Please activate JavaScript!
Please install Adobe Flash Player, click here for download

CD0412

I special _ practical periodontics Fig. 16_Tooth #46 with 10 mm pocketing mesially. Fig. 17_Tooth #45 with 9 mm pocketing mesially. Fig. 18_Largest interdental brush for tooth #46 demonstrated to patient. Fig. 19_Largest interdental brush for tooth #45. Fig. 20_Tooth #46 with 6 mm pocketing mesially after simple oral hygiene instruction given (large interdental brushes). Fig. 21_Tooth #45 with 7 mm pocketing mesially after simple oral hygiene instruction given (large interdental brushes). Fig. 22_Teeth #43 to 46 show increased recession and a reduction in probing depth to 3 mm after non-surgical therapy. Fig. 23_Gingival health after initial therapy with a reduction in probing depth. of evidence that regular plaque removal around periodontally involved teeth at a level that prevents bleeding on probing leads to a reduction in disease progression. It is essential that the patient be taught simple,yeteffectivewaystoimprovehisorherplaque control at home with daily use of a rotating-oscil- lating electric toothbrush and interdental brushes (Fig.12).AsystematicreviewbytheCochraneLibrary has shown that a rotating-oscillating electric tooth- brush is far more effective at removing plaque.1 A study has shown that using the correct size interdental brushes can improve the periodontal condition significantly.2 A recent systematic review has also shown that flossing by patients has no effect on the plaque index or gingival index and that flossing is not effective in periodontally com- promised patients. Interdental brushes have been shown to remove more plaque than flossing.3 Itisimportanttomotivateyourpatientstousethe largest interdental brushes (Figs. 12 & 13), but this can be a little difficult because they may not be able to see the short-term benefits, as their gums may bleedmoreandtheinterproximalspaceswillbecome larger. It is essential to reinforce the same message. This will reassure the patient and after a short time they will see visible benefits, that is, less bleeding on cleaning and a healthier-looking gingiva. _Case report A 32-year-old male patient was referred to me complaining of loose teeth and bleeding gums for over 12 months. He was fit, apparently healthy and anon-smoker.Adiagnosisofgeneralisedaggressive periodontitis was made from the clinical examina- tion(Figs.14–17).Attheconsultationappointment, oral hygiene instruction was given and the largest interdentalbrushesdemonstrated.Atthefollowing appointment, the full-mouth non-surgical phase was carried out with systemic antibiotics.4 From Figures 18 to 21, it can be noted that using the correct size interdental brushes can lead to a re- duction in inflammation and therefore a reduction in pocket depth. Eight weeks after the non-surgical phase, the patient was reviewed for a periodontal reassess- ment. It was noted that the periodontal tissue had respondedextremelywelltotheinitialtherapywith pocket depth of 3 to 4 mm throughout the mouth (Figs. 22 & 23). At this point, the patient would be placed on a three-monthly maintenance regime, with reinforcement of oral hygiene instruction and subgingival plaque removal for any deep sites. This would be carried out by his general dentist or hy- gienist.Myplanwouldbetoreviewthepatientinsix months’ time to review his periodontal condition. It is important to know that periodontal therapy works and a healthy periodontium is the backbone of good restorative dentistry. Treating periodontal disease can be challenging but can also be very re- warding. Careful assessment, treatment, referral to a specialist if necessary and monitoring of your pa- tientsareessentialforavoidinganyfutureproblems. For further information regarding the BPE and referral guidance, contact the British Society of Perio- dontologyorrefertoitswebsite:www.bsperio.org.uk._ Editorial note: A complete list of references is available fromthepublisher. 16 I cosmeticdentistry 4_2012 Dr Amit Patel Specialist in Periodontics & Implant Dentist,Associate Specialist Birmingham Dental Hospital,Honorary Clinical Lecturer University of Birmingham School of Dentistry cosmeticdentistry _about the author Fig. 20 Fig. 21 Fig. 22 Fig. 23 Fig. 16 Fig. 17 Fig. 18 Fig. 19