Mechanical biofilm management at home

PD Dr. Kristina Bertl, PhD MSc MBA

Mechanical biofilm management at home is indispensable for preventing gingivitis and subsequent periodontitis. The German Society for Periodontology (DG Paro) recently published new guidelines on this topic: ‘Mechanical biofilm management at home for the prevention and treatment of gingivitis’

These guidelines contain recommendations regarding the following 5 questions:

1. How do electric and manual toothbrushes compare in terms of cleaning effectiveness?
2. What effects do adjunctive aids have on interdental cleaning?
3. What are the effects of the additional use of toothpaste?
4. What do you need to look out for in particular when it comes to implants?
5. What unwanted side effects can be caused by mechanical biofilm management?

1. How do electric and manual toothbrushes compare in terms of cleaning effectiveness?
Both manual and electric toothbrushes are effective at reducing oral biofilm and at reducing gingivitis and signs of bleeding. Electric toothbrushes (particularly those with an oscillating–rotating movement) lead to a slightly larger reduction in gingivitis than manual toothbrushes do. Regardless of the type of brush they use, patients should adhere to a brushing duration of at least 2 minutes, and they should be given detailed instructions about how to use their toothbrush. Above all, the dentist should make sure that the patient establishes a system for brushing that ensures all tooth surfaces get cleaned. Special attention should be paid to cleaning the area of the gingival margin.

2. What effects do adjunctive aids have on interdental cleaning?
Compared with using a toothbrush alone, using interdental cleaning aids has an additional benefit in terms of reducing gingivitis in the interdental spaces. It is best to use interdental brushes. This is because more evidence is available for interdental brushes than for other interdental aids, and they have the greatest effect in terms of reducing gingivitis. Patients should only switch to other interdental aids, such as dental floss, if their morphological features preclude the use of interdental brushes. In general, the dental team should always provide the patient with personalized instructions about how to use interdental cleaning aids, and their use should be tailored to the patient’s anatomical conditions.

3. What are the effects of the additional use of toothpaste?
Toothpastes have no additional effect on reducing gingivitis compared with brushing with a toothbrush alone. For reasons of acceptance, and particularly in terms of caries, patients should nonetheless be recommended to use a fluoride-containing toothpaste when brushing.

4. What do you need to look out for in particular when it comes to implants?
Dental implants also require mechanical management of biofilm to control peri-implant inflammation. Recommendations regarding home-based mechanical biofilm management for implants should be similar to those for the natural teeth.

5. What unwanted side effects can be caused by mechanical biofilm management?
Incorrect biofilm management rarely causes trauma, and any trauma is usually localized. However, because it is easy to miss early signs of trauma, particular attention should be paid to this, despite its low incidence. It is important to note that interdental brushes should not be used with toothpaste during cleaning.