As implants become a more common option to replace natural teeth, so do their issues. The most common reason for implant failure is peri-implantitis, which is brought on by too much biofilm. Implant failure is on the rise. The only way to get rid of this biofilm is to work with patients to develop a simple at-home regimen. The issue is that implants are frequently inserted into the mouths of patients who most likely lost their original tooth (or teeth) as a result of years of neglecting their dental care. Poor home care is the root of most oral health problems, including implant failure. Even when the original tooth has been replaced, the condition persists. Long-term implant success depends on educating patients about the fact that failure of an implant occurs for the same reasons that their natural tooth failed. When a patient becomes a candidate for implant placement, dental practitioners need to provide them with the appropriate tools and knowledge. Let's look into strategies for controlling implants and the development of peri-implant illness.
Before The Implant Is Placed
Giving implants to people whose oral hygiene caused them to lose their natural teeth is the same as giving an alcoholic a new liver. Without reform, the issue is likely to stay the same. We may use the reasoning that many orthodontic offices employ before treatment, where the patient occasionally needs to "show" that they are able to maintain their oral hygiene. If not, therapy is put on hold until they can show improvement. Patient compliance impacts the success of an implant, much like it does in orthodontics. This point must be understood by the patient. Since we encourage patients with poor oral hygiene to refrain from brushing or flossing the surgical site for a few weeks while it heals, implants provide a unique set of challenges from the start.The poor habits that were already in place are just reinforced by this.
One of the most crucial duties for a patient is the management of biofilm (dental plaque), which is necessary for the long-term effectiveness of an implant and the avoidance of peri-implantitis. According to numerous studies, the main etiological factor in the onset and spread of peri-implant infections is biofilm. The therapeutic properties of being able to break up biofilm or kill bacteria (and other pathogens) are not present in products like toothpaste, flossing, water piking, interdental brushes, etc. These are all mechanical techniques of removal. Biofilm, in particular around an implant, can be challenging to remove because it is difficult to reach with standard brushing and flossing. Therefore, a device that is both therapeutically effective and able to reach difficult-to-reach places must be used.
Maintaining Implant Health
There are several clinical therapies available to help manage peri-implant disorders, but the key to excellent outcomes is early detection and avoidance of problems. Infection, poor dental health, and general ill health are all factors that might cause implants to fail during the initial stages of installation. Thus, keeping the hard and soft tissues around the implant healthy is essential because they serve as biological barriers to prevent peri-implant illness. Periodontitis and peri-implant disease are both caused by microorganisms that are closely related to one another. These include microorganisms such as bacteria, viruses, fungi, and biofilm. The microorganisms are left behind in uncleaned, undisturbed parts of the mouth and, similar to periodontal disease, become more sophisticated as they age. This makes them more difficult to get rid of over time. This is why peri-mucositis is the first infection to show up surrounding a poorly maintained implant. In contrast to more severe, permanent peri-implantitis, this can be reversed. It is our responsibility as dental professionals to aid in the prevention of this condition and instruct patients on the appropriate instruments to use.
Reducing The Risk For Implant Failure
Consequently, how can we assist? During the healing process, implants need to be protected. In a perfect world, the defense would start during surgery, with therapeutic medicines helping to lessen pollutants at the surgical site. Since they cannot employ mechanical means of disruption during this period, they must instead continue to keep the area clean using something like a rinse. This will not only improve the environment for recovery but also highlight the need to provide their newest member with specialized care. A rinse might help with implant maintenance in the long run.
We advise our patients to clean and floss their teeth, and we hope they do so frequently, but even when they do, it is still purely mechanical. If these measures were sufficient to prevent gum disease, just 47% of Americans would have it, and that percentage wouldn't rise to 70% after age 60. These numbers are bad news for dental implants because they are more difficult to maintain using conventional methods. In order to provide patients with implants, improved techniques for treatment must be adopted as quickly as possible. To reduce the risk of implant failure, a treatment alternative that eliminates bacteria, fungi, and viruses as well as neutralizes volatile sulfur compounds and disassembles biofilm is required.
Studies have found that certain goods' medicinal ingredients can lessen the viability of pathogens in biofilm. Activated chlorine dioxide falls under this category. It has the power to eliminate fungi, viruses, bacteria, and biofilm while lowering volatile sulfur compounds. Daily usage of this active component for implants and general hygiene is safe. The Reassure system from OraCare is one such item that includes these components. Both a gel and a take-home rinse are included in this medication to assist the patient after surgery. It is our responsibility to develop more effective methods to prevent peri-implantitis given the rising popularity of implants. We need to give patients the right equipment because we are aware that most implant failures are caused by subpar homecare. Our best defense against the leading reason for implant failure is to develop a daily routine that includes a rinse with therapeutic benefits.
