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SANZ et al .
8.3 | Intervention: Adjunctive therapies for gingival inflammation
Available evidence The underlying systematic review (Slot et al., 2020) identified three RCTs assessing the use of an adjunctive oral irrigator: two out of three studies demonstrated a significant effect of the irrigator on measures of gingival inflammation, but not on plaque scores. Rubber/elastomeric cleaning sticks are a rela - tively newly developed instruments with an increasing market share, and there only little evidence available on gingivitis pa - tients that these devices are effective in reducing inflammation with no difference to interdental brushes (Abouassi et al., 2014; Hennequin-Hoenderdos, van der Sluijs, van der Weijden, & Slot, 2018).
R4.10 | What is the value of adjunctive antiseptics/ chemotherapeutic agents for the management of gingival inflammation? Expert consensus-based recommendation (4.10) The basis of the management of gingival inflammation is self- performed mechanical removal of biofilm. Adjunctive measures, including antiseptic, may be considered in specific cases, as part of a personalized treatment approach. Supporting literature Figuero, Roldan, et al. (2019) Grade of recommendation Grade 0—↔ Strength of consensus Consensus (11.8% of the group abstained due to potential CoI)
Risk of bias High.
Consistency Not evaluated.
Background
Clinical relevance and effect size Considered as moderate.
Intervention In order to control gingival inflammation during periodontal mainte - nance, the adjunctive use of some agents has been proposed. These agents are mainly antiseptics agents, and can be delivered as denti - frices, as mouth rinses or both. Available evidence A systematic review (Figuero, Roldan, et al., 2019) was conducted, aiming to identify RCTs of, at least, 6 months of follow-up, in treated periodontitis patients or in gingivitis patients, in which antiseptics, prebiotics, probiotics, anti-inflammatory agents and antioxidant micronutrients were used as adjuncts to mechanical supragingival biofilm control. For antiseptic agents, the impact in the primary outcome, changes in gingival indices (analysed in 52 studies with 72 comparisons, including 5,376 test and 3,693 control patients), was statistically significant ( p < .001) and the additional reduction, expressed as standardized weighted mean difference (S-WMD), was −1.3 (95% CI [−1.489; −1.047]), with sig - nificant heterogeneity ( p < .001). In treated periodontitis patients, analysed in 13 studies with 16 comparisons, including 1,125 test and 838 control patients, the impact was statistically significant ( p < .001) and the additional reduction, expressed as S-WMD, was −1.564 (95% CI [−2.197; −0.931]), with significant heterogeneity ( p < .001). No conclusions could be made for other, non-antiseptic, agents, since only one study was identified. Longer-term stud - ies in treated periodontitis patients are also relevant to assess periodontal stability. In the systematic review (Figuero, Roldan, et al., 2019), four long-term studies (1.5–3 years) were identi - fied, and no significant impact was observed for gingival indices. However, a 3-year study demonstrated significant benefits in terms of frequency of deep periodontal pockets and in the num - ber of sites that exhibited additional attachment and bone loss (Rosling et al., 1997).
Balance of benefit and harm Up to now no adverse effects have been reported.
Economic considerations Not considered.
Patient preferences Rubber/elastomeric cleaning sticks are highly accepted by patients as are oral irrigators. Applicability The guideline can be applied since appropriate quantities and varie - ties of interdental cleaning devices are available on the European market.
R4.9 | What additional strategies in motivation are useful?
Expert consensus-based recommendation (4.9) We recommend utilizing the “First Step of Therapy” section of this guideline. Supporting literature Carra et al. (2020) Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Background
Background information and the discussion of additional factors can be found in the section dealing with patients in active periodontal therapy (first step of therapy).
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