Mouthwashes for the control of supragingival biofilm and gingivitis in orthodontic patients: evidence-based recommendations for clinicians

Properly performed daily mechanical biofilm control is the most important prevention strategy for periodontal diseases. However, proper mechanical biofilm control is not performed effectively by the majority of the population, mainly due to lack of motivation and of manual dexterity. Local biofilm retention factors may aggravate home oral hygiene quality. For this reason, patients wearing fixed orthodontic appliances comprise a group that may benefit from the daily use of mouthwashes. The purpose of this review was to perform a systematic search in the literature on antiseptics used to control supragingival biofilm and gingivitis in orthodontic patients. Six studies investigating the effect of chlorhexidine and 5 studies evaluating the effect of the daily use of antiseptics were found. Chlorhexidine showed better results in reducing plaque and gingivitis. However, because of its adverse effects after continuous use, it should not be indicated for long-term periods. Among the agents considered for daily use, the fixed combination of essential oils was the only one evaluated in a clinical trial, in which a comparative group presented a statistically significant clinical impact. There is no direct evidence supporting the indication of antiseptic agents for orthodontic patients other than chlorhexidine and essential oils. It can be concluded that, for patients undergoing orthodontic treatment, chlorhexidine should be considered for treating acute gingival inflammation, whereas essential oils should be indicated for long-term daily use in controlling supragingival biofilm

The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review

Objectives: The aim of this study was to assess systematically the adjunctive effect of both flossing and toothbrushing versus toothbrushing alone on plaque and gingivitis. Materials: The MEDLINE and Cochrane Central register of Controlled Trials (CENTRAL) databases were searched through December 2007 to identify appropriate studies. The variables of plaque and gingivitis were selected as outcomes. Results: Independent screening of titles and abstracts of 1166 MEDLINE-Pubmed and 187 Cochrane papers resulted in 11 publications that met the eligibility criteria. Mean values and SD were collected by data extraction. Descriptive comparisons are presented for brushing alone or brushing and flossing. A greater part of the studies did not show a benefit for floss on plaque and clinical parameters of gingivitis. A meta-analysis was performed for the plaque index and gingival index. Conclusions: The dental professional should determine, on an individual patient basis, whether high-quality flossing is an achievable goal. In light of the results of this comprehensive literature search and critical analysis, it is concluded that a routine instruction to use floss is not supported by scientific evidence

The effect of cetylpyridinium chloride-containing mouth rinses as adjuncts to toothbrushing on plaque and parameters of gingival inflammation: a systematic review

Objective: To review the literature concerning cetylpyridinium chloride (CPC) containing mouth rinses as effective adjuncts to toothbrushing in the prevention of plaque accumulation and gingival inflammation. Materials and methods: Medline and the Cochrane Central Register of Controlled Trials were searched up to January 2008 to identify appropriate studies. The primary outcome measurements were plaque accumulation and gingivitis. Results: Independent screening of titles and abstracts of 3250 papers resulted in eight publications that met the criteria of eligibility. Mean values and standard deviations were obtained by data extraction. Descriptive comparisons are presented for brushing only or brushing and rinsing. Meta-analyses were performed when possible. Conclusions: The existing evidence supports that CPC containing mouth rinses, when used as adjuncts to either supervised or unsupervised oral hygiene, provide a small but significant additional benefit in reducing plaque accumulation and gingival inflammation