Evidence-based Oral Hygiene Regimen Provides Sustained Supragingival Biofilm Reduction

You're listening to The Dr. Phil Klein Dental Podcast Welcome to the show. I'm Dr. Phil Klein. Today we'll be exploring exciting new clinical data on adjunctive oral hygiene regimens and recommendations for dental professionals looking to apply the data to their patient care. Our guest is Dr. Juan Yepes, an associate professor in the Department of Pediatric Dentistry at Indiana University School of Dentistry and an attending at Riley Children's Hospital in Indianapolis, Indiana. He is board certified by the American Boards of Pediatric Dentistry, Oral Medicine, and Dental Public Health. Before we get started, I would like to mention that Dr. Yepes' webinar titled The Oral Microbiome and Antimicrobial Interventions is now available as an on-demand webinar on VivaLearning.com. Simply type in the search field, Yepes, Y-E-P-E-S, and you'll see it. It's an excellent webinar on VivaLearning.com, and I recommend it for the entire dental team. Dr. Yepes, it's a pleasure to have you on Dental Talk. Phil, Dr. Klein, it's an absolute pleasure. I feel like we are all friends and that will make this conversation double interesting because I know you, you know me. So I'm so happy to see you again. And not just only to see you, to listen to you again. Yes, absolutely. Absolutely. Again, I mentioned your webinar in the introduction to this podcast, the enthusiasm that came across. It was just really, truly inspiring to hear your excitement about the findings of some of the research you did, which we're going to talk about on this podcast because it really is. at least for me, was a kind of a game changer because I'm one that flosses every single day and I've been doing it for 35 years, 40 years. So not that I'm going to give up flossing, but I still thought the research was just phenomenally interesting. Really, really interesting. So before we get started and too deep into it, share with us a little bit about your background and why you are so excited about some of the new research on the oral microbiome and the antimicrobial interventions. Well, Dr. Klein, I am... am as excited as you are. And thank you for referring to my previous webinar. I am, and I was very excited to present this new information that we are going to share in a minute. But before that, I'm a pediatric dentist. I am also a researcher. I'm a faculty at Indiana University, and I work in the Department of Pediatric Dentistry. Recently, I was appointed as the associate editor of the Journal of the American Dental Association, which is a wonderful opportunity that I have from the chief editor because I'm active looking at articles, looking at research, and deciding. what is going to be in the journal and looking at good research. I am a board certified in pediatric dentistry, oral medicine, dental public health. I have a doctorate degree in epidemiology and I have a lot of experience speaking about medically compromised patients, pediatric dentistry, oral hygiene and overall health. I think so that's probably a good way to give you a summary of my life. So with all that background, that you have. Can you give us a quick summary of the research you alluded to in your webinar, which really appears to be a game changer in my mind, and why were you so excited about it? Dr. Klain, I think so. If you ask me to really summarize in just a couple of bullet points, number one, Listerine antiseptic is about 4.6 times more effective than FLAS for sustained supragingible biofilm reduction. You know, we dental professionals, we all understand how important is having a good oral hygiene. This research really proved that mechanical methods and chemotherapeutic agents, like Listerine antiseptic, they are fundamental for the prevention of oral diseases. Before you get too deep, let me just give a little bit of a summary to our audience, and then we want to hear what you have to say, of course. The main study that Dr. Yepes referred to in his webinar... It was broken up into several groups and I'm not going to get into the details, but the final outcome clearly showed that using Listerine rinse with brushing alone, right? Listerine and brushing compared to brushing and flossing with supervision from somebody that knows what they're doing and then brushing and flossing by a hygienist. The research that you talked about showed that rinsing with Listerine and brushing alone in almost every measure the way we measure gingivitis and plaque index and everything else did better. Yeah, Dr. Klein, let me even, yeah, you just summarized in a wonderful way the study. So this is 156 subjects. They were divided in four different groups. One of the four groups was the control group. And then the other three groups was brush twice a day and floss supervised by a hygienist. The next group was brush and flossing by a hygienist. And then the group was just brushing and listering antiseptic, just brushing and listering. And that showed that in all the different indexes that they were using this study, it was a 22.8% reduction in bleeding and plaque. And that is statistically significant when they compare with brushing and flossing by a hygienist and brushing and flossing under supervision. Honestly, that is remarkable. point in your brief introduction about this article, I need to also add that from the methodological perspective, Dr. Klein, this article was very well designed. 