Periodontal Disease - Prevention

Mouthwashes. The value of many mouthwashes is highly controversial. Many have only temporary antibacterial value. Some can even harm the mucus membrane and they can be dangerous to children who drink them. Those that are considered plaque fighters are chlorhexidine and Listerine, which is available over the counter.

Chlorhexidine (Peridex or PerioGard) is available by prescription only. It reduces plaque by 55% and gingivitis by 30 - 45%. Patients should rinse for 1 minute twice daily. They should wait at least 30 minutes 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.
Listerine 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. Some people might object to or have concerns about the high alcohol content in the standard version. Other forms of Listerine that have a different taste and lower alcohol content retain the same active ingredients and appear to be as effective. The usual regimen is to rinse twice a day. Generic equivalents are available. (Listerine PocketPaks, which are strips that dissolve on the tongue, have no proven effects on plague and gingivitis.)
Mouthwashes containing cetylpyridinium (Scope, Cepacol) have moderate 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) is moderately effective, but also not as effective as effective as Listerine or chlorhexidine.
Fluoride mouthwashes (Reach Act) are helpful in preventing cavities.
Plax offers only modest protection against plaque and gingivitis. Even Advanced Formula Plax, which may show a minor reduction in plaque levels, does not seem to provide any protection against periodontal disease.

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Flossing. The use of dental floss, either waxed or unwaxed, is critical in cleaning between the teeth where the toothbrush bristles cannot reach. In spite of this, nearly two-thirds of people do not floss.

To floss correctly, the following steps may be helpful:

Break off about 18 inches of floss and wind most of it around the middle finger of one hand and the rest around the other middle finger.
Hold the floss between the thumbs and forefingers and gently guide and rub it back and forth between the teeth.
When it reaches the gum line, the floss should be curved around each tooth and slid gently back and forth against the gum.
Finally, rub gently up and down against the tooth. Repeat with each tooth, including the outside of the back teeth.
If, on repeated flossing attempts, the floss becomes shredded or cannot be removed easily from between the teeth, a rough crown or overhanging filling may be the cause. In such cases, the restoration should be redone. Such areas create spaces for the collection of food debris, plaque, and calculus.