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ISSN 2304-3415, Russian Open Medical Journal
2017. Volume 6. Issue 2. Article CID e0208 _DOI: 10.15275/rusomj.2017.0208_
Research letter
Practice patterns in prescribing oral care products by dental practitioners
Alena B. Abdrashitova, Rinat A. Saleev, Linara T. Musina
Kazan State Medical University, Kazan, Russia
Received 2 November 2016, Revised 30 December 2016, Accepted 13 February 2017
© 2016, Abdrashitova A.B., Saleev R.A., Musina L.T. © 2016, Russian Open Medical Journal
Abstract: This paper describes the practice patterns of dental practitioners in how they choose oral care products for prescriptions to their patients. One hundred seventy-three respondents were selected for a medico-sociological study. They were divided into 3 groups based on their work experience: less than 5 years (30.0%), 5-9 years (40.0%) and 10-14 years (30.0%). The majority of respondents were dental therapists (71.0%), and the rest were paedodontists, dental surgeons, periodontists and orthodontists (11.0%, 7.0%, 4.0% and 1.0%, respectively). The study was conducted using a questionnaire specially developed by us, which consisted of 34 questions grouped into several domains. Analysis of the obtained results has shown that the majority of dental practitioners (88.7%) were competent in prescribing oral care products. Professionals with work experience over 10 years often choose oral care products incorrectly; 80.6% of them believe that long-term use of personal oral care products containing antiseptic components affects the oral microbial flora, which suggests that it is necessary to amend the existing classification of toothpastes.
Keywords: oral hygiene, personal hygiene products, toothpastes
Cite as Abdrashitova AB, Saleev RA, Musina LT. Practice patterns in prescribing oral care products by dental practitioners. Russian Open Medical Journal 2017; 6: e0208.
Correspondence to Alena B. Abdrashitova. Address: Apt 35, 13, Meridiannaya str., 420095, Kazan, Russia. Tel.: +7-917-854-5125. E-mail: egorova-alena@mail.ru
Introduction
Prevention of dental diseases is one of the most important tasks of health workers. One of the most popular preventive measures for development of dental diseases is a personal oral hygiene [1]. Personal oral hygiene program should be based on the following principles: total individualization; development of oral self-care skills corresponding to the dental and oral hygiene status of each patient; case monitoring and control of program execution [2]. The development of an effective oral care program is aimed at improving and maintaining the condi-tion of oral cavity and prevention of incidence and progression of dental diseases. To achieve this task, the dental practitioner must be fully informed of oral care products with numerous va-rieties of them available on the market [3-5].
Currently, the toothpastes contain two antiseptics: chlorhexidine and triclosan. The latter component may be present in two forms: combined with Gantrez system (copolymer of polyvinylmethyl ether and maleic anhydride) and as a single agent [6]. The antiseptics contained in toothpastes may have bacteriostatic (by suppressing the assimilation of indispensable amino acids by microorganisms) and bactericidal (by disorganizing the cytoplasmic cell membrane of microbes) properties against gram-positive and gram-negative bacteria, dermatophytes and yeasts [7].
Available literature shows the possibility of such antiseptics' influence on oral microflora [8, 9]. However, the duration of exposure and its effect on dental and microbiological state of patients have not been studied. In addition, we did not find any data on the level of dentists' competence regarding the prescription of personal oral care products to their patients in the available foreign literature.
Research objective was to study the competence of dental practitioners at prescribing personal oral care products.
Material and Methods
One hundred seventy-three respondents with experience of less than 5 years (30.0%), 5-9 years (40.0%) and 10-14 years (30.0%) were selected for medico-sociological study. The majority of respondents were dental therapists (71%), paedodontists (11.0%), dental surgeons (7.0%), periodontists (4.0%) and orthodontists (1.0%). The majority (78%) of the respondents worked in public institutions, the rest (22%) worked in private health care organizations.
