Dental prophylaxis in the modern dental setting
Routine dental care is an important aspect of long-term oral and general health. This is why patients are encouraged to attend regular dental and/or hygiene appointments, even if they are not experiencing problems or seeking treatment. Aside from oral cancer screening, oral health education and more, the clinician may use these visits as an opportunity to deliver prophylaxis, removing plaque, calculus and staining to help patients maintain good dental health. To do this effectively, it is important to use the right products.
Dental prophylaxis is generally indicated for as a long-term oral health maintenance option for patients with no history of periodontitis, performed at risk-based intervals. The recall interval will depend on the individual patient’s clinical history, risk assessment and personal wishes. Prophylaxis may also be appropriate for patients with periodontal disease, all the while they respond positively to non-surgical and supportive periodontal therapy.[i] In fact, there is a wealth of evidence demonstrating the effectiveness of mechanical, non-surgical therapy for the successful treatment of periodontal disease. Further still, there seems to be little difference in the efficacy of hand instrumentation and machine-driven therapy – good news for all professionals prioritising manual procedures where possible.[ii]
Some studies suggest that dental prophylaxis eliminates the barrier that might otherwise reduce the clinical efficacy of the topical fluoride application that follows as well. The concept is that this enables greater contact between the fluoride and tooth enamel for improved caries prevention, as well as reduced gingivitis risk, though there are papers to contradict this thinking and so more research is needed.[iii] In addition, prophylaxis may be performed prior to impression taking or tooth whitening treatment to optimise the result achieved.[iv]
Choosing the right products
Among the various products and materials used for effective prophylaxis is prophylaxis paste – or prophy paste. This is utilised to ensure the comprehensive removal of any calculus, soft deposits, plaque, salivary pellicle and extrinsic staining present on the supragingival and unattached subgingival surfaces of the teeth. To be effective, the product typically contains a mixture of binders, humectants (to retain moisture) and abrasives, among other elements. The size of the abrasive particles will dictate how coarse the product is.
A small survey[v] was conducted last year to see what dental professionals were most interested in when selecting a prophylaxis paste. Flavour and price rated highly for influencing purchase decisions, as did polishing effectiveness. This suggests that patient comfort and satisfaction, as well as cost-efficiency are valuable characteristics for a high-quality solution. Other than these properties, clinicians should also consider the reputation of the brand they use, the consistency of the paste and its ease of handling.
The Kemdent Prophylaxis Paste features a medium grit and unique formulation that effectively, quickly and easily eliminates food and drink stains from the tooth surface. Its viscosity is optimised to improve adherence to the brush and it is thixotropic so as not to spatter for a cleaner and more pleasant patient and practitioner experience. Fluoride-free and easily polishable for a smooth finish, the product is available in several flavours to meet the preferences of various patients and further improve their comfort during the prophylaxis procedure.
Whether you’re providing dental prophylaxis for a patient or not, it’s important that they understand this alone is not enough to maintain the highest levels of oral health. Patients need to take some of the responsibility and appreciate their role in optimising their dental hygiene routines at home for the very best results. Equally, they sometimes need to be educated on the need for professional intervention or support. Though frequent toothbrushing and interdental cleaning do aid mechanical removal of plaque, studies have demonstrated that these measures will not sufficiently improve the symptoms of gingivitis.[vi] It’s about teamwork. By working together, patient and practitioner can ensure an effective combination of at-home and in-practice techniques to optimise the patient’s long-term oral health.
Prevention, always the priority
Dental prophylaxis is one of many services the dental team can provide to help patients maintain oral health and avoid the risks of dental problems. It can also offer an effective non-surgical approach to mild-moderate gingival diseases in some instances, preventing further development of the condition. Further still, it is an opportunity for effective skill mix within the practice, given that both dentists and dental hygienists may deliver treatment. Though time restrictions have long been a challenge for dental professionals, the issues have intensified since the pandemic. Where the workload can be shared without compromising on patient education and prevention, that’s a win-win.
[i] Scottish Dental Clinical effectiveness Programme. Prevention and treatment of periodontal diseases in primary care. Dental clinical guidance. June 2014. https://www.sdcep.org.uk/wp-content/uploads/2015/01/SDCEP+Periodontal+Disease+Full+Guidance.pdf [Accessed February 2021]
[ii] Matthews D. Conclusive support for mechanical nonsurgical pocket therapy in the treatment of periodontal disease. How effective is mechanical nonsurgical pocket therapy? Evidence-based Dentistry. Sept 2005; 6(3): 68-9
[iii] Azarpazhooh A, Main PA. Efficacy of dental prophylaxis (rubber cup) for the prevention of caries and gingivitis: a systematic review of literature. British Dental Journal. 2009; 207:E14
[iv] MA Healthcare, An overview of prophylaxis paste and its sue in dentistry. Dental Nursing. March 2014. https://www.dental-nursing.co.uk/features/an-overview-of-prophylaxis-paste-and-its-use-in-dentistry [Accessed February 2021]
[v] Kemdent SurveyMonkey Analysis – Kemdent Prophylaxis Paste Survey. Internal data
[vi] van der Weijden GA, Hioe KP. A systematic review of the effectiveness of self-performed mechanical plaque removal in adults with gingivitis using a manual toothbrush. J Clin Periodontol. 2005;32 Suppl 6:214-28. doi: 10.1111/j.1600-051X.2005.00795.x. PMID: 16128840.