Oral hygiene instruction and BPE presentation Flashcards
what is the aetiological agent for gingivitis and periodontitis
plaque
define plaque induced ginigvitis
an inflammatory response of the ginigival tissues resulting from bacterial plaque accumulation located at and below the gingival margin
what are the clinical signs of plaque induced gingivitis
- bleeding on probing
- high plaque score
- high bleeding scores
- gingival swelling and redness
what does the patient notice with plaque induced gingivitis
- blood in saliva
- bleeding with toothbrushing and interdental cleaning
- bad breath
key points to know about plaque induced gingivitis
- reversible inflammation of the gingival tissues
- swelling and bleeding at the gingival margins
- risk factor for periodontitis
- probing depths ≤3mm
- no attachment loss
- no radiographic bone loss
define periodontitis
an inflammatory disease initiated by bacteria which, in susceptible people, cause severe inflammation and loss of bone around the teeth
clinical signs of periodontitis
- bleeding on probing
- radiographic bone loss
- gingival recession
- probing depths ≤4mm (clinical attachment loss)
what the patient notices with periodontitis
- blood in saliva
- bleeding with toothbrushing and interdental cleaning
- bad breath
- black triangles
- tooth movement
key points to know for periodontitis
- inflammation of the supporting structures of the teeth
- bleeding on probing in active disease
- probing depths ≤4mm
- radiographic bone loss
- susceptible patients most at risk for tooth loss
- can be modified by systemic disease
What 3 booklets do i need to read
- the good practitioner’s guide to periodontology
- guidelines for effective prevention of periodontal diseases
- SDCEP prevention and treatment of periodontal diseases in primary care
What questions do you ask in a dental history
- how often do you brush your teeth
- do you use a manual or powered toothbrush
- what toothpaste do you use
- do you clean in between your teeth with floss or interdental brushes
- do you use any mouthrinse?
- do you attend the dentist regularly
- do you have your teeth cleaned by the dentist/ hygienist?
How do you screen for periodontal disease
the basic periodontal examination (BPE)
How is the mouth divided in a BPE exam
into sextants
UR7-UR4, UR3-UL3, UL4-UL7, LR7-LR4, LR3,LL3, LL4-LL7
What do you record in a BPE
the highest score recorded in each sextant
What tool do you use for a BPE
WHO CPITN probe is walked around the gingival margin of the teeth
What does a BPE score of 0 indicate
Probing depth: black band completely visible
Observation: no probing depths >3.5mm, no calculus/overhangs, no bleeding after probing
What does a BPE score of 1 indicate
Probing depth: black band completely visible
Observation: no probing depths >3.5mm, no calculus/overhangs, but bleeding after probing
What does a BPE score of 2 indicate
Probing depth: black band completely visible
Observation: no probing depths >3.5mm, but supre- or sub-gingival calculus/overhangs present
What does a BPE score of 3 indicate
Probing depth: black band partially visible
Observation: probing depth(s) of 3.5-5.5mm present
What does a BPE score of 4 indicate
Probing depth: black band entirely within the pocket
Observation: probing depth(s) of 6mm or more present
What does a BPE score of * indicate
furcation involvement
What things do you check when asking about their personalised oral hygiene regime
- toothpaste
- toothbrush
- method
- duration
- frequency
- interdental cleaning
- mouthrinse
- denture hygiene
What acryonm is used for giving oral hygiene advice and what does it stand for?
(KNOW THIS)
TIPPS
T - talk
about the causes of dental disease and discuss any barriers to effective plaque removal
I - instruct
the patient on the best ways to perform effective plaque removal
P - practise
ask the patient to clean his/her teeth and to use the interdental cleaning aids whilst in the dental surgery
P - plan
put in place a plan which specifies how the patient will incorporate OH into daily life
S - support
provide support to the patient by following up at subsequent visits
What tooth paste should someone use
fluoride (1400ppm for adults)
What ingredients are good for desensitising toothpastes
potassium-,stannous fluoride, potassium and stannous fluoride, calcium sodium phosphosilicate, and arginine containing desensitizing toothpastes (not strontium containing desenstizing toothpastes)
powered or manual toothbrush
powered meant to be a little better
what type of powered toothbrush?
rotation oscillation meant to be better at reducing plaque than side to side
what toothbrushing technique should you use
Modified bass
how long should you brush for
twice a day for at least 2 mins
n.b. for periodontitis 2 mins is insufficient (need for additional inter-dental cleaning)
what interdental cleaning to do
yes to doing interdental cleaning
interdental brushes may be more effective than floss
limited evidence for tooth cleaning sticks and oral irrigators
what mouth rinse to use?
daily use = fluorigard (if high caries risk)
severe gingivitis = corsodyl (not daily use)
Key points to remember about changing a patients behaviour?
- learning a skill is fast but changing a habit takes weeks/months
- instruction is meaningless and easily forgotten without understanding the context in which it fits
- a few appropriately selected and delivered words are more effective than a full lecture delivered with the hope the patient will grasp the relevant details
- repeating instructions multiple times will not increase motivation (may decrease)
- offering assistance, and seeking permission to give knowledge or teach skills facilitates patient ownership of the task. Natural response to force is resistance
- motivation is not static but can vary as an individual is affected by other life related factors and stresses
