Periodontal Disease - Prevention

In general, studies have reported no differences between electric and manual toothbrushes in their ability to remove plaque. (One study showed considerable improvement in groups using sonic toothbrushes, particularly in those with moderate periodontal disease.) Experts recommend, however, that if a regular toothbrush works, then it isn't necessary to buy an expensive electric one.

text continues below

For individuals with average dexterity, a four- or five-rowed, soft, nylon-bristled toothbrush is sufficient. The most important factor in buying any toothbrush, electric or manual, is to choose one with a soft head. Soft bristles get into crevices easier and do not irritate the gums. One study found that those who used a soft toothbrush had 4.7% of exposed tooth below the gum line compared to 9.4% with hard brush users. A useful toothbrush called Alert has been developed that flashes a red light when too much pressure is being placed on the gums.

Experts generally recommend replacing toothbrushes each month Not only do they become breeding grounds for bacteria, but the worn bristles are less effective at removing plaque. (One study reported that a three-month old toothbrush was as effective as a new one at removing plaque, although it's probably wise not to go longer than three months.)

Toothpaste. The object of a good toothpaste is to reduce the development of plaque and eliminate periodontal causing microorganisms without destroying the organisms that are important for a healthy mouth. All brands should show ADA approval. Even a good toothpaste, however, cannot be delivered past 3 mm below the gum line, where periodontitis develops.

Toothpastes are a combination of abrasives, binders, colors, detergents, flavors, fluoride, humectants, preservatives, and artificial sweeteners. Highly abrasive toothpastes should not be used, especially by individuals whose gums have receded.

Active agents contained in toothpastes may include the following:

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. Some argue that this antibacterial activity may help control plaque.
Triclosan. Colgate's Total toothpastes contain a fluoride and triclosan, an extremely potent anti-bacterial agent. The toothpaste also contains an agent that keeps triclosan active in the mouth for 12 hours. Total is the first FDA approved toothpaste for the prevention of tooth decay, gingivitis, and plaque. Still the benefits of this toothpaste are limited and are most pronounced in people with severe gingivitis. Of some concern are studies reporting development of bacteria resistant to triclosan. More studies are needed. Anyone with periodontal disease should not rely on this product alone.
Metal salts. Metal salts such as stannous and zinc serve mostly as anti-bacterial agents in toothpastes. Stannous fluoride gel toothpastes do not reduce plaque, however, even though they have some effect against the bacteria that cause it, but slightly reduce gingivitis. Such toothpastes can cause staining that requires professional cleaning. Crest Plus Gum Care contains a stabilized form of stannous fluoride. Studies conducted by the manufacturer suggest that is has antibacterial activity and that it might be more effective than Colgate's Total in reducing gingivitis and bleeding.
Enzymes called glucanases.
Plant extracts (such as sanguinarine). Viadent toothpaste and mouthwash contain an anti-bacterial herbal extract called sanguinarine. The two products provide minimal results when used individually, but if the mouthwash and toothpaste are used together they have produced plaque reductions of 17% to 42% and reductions of gingivitis of 18 - 57% during a 6-month period. It should be noted that some questions have been raised about the safety of prolonged use of sanguinarine.
Peroxide and baking soda. Toothpastes with these ingredients appear to offer no benefits against gum disease. In fact, tooth whiteners are usually made with carbamide peroxide, which breaks down into hydrogen peroxide, and brushing with hydrogen peroxide is not recommended. Studies have indicated that overuse of this solution may actually damage cells and soften tooth surfaces. Of concern was a recent animal study suggesting a link between hydrogen peroxide and precancerous cell changes in the mouth. Researchers retracted the findings because of these implications and pointed out that no cancer lesions have developed in any animals since the study began. People who smoke or drink alcohol, however, might avoid products with hydrogen peroxide in them.
Antibacterial sugar substitutes (e.g., xylitol), and detergents (delmopinal).