Periodontal Disease - Prevention

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Mouthwashes. The value of many mouthwashes is highly controversial. Many have only temporary antibacterial value. Some can even harm the mucus membrane, and they can be dangerous to children who drink them. Those that are considered plaque fighters are chlorhexidine (prescription) and Listerine, which is available over the counter.

• Chlorhexidine (Peridex or PerioGard) is available by prescription only. It reduces plaque by 55% and gingivitis by 30 - 45%. Patients should rinse for 1 minute twice daily. They should wait at least 30 minutes between brushing and rinsing since chlorhexidine can be inactivated by certain compounds in toothpastes. It has a bitter taste. It also binds to tannins, which are in tea, coffee, and red wine, so it has tendency to stain teeth in people who drink these beverages.
• Listerine is composed of essential oils and is available over the counter. It reduces plaque and gingivitis, when used for 30 seconds twice a day. It leaves a burning sensation in the mouth that most people better tolerate after a few days of use. Some people might object to or have concerns about the high alcohol content in the standard version. Other forms of Listerine that have a different taste and lower alcohol content retain the same active ingredients and appear to be as effective. The usual regimen is to rinse twice a day. Generic equivalents are available. (Listerine PocketPaks, which are strips that dissolve on the tongue, have no proven effects on plague and gingivitis.)
• Mouthwashes containing cetylpyridinium (Scope, Cepacol) have moderate effect on plaque, but only if they are used an hour after brushing. None are as effective as Listerine or chlorhexidine, but they may still have some value for people who cannot tolerate the other mouthwashes.
• Mouthwashes containing stannous fluoride and amine fluoride (Meridol) are moderately effective, but are also not as effective as effective as Listerine or chlorhexidine.
• Fluoride mouthwashes (Act) are helpful in preventing cavities.
• Plax offers only modest protection against plaque and gingivitis. Even Advanced Formula Plax, which may show a minor reduction in plaque levels, does not seem to provide any protection against periodontal disease.

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Flossing. The use of dental floss, either waxed or unwaxed, is critical in cleaning between the teeth where the toothbrush bristles cannot reach. In spite of this, nearly two-thirds of people do not floss.

To floss correctly, the following steps may be helpful:

• Break off about 18 inches of floss and wind most of it around the middle finger of one hand and the rest around the other middle finger.
• Hold the floss between the thumbs and forefingers and gently guide and rub it back and forth between the teeth.
• When it reaches the gum line, the floss should be curved around each tooth and slid gently back and forth against the gum.
• Finally, rub gently up and down against the tooth. Repeat with each tooth, including the outside of the back teeth.
• If, on repeated flossing attempts, the floss becomes shredded or cannot be removed easily from between the teeth, a rough crown or overhanging filling may be the cause. In such cases, the restoration should be redone. Such areas create spaces for the collection of food debris, plaque, and calculus.

Here are some tips in choosing the right floss or flossing device:

• Use a floss that does not shred or break.
• Avoid a very thin floss, which can cut the gum if brought down with too much force or not guided along the side of the tooth.
• People who have very tight spaces between their teeth should consider flosses that are made of Gore-Tex. This floss slips easily between tight teeth and will not tear on sharp edges. It does cost slightly more, however.
• A floss threader is an invaluable aid for the person who has bridgework. Made of plastic, it looks like a needle with a huge eye, or loop. A piece of floss is threaded into the loop, which can then be inserted between the bridge and the gum. The floss that is carried through with it can then be used to clean underneath the false tooth or teeth and along the sides of the abutting teeth.
• Another handy device for cleaning under bridges is a Proxabrush. This is a tiny narrow brush that can be worked in between the natural teeth and around the attached false tooth or teeth.
• The Floss Plus easy flosser device is also effective and may make it easier for some people to floss.
• Special toothpicks such as Stim-U-Dent may be effective for wide spaces between teeth but should never replace flossing. Standard toothpicks should never be used for regular hygiene.
• Electronic products such as Oral B Innerclean and the Water Pik Flosser are as effective as manual flossing. These devices are expensive but may improve compliance.

Producing Saliva and Drinking Water. Saliva is important for diluting the toxins created by plaque. Drinking at least 7 glasses of water a day helps reduce inflammation in the mouth by producing more saliva. Increasing water intake is particularly important as one ages, when less saliva is produced.

Review Date: 11/10/2006
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).