Periodontal Disease - Diagnosis

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• Fluoride. Most commercial toothpastes contain fluoride, which both strengthens tooth enamel against decay and enhances remineralization of the enamel. Fluoride also inhibits acid-loving bacteria, especially after eating, when the mouth is more acidic. This antibacterial activity may help control plaque.
• Triclosan. Triclosan is an anti-bacterial substance that may help reduce mild gingivitis.
• Metal salts. Metal salts, such as stannous and zinc, serve as anti-bacterial substances in toothpastes. Stannous fluoride gel toothpastes do not reduce plaque, even though they have some effect against the bacteria that cause it, but slightly reduce gingivitis.
• Peroxide and baking soda. Toothpastes with these ingredients claim to have a whitening action, but while they may help remove stains there is little evidence they whiten the actual color of the teeth. In addition, these substances appear to offer no benefits against gum disease.
• Antibacterial sugar substitutes (xylitol), and detergents (delmopinol)

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Mouthwash. The American Dental Association recommends (in addition to daily brushing and flossing) antimicrobial mouthwash to help prevent and reduce plaque and gingivitis, and fluoride mouthwashes to help provide additional protection against tooth decay.

• Chlorhexidine (Peridex or PerioGard) is an antimicrobial mouthwash available by prescription to help reduce plaque and prevent gingivitis. Patients should rinse for 1 minute twice daily. They should wait at least 30 minutes (and preferably 2 hours) 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. Studies are mixed as to its effectiveness for preventing or reducing periodontal disease.
• Listerine is another antimicrobial mouthwash. Generic equivalents are available. It 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. The usual regimen is to rinse twice a day. (Listerine PocketPaks, which are strips that dissolve on the tongue, have no proven effects on plaque and gingivitis.)
• Mouthwashes containing cetylpyridinium (Scope, Cepacol, generics) have moderate antimicrobial 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 and generics) are helpful in preventing cavities.
• Mouthwashes that contain alcohol are dangerous for children and should be kept away from them.

Lifestyle Changes

Diet. A well-balanced and nutritious diet is important for good oral health. Limit between-meal snacks and be sure to brush and floss after every meal. It is also important to drink lots of water to help increase saliva and flush away plaque.

Quitting Smoking. Smoking is a main risk factor for periodontal disease. For smokers, quitting is one of the most important steps toward regaining periodontal health.

Review Date: 02/16/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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