Common mouthwash advice ‘not evidence-based’

By Joanna Lyford, Senior medwireNews Reporter

People with fixed dental appliances use fluoride-containing mouthrinses less often than is optimal to prevent the development of white spot lesions, researchers have found.

They suggest that orthodontists ought to change their advice to patients to include mouth-rinsing at times other than directly after toothbrushing in the evening to maximize fluoride intake.

Anne Marie Kuijpers-Jagtman (Radboud University Nijmegen Medical Centre, the Netherlands) and team conducted a postal survey of all 189 orthodontists in private practice in the Netherlands.

The questionnaire asked what measures orthodontists recommended to prevent white spot lesions (enamel decalcifications) during treatment with fixed appliances. A total of 154 (81%) orthodontists replied.

Results showed that 93% of orthodontists had in place a basic caries preventive protocol for patients with fixed appliances, while 4% instituted such a protocol only when white spot lesions occurred, and 3% had no such protocol.

Preventive protocols typically comprised instruction on oral hygiene (92%) and prescription of fluoride mouth rinses (64%). Other measures, such as fluoride tablets and chlorhexidine varnish were rarely used.

Sodium fluoride mouth rinses were most often prescribed at a concentration of 0.05% (65%) or 0.025% (17%). Ninety percent of orthodontists advised patients to rinse once per day, typically in the evening, while 7% advised rinsing twice daily, each time after toothbrushing.

Interestingly, two-thirds of orthodontists said they considered patients with fixed appliances to have insufficient or poor oral hygiene. Only 42% said that they expected oral hygiene to improve after instruction, and 58% said they expected little or no improvement.

Finally, just 53% of orthodontists said they thought that patients used mouth rinse according to instructions while 33% believed that patients followed advice only occasionally.

Writing in Acta Odontologia Scandinavica, Kuijpers-Jagtman and team say that "the commonly used practice of fluoride mouth-rinsing directly after evening toothbrushing "ignores actual evidence of preventive advice."

"A change of the orthodontists' advice, to rinsing at a time other than directly after tooth brushing, would lead to more fluoride intake and thus a possible decrease in the prevalence of white spot lesions," they write.

"Rinsing directly after coming home from school, for example, will lead to additional fluoride exposure, without any increase of healthcare costs. Moreover, patients might accept rinsing more than additional tooth brushing."

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