Introduction
The standard of practice and management of periodontal disease is continually evolving. As dental hygienists, we are keenly aware of the oral systemic connection and the critical role we serve in getting our patients healthy. We also know that in order for nonsurgical periodontal therapy to be truly successful, the biofilms that contain the smear layer of endotoxins, bacteria, and contaminated cementum are what need to be completely removed.1 Scaling and root planing (SRP) will continue to be the ‘gold standard’ for nonsurgical treatment of periodontal disease, however completely eradicating these biofilms can be challenging for clinicians, especially in areas where instrumentation is difficult or where harmful microbes have penetrated the dentinal tubules.1 Adjunctive therapies to SRP, such as chemotherapeutic agents and systemic, as well as locally delivered antibiotics have all been used in an attempt to change the subgingival microbial environment. Studies have pointed to limitations with these agents as well due to the chemical makeup of biofilms being resistant to antimicrobials and antibacterials. A new wave of gel desiccants that are showing statistically significant results, have been developed as an adjunctive treatment to SRP that is able to effectively penetrate and eradicate subgingival biofilms. This article aims to provide an overview of desiccants and how this simple therapy could transform your treatment and maintenance of periodontal disease.
What is a desiccant?
By definition, desiccants are materials that absorb moisture and humidity from the environment and are able to attract and hold gases or liquids.2 In the gel form for dental procedures, desiccants are made up of a concentrated blend of sulphonic and sulphuric acids. When evaluating the consistency of the oral microbiome, it is made up of bacterial microorganisms in a matrix of 70% water and 10-30% extracellular substances.1 Desiccants are unique in that they are able to bind to water in the biofilm matrix and quickly detach, destroy, and get rid of the biofilm in subgingival areas.1 Systemic and local delivery antibiotics have been used an adjunctive therapy to SRP for years, however there are concerns with overuse and microbial resistance.1 Not to mention that these agents may not be targeting the biofilm in a way that truly breaks down its cellular matrix. Similarly, antiseptic agents used as irrigation may inhibit new plaque formation, but are not able to break down biofilm.3 Administration of desiccants can also assist with targeting biofilms in areas that are difficult to instrument, thus altering the microbial environment leading to significant improvements in clinical and microbial indices.
In a randomized controlled clinical trial that compared the treatment outcomes of a desiccant in addition to SRP versus SRP treatment alone, the results for the desiccant treatment group showed statistically significant reductions in clinical, microbial, and inflammatory mediators.4 These mediators were evaluated at 15, 30, 60, 180, and 365 days following treatment. At 12 months, the SRP group alone showed significant probing depth reductions of 2.23mm plus or minus 0.31 mm compared to the SRP plus desiccant group that showed 3.25mm plus or minus 0.57mm reduction that was statistically significant. For bleeding on probing (BOP), the SRP group alone showed at 4.56% plus or minus 1.5% reduction, compared to the SRP plus desiccant group showed a 34.23% plus or minus 4.2% reduction that was statistically significant. Also during this study, 40 microbial species were evaluated at all the same aforementioned time intervals. At 180 and 365 days, results for the SRP plus desiccant group showed a statistically significant reduction in orange and red complex bacteria in comparison to the SRP treatment group alone.4 Although SRP treatment is still the gold standard for non-surgical periodontal therapy, simply removing calculus and biofilms through mechanical instrumentation does not appear to be adequate, as we can see the importance of eradicating the biofilms with adjunctive therapies and how this leads to improved clinical markers over an extended period of time.
Incorporating into practice: How it is used and the benefits to the patient and clinician
The trial previously described was one of many that demonstrate how desiccants can enhance the clinical efficacy of SRP treatment.4 Even the most skilled clinicians with advanced instrumentation abilities face challenges in difficult to access areas, such as furcas and profound pocket depths. As practitioners, we know that if the biofilm is not completely removed, the inflammatory process will continue leading to further tissue destruction and bone loss. When desiccants break down the biofilm matrix, calculus is softened, making instrumentation easier and more efficient for the clinician.3 To administer these agents, it is recommended to apply to all periodontally effected pockets and to leave on no longer than 30 seconds, followed by a thorough rinse for the patient. Due to the acidic nature, it is important to be aware that application around the cervical dentin could result in hypersensitivity, since desiccants strongly contact biofilm and dentin.2 Desiccants play a critical role during nonsurgical periodontal treatment and can be used during periodontal maintenance visits as well.
Not only does this support clinicians in enhancing the efficacy of SRP, it can also assist in establishing long term maintenance of periodontal disease. In a systematic review and meta-analysis that evaluated topical agents in biofilm disaggregation, the results showed that compared to sodium hypochlorite, the application of gel with sulfonate and sulfuric acid in addition to SRP was statistically significant in improving clinical and microbiological parameters.3 The results of the various studies included in the review were evaluated even at one year following treatment. This is encouraging to consider that with the addition of a desiccant to nonsurgical periodontal therapy, we have the potential to move patients toward stable periodontal maintenance while avoiding consistent retreatment with SRP periodically.
Conclusion
Understanding the biofilm matrix and its role in the inflammatory process of periodontitis is critical to controlling this chronic condition and moving patients toward a state of maintenance. Mechanical instrumentation has been the gold standard and will continue to be, however there are agents available as an adjunct that are proving significant in reducing the microbial load and improving clinical parameters such as probing depths, bleeding on probing, and attachment loss. Incorporating this treatment into practice is efficient and has the potential to support both the clinician and the patient.
References
1. Khalil B, Sulaiman AA, Hajjar BA. Th effects of adjunctive use of a desiccant agent in the treatment of stage III periodontitis (Randomized controlled clinical trial). Saudi Dent J. 2023;35(2): 172-177. DOI: 10.1016/j.sdentj.2023.01.001
2. Desiccant. Science Direct. Accessed July 16, 2024. https://www.sciencedirect.com/topics/medicine-and-dentistry/desiccant
3. Pardo A, Fiorini V, Zangani A, et al. Topical Agents in Biofilm Disaggregation: A Systematic Review and Meta-Analysis. J Clin Med. 2024;13(8): 1-14. DOI: 10.3390/jcm13082179
4. Isola G, Matarese G, Williams R, et al. The effects of a desiccant in the treatment of chronic periodontitis: a randomized, controlled clinical trial. Clin Oral Invest. 2018;22: 791-800. DOI: 10. 1007/s00784-017-2154-7
