As dental professionals, our goal is to prevent the onset of disease. The right products can positively impact the outcomes of services we provide, as well as aid in maintaining a patient’s oral health between appointments. Guidance on product selection is an important benefit we can provide to patients. There are three choices: professional product options, over-the-counter (OTC) products, or recommending nothing and leaving product selection entirely up to the patient.
Professional products
Professional products are the products that can’t be found in stores. This is challenging because they aren’t easily accessible to patients and must be carried in office or prescribed. Professional products are more effective at treating the problem. It’s like the difference between clear aligners made in-office, overseen by a dental professional, versus a home kit that a patient buys. The at home kit may work in a limited number of cases, but the professional could work on all cases, especially the tough ones.
If you want professional results, you need to use professional products. Take rinses. There are really only two options that are considered professional products—chlorhexidine and activated chlorine dioxide (OraCare). Neither of these products can be found over the counter and must be given directly to the patient or prescribed by a dental professional.
Hygienists often default to using chlorhexidine because it is what we learned in school. The reason we have continued to use chlorhexidine is because it is a great bacteria killer. Many are discontinuing its use because of the many side effects from this strong biocide (1,200 ppm).
In addition to the staining and additional calculus build-up, numerous studies confirm that chlorhexidine damages fibroblasts and disrupts the healing process.1-3 It is also inactivated by blood, saliva, and if used within 30 minutes of brushing your teeth.4,5 Another challenge is that it is only recommended for two weeks of use total therefore can’t be used for regular homecare. Usually gingiva takes a minimum of 34 days to heal from a disease state to a healthy state.6 This being a major reason we don’t get great results using chlorhexidine.
The only other professional rinse choice is OraCare. It was created by dental professionals trying to replace chlorhexidine because of the problems it creates. This rinse has challenges too. It is only found in dental practices and tends to be more expensive than OTC choices. The good news about OraCare is that it outperforms OTC products and kills the same bacteria as chlorhexidine.7 It also kills viruses, fungi, neutralizes volatile sulfur compounds, and breaks up biofilm with none of the side effects of chlorhexidine.
OraCare does all of this with only 44 ppm, meaning that patients can use it daily, which is the whole definition of home care. Dental professionals that have made the switch have made this a go-to product when looking for a tool to improve homecare.
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Over-the-counter products
OTC products are easy to find, and are cheaper than professional products. However, they generally do not have the same level of effectiveness, and there is no professional guidance. For example, prescription fluoride gel does a better job than OTC toothpaste at decreasing sensitivity. It’s used for a specific patient need and is stronger and more effective. The OTC product fits a more general population, but its effectiveness is limited.
Also, most OTC products address only one part of complex dental problems. Take halitosis. It is caused by two contributing factors: bacteria and volatile sulfur compounds. Both must be addressed long term, and most OTC products only fight bacteria. We’d prefer patients use professional products but recognize that OTC products have their place.
Recommend nothing
You can always choose to recommend nothing, leaving it up to the patient to decide what to use. While this eliminates any hurdles you may face, it is also likely that you won’t get the desired results. It is our duty to guide our patients to the best possible oral health. Even if patients choose not to follow our advice, we need to educate them.
We know that preventing disease depends heavily on what patients do in between appointments. That is why it's important to strategize our patients’ homecare. Professional products have the ability to provide this elevated level of care that patients need.
Let’s choose the path that leads to better clinical outcomes—it is our responsibility.
Editor's note: This article appeared in the March 2022 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
- Alleyn CD, O'Neal RB, Strong SL, Scheidt MJ, Van Dyke TE, McPherson JC. The effect of chlorhexidine treatment of root surfaces on the attachment of human gingival fibroblasts in vitro. J Periodontol. 1991;62(7):434-438. doi:10.1902/jop.1991.62.7.434
- Chlorhexidine (oral route) side effects. Mayo Clinic. Updated February 1, 2021. www.mayoclinic.org/drugs-supplements/chlorhexidine-oral-rout/side-effects/drg-20068551?p=1
- Wyganowska-Swiatkowska M, Kotwicka M, Urbaniak P, et al. Clinical implications of the growth-suppressive effects of chlorhexidine at low and high concentrations on human gingival fibroblasts and changes in morphology. Int J Mol Med. 2016;37(6):1594-1600.
- Tsourounakis I, Palaiologou‐Gallis AA, Stoute D, et al. Effect of essential oil and chlorhexidine mouthwashes on gingival fibroblast survival and migration. J Periodontol. 2013;84(8):1211-1220.
- Kolahi J, Soolari A. Rinsing with chlorhexidine gluconate solution after brushing and flossing teeth: a systematic review of effectiveness. Quintessence Int. 2006;37(8):605-612.
- Smith PC, Cáceres M, Martínez J. Gingival wound healing: an essential response disturbed by aging? J Dent Res. 2015;94(3):395-402.doi:10.1177/0022034514563750
- Downs RD, Banas JA, Zhu M. An in vitro study comparing a two-part activated chlorine dioxide oral rinse to chlorhexidine. Perio Implant Advisory. January 15, 2015. www.perioimplantadvisory.com/clinical-tips/hygiene-techniques/article/16411500/an-in-vitro-study-comparing-a-twopart-activated-chlorine-dioxide-oral-rinse-to-chlorhexidine
