Patient Home Care Instructions - OHI | Questions and Answers

Patient Home Care Instructions - OHI | Questions and Answers What are the two most common periodontal diseases? Gingivitis and periodontitis What are the three things required for periodontal disease? O A bacterial insult o A host response o A periodontium What is gingivitis? The REVERSIBLE presence of gingival inflammation without loss of connective tissue attachment What is the diagnostic sign of gingivitis? BOP What is periodontitis? = inflammation of the gingiva and the attachment apparatus; IRREVERSIBLE loss of connective tissue attachment What are the features of periodontitis that contrast with gingivitis? - Ulceration of the junctional and pocket epithelium - Loss of connective tissue attachment - Bone resorption When does periodontitis result? When the rate of tissue breakdown the rate of tissue repair What is the hallmark sign of periodontitis? Loss of attachment w/ increased pocketing Is BOP diagnostic of periodontitis? No What makes periodontitis localized vs generalized? Localized if 30% of the teeth are involved; generalized if 30% How do you characterize severity of periosontitis? Clinical attachment loss What is considered slight clinical attachment loss? 1-2 mm What is considered moderate clinical attachment loss? 3-4 mm What is considered severe clinical attachment loss? ≥5 mm How often should you brush and for how long? 2x per day for 2 minutes using a soft bristled brush How long after eating should you wait before brushing? 30 minutes. This keeps you from brushing in an acidic environment, which can be damaging to the teeth How much toothpaste should you use? Pea-sized amount use toothpaste with fluoride What is the preferred method of manual brushing currently? Modified bass technique Describe the modified bass technique for brushing? O Bristles are placed at a 45° angle pointing toward the gingival margin o Place 1 row of bristles on the gingiva, the rest on the tooth surface o Move the brush back and forth in short strokes covering 2-3 teeth (small vibratory motions) o Then sweep the brush away from the gingiva o Move to the next few teeth and repeat to the end of the quadrant or arch. O Repeat this for the next set of surfaces (ex. Linguals) **Slightly different for linguals of anterior teeth: turn the brush verticallyand use an up-and-down stroke For which patients are powered toothbrushes most helpful? Those with limited dexterity and orthodontic appliances Does using a power toothbrush replace the need for flossing? No Is technique as important with a power toothbrush as it is with manual? No. Let the power toothbrush do the work, don't need to focus on the technique Are certain types of power toothbrushes better than others? No. They are all considered safe and effective and generally perform at similar levels of effectiveness What are the 3 main types of power toothbrush? Oscillating sonic/ultrasonic rotary/contra-rotary Which brand makes an oscillating toothbrush? Oral-B Which brand makes sonic/ultrasonic toothrbushes? Sonicare How do sonic/ultrasonic toothbrushes work? - Uses high frequency and amplitude clean with 30K strokes/min - Forces fluid between contacts and into sulcus where bacteria flourish - Place the brush along the gingiva at a 45-degree angle What is the main difference between manual vs power toothbrushes? Both are equally effective but power toothbrushes are more efficient Do power toothbrushes have an advantage over manual toothbrushes? No. When should a power toothbrush be recommended? When a patient cannot effectively remove plaque with a manual brush - it is easier to introduce a new concept than to break bad habits What toothbrush bristle materials are safe for use on implants? Nylon or plastic Can any tooth brushing technique assure interproximal plaque removal? No What is flossing? Interproximal technique of choice for patients with no or minimal attachment loss, with little interproximal recession How often should you floss? Minimum of 1x/day Which type of floss is most effective? All equally effective For which patients is waxed floss recommended? Recommended to a patient with rough interproximal spaces When is PTFE floss recommended? Helps when there are very tight contacts, same material as Gore-Tex and Teflon What is dental tape? When is dental tape recommended? A wider version of floss, useful in tight contacts Describe the proper flossing technique - Use about 18-24 inches of floss (approx. Length from fingers to elbow) - Wrap floss around your middle fingers, then pinch a short zone of floss with your index (pointer) finger and thumb - Keep hands close together, slide back and forth until below the contact area - Once below contact, hug or wrap around the side of one tooth, insert into sulcus, move up and down 3-4 times - NOT