Long term Maintenance of Periodontal and Implant Health

Teeth affected by periodontal disease and dental implants can be kept healthy and maintained in the mouth over a long period of time. A number of factors must be addressed in order to maintain periodontal and implant health.

Oral Hygiene Measures

This is probably the most important factor in deciding long term periodontal and implant health. When performed correctly, there may be some bleeding noticed initially, this is merely a sign of inflammation and will resolve with time. In order to maintain minimal plaque levels and health, we advise the following regimen:

- Toothbrushing twice a day, ideally with an electric toothbrush.

I recommend the Oral B io range as they have a pressure sensor which shows not only when you are brushing too hard but also that you are using the correct pressure.

Correct technique for brushing is essential in order to achieve the results. Various videos can be found online showing how to use electric brushes correctly. However, I find carrying out a demonstration with your own brush to be the most useful so please do bring your brush along to your next dental or hygiene appointment.

- Interdental brushing at least once a day.

Using just an electric brush is not sufficient to clean the mouth as these will not clean the space between the teeth.

It is essential to use brushes that are tight fitting to achieve a good result. If the brushes are too small or loose fitting they do not clean sufficiently. Indeed there can be some discomfort when using the correct size brushes but this improves over time.

The most commonly available interdental brushes are Tepe brushes.

Curaprox do an eco-friendly alternative to Tepe brushes. They provide a reusable plastic or metal handle and inserts, with each insert lasting up to 1 week. These can be purchased online at:

Please note that the Tepe and Curaprox colours do not match, please use the following conversion chart:

 

 

Curaprox conversion chart

- Single tufted brushes are very useful to clean around areas where teeth are crowded and/or inclined and in areas next to missing teeth. 

- Floss is not as effective as interdental brushes in cleaning around the gum area but it does clean the contact area between teeth and help prevent tooth decay.Floss may be used where it is not possible to insert even the smallest interdental brush. 

The use of superfloss is recommended around bridges and the use of Curaprox Implant saver floss around implant crowns and bridges.

- Water flossers are not as effective as interdental brushes in cleaning the gum area but can be used as an adjunct. Water flossers are useful for cleaning around bridges and dental implants.

- Any toothpaste with fluoride is recommended. Sensitive toothpastes are very useful in situations where there is ongoing sensitivity to hot or cold. If you do require a sensitive toothpaste, please continue to use exactly the same toothpaste that is effective for you as changing to alternatives may not be as effective. 

- Mouthwashes are not generally recommended where sufficient mechanical cleaning using brushes is being carried out.

Mouthwashes such as Fluorigard and Listerine can be a source of fluoride and help in patients with high susceptibility to tooth decay.

Antiseptic mouthwashes such as Corsodyl and Peroxyl can be useful when it is difficult to perform adequate mechanical cleaning, for example, when mouth ulcers are present or after treatment. 

Curaprox Perioplus Regenerate or Corsodyl/Curasept daily together with Gengigel (gel version) and/or Blue M gel are recommended for healing following a surgical procedure.

Here are links where some of the above recommended products can be viewed and/or bought:

Electric brushes:

https://www.oralb.co.uk/en-gb/product-collections/electric-toothbrushes

https://www.philips.co.uk/c-m-pe/electric-toothbrushes

Single tufted and post surgical brushes:

https://curaprox.co.uk/info/toothbrushes/cs-1006

https://curaprox.co.uk/shop/toothbrushes/medical-toothbrushes/cs-surgical

Interdental brushes:

https://curaprox.co.uk/info/interdental

Implant saver floss:

https://curaprox.co.uk/shop/interdental/dental-floss/df-846-implant-saver

Mouthwashes and gels:

https://curaprox.co.uk/shop/oral-rinses-and-gels/oral-rinses/perioplus-regenerate

https://www.gengigel.co.uk/products/gengigel-gel/

https://www.bluemshop.co.uk/product/bluem-oral-gel-15ml/

NB: I have no financial or other affiliations with any of the above recommended products and manufacturers.

Smoking

Smoking is one of the most common risk factors associated with periodontal and implant disease. Smoking reduces blood supply, affects immune function and can alter the bacterial balance in the mouth. The effects of smoking are dose dependent, hence the more you smoke the higher your risk of disease. Smokers generally display worse outcomes of periodontal treatment both in the short and long term. 

There is limited data regarding the impact of vaping on periodontal and implant disease. However, preliminary data indicates there may be reduced treatment outcomes where there is a high overall dose of nicotine intake.

Hence it is recommended to not smoke or vape in order to maintain good periodontal and implant health.

We appreciate it is not always easy or straightforward to stop smoking, hence why we recommend the use of a smoking cessation service. Such services have been shown to be more effective as stopping smoking and to remain stopped over a long period of time.

Smokefree is a free smoking cessation service that I highly recommend. Please pay them a visit on:

https://smokefree.gov/

Regular dental and hygiene visits

It is essential to visit the dentist and/or hygienist on a regular basis. They will monitor your oral hygiene and assess your periodontal and caries (decay) status and also check for things such as teeth grinding and oral cancer. 

Periodontal and implant disease don't tend to cause symptoms until at a moderate - late stage. Regular visits to dentists and hygienists means potential problems can be detected earlier and hence easier to rectify with a higher chance of success.

Infrequent visits to the dentist and/or hygienist following completion of periodontal and/or implant treatment has been shown to be a cause for long term disease and/or failure of treatment.

Bruxing (Teeth grinding/clenching)

Bruxing is on the increase in current adult populations. Almost all my adult patients show signs of bruxing but only a small proportion are aware of bruxing or get problems from it. Bruxing can be a very destructive process causing damage to the jaw joint, teeth and restorations (fillings, crowns, bridges and dental implants). Bruxing can also accelerate the rate of bone loss where there is pre-existing periodontal disease.

If you are aware or have been made aware you are a likely bruxist, it is highly recommended to have a custom mouthguard fabricated by your dentist. There are several options for mouthguards. The one I recommend is a Sleep Clench Inhibitor (SCi). This is amongst the smallest mouthguards hence being the most comfortable. Unlike other mouthguards which are designed to protect the teeth, the SCi also protects the jaw joint and head and neck muscles. More information on the SCi can be found at:

https://www.s4sdental.com/teeth-clenching-grinding-migraines-headaches

See the video below for a patient testimonial on the SCi splint.