Prevention of gingivitis and treatment of periodontitis: Chlorhexidine gels and dental lasers

It is a universal advice from dental care professionals to brush twice daily with a fluoride dentifrice. It would be ideal to incorporate an effective anti-microbial agent such as chlorhexidine in a dentifrice formulation. A well-known side effect of chlorhexidine is tooth discoloration. Reduced concentrations have been suggested to decrease side effects. The low dosage 0.12% chlorhexidine dentifrice gel, which is available in the Netherlands, was the subject of two research projects as presented in this thesis. It appeared to be as effective as a regular dentifrice in the prevention of plaque accumulation and is therefore a poor alternative because it is does not contain fluoride. This thesis also shows that a 0.2% CHX mouthwash does provide a benefit which can be used in conjunction with a regular fluoride toothpaste.
Lasers are used throughout the medical field for different indication and have been suggested as an adjunct to scaling and root planing in patients with periodontitis. Two research projects as presented in this thesis showed that there is no evidence to support the adjunctive use of the water cooled Nd:YAG laser. The effect of sub-gingival debridement as performed with manual and/or power-driven instruments in periodontitis patients as well as during periodontal maintenance care was not improved when followed by the application of this laser. An extensive literature review supported these findings. These results therefore support a firm statement to refute the use of laser technologies in non-surgical periodontal treatment based on the lack of clinical efficacy and the potential extra costs.