We have all had in-depth discussions about brushing and flossing with patients. Although the recommended brushing duration is 4 minutes per day, most people make an effort to brush for 40 to 70 seconds on average each day. Some people floss, but none of my patients do (hopefully yours do). It is hardly surprising that 76% of American adults have gum disease in some form. But how can we reduce this figure? Although I don't believe that what we are doing now is incorrect, our strategy for preventing and treating gum disease needs to be changed. The mechanical actions of brushing and flossing don't actually kill anything but will physically remove plaque from teeth. These two conventional procedures don't help the body fight systemic oral infections, they don't kill bacteria, and they don't lower therapeutic volatile sulfur compounds, all of which play a part in gum disease. Let's examine each of the three approaches and how they might be used to combat this expanding issue.
Mechanical removal techniques include brushing, flossing with string or water, and general interdental cleaning. Brushing and interdental cleaning are crucial, and there is no disputing that. These techniques are essential for better oral hygiene. The real meaning of mechanical removal, however, is "picking up germs and throwing them away, rather than killing them with chemicals or heat.” Simply removing some of the plaque from the tooth during brushing and flossing, adding it to our saliva along with some toothpaste (for fresh breath, of course), and then spitting it all out is brushing and flossing. It offers nothing to aid the patient in battling an ongoing infection and does nothing to eradicate any pathogenic germs. Brushing and flossing are not sufficient if our ultimate goal is to reduce gum disease in our patients.
It is very challenging to control a disease once it has spread to the oral cavity. This is especially true in cases of periodontal disease, which gets worse over time if left untreated. Once the infection has been shown to be active, it can be treated with an antibiotic to start periodontal therapy. This is fantastic for treating the initial infection, but a patient cannot take antibiotics for an extended period of time. As your body develops resistance, using antibiotics may become ineffective in the future. We definitely do not want this to occur. We require an additional resource that our patients can regularly and securely use.
The greatest features of mechanical and systemic removal are combined with therapeutic choices to improve routine treatment. The primary item that fits into this category are rinses. As a result of how simple a rinse is for patients to use, this is where we may have a tremendous impact on dental health. In addition to reducing viruses, fungus, and volatile sulfur compounds (VSCs), some rinses can also break up biofilm and kill bacteria, all of which are linked to gum disease and other oral illnesses. It is crucial to remember that not all rinses have these features or can be used for a prolonged period of time; thus, strict criteria should be utilized when selecting rinses. As an example, chlorhexidine is excellent at killing bacteria but ineffective against viruses, fungus, biofilm, or VSCs and has a short shelf life. In addition to its therapeutic limits, the buildup of stains and calculus adds to the workload. Better patient health is what we're after, not adding on more work.
Activated chlorine dioxide is an active component to look for in rinses. The same germs that chlorhexidine and other disease-causing pathogens quickly destroy with this substance, but without the unpleasant side effects (no staining, yay!) and may be used for long-term daily use without risk. OraCare is a rinse made with activated chlorine dioxide that is sold in dental offices. The addition of xylitol to this rinse only increases its medicinal advantages. Additionally, patients will actually utilize it, and they’ll love the taste.
Every day, mechanical and therapeutic measures must be used to combat gum disease, and if an infection is present, systemic treatment may also be necessary.
In 1954, chlorhexidine was first used in clinical settings. Since then, patients have received it to treat a range of dental problems, including but not limited to gum irritation, swelling, and bleeding. Great, right? Wrong. While there are benefits to this rinsing, the disadvantages outweigh them by a wide margin. Which raises the question of whether we should continue using chlorhexidine. Let's explore this further to find the answer.
Dental offices now use chlorhexidine as a "safety shield." Even though it's solely meant to treat gingivitis, many dental practitioners advise using it for a number of off-label purposes. This rinse is recommended as a last resort. How effective is it, though? Even though chlorhexidine has excellent antibacterial properties and can treat gingivitis, it also contains a substantial amount of 1200 parts per million. This then raises the possibility of adverse side effects.
