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Endemic Oral disease > PAP4 -Self performed plaque control > Flashcards

PAP4 -Self performed plaque control Flashcards

1
Q

what is essential for periodontal disease to be controlled?

A

plaque levels must be below the individual’s disease threshold

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2
Q

who needs better plaque control?

A

The higher the patient’s susceptibility, the better their plaque control needs to be (if stability is to be achieved and maintained)

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3
Q

what were the findings of adult dental health survey?

A

• 75% of dentate adults claimed to clean their teeth x2 daily
• 66% had visible plaque on >1 tooth
• Mean proportion of teeth affected increased from 30% in 25-34 year olds to 44% in those aged 65+
• Dentate adults who reported attending a dentist regularly were less likely to have visible plaque (61% versus 76% in patients who only attend with problems)
• Most people find it difficult to clean their teeth effectively.
• 78% of adults claimed to have received a demonstration of toothbrushing from the dental team
• Only 21% reported to use dental floss
• Patients must receive tailored OH instruction if
periodontal treatment is to be effective

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4
Q

what is the outcome of any periodontal treatment reliant on?

A

the patients level of home care

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5
Q

what are the 3 current recommendations in DDH periodontal clinic?

A
  • Patients receive an explanation that plaque is the initiator in the development of periodontal diseases
  • Patients should be informed about their susceptibility to periodontal diseases
  • Patients are informed that for periodontal treatment to be effective they must keep their plaque levels below their own disease threshold.
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6
Q

what were the different methods of mechanical plaque removal through the ages?

A
  • Woodsticks
  • Finger and abrasive
  • Siberian wild bore bristles attached to bone or bamboo!
  • Horsehair bristles attached to bone handles (used by Napoleon), pig and badger hair was also used
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7
Q

what do we use now for mechanical plaque removal?

A

nylon filaments

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8
Q

For the majority of patients, is mechanical or chemical plaque controlled required?

A

mechanical plaque control

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9
Q

what is only recommended in particular situations?

A

Mouthwash

however 31% of adults report to use mouthwash

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10
Q

what does mouthwash not get through?

A

Mouthwash does not get through biofilm- needs to be mechanical

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11
Q

what can be used on clinic to highlight plaque presence while delivering oral hygiene instruction to patients?

A

Disclosing tablets/ solution

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12
Q

what are the colourations of plaque using disclosing tablets?

A

Blue- where the plaque has been there for around 2 weeks

pink- for plaque that has not been there as long

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13
Q

what are the current oral hygiene recommendations at DDH? (at home)

A

• Toothbrushing x2 daily ideally using ‘Bass Technique’
• A systematic brushing technique is advised to ensure cleaning of all
areas
• Fluoride-containing toothpaste advised
• Spit out excess toothpaste but do not rinse out
• Cleaning of approximal surfaces once daily after brushing
• Do not use mouthwashes at the same time as brushing

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14
Q

what is the bass technique?

A
  • Angle of brisles is 45degrees to the gingival margin, brissels not directly on teeth or on gum
  • back and forth motion over gingival margin
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15
Q

what negative effects can mouthwash have?

A

It can’t distinguish between pathogens and commensals and so it messes up the commensal (its a cosmetic product )

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16
Q

what are the patients advised/shown about plaque removal?

A

• Advise patients that bleeding on brushing may occur initially
• Brushing will remove plaque from buccal, lingual and palatal surfaces
but is relatively ineffective inter-proximally
• When OHI is given it should always be instructed in the patient’s mouth
• Patient must be given opportunity to practice in the clinic and demonstrate OHI skills back to clinician.

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17
Q

what was the evidenced base -psychological interventions of OHI?

A

Only four studies met the inclusion criteria but demonstrated that psychological approaches to behaviour management can improve oral hygiene related behaviours

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18
Q

How do we change patients behaviour?

A
  • talk
  • Instruct
  • Practice
  • Plan
  • Support
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19
Q

Describe what you tell your patient in the “talk”.

A
  • Cause of disease
  • Brushing frequency
  • Brushing technique
  • Type of brush
  • Toothpaste use
  • Interdental cleaning
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20
Q

what do you “instruct” your patients to do?

A

Instruct Your patient by demonstrating in their mouth (not on a plastic model)

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21
Q

Describe how the patients “practices”.

A
  • Let your patient practice while you observe
  • Correct their technique as required
  • Ask patient for their feedback
  • Address concerns regarding bleeding on brushing/flossing etc
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22
Q

Describe the “plan”.

A

Best times of day for your patient to clean

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23
Q

Describe the “support”.

A

Follow up advice on next appointment

24
Q

what toothbrushing approach is to be used?

A

systemic approach (decide with patient what their approach is gonna be)

25
Q

what is the evidence summary of frequency of brushing?

A

• Effective plaque removal every 2 days to prevent/resolve experimental gingivitis
• Optimum frequency not determined
• Consensus that x2 daily brushing is consistent with
gingival health

26
Q

what are the evidence findings of brushing duration and technique?

A
  • Brushing time under-estimated
  • Most use simple horizontal brushing action
  • Most spend too little time on brushing lingual areas
  • Most fail to effectively remove plaque from approximal surfaces of molars/premolars
27
Q

what is to be emphasised durning recommendations?

A

Emphasise a systematic approach to maximise plaque removal

28
Q

what are the recommendations of a manual toothbrush?

A
  • be medium hardness
  • have a simple straight handle
  • be multi-tufted
  • have a small head size
  • should be replaced every 6-8 weeks on average
29
Q

what is the evidence summary of manual toothbrushes?

