QUESTION: I am a 64 year old male. For many years, I had routine dental cleanings twice yearly. I have all my own teeth. I have some periodontal disease, but not serious enough to be referred to a periodontist. My general dentist treats me. For the past 18 months, I have been going for dental cleanings every three months at the recommendation of my dentist because some of my "pockets" have gotten worse, I have some pockets around the molars measured at 7. My most recent visit for a cleaning was last week. After the cleaning,the hygienist consulted with the dentist and I was given an Rx for chlorhexidine gluconate 0.12% oral rinse. The hygienist told me to use it only 2-3 times a week before bed ( not daily) as it can stain teeth. Does this frequency likely to make a difference in reducing the size of my pockets? Thanks
ANSWER: Dear Jeff,
Chlorhexidine is a very good germ killer for periodontal bacteria. But the effectiveness of the product depends upon the chlorhexidine actually contacting the bacteria in the pockets. The deeper the pockets, the more difficult they are to reach. Unfortunately the deepest you can reach with rinsing or toothbrush is at best 1 mm. There are various effective consumer devices on the market that are designed to help you deliver rinses and antibacterial products like chlorhexidine into the deeper pockets. You will find many choices by Googling - periodontal pocket irrigators.
With your attitude plus your excellent hygienist and dentist, I'm sure that you can avoid that visit to a periodontist. I would add that Listerine will be about as effective as chlorhexidine without the negative side effects and high cost. I suggest irrigating once a week with the chlorhexidine and then as often as you like with the Listerine.
As for frequency, you can apply the Listerine as often as you want. Daily would be best until symptoms disappear. Then perhaps once or twice per week for maintenance. Pocket depth often shrink somewhat with this type of treatment. But if pockets don't shrink, that is not necessarily a sign of failure. Your actual realistic goal for success is to not have pockets getting deeper over time. If pockets are not getting deeper over time, this denotes that the progress of the disease has been halted. On the other if pockets continue to get deeper and supporting bone appears to be disappearing, this would be a sign that the periodontitis is progressing and the therapy should be ratcheted up.
Sorry for the delay
Larry Burnett DDS
---------- FOLLOW-UP ----------
QUESTION: Thanks very much for the answer and the suggestions!One follow-up: if the Chlorhexidine isn't likely to reach the pockets, what do you think of Arestin? Would this be a better option? My wife uses a different dentist and he has used Arestin on her pockets. Thank you!
Arestin is an effective germ killer that is placed deep in the pocket by a professional. Arestin is not used on a daily or weekly basis like irrigation with chlorhexidine or Listerine. The germs tend to repopulate the pocket which makes frequent application necessary to hold down the numbers of germs. Arestin should be used as a way to ratchet up treatment for resistant infections when the Chlorhexidine or Listerine is not working to stop the progression of gum disease. And of course Arestin is a more costly form of treatment.
Larry Burnett DDS