Many people are not aware of the more serious repercussions, one of which is the inhibition of fibroblasts, even though the majority of chlorhexidine users report "manageable" side effects (i.e. staining). In a 1991 study, it was discovered that using 0.12% chlorhexidine on human gingival fibroblasts greatly hampered the periodontium's ability to heal and regenerate. The additional dangers associated with patients utilizing the rinse over an extended period of time are a serious issue as well. As briefly indicated above, this product has exceptionally high parts per million, which limits consumption to no more than two weeks. Unaware of the additional harm they are doing to both their patients and themselves, sadly, many dental professionals are sending their periodontal patients home with the product to use after this time period. Even though it may be unfortunate, these are not the only issues. Staining, burning, cytotoxicity, calculus formation, inactivation in blood/saliva, etc. are a few of the other contraindications. Why is it still suggested, then? Comfortability, to put it simply.
68 years ago, dental practitioners learned about chlorhexidine in academic settings, and it’s been carried over since. Consequently, it became their only alternative. But chlorhexidine is no longer considered the gold standard of care, just like other dental treatments, procedures, and products that were formerly advised. Let's examine amalgams as an example. 150 years later, we are learning that amalgams are poisonous, impair tooth structure, and can cause significant illness or additional decay. Don't forget about airflow versus scale and polish. This approach is not only quicker but also more effective because it can clean those difficult-to-reach areas. As is evident, dentistry has advanced. Because of the convenience of use, the technique, and the risks, we have subsequently progressed past the previously described. With chlorhexidine, it's time to take similar action.
Despite the fact that chlorhexidine's dangers clearly exceed its benefits, many dental offices continue to use this rinse. This often comes down to familiarity and a lack of understanding about a better option. The good news is that activated chlorine dioxide is an additional choice. Although activated chlorine dioxide (CLO2) has been around since the 1800s, the dental industry only became aware of it in the early 2000s. While not to be mistaken with stabilized chlorine dioxide (NaCLO2), this potent ingredient treats a variety of dental problems, including halitosis and periodontitis. To enhance the oral health of all dental patients, it can be applied universally in dentistry.
Additionally, it can address similar problems at considerably lower parts per million (44ppm).
The best part of activated chlorine dioxide is that it has neither adverse effects nor limitations. As a result, this serves as both a chlorhexidine substitute and a general oral health option.
In light of the findings, we no longer have to rely solely on believing in and trusting chlorhexidine. To answer the original query posed at the start of this article, "Should we still be using chlorhexidine?" The response is simple to understand. No.
We are all aware that there is a pandemic going on. Everyone has encountered deserted waiting areas, burning through multiple layers of PPE, and intensified disinfection efforts, but there may be some good news. We can see this as a chance to modernize our infection prevention measures, which is crucial for our patients, ourselves, and our families. You now have your doctor's attention; therefore, there is no time like the present.
This pandemic is forcing us to alter our practices, much like the HIV/AIDS crisis did in the 1980s. Both the modifications we made at the time and the current modifications are required advancements. Previously, treating a patient without gloves was permissible, but today, that is the accepted standard of care. Pre-rinsing has always been advised but is only recently being acknowledged as an essential step in infection management, similar to the wearing of gloves.
It is well known that dental aerosols are dangerous. Pre-rinsing, however, kills the bacteria before they become aerosolized, in contrast to the majority of our present PPE, which is made to act as a barrier between us and particles. Is this effective? Let's turn to science; a recent study found that pre-procedural rinse significantly reduces the germs in aerosols by 97%. This result was discovered by taping agar plates to the walls of a treatment room during the investigation. The plates were subsequently grown in an incubator following the aerosol exposure. There was 94% less bacterial growth when the patient pre-rinsed before receiving treatment. As a result, there will be less bacteria on the countertops, walls, equipment, air, operator's clothing, and clinician's lungs. This demonstrates that a little pre-rinse can at the very least cut down on the contaminants that are still in the air.
Pre-rinsing is a straightforward process, but picking the ideal rinse can be challenging. While viruses are under scrutiny in the contemporary climate, bacteria have historically been the primary concern in dentistry. As a result, several commonly used pre-rinses (such as Listerine and Chlorhexidine) do relatively little to eliminate viruses. Pre-rinses have to be able to eradicate fungus and viruses in addition to bacteria.
A good pre-rinse should also have the capacity to kill swiftly, ideally in under a minute. In a typical dental situation, waiting 5 to 10 minutes for your pre-rinse to take effect is not practical. Who has time to wait that long to begin treating their patient? For instance, hydrogen peroxide shows limited virucidal activity until 5 minutes of contact, and effectiveness also seems to decline with a decreased concentration of the active element. Additionally, effectiveness seems to decline with a decreased concentration of the active element. Using commercially available rinses (1.5% and 3.0% H2O2), a research by the American College of Prosthodontists found that these concentrations have limited virucidal action at both 15 and 30 second exposures, which is a normal rinse time.
