Plaque control/motivation

Question 1

Is peri-implant disease caused by plaque?

Answer 1

Yes
Lindquist 1996 - link between poor oral hygiene and marginal bone loss in implants

Question 2

How is recovery from inflammation different in implants vs. tooth?

Answer 2

Implants take longer
Salvi et al. 2012 - Implants had a faster and more intense inflammatory reaction and slower recovery
Chan 2019 Deep mucosal tunnel

Question 3

What are some predictors of peri-implant disease?

Answer 3

According to Schwarz 2018 - 2017 world workshop on Peri-Implant disease - Poor oral hygiene at the final exam was the strongest predictor of peri-implantitis

Question 4

How does KG effect implants?

Answer 4

less than 2mm = discomfort brushing, more plaque accumulation, and BOP (Souza 2016)

Little evidence that it is a risk factor for peri-implantitis (Schwarz 2018)

Question 5

How does KG effect Teeth?

Answer 5

Lang and Loe - <2mm = attachment loss
Wennstrom and Lindhe 1983 - w/ good OH - its ok
Cortellini & Bissada 2018 - w/ good OH - its ok

Question 6

What are the different penetration depths of Oral hygiene instruments?

Answer 6

Toothbrush - 1mm (Waerhaug 1981)
Oral rinse - 2mm (Wunderlich et al. 1984)
Interdental B - 2-2.5mm (Waerhaug 1976)
Floss - 2-3.5mm (Waerhaug 1981b)
SubG Irrigation - 50% pocket (Eakle 1986)

Question 7

How do you prevent periodontal disease?1

Answer 7

Tonetti et al. 2015
Consensus on prevention
Management of perio and caries depends heavily on plaque control and interdental cleaning

Question 8

How often do you need ot brush to avoid gingivitis?

Answer 8

48hrs (Lang et al. 1973)
Gingivitis signs appear after 4days with no OH

Question 9

How is a clensible prosthesis related to Pi development?

Answer 9

Serino & Strom 2009
No access for OH had a positive predictive value of 65%

Question 10

How long do you have to brush?

Answer 10

Duration of 2min is sufficient for effective plaque
removal. Excess duration does not lead to clinically
significant improvement.
Gallagher et al. 2009

Question 11

How do bristles impact plaque removal?

Answer 11

Unless contraindicated by thin biotype, medium-stiff bristles should be recommended over soft.
Taper ended filaments increase interproximal plaque removal.
Versteeg et al. 2009

Question 12

Are electric brushes better than manual?

Answer 12

Electric toothbrushes are more effective than manual toothbrushes.
The gain in efficacy is greatest at interproximal plaque removal and at 30s/quadrant.
Van der Weijden et al. 1993

Question 13

How deep does a toothbrush reach beneath the gumline?

Answer 13

0.5-1mm Waerhaug

Question 14

How deep do interdental brushes reach below the gumline?

Answer 14

2-2.5mm Waerhaug

Question 15

Which is better, flossing or IDB?

Answer 15

IDB for periodontitis patients (Slot 2008)

Question 16

How deep can floss reach below the gumline?

Answer 16

2-3.5mm Waerhaug

Question 17

Long term effects of CHX

Answer 17

THIS M
• Hypersensitivity reaction (Beaudouin et al. 2004)
• Taste alterations (Marinone & Savoldi, 2000)
• Mucosal erosion (Almqvist & Luthman, 1988)
• Increase in calculus formation (Yates et al. 1993)
• Staining of teeth, mucosa, dorsum of tongue, or even restorations
(Fløtra et al. 1971)

Question 18

Essential oils vs CHX

Answer 18

• Meta-analysis showed they result in less staining and calculus formation
than CHX but confirmed CHX is better at plaque control (Van Leeuwen et
al. 2011)