Interview Practice

“Speaking from my experience … chlorhexidine is the gold standard”

Based in the Croatian town of Rijeka, periodontal specialist and implantologist Dr Mia Girotto’s main goal is to help patients in every possible way. Where prevention is still possible, she instructs patients on how to achieve optimal oral hygiene and avoid future disease, and for those patients who have missed the opportunity, she repairs or replaces with implants. Chemical cleaning with mouthwashes is an integral part of her job and, together with proper brushing and patient compliance, a decisive factor for successful treatment results.

Mia, during what stage of treatment do mouthwashes come into play?
Mouthwashes are a significant part of periodontal therapy, as well as periodontal and implant surgery. Periodontal diseases are caused by bacterial biofilm, so periodontal therapy is often preceded by mechanical therapy. We prescribe a mouthwash for home support, along with tooth brushing. By giving the patient a mouthwash to rinse as a first step, we control the quantity of the overall bacteria, hence lowering the dissemination during the upcoming treatment. We usually also recommend the use of mouthwash as a chemical support in the first few days up to two weeks post-surgery, depending on the patient and case.

How important is patient compliance for treatment success?
Very, very important. Patients have to be educated on the correct amount of mouthwash and frequency of rinsing. This is especially important when a mouthwash is combined with sodium lauryl sulphate-containing toothpastes, specific drugs or pigmented foods—some of which can completely annul the effects of the chlorhexidine in the mouthwash.

Do you find that the side effects of chlorhexidine mouthwashes influence patient compliance?
As an answer to your question, I’ll tell you an anecdote from my early career as a periodontist. I had a patient with periodontitis, a young, ambitious chef who wanted to have therapy done and have everything cured as fast as possible. In addition to intense mechanical therapy, I prescribed a chlorhexidine-based mouthwash. This was about 18 years ago, mind you, when there were only a few very strong chlorhexidine mouthwashes on the market and they also contained alcohol. Little did I know, at that point of time, that he would lose his sense of taste. Fortunately, this was only temporary, but because of it he started to lose confidence in the therapy as a whole. I learnt my lesson, and although we’ve seen improved products hitting the market in the meantime, every improvement is always welcome.

Unfortunately, taste disturbances, tooth discoloration and allergic reactions are still possible and can occur with high dosages or prolonged or unsupervised use. However, speaking from my experience and the results I’ve seen in my patients, I would still say that chlorhexidine is the gold standard.

CURAPROX’s Perio Plus+ contains Citrox. Can natural antiseptics like Citrox be a solution?
As a believer in and a consumer of organic food products, I had heard about Citrox before. It is an organic bioflavonoid and disinfectant sourced from bitter oranges. As such, its side effects are minimal, it is hypoallergenic, and no cross-interaction with other drugs and chemical components is to be expected. This makes it a very exciting and promising product, and doctors, patients and the general public should be looking forward to these kinds of products that offer maximal effects and minimal side effects!

Finally, what can dental professionals do to enhance patient compliance?
A first step for dental professionals would be to try to get to know their patients. Then, it would be easier to effectively assess the need for chemical support or increased frequency of recall. Also, it would be prudent to enquire about all the possible effects of chemicals in a mouthwash, or any drug, prior to prescribing it to a patient. When it comes to mouthwashes, I mainly think about the possible interactions the mouthwash’s ingredients can have with the bacteria in a patient’s mouth, pigmented foods that could lead to tooth discoloration, or other drugs.

Periodontal specialist and implantologist Dr Mia Girotto emphasises the importance of patient compliance during treatment, as well as the great potential of natural oral health care products. (Photograph: Curaden)

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