Dr Milan Stojanovic studied dentistry at the University of Bern in Switzerland, and after working as a maxillofacial surgeon at Bern’s Inselspital (university hospital), he returned to his alma mater as a researcher. Since 1996, he has run a typical family dental practice in the Swiss town of Niederbipp. In the last decade, he has also been lecturing future dental assistants, teaching orthodontics and aesthetic dentistry master’s classes, and educating practitioners worldwide on several aligner systems. In this interview, he shares his experiences of treating patients with the new CURAPROX Perio Plus+ antiseptic range.
Dr Stojanovic, which Perio Plus+ samples did you use in the recent trial?
We were lucky to be able to use the samples for 15 long-time patients. We prescribed Perio Plus+ Protect and Focus to three patients with fixed prosthetic restorations, and Perio Plus+ Forte after surgical procedures such as implant placement and third molar extraction. In our experience, Perio Plus+ Forte was extremely effective after surgical procedures, and we observed no side effects or post-surgical wound infection at all. In general, the wound healing was perfect for all patients, and the team felt that all surgical wounds had healed very well and nicely without complications—I would even say better than with purely chlorhexidine-based products.
You mentioned long-term patients. What were their reactions to Perio Plus+?
The feedback from the patients was unanimously positive. They found the new Perio Plus+ products very pleasant and refreshing, and they definitely would prefer to keep using the new product. Since we had previously worked almost exclusively with a similar product, the change was not problematic for us and our patients. On a side note, our patients usually come to our practice again to get the product, or they get it in pharmacies, so it is important that Perio Plus+ is also available at these places.
Do you have a specific protocol for mouthwash treatment?
We had a certain treatment protocol with our previous product, depending on the case and patient. This protocol can be even better achieved with Perio Plus+. Briefly, we prescribe Perio Plus+ Balance to patients without complications after surgery, as a daily supplement to oral hygiene. Patients with resurgent periodontitis are prescribed daily use of Perio Plus+ Protect with Perio Plus+ Support toothpaste for the inflamed areas. Patients with periodontitis are given Perio Plus+ Forte in combination with Perio Plus+ Support, with strict recall intervals of course. After surgical procedures, I give patients Perio Plus+ Forte for two to three weeks, then change to Perio Plus+ Protect, and if the patient shows optimal oral hygiene, I switch to Perio Plus+ Balance. With implants, I additionally prescribe Perio Plus+ Support. Lastly, I prescribe Perio Plus+ Protect when complementary oral hygiene is needed during orthodontic treatment with fixed appliances.
Perio Plus+ should lead to better patient compliance owing to its pleasant taste. Have you had negative experiences with chlorhexidine in the past?
Chlorhexidine is highly unpopular with patients and very often leads to a discontinuation of treatment. The patients we interviewed in our practice were extremely positive about Perio Plus+ and, accordingly, said they could imagine using Perio Plus+ products in the future. Our practice definitely will.
“Mechanical cleaning at the beginning of wound healing is limited after treatment, so adding CITROX® can definitely reduce the pathogenic microbial film on the wound.”
How does Perio Plus+ differ from other chlorhexidine mouthwashes?
For patients, Perio Plus+’s taste definitely makes the difference. I have also tasted Perio Plus+ personally and find it very pleasant, and without major side effects such as burning or taste changes.
What role does biofilm removal play when using a chlorhexidine-based mouthwash?
Proper biofilm removal is key to good oral hygiene. Without it, the pathogenicity is delayed rather than completely suppressed, even with a mouthwash. A combination of correct biofilm removal through normal and interdental brushing on the one hand and using a mouthwash on the other is the optimal form of prophylaxis. The main reason for chlorhexidine stains is that chlorhexidine attaches to the biofilm in the mouth. This discoloration is usually very unsightly and quite persistent. Biofilm removal will reduce the possibility of such stains.
In the long term, CURADEN’s intention is to move towards a situation where dental professionals switch to a lower dosage of chlorhexidine more quickly and complement it with CITROX®.
Yes, I welcome an approach that allows switching to lower doses of chlorhexidine more quickly. It is higher doses of chlorhexidine that frequently lead to side effects such as discoloration and taste changes, or even cause the therapy to be broken off by patients. The addition of natural antiseptics is advantageous, and in my opinion, it definitely promotes wound healing. Also, mechanical cleaning at the beginning of wound healing is limited after treatment, so adding CITROX® can definitely reduce the pathogenic microbial film on the wound.
