An integrated approach to the management of dental biofilms.

Abstract

Objectives: Mechanical plaque control methods can potentially reduce dental biofilms for the prevention and control of gum disease. However, clinical experience and research demonstrate that the vast majority of individuals fail to employ these methods sufficiently and consistently. The purpose of this paper is to review the literature for current evidence evaluating the benefits on the oral health in adults when adding antimicrobial mouthrinses into daily oral care compared to mechanical plaque removal alone and identifying ways to implement this evidence into practice. Method: Several databases were searched for relevant literature which satisfied the inclusion criteria. Systematic reviews and clinical trials, of at least four weeks duration and involving adults with gingivitis were considered. Mouthrinses approved by the American Dental Association and available locally were investigated for efficacy against gum disease using universal indices to measure plaque and gingivitis. The six studies retrieved were critically appraised using CASP tools. Results: Strong evidence supports the efficacy of chlorhexidine and essential oil mouthrinses in controlling dental biofilms and reducing gingivitis when used with traditional oral hygiene practices. The subsequent staining associated with long term use of chlorhexidine advocates a shorter period of application. Although, Cetyl pyridinium chloride also exhibits antiplaque and antigingivitis properties the evidence is weaker mainly due to the diverse formulations ofthis mouthwash used in clinical trials. Essential oils and cetyl pyridinium chloride produce negligible adverse effects. Conclusions: Antimicrobial mouthrinses, when used as adjuncts to daily, self-performed, mechanical oral hygiene procedures provide additional benefit in controlling plaque and reducing gingival inflammation. This evidence has clinical usefulness for the prevention and treatment of gum disease. It serves to guide health professionals and consumers in the appropriate use of mouthrinses. Evidence demonstrates that public health implications and social equity demand an integrated approach involving all the stakeholders.