Peridontics : 2/cpatient’S Role In Periodontal Therapy/ First Semester

Front 1

define " plaque control "

Back 1

the REGULAR removal of dental plaque and the prevention of its acculmation on the teeth and adjacent gingival surfaces

Front 2

List the biologcial rationale for plaque control

Back 2

In the absence of bacteria in gnotobiote (germ-free animal)
gingivitis and periodontitis do not develop

Accumulation of plaque on teeth induces an inflammatory
response in adjacent gingival tissues while plaque removal
results in resolution of gingival inflammation

All successful periodontal therapy involves the substantial
reduction of the sub-gingival microbiota

Optimal oral hygiene, preventing re-growth of bacterial
deposits, is critical in the long-term success of periodontal
therapy

Front 3

Talk about the bizzare Loe expirment he did on school children

Back 3

In a series of classic experiments conducted in the 1960s,
oral hygiene was suspended in a group of dental students.

• All of the subjects rapidly formed supra-gingival plaque
• Gingivitis developed within 2 to 3 weeks
• When oral hygiene was resumed, the condition was reversed and
health was reestablished

Front 4

Talk about Alexson and Lindhe expirment

Back 4

By regularly repeated OHI & prophylaxis, stimulate
adults to adopt proper oral hygiene habits

Persons who utilized proper
oral hygiene techniques had :

Negligible signs of gingivitis
No loss of periodontal tissue attachment
No new carious lesions

Control patients, who received
merely traditional dental care
(symptomatic treatment) suffered
from :

Gingivitis
Lost periodontal tissue support
New as well as recurrent carious lesions

Front 5

THIS IS IMPORTANT

Back 5

Results indicate that dental treatment (ALONE) is a highly
ineffective means of curing caries and periodontal disease

Front 6

Talk about patient education and motavtaiton

Back 6

 Explain what Gingivitis/Periodontitis is
 Reasons why people get them
 Why patient involvement in treatment is vital
 Daily OH is necessary for reducing/eliminating the ability of
microbial plaque to initiate or maintain gingival inflammation
 Most people brush fairly regularly but need to be shown a
thorough systematic method

Front 7

talk about patient education and motavation technique

Back 7

 Proper clinical setting. (Face to face)
 Talk at the patient’s level.
 Explain to your patient his/her condition.
 Show your patient their periodontal condition clinically and
radiographically.
 Explain treatment plan.
 Explain to the patient their role in treatment
 Help the patient to recognise the benefits of prevention (prevention of
tooth loss, financial benefit, aesthetics, others)

Front 8

define " OHI "

Back 8

the goal of OHI is the physical and chemical disruption of the biofilm on a frequent basis

Front 9

General questions to prepare you for what we're going to talk about : list all the home care techniques

Back 9

1)Tooth brushing :
manual MTP
electric PTB powerd toothbrush
dentifrices

2) Interdetnal cleaning devces :
floss
interdental brushes IDB
woodsticks

3) Oral irrgartion :
supragingival irrgation
supgingival irrgation

4)checmial plaque control

5) tounge cleaning

Front 10

List the aim of tooth brushing

Back 10

1) Primary :
Carry Dentifrice to tooth surface
Remove the dental plaque,Disturb reformation
Clean teeth of food debris and stain
Massage the gingival tissue

2) Secondary :
it allows for the delivery of
therapeutic agents , like :
Fluoride
Desentising agents
antimicrobal agents
( and these agents may contribute to carries prevention )

Front 11

What are the requirments of a standared tooth-bursh

Back 11

SIZE
SHAPE.
MATERIAL .
TEXTURE (Stiffness)

Front 12

Talk about the "ideal toothbrush "

Back 12

Handle size appropriate to user age and dexterity

Head size approprtie to the user

use of endrounded nylon or polyester filmaents ( NOT LARGER THAN 0.23 in diameter )

soft filament
configurations as
defined by the
acceptable
international industry
standards (ISO)

Filament patterns which
enhance plaque removal
in the proximal spaces
and along the gum line

Front 13

Talk about toothbrush bristle

Back 13

Natural -------- Synthetic :

#soruce : Hair of hog or wild bear ---- Mainly NYLON but also of
synthetic plastic material

#Uniformity : No uniformity in texture ---- unfiormity controlled of size and elasticty

#diameter : vaires depending on the life and age of the animal ------ Range from extra soft at
0.075mm (0.003inch) to hard
at 0.3mm(0.012inch)

#end shape Deficient, irregular,
frequently open-ended --------- End rounded to ensure fewer
trauma

Advantage and disadvantages

1) Cannot be standardized
2) Wear rapidly & irregularly
3) Hollow ends allow microorganisms
& debris to
collect inside.
--------------
1) Rinse, clean, dries rapidly.
2) Durable & maintain longer.
3) End rounded & closed, repel
debris & water.
4) More resistant to accumulate
micro-organisms

Front 14

What are the other additonal ideal tootbursh carchatistcs ?