Few compounds rival the oxidizing potency of chlorine dioxide when it comes to destroying bacteria, fungus, and viruses. Chlorine dioxide has been used to aid in disinfection in various industries for close to 200 years, despite its more recent application in dentistry. In contrast to other oxidizers like ozone and peroxide, chlorine dioxide is a very selective oxidizer. What does the term "selective" mean? Ozone and peroxide are stronger oxidants that react with many of the other components of saliva because they are less selective in what they break down. The oxidation potential is exhausted before it has a chance to interact with the target pathogen. Additionally, it interacts with bodily cells, which has a detrimental effect on tissue responsiveness. For this reason, surgeons traditionally avoid using products that include peroxide.
Chlorine dioxide is safe and efficient. Even medical equipment and electronic devices utilized in the treatment of patients on the front lines of the fight against Ebola in West Africa were sterilized by the US military using chlorine dioxide. Additionally, it has a history of use and success against the influenza A virus.
OraCare is one of the only products that uses activated chlorine dioxide. It has various medical applications, but pre/post rinsing has been its primary use for the past ten years. Furthermore, a recent study validated OraCare's capacity to eradicate human Coronavirus with no cell damage. OraCare can safeguard you as a dental expert in addition to helping your patients' oral health.
Learn about your options because there are many, as with anything else. Any pre-rinse is always preferable to doing nothing at all. Just make sure the rinse you select eliminates all the microorganisms without harming your patient.
Things will change once we start treating patients like "normal" again. I can be assured of this. There might even be updated OSHA regulations, or we'll at least adhere to the existing regulations much more closely. Pre-rinsing is one aspect of every patient visit that will remain constant. Despite the fact that we were all taught to do this in school and that we should all be doing it, less than 20% of the people I contacted (I contacted 25 friends) pre-rinsed prior to the Covid-19 pandemic. If you're still not convinced, ask yourself if you pre-rinsed everyone. I predict that the answer is no, but I'm fairly confident that after the pandemic, that will be near 100%.
Some of the most hazardous contaminant transmitters in the dental office are dental aerosols. During an appointment, secretions from the nose, throat, and blood can all get aerosolized. These aerosols, which contain bacteria, viruses, and fungus, can be inhaled more than once, land on surfaces, and persist in the air. According to studies, pollutants can spread approximately 30 feet and may even be found on surfaces that aren't being used at the time of a dental treatment. The amount of germs, viruses, and fungi that are expelled from the mouth as aerosols should be reduced or eliminated. Chlorhexidine or another widely accessible over-the-counter product has been utilized by many pre-rinsing offices; this is preferable to doing nothing. However, these medications are only effective against bacteria and have no effect on viruses or fungi. The decrease in viruses is essential to protecting ourselves and our patients, as recent occurrences have brought to our attention. You must find a pre-rinse that is efficient against each of these infections, particularly viruses, if you want to lower the danger.
Few chemical substances can match the oxidizing strength of chlorine dioxide when it comes to killing bacteria, fungus, and viruses. It has a long history of use, is effective against bacteria, viruses, and fungi, and is applied to various industries to dissolve biofilm. Unexpectedly, it is a gas that water treatment plants have long employed to keep drinking water safe. In the aftermath of anthrax attacks, it has also been used to disinfect buildings and post-harvest food. Because chlorine dioxide has a distinct and superior method of eliminating bacteria compared to other disinfectants, it is used in each of these instances. As a virucide, it stands out in particular as being superior to many other products. Activated chlorine dioxide is often regarded as the perfect pre-rinse by dental practitioners. Many dental clinics now include it in their daily routine of personal preventive measures due to its efficiency in killing not only bacteria but also viruses and fungi.
Stabilized chlorine dioxide is something to be on the lookout for. You might believe you are receiving all of these advantages when you are not, since this is not genuine chlorine dioxide. Unfortunately, the term "stabilized chlorine dioxide" is incorrectly used to refer to sodium chlorite, a salt, whereas in fact the compound is stabilized chlorine dioxide. The term "stabilized" seeks to designate a formulation with qualities chemically equivalent to or similar to activated chlorine dioxide. They are remarkably dissimilar. By buffering sodium chlorite with carbonate, phosphate, and hydrogen peroxide, stabilized chlorine dioxide is created. In actuality, this method stabilizes chlorite rather than chlorine dioxide. The stabilized substance differs from chlorine dioxide and does not possess the same oxidizing qualities. The chemical is substantially less effective as a product in general and has a much lower oxidizing potential. Since it would be difficult to hold the gas in a single bottle, genuine chlorine dioxide must be mixed every time before use. Activated chlorine dioxide is the gas that is produced when those two liquids combine.
