title: Primary prevention of periodontitis: managing gingivitis.
abstract: Periodontitis is a ubiquitous and irreversible inflammatory condition and represents a significant public health burden. Severe periodontitis affects over 11% of adults, is a major cause of tooth loss impacting negatively upon speech, nutrition, quality of life and self-esteem, and has systemic inflammatory consequences. Periodontitis is preventable and treatment leads to reduced rates of tooth loss and improved quality of life. However, successful treatment necessitates behaviour change in patients to address lifestyle risk factors (e.g. smoking) and, most importantly, to attain and sustain high standards of daily plaque removal, lifelong. While mechanical plaque removal remains the bedrock of successful periodontal disease management, in high-risk patients it appears that the critical threshold for plaque accumulation to trigger periodontitis is low, and such patients may benefit from adjunctive agents for primary prevention of periodontitis.
  
  
  OBJECTIVE
  The aims of this working group were to systematically review the evidence for primary prevention of periodontitis by preventing gingivitis via four approaches: 1) the efficacy of mechanical self-administered plaque control regimes; 2) the efficacy of self-administered inter-dental mechanical plaque control; 3) the efficacy of adjunctive chemical plaque control; and 4) anti-inflammatory (sole or adjunctive) approaches.
  
  
  METHODS
  Two meta-reviews (mechanical plaque removal) and two traditional systematic reviews (chemical plaque control/anti-inflammatory agents) formed the basis of this consensus.
  
  
  RESULTS
  Data support the belief that professionally administered plaque control significantly improves gingival inflammation and lowers plaque scores, with some evidence that reinforcement of oral hygiene provides further benefit. Re-chargeable power toothbrushes provide small but statistically significant additional reductions in gingival inflammation and plaque levels. Flossing cannot be recommended other than for sites of gingival and periodontal health, where inter-dental brushes (IDBs) will not pass through the interproximal area without trauma. Otherwise, IDBs are the device of choice for interproximal plaque removal. Use of local or systemic anti-inflammatory agents in the management of gingivitis has no robust evidence base. We support the almost universal recommendations that all people should brush their teeth twice a day for at least 2 min. with fluoridated dentifrice. Expert opinion is that for periodontitis patients 2 min. is likely to be insufficient, especially when considering the need for additional use of inter-dental cleaning devices. In patients with gingivitis once daily inter-dental cleaning is recommended and the adjunctive use of chemical plaque control agents offers advantages in this group.
authors: Periodontal Research Group & MRC Centre for Immune Regulation Birmingham Dental School, Birmingham, UK.
authors: Iain L C
authors: IL
authors: Chapple
authors: Fridus
authors: F
authors: Van der Weijden
authors: Christof
authors: C
authors: Doerfer
authors: David
authors: D
authors: Herrera
authors: Lior
authors: L
authors: Shapira
authors: David
authors: D
authors: Polak
authors: Phoebus
authors: P
authors: Madianos
authors: Anna
authors: A
authors: Louropoulou
authors: Eli
authors: E
authors: Machtei
authors: Nikos
authors: N
authors: Donos
authors: Henry
authors: H
authors: Greenwell
authors: Ari J
authors: AJ
authors: Van Winkelhoff
authors: Bahar
authors: B
authors: Eren Kuru
authors: Nicole
authors: N
authors: Arweiler
authors: Wim
authors: W
authors: Teughels
authors: Mario
authors: M
authors: Aimetti
authors: Ana
authors: A
authors: Molina
authors: Eduardo
authors: E
authors: Montero
authors: Filippo
authors: F
authors: Graziani
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003742:Dental Devices, Home Care; D003773:Dental Plaque / Q000517:prevention & control; D003802:Dentifrices / Q000627:therapeutic use; D005891:Gingivitis / Q000517:prevention & control*; D006801:Humans; D009910:Oral Hygiene; D010518:Periodontitis / Q000517:prevention & control*; D011322:Primary Prevention; D012648:Self Care; D014099:Toothbrushing / Q000379:methods
chemical_list: D000893:Anti-Inflammatory Agents; D003802:Dentifrices
keywords: NSAIDs; adverse effects; anti-inflammatory agents; chemical plaque control; floss; gingivitis; inter-dental brushes; inter-dental cleaning; manual toothbrushes; mechanical plaque control; meta-analysis; meta-review; oral hygiene instruction; periodontitis; power toothbrushes; primary prevention; safety; secondary prevention; self-administered care regimes; systematic review; water irrigator; wood sticks