The study was conducted by using a specially developed questionnaire, which consisted of 34 questions divided into several domains (Appendix 1). Each domain was designed to evaluate the following aspects:
ISSN 2304-3415, Russian Open Medical Journal
2017. Volume 6. Issue 2. Article CID e0208 DOI: 10.15275/rusomj.2017.0208_
i) level of professional competence of dental practitioners at prescribing personal oral care products to the patients;
ii) practice patterns of dental practitioners in prescribing the antiseptic-containing toothpastes to the patients.
Results and Discussion
The dental practitioners use personal oral care products themselves, recommend them to their family members and prescribe them to patients. Our research has shown that the majority of respondents prefer four brands among the wide range of personal oral care products on the market: Sensodyne (toothpaste with sodium fluoride and potassium chloride, which has a pronounced anti-caries and anti-hypersensitivity effect) (34.0%), Parodontax (toothpaste with herbal ingredients -Echinacea, myrrh, chamomile, sage, mint, rhatany - for treatment of periodontal diseases) (25.0%), Lacalut (toothpaste with chlorhexidine for treatment of periodontal diseases with recommended course of application) (22.0%), Blend-a-med (chamomile, sage, eucalyptus) (16.0%). Other 15 brands of oral care products were mentioned in no more than 1.0% of all cases. Oral care products listed above have a wide range of indications for prescription; they are widely advertised in mass media, although they belong to a high price category.
Composition was a key factor for the majority of respondents (93.8%) when prescribing oral care products. They are mostly interested in fluorine (33.1%) and mineral content (25.6%). Oral care products are often prescribed to provide anti-caries (25.1%) and anti-inflammatory (20.3%) effects, as well as to solve several problems simultaneously (18.6%). Thus, the composition of oral care products and their effect on organs of oral cavity are important for most dental practitioners.
Analysis of questionnaires has shown that 62.4% of respondents prescribe oral care products based on individual indications and 38.1% do not consider them, and the rest found it difficult to answer this question. As we see it, this situation is related to a wide range of oral care products with multiple effects being present on the market. However, it should be noted that in various conditions of oral cavity some components of oral care products have a positive effect, while others can affect negatively.
The second domain of questionnaire is related to prescription of antiseptic oral care products. Thirty-four percent of respondents indicated that antiseptics may be contained in toothpastes, 48% - In mouthwashes, 10% - in flosses, 85% - in chewing gums, despite the last two statements being incorrect. The low frequency of correct answers is apparently related to the fact that products of only certain brands contain antiseptics.
The questionnaire included questions on specific types of antiseptics, namely chlorhexidine and triclosan. Currently, chlorhexidine is the most well-known of them; it is contained in oral care products under Lacalut brand, which was preferred by 47.3% of respondents. At the same time, it was shown that dental practitioners find it difficult to name the brands of personal oral care products which contain chlorhexidine. We observed the same situation when analyzing answers to questions in triclosan-dedicated domain. Despite the fact that 52.4% of respondents preferred it, they still found it difficult to name a brand of oral care products with this component. Currently, antiseptic toothpastes belong to therapeutic category and are recommended for
continuous use [10]. The opinions of dental practitioners on this issue are shown follow.
The dental practitioners' awareness of toothpaste category was follow: theraupetic - 45%, theraupetic and preventive - 41%, hygienic - 12%, cannot say - 2%.
The dental practitioners' opinions on the duration of antiseptic toothpastes use were as follows: 1-4 weeks - 76%, up to 6 months - 19%, up to year - 1%, constantly - 0%, cannot say - 4%.
Despite the current classification of oral care products, the dental practitioners point out the necessity of its revision and inclusion of antiseptics to the therapeutic category. The obtained results reflect drawbacks of the existing classification, namely the notion that these hygiene preparations belong to the therapeutic category and can be used not only with therapeutic purpose, but also preventively and, therefore, without restrictions. Analysis of this situation has shown that dental practitioners believe that duration of oral care products use (42.4%), allergy (18.2%), indications (16.3%) and impact on the oral flora (12.1%) are the main limitations of antiseptic-containing oral care products. The majority of respondents (85.9%) noted that prolonged use of antiseptic oral care products may lead to disruption of the oral microbial flora, so it is recommended to use them for no more than 1-4 weeks.