Back 14

inexpesive , durable , impervoius to moisture and easily cleaned

Front 15

talk about the care of toothburshes

Back 15

clean after use , store in open air apart from contact with other brushed , replace when worn and disinfect or replace after illness

Front 16

General question : list the burshing techniques avalible

Back 16

1) horizntal (scrub )
2) vertical ( Leonard )
3)Circular (Fones )
4)Sulcualr (Bass )
5)Vibratory ( Stillman and charters )
6) Roll ( roll method or moeifed stillman technique )

Front 17

Talk about cicular ( fones ) burshing technique

Back 17

Easy to learn and can be mastered by small children

Front 18

talk about the bass brushing technique

Back 18

The bristles are angled into the sulcus at a 45-
degree angle

Exert gentle vibratory pressure, using short, back&
forth motions without dislodging the tips of the
bristles

This motion forces the
bristle ends into the gingival
sulcus area as well as partly
into the interproximal
embrasures

•On lingual surfaces of the
anterior teeth, turn vertically

•Brush the occlusal surfaces
by pressing the bristles firmly
into the pits & fissures and
brushing with several short,
back-and forth strokes.

Most often recommended because it
emphasizes sulcular placement of bristles << important

Front 19

talk about The charters brushing technique

Back 19

The bristles are held
perpendicular to the long
axis of the teeth and are
forced into the interproximal
spaces
The bristles of the brush
deflect toward the
occlusal surface
The brush is moved with
short circular or backand-
forth strokes

Front 20

talk about the modified stillman or "roll " technique

Back 20

 The bristles are angled
into the sulcus at a 45-
degree angle and
overlap onto the facial
gingiva.
 The head of the brush
is then "rolled" so that
the bristles move
occlusally

Front 21

What are the indictions of electrical brushes ?

Back 21

Children and
adolescents

Patients with
physical or
mental
disabilities

Hospitalized
patients
including older
adults who need
to have their
teeth cleaned by
care givers

Patients with
fixed orthodontic
appliances

Front 22

Name the diffrent types of motion the electrical brushes have

Back 22

Rotary --> entire bursh head turn into full circle

counter rotaitonal --> diffrent tuffs in the head rotate in diffrent directions

Sonic --> side to side motion

oscallating / rotating : entire brush head oscalliates from center point . DOE NOT ROTATE IN FULL CIRLCE

Front 23

what's more effeicent the manual toothbrushes or the electrical toothburshes ?

Back 23

"powered toothbrushing is at least
as effective as manual brushing and
there is no evidence that it will
cause any more injuries to the gums
than manual brushing"

Front 24

List the compound and concetration of toothpastes

Back 24

Abrasve --> 20-50%

water ---> 20-40%

Humectants --> 20-35%

Detergant --> 1-3%

Thikcning agent --> 1-2 %

flavoring agent --> 0-2%

sweeting agent --> 0-2%

therpatiuc agent --> 0-2%

coloring or presservative --> 0.05-0.5%

Front 25

Explain what each compound in the toothpaste do

Back 25

abrasive --> cleaning / stain removal

water --> solvent for ingereditnets

humecantats ---> prodivde creamy texture

detergant --> surfacnat/form builder

thicking agent --> controls viscoisty

flavroing agent --> imporves tasts

sweeting agent --> enhances flavor

therpautaic agent --> active ingeredient(s)

color preservative --> color or preservative

binder --> holds ingeredient togeather

Front 26

talk about tooth burshing

Back 26

Recommendation to brush twice daily and
use interdental cleaning aids at least once
daily
 It is likely that the thoroughness and
duration of the oral hygiene session, rather
than the frequency, are the critical factors
 2 minutes an optimum in plaqueremoving
efficacy was reached with both a
manual and electric toothbrushes (Van der
Weijden et al. 1993)

Front 27

talk about the interdental cleaning aids

Back 27

 Necessary because no toothbrush cleans
interproximally

 Different types: Dental Tape, Toothpicks, Interproximal
Brushes, Single-tufted Brushes

Interproximal brushes clean the best

keep it simple for the patient

Front 28

what does the shape of the aid depends largely on ?

