Four hours per year with the hygienist vs 8,756 hours at home

Every cycle so far has been about staying in place. There is a way to improve from here, not only to hold the position.

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For most patients who have been managing periodontitis for years, every quarterly cycle has the same shape. You come in, the hygienist does the work that needs to be done, you leave with the bleeding index back down, and over the next three months it drifts back up to roughly where it was before. The next visit resets it again. That pattern works in the sense that you still have your teeth and probably will for a long time, but the trajectory is essentially flat, and you are spending real money every year to stay in roughly the same place.

In the HOPE-CP study, the group that added a daily home routine to that same pattern produced a different result. After six months, 51 percent of them had reached the European clinical definition of healthy gums, which is bleeding on probing under 10 percent, compared with 23 percent in the group receiving only the standard care. That number represents a real shift in the underlying state of the mouth, rather than another short-term reset between appointments. For someone who has been on this cycle for a few years, this is the most useful piece of clinical news from 2026.

The reason flossing has not worked has very little to do with you.

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Most of the periodontitis patients I see in my chair have given flossing a serious try at some point. They start in the first week after an appointment, often with the floss the hygienist handed them, and by the third week the floss is back in the drawer. The research on flossing adherence shows roughly the same pattern: the large majority of people who start a flossing routine stop again within one to two weeks. When the gums are already inflamed, flossing is uncomfortable and tends to cause additional bleeding, which gives the impression that the routine is making things worse rather than better.

What is more relevant than the adherence question is what flossing actually reaches when you do manage to keep it up. The bacteria responsible for periodontitis live in the biofilm under the gum line, about one to four millimetres below the surface, which is below the depth that floss can clean on most teeth. Even patients who floss every day, perfectly, are cleaning above the layer where the actual problem sits. That layer is the one your hygienist reaches during your quarterly visits, and once you leave the chair, it stays untouched until you come back three months later.

In the largest European periodontitis study of 2026, twice as many patients reached clinically healthy gums with one specific addition to their existing care.

The HOPE-CP study followed 200 patients with periodontitis between Stage I and Stage III for six months. The setup was deliberately straightforward: half of them continued with the standard care any Dutch periodontology practice would provide, and the other half received the same care together with daily use of a Finnish home device called Lumoral.

After six months, 51 percent of the patients in the Lumoral group had reached the European clinical definition of healthy gums, compared with 23 percent in the standard care group. 63 percent of the Lumoral group also reached good plaque control, compared with 38 percent in the standard care group. The adherence number from the study is the one that tends to interest other hygienists most: 85 percent of the patients in the Lumoral group were still using the device every day at the six-month mark, which is well above what most home routines in oral care can produce. The general oral flora in the mouth was not significantly disturbed by the treatment, which was confirmed in an earlier study by Nikinmaa and colleagues in 2021, and there were no serious adverse events.

The paper was peer-reviewed by the American Academy of Periodontology and published in the Journal of Periodontology in January 2026 by Pakarinen and colleagues, under DOI 10.1002/jper.70082.

Ten minutes a day, with adherence numbers we never see with flossing.

The reason patients keep using Lumoral when they have given up on flossing has more to do with the design of the routine than with willpower. You rinse your mouth with the Lumorinse rinse, which contains a light-sensitive molecule that attaches to the bacteria in the biofilm under your gum line. You then click the mouthpiece into your mouth, and for ten minutes it emits blue light at 405 nanometres and red light at 810 nanometres into the gum tissue. The light activates the molecule, which in turn attacks the bacteria in the place they actually live.

In a normal evening this happens while you watch an episode of something on the couch. The device handles the active part of the work. There is no change to your toothpaste, no new brushing routine, and no need to add flossing on top of what you already do. For patients who have always struggled to keep up the home routine their hygienist asked them to do, this is probably the most useful practical difference: the routine does not depend on your technique, your timing or your tolerance for sore gums on the days that floss makes them bleed.

249€ once, on top of what you already spend, is the smallest item on the whole bill.

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You probably know your annual costs without needing to be reminded, but it is useful to put them in one place. A combinatieafspraak with the dentist and the hygienist runs at around 100€ per visit (roughly 20€ for the dentist and 80€ for the hygienist), which adds up to about 400€ a year for four routine visits. A more complex periodontal aftercare schedule with T042, T043 or T044 codes sits between 115€ and 200€ per visit, which pushes the annual total to somewhere between 600€ and 800€. Supplementary dental insurance costs roughly 15€ to 20€ per month, so 180€ to 240€ a year, and reimburses between 250€ and 1.500€ depending on the policy you have. A repeat of the begintraject, if it ever comes to that, is around 1.600€. An implant is around 2.100€ per element.

Lumoral is 249€, paid once, with no subscription and no annual renewal. That is slightly more than two combinatieafspraken, or roughly two months of the higher-end aftercare schedule. It is the smallest item on the list, and it does not change anything else you already pay for in a normal year.

Bring it to your next hygienist appointment and we will look at it together.

Clinical illustration

Lumoral is a CE-certified Class IIa medical device, developed by Finnish dental researchers and tested in the HOPE-CP study. The underlying technology, photodynamic therapy, has been used in periodontology practices in various forms for years, but the at-home version of this approach was only validated in this kind of patient population when the January 2026 paper was published.

What I tend to suggest to my own patients is to order it, use it daily for six weeks and bring it along to the next appointment. Most hygienists will be willing to compare your bleeding index from the previous visit with the current one, read the abstract of the HOPE-CP paper next to your file, and give you their opinion on whether it fits your treatment plan. In my own practice, most of the patients who have done this come out of the conversation with the hygienist supportive of continuing. The device is meant to be used alongside your normal care, not as a replacement for any of it, and the tartar removal stays the hygienist's work. Heavy smokers were excluded from the HOPE-CP study, so the evidence we currently have applies to non-smokers and former smokers only.

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— Sanne de Vries, dental hygienist

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