The active components in OraCare include xylitol and activated chlorine dioxide. Patients can use it for a variety of conditions, such as oral sores, dry mouth, foul breath, periodontitis, and bleeding gums. In-office usage includes irrigation and pre/post rinsing. OraCare can safeguard you as a dental professional in addition to assisting with oral health improvement. The moment has come to examine our daily defensive measures critically. In truth, we are always at risk, and pre-rinsing is a crucial step in ensuring our safety.
At some point during our dentistry careers, we have all heard about Chlorhexidine. We were instructed to use it in office after being taught about it at school. It used to be the only option, but as dentistry changes, it's critical that we talk about the misconceptions and realities surrounding the rinse that experts in the field of dentistry so frequently advocate for and employ.
Here are five myths and the reasons why you should start looking for a substitute.
Myth: Long-term CHX use is possible.
Truth: It should only be used for two weeks at most. A two week time frame doesn't work because tissue needs at least 30 days to recover. For the duration of the healing process, patients will need to continually try to minimize the bacteria and volatile sulfur compounds that inhibit wound healing after a procedure. If used for more than two weeks, the patient's teeth will eventually become visibly stained and will develop further calculus, which can only be removed by a professional cleaning. The aftertaste is greatly disliked by many patients. Patients will have to wait for numerous hours for Chx to take effect, which creates a major barrier and is the reason for low compliance. Using Chx as a long-term alternative should be undesirable because of these adverse effects, the possibility of allergic responses, the inhibition of fibroblasts, and its subpar antibacterial properties.
Myth: The only issue with CHX is that it causes dental discoloration.
Truth: Patients and dental hygienists both complain about staining most frequently, and they both agree that it makes their jobs more challenging. However, it is not the only negative impact. One significant concern involves uncommon but unavoidable allergic reactions, which might present as minor mouth burning or extreme life-threatening symptoms. Chx inhibits fibroblasts, has subpar antibacterial properties, and recent research has discovered problems with Antimicrobial Resistance (AMR), where the rinse itself degrades and develops cross-resistance to other types of bacteria. Every time a patient uses Chx, staff and the patient should keep these more serious hazards in mind.
Myth: Using Chx as a pre-rinse is adequate.
Truth: Chx has weak antiviral properties. In reality, there is conflicting information regarding Chx's capacity to lessen oral microbial load. Studies on Chx's antiviral properties reveal that what it does kill occurs over a long period of time, preventing it from killing viruses quickly enough to be an effective pre-rinse. Can it be helpful if we use it to lower the microbial load before treating a patient but it takes many hours to do so? Isn't that the point behind the pre-rinse?
Myth: You can use chx for perio, implants, and post-operative care.
Truth: Chx should only be used to treat gingivitis. Chx is a powerful weapon against germs, according to research, but it also causes a high rate of cell death in human gingival fibroblasts and kills without discrimination. Chx has a strong potential for cytotoxicity, and since it needs fibroblasts for tissue repair, it slows down the healing process. To aid in healing during the crucial healing phase following an SRP or treatment, healthy cells and fibroblasts are required. Simply put, a salt rinse works better than a Chx rinse after surgery.
Myth: Chlorhexidine is the only rinse that effectively destroys bacteria.
Truth: Chx is not the only professional choice. Even with all of its drawbacks, we already know the truth about Chx: it is efficient against bacteria. But does it make sense to continue using it after taking all of the dangers and adverse effects into account? There is one rinse that is the only other choice. OraCare. When OraCare's active component, chlorine dioxide, is activated, it has the same effectiveness in killing bacteria as Chx while doing so with fewer parts per million. It has been determined to be the best replacement for Chx due to its capacity to eradicate viruses, fungus, and volatile sulfur compounds while posing no adverse side effects and improving home care.
The Doctor’s View:
There are a variety of viewpoints on this issue which affects dentists and hygienists frequently. I need more details before I can provide my opinion. What are you being asked to do by your dentist during the prophy? Are you enrolling each patient and conducting co-discovery, or are you merely cleaning their teeth?
It would be unfair to compare hygiene prophy times. It’s like comparing apples and oranges. Everything depends on the hygienist's responsibilities.
As a hygienist, I agree with the dentist that your time should be limited if all you are doing during a prophy is cleaning teeth.
