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PUBLISHED IN DUBAI www.dental-tribune.me July-August 2017 | No. 4, Vol. 7 Have fun, will brush: Improving orthodontic outcomes with effective home care By Dr Dana Van Elslande, Canada Getting braces is a time of both ex- citement and dread. For kids and teens, braces can be a rite of passage. For adults, it is an opportunity to invest in an improved appearance and more attractive smile. With this excitement comes a bit of worry for patients (and parents) though – how will I (or how will my child) manage oral hygiene with all this apparatus in the way? The orthodontic provider feels the same concern. Once the braces go on, brushing becomes much more chal- lenging, and poor brushing leaves patients at risk for gingivitis, white scars and tooth decay.1 Ensuring ad- equate home care is one of the big- gest challenges in most orthodontic offi ces: unless patients adopt some of the oral hygiene practices we rec- ommend, they are not going to at- tain the incredible results that are possible Like many practices, we are seeing more adult patients every year – currently about 25 % of our patients are adults. Often, they are parents of our younger patients; through their child’s experience, parents can see how the technology has changed Brought to you by since they were kids. Braces are gen- tler, easier to manage, and often have shorter treatment time. Contempo- rary oral hygiene products also make it easier to get from ‘braces on’ to the end goal of ‘beautiful smile’. A comprehensive programme Our practice adopted Crest Oral-B Ortho Essentials because we wanted a comprehensive programme to help encourage and motivate pa- tients with their oral hygiene. Pro- gramme elements include an Of- fi ce Oral Hygiene Visual Analogue Chairside (Fig. 1), commitment letter, communication letters for patients and parents, a ‘how to care for your braces at home’ video, and a regimen of advanced home care products: an oscillating-rotating power tooth- brush; stannous fl uoride toothpaste; fl uoride mouth rinse; and an ortho- dontic specifi c dental fl oss. These four products work together to help reduce plaque buildup and protect teeth from gingivitis, white scars and cavities. One unique aspect of this pro- gramme is that the Offi ce Oral Hy- giene Visual Analogue Chairside scale interacts with our manage- ment software, allowing us to graph patients’ hygiene over time so we can show our pa- tients (or mom and dad) how well they are do- ing with self-care. Together with patients, at each appointment we score their oral hygiene on a scale from 1–5. A score of indicates very poor oral ‘5’ care, whereas indicates excel- lent care. These scores are entered into our software p r o g r a m m e , which has the ability to gener- ate a graph where we can monitor how the oral care progressing is throughout the patient’s treat- ment. It is a won- derful tool to use with children and adults alike, as it Excellent Clean Routine Healthy gums and teeth ‘1’ provides us with a visual represen- tation of how performance has ei- ther improved (meaning we need to celebrate) or declined (meaning we need to make changes before there is irreversible damage). In addition, we incentivise patients by giving tokens at each visit if they receive scores over a ‘3’. These tokens can be cashed in for merchandise or gift cards to their favorite stores or on-line sites. The technology helps us engage our orthodontic patients in a fun way, and not surprisingly, adults enjoy ‘seeing’ their results just as much as kids do. Noticeable outcomes The Ortho Essentials kit contains four key products that work together to help achieve the outcomes we want. The Oral-B PRO 5000 Smart Series Power Toothbrush with bluetooth technology with ortho brush head is a cornerstone of the kit. The Ortho brush head is specifi cally designed to clean around brackets and wires,2 which can be very challenging to manage without additional tools (Fig. 2). The toothbrush’s built-in technology enhances compliance with good brushing habits.3 Patients begin use by downloading a free app onto their mobile device (usually a phone), then sync their power brush to the app. Every time the patient brushes, the app receives brushing data, and the patient gets immedi- ate feedback on the mobile device screen. Using the built-in 2-minute timer, patients can see how long they have been brushing, and a red light ‘alert’ lets them know if they are using excessive force. On the mobile screen, the app provides informa- tion about the brushing mode, bat- tery status, and a reminder to change the toothbrush head. To keep the user experience fresh – and to keep