The dental practitioners' opinions regarding the indications for use of antiseptic toothpastes were following:
i) at acute periodontal diseases - 40%,
ii) at chronic periodontal diseases - 21%,
iii) at oral mucosa diseases - 29%,
iv) at caries - 9%,
v) at hyperesthesia - 1%.
Analyzing the answers of dental practitioners regarding the indications for use of antiseptic-containing toothpastes, it was found that in most cases the respondents considered acute periodontal diseases to be the primary indication for prescribing antiseptic toothpastes, which is the most correct answer. However, some doctors answered this question incorrectly.
As a part of this study, we found that 76.0% of dental practitioners believe that oral care products with antiseptic (triclosan) may affect the oral microflora; 81.0% of respondents stated that the same effect is observed with chlorhexidine. The obtained results are likely to be related to the opinion of the dental practitioners on the effect of antiseptics on oral mucosa.
Conclusion
Most dental practitioners (88.7%) showed a high level of professional competence at prescribing personal oral care products. Most commonly, the persons with work experience over 10 years show incompetence in prescribing them. The obtained results confirm the need for teaching in-depth knowledge of composition, mechanism of action, indications, duration and limitations of toothpastes at the post-diploma educational courses for dental practitioners based on recent data concerning the effect of antiseptics on the oral microflora.
According to 80.6% of respondents, prolonged use of antiseptic oral care products has an impact on oral microbial flora, indicating the need for separation of oral care products for therapeutic and for preventive purposes.
ISSN 2304-3415, Russian Open Medical Journal
2017. Volume 6. Issue 2. Article CID e0208 DOI: 10.15275/rusomj.2017.0208_
Conflict of interest: none declared. References
1. Ulitovsky SB, Alekseeva ES, Kalinina OV. Oral hygiene preparations as a motivation of dental health. Parodontologiya 2011; 16(2): 65-66. Russian
2. Garanina TS. The role of personal oral hygiene in the treatment of generalized periodontitis. Molodoy Uchenyy 2014; (3): 155-157. Russian
3. Kopetsky IS, Pobozhyeva LV. Modern treatment products for personal oral hygiene. Lechebnoe Delo 2012; (3): 29-32. Russian
4. Akulovich AV, Suetenkov DE, Yalyshev RK, Konovalova AYu, Novak MO. Assessment of efficiency of use of calcium hydroxyapatite hygiene preparations for tooth enamel sensitivity reduction. Stomatologiya Detskogo Vozrasta i Profilaktika 2015; 14(4): 41-44. Russian
5. Islamova DM, Valeev IV, Bulgakova AI. The justification for Sensodyne® use in dental hyperesthesia treatment. Stomatologiya dlya Vsekh 2015; (4): 10-12. Russian
6. Urazova RZ, Musina LT, Egorova AB. A comparative analysis of antiseptic toothpastes. Practical Medicine 2009; (1): 84-86. Russian
7. Troyanenko LI, Chumakova YuG. Comparative evaluation of therapeutic action of toothpastes on model of periodontitis in rats. Vestnik Stomatologii 2014; (3): 9-14. Russian
8. Musina LT, Egorova AB, Urazova RZ. Influence of tooth paste antiseptics on the oral mikroflora. Kazan Medical Journal 2010; 91(4): 525-528. Russian
9. Mikhalchenko DV, Fedotova YuM, Mikhalchenko VF, Dimitrova MS, Veremeenko TV, Baklanova A.A. The effectiveness of asepta and listerine total care therapeutic-preparations at inflammatory periodontal diseases treatment. Mezhdunarodnyy Zhurnal Prikladnykh i Fundamental'nykh Issledovaniy 2016; (3-1): 83-86. Russian
10. Ulitovsky SB. Modern trends of toothpaste market development. Forum Praktikuyushchikh Stomatologov 2012; (5): 12. Russian
Authors:
Alena B. Abdrashitova - MD, PhD, Associate Professor, Department of Pediatric Dentistry, Kazan State Medical University, Kazan, Russia. Rinat A. Saleev - MD, DSc, Dean of Faculty of Dentistry, Kazan State Medical University, Kazan, Russia.
Linara T. Musina - MD, DSc, Professor of Department of Microbiology, Kazan State Medical University, Kazan, Russia.
