302 Orthodontics question

5 components of care plan

Debridement, fluoride, interdental aids, OHI and recall

Debridement management

Guided biofilm therapy including disclosing gel, airflow for plaque removal, and USS with piezon attachment and hand scalers for calculus removal.

Justification for debridement

• Calculus and fixed orthodontic appliances are plaque retentive features as they create more sites for adhesion

• calculus is difficult to remove with home care methods. Professional debridement is the primary method for stabilising plaque-induced gingivitis

• plaque control should aid in resolution of gingival enlargement and reduce chances of WSLs

• can delay tx as if deposit removal is not under control, orthodontist may decide to stop tx temporarily in the pts best interest

Fluoride management

application of professional fluoride varnish (duraphat) every 6 weeks. Also recommend tooth mousse plus, neutrafluor 220 or CHX mouthwash.

Fluoride justification

• NaF varnish provides continuous naf release over a long period and has been proven to reduce WSL development

• Tooth mousse plus creates a calcium and phosphate ion reservoir when reacting with hydroxyapatite, which drives remin, buffer acid and reduces the plaque acid effect on tooth surface

• Neutrafluor 220 contains 220ppm naf which promotes remin and should be used daily

• CHX reduces bacterial load by interacting with the bacterial cell wall

Interdental aids management

Recommend appropriately sized ID brushes and superfloss and demonstrate how to clean around the arch wire and between brackets. Recommend soaking ID brushes in mw or putting tp on the bristles

ID aids justification

orthodontic appliances are a plaque-retentive feature where standard toothbrush bristles are not able to effectively clean around the brackets and wires, and between the teeth.

OHI management

Recommending ETB or manual orthodontic tb. Advising brushing for 3 minutes at least twice daily using naf tp. Also using plaque disclosing gel. Diet modifications.

OHI justification

• effective plaque removal is the primary method of controlling plaque-induced gingival inflammation

• plaque disclosing gel will highlight key areas that the pt should be targeting with their home care routine. It can also tell the pt the nature of plaque (<24 hours, mature or acidic plaque)

• Avoiding sticky and retentive foods and reducing cariogenic food/drinks

Recall management

shorter recall of 3-6 months due to high risk

Recall justification

reassessment of plaque scores, bop, gingival appearance, probing depths and pt compliance aid in determining whether the interventions from the initial tx plan have been effective and further tx or adjustments are required.

Clinical report

Chief complaint, pt presented with…, recommend a GBT approach where pt will benefit from full mouth polish and debridement, OHI given, any recommendations to orthodontist