in a back and forth, "shoeshine" motion. Then lift the floss up and over the papilla without leaving the contact, wrap the side of the other tooth in a c-shape and repeat. What. Are some consequences of improper flossing technique? Can cause trauma/lacerate the papilla Should you snap the floss through the contact, onto the papilla? No Does automated flossing work? Yes, found to be safe and effective What are some examples of automated flossing? Water flossing and vibrating floss For which patients are flossing aids helpful? For pts who have difficulty guiding the floss with their fingers What are some examples of flossing aids? Disposable floss-picks (plackers), floss holders, floss threader, super floss What are disposable floss-picks? Are they any good? Disposable floss in a holder; convenient, but doesn't wrap around tooth very well; not as good as string floss but better than nothing. What is a main benefit of disposable floss picks? Can help pt build a flossing habit What is a floss holder? Which patients is it good for? Y-shaped tool that holds floss between two prongs; helpful for patients who have difficulty holding regular floss. Similar idea as dispoable floss-picks, but is multi-use and has a larger handle What are floss threaders good for? Splinted teeth / orthodontic wires / underneath bridges What is super floss? What is it good for? Pre-cut floss with 3 sections: 1. Stiff on one end for ease of threading 2. About 6" of sponge-like material for cleaning tricky areas 3. Regular floss for cleaning normal areas good for splinted teeth / orthodontic wires / underneath bridges For which areas are interdental cleaning aids required? Proximal surfaces that are concave and inaccessible to the cleaning fibers of regular floss. What are some examples of interdental cleaners? Proxa-brushes rubber or plastic tipped interproximal devices stim-u-dent strips of gauze (in 1-1.5" width) What are proxa brushes? What are they good for? Resemble a miniature toothbrush. Available in different shapes and sizes. Good for wider embrasures, open contacts, furcation areas exposed by attachment loss, and behind wires in orthodontic cases. How do you use proxa-brushes? In a back-and-forth and rotary motion from both a facial and lingual approach Can patients with dental implants use proxa-brushes? Yes, but only if they have a teflon-coated wire core What are rubber or plastic tipped interproximal devices used for? Gingival massage, stimulates tissue. Good for exposed furcations What is a stim-u-dent? What is it used for? Wooden pick made out of soft balsa wood (not a traditional toothpick). Has a triangular shape, similar to an interdental wedge. When used properly can be effective in removing food from exposed furcation, crown margins, and areas of recession. Improper use can damage papilla What are strips of gauze 1-1.5" in width good for? Proximal surfaces adjacent to an edentulous area / distal of last molar What are some aids for cleansing inaccessible areas? End tuft brush - fits perfectly in the distal furcation of maxillary molars; also good for malpositioned teeth Is tongue scraping a good idea? It can be, when performed daily it can reduce halitosis. How can you clean the tongue? Using a tongue scraper. Start at the back of the tongue and pull the scraper forward. Can also be done with a toothbrush but is less effective What do you need to consider before recommending products for dry mouth? Many of them have an acidic ph so you need to look up the ph of a particular brand before recommending it to patients What are mouthwashes? Agents useful in controlling the etiologic agents of periodontal disease by reducing plaque below an individual's threshold for disease. What are the 5 categories of chemotherapeutic mouthwashes? Antiseptics antibiotics enzymes denaturing agents agents that interfere with attachment to the pellicle What do antiseptic mouthwashes utilize? Broad spectrum antibacterial activity What are antibiotic mouthwashes doing? Killing specific groups of bacteria What do enzyme mouthwashes do? Break up plaque matrix What do mouthwashes with denaturing agents do? Alter the metabolic activity of the plaque What are the main uses of chemotherapeutic mouthwashes? To replace mechanical toothbrushing when it is not possible. As an adjunct to normal mechanical oral hygiene. What are some situations in which toothbrushing would not be possible? (chemotherapeutic mouthwash recommended) After oral or periodontal surgery, after inter-maxillary fixation to treat jaw fracture, with acute gingival infections, for handicapped patients unable to brush. When might chemotherapeutic mouthwashes be recommended as adjuncts to normal mechanical hygiene? Following scaling when there is dental hypersensitivity. Adjunct to everyday personal plaque removal routine.