Oral hygiene instruction and BPE presentation

Question 1

what is the aetiological agent for gingivitis and periodontitis

Answer 1

plaque

Question 2

define plaque induced ginigvitis

Answer 2

an inflammatory response of the ginigival tissues resulting from bacterial plaque accumulation located at and below the gingival margin

Question 3

what are the clinical signs of plaque induced gingivitis

Answer 3

• bleeding on probing
• high plaque score
• high bleeding scores
• gingival swelling and redness

Question 4

what does the patient notice with plaque induced gingivitis

Answer 4

• blood in saliva
• bleeding with toothbrushing and interdental cleaning
• bad breath

Question 5

key points to know about plaque induced gingivitis

Answer 5

• reversible inflammation of the gingival tissues
• swelling and bleeding at the gingival margins
• risk factor for periodontitis
• probing depths ≤3mm
• no attachment loss
• no radiographic bone loss

Question 6

define periodontitis

Answer 6

an inflammatory disease initiated by bacteria which, in susceptible people, cause severe inflammation and loss of bone around the teeth

Question 7

clinical signs of periodontitis

Answer 7

• bleeding on probing
• radiographic bone loss
• gingival recession
• probing depths ≤4mm (clinical attachment loss)

Question 8

what the patient notices with periodontitis

Answer 8

• blood in saliva
• bleeding with toothbrushing and interdental cleaning
• bad breath
• black triangles
• tooth movement

Question 9

key points to know for periodontitis

Answer 9

• inflammation of the supporting structures of the teeth
• bleeding on probing in active disease
• probing depths ≤4mm
• radiographic bone loss
• susceptible patients most at risk for tooth loss
• can be modified by systemic disease

Question 10

What 3 booklets do i need to read

Answer 10

• the good practitioner’s guide to periodontology
• guidelines for effective prevention of periodontal diseases
• SDCEP prevention and treatment of periodontal diseases in primary care

Question 11

What questions do you ask in a dental history

Answer 11

• how often do you brush your teeth
• do you use a manual or powered toothbrush
• what toothpaste do you use
• do you clean in between your teeth with floss or interdental brushes
• do you use any mouthrinse?
• do you attend the dentist regularly
• do you have your teeth cleaned by the dentist/ hygienist?

Question 12

How do you screen for periodontal disease

Answer 12

the basic periodontal examination (BPE)

Question 13

How is the mouth divided in a BPE exam

Answer 13

into sextants

UR7-UR4, UR3-UL3, UL4-UL7, LR7-LR4, LR3,LL3, LL4-LL7

Question 14

What do you record in a BPE

Answer 14

the highest score recorded in each sextant

Question 15

What tool do you use for a BPE

Answer 15

WHO CPITN probe is walked around the gingival margin of the teeth

Question 16

What does a BPE score of 0 indicate

Answer 16

Probing depth: black band completely visible

Observation: no probing depths >3.5mm, no calculus/overhangs, no bleeding after probing

Question 17

What does a BPE score of 1 indicate

Answer 17

Probing depth: black band completely visible

Observation: no probing depths >3.5mm, no calculus/overhangs, but bleeding after probing

Question 18

What does a BPE score of 2 indicate

Answer 18

Probing depth: black band completely visible

Observation: no probing depths >3.5mm, but supre- or sub-gingival calculus/overhangs present

Question 19

What does a BPE score of 3 indicate

Answer 19

Probing depth: black band partially visible

Observation: probing depth(s) of 3.5-5.5mm present

Question 20

What does a BPE score of 4 indicate

Answer 20

Probing depth: black band entirely within the pocket

Observation: probing depth(s) of 6mm or more present

Question 21

What does a BPE score of * indicate

Answer 21

furcation involvement

Question 22

What things do you check when asking about their personalised oral hygiene regime

Answer 22

• toothpaste
• toothbrush
• method
• duration
• frequency
• interdental cleaning
• mouthrinse
• denture hygiene

Question 23

What acryonm is used for giving oral hygiene advice and what does it stand for?
(KNOW THIS)

Answer 23

TIPPS

T - talk
about the causes of dental disease and discuss any barriers to effective plaque removal

I - instruct
the patient on the best ways to perform effective plaque removal

P - practise
ask the patient to clean his/her teeth and to use the interdental cleaning aids whilst in the dental surgery

P - plan
put in place a plan which specifies how the patient will incorporate OH into daily life

S - support
provide support to the patient by following up at subsequent visits

Question 24

What tooth paste should someone use

Answer 24

fluoride (1400ppm for adults)

Question 25

What ingredients are good for desensitising toothpastes

Answer 25

potassium-,stannous fluoride, potassium and stannous fluoride, calcium sodium phosphosilicate, and arginine containing desensitizing toothpastes (not strontium containing desenstizing toothpastes)

Question 26

powered or manual toothbrush

Answer 26

powered meant to be a little better

Question 27

what type of powered toothbrush?

Answer 27

rotation oscillation meant to be better at reducing plaque than side to side

Question 28

what toothbrushing technique should you use

Answer 28

Modified bass

Question 29

how long should you brush for

Answer 29

twice a day for at least 2 mins n.b. for periodontitis 2 mins is insufficient (need for additional inter-dental cleaning)

Question 30

what interdental cleaning to do

Answer 30

yes to doing interdental cleaning interdental brushes may be more effective than floss limited evidence for tooth cleaning sticks and oral irrigators

Question 31

what mouth rinse to use?

Answer 31

daily use = fluorigard (if high caries risk) severe gingivitis = corsodyl (not daily use)

Question 32

Key points to remember about changing a patients behaviour?

Answer 32

- learning a skill is fast but changing a habit takes weeks/months - instruction is meaningless and easily forgotten without understanding the context in which it fits - a few appropriately selected and delivered words are more effective than a full lecture delivered with the hope the patient will grasp the relevant details - repeating instructions multiple times will not increase motivation (may decrease) - offering assistance, and seeking permission to give knowledge or teach skills facilitates patient ownership of the task. Natural response to force is resistance - motivation is not static but can vary as an individual is affected by other life related factors and stresses