inflammatory disease of the periodontium. Even though the disease is therefore directly confined to the mouth, it nonetheless has an impact on the entire body; for example, on diabetes or cardiovascular diseases. By the same token, however, lifestyle changes can also have an impact on periodontal disease.
Smoking & peri-implantitis
Tabakkonsum ist unumstritten als Risikofaktor für Parodontitis – sowohl in Bezug auf das Auftreten und Fortschreiten einer Parodontitis, im Therapieansprechen, als auch in der Erhaltungsphase (siehe dazu: Rauchen & Parodontitis sowie Rauchen beeinflusst die Erhaltungsphase).
NIWOP – consistent and long-term follow-up treatment
The patient has been successfully pretreated (NIWOP – pretreatment = the right start!) ) and they have successfully completed implant treatment and been fitted with their prosthetic restoration – in short, the patient is now in phase 3 (‘Aftercare/follow-up phase’) of the NIWOP approach (NIWOP – No Implantology Without Periodontology). And this is the point at which the prophylaxis team should take on the patient again
Subgingival instrumentation – Part I
Based on the results of the Perio Workshop 2019, we previously discussed possible local and systemic adjunctive therapies for treating periodontitis (Adjunctive therapies in non-surgical periodontal treatment Part I, Part II and Part III). However, the key component of periodontal treatment remains subgingival instrumentation.
NIWOP – Part 1: The pre-treatment
NIWOP is a plannable workflow that starts long before implantation and continues beyond the prosthetic restoration. Its goal, aside from actual implant placement, is minimising the incidence of biological complications such as peri-implant mucositis or peri-implantitis. (The pre-treatment as per articles from PD Dr Kristina Bertl, PhD, MBA, MSc)