1. Oral Hygiene Instruction – Case Study By: Ashly Adermann DH2

2. First Appointment – Patient is an adult male who was last seen in our clinic for NSPT treatment in 2012. Patient presented as a generalized case type III, with localized case type IV. Generalized moderate inflammation. Pocket depths were generalized 5-7 mm with localized 7+ mm. Localized recession present. Took bitewings at appointment (FMX was current). Generalized moderate horizontal bone loss, with localized severe bone loss present Patient was rated 2/2.5 Due to anxiety and tenacious calculus I saw this patient a total of three NSPT appoitments.

3. First Appointment – Intraoral Photos

4. First Appointment – Intraoral Photos Cont.

6. First Appointment – Plaque Index Patient had a total of 29 teeth (145 surfaces). 99 of the surfaces had biofilm present (68%). Patient was 46% plaque free. Patient stated he had been brushing 2x per day and that he had not been flossing. Since the patient had wisdom teeth present (hard to reach) and had active periodontal disease, OHI is really important! Chart Note – Generalized, moderate plaque was present interptoximally and at the gingival 1/3 (buccal and lingual surfaces).

7. First Appointment – Oral Hygiene Instructions Discussed why home care is so important with the patient. Explained that periodontal disease is not curable but can be controlled and maintained. Recommended that the patient continue to brush 2x per day. Discussed brushing teeth using a 45 degree angle along the gum line for 2 minutes. Explained to the patient that this allows the bristles to get into the pockets and disrupt plaque and bacteria that are present. Used show, tell, do. Patient stated he did not like to use regular floss and that it was too difficult. Suggested using floss picks or soft picks. Although with floss picks using a “C” shape is harder I showed him how to pull to each side instead of flossing straight down. Used show, tell, do. Patient stated that these would be helpful and that he would try the techniques at home.

8. Second Appointment – Patient stated he was brushing 2x per day and that he tried the soft picks but he ran out. He stated he knew he could purchase them at the store but hadn’t got a chance to and that he would go after the appointment. I asked him how brushing along the gum line had been working. He said it was going well but he was having a hard time getting his toothbrush back far enough to reach his wisdom teeth. He explained that he thought the brush head was too big. I recommended an end tuft brush for his wisdom teeth hoping that the smaller head might fit back in the areas better. I sent him home with another pack of soft picks incase he didn’t make it to the store for a few more days.

9. Final Appointment – Intraoral Photos

10. Final Appointment – Intraoral Photos Cont.

12. Final Appointment – Plaque Index Score 41 of the surfaces had biofilm present (28%). Patient was 72% plaque free. Patient stated he is still brushing 2x per day and is now using soft picks 1x per day. Chart Note – Generalized plaque present interproximally and localized plaque present on the buccal and lingual surfaces. Plaque is lighter than at patients first appointment.

13. Final Appointment – Oral Hygiene Instructions Emphasized that is was great that he is doing a lot better with brushing and that he is now using soft picks 1x per day. Showed patient where he is still missing and explained that using floss picks would help with the light interproximal plaque. Explained that you can’t pull toward each tooth with the soft picks like you can with floss. Suggested trying the floss picks again. Patients inflammation is slightly decreasing and tissue seems to be healing.

14. Observation/Reflection – Patient seemed to understand all OHI instructions and was open to most suggestions. It was helpful knowing from the beginning that he would not try and use regular floss. Instead of trying to get him to do something he wouldn’t do this allowed me to start with other alternatives. Him telling me that it was hard to fit his toothbrush back around his wisdom teeth was also helpful. I was able to suggest and end tuft brush to hopefully make it easier. I feel like my patient was very honest and interested in improving his home care. Although I know regular floss would have been extremely beneficial it is better to suggest something that your patient will actually try and use. Patient’s motivation was good throughout treatment.