ISSN 2304-3415, Russian Open Medical Journal
2017. Volume 6. Issue 2. Article CID e0208 DOI: 10.15275/rusomj.2017.0208_
Appendix 1. The medico-sociological questionnaire for dental practitioners (page 1)
1. Your profession: 11. Which means of topical oral care do you 19. What toothpaste do you use?
□ Dental Therapist prescribe to your patients to prevent dental □ Blend-a-med 7 Complete (oak bark, herbs)
□ Prosthodontist diseases? □ Blend-a-med (propolis)
□ Periodontist □ coating the teeth with fluoride varnish □ Blend-a-med (chamomile, sage, eucalyptus, oak
□ Orthodontist □ gels bark)
□ Dental Surgeon □ electrophoresis with minerals □ Blend-a-med (chamomile)
□ Paedodontist □ phonophoresis with minerals □ Colgate Total 12
□ Diplen film □ Lacalut line
2. Your experience: □ other option □ Parodontax
□ Sensodyne
3. Where do you work? 12. What determines your choice of toothpaste? □ New Zhemchug Total
□ in a public institution (you can select multiple positions) □ New Zhemchug with Laminaria extract
□ in a private dental clinic □ anti-caries properties □ Aquafresh
□ whitening effect □ Synquel
4. When buying toothpaste, which ingredients do □ anti-inflammatory properties □ Rocs
you pay attention to? □ satisfactory price □ Glister
□ fluorine □ antibacterial properties □ Other (specify any)
□ mineral components □ brand loyalty
□ bleaching agents □ ability to reduce gum bleeding 20. How long have you been using this
□ antiseptics □ combination of several of these effects toothpaste?
□ enzymes □ interaction with brand representatives □ 1 month
□ phytocomponents □ ability to reduce dental hypersensitivity □ 2 months
□ your option □ your option □ 2-4 weeks
□ other
5. Do you prescribe oral care products for 13. Do the members of your family use one
prevention of dental diseases to your patients? toothpaste? 21. Do you have stomatopathy at present?
□ yes □ yes □ no
□ no □ no □ 1 have:
□ cannot say □ caries
14. Do you believe that toothpaste with triclosan □ acute periodontal diseases
6. Do you think that there are limitations for using may affect the microflora of the oral cavity? □ chronic periodontal diseases
toothpastes with antiseptic components? □ yes, 1 think so □ oral mucosa diseases
□ yes, 1 think so □ no, 1 don't think so □ hypersensitivity of dental tissues
□ no, 1 don't think so □ never thought about it □ other
□ never thought about it
15. Do you pay attention to the composition of 22. Do you think that toothpaste with
7. If yes, what are those limitations in your the toothpaste when it is selected? chlorhexidine can affect the oral microflora?
opinion? □ yes □ yes, 1 think so
□ no □ no, 1 don't think so
8. To which group of toothpastes would you □ cannot say □ never thought about it
ascribe the antiseptic toothpastes?
□ hygienic toothpastes 16. Which criteria do you use when you prescribe 23. Do you think that toothpaste with triclosan
□ therapeutic pastes antiseptic toothpaste to your patients? can be used continuously for an unlimited period
□ dental treatment pastes □ anti-inflammatory effect of time?
□ cannot say □ antibacterial effect □ yes
□ whitening effect □ no
9. Do you think that prolonged use of antiseptic □ anti-caries effect □ cannot say
toothpastes can lead to the violation of the oral □ reducement of dental hypersensitivity
cavity microflora? □ your option 24. Do you/Did you use a toothpaste with
□ yes, 1 think triclosan?
□ no, 1 don't think 17. Do children and adults in your family use the □ yes
□ never thought about it same toothpaste? □ no
□ yes □ cannot say
10. How do you think, which oral care products □ no
may contain antiseptics? 25. For how long did you use a toothpaste with
□ toothpaste 18. What means of systemic action do you triclosan?
□ chewing gum prescribe to your patients to prevent dental
□ oral rinse diseases? 26. For how long do you recommend to use
□ dental floss □ intake of trace elements (fluorine) antiseptic toothpastes?