You will need additional time if you are performing co-discovery, which entails examining the patient's radiographs, probing to evaluate gingival health, looking for any suspicious lesions, and checking for decay while also evaluating the patient's oral health. Because hygienists are typically unable to provide a final diagnosis for these illnesses, we refer to this as co-discovery. Then, you would require more time if you were to deliver these results and enroll the individuals in treatment. Naturally, the dentist will check everything the hygienist finds, but the more involved the hygienist is with the patient's health and education, the more time is required.
As a dentist, I believe that my hygienist deserves more time for a prophy session the more value they add to the patient.
The Hygienist’s View:
This problem affects so many hygienists! The amount of time allocated for procedures differs from office to office, but how much time is really necessary? We realize that asking for 90 minute prophy times for every patient is unrealistic. What am I currently unable to perform in the time that is available to me should be your first thought. By first asking yourself this question, you can gain some understanding of what you are actually seeking in the time that you have available. You may not necessarily require more time for the prophy, but rather more time to offer a higher caliber of care.
Increasing the standard of care is the best approach to boost output. Many doctors disagree with adding more time to a prophy because, in their opinion, adding an extra 10 minutes to your scaling time would be ineffective. Instead of going to your doctor and requesting "more prophy time," request extra time for sealants, fluoride treatments, talking about additional treatment choices (including the treatment they may provide), or enrolling patients in periodontal therapy. These office productivity-boosting care strategies also give you the brief window of time you might need.
Expectations are the key to everything. If all you are doing with an adult recall patient is scaling, we believe between 30-40 minutes is the right amount of time. A better amount of time would be 50–60 minutes if you were offering value, such as co–discovery, patient education, or therapy enrollment. Typically, you would allow an extra 20 to 30 minutes for establishing a rapport with a new patient, recording their progress, and finishing their films.
Every doctor and hygienist has a unique work schedule, and the times listed above are only suggestions. The doctor-hygiene partnership should, in the end, be a collaborative effort with honest communication about your roles and responsibilities. Expectations must be discussed with your doctor before discussing prophy time.
Do the crowded tables, flashing lights, and winning money excite you? If so, Las Vegas might be the place for you. However, choosing red or black on the roulette wheel is not as simple in dentistry. Chlorhexidine is one of several high-stakes hazards that you might not be aware of, despite the fact that the payoff isn't worth it. Chlorhexidine was once regarded as the gold standard, but as time went on and because of its capacity to destroy bacteria, we ignored the drawbacks including staining, calculus buildup, and loss of taste. However, things only grow worse, and the odds are not on your side.
Inactivation in Blood and Saliva
The mouth is not often a dry location, unlike the desert around Las Vegas. Blood, saliva, and even toothpaste have been found to significantly impair chlorhexidine's antibacterial properties. According to studies, you should wait up to an hour before eating or drinking to prevent inactivation, and wait 30 minutes after using chlorhexidine as a mouthwash.
Inhibition of Fibroblasts:
One point to emphasize while using chlorhexidine is how it affects the fibroblasts that produce the periodontal ligament. Chlorhexidine has been reported to harm fibroblasts and other collagen-producing cells, according to studies. In order for periodontal therapy to be effective, it is crucial that these cells are created appropriately. Improper development might result in reattachment problems, delayed healing, and an unfavorable outcome for the patient.
Death is the most severe side effect of a chlorhexidine rinse that has been documented. The Food and Drug Administration has received reports of over 52 anaphylactic cases. In two of these cases, a fatality following dental extractions has been reported. Chlorhexidine is not meant to be used after surgery or on any open wounds due to its 1,200 ppm concentration. It's crucial to keep in mind that chlorhexidine wasn't intended to be used as a rinse for implants, extractions, or periodontal therapy. It was intended to be used only to treat gingivitis' swelling, bleeding, and inflammation and to be stopped after two weeks. Chlorhexidine use outside of the recommended dosage can have serious consequences.
Only one other professional rinse makes use of activated chlorine dioxide. Fortunately, there are no hazards associated with using this rinse, and both you and your patients will greatly benefit from using it. Professional rinses are only available from licensed professionals and cannot be purchased over the counter.
The same germs can be killed by activated chlorine dioxide just like they can be by chlorhexidine, but it also does it more quickly and with fewer parts per million. Since chlorine dioxide is a gas, it can swiftly leave the tissues with no lasting consequences. It is known to be superior to other products at not only getting rid of bacteria but also viruses, fungus, and volatile sulfur compounds.
Our patients' many challenges range from simple ones, such as everyday care, to complex ones like chemotherapy or radiation. Help may be just a swish away if they need it. Professional mouth rinses are one of the most underutilized types of products in the dental field, and they are specifically designed to help our patients through some of these challenges. These mouthwashes aren't like the ones your grandparents used, yet they are still effective for bad breath. The rinses of today are supported by science and research. Some contain ingredients that break up biofilm and eliminate bacteria, viruses, fungi, and volatile sulfur compounds, which play a detrimental role in periodontal disease and wound healing.
