A group of specialists, in which members of the Spanish Society of Periodontology and Osteointegration (SEPA) and its Foundation have participated, has met in New Jersey (United States) to continue developing the recommendations of "Principles for Oral Health" (Principios para la Salud Oral).
In this meeting, the multidisciplinary team has worked on adapting these recommendations to the healthcare reality of oral health in the United States, with the goal of reinforcing the prevention and management of periodontal diseases. This action is part of an initiative promoted by the SEPA Foundation and supported by LISTERINE.
In the meeting, experts from different areas and institutions have participated, including the Medical Affairs Lead, Oral Care, Kenvue, Smruti Nair, who has emphasized that "prevention must occupy a central place in periodontal care." In her opinion, "translating rigorous science into practical and personalized recommendations for the dental team has never been so important."
During the session, it was noted that 42.2 percent of American adults aged 30 and older with natural dentition present some degree of periodontitis, according to the National Health and Nutrition Examination Survey (NHANES). In light of these figures, specialists insist on the need to detect groups with a higher disease burden or with more difficulties in controlling biofilm and to incorporate individual risk assessment into preventive strategies.
Participants have emphasized that the prevention of periodontal disease starts with adequate control of gingivitis, a reversible inflammation of the gums that precedes periodontitis. Therefore, the management of gingivitis is considered a key intervention opportunity, and oral hygiene carried out by the patient themselves — with tooth brushing and interdental cleaning — remains the foundation of the preventive and therapeutic approach to periodontal pathologies.
Furthermore, it has been highlighted that the reviewed scientific literature supports the use of certain antiseptics and mouthwashes as a complement to mechanical oral hygiene measures. In this regard, essential oils, chlorhexidine, and cetylpyridinium chloride have proven to be the most effective in reducing dental biofilm and gingival inflammation when used alongside mechanical control.
Nevertheless, it is emphasized that its use must be integrated into an individualized and risk-based approach, avoiding recommending these products indiscriminately to the entire population. This personalization is particularly relevant for patients already treated for periodontitis and included in periodontal maintenance programs.
Identify the factors that hinder biofilm control
Experts have also stressed the importance of detecting the conditions that complicate the daily control of biofilm. Among the local factors are the difficulty of access and cleaning of certain areas, as well as anatomical features that favor the retention of biofilm. Likewise, people with extensive or complex prosthodontic restorations may require a specific approach.
Regarding general factors, various chronic diseases are included—especially poorly controlled diabetes—, fragility and advanced age, temporary or permanent limitations of manual dexterity, and low motivation to maintain adequate oral hygiene habits. Additionally, the recovery period after some surgical interventions may temporarily reduce the patient's ability to perform effective mechanical hygiene.
"Not all patients have the same ability to achieve effective biofilm control through mechanical measures," emphasized the co-leader of the project and clinical professor at the University of Michigan School of Dentistry (United States), Dr. Gustavo Ávila-Ortiz, who believes that "it is essential to identify the circumstances that may hinder daily oral hygiene and assess when a complementary strategy may provide additional benefit."
The recommendations, which also consider clinical scenarios where mechanical control of biofilm is temporarily limited, highlight, according to the also co-leader of the project and associate professor of Periodontology at the Complutense University of Madrid (UCM), Dr. Ana Molina, that "the value of antiseptics does not lie in replacing tooth brushing or interdental cleaning, but in their ability to provide additional support."
In addition, it is reminded that children under six years old and people who do not control swallowing well should avoid the use of mouthwashes to prevent accidental ingestion. Likewise, it is noted that their safety has not been sufficiently studied in pregnant women or during lactation, so it is recommended to follow local regulations and the indications of healthcare professionals.
Overall, this work aims to integrate the individual risk assessment in periodontal prevention. The available evidence allows defining situations in which certain complementary strategies can provide an added benefit, but their application must always be framed within a model focused on the mechanical control of biofilm, patient education, and ongoing professional follow-up.