Download oral HYGIeNe IMProveMeNT BY dISCloSING aGeNTS

CASE PRESENTATION
ORAL HYGIENE IMPROVEMENT BY DISCLOSING AGENTS
Roxana Romaniţa Ilici1, Christina Mihai2, Lelia Mihai3, Ruxandra Sfeatcu4
1Discipline
of Denture Technology and Dental Materials, Faculty of Dentistry, University of Medicine and Pharmacy
“Carol Davila”, Bucharest, 2Discipline of Preventive Dentistry, Faculty of Dentistry, University of Medicine and Pharmacy
“Carol Davila”, Bucharest, 3Discipline of Oral Medicine, Faculty of Medicine, University of Medicine “Titu Maiorescu”,
Bucharest, 4Discipline of Oral Health and Behavioral Sciences, Faculty of Dentistry, University of Medicine and Pharmacy
“Carol Davila”, Bucharest
Address for correspondence:
Ruxandra Sfeatcu
Bucharest, 4-6 Eforie Street, 3rd Floor, Room 24
Tel.: 0722576219
E-mail: [email protected]
Received: 13.05.2014
Accepted: 25.05.2014
Med Con June 2014, Vol 9, No 2, 45-48
Abstract
Background and aim: Generally, patients are
motivated and instructed to acquire the dexterity to
perform a proper oral cleaning. The aim of this paper is
to show one way to educate patients to achieve personal
daily oral hygiene behavior using disclosing agents,
during professional cleaning in the dental office.
Case report: A 37-year-old female patient presented
to the dental office for specialist advice due to the
esthetic dysfunction caused by extrinsic dental stains.
Prosthetic treatment necessary to treat lower molars
edentulous sites has been recommended. As an aid in
choosing further therapeutic solution for the prosthetic
treatment related to the patient’s dental hygiene
maintenance, the dentist initially recommended a
professional cleaning with disclosing plaque and plaque
indices measurement, to assess analytical quality of
tooth brushing. After a week, during the reexamination,
the results showed a significant decrease in plaque
indices scores.
Discussion: There is an improvement in the oral
hygiene level, quantified by a decrease in plaque indices
scores, noticed also by the patient, who is finally happy
Oral Hygiene Improvement by Disclosing Agents
with her appearance and motivated to achieve a proper
daily oral hygiene, to optimize the oral health status and
to promote the prerequisites for setting prosthetic
treatment and preservation of long-term therapeutic
results.
Keywords: oral hygiene, motivation, disclosing
agent, plaque indices, professional care
Background and aim
A significat role in preventing dental caries and
periodontal diseases is the obtaining and maintaining a
proper oral hygiene condition [1]. In this regard, it is
important to get the awareness and motivation of the
patient in order to achieve a daily personal oral hygiene
behavior, as well as the regular professional cleaning in a
dental clinic [2]. In most cases, a motivated and instructed
patient will get the required dexterity to perform a proper
oral care [3]. As is well known, in order to assess the level
of oral hygiene (as the first step of a preventive program),
to check the accuracy of the personal tooth brushing and
dental flossing, but also to increase the oral hygiene level,
usually the disclosing agents and the dental plaque indices
assessment are used [4].
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CASE PRESENTATION
MEDICAL CONNECTIONS • NUMBER 2 (34) • JUNE 2014
Figure 1. Initial oral health status of the
patient, during the first clinical examination
Figure 4. Clinical aspect during
professional air flow
Figure 2. Clinical aspect after plaque
disclosure and water rinsing, anterior view
Figure 5. Professsional cleaning and
fluoridation
preventive and curative treatment and approval for taking
photos for publication in a scientific journal was obtained.
Treatment and evolution
Figure 3. Clinical appearance after plaque
disclosure and water rinsing, from lateral view
The aim of this paper is to demonstrate the way a
patient could be educated to achieve personal daily oral
hygiene behavior using disclosing agents, during
professional cleaning.
Case report
A 37 year old female patient with good general
health, formerly bearing mobile orthodontic brace, with
irrelevant family and dental history, presented in the
dental office for esthetic dysfunction due to extrinsic
dental staining (Figure 1). During oral examination, two
untreated lower molars edentulous sites were seen. A
written informed consent of the patient to establish
46
After presenting treatment alternatives, the patient
has shown interest in dental implants. In order to
support the choice of the right prosthetic treatment, an
initial appointment for professional dental care,
including dental plaque staining with disclosing gel was
recommended. Patient, formerly carrying mobile braces,
now refuses to establish a fixed orthodontic treatment to
treat malocclusion.
After applying the dual-tone disclosing gel, the
newly formed dental plaque appeared colored in red and
the mature microbial plaque in blue color. Subsequently,
two plaque indices to assess analytical quality of personal
tooth brushing (Figure 2 and 3): O’Leary Index and
Approximal Plaque Index (API) were measured.
O’Leary index was recorded as the presence or
absence of disclosing agent on four sites (mesial, distal,
buccal and lingual)/tooth. After applying the disclosing
agent on all tooth surfaces, the dentist examined using
the tip of a probe and recorded the entire stained surface
at the dentogingival junction. The index was calculated
by dividing the total number of available surfaces to the
number of plaque containing surfaces [1,4].
Ilici et al
CASE PRESENTATION
MEDICAL CONNECTIONS • NUMBER 2 (34) • JUNE 2014
A
B
Figure 6. A. Clinical bimaxilar aspect after tooth brushing – first professional cleaning session.
B. Clinical mandibular aspect after tooth brushing – first professional care session
Figure 7. Clinical appearance at the beginning
of the second session of professional cleaning
A
B
Figure 8. A. Clinical situation after plaque disclosing – second professional cleaning session.
B. Clinical situation after plaque disclosing – lingual view
To calculate the Approximal Plaque Index (API), a
periodontal probe was gently guided through approximal
spaces of the first and third quadrants from the oral
aspect and from the buccal aspect for the second and
fourth dental quadrant. Percentage of dental surfaces
covered with microbial plaque was recorded [1,4].
The baseline scores were 75% for O’Leary index
and 85% for API, which shows an incorrect personal
tooth brushing and a poor dental plaque control [5].
For complete removal of the disclosing gel an airpolishing unit with calcium carbonate powder for the
biofilm removal was used (Figure 4).
For cleaning and fluoridation, Hawe polishing
brush with nylon bristles and professional paste with
Oral Hygiene Improvement by Disclosing Agents
three fluoride complexes (sodium fluoride, calcium
fluoride and monofluorphosphate) were used. The
clinical view is shown in Figure 5.
Final clinical aspect is presented in Figures 6.A and 6.B.
The roll tooth brushing technique and the use of
dental floss were demonstrated to the patient.
After a week, during the reexamination (Figