Chapters 26 & 33 Flashcards
How does a water flosser work?
Delivers a pulsating stream of water or other solution supragingivally and into the sulcus or perio pocket
What is the function of a water flosser?
- Pulsating delivery of compression and decompresion phases efficiently displaces biofilm, bacteria and debris
- “hydrokinetic activity”
What are the two zones of oral irrigation?
Impact zone: initial fluid contact area near the gingival margin
Flushing zone: Depth of penetration subgingivally
What do water flossers work to reduce?
- Reduction in gingival inflammation
- Reduction of periodontal pathogens
- Reduction in inflammatory mediators
Purported mechanism of action hypothesis of water flossers
- Hydrokinetic movement may physically disrupt biofilm and interfere w/ plaque maturation
- Hydrokinetic movement may later host inflammatory response reducing the level of inflammation irrespctive of biofilm removal
- Water may provide a flushing effect that removes loose, non-adherent plaque biofilm, food, debris, and dead bacteria
- Initial contact at the impact zone may mechanically stimulate the gingiva
Indications for recommendation of home irrigation
- Perio maintenenace pts- 5mm+ pockets
- Pts non-compliant w/ flossing- effective alternative
- Special needs pts
- Dental implant pts
- Diabetic pts- 44% reduction in bleeding
- Orthodontic pts- 3.76X biofilm removal- 26% better bleeding reduction over floss threader
Solutions that may be used in a water flosser
- Water- highly effective
- Chlorhexadine- Diluted is acceptable, reduces staining
- Essential oils (listerine)- Only effective at full strength
What are the 3 type of irrigation tips?
- Standard
- Soft rubber tip- perio
- Soft tapered brush- ortho
- Filament brush tip
How is the standard irrigation tip used?
- General irrigation
- Penetrates 50% of the pocket
- Hold at 90 degrees and trace the GM
- Start at low power and increase as health inproves
How is the soft rubber tip used?
- Delivers solution to deep pockets, furcations and around implants
- 90% penetration into <6mm pockets
- 64% penetration into 7+mm pockets
- Place tip at 45 degree angle
How is the soft tapered brush end used?
- More effective than floss at plaque removal
- More effective than brushing alone
- Start at lowest setting and increase as health imrpoves
- Also used to clean brackets and wires
How is the filament brush tip used?
- Three filaments surround a standard tip
- use at a 90 degree angle at GM, pausing at interproximal
- Start low and increase as health improves
- Reduces bleeding around implants over brushing and flossing
What is the goal of professional subgingival irrigation?
To enhance the outcome of instrumentation by disrupting and diluting bacterial biofilm and products within the pocket
What solutions may be used for professional subgingival irrigation?
- Chlorhexadine gluconate
- Povidone-iodine-water
- Stannous fluoride rinse
- Tetracycline solutions
- Listerine
What have systematic reviews determined about professional subgingival irrigation?
- No additional benefit over SRP
- No long-lasting substantivity of antimicrobial agent in the perio pocket due to continual flow of gingival crevicular fluid from the pocket and presence of serum and proteins in pocket
What are the goals of periodontal maintenence?
- Minimize the recurrence and progression of periodontitis
- Reduce the incidence of tooth loss
- Increase the probability of detecting and treating other oral conditions
What are the phases of periodontal therapy?
- Clinical perio assessment
- Establish diagnosis and plan therapy
- Perform nonsurgical therapy
- Reevaluate results of nonsurgical therapy
- One of the following;
a) perio disease appears controlled
b) need for perio surgery identified and performed
c) need for additional nonsurgical therapy identified and performed - Periodontal maintenance
What are the steps performed at perio maintenance appointment?
- Update medical status
- Pt interview
- Clinical assessment
- Evaluation of effectiveness of patient self-care
- Identification of treatment needs
- Perio instrumentation
- Pt. counseling/education
- Application of fluoride
What will determine the appropriate maintenance interval?
- Severity of perio- increased severity indicates shoter intervals
- Adequacy of pt. self-care
- Host response- systemic/genetic factors may negatively affect host response (diabetic control)
- Repopulation of perio pathogens- pathogens return to preinstrumentation levels in approx. 9-11 weeks. 3 mos or less interval recommended for disruption and removal of subgingival biofilm/pathogens
How to clinically recognize recurrence of periodontal disease
- Progressive CAL
- Pockets deepening over time
- BOP
- Exudate
- Redigraphic evidence of progressive bone loss
- Increasing tooth mobility
Reasons for disease recurrence
- Inadequate self-care/poor adherence to maintenance program
- Incomplete professional treatment- instrumentation or failure to identify local risk factors
- Failure to control systemic factors
- Inadequate control of occlusal factors
- Improper surgical technique
- Attempting to treat teeth w/ a poor prognosis- May have been done well enough for initial successful treatment
What is recurrent disease?
Return of disease in a patient who has been previously, successfully treated
