When a patient presents with signs of gingivitis, the first course of action is usually to encourage mechanical biofilm control. Without a doubt, this is critical for the prevention and management of periodontal disease, however research shows that we could be helping our patients to gain more benefit by adding one simple recommendation.
The need for biofilm control
It is well established that oral biofilm accumulation is at the root of several oral diseases, including gingivitis and periodontitis. As such, successful biofilm control is necessary for the prevention and management of periodontal disease. This is achieved by a) disrupting biofilm to prevent accumulation, and b) the use of chemotherapeutics.
Mechanical biofilm control is needed: twice-daily brushing and daily interdental cleaning. This is an effective method of disrupting and reducing biofilm when performed correctly and consistently. A body of research shows that adding chemical biofilm control agents (chemotherapeutics) can offer greater protection.
Adding value with chemotherapeutics
Recommending a toothpaste and mouth rinse with antibacterial ingredients is an easy way to help patients incorporate chemical biofilm control into their oral health routine. These fit seamlessly into patients' existing daily routine by taking the place of products they already use, thereby increasing compliance.
One example is the combination of amine fluoride (AmF) and stannous fluoride (SnF2), as found in meridol toothpaste and meridol mouth rinse. In this dual-fluoride combination, amine fluoride stabilizes stannous ions and delivers them directly to the gingival margin. The bacterial biofilm responsible for periodontal diseases is then effectively targeted, offering:
Relief from inflammation, irritation, redness and swelling of the gingival tissue
Prevention of biofilm accumulation
Protection from periodontal disease and dental caries.
The research
The efficacy of AmF and SnF2 has been clinically demonstrated in several meridol products. In one study, meridol toothpaste was shown to reduce gingival bleeding by 45% after 12 weeks of use. (Banach et al 2007) Meanwhile, in patients who had received dental implants, meridol mouth rinse was shown to provide antibacterial effect on par with chlorhexidine, the current gold-standard.
In another study, the use of meridol toothpaste and mouth rinse was compared to use of a sodium fluoride toothpaste and mouthwash. (Danser et al, 2001) It was found that the meridol group had significantly lower biofilm scores after two years. In another one, of 12 weeks duration, researchers compared the following four combinations:
meridol Toothpaste with AmF and SnF2
Placebo toothpaste
meridol Toothpaste and meridol Mouth Rinse, both with AmF and SnF2
Placebo toothpaste and meridol Mouth Rinse with AmF and SnF2
Significant reductions in biofilm and gingival bleeding were found for all groups except the placebo group. Additionally, plaque and enamel fluoride content increased for the groups using the test toothpaste, and decreased acid solubility was observed only in the group using the combination of meridol toothpaste and mouth rinse.
Lastly, two groups used an AmF/SnF2 toothpaste twice daily for four weeks in another study, with the experimental group also using an AmF and SnF2 mouth rinse. Both groups showed a reduction in the plaque index (Silness and Löe) and the gingival index (Löe and Silness), with greater reductions observed for the group using the mouth rinse in addition to the toothpaste.
We can conclude that while an antibacterial toothpaste containing amine fluoride and stannous fluoride (meridol) can support periodontal health and caries prevention, our patients can benefit further by adding an antibacterial mouth rinse containing the same active ingredients to their daily regimen.
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