Let's explore eight ways rinses can tackle some of the difficulties that are given to you and your patients.
Challenge Number 1- Everyday Care
We all advise our patients to brush and floss their teeth, but as we all know, they don't do a very good job of it. In 2014, a Delta Dental survey found that only four out of ten Americans floss at least once a day, while two out of ten never floss. Additionally, the patients who floss are urged to do it properly. You already know that flossing involves creating a C-shape around each tooth and sliding the floss up and down to remove bacteria. The question is how many of your patients do that correctly?
Patients who don't floss or who do it incorrectly may benefit from professional rinses. Please understand that I am not saying that flossing is not vital; nonetheless, I see so many patients who floss poorly or not at all (even after they have had in-chair instruction). Furthermore, neither flossing nor brushing is antibacterial; they are just mechanical. Here, the appropriate rinse might aid in preventing plaque buildup. Rinses can also get to places that brushing and flossing can't, such as the tongue, the floor of the mouth, and any other crevice in the mouth where germs hide and thrive.
Challenge Number 2- Plaque Reduction
Bacteria form a matrix and create biofilm as a result. This also makes it possible for other germs to attach to the tooth, such as viruses, fungus, and different kinds of bacteria. Many solutions can kill a single strain of bacteria; however, few rinses actually break up biofilm and destroy the remaining bacteria. Dental plaque is a biofilm that can cause significant damage to the oral environment when not adequately removed. Plaque can be significantly reduced by rinses that dislodge biofilm, especially in compromised patients, children, and patients wearing braces.
Challenge Number 3- Periodontal Therapy
There are many variables that can lead to periodontal disease. We prefer to hone in on bacteria, but we must recognize that studies suggest viruses, fungus, and volatile sulfur compounds are all involved when dealing with any sort of gingivitis or periodontitis. Patients can achieve their ideal outcomes by acknowledging these extra factors during treatment and figuring out simple ways to get rid of them. Plaque and calculus must also be eliminated so that the gingiva can properly recover. Professional rinsing should eradicate volatile sulfur compounds, bacteria, viruses, and fungi without leaving behind stains or calculus.
Challenge Number 4- Bad Breath
I think we all know that rinses can help with bad breath. However, most over-the-counter rinses simply mask the issue or focus only on killing bacteria. You must kill bacteria and their excretions, which are volatile sulfur compounds (VSCs), if you want to get rid of bad breath. If you've ever come across a patient with halitosis, you are already familiar with the smell that VSCs can provide. The mouth is filled with bacteria and VSCs, particularly on the tongue and beneath the gingiva. By destroying germs and VSCs, the correct rinse can eliminate bad breath for eight to twelve hours.
Challenge Number 5- Tissue Management After Surgery
The mouth is one of the hardest places to heal after procedures like extractions and implant placements. The mouth cavity is a good environment for bacteria, viruses, fungus, and VSCs. It's also a location where it's challenging to keep wounds clean and dry. This is why professional rinses can speed up healing by assisting in the battle against bacteria and their byproducts. Additionally, it takes the gingiva 32 to 34 days to recover, making it crucial to have a rinse that can be used consistently over an extended period of time.
Challenge Number 6- Fungal Infections
The mouth is damp and dark. Fungi flourish in the mouth cavity because of this. Although candidiasis, a common fungus, can affect any patient, it is more common in infants, people with immune system disorders, and the elderly, particularly those who wear dentures. Another fungus infection that affects the corners of the mouth is angular cheilitis. These diseases can be cured in a few days with the help of contemporary rinses that kill fungi.
Challenge Number 7- Pre Rinsing
I believe it is common knowledge that patients should be pre rinsed before every surgery. We should do this for three reasons: (1) to affect the working environment, (2) to avoid patient-to-patient cross-contamination, and (3) to prevent patient-clinician cross-contamination.
Before we start working, we should strive to eliminate as many bacteria as possible because the handpieces we use emit aerosols that contain millions of them. Use a rinse that kills both bacteria and viruses as you practice. Many individuals I speak with use a rinse that simply kills bacteria, but viruses are a major threat when we're concerned about cross-contamination.
Challenge Number 8- Cancer Care
More than 1.5 million new cases of cancer are diagnosed each year, and many patients receive chemotherapy, radiation, or even a combination of the two. The oral mucosa suffers greatly as a result. Many of these patients have dry mouth, burning, and uncomfortable sores. The appropriate rinse, used daily, can significantly lower these problems and keep patients more comfortable.