□ other (specify any) □ intake of macroelements (calcium, phosphorus) □ 1-4 weeks
□ adaptogenic drugs □ up to 6 months
□ vitamins □ up to 1 year □ permanent use □ cannot say
ISSN 2304-3415, Russian Open Medical Journal
2017. Volume 6. Issue 2. Article CID e0208 DOI: 10.15275/rusomj.2017.0208_
Appendix 1. The medico-sociological questionnaire for dental practitioners (page 2)
27. If you are approached by a patient with acute 29. If you are approached by a patient with 32. Which toothpastes containing Chlorhexidine
periodontal inflammation, which toothpaste chronic periodontitis in remission, which do you usually recommend to your patients?
would you recommend? toothpaste would you recommend? Blend-a-med 7 Complete (oak bark, herb)
□ Blend-a-med 7 Complete (oak bark, herb) Blend-a-med 7 Complete (oak bark, herb) □ Blend-a-med (propolis)
□ Blend-a-med (propolis) □ Blend-a-med (propolis) □ Blend-a-med (chamomile, sage, eucalyptus, oak
□ Blend-a-med (chamomile, sage, eucalyptus, oak □ Blend-a-med (chamomile, sage, eucalyptus oak bark)
bark) bark) □ Blend-a-med (chamomile)
□ Blend-a-med (chamomile) □ Blend-a-med (chamomile) □ Colgate Total 12
□ Colgate Total 12 □ Colgate Total 12 □ Lacalut line
□ Lacalut line □ Lacalut line □ Parodontax
□ Parodontax □ Parodontax □ Sensodyne
□ Sensodyne □ Sensodyne □ New Zemchug Total
□ New Zemchug Total □ New Zemchug Total □ Aquafresh
□ Aquafresh □ Aquafresh □ New Zemchug with Laminaria extract
□ New Zemchug with Laminaria extract □ New Zemchug with Laminaria extract □ Synquel
□ Synquel □ Synquel □ Rocs
□ Rocs □ Rocs □ Glister
□ Glister □ Glister □ Other (specify any)
□ Other (specify any) □ Other (specify any)
33. Which antiseptics do you prefer as a
28. Which triclosan-containing toothpastes do 30. If you are approached by a patient with high component of oral care products?
you usually recommend to your patients? caries activity, which toothpaste would you □ triclosan
Blend-a-med 7 Complete (oak bark, herb) recommend? □ Chlorhexidine
□ Blend-a-med (propolis) Blend-a-med 7 Complete (oak bark, herb) □ calcium glycerophosphate
□ Blend-a-med (chamomile, sage, eucalyptus, oak □ Blend-a-med (propolis) □ cetylpyridium chloride
bark) □ Blend-a-med (chamomile, sage, eucalyptus oak
□ Blend-a-med (chamomile) bark) 34. Which antiseptic-containing toothpaste do
□ Colgate Total 12 □ Blend-a-med (chamomile) you usually recommend to your patients?
□ Lacalut line □ Colgate Total 12 Blend-a-med 7 Complete (oak bark, herb)
□ Parodontax □ Lacalut line □ Blend-a-med (propolis)
□ Sensodyne □ Parodontax □ Blend-a-med (chamomile, sage, eucalyptus, oak
□ New Zemchug Total □ Sensodyne bark)
□ Aquafresh □ New Zemchug Total □ Blend-a-med (chamomile)
□ New Zemchug with Laminaria extract □ Aquafresh □ Colgate Total 12
□ Synquel □ New Zemchug with Laminaria extract □ Lacalut line
□ Rocs □ Synquel □ Parodontax
□ Glister □ Rocs □ Sensodyne
□ Other (specify any) □ Glister □ Other (specify any) □ New Zemchug Total □ Aquafresh □ New Zemchug with Laminaria extract
31. When do you recommend your patients to □ Synquel
use antiseptic toothpaste? □ Rocs
□ in case of acute periodontal diseases □ Glister
□ in case of chronic periodontal diseases □ Other (specify any)
□ in case of oral mucosa diseases
□ in case of caries
□ in case of hyperesthesia
□ in case of other diseases
