OHI

Question 1

What can poor OH cause?

Answer 1

 Inflammation
 Halitosis
 Teeth coated with plaque and deposits
 Tongue coated and discoloured
 Gums bleeding (brushing, eating, spontaneously)
 Caries
 Calculus build up – plaque retaining factor
 Pocketing (attachment loss of tissues to root, leading to mobility and drifting of teeth)

Question 2

Bacterial biofilm full of microbes causes an immune-inflammatory response. Increasing links between periodontal disease and systemic diseases:

Answer 2

 Coronary artery disease
 Chronic obstructive airway disease
 Pre-term low birth-weight babies
 Diabetes
 Stroke
 Pancreatic cancer
 Rheumatoid arthritis
 Alzheimer’s disease

Question 3

What questions should you ask about their current OH regime?

Answer 3

o Do you use a manual or electric/battery brush?
o How often do you brush?
o Has anyone watched you with your brush in your mouth to check you are using it correctly?
o How often do you change your brush?
o What do you use to clean between your teeth?
o How often?
o Have you had formal instruction with someone showing you in your mouth how to use it?
o Do you use a mouthrinse? What? How often? (less important and less emphasis needed on products)
o What toothpaste do you use? (less important)

Question 4

What toothbrush should patients be using?

Answer 4

 Types of toothbrush:
* Compact head and dense filaments
* Medium stiffness filaments
 Manual or electric – as long as technique is correct and bacterial biofilm is removed from tooth and gumline

Question 5

When should you change your toothbrush?

Answer 5

• Filaments splay
• Filaments lose resiliency
• Colour indicator changes on some brushes

Question 6

What is the method of brushing?

Answer 6

 Filaments angled into gingival crevice (gum-line)
 Short scrub/circular motion
 Circular/stroking (within the gingival sulcus) motion if recession (takes ferocity out of the action)
 Electric brush still needs to apply enough pressure for filaments to enter the gingival crevice
 Start somewhere and work consistently around the mouth to ensure not missing areas.

Question 7

What areas are commonly not brushed well?

Answer 7

 Anterior sextants:
* Arch restriction
* Use brush more vertically and obliquely
* Target instructions to areas of mouth
 Distal of posterior teeth:
* Bristles must go down and behind the back of the tooth into the gum-line
 Buccal of upper posterior teeth:
* Swing mandible over to side brushing to create space for brush
 Lingual lower posterior teeth:
* Must feel bristles along and into gum-line

Question 8

What are single tufted brushes used for?

Answer 8

 For recession defects
 Furcations
 Partially erupted teeth

Question 9

How do you use a single tufted?

Answer 9

• Gently wiggle/stroke the brush in the gingival crevice or into furcation or under operculum
• Remove plaque film to reduce and eliminate inflammation

Question 10

Why and how should we clean the tongue?

Answer 10

It is a microbial reservoir
Brush and scrapers
Normal tb brushed into filaments of the tongue

Question 11

What are options for interproximal cleaning?

Answer 11

 Essential to clean between soft tissue and adjacent crown and root surface, not just between the teeth
 Floss, interdental brushes
 Correct device for correct area
 TP brush:
* Short in length
* Degree of flexibility
* Not ideal for significant periodontal disease
 Vision brushes:
* Precurved brushes
* Have a bend which allows you to clean further down into the gingival crevice and pocket areas

Question 12

What should you tell patients abt once their hygiene improves?

Answer 12

Bleeding will occur, but will stop after a few days of thorough cleaning

Question 13

Toothpaste/mouthrinse

Answer 13

 Contains fluoride (unless contraindication, care children dosages)
 Desensitising properties
 Care with toothpaste claims for smokers, whitening (abrasion/chemical damage)
 Corsodyl 0.2% - short term use (stains, astringent, suppresses healthy bacteria)
 Supermarket mouthwashes – product will not get to deep pocketing areas. Superficial action only.