Plaque control advice for patients

Question 1

What are the requirements for sustained plaque control

Answer 1

• Right attitude
• Patient education
• Motivation
• Manual dexterity

Question 2

What is motivational interviewing

Answer 2

• Encourages development of constructive clinician and patient relationships - leads to better outcomes
• Strengthening intrinsic motivation

Question 3

What can the different forms of plaque control be grouped into

Answer 3

Mechanical:
- Manual tooth brushes including interdental cleaning
- Powered toothbrushes
Chemical/pharmacological agents:
- Enzymes
- Metal ions
- Oxygenating agents

Question 4

What behaviours are linked with better periodontal health

Answer 4

• Brushing
• Flossing
• Periodic dental visits

Question 5

What are the arguments for manual toothbrushes

Answer 5

• Toothbrushes with multilevel profiles were consistently more effective than flat brushes
• However theres an argument that multilevel profiles don’t clean flat surfaces as efficiently

Question 6

What are the requirements of a satisfactory toothbrush

Answer 6

• 2.5cm head for adults; 1.5cm head for children
• Bristle texture should be capable of entering into gingival crevice
• Bristles are 10-11mm long in an adult toothbrush
• 90% of bristles should be round ended
• Diameter of filament varies:
• Soft brush: 0.15-0.18mm
• Medium brush: 0.18-0.23mm
• Hard brush: 0.23-0.28mm

Question 7

What are the objectives of toothbrushing

Answer 7

1. Remove plaque biofilm and disturb reformation
2. Clean teeth of food, debris and stain
3. Maintain the health of the gingival/periodontal tissue
4. Apply dentifrice with specific active ingredients to address dental caries, periodontal disease, or sensitivity

Question 8

What is the toothbrushing instruction

Answer 8

• Disclose the plaque
• Record the plaque free score
• Show the patient the disclosed plaque in a mirror
• Let the patient brush their teeth with their own toothbrush
• Modify the technique as necessary
• Let the patient try the new technique

Question 9

Describe the modified bass technique

Answer 9

Significantly superior to other tooth brushing practices in supragingival plaque removal

Question 10

Describe arginine

Answer 10

• Amino acid - building block of proteins + plays a critical role in our bodies
• Naturally present in our mouths

Question 11

Describe triclosan

Answer 11

• Broad-spectrum antibacterial agent
• Effective against a wide variety of bacteria
• Widely used as an antibacterial agent in OTC products
• Oral retention can be improved by copolymer of methoxy ethylene and maleic acid (Gantrex)

Question 12

Describe stannous salts

Answer 12

Reported activity against caries, plaque and gingivitis

Question 13

Describe anti-calculus dentifrices

Answer 13

• Interrupt the process of mineralisation of plaque to calculus due to the super saturation of saliva w/ calcium & phosphate ions
• Crystal growth inhibitors may be added to dentifrices to provide a reduction in calculus formation

Question 14

What do active ingredients do OTC dentifrices contain

Answer 14

• Potassium nitrate
• Potassium citrate
• Arginine
• Sodium citrate
• Stannous fluoride

Question 15

What is the interdental cleaning method for:
Type 1 - Intact interdental papillae

Answer 15

Dental floss

Question 16

What is the interdental cleaning method for:
Type 2 - slightly open interdental space

Answer 16

Dental floss/small ID brush

Question 17

What is the interdental cleaning method for:
Type 3 - Complete loss of papillae

Answer 17

Tepes/ID brushes

Question 18

What is the interdental cleaning method for:
Type 4 - Wide embrasure space

Answer 18

Single tufted

Question 19

Describe tongue cleaning

Answer 19

• Many bacteria can be found on the tongue
• Individuals with coated tongues showed significantly higher malodor scores than individuals with non-coated tongues

Question 20

Describe chlorhexidine

Answer 20

• One of the most effective antiplaque agents to date
• Slowly released in active form over 12-24 hours
• Can cause staining of teeth, altered taste sensation, evidence of increased deposition of supragingival calculus

Question 21

Describe the prescription of chlorhexidine

Answer 21

• 0.2% 10 ml volume per rinse delivers about 20mg of chlorhexidine
• Longer periods use not encouraged
• Short periods for up to 2 weeks
• Maybe as an adjunct for initial periodontal treatment but only for 2 to 3 days after which the normal brushing and flossing must be reduced

Question 22

Give some aids in smoking cessation

Answer 22

• Will-power
• Advice and counselling
• Hypnosis
• Acupuncture
• Behavioural therapy