initial therapy, part 1

lecture given 9/2/2026

how does a pt decide what toothbrush/toothpaste/floss to get?

dentist recommendation

price

packaging

brand

ingredients

social media

flavor

whitening

fluoride

motivational interviewing

appropriate positioning of the pt and provider (sit at eye level so its a conversation, not lecture)

ask open ended questions

affirm pt, acknowledge the pts strengths

reflect what the pt is communicating (showing you understand vs judgement)

summarize

3 steps of motivational interviewing

1- elicit the pts readiness and interest in hearing the information

2- provide the information in a neutral manner

3- elicit the pt’s reaction to the information

modified bass technique

-hold the head of the toothbrush horizontally against your teeth with the bristles part way on the gums

-tilt the brush head to about 45° angle so the bristles are pointing under the gum line

-move the toothbrush in very short, horizontal strokes so the tips of the bristles stay in one place, but the head of the brush waggles back-and-forth. Or use tiny circular motions. This allows the bristles to slide gently under the gum. Do this for about 20 strokes. This assures that adequate time will be spent cleaning away as much plaque as possible. Note: this is a very gentle motion. In healthy gums, this should cause no pain. Brushing too vigorously or with large strokes can damage gum tissue.

-roll or flick the brush so that the bristles move out from under the gum where the biting edge of the tooth. This helps move the plaque out from under the gum line.

-repeat for every tooth, so that all tooth surfaces and gum lines are cleaned

-for the insides of your front teeth, where the horizontal brush position is cumbersome, hold the brush vertically instead. Again, use gentle back-and-forth, brushing action and finish with a roll or flick of the brush towards the biting edge.

-to clean the biting or chewing surfaces of the teeth, hold the brush, so the bristles are straight down on the flat surface of the molars

-gently move the brush back-and-forth or in tiny circles to clean the entire surface. Move to a new tooth or area until all teeth are cleaned.

-rinse with water to clear the mouth of food, residue, and removed plaque

-you can clear even more bacteria out of your mouth by brushing your tongue. With your toothbrush, brush firmly but gently from back to front. Do not go so far back in your mouth that you gag, rinse again.

is a manual or electric toothbrush more effective?

equally effective

is a manual or electric toothbrush more efficient?

electric

floss tips for pts

correct placement into sulcus

wrapping the proximal area

correct, controlled motion

what are the types of floss?

waxed, unwaxed, tape, narrow, fluoride, woven, gore-tex

dental floss and tape are ___% effective in plaque removal, but only ___% of adults floss regularly

80, 18

what should be used to floss wider embrasures?

super floss, ultra floss, butlerweave

what are uses for interdental or proxa brushes?

large embrasure space

distal of last molar

around pontics

orthodontic appliances

implant abutments

is an interdental brush more effective than floss?

in the spaces it is designed to be used, yes

what are interdental (rubber) tips indicated for?

exposed furcations

concavities

massaging gingival tissue

interdental stimulators

only used from buccal surface

triangular shape

made of balsa wood

moisten before using

what is an acceptable level of plaque for a pt?

<10-12%

what is the rationale for SRP?

clinical benefits are derived from the removal of subgingival plaque and calculus and the disruption of the subgingival microbial flora, thereby delaying a repopulation of pathogenic microbes

what are measurable endpoints for SRP?

loss or gain in clinical attachment levels

probing depths

gingival inflammation

bleeding on probing

changes in subgingival microflora

what is the difference between clinical attachment levels and histologic attachment loss?

the friends we made along the way <3

jk but really, I don’t think we got a completely straight answer on this, besides clinical is what you can measure clinically, whereas histologic is what can be seen under the microscope and includes cells, ect

does the tip of the probe always end up at the base of the histologic sulcus?

no! can enter the CT if there is severe inflammation, or may stop sooner (if caught by calculus)

is there a relationship between clinical attachment levels and attached gingiva?

no real, quantifiable relationship

real pocket

probing beyond the CEJ

pseudopocket

probe doesn’t go beyond the CEJ, gingival margin is coronal

attached gingiva

keratinized tissue minus the probing depth

keratinized tissue / masticatory mucosa

free gingival margin to the mucogingival junction

clinical attachment levels

CEJ to the depth of the clinical pocket

aka recession + pocket depth

is SRP good for shallow pockets and why?

no! tends to lose attachment related to mechanical trauma from instrumentation or aggressive oral hygiene procedures

is SRP good for deeper pockets?

yes! tends to show a gain in clinical attachment (decrease probing depths)

are clinical attachment gains from SRP reliable indicators?

not always, other explanations for the CAG can be decreases in inflammation which results in decreased probing depths, recession, or probing force

are probing depths reliable?

eh? force used to probe can vary between operators and by same operator on different days