Back 28

The size and shape
of the interdental
embrasure and the
degree to which
soft tissue fills the
space


Presence of
furcations,
tooth
alignment

Presence of
Orthodontic
appliances or
fixed
prostheses

Ease of use and
patient
cooperation


Front 29

list all the interdental aids with their indications

Back 29

1)))Dental floos / tape ---> all interdental spaces ; can be diffcualt to use effectivey , most effective in GINGVAL SULCUS

2))) super floss ---> bridgework

3)) interdetnal brushes ---> 1)all interdental spaces 2) easy to use

4) single tufed brushes ---> 1) crowding 2) localaized recession

5) woodsticks ---> all interdental spaces , 2) simple to use

Front 30

talk about the dental floss

Back 30

 Cleans interdentally
 Extends subgingivally
 Can extend all the way to the junctional
epithelium

Clinical research has demonstrated no
significant differences in the ability of the
various types of floss to remove dental
plaque; they all work equally well

 15 to 18 inches
 Floss is slipped
between contact
area and wrapped
around tooth
surface- up and
down strokes

Front 31

When do we use floss holders ?

Back 31

To assist patients who have difficulty flossing

Front 32

talk about powerd flossing device

Back 32

•have a single bristle that
moves in a circular motion
•safe and effective, but no
better at plaque removal than
finger flossing
•can be easier for
some patients to use than
handheld floss

Front 33

talk about the superfloss

Back 33

Designed to use under bridges and orthodontic wires

Front 34

talk about the interdetnal burshes

Back 34

In open embrasures with
low papillary height where
the brush can fit easily in
the available space
without causing trauma to
the papilla

Provide access into developmental grooves
 Good for patients with attachment loss and complex
root anatomy

Front 35

talk about single tufed brush

Back 35

 The tuft may be 3–6 mm in
diameter and can be flat or
tapered

it's designed to :

1) Improve access to distal surfaces of
posterior molars, tipped, rotated or
displaced teeth

2) To clean around and under fixed
partial dentures, pontic, orthodontic
appliances, or precission attachment

3) To clean teeth affected by gingival
recession and irregular gingival
margin or furcation involvement

Front 36

OHI

Back 36

Check patient’s technique & modified according to patient needs and
abilities
 Better when explained in pt mouth
 Gradual tapering towards Ideal.
 Avoid overwhelming patient with information at a single visit
 Continuous assessment of patient’s plaque control
 Show patient residual plaque.
 Provide positive reinforcement (praise progress)
 Continuous reinforcement throughout visits.

Front 37

The precesnce of palque can be demoenstrated either directely or indirectely

Back 37

directly :  By the dull appearance
of the dried tooth surface
which is covered with
plaque.
 By using a probe to
remove plaque from the
tooth surface.
 By staining the teeth
with disclosing solution.
This is probably the most
useful method.

Indirectily :  The presence of chronic marginal gingivitis is
indicative of inadequate plaque control even if the
plaque is not present clinically - having been removed
by the patient prior to their attendance

Front 38

The patient knows what to
do, but is unable to perform
(lacks dexterity)

Back 38

• best to find an alternative method (e.g., an EMB) that
will enhance her efforts.
• It may also be necessary to see her more frequently
for maintenance.

Front 39

The patient does not know
what to do
(lacks knowledge)

Back 39

• Reinstruction is indicated.
• If continued efforts at instruction and feedback are
ineffective, an alternative might be considered, such
as another brushing technique or an EMB.

Front 40

The patient knows what to
do, is able to do it, but simply
doesn't comply with the
regimen
(lacks motivation)

Back 40

• motivation is missing
• The key is to focus on the problem: the presence of
unacceptable amounts of plaque and the associated
biologic response to the plaque, such as bleeding on
probing.

Front 41

Smoking

Back 41

Tell your patient that the
relationship between periodontal
disease and smoking is dose
dependant.

Reinforcement on multiple visits.

Smoking cessation clinic.