(28) The Effects of Interproximal Home Hygiene Regimens on Inflammatory Biomarkers in Periodontal Maintenance Patients

Introduction: A survey of dental hygienists in general practice (DHGP; n = 74) and periodontal practice (DHPP; n = 62) indicated a significant difference (p  0.04) in preference for interproximal cleaning of posterior inflamed pockets (5-8 mm) with oral irrigators (DHGP) and interproximal brushes (DHPP) during periodontal maintenance therapy (PMT). The purpose of the subsequent blinded, randomized controlled clinical trial was to compare the effect of interproximal irrigators, brushes or brushes with a smart-phone tracking device on reducing inflammation in posterior periodontal pockets in patients on PMT.

Methods: Seventy-six patients diagnosed with generalized periodontitis Stage III and IV Grade B, with history of a 5-8 mm interproximal probing depth and bleeding on probing (BOP) were randomly allocated to one of three interproximal, home hygiene groups: 1) interproximal brush with tracking device (BL; n=23), 2) oral irrigator (W; n =27) or 3) interproximal brush alone (IBA; n=26). Standardized instructions were given to use their assigned oral hygiene modality at the test site once daily, for 6 weeks. Clinical measurements, including probing depth (PD), plaque index (PI) and clinical attachment level (CAL) were collected at baseline and 6-weeks. Inflammation was assessed by BOP, Gingival Index (GI) and gingival crevicular fluid (GCF; 30 sec sample) inflammatory profiles at baseline and 6-weeks. Proinflammatory analytes IL-1B, IL-6, IL-17A, TNF-a and anti-inflammatory analytes IL-4, IL-10 and IFN-y were assessed with Human Milliplex Analysis. Inflammatory comparisons were analyzed Fischer’s exact, Kruskal Wallis, Wilcoxon Rank Sum tests and Bonferroni adjusted.

Results: A significant improvement in PD and CAL was seen in all three groups at the experimental site (p < 0.0001), but there was no significant difference among groups. A significant improvement in PI was seen in both brush groups (p < 0.01), but not for the oral irrigator group. BOP and GI were significantly reduced (p < 0.0001) in all three groups with no significant difference among groups. There was no significant difference among the groups for all cytokines at baseline. There was a significantly greater reduction for GCF IL-1B in the interproximal brush with tracking device compared to oral irrigator (p < 0.05). There was a similar trend for GCF IL-6 (p = 0.05).

Conclusions: While interproximal brushes were superior in reducing plaque scores over time, all groups showed similar improvement in PD, CAL, GI and BOP. However, interproximal brush with tracking device showed more reduction in GCF pro-inflammatory cytokines IL-1B and IL-6, indicating that devices to encourage homecare interproximal cleaning compliance may enhance the reduction of important markers of inflammation.

Lead Author’s Contributions to the Research Project: The Lead Author was responsible for research design, patient recruitment, standardized patient instruction, interpreting statistical analysis, and the composition of the abstract.