Home Care Flashcards
Old belief that occlusion caused perio
Karolyi 1901; Stillman et al 1920)
Old belief that calculus caused perio
Mandel 1986
Loe 1965
Abstain from oral hygiene for 3 weeks
Gingival inflammation was resolved after 1 week of resuming OH
Periodontitis defintion
Papapanou et al 2018
AAPWW
Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic plaque biofilms and characterized by progresive destruction of the tooth-supporting apparatus
Lang 1973
How often to brush? Healthy patients
plaque removal every 48 hours was sufficient to avoid developing gingivitis
Gingivitis developed at 3-4 days
Maier 2020
RCT; home care frequency for past perio patients
Home care every 12-24 hours prevented gingivitis in patients with a history of periodontitis
Preus 2019
Oral hygiene instruction efficacy
Pt given OHI 3 months before perio therapy showed SSD reduced pocket depths than those who did not receive OHI
Poor oral hygiene and implant failure
Poor oral hygiene has been longitudinally associated with an increased chance of
implant failure (Steenberghe et al. 1993) as well as marginal bone loss (Lindquist et al. 1996).
Renvert 2018
Plaque is the etiological factor for peri-implant mucositis
Heitz-Mayfield 2011
CHX + toothbrushing RCT for peri-implant mucositis
Half of patients (n=15 per group) took 0.5% CHX gel + toothbrushing for 1 month; other half just toothbrushing
No SSD between groups
Plaque control and peri-implantitis
Poor plaque control is a strong predictor for peri-implantitis
Schwarz 2017
Access to clean implants and peri-implant mucositis
Serino and Strom 2009
* peri-implantitis associated with poor access to clean
Pons 2021 (x-sectional study)
* SSD between improper access and** mucosal redness**
* peri-implantitis was related to self-assessment of oral hygiene measures
Compliance related to
Good compliance:
* fewer sessions per day
* easier tasks
* Better communication skills
Bad compliance:
* higher number of devices needed
* more complex requirements
* longer treatment time
Harnacke 2012
verbal OHI vs leaflet OHI
Patients who received oral instructions had **better results **
This is in contrast with Glavind 1983 which showed no difference in type of OHI communication style
Tonetti 2015
Steps for achieving improved home care
- goal setting
- planning
- self-monitoring
Wilson 1984
Pt compliance for maintenance
private practice patients requiring maintenance; 8 year study
- 16% complied
- 49% were erratic compliers
- 34% non-compliers
Bleeding on brushing significance
- Good indicator of peri-implant and periodontal disease
- good predictor for BOP (Tonetti 2020)
Subg penetration depth by cleaning method
Toothbrush: 1mm
Floss: 2-3.5mm
Interdental brush: 2-2.5 mm
All of the above were Waerhaug studies
SubG irrigation: 50% of pocket depth (Eakle et al 1986)
Toothbrushing techniques
- Vetical strokes
- Fone’s circular (Fone 1934)
- Bass (1948)
- Modfieid Bass (Bass +Stillmans)
- Stillmans vibratory (1932)
- Charters vibratory (1948)
- Horizontal scrub
Bergenholtz 1984
Study comparing toothbrushing techniques
Bass technique showed best ability for plaque removal
Yaacob et al 2014
Chochrane review of manual vs powered toothbrushing
Powered toothbrushes more effective at reducing plaque and gingivitis
Sambunjak 2011
Systematic review on flossing efficacy
Toothbrushing + flossing showed only a modest improvement in reducing gingival inflammation
Resulted in controversy after the new york times released an article saying flossing was unnecessary
AAP/ADA 2016 recommendations for home oral hygiene
Brush 2x per day for 2 minutes, floss (or use interdental cleaner) once per day
Oral irrigators vs flossing
Costa et al 2019
Brushing + flossing + oral irrigator group had reduced perio recurrence compared to just B+F group
