Chapters 26 & 33

Question 1

How does a water flosser work?

Answer 1

Delivers a pulsating stream of water or other solution supragingivally and into the sulcus or perio pocket

Question 2

What is the function of a water flosser?

Answer 2

• Pulsating delivery of compression and decompresion phases efficiently displaces biofilm, bacteria and debris
• “hydrokinetic activity”

Question 3

What are the two zones of oral irrigation?

Answer 3

Impact zone: initial fluid contact area near the gingival margin
Flushing zone: Depth of penetration subgingivally

Question 4

What do water flossers work to reduce?

Answer 4

• Reduction in gingival inflammation
• Reduction of periodontal pathogens
• Reduction in inflammatory mediators

Question 5

Purported mechanism of action hypothesis of water flossers

Answer 5

• 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

Question 6

Indications for recommendation of home irrigation

Answer 6

• 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

Question 7

Solutions that may be used in a water flosser

Answer 7

• Water- highly effective
• Chlorhexadine- Diluted is acceptable, reduces staining
• Essential oils (listerine)- Only effective at full strength

Question 8

What are the 3 type of irrigation tips?

Answer 8

• Standard
• Soft rubber tip- perio
• Soft tapered brush- ortho
• Filament brush tip

Question 9

How is the standard irrigation tip used?

Answer 9

• General irrigation
• Penetrates 50% of the pocket
• Hold at 90 degrees and trace the GM
• Start at low power and increase as health inproves

Question 10

How is the soft rubber tip used?

Answer 10

• 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

Question 11

How is the soft tapered brush end used?

Answer 11

• 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

Question 12

How is the filament brush tip used?

Answer 12

• 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

Question 13

What is the goal of professional subgingival irrigation?

Answer 13

To enhance the outcome of instrumentation by disrupting and diluting bacterial biofilm and products within the pocket

Question 14

What solutions may be used for professional subgingival irrigation?

Answer 14

• Chlorhexadine gluconate
• Povidone-iodine-water
• Stannous fluoride rinse
• Tetracycline solutions
• Listerine

Question 15

What have systematic reviews determined about professional subgingival irrigation?

Answer 15

• 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

Question 16

What are the goals of periodontal maintenence?

Answer 16

1. Minimize the recurrence and progression of periodontitis
2. Reduce the incidence of tooth loss
3. Increase the probability of detecting and treating other oral conditions

Question 17

What are the phases of periodontal therapy?

Answer 17

1. Clinical perio assessment
2. Establish diagnosis and plan therapy
3. Perform nonsurgical therapy
4. Reevaluate results of nonsurgical therapy
5. 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
6. Periodontal maintenance

Question 18

What are the steps performed at perio maintenance appointment?

Answer 18

1. Update medical status
2. Pt interview
3. Clinical assessment
4. Evaluation of effectiveness of patient self-care
5. Identification of treatment needs
6. Perio instrumentation
7. Pt. counseling/education
8. Application of fluoride

Question 19

What will determine the appropriate maintenance interval?

Answer 19

• 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

Question 20

How to clinically recognize recurrence of periodontal disease

Answer 20

• Progressive CAL
• Pockets deepening over time
• BOP
• Exudate
• Redigraphic evidence of progressive bone loss
• Increasing tooth mobility

Question 21

Reasons for disease recurrence

Answer 21

• 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

Question 22

What is recurrent disease?

Answer 22

Return of disease in a patient who has been previously, successfully treated