Toothbrushing and Chemical Adjuncts

Question 1

Is electric or manual toothbrushing better?

Answer 1

According to a cochrane review electric toothbrushes show greater benefits in reduction of plaque and gingivitis in the short and long term, however, there are currently not enough statistics available to draw a clinical conclusion to recommend an electric over manual.
- as long as the technique is correct, effective plaque removal can be achieved with both brushes

Question 2

Describe the bass technique for toothbrushing:

Answer 2

• toothbrush bristles angled at 45 degrees to the tooth and gingiva so the bristles reach under the gingival sulcus
• apply gentle pressure in a small, circular motion
• prevents overzealous brushing

Question 3

Describe the stillman brushing technique:

Answer 3

• bristles are held at 45 degrees to the gingivae, half the bristles should cover the gingivae, half cover the tooth
• make short, light horizontal movements to remove plaque from the gingival sulcus

Question 4

What is the rolling technique?

Answer 4

• use a rolling technique with your toothbrush away from the gingivae
• angle bristles towards the gingiva then sweep them from gingival margin to occlusal surface
• effective in abrasive brushers

Question 5

What is the mini-scrub technique?

Answer 5

• back and forth movements

Question 6

What is the broad term given to chemical adjuncts and which forms are they available in?

Answer 6

Antimicrobials: antiseptics or antibiotics, local delivery or systemic

Antiseptics are local delivery only

Question 7

What antiseptic can be used as a chemical adjunct?

Answer 7

Chlorhexidine gluconate:
- pocket can be irrigated with liquid in a blunt ended syringe or gel can be used but not retained in pocket for long when used this way
- slow release device such as perio-chip

Question 8

What is the periochip and how is it used?

Answer 8

• contains 2.5mg chlorhexidine, gelatine and water
• takes around 7 days to biodegrade
• placed into periodontal pocket following RSD and arrest of haemorrhage
• chip swells on contact with moisture and this retains it in the pocket
• eliminates pathogenic bacteria
• levels remain decreased for up to 100 days

Question 9

What are some benefits to local delivery of antibiotics?

Answer 9

• local administration produces much higher concentrations in pocket
• much lower total dose of antibiotic
• very low systemic overspill, decreasing risk of hypersensitivity and resistance

Question 10

Which slow release gels are available in local antibiotic delivery?

Answer 10

Dentomycin gel - 2% tetracycline, applied 2-3 times with 2 weeks between each administration
Elyzol gel - 25% metronidazole, probably kills A.a, injected into pocket and becomes semi-solid

Question 11

Which slow release fibres are available as a chemical adjunct?

Answer 11

Actisite: 25% tetracycline, active for 10 days, packed into pocket with flat plastic, left for 10 days then removed with scaler

Question 12

What is periostat?

Answer 12

• sub-antimicrobial dose of doxycycline
• taken for a long period of time
• at least 3 months, but can be 6/9/12 months