kids checking in –the app also incorporates news, weather, and oral care tips. Additionally, the Focused Care feature can be custom- ised to show areas of the mouth that need special attention, so the patient can brush those areas again after the regular 2-minute brushing is com- plete. Crest Pro-Health toothpaste con- tains stannous fl uoride – an active ingredient well-known to protect against plaque, gingivitis, cavities, dietary acid erosion, and sensitivity.4 Regular use of this paste has been clinically shown to inhibit plaque build-up between brushings.5 The Crest Pro-Health Advanced with Ex- tra Deep Clean Rinse offers addition- al anti-cavity fl uoride protection. Oral-B Superfl oss has a stiffened end fl oss threader that helps patients (particularly kids) easily thread fl oss under the braces wires. The four components of the Ortho Essentials Kit work together to keep the teeth and gums protected and healthy. We recommend that pa- tients brush in the morning, after lunch if possible, and then thorough- ly before bed. The most important session is a very careful brushing right before bed (with, of course, no food or drinks afterwards). The combination of mechanical brush- ing and fl ossing plus chemical paste and rinse action helps to reduce plaque build-up and protect against cavities. This regimen of oral hygiene provides excellent care for patients without braces as well. Enabling compliance Compliance with a proven oral care regimen is essential to successful orthodontic outcomes. If a patient is not able or willing to maintain good oral care, the braces may have to be removed and treatment delayed un- til he or she is able to comply, so we do everything possible to set patients up for success. Technique is very im- portant; we show our patients from the very beginning how to use each component in the kit, and we review their technique whenever we see that oral hygiene is slipping. If a patient has certain areas they are struggling with, we can use the built- in technology to programme these areas into a diagram on their mobile device app. By working with a cell phone and the Bluetooth-enabled toothbrush, the app provides im- mediate feedback during home care. With these tools, the patient can con- tinue to work on trouble areas be- tween scheduled appointments and receive feedback on their progress. Supported by clinical evidence As a practitioner, I am very evidence- based, so I feel comfortable recom- mending ‘proven products’ to my patients that involve the most cut- ting edge technology available. Some patients appreciate knowing about the clinical data behind the products we recommend. For patients who are not ‘wowed’; by clinical evidence, they usually just want to know what Fig. 2: Ortho brush head products I use at home. I would not recommend the programme if I did not personally believe in it. Conclusion In the end, orthodontic treatment is not just about positioning the teeth and improving looks, it is also about better functioning and oral health. Patients are expecting a certain ‘look; when their braces are removed – beautiful, white, shiny teeth and tight pink gums – and their routine oral hygiene directly affects that out- come. We know that kids and adults are busy – so we have implemented a programme that fi ts into the busi- est of schedules. The Ortho Essentials programme has been a game-chang- er for our practice, directly leading to better outcomes for our patients. Editorial note: a list of references is available from the publisher. Dr Van Elslande As an orthodontist, Dr Van Elslande has specialised training in orthodontics. She received her Bachelor of Medical Science, Doctor of Dental Surgery degree and her Masters in Clinical Orthodontics from the University of Alberta. www.smilezone.ca Your clean routine check-up EXCELLENT Awesome! You should be seeing clean teeth and healthy gums. Keep doing what you’re doing. GOOD You’re almost acing it. You might see redness or swelling of your gums around a few teeth. Keep doing what you’re doing to get even better. AVERAGE You’re getting there. You might see some redness or swollen gums. Keep on brushing, flossing, and rinsing. NOT SO GOOD Could make your treatment take longer. You might see plaque, chalky white spots on your teeth, or swollen gums. Be sure to brush twice a day, floss at least once a day, and use your rinse. POOR Alert! You probably see plaque; chalky white spots on your teeth; or swollen, bleeding gums. Review the correct way to brush, floss, and rinse. 5 4 3 2 1 Poor Clean Routine Swollen gums, white spots on teeth For more tips, visit embraceit.com Fig. 1: Example of offi ce oral hygiene visual analog scale.