In conclusion, a professional rinse must get rid of bacteria, fungi, viruses, VSCs, and biofilm in order to handle all of these problems. Additionally, because gingiva takes 32–34 days to heal, it must be safe enough to be used every day. There are rinses on the market that address some of these problems, but OraCare is the only one that provides a fix for all eight problems. These microorganisms are eliminated by the active ingredients in OraCare, activated chlorine dioxide and xylitol, which are safe to use daily and do not stain teeth or create calculus. Professional rinses should be an integral part of preserving and improving your patients' oral health, whether you use OraCare or a solution created especially to treat one of the issues mentioned above.
You can learn more about OraCare's revolutionary health rinse at www.OraCareProducts.com or by calling 855-255-6722.
We are all aware of how important bacteria are for the treatment of wounds, periodontal disease, and foul breath. But are you aware of the secret adversary? The one that bacteria exude to aid in their own success? Like all other living things, bacteria must consume food in order to thrive. They have to use the restroom after eating. Volatile sulfur compounds (VSCs) are emitted and exist uncontrolled in the mouth. VSCs are connected with poor breath because they smell, but they are also poisonous to your tissue, encourage bacterial assaults, and slow the healing of wounds. As a result, they play a significant role in infections, periodontal disease, and the impairment of gingival repair.
If you are familiar with VSCs, you have probably heard of them in relation to bad breath. The unpleasant scent that we detect on patients' breath is due to VSCs. As dental professionals, we are expected to provide a remedy for this since it is the most common patient complaint. Patients who suffer from bad breath find it disruptive to their everyday lives and spend more than $1 billion annually on halitosis solutions. They frequently experience embarrassment and frustration since they have tried every over-the-counter remedy without success. This is because the majority of these products either target bacteria only or attempt to cover up the odor. Eliminate bacteria and VSCs from your mouth to combat foul breath.
Toxic to the Tissue
VSCs are hazardous to tissue, even at low concentration levels. VSCs are directly harmful to periodontal tissue, according to studies. Everyone has encountered a patient whose periodontal disease is immediately apparent as they enter the room. In dentistry, we occasionally get things backwards: the smell (VSCs) is what truly causes periodontal disease, not the other way around.
Bacteria excretions and death cause VSCs, which make the cell wall easier for bacteria to move through and essentially allow a bacterial assault on the already compromised tissues. Given that both hard and soft tissues are affected, the presence of VSCs speeds up the transformation of gingivitis, the initial infection, into full-blown periodontitis. The longer VSCs go uncontrolled, the more damage they are able to do, and they actually have a multiplier effect that can worsen periodontal disease.
Impede Wound Healing
There are numerous hypotheses regarding how VSCs hinder wound healing. Some contend that they stop oxygen from reaching the site, while others assert that they promote collagen degradation. What is certain is that there is a connection between VSCs and inadequate healing. Numerous studies have shown that reducing VSCs helps speed up the healing process. For those of us in dentistry, the particular problem is getting wounds to heal in a setting that isn't really conducive to healing. The mouth is the ideal environment for VSC proliferation and microbial development.
It goes without saying that we must address VSCs in order to combat bad breath, periodontal disease, and infections while promoting gingival repair.
Therefore, the greatest strategy to aid in bad breath, give appropriate tissue management, and shorten healing time is to regulate the bacteria and VSCs. The placement of VSCs makes removal difficult. They are typically found in places where patients frequently forget to brush and floss and miss them altogether. The regions with the largest levels of bacteria and, consequently, VSCs are the interproximal regions, the back of the tongue, and periodontal pockets. Without introducing something therapeutic, we can't effectively remove VSCs since brushing and flossing only mechanically remove debris.
One of the most popular VSC removers has been shown to be activated chlorine dioxide. This is due to the fact that it is a gas that directly interacts with gaseous VSCs in the mouth. Additionally, this chlorine dioxide gas can get to those tricky-to-reach places that are typically neglected. It has to come from a two-bottle system because you must activate that gas with each use. Single bottle systems that advertise themselves as chlorine dioxide are actually just sodium chlorite and do not remove VSCs as quickly as actual activated chlorine dioxide. When selecting a product to combat volatile sulfur compounds, keep that in mind.
In conclusion, it is well known that microorganisms thrive in the mouth. We must choose products that destroy germs as well as the hidden enemy known as VSCs.
Kristin Goodfellow RDH
Kristin is Chief Clinical Officer of OraCare, a practicing Registered Dental Hygienist