Proven Primary Prevention Strategies for Plaque-Induced Periodontal Disease – An Umbrella Review

Authors: Eva I. Volman, Elizabeth Stellrecht and Frank A. Scannapieco


Aim: The aim of this umbrella review was to provide a summary of the findings based on the highest level of evidence from published systematic reviews to identify proven, self-administered interventions to prevent periodontal disease. Methods: A search for systematic reviews and meta-analyses was conducted using the following search terms: systematic review, periodontal disease, periodontitis, gingivitis, and primary prevention. Outcomes included indices for dental plaque (oral biofilm), gingival inflammation, gingival bleeding, and probing pocket depth. Results: No systematic reviews were found that evaluated the effectiveness of toothbrushing for daily oral hygiene. Methods of mechanical oral biofilm control found to be effective when compared to toothbrushing alone included powered toothbrushes, oral irrigators, and interdental cleaning devices (triangular woodsticks and interdental brushes). Manual tooth brushing and powered tooth brushing were found to be equivalent. Effective topical chemical interventions include chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC), and essential oils. Other interventions, including sodium benzoate (PLAX), stannous fluoride, hexetidine, hydrogen peroxide, other natural compounds, 0.2% delmopinol, probiotics, anti-inflammatory agents, dietary supplements, anti-oxidants, and smoking cessation are supported only by limited evidence. Triclosancontaining dentifrice adds to the effectiveness of toothbrushing to reduce gingivitis. Conclusion: Relatively few interventions have been proven to prevent gingivitis and periodontitis.

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