12 weeks, as you know, is a long time of following this group of patients. Plus, if you look in detail to the study, pretty much everybody completed the study. Usually in this study, you see that 10, 20% of the patients, they actually decide at some point during the study to say, that's it. Very well designed. And at the end, they showed that brush twice a day and rinse with 20 ml of Listerine antiseptic for 30 seconds twice a day following brushing. It was a statistically significant percent reduction in the bleeding and also in the plaque. In comparison to brushing and flossing. In comparison with brushing and flossing. So it seems to me as a dentist, and I've been in the business for, I don't know, 30, 40 years, proposed that study to me. I would certainly think that using floss, a physical debridement of plaque, biofilm, using floss, especially supervised by somebody that knows what they're doing, and even in the group, especially in the group that was performed by a hygienist, flossing by a hygienist on those patients, that would be superior to using an oral rinse. Most dentists would believe that, right? Were you not surprised by the results? When you look in the details of the study, how well designed, then you realize, well, Listerine antiseptic using twice a day, it really make a difference. So not just only Listerine antiseptic deliver immediately patient benefits, but part of the benefits is the deepest penetration of Listerine antiseptic in the black biofilm. And also Listerine antiseptic inhibit the growth of... gram-positive and gram-negative bacteria, and also delivers long-term auto health benefits. So sometimes, as you know, Dr. Klein, you can do the flossing, but you may not get to these deepest areas that, you know, even floss by a hygienist is challenged to do that. So when you use Listerine antiseptic, you are actually reaching all these unmolested areas that otherwise, if you don't complement your flossing and brushing, which we need to keep doing that. no question about that but listering is a complement to what we have been doing for many many years with all this clear evidence, I added years ago Listerine antiseptic as part of my toolkit that I have for oral hygiene. Right. Now, a lot of patients will take it very seriously if it's recommended by their dentist. You were proposing this in the webinar that dentists should seriously consider recommending to their patients using Listerine oral rinse based on these studies. Yes, absolutely. Dr. Klain, we remind to our patients over and over and over and over how important it is to brush, which is the mechanical removal of the plaque, how important it is to do flossing. But as you know, Phil, not everybody's complaining. In fact, many, many patients, as you know, they will tell you, yes, I'm flossing and they really are not. Yes, I'm brushing twice a day and they are really not. So we as dentists and other health care providers and hygienists, We need to actually explain to the patient that not everything is related with mechanical removal of the plaque. Now, that is important. We need to keep doing that. But we also need to introduce to our patients other tools that we have in our toolbox. And these tools are going to help us to decrease the biofilm. And then listed in antiseptic is one of these tools. So that is a very critical take-home message that we need to deliver to our patients. We need to make sure that they understand that... need to continue brushing. They need to continue flossing. But then we need to add something else that actually is going to help us to remove that plaque from the deepest area that is very challenging. Even if you are the perfect, absolutely the most amazing brusher and you have all the ability to floss, some areas are not going to be really rigid by the floss or by the toothbrush. It seems to me that if a dentist has... set of patients that they know over the years have not really complied with flossing. They're just not compliant with using dental floss. So you can tell them time and time again on the re-care visits, and they're not going to floss for the most part. Using Listerine along with brushing seems like a fantastic approach. Dr. Klein, it is a fantastic approach. I want to kind of, if you don't mind, let me mention just a few words. As you said before, I was very excited with the webinar that I presented a few weeks ago. And in that webinar, I also talk