Based in Zagreb in Croatia, Prof. Andrija Petar Bošnjak is a periodontist with nearly 20 years of clinical experience in running his own implant and periodontics practice. In his role of professor of periodontics, he teaches dental students at the universities of Split and Rijeka, where he also works as an academic researcher. Most recently, Prof. Bošnjak was one of the first dental professionals to put CURAPROX Perio Plus+ to the test. In this interview, he talks about treating patients with the new antiseptic range and how natural antiseptics could improve treatment.
Prof. Bošnjak, which Perio Plus+ solutions did you use?
I used all four solutions of Perio Plus+ as well as the Perio Plus+ Focus gel. Depending on the situation and medical history of the patient, I used Perio Plus in the formulation that I considered to be appropriate.
My recall patients received the Balance solution, my post-surgery cases received the Protect solution, my first-time periodontal patients—who were undergoing periodontal therapy—received the Forte solution, and my mucogingival and implant surgery patients received the Regenerate solution. All were advised to use the solution for a week and then report back to my dental office. Lastly, two patients with peri-implantitis received the Focus gel with the instruction to apply it to the inflamed area around the implants with an interdental brush.
When treating these patients, what does the therapy normally entail?
Therapy usually starts with oral hygiene instruction—regardless of the diagnosis and condition. In this first phase, we only discuss mechanical prevention and cleaning tools, and only when patients show that they have mastered this part of the therapy do I start chemical treatment.
The part of therapy where the dental team comes in starts with the dental hygienist performing the supragingival cleaning or depuration, and after that we go one step further with subgingival scaling—quadrant by quadrant—and additional surgical therapy—periodontal or implantological—never forgetting the instruction and re-instruction on proper oral hygiene.
What were the reactions of your patients to Perio Plus+?
I must say that all of the patients were positive about the taste, some even commenting on its freshness and a slight tingling that they found quite pleasant.
Chlorhexidine normally has a number of side effects, such as tooth discoloration and unpleasant taste. Have you noticed any side effects with Perio Plus+?
I have not seen the usual chlorhexidine side effects, but then again, I only prescribed Perio Plus+ for a week. Maybe I would be better able to comment on this after patients have used the product a bit longer, especially in the case of the Balance and Regenerate solutions.
“Restoring that equilibrium in the mouth and restoring the natural relationship between host and bacteria are something we must research not only for patients with oral disease but also for healthy patients so that they can maintain the homeostasis that they have.”
I have had plenty of negative experiences with the side effects of chlorhexidine rinses and gels in the past, though. They ranged from some really unpleasant ulcerations on the mucosa with alcohol-based solutions, to really heavy discoloration of the teeth and tongue. One thing that still stands out for me was the complaint of a friend of mine about the strange taste in his mouth after using a chlorhexidine rinse akin to having eaten a lot of onion the night before.
According to Prof. Bošnjak, switching to lower doses of chlorhexidine complemented with natural antiseptics is something that we should investigate and pursue to preserve the oral balance in patients. (Photograph: Dental Centar Čes)
What would you say is the difference between Perio Plus+ and other chlorhexidine mouthwashes?
I think that the taste makes all the difference, viewing therapy from the patient’s perspective. But from a professional point of view, I feel that the addition of Perio Plus+’s active ingredients—Citrox and polylysine—makes all the difference.
How was wound healing?
The wound healing was spectacular. From experience, I would say that my patients heal quickly and with minimal complications, but the patients that used the Regenerate and Forte solutions really showed perfect healing. I believe Perio Plus+ is to thank for that.
Would you use Perio Plus+ in the future? If so, why?
Definitely, as soon as it is launched and sold in Croatia, I will move all my patients to Perio Plus+ solutions.
So Perio Plus+ contains Citrox, a natural antiseptic composed of a number of bioflavonoids. What is your opinion on using the usual therapeutic doses of chlorhexidine pre- and post-surgery, but switching to a lower dose of chlorhexidine more quickly, one that is complemented with natural antiseptics?
It would be really great if we could find something that could replace chlorhexidine, since the homeostasis of the oral microbiome is of utmost importance in preserving oral health and not letting it slip towards disease.
The aetiology and the pathogenesis of periodontal disease are still not completely clear—the new classification for periodontitis is actually just further proof of that. I graduated in 1996 and this is actually the third “new” classification of periodontal diseases I have seen. So, I think that, with patients with a healthy periodontium and healthy oral mucosa, our main focus must be the preservation of this oral balance, and in patients with oral disease, we should try to get the oral balance back to the one we find in healthy patients.
Killing all bacteria in our mouth is so wrong, so bad, and we should really not be taking the risk of enabling periodontal pathogens to thrive. I think that switching to lower doses of chlorhexidine complemented with natural antiseptics is something that we should investigate and pursue.
Lastly, how do you see the potential of natural antiseptics in oral health?
Since I am currently in negotiations with a company that produces probiotics and prebiotics in the hope of doing research in this field, I am looking forward to natural antiseptics very much. Any product that is not completely synthetic and anything that mimics the body’s healthy biological environment are more than welcome. Restoring that equilibrium in the mouth and restoring the natural relationship between host and bacteria are something we must research not only for patients with oral disease but also for healthy patients so that they can maintain the homeostasis that they have. I am interested in a product that comes from nature and enables nature to thrive.