Home Care

Question 1

Old belief that occlusion caused perio

Answer 1

Karolyi 1901; Stillman et al 1920)

Question 2

Old belief that calculus caused perio

Answer 2

Mandel 1986

Question 3

Loe 1965

Answer 3

Abstain from oral hygiene for 3 weeks

Gingival inflammation was resolved after 1 week of resuming OH

Question 4

Periodontitis defintion

Papapanou et al 2018

AAPWW

Answer 4

Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic plaque biofilms and characterized by progresive destruction of the tooth-supporting apparatus

Question 5

Lang 1973

How often to brush? Healthy patients

Answer 5

plaque removal every 48 hours was sufficient to avoid developing gingivitis

Gingivitis developed at 3-4 days

Question 6

Maier 2020

RCT; home care frequency for past perio patients

Answer 6

Home care every 12-24 hours prevented gingivitis in patients with a history of periodontitis

Question 7

Preus 2019

Oral hygiene instruction efficacy

Answer 7

Pt given OHI 3 months before perio therapy showed SSD reduced pocket depths than those who did not receive OHI

Question 8

Poor oral hygiene and implant failure

Answer 8

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).

Question 9

Renvert 2018

Answer 9

Plaque is the etiological factor for peri-implant mucositis

Question 10

Heitz-Mayfield 2011

CHX + toothbrushing RCT for peri-implant mucositis

Answer 10

Half of patients (n=15 per group) took 0.5% CHX gel + toothbrushing for 1 month; other half just toothbrushing

No SSD between groups

Question 11

Plaque control and peri-implantitis

Answer 11

Poor plaque control is a strong predictor for peri-implantitis

Schwarz 2017

Question 12

Access to clean implants and peri-implant mucositis

Answer 12

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

Question 13

Compliance related to

Answer 13

Good compliance:
* fewer sessions per day
* easier tasks
* Better communication skills

Bad compliance:
* higher number of devices needed
* more complex requirements
* longer treatment time

Question 14

Harnacke 2012

verbal OHI vs leaflet OHI

Answer 14

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

Question 15

Tonetti 2015

Steps for achieving improved home care

Answer 15

1. goal setting
2. planning
3. self-monitoring

Question 16

Wilson 1984

Pt compliance for maintenance

Answer 16

private practice patients requiring maintenance; 8 year study

• 16% complied
• 49% were erratic compliers
• 34% non-compliers

Question 17

Bleeding on brushing significance

Answer 17

• Good indicator of peri-implant and periodontal disease
• good predictor for BOP (Tonetti 2020)

Question 18

Subg penetration depth by cleaning method

Answer 18

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)

Question 19

Toothbrushing techniques

Answer 19

1. Vetical strokes
2. Fone’s circular (Fone 1934)
3. Bass (1948)
4. Modfieid Bass (Bass +Stillmans)
5. Stillmans vibratory (1932)
6. Charters vibratory (1948)
7. Horizontal scrub

Question 20

Bergenholtz 1984

Study comparing toothbrushing techniques

Answer 20

Bass technique showed best ability for plaque removal

Question 21

Yaacob et al 2014

Chochrane review of manual vs powered toothbrushing

Answer 21

Powered toothbrushes more effective at reducing plaque and gingivitis

Question 22

Sambunjak 2011

Systematic review on flossing efficacy

Answer 22

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

Question 23

AAP/ADA 2016 recommendations for home oral hygiene

Answer 23

Brush 2x per day for 2 minutes, floss (or use interdental cleaner) once per day

Question 24

Oral irrigators vs flossing

Costa et al 2019

Answer 24

Brushing + flossing + oral irrigator group had reduced perio recurrence compared to just B+F group

Question 25

Oral irrigator penetration depth

Eakle et al 1986

Answer 25

Angled at 45 or 90 degrees

Penetration depth ~50% of pocket depth

Question 26

CHX popularity for oral rinse

Answer 26

1. antimicrobial
2. bacteriocidal and static effects
3. high substantivity
4. lack of systemic toxicity
5. bacterial resistance

Limitations:
* extrinsic pigmentation
* taste alterations

Question 27

Toothpaste necessity for plaque removal

Answer 27

No evidence that toothpaste increases plaque removal compared to toothbrushing alone

Valkenberg et al 2016

Plaque removal with toothpaste: 49%, without 50%

Mechanical effects of toothbrushing are sole reason for plaque removal

Question 28

Sodium lauryl sulfate

Sabri 2023 systematic review

Answer 28

Conflicting evidence

SLS is a risk indicator for prolonged oral wound healing time, recurrent apthous stomatitis

Question 29

Ramfjord et al 1981

Perio maintenance

Answer 29

78 patients followed for 8 years

3 month maintenance maintained attachment levels and pocket depths

Question 30

Cortellini, Pini-Prato and Tonetti, 1994

Regenerative therapy +/- maintenance

Answer 30

Sites treated with GTR, followed for 4 years

Pts receiving regular recalls had 50-fold reduced risk of attachment loss compared to non-compliant patients

Question 31

Delgado 2021

Xylimelts

Answer 31

Xylimets had less enamel and dentin loss (better compared to other products)