Routine scale and polish has little or no effect on gingivitis

Scaling and polishing removes deposits such as plaque and calculus (tartar) from tooth surfaces. Over time, the regular removal of these deposits may reduce gingivitis (a mild form of gum disease) and prevent progression to periodontitis (severe gum disease). Routine scale and polish treatment is sometimes referred to as “prophylaxis”, “professional mechanical plaque removal” or “periodontal instrumentation”. Many dentists or hygienists provide scaling and polishing for most patients at regular intervals even if the patients are considered to be at low risk of developing gum disease. There is debate about whether scaling and polishing is effective and the best interval between treatments. Scaling is an invasive procedure and has been associated with a number of negative side effects including damage to tooth surfaces and tooth sensitivity.

For the purposes of this review, a ‘routine scale and polish’ was scaling and polishing of both the tooth and the root of the tooth to remove plaque deposits (mainly bacteria), and calculus. Calculus is so hard it cannot be removed by toothbrushing alone and this along with plaque, other debris and staining on the teeth is removed by the scale and polish treatment. Scaling or removal of hardened deposits is done with specially designed dental instruments or ultrasonic scalers, and polishing is done mechanically with special pastes. In this review, we included scaling above and below the gum level; however, we excluded any surgical procedure on the gums, any chemical washing of the space between gum and tooth (pocket) and root planing, which is more intense scraping of the root than simple scaling.

Continue reading

Only very low quality evidence available on the use of platelets for jawbone defects

Teeth are maintained in their position by soft and hard tissues (gums and surrounding bone). Gum disease or periodontitis, is an inflammatory condition of all these tissues caused by the bacteria present in the dental plaque. If left untreated, gum disease can cause teeth to loosen and eventually lead to tooth loss. The destruction of jaw bone around teeth (called the alveolar bone) during gum disease, can be horizontal (where the whole level of bone around the root is reduced) or vertical, forming a bone defect within the bone (infrabony defect). There are several available surgical treatments for infrabony defects, including: 1. open flap debridement in which the gum is lifted back surgically in order to clean the deep tartar; 2. bone graft in which a portion of natural or synthetic bone is placed in the area of bone loss; 3. guided tissue regeneration in which a small piece of membrane-like material is placed between the bone and gum tissue in order to keep the gum tissue from growing into the area where the bone should be; and 4. the use of enamel matrix derivative, a gel-like material which is placed in the area where bone loss has occurred and promotes its regeneration. In order to accelerate the healing process, autologous platelet concentrates have been recently used. They are concentrates of the platelets of patient’s own blood containing growth factors that are thought to promote tissue regeneration. The aim of this review was to assess if the addition of APC brings any benefits in the treatment of infrabony defects when combined with different surgical treatments. Continue reading

Treating gum disease to prevent heart disease: the evidence is unclear

Heart diseaseGum disease is a common chronic or persisting condition that can get worse over time. It involves inflammation of the gums, which surround and support the teeth, causing swollen and painful gums and in severe cases loss of the bone (alveolar) that supports the teeth. Clinical investigations have shown that there might be a link or association between chronic, ongoing gum disease and heart and blood vessel disease (cardiovascular disease). Some investigators believe that the treatment for gum disease, which gets rid of bacteria and infection and controls inflammation, might prevent the occurrence or recurrence.

Continue reading

Chlorhexidine mouthrinse reduces plaque and can improve gum health in people with low levels of gingivitis

Chlorhexidine mouthrinse_croppedGingivitis is a reversible condition when gums become red, swollen and can bleed easily. Gingivitis is also very common – studies suggest that as many as 50% to 90% of adults in the UK and USA suffer from it. In susceptible people gingivitis may lead to periodontitis, which is not reversible. In periodontitis inflammation is accompanied by loss of ligaments and bone supporting the teeth. If untreated it may eventually lead to tooth loss. Severe periodontitis is the sixth most widespread disease globally.

It is recognised that maintaining a high standard of oral hygiene is important for the prevention and treatment of gingivitis. Toothbrushing is the main method for maintaining good oral hygiene. Other cleaning methods commonly used include dental floss, interdental brushes and scaling and polishing carried out by a dental professional. Some people have difficulty controlling plaque build-up and preventing gingivitis using only conventional tooth cleaning. Therefore people sometimes use mouthrinses containing chlorhexidine in addition to conventional tooth cleaning. These mouthrinses are readily available over the counter; prescriptions generally not being required outside the USA. Continue reading

Treating gum disease: can it help diabetics control their blood sugar levels?

iStock_000013589042_SmallGum disease treatment is used to reduce swelling and infection from gum disease. Keeping blood sugar levels under control is a key issue for people with diabetes, and some clinical research suggests a relationship exists between gum disease treatment and glycaemic control. As a result, it is important to discover if gum disease treatment does improve glycaemic control to encourage better use of clinical resources.

There is a broad range of gum disease treatments available for treating patients with diabetes. This review considered:

1. Does gum disease treatment improve blood sugar control in people with diabetes?
2. Does one type of gum disease treatment have a bigger effect than another in improving blood sugar control?

Continue reading

Treating all teeth within 24 hours for chronic gum disease

FMSGum disease or periodontitis is a chronic inflammatory disease that causes damage to the soft tissue and bone around the teeth. Mild periodontitis is common in adults with severe periodontitis occurring in up to 20% of the population. Non-surgical treatments based on the mechanical removal of bacteria from infected root surfaces are used in order to arrest and control the loss of the bone and tissue that support the tooth in adults suffering from chronic gum disease. These treatments can be carried out in a different area of the mouth in separate sessions over a period of several weeks (SRP), which is the conventional method, or alternatively, can be done within 24 hours in one or two sessions, which is termed ‘full-mouth scaling’ (FMS). When an antiseptic agent (such as chlorhexidine for example) is added to the full-mouth scaling the intervention is called ‘full-mouth disinfection’ (FMD). The rationale for full-mouth approaches is that they may reduce the likelihood of re-infection in already treated sites. This review is an update of one originally published in 2008, and considers the effectiveness of full mouth treatments. Continue reading

Treating chronic gum disease – can it help to prevent heart disease?

Heart diseaseGum disease (periodontitis) is a common chronic or persistent condition that can get worse over time. It involves inflammation of the gums, which surround and support the teeth, causing swollen and painful gums and in severe cases loss of the bone that supports the teeth. Clinical investigations have shown that there might be a link between chronic, ongoing gum disease and heart and blood vessel disease (cardiovascular disease). Some investigators believe that the treatment for gum disease, which gets rid of bacteria and infection and controls inflammation, might prevent the occurrence or recurrence of heart disease. Continue reading