TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

1. TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

2. UCLA SCHOOL OF DENTISTRY SECTION OF PERIODONTICS

3. Presents Dr. E. Barrie KenneyProfessor & ChairmanSection of Periodontics Dr. Heddie O. Sedano Professor Emeritus & Lecturer Section of Periodontics

4. PHASE ONE THERAPY (INITIAL THERAPY)

5. Comprehensive • Emergency Therapy • Examination Diagnosis and Treatment Plan • Phase one therapy (initial therapy) • Evaluation of phase one therapy • Phase two therapy • Evaluation of phase two therapy • Maintenance therapy

6. Phase two therapy • Periodontal surgery • Dental implants • Crown and bridge • Removable partial dentures

7. NECROTIZING ULCERATIVE GINGIVITIS (NUG) EMERGENCY THERAPY

8. Two weeks NUG resolved by root planning and good oral hygiene Proceed to complete examination and diagnosis

9. Phase one therapy • Control of plaque • Control of diet • Control of systemic factors • Control of oral malodor and taste abnormalities • Control of tobacco smoking

10. Presence of plaque in red for 4 surfaces of each tooth CONTROL of PLAQUE

11. Need to stress floss or interdental brush utilization Presence of interproximal plaque is prominent

12. Plaque and bleeding scores at 4 time periods Progressive improvement to less than 20% of surfaces with plaque

13. CORRELATION OF MANUAL DEXTERITY AND KNOWLEDGE WITH ORAL HYGIENE

14. MANUAL DEXTERITY TEST

15. CORRELATION COEFFICIENTS BETWEEN RIGHT HAND DEXTERITY AND BUCCO-LINGUAL PLAQUE IN 59 ADULTS DAY 0 0.41 DAY 7 0.38 DAY 14 0.33

16. CORRELATION COEFFICIENTS BETWEEN KNOWLEDGE AND BUCCO-LINGUAL PLAQUE DAY 0 0.38 DAY 7 0.32 DAY 14 0.30

17. Patient with plaque induced gingivitis

18. Three weeks following compliance with excellent oral hygiene and plaque control

19. Brush is vibrated by bass technique of oral hygiene Soft brush positioned at 45° to gingiva

20. Best used for interproximal plaque when interdental papillae are present Dental Floss

21. Interdental brush Tuft brush

22. Best used when interdental papillae are reduced Interdental brush

23. Rubber interdental stimulator Least efficient interproximal cleaner

24. Use of gauze to clean distal surface of teeth adjacent to edentulous areas Gauze is most efficient for these teeth

25. Electric brushes used for patients with poor manual dexterity Electric brushes can motivate some patients to improve their oral hygiene

26. Clinical Evaluation of the Efficiency and Safety of aNew Sonic Toothbrush Johnson, B.D., McInnes, C., J. Periodontol 65:692, 1994

27. 51 subjects got either Sonicare orhand brush. Instructed in use orModified Bass Technique withOral B 30.

28. Plaque scores, gingivitis scoresand sulcular bleeding scores at0, 1, 2, 4 weeks. 29 subjects seen at 6 months

29. All subjects got timer and did notuse floss mouth rinses or otheroral hygiene aids for first 4 weeks.

30. Plaque Index

31. Sulcular Bleeding Index

32. Gingivitis

33. No increase in gingival recessionor other oral lesions associatedwith either brush at 6 months.

34. Comparison of an Oscillating Rotating Electric Toothbrush and a Sonic Toothbrush in Plaque Removing Ability Van Der Weijden, S.A., Timmerman, M.F., Van Der Velden, V. J Clin. Periodontol 23:407, 1996

35. 35 non dental students given aSonicare and a Braun Oral B plakcontrol brush and instructed to useeach brush every other day.

36. 2 weeks later subjects no brushingfor 24 hours then reevaluated thenmouth brushed by an examinersplit mouth using both brushes.

37. Plaque IndexAfter 2 minutes Professional Brushing

38. They repeated this 4 weeks laterwith brushing using Zendiumtoothpaste by the students.

39. Plaque IndexAfter 2 minutes Panellist Brushing

40. At end of study they could keepone brush. 34 out of 35 keptBraun brush.

41. Clinical efficacy of flossing versus use of antimicrobial rinses.Zimmer. S, et al J. Periodontol. 2006 77:1380

42. 156 patients used brush +daily rinse 0.06% chlorhexidine 0.025% fluoride or brush+ 0.1% cetylpyridiniumchloride +fluoride or brush + floss or brush alone.Evaluated at 8 weeks.

43. CHX NaF 1.58 CPC/NaF 1.54 FLOSS 2.10 BRUSH 2.00 / MODIFIED PROXIMAL PLAQUE INDEX

44. Papilla Bleeding Index CHX /NaF 0.67 CPC/NaF 0.75 FLOSS 0.77 BRUSH 0.89

45. Additional effect of dentifrices on the instant efficacy of tooth brushing.Paraskevas S .et al J. Periodontol.2006 77:1522

46. 3 toothpastes used in 40 patients each after 48 hours plaque accumulation.Split mouth hand brush with or without paste.

47. Tooth paste gave average of 3% more plaque than brush alone.More abrasive pastes no more effective.

48. CONTROL OF DIET More benefit comes from reduction of sucrose in diet so less caries and less plaque minimal effect on gingival inflammation from other dietary modifications

49. CONTROL OF SYSTEMIC FACTORSCONSULT WITH PATIENT’S M.D. Control of Hemostasis Control of Bacteremia Control of Diabetes Control of Medications

50. CONTROL OF ORAL MALODORAND TASTE ABNORMALITIES Plaque control is most predictable way to reduce oral malodor together with daily tongue scarping to reduce bacterial load of oral cavity.