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The Scientific Approach to Effective Oral Hygiene Instruction. G. Todd Smith, DDS, MSD IHS Periodontal Consultant. The Problem:. Less than half of all patients clean their teeth as you ask them to do. Most people feel their OH is good!. Question:.

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The Scientific Approach to Effective Oral Hygiene Instruction


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    1. The Scientific Approach to Effective Oral Hygiene Instruction G. Todd Smith, DDS, MSD IHS Periodontal Consultant

    2. The Problem: • Less than half of all patients clean their teeth as you ask them to do. • Most people feel their OH is good!

    3. Question: • Can patients become unexpectedly motivated to better oral hygiene? • Can we tell up front who these patients are?

    4. The Big Question: How can we help modify our patient’s behavior to improve compliance / oral hygiene?

    5. Factors determining behavior change: • Predisposing factors: relate to the motivation to act or change • Knowledge • Beliefs • Attitudes

    6. Do we have an attitude problem here?Larsen

    7. Important patient knowledge: • Is his/her oral health in jeopardy? • How severe is the gum disease? • Is the patient susceptible to advanced gum disease and tooth loss? • Does the gum disease pose a threat for systemic illness?

    8. Knowledge is a necessary but not sufficient factor in changing health behavior

    9. Factors determining behavior change: • Reinforcing factors: Determine whether improved oral hygiene is supported by: • Family • Peers • Dental Staff

    10. Factors determining behavior change: • Enabling factors: skills and resources necessary to perform oral hygiene: • Dexterity • Availability of dental resources • Accessibility of dental resources

    11. Improve Patients’ Adherence to a Daily OH Regimen: • Simplify language and recommendations • Modify OHI to accommodate patients’ specific abilities, motivations, and lifestyles • Provide written copies of recommendations • Provide positive feedback and reinforcement • Identify potential noncompliers and discuss consequences of noncompliance/nonadherence before therapy begins. • Assess attitude. From Wilson

    12. Health Belief Model For behavior change to occur, the person must: • Believe his or health is in jeopardy • Understand the potential seriousness (i.e. periodontitis, tooth loss) • Benefits of health behavior can be achieved • Benefits must outweigh the costs or obstacles (eg fear, economics, and time) • There must be a cue to take action Hochlau

    13. The cue to take action: • Bad Breath • Tooth loss and poor esthetics • Chewing and taste • Pain and abscess • Poor systemic health

    14. Show them the signs of gum disease intra-orally: • Red and swollen • Bleeding upon probing, brushing, or flossing • Loose or separating teeth • Recession • Pus

    15. Social Learning Theory: We learn new behaviors through: • Visualization • Modeling • Skill training • Self assessment

    16. Chairside Education

    17. How severe is the patient’s disease?

    18. Discuss Their Own X-rays

    19. Social Learning Theory: We learn new behaviors through: • Visualization • Modeling • Skill training • Self assessment

    20. Oral Hygiene Aids • Toothbrushes • Floss and floss holders • Interproximal brushes • Rubber Tip • Wooden wedges and toothpicks • Oral irrigators

    21. Patient Demonstrates Technique

    22. Brush at the Gum Line

    23. Plaque Assessment • Dry the teeth • Paint on or swish disclosing agent • Rinse twice • Count the surfaces with plaque and divide by the total possible surfaces.

    24. Disclosed Without Rinsing

    25. Disclosed and Rinsed Twice

    26. Plaque Map

    27. Social Learning Theory: We learn new behaviors through: • Visualization • Modeling • Skill training • Self assessment

    28. What’s the best toothbrush?

    29. Are electric toothbrushes better? • Cochran Oral Health Group 2003-comprehensive independent review. • Rotational/oscillation type brushes more effective than manual and other powered brushes. • Powered Brush better than manual brush. Nanning 2008

    30. Inexpensive electric toothbrushes

    31. Flossing with 3rd finger wrap Up & down motion, wrap around, fingers close, and floss two sides

    32. Waxed or unwaxed? • 4 of 5 prefer waxed or lightly waxed • No difference in effectiveness between an unwaxed, woven, or shred resistant floss. Powered flosser best… Terezhalmy 2008

    33. Are floss holders preferred over manual flossing? • 50% of nonflossers started regular flossing • 85% still using after 6 months. • 15% preferred manual floss Kleber 1990

    34. WaterPik Flosser Disposable Sword Flossers For those having difficulty flossing:

    35. Shred Resistant Floss

    36. Bridge Threaders for Closed Contacts

    37. Super Floss Under Bridges, Braces…

    38. What’s the best aid for interproximal cleaning?

    39. What’s the best aid for interproximal cleaning?

    40. Interproximal brushes

    41. Patient demonstrates proxabrush technique

    42. Proxabrush Trav-ler

    43. Interproximal Wooden Wedges

    44. Interproximal Disposable Soft-Picks

    45. Floss and proxabrushes aren’t effective in deep pockets

    46. Rubber tip for deep pockets

    47. Teledyne Water Pic Pic-Pocket

    48. Teledyne Water Pic Pic-Pocket