Ramping Up Home Care
George Freedman, DDS, BSc
The dental profession is entering a more advanced phase of patient care, increasingly focusing on the preventive aspects of the dental disease process. Over the past century, and particularly the last 50 years, dental professionals have been diligent in promoting health maintenance, patient education, and early disease interception (as opposed to the surgical model of earlier years). As the oral health level of the general population attests, dentistry has been one of the most successful professions in this respect. Now, having changed the scope and pattern of active dental disease, the dental team is becoming even more proactive in eliminating oral biofilms, complex communities of bacteria that are the primary causative factors of gingival disease and dental decay.
Fluoridation, patient education, and home care are the most successful preventive modalities. In fact, home care must be recognized as the key element in the overall effort to combat dental disease. While the dental team can treat, assess, and guide the patient's oral health twice a year during scheduled recall appointments, the long-term health of the oral cavity is entirely in the patient's own hands the other 363 days of the year. Thus, professionally guided home care is the patient-delivered daily process that can, with appropriate tools, prevent the slow and insidious bacterial destruction of oral tissues, both soft and hard.
The ultimate goal is effective home care; the variables are its perceived value to the patient and the ease of performing the task. If dental home care is seen as being too cumbersome, difficult, or time consuming, patients will not be inclined to readily incorporate it into their daily hygiene routine. Patients are more likely to be compliant if the home care process is comfortable and easy to perform, and if they feel and see immediate tangible benefits (ie, a cleaner feeling of the teeth and/or gingiva).
Extensive research has been conducted into the various techniques and materials that patients can use for home care and well-established, scientifically determined methods for cleaning teeth. Historically, these modalities involved the use of manual toothbrushes manipulated by the patient's hands in strictly specified directions and motions to remove food debris and bacterial plaque from the smooth and occlusal surfaces of the teeth. These methods can be effective (at the targeted surfaces only though, not properly accessing the interproximals) as long as the patient brushes regularly, in the right directions, with the right motions, not too hard, and for long enough. Some patients are both adept at and committed to performing these repetitive procedures regularly, twice per day. Most find these manual toothbrushing techniques too complicated and cumbersome. Interestingly, this is the very group that benefits most from sonic toothbrushing, which simplifies the task. Sonic toothbrushes are designed to make the ideal motions for maximum biofilm and food removal while the patient effectively moves the instrument in a simple straight line along the teeth and soft tissues, making the process easier and increasing compliance.
The profession has long considered dental floss to be an indispensable part of home oral care.
Research on this subject seems less conclusive; Berchier et al reported on the efficacy of the use of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation.1 Their systematic review reported on the results of comparing toothbrushing alone with toothbrushing and flossing. The meta-analysis for the plaque and gingival indices showed no differences between the groups. The entire issue of flossing is largely academic anyway, as most patients simply do not floss regularly.
Another widely available technology is able to effectively clean both interproximal surfaces and gingival pockets, complementing effective toothbrushing to remove debris from all five exposed dental surfaces. The first oral irrigator (now a water flosser), designed by Gerald Moyer, DDS, and John Mattingly, a hydraulic engineer, to improve patients' oral hygiene was introduced in 1962.
Since the introduction of this novel oral care approach, more than 70 scientific studies have documented its benefits, and many show that a water flosser removes biofilm from tooth surfaces and bacteria from periodontal pockets better than traditional flossing and manual toothbrushing-together or alone. Rosema et al concluded that water flossing was twice as effective in decreasing gingival bleeding as string floss at 2 weeks, with even greater differences when the study was concluded at 4 weeks.2
Numerous studies over the years have demonstrated the value of water flossing in treating gingivitis and periodontitis and in removing plaque. It has been found (with scanning electron microscopy studies) that water flossing can remove 99.9% of the biofilm on tooth surfaces. Water flossing is indicated for diabetic patients as an adjunct to their routine home oral care. Reducing the level of gingival inflammation is vital to these at-risk individuals.
It has also been established that the water flosser's mechanism of action is safe and effective. It does not push bacteria or debris into the periodontal pocket. The cleansing is accomplished by the pulsating action of the device that clears the bacteria and debris with alternate pressurized water impact and flushing of the pocket. These rapidly repeated compression and decompression phases safely remove the debris without damaging the epithelial lining of the pocket or penetrating into the soft tissue.
For many years, patients' most effective home care routine was sonic (or power) toothbrushing followed by water flossing, with the possible use of string floss. Needless to say, this suggested regimen is a long and laborious one, and all but the most dedicated of patients are likely to skip one or more of these important components. Patients often complained that, while they realized the impact or their oral health, they simply did not have the time (and/or the motivation) to accomplish all the recommended steps.
The introduction of the Waterpik® Sonic-Fusion solves this dilemma for both patient and dental professional. By combining the proven practice of sonic toothbrushing and the equally proven technique of water flossing into one device-enabling one procedure-comprehensive cleaning of the oral tissues, both soft and hard, is available in a single step. Patients can now effectively brush and floss in one action with no complications or technique sensitivity. Combined sonic toothbrushing and flossing can make home care better, faster, and easier.
About the Author
George Freedman, DDS, BSc
Adjunct Professor of Dental Medicine, Western University, Pomona, California; Founder and Past President, American Academy of Cosmetic Dentistry; Founder, Canadian Academy for Esthetic Dentistry; Private Practice, Toronto, Canada
References
1. Berchier CE, Slot DE, Haps S, Van der Weijden GA. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. Int J Dent Hyg. 2008;6(4):265-279.
2. Rosema NA, Hennequin-Hoenderdos NL, Berchier CE, et al. The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol. 2011;13(1):2-10.
