Oral hygiene – just get stuck in ...?

14.12.2021

PD Dr. Kristina Bertl, PhD MSc MBA

Anyone who works in prophylaxis is aware of the importance of oral hygiene home care, particularly if we want to treat our periodontitis patients successfully in the long term.

Over the years, the ‘when’ and ‘how’ of instructing our patients about oral hygiene home care has changed somewhat. In the 1970s and 1980s, it was still often the case that the actual non-surgical treatment was preceded by a very prolonged oral hygiene phase. Over time this situation changed, with both elements increasingly being done in parallel – i.e. supra- and subgingival cleaning with simultaneous instruction of the patient regarding oral hygiene home care.

A very recent Norwegian study has taken up this ‘old’ topic again, wanting to take another closer look at the effect of intensive oral hygiene instructions alone (Preus et al. 2020). They divided 44 periodontitis patients into two groups of 22 patients each:

Control group: In the control group, no treatment and no oral hygiene instructions were given for three months after the initial examination. After three months, the periodontal status of the group was recorded for a second time.
Test group: In the test group, patients received detailed and, most importantly, individually tailored information about optimized oral hygiene home care in both verbal and written form after the initial examination. Supragingival calculus removal was only performed on sites where calculus was preventing interdental cleaning. After three months, the test group’s periodontal status was recorded for a second time.

Whereas no significant change in the periodontal status of the control group was observed after the three months, the importance of oral hygiene home care was apparent from the test group’s results. In the test group, a statistically and clinically significant decrease in all recorded periodontal parameters (plaque, bleeding, probing pocket depth) was found. In detail, the following improvements were observed:

Plaque values decreased on average by 30%. In individual patients, this decrease was as high as 80%! After the three months, the average percentage of sites with plaque was only 5%.
Bleeding on probing also decreased by approximately 30%, and the average percentage of sites with bleeding on probing after the three months was only approximately 11%.
The average probing pocket depth decreased from 4.4 mm to 2.8 mm, and the proportion of increased probing pocket depths fell considerably in all groups. The average number of sites per patient with a …

o probing pocket depth ≥ 4 mm decreased from 52.2 to 19.1 sites

o probing pocket depth ≥ 5 mm decreased from 44.6 to 9.5 sites

o probing pocket depth ≥ 6 mm decreased from 30.9 to 3.0 sites

o probing pocket depth ≥ 7 mm decreased from 15.6 to 0.9 sites

To express it differently: At the start of the study, the patients in the test group had a total of 680 sites with a probing pocket depth of ≥ 6 mm. After three months of intensive oral hygiene home care, only 67 sites remained that had a probing pocket depth ≥ 6 mm.

It should be mentioned that, despite randomization, the severity of periodontal disease was statistically significantly lower in the test group than in the control group. Despite this limitation, however, this study clearly shows how great the positive effect of optimized and individually tailored oral hygiene home care can be. Of course, in no way does this mean that periodontitis patients can be treated by means of oral hygiene instruction alone – the subsequent step of non-surgical supra- and subgingival cleaning is also indispensable. However, it should motivate us and, above all, our patients that the treatment of periodontitis is a matter of teamwork!

Reference

Preus HR, AL‐Lami Q, Baelum V. Oral hygiene revisited. The clinical effect of a prolonged oral hygiene phase prior to periodontal therapy in periodontitis patients. A randomized clinical study. J Clin Periodontol. 2020;47:36–42. https://doi.org/10.1111/jcpe.13207