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B2 HYGIENE TRIBUNE Dental Tribune Middle East & Africa Edition | 4/2017 Applying evidence based practice in oral hygiene education By Philips Sonicare I’ve worked as a Dental Hygienist for the last 11 years after qualifying in the Royal Air Force in 2006, hav- ing practised throughout the United Kingdom in a whole range of set- tings, from military, NHS hospital, private practice, mobile dental units at humanitarian events and a mobile clinic in Kenya. Currently I’m work- ing in a private practice in Dubai and delighted to be a Key Opinion Leader for Philips. Throughout that time I’ve consistently recommended one brand to my patients and anyone else asking for help choosing an elec- tric toothbrush. Clinically, I see the improvement in oral health when people begin using a Philips Sonicare and most recently the Diamond- Clean range. Introduction Philips Sonicare have reinforced their commitment to patient and professional partnership by continu- ally developing new products, which undergo rigorous testing and clinical trials to demonstrate the safety and effi cacy of their products. Philips is committed to improving the lives of 3 billion people a year by 2025, through their ongoing collaboration with scientifi c experts, research sci- entists and dental professionals. As the associations between oral and systemic health grow year on year including serious conditions such as diabetes, atherosclerosis, preterm/ low birth weight babies, Alzheimer’s disease, chronic kidney disease and certain cancers (Craig & Kamer, 2016). We know that gingival infl am- mation and periodontal disease is initiated by the complex microbial biofi lm, plaque and the destruction of the supporting tissues including the periodontal ligament, bone and cementum is mainly caused by the host-mediated innate and adaptive immune response (Craig & Kamer, 2016). Periodontal disease is the most prevalent ailment affecting mankind globally, and severe peri- odontitis is responsible for the abso- lute majority of tooth loss and eden- tulousness in adults (Jin et al. 2016), clinicians are looking for the most reliable and evidence based aids to enable their patients to take control of their oral health. With the release of the latest studies found in A Special Issue of the Jour- nal of Clinical Dentistry carried out by Philips, I can be sure that the ad- vice I’m giving patients is evidence based, high on the evidence pyramid are systematic reviews with meta- analysis which provide a reliable answer because they integrate all the relevant evidence (Berlin & Golub, 2014). The meta-analysis comparing the effectiveness of manual versus high-frequency, high-amplitude sonic powered toothbrushes showed plaque removal was increased by 20% and a decrease in gingivitis of 10% (de Jager et al. 2017); thus; reduc- ing the systemic infl ammation and improving not only the patient’s oral health but general health too. To encourage people to swap from a manual to an electric toothbrush, I tell them it’s like comparing rid- ing a bicycle with a motorcycle, one is much more effi cient and doing the work for you! This is confi rmed by studies comparing gingivitis reduction using a Philips Sonicare DiamondClean versus a manual toothbrush, after just 2 weeks the Di- amondClean showed a 52.2% reduc- tion in gingival bleeding compared with only 17% using a manual tooth- brush. After 4 weeks, the Sonicare showed 57.4% reduction in gingival bleeding compared with 31.4% using a manual toothbrush (DeLaurenti et al, 2017). Patients often ask which model should I buy, there are so many?! The high-frequency, high-amplitude technology applied to all Philips Son- icare brushes is refl ected in a study comparing the Sonicare FlexCare Platinum and Premium plaque de- fense*, brush head with a manual toothbrush, 154 participants re- viewed after 2 weeks use showed a 47.97% reduction in gingival bleed- ing using a FlexCare Platinum com- pared with only 8.64% for a manual toothbrush and after 6 weeks 58.36% reduction