Non-surgical prophylaxis – Kate Scheer W&H UKFeatured Products Promotional Features
Posted by: The Probe 16th December 2019
Oral prophylaxis is a cornerstone of oral hygiene and health. Patients taking care of their teeth through regular, twice daily brushing with a fluoride toothpaste is the frontline defence against dental caries and the development of periodontal diseases. However, whether through inaction, difficulty or circumstance (for example, the presence of an orthopedic device, or a predisposing health condition), biofilms can advance in many patients to a stage beyond their ability to remedy. Removal of calcified deposits cannot be accomplished through regular means available to the public, and amateur attempts to do so can result in injury and further tissue damage. Non-surgical removal of these established biofilms through scaling and root planing (SRP) can rapidly and markedly reduce the bacterial load, in turn relieving the host’s immune response and reducing inflammation.
SRP does have some limitations, primarily in terms of access. This is chiefly a problem in cases of chronic periodontitis, where deep pockets, furcations and other subgingival sites can prove difficult to disinfect. Harmful bacteria (including P. gingivalis) are able to infect the epithelium, which not only protects them from the patient’s immune system, but also makes SRP more challenging. In cases of severe periodontitis, where the patient has deep pockets, using antibiotics in conjunction with SRP may be warranted. Where biofilms are accessible, the use of antibiotics is unnecessary and potentially harmful, as it provides additional opportunities for the bacteria to acquire resistance – most cases of periodontitis respond favourably to SRP without them. Antibiotics are less effective against bacteria within a biofilm (as opposed to free-floating), due to the protection it provides and so should not constitute the sole means of periodontal therapy. SRP helps disrupt biofilms, increasing the efficacy of antibiotic therapy where it is justified.[i]
For patients with halitosis, a tongue scraper and instructions in its use may be helpful. A study of patients with gingivitis followed two groups after they received scaling and polishing treatment. One followed a standard oral hygiene regime, while the other also included the use of a tongue scraper. Both groups saw significant improvements in their periodontal health, and the additional use of a tongue scraper was found to further reduce levels of volatile sulphur compounds. Gingival crevicular fluid analysis revealed that the group that also used the tongue scraper had significantly lower levels of proinflammatory cytokines (IL-1β and IL-8).[ii], [iii]These results would suggest that tongue cleaning may be a beneficial adjunct to patients’ oral hygiene, particularly following treatment for gingivitis.
Extractions and diabetes
Where periodontal status has reached a point where an extraction proves necessary, dental prophylaxis has proven its value as a non-surgical step that significantly improves outcomes. Studies show that full-mouth tooth cleaning following tooth extraction in patients with moderate to severe periodontitis, has significant therapeutic benefits over and above an extraction alone. While all periodontal patients benefit from as rapid a resolution as possible, it can be particularly valuable for patients with diabetes.[iv]
For patients with diabetes mellitus, there exists a bidirectional relationship between periodontal inflammation and the condition, with each increasing the risk and severity of the other. In patients with diabetes, proinflammatory expression is elevated, amplifying connective tissue damage and impairing wound healing.[v]Non-surgical treatments such as scaling have been demonstrated to significantly improve glycaemic control in patients with type 2 diabetes.[vi]
Non-surgical treatment can be just as useful to an individual with dental implants as it is to natural teeth. Air polishing systems have demonstrated their usefulness as an effective treatment option for mucositis. Non-surgical treatment using such systems can also help reduce the inflammation and number/depth of peri-implant pockets caused by peri-implantitis. However, there is disagreement in the literature as to whether it is a reliable treatment for peri-implantitis.[vii], [viii]
W&H provides a complete solution of products to enhance the quality of prophylaxis treatment. These include the new Proxeo Aura air polishing system and Proxeo Ultra piezo scalers.
W&H also offers the new Proxeo Twist LatchShort polishing system with a working height that is 4mm shorter than standard to ensure easy access to hard-to-reach areas. In addition, the Proxeo Twist Cordless facilitates far greater freedom of movement for easier, more effective prophylaxis, making this device ideal for domiciliary care. Accessing difficult to reach pockets of bacteria is a challenge to SRP, which can delay or thwart resolution of the disease – with advanced, space-efficient systems, targeting these last bastions is more achievable.
Non-surgical prophylaxis is valuable as an intervention, enabling dental professionals to restore oral hygiene by arresting the development of gingivitis and periodontitis. Where a tooth proves unsalvageable and an extraction and/or restoration is required, oral prophylaxis remains a useful treatment for helping to reduce inflammation and restore gingival health.
[i] Walters J., Lai P. Should antibiotics be prescribed to treat chronic periodontitis? Dental Clinics of North America. 2015; 59(4): 919-933. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592514/ June 20, 2019.
[ii] Acar B., Berker E., Tan Ç., İlarslan Y., Tekçiçek M., Tezcan İ. Effects of oral prophylaxis including tongue cleaning on halitosis and gingival inflammation in gingivitis patients – a randomized controlled clinical trial. Clinical Oral Investigations. 2019; 23(4): 1829-1836. https://link.springer.com/article/10.1007/s00784-018-2617-5 June 20, 2019.
[iii] Silva A., Faria M., Fontes A., Campos M., Cavalcanti B. Interleukin-1 betat and interleukin-8 in healthy and inflamed dental pulps. Journal of Applied Oral Science. 2009; 17(5): 527-532. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327685/ June 20, 2019.
[iv] Bukleta D., Krasniqi S., Beretta G., Daci G., Daci A., Nila A., Komoni T., Selmani M., Elshani B., Schara R. Impact of combined non-surgical and surgical periodontal treatment in patients with type 2 diabetes mellitus – a preliminary report randomized clinical study. Biomedical Research. 2018; 29(3): 633-639. http://www.alliedacademies.org/articles/impact-of-combined-nonsurgical-and-surgical-periodontal-treatment-in-patients-with-type-2-diabetes-mellitusa-preliminary-report-ra-9659.html June 20, 2019.
[v] Sun K., Chen S., Lin C., Hsu J., Chen I., Wu I., Palanisamy K., Shen T., Li C. The association between type 1 diabetes mellitus and periodontal diseases. Journal of the Formosan Medical Association. 2019; 118(6): 1047-1054. https://www.sciencedirect.com/science/article/pii/S0929664618305941 June 19, 2019.
[vi] Salman S., Khan K., Salman F., Hameed M. Effect of non-surgical periodontal treatment on glycaemic control among type 2 diabetes mellitus patients with periodontitis. Journal of Ayub Medical College Abbottabad. 2016; 28(4): 442-445.
[vii] Del Amo F., Yu S., Wang H. Non-surgical therapy for peri-implant diseases: a systematic review. Journal of Oral & Maxillofacial Research. 2016; 7(3): e13. http://www.ejomr.org/JOMR/archives/2016/3/e13/v7n3e13ht.htm June 19, 2019.
[viii] Schwarz F., Schmucker A., Becker J. Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis. International Journal of Implant Dentistry. 2015; 1: 22. https://journalimplantdent.springeropen.com/articles/10.1186/s40729-015-0023-1 June 19, 2019.