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Dental care:the best, worst and unproven tools to take care of your teeth

Do Probiotics Prevent Gum Disease? Is flossing necessary? Many people are unable to answer these questions and more with confidence due to the plethora of conflicting medical information. However, new research led by the University at Buffalo aims to separate fact and fiction in determining which oral hygiene tools actually prevent gum disease.

The result: only a handful of self-administered interventions provide additional protection against gingivitis and periodontitis, beyond brushing with a regular toothbrush. At this time, all other oral hygiene interventions are only supported by insufficient evidence, says Frank Scannapieco, DMD, PhD, principal investigator and chair and professor of oral biology at the UB School of Dental Medicine.

The findings, he says, will help identify best practices for preventing gum disease.

Additional researchers include Eva Volman, DDS, first author, UB alumna and regular dentist of the Eastman Institute for Oral Health; and Elizabeth Stellrecht, interim head of health sciences library services at the UB.

The proven: basic toothbrush; interdental brush; flossing with water; Chlorhexidine Gluconate (CHX), Cetylpyridinium Chloride (CPC) and Essential Oil (Listerine) Mouthwashes.

Brushing your teeth is the cornerstone of daily oral hygiene and is a reliable way to control plaque, Scannapieco says. And according to the study, interdental brushes and flossing outperformed other interdental oral hygiene devices in reducing gingivitis, and both should be used in conjunction with daily tooth brushing to prevent gum disease.

Of the numerous mouthwashes studied, those based on CHX, CPC and essential oils (such as Listerine) have been shown to be effective in significantly reducing plaque and gingivitis.

While they weren't effective at fighting gingivitis, toothpicks were helpful for monitoring gum health, Scannapieco says. By gently pricking the gums with a toothpick and checking for bleeding, patients were able to detect signs of gum disease.

The bad: triclosan

Triclosan toothpastes and mouthwashes significantly reduced plaque and gingivitis, but the compound has been linked to the development of several cancers and reproductive defects. Triclosan has been removed from most popular toothpastes.

The unproven: electric toothbrushes, dental floss, probiotics, nutritional supplements and countless mouthwashes

Electric-powered toothbrushes are no more effective at reducing plaque and gingivitis than a standard toothbrush, the researchers found. And little evidence has been published to support dental floss — the mainstay of interdental cleaning — for reducing plaque and gingivitis. But don't throw away your floss yet, says Scannapieco, because flossing is beneficial.

“While there are few studies available that specifically examined just toothbrushes or floss, both are still essential. Floss is especially useful for removing interdental plaque for people who have a tight space between their teeth. Floss probably also reduces the risk of cavities between the teeth,” says Scannapieco.

The researchers found insufficient evidence that mouthwashes based on tea tree oil, green tea, anti-inflammatory agents, hydrogen peroxide, sodium benzoate, stannous fluoride, hexetidine or delmopinol reduce gingivitis.

The use of probiotics, while promising as a preventive strategy against gum disease, has not been proven. The researchers found little evidence to support the claim that dietary supplements improve gum health. The researchers also found insufficient evidence that professional plaque removal (known as scaling, the process of removing plaque with a scraper) prevents gum disease.