about the second study. If you don't mind, you know, the final conclusions from the first one and the second one are obviously in the same page. But it's something interesting about the second study that is maybe connected with our just conversation now, which the second study, they added two different components. One component is about dexterity. which we know that not all the patients they have the same ability to brush and the second component is about behaviors about why you floss or why you don't floss so you mentioned dexterity and compliance And compliant. So, you know, it's very interesting. And it's actually one of the conclusions of the second study that not all the patients, they have the same dexterity. We know that as a dentist, as a dental hygienist, we know that not everybody has the same ability to brush. So one more reason why Listerine Antiseptic is a wonderful tool to help the patient that they don't have a perfect dexterity. And believe me. After all these 20 years of clinical dentistry, many, many patients, they don't have a lot of dexterity. You know, when you learn in dental school the perfect way to brush, we don't do that, Dr. Klein. We don't. So dexterity is a factor that is going to affect the quality of your brushing. And sometimes it's not the best quality just because you don't have the ability to brush. So Listerine, again, is the extra tool that we can help that patient with a low dexterity. to improve the oral hygiene. So Listerine also has shown to improve the oral microbiome. Can you just briefly talk about that? Yes. You know, a healthy mouth is an important ongoing part of our health. Nobody discussed that. That's something that we as a dental professionals, we play a very critical role and we can make a huge difference to our patients when we explain to the patients that the mouth is connected with the systemic health. So we as a dentist and hygienists. We are the ones who understand what's going on inside the mouth. We are the ones who understand what is the biofilm, and we know the role of the biofilm in inflammation. We know the role of biofilm in disease, and that's something that we face that in all the patients that we see in our practice. So when we use listerine antiseptic, we are actually reducing the biofilm, and we are creating a more, I will say, more balanced oral microbiome. Listerine antiseptic actually slows the repopulation rate of bacteria. No matter what, bacteria will come back. You can spend three hours brushing. You know, very soon after you finish brushing, bacteria will come back. That's a fact. But Listerine antiseptic will slow that repopulation and also helps to decrease the entire microbial mass over time. That will make more thin the biofilm, and that will actually, at the end, the big consequence is going to decrease the pathogenesis or the ability to cause problems of the bacteria. So this sustained impact of Listerine antiseptic helps prevent plaque formation and prevent early gum disease and helps resets. the patient oral microbiome to a more healthier state. I think so sometimes we need to explain to our patients that the mouth is just, you know, we need to see the big picture. The mouth is part of my body. So listerine antiseptic actually helps to control all these quote, quote, bad bacteria who may actually are going to cause not just only problems in my mouth, that problems can actually reflect in my entire health. These studies are something that every dentist should look at because they see As Dr. Yepes just said, they see these problems on every single patient that walks in the dental office. As soon as you finish brushing, there's going to be the start of new bacteria populating. And this particular methodology of handling patients, especially that are not good flossers. And what are we looking at now? 40% of the dental population flosses anyway, right? Less than 40%? I will say probably less than 40%. Dr. Klein, as you know, Listerine is recommended for patients 12 and older. to use it daily twice a day. You know, many patients that I see in my office, they are teenagers. They are 13, 14, 15, 16 young adults. When I show the floss, they look at me and say, what is that? Seriously, do I need to do that? When you think about the diet of teenagers, how much sugar they ingest in a day, constantly munching on power bars and things like that. So that's why I keep recommending your webinar. I think every clinician should take a look at that. Look at the studies that have been released recently, and it's just, it's, in my opinion, a real game changer. Well, thank you very much, Dr. Yepes. We want to have you on again soon. There's so much to learn from you, and we're very happy to have you on the program. Thank you so much. Yeah, thank you, Dr. Klein. I feel extremely happy always when I see you, when I listen to you, and thank you for this time with me. I really appreciate that. Thank you, Dr. Klein.