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Gum Care on teeth and implants

5th September 2012 0

The oral cavity, being an open and dynamic ecosystem, is exposed to numerous factors that regulate microbial composition. Altering the balance of the mouth results in the possible occurrence of gum disease by accumulation of microorganisms that form the biofilm oral (dental plaque).

A gum health conditions should not have swelling or bleeding. If this condition occurs, it may be because the patient has gum disease, which can develop on teeth (gingivitis and periodontitis) or dental implant (peri-implant mucositis and peri). The main causal agent is the accumulation of plaque (oral biofilm).

Gingivitis is characterized by swelling and bleeding of the gums. Usually redness, swelling and bleeding of the gums, without allowing it to affect the tissues that support the teeth (periodontium). This condition is reversible, but if left untreated can progress and develop into periodontitis.

Periodontitis is characterized by redness, swelling, bleeding, gum recession, tooth mobility and loss of alveolar bone that supports the teeth, and may lead to tooth loss.

Furthermore, the lining is formed around implants shares similarities with the gum which forms around teeth. As the periodontal tissue, peri-implant soft tissues have a function of protection against external environmental aggressions such as microorganisms. Periimplant mucosal inflammatory response presents a different, so that after the oral biofilm accumulation of extension of the inflammation may become deeper. Therefore, peri-implant tissues have less capacity to respond to the aggression of oral biofilm compared to the periodontal tissues.

The presence of microorganisms on the surface of dental implants occurs rapidly after exposure to the oral cavity, being able to produce peri-implant disease (periimplant mucositis and periimplantitis).

Periimplant mucositis is an inflammatory lesion is produced in the mucous membrane which surrounds an implant. The most common features are: edema, redness and hyperplasia of the mucosa, bleeding (Ikeda-Artacho et al. 2007) without loss of surrounding bone. The continued presence of plaque (oral biofilm) on implants induce this inflammatory reaction and, if not treated properly, can evolve periimplantitis.

Periimplantitis is an inflammatory lesion of the mucous membrane which surrounds an implant in function associated with the loss of supporting bone (Zitmann and Berglundh 2008). The injuries are poorly encapsulated periimplantitis, extending to the marginal bone tissue and, if they advance, they can cause the loss of the implant.

Prevention and treatment

The prevention and treatment of periodontal and peri-implant these diseases should focus on the implementation of anti-infective measures. The goal is to get the mechanical disintegration plaque (oral biofilm) and reducing bacteria that cause diseases to levels compatible with health. This requires performing combined treatments that include mechanical and chemical treatment. The mechanical treatment destructured plaque (oral biofilm), however, presents certain limitations in patients who did not.

Therefore, the use of an adjuvant is indispensable as antiseptics chemical mechanical treatment in biofilm control.

Of these it is known that bisguanidinas antiseptics such as chlorhexidine, gold standard of antiseptics (Jones 1997; Quirynen 2005) and quaternary ammonium compounds such as cetylpyridinium chloride, are effective agents and antiplaque antigingivitis. Not all chlorhexidine mouthwashes have the same effectiveness as it depends on the formulation. Chlorhexidine 0.12%, in combination with cetylpyridinium chloride 0.05% without alcohol, is indicated in specific situations such as periodontitis (Herrera et al. 2003) and periimplantitis (Garcia and Lopez 2010). Numerous scientific publications is endorsed as the most effective antiseptic formulation (Quirynen et al. 2001, Herrera et al. 2003).

Chlorhexidine at low concentrations in combination with 0.05% cetylpyridinium chloride can be 0.05% of the daily recommended to monitor the recurrence of periodontal disease, particularly in patients who did not adhere as well as in situations less complex (Escribano et al. 2010).

Cetylpyridinium chloride is an inhibitor of plaque classified by the FDA under the category I (safe and effective). Recommend its use on a daily basis to prevent gingivitis and peri-implant mucositis (Dr. Augustine Homes: 'peri-implant mucositis: how can you prevent it?', I SEPADENTAID Symposium 2012).

That is why efforts should focus on maintaining the health of teeth and implants or, which is, in preventing the onset of periodontal and peri-implant diseases, which will aim to prevent inflammation and infection of the and peri-implant dental tissues and prevent the formation of a pathogenic biofilm, thus minimizing the risk of treatment failure and periodontal implants.


1. Escribano M., Herrera D., S. Morante, Teughels W., Quirynen M., Sanz M. (2010). 'Efficacy of a low-concentration chlorhexidine mouth rinse in noncompliant periodontitis patients attending a supportive periodontal care program: a randomized clinical trial'. Journal of Clinical Periodontology, 37: 266-275.
2. D. Garcia and M. Lopez (2010). 'Drug Interactions in periimplantitis'. Journal of the American Dental Association, Vol.5 No.1.
3. Herrera D, Roldán S., I. Santacruz, S. Santos, Masdevall M., Sanz M. (2003). 'Differences in antimicrobial activity of four commercial 0.12% chlorhexidine mouthrinse Formulations: an in vitro contact test and salivary bacterial counts study'. Journal of Clinical Periodontology, April, 30 (4): 307-14.
4. Ikeda-Artacho M., Ceccarelli, J. Street, D. Casalino Proaño- (2007) 'Periimplantitis and peri-implant mucositis.' Herediana Stomatology Magazine, 17 (2): 90-98.
5. Jones C. (1997). 'Chlorhexidine: is it still the gold standard?'. Periodontology 2000, 15, 55-62.
6. Quirynen M., Avontroodt P., Peeters W, Pauwels M, Coucke W, van Steenberghe D. (2001). 'Effect of different chlorhexidine mouthrinses on the Formulations in novo plaque formation.' Journal of Clinical Periodontology, 28: 1127-36
7. Quirynen M., C. Soers, Desnyder M., C. Dekeyser, M. Pauwels, D. van Steenberghe (2005). 'A 0.05% cetyl pyridinium chloride/0.05% chlorhexidine mouthrinse During maintenance phase after initial periodontal therapy'. Journal of Clinical Periodontology, 32: 390-400.
8. Zitzmann N. and T. Berglundh (2008). 'Definition and Prevalence of periimplant diseases'. Journal of Clinical Periodontology, 35 (Suppl. 8): 286-291.



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