The EFP scientific recommendations for perio and caries management

In 2016, Colgate collaborated with the European Federation of Periodontology (EFP) and the European Organisation for Caries Research (ORCA) to host the consensus Perio Workshop 2016. Here, we discuss the findings of the workshop, the subsequent Perio & Caries project, and the evidence-based guidelines dentists can adopt for the prevention and management of both diseases.

Perio Workshop 2016 and the Perio & Caries project

Caries and periodontal disease have historically been considered separate and distinct diseases. However, although the diseases do follow different trajectories, a growing body of evidence pointed to:

• Oral biofilm as the major determinant in the development of both diseases;

• Shared genetic, behavioral, social and environmental risk factors; and

• The potential for a single approach to the management of both diseases.

At Perio Workshop 2016, 75 leading global specialists in cariology and periodontology came together to review this body of evidence. They concluded that a single approach, based around routinely-performed oral hygiene and dietary modification to control biofilm, is effective in the prevention and management of both dental caries and periodontal disease.

The conclusions of Perio Workshop 2016 have since formed the basis of the Perio & Caries project, a joint initiative between Colgate and the EFP. The following are among the recommendations identified by the campaign to help dentists support their patients in simultaneous caries and perio prevention and management.

Recommendations for simultaneous management and prevention

1. Discuss the commonalities of caries and perio with all patients, of all ages and backgrounds, with a particular emphasis on the importance of controlling biofilm.

2. Routinely enquire about dietary behaviors, sugar and fermentable carbohydrate consumption, lifestyle behaviors (e.g., smoking), and other risk factors.

3. Routinely question patients on their family history of both diseases to identify genetic susceptibility.

4. Use validated risk assessment tools like the American Dental Association’s (ADA) caries risk assessments (found under “ADA Resources”).

5. Design an individualized risk-based prevention/management program for each patient that incorporates regular professional cleaning and fluoride application.

6. Using an “educate, motivate, support” approach, emphasize the importance of an oral hygiene routine that involves twice-daily brushing and daily interdental cleaning for mechanical biofilm control.

7. Recommend a fluoride toothpaste and mouth rinse supplemented with antimicrobial agents for chemical biofilm control to manage gingivitis. Examples of appropriate toothpastes include Colgate Total Toothpaste and meridol Gum Protection Toothpaste. Appropriate mouth rinses include Colgate PerioGard and meridol Med CHX 2% Antiseptic Mouth Rinse, both with chlorhexidine gluconate.

8. When there is active disease present, conduct a nutritional assessment and advise the patient to cease sugar consumption between meals. Refer patients to dieticians or other medical practitioners for nutritional support where necessary.

9. Assess for, and address, contributing factors such as reduced salivary flow. In the case of medical or behavioral factors, refer patients to appropriate practitioners or signpost support services.

10. Proactively collaborate with other physicians, health professionals, and caregivers involved in the patient’s healthcare. You may wish to direct them to the campaign’s Recommendations for Non-Dental Health Professionals.

Further resources

Visit the EFP’s Perio & Caries campaign hub for more information on preventing and managing periodontal disease and caries. The campaign hub features extensive resources to help you help your patients, including:

• Video summaries of outcomes, guidelines and core strategies.

• Key scientific papers and reports.

• Recommendations for dental and non-dental health professionals, patients, policymakers and researchers.

• Feature articles from experts and thought leaders.

• Patient-led oral health assessments.