versus -3.14% manual brushing. Similarly, the FlexCare Platinum showed 50.59% plaque re- duction after 2 weeks and 3.08% for manual brushing and after 6 weeks 46.55% reduction for FlexCare Plati- num compared to -1.58% for manual brushing(Jenkins et al. 2017). The next common question is, should I use sonic or rotary? I’ve al- ways said that if you had 100 dental hygienists in a room and asked them, you would have a 50/50 split, yet in the latest comparison study using a statistically signifi cant number of participants, the Philips Sonicare Di- amondClean with Premium plaque defense brush head showed gingival infl ammation reduced by 44.73% af- ter 2 weeks, compared to just 27.92% using the Oral-B 7000 with CrossAc- tion brush head and after 6 weeks 45.68% compared with 26.83% re- spectively (Starke, et al. 2017). Gingival bleeding indices is often used as a benchmark for dental hy- gienists to commence periodontal therapy, encouraging patient com- pliance with treatment and also bet- ter clinical results, using a Sonicare DiamondClean for 2 weeks reduced gingival bleeding by 66.75% com- pared to 49.38% using an Oral-B 7000, and after 6 weeks a whopping 75.81% reduction in gingival bleed- ing compared to a lesser 58.76% for Oral-B. Eliminating plaque is critical to en- suring ongoing oral health, after 2 weeks using a Philips Sonicare Dia- mondClean with Premium plaque defense brush head subjects re- corded a 38.68% reduction in plaque compared to just 18.28% using an Oral-B 7000 with CrossAction brush head, with the trend continuing after 6 weeks of use with Sonicare pro- viding 37.58% reduction and only 20.70% using an Oral-B (Starke, et al. 2017). I’m sure all dental professionals agree that gaining patient compli- ance to carry out daily interden- tal cleaning is one of our greatest challenges, patients cite diffi culty fl ossing or interdental brushes that bend or break as a main barrier. The Philips Sonicare AirFloss Pro gives an effective and easy to use alternative, when fi lled with an antimicrobial rinse and used daily is as effective as fl ossing. Following 2 weeks of use fl oss shows 26.90% reduction in gin- gival bleeding and 24.61% using an AirFloss Pro with BreathRx mouth rinse, after 4 weeks this remained consistent at 43.31% for fl oss and 36.79% for AirFloss Pro and BreathRx (Mwatha et al. 2017). Dental health is a basic human right and I believe as dental and public health professionals it is our duty to ensure our patients, friends and fam- ily are using the most effective aids to fi ght the global epidemic of dental disease. *also known as ROW, Control in NA only References Berlin JA, Golub RM. Meta-analysis as Evidence Building a Better Pyra- mid. JAMA. 2014;312(6):603-606. doi:10.1001/jama.2014.8167 Craig R and Kamer A. Introduction and Overview of the Systemic Ef- fects of Periodontal Diseases. A Cli- nician’s Guide to Systemic Effects of Periodontal Diseases. Springer Berlin Heidelberg. (2016) doi.10.1007/978-3- 662-49699-2_1 De Jager m, Rmaile A, Darch O, Bik- ker JW. The Effectiveness of Manual versus High-Frequency, High-Am- plitude, Sonic Powered Toothbrush- es for Oral Health: A Meta-Analysis. Journal of Clinical Dentistry. 2017; 28:A13-28 Editorial note: The complete reference list is available from the publisher. Rachael England trained as a Dental Hy- gienist in the Royal Air Force and qualifi ed in 2006. She is passionate about dental prevention, regularly supporting the Dubai Smiles Healthy Campaign which aims to enable daily tooth brushing with fl uoride toothpaste in schools, dental screenings and regular oral health educa- tion. She recently began working to with the members of the Emirates Dental Hy- gienists Club to improve the dental health of the UAE population. An Evidence-based Approach to Daily Plaque Control and Gingival Health New Philips Sonicare clinical studies in brief Study 3 The Effectiveness of Manual versus High-Frequency, High-Amplitude, Sonic-Powered Toothbrushes for Oral Health: A Meta-Analysis de Jager M, Rmaile A, Darch