A
  • Handle size appropriate to user age/dexterity
  • Head size appropriate to user’s mouth
  • Compact arrangement of medium, end rounded nylon filaments not >0.009 inches diameter
  • Bristle patterns which enhance plaque removal in IP sites & along gum margin
30
Q

why are toothbrushes with filaments arranged at different heights and angles more effective and there fore what is recommended?

A
  • more effective at plaque removal/reducing gingivitis than flat trim brushes
  • Use small headed brush with rounded filaments, a compact angled arrangement of long & short filaments & comfortable handle
31
Q

what type of powered toothbrush resulted in reduced gingivitis scores?

A

rotation oscillation powered brushes

32
Q

what was not statistically significant in powered toothbrushes evidence?

A

They also removed more plaque compared to manual brushes but this improved plaque removal was not statistically significant.

33
Q

what are the modes of action of power brushes?

A
  • Side to side
  • Counter oscillation
  • Rotation oscillation
  • Circular
  • Ultrasonic/sonic
34
Q

What are the 2 main advances in design of powered toothbrushes?

A
  1. Small circular head which performs oscillating, rotating or counter-rotational movements. Said to improve efficiency of IP cleaning
  2. Increased frequency of brush vibration. Said to improve cleaning by 2 biophysical actions – Cavitation & Acoustic Microstreaming.
35
Q

what is the role of cavitation effect?

A

Successfully used to remove stain & calculus from root surfaces

36
Q

what range of bubble behaviour is used in the cavitation effect?

A
  1. gentle linear pulsations of gas-filled
    bodies (stable cavitation)
  2. violent and highly destructive formation and collapse of vapour-filled voids and cavities (transient cavitation)
37
Q

why do tradition powered brushes unlikely to generate destructive transient cavitation ?

A

Traditional powered brushes operate at low frequencies – unlikely to generate destructive transient cavitation

38
Q

what is the main effect of powered brushes?

A

aeration of water

39
Q

what effect may more expensive powered brushes have?

A

have a higher operating frequency and may produce some cavitation effect

40
Q

Describe acoustic microstreaming.

A

• Occurs around the bristles of a powered brush and this is accompanied by large hydrodynamic shear stresses
• These forces may dislodge plaque but are not strong enough to disrupt cells and tissues
( movement of stare between anything that is vibrating)

41
Q

What effect may acoustic microstreaming have?

A

May have a synergistic effect with anti-plaque irritant (chemical and mechanical effects working together)

42
Q

Is the effects of microstreaming in the oral cavity as dramatic as seen in model lab systems?

A

No - in the mouth a powered brush operate in as all fluid volume of toothpaste and salvia

43
Q

what are the timers on powered brushes?

A

Powered toothbrushes often incorporate two-minute timers to encourage brushing for the recommended time

44
Q

What did two studies report using powered brushes?

A

improved compliance

45
Q

what should clinicians tell patients about powered brushes?

A

clinicians should provide advice & instruction in their use

46
Q

who will benefit most from powered brushes ?

A

For some individuals unable to maintain effective plaque control and periodontal health, powered brushes with oscillating/rotating action may be more effective than manuals

47
Q

what are the recommendations for interproximal cleaning?

A
  • should not be demonstrated until smooth surfaces are maintainable by the patient
  • should always be done after brushing
  • should be done x1 daily (night is best)
  • aids are primarily chosen according to the size of the interproximal space
48
Q

what are the choices for inter proximal cleaning?

A
  • Dental floss/tape
  • TePe brushes
  • Superfloss
  • Flossette/ dental harp
  • Single tufted brushes can clean the approximal surfaces of lone standing teeth
49
Q

what do some patients use for interproximal cleaning which are ineffective and not recommended?

A

toothpicks or woodsticks

50
Q

what technique should be used for flossing?

A

wrap between middle fingers so only two fingers int he mouth wrap around tooth in C shape

51
Q

what are the different tepe for interproximal cleaning?

A

Different colours for different sizes and a patient should be given 2/3 (to fit in all parts of the mouth)

52
Q

what can be used for interproximal cleaning in tight contact with normal papillae?

A

flossette

53
Q

what is considered when choosing interproximal aid?

A
  1. The size of the space
  2. The interdental papillae
  3. Tooth anatomy
  4. Patient’sability
54
Q

what are the recommendations in perio clinic when reviewing oral hygiene?

A
  • It is essential to review the patient a short time (ideally 2/52) after OHI to check whether plaque control is effective
  • modifications of technique may be suggested after the clinician assesses current OHI practice as performed by the patient
  • Plaque charts may help monitor patient’s progress
55
Q

what is the outcome if OH consistently remains inadequate (ie. periodontal disease is not controlled – presence of bleeding on probing and pockets >3.5mm deep)?

A

-Treatment is very unlikely to be successful irrespective of the professional care given
• Palliative care is the most suitable option.

56
Q

What are the OHI key points?

A

• Teach patients according to evidence- use OH TIPPS
• Advise toothbrushing twice daily, fluoride toothpaste
• SpitDon’tRinse
• Change brush every 2-3 months, same timescale for
head on power brush
• Teach interproximal cleaning after patient has mastered toothbrushing
• Interproximal aid depends on patient ability and anatomy of area
• Interproximal cleaning once daily after brushing
• Review the patient and monitor OH
• Mouthwash is NOT recommended.

Endemic Oral disease (13 decks)

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