Maximising patient support with evidence-based plaque management

When Johnson & Johnson brought together a group of dental hygienists and therapists for the very first Hygienist Advisory Panel meeting, they shared their views in relation to plaque management.

The group also explored the evidence base in relation to the benefits and any limitations of mechanical cleaning. As well as possible adjunctive support in the form of a chemotherapeutic mouthwash.

Building on the outcomes of the earlier National Advisory Panel formed of key opinion leaders, the group then agreed on the following consensus:

‘Healthy gums don’t bleed when brushed. Twice daily brushing along the gum line and cleaning in between the teeth is essential to support a healthy mouth. Fluoride mouthwashes clinically proven to reduce germs (plaque) offer additional benefit.’

Below the age of seven

‘Spit don’t rinse.’

Over the age of seven

‘For better gum health, after brushing spit and then rinse with a fluoride mouthwash that is clinically proven to reduce germs (plaque).’

The current evidence base

When investigating the evidence base for adjunctive plaque management, Figuero and colleagues (2020) concluded that adjunctive antiseptics in mouthwash provide statistically significant reductions in plaque compared to mechanical cleaning alone at six months.

This was the outcome of a systematic review and meta-analysis exploring the adjunctive use of 11 different mouth rinse formulations (Figuero et al, 2020).

They also came to the conclusion that: ‘…despite the high variability in the number of studies comparing each active agent and the different risks of bias, CHX [chlorhexidine] and EOs [essential oils], in mouthrinses appeared to be the most effective active agents for plaque…control.’

The Figuero and colleagues’ (2020) outcomes add to the pre-existing evidence base presented by Araujo and colleagues (2015). This was the first meta-analysis to demonstrate the clinically significant, site-specific benefit of adjunctive essential oil mouthwash in people within a six-month period (that is, between dental visits).

The analysis revealed that 36.9% of subjects using mechanical methods with essential oil-containing mouthwash experienced at least 50% plaque-free sites after six months. This compares to just 5.5% of patients using mechanical methods alone (Araujo et al, 2015).

The Johnson & Johnson mouthwash range

Within the Johnson & Johnson mouthwash range, it has been demonstrated that, when used as an adjunct to mechanical cleaning, Listerine Total Care, an essential oil mouthwash with fluoride, manages plaque levels to help prevent gingivitis and caries (Boyle, Koechlin and Autier, 2014; Duckworth et al, 2009).

Listerine Total Care may therefore support the efforts of a patient requiring early intervention. This is by virtue of its essential oil formulation consisting of eucalyptol, thymol, menthol and methyl salicylate, all of which are proven to:

  • Penetrate the plaque biofilm (Pan et al, 2000)
  • Manage the bacterial load of the mouth (Minah et al, 1989)
  • Reduce maturation of remaining biofilm colonies (Johnson & Johnson data on file).

It has been demonstrated that, when used as an adjunct to mechanical cleaning, Listerine Total Care achieves five times more plaque-free sites than mechanical methods alone, which may help to prevent gum disease (Araujo et al, 2015).

Listerine Total Care products also contain fluoride, from 220 ppm to 300 ppm, depending on the product in question, which may contribute to anti-caries protection (Duckworth et al, 2009) .

Through its range of mouthwashes, Johnson and Johnson helps dental teams work in partnership with patients, with specific products designed to improve home care routine outcomes significantly, which helps to support the periodontal and dental health of your patients when used in conjunction with mechanical cleaning.

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Araujo MWB, Charles C, Weinstein R, McGuire J, Parikh-Das A, Du Q, Zhang J, Berlin J and Gunsolley J (2015) Meta-analysis of the effect of an essential oil-containing mouthrinse on gingivitis and plaque. J Am Dent Assoc 146: 610-22

Boyle P, Koechlin A and Autier P (2014) Mouthwash use and the prevention of plaque, gingivitis and caries. Oral Dis 20(1): 1-76

Duckworth RM, Maguire A, Omid N, Steen IN, McCracken GI and Zohoori FV (2009) Effect of rinsing with mouthwashes after brushing with a fluoridated toothpaste on salivary fluoride concentration. Caries Res 43: 391-6

Figuero E, Roldán S, Serrano J, Escribano M, Martín C and Preshaw P (2020) Efficacy of adjunctive therapies in patients with gingival inflammation. A systematic review and meta-analysis. J Clin Periodontol 47: 125-43

Minah GE, DePaola LG, Overholser CD, Meiller TF, Niehaus C, Lamm RA, Ross NM and Dills SS (1989) Effects of 6 months use of an antiseptic mouthrinse on supragingival dental plaque microflora. J Clin Periodontol 16: 347-52

Pan P, Barnett ML, Coelho J, Brogdon C and Finnegan MB (2000) Determination of the in situ bactericidal activity of an essential oil mouthrinse using a vital stain method. J Clin Periodontol 27: 256-61

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