O, Bikker JW. J Clin Dent 2017;28(Spec Iss A):A13-28. Products Subjects Design Results Percentage change after everyday use High-frequency,b High-frequency,b high-amplitudeb high-amplitudeb powerbtoothbrushesb powerbtoothbrushesb vs.bMTB 1,870 4 weeks >> 3 months Studies: 18 Randomized, controlled clinical trials removal 20% morebplaque 10% greaterbdecreaseb inbgingivitis SSudy 1 Comparison of GingiviSis ReducSion and Plaque Removal by Philips Sonicare DiamondClean and a Manual TooShbrush Delaurenti M, Ward M, Souza S, Jenkins W, Putt MS, Milleman KR, Milleman JL. J Clin Dent 2017;28(Spec Iss A):A1-6. ProducSs SubjecSs Design ResulSs - PercenS reducSion aS Week 4 Philips Sonicare DiamondClean vs. MTB 141 week 2 >> 4 Mean age: 42.1 Randomized, Sonicare MTB Gingivitis 25.5% 19.1% Bleeding 57.4% 31.4% parallel, single-blind Plaque 34.9% 8.0% Key conclusion Twice daily brushing with Philips Sonicare DiamondClean is significantly better than using a manual toothbrush for reducing plaque and improving gingival inflammation and gingival bleeding within just two weeks, persisting to four weeks. Key conclusion Results of this comprehensive meta-analysis showed that high-frequency, high-amplitude, sonic-powered toothbrushes decrease plaque and gingivitis significantly more effectively than manual toothbrushes in everyday use, in studies lasting up to three months. Study 4 An Assessment of Gingivitis Reduction and Plaque Removal by Philips Sonicare DiamondClean with Premium Plaque Control Brush Head and Oral-B 7000 with CrossAction Brush Head Starke M, Delaurenti M, Ward M, Souza S, Milleman KR, Milleman JL. J Clin Dent 2017;28(Spec Iss A):A29-35. Products Subjects Design Results - Percent reduction at Week 6 PhilipsbSonicareb DiamondCleanbvs.b Oral-Bb7000 284 week 2 >> 6 Mean age: 38.6 Randomized, Sonicare Oral-B Gingivitis 45.68% 26.83% Bleeding 75.81% 58.76% parallel, single-blind Plaque 37.58% 20.70% Key conclusion Philips Sonicare DiamondClean with Premium plaque control* brush head is statistically superior to Oral-B 7000® with CrossAction™ brush head and SmartGuide accessory in reducing gingival inflammation, gingival bleeding and surface plaque. SSudy 2 *Brush head formerly called AdaptiveClean Comparison of Plaque and GingiviSis ReducSion by Philips Sonicare FlexCare PlaSinum wiSh Premium Plaque ConSrol Brush Head and a Manual TooShbrush Jenkins W, Souza S, Ward M, Defenbaugh J, Milleman KR, Milleman JL J Clin Dent 2017;28(Spec Iss A):A7-12. ProducSs SubjecSs Design ResulSs - PercenS reducSion aS Week 6 Study 5 A Study to Assess the Effects of Philips Sonicare AirFloss Pro, when Used with Antimicrobial Rinse, on Gum Health and Plaque Removal Mwatha A, Olson M, Souza S, Ward M, Jenkins W, Amini P, Gallob J, Fafard T J Clin Dent 2017;28(Spec Iss A):A36-44. Philips Sonicare FlexCare Platinum vs. MTB 143 week 2 >> 6 Mean age: 40.6 Randomized, parallel, single-blind Plaque 46.55% -1.58% Key conclusion Twice daily brushing with Philips Sonicare FlexCare Platinum with Premium plaque control* brush head is significantly better than using a manual toothbrush for reducing plaque and improving gingival inflammation and gingival bleeding within just two weeks. Statistically significant differences in all metrics persisted until study completion at Week 6. *Brush head formerly called AdaptiveClean Sonicare MTB Gingivitis 45.79% -0.71% Products Subjects Design Bleeding 58.36% -3.14% PhilipsbSonicareb AirFlossbProbandb antimicrobialbrinseb vs.bMTBbandbstringb flossbvs.bMTB Key conclusion 286 week 2 >> 4 Mean age: 35.6 Randomized, Results - Percent reduction at Week 4 MTB + AirFloss Pro + rinse MTB Gingivitis 8.52% 1.10% Bleeding 36.79% 4.03% parallel, single-blind Plaque 22.41% 5.70% Daily use of Philips Sonicare AirFloss Pro with antimicrobial rinse as an adjunct to manual toothbrushing was shown to improve gum health and reduce plaque significantly better than manual toothbrushing alone. Moreover, a non-inferiority test showed AirFloss Pro to be similar to string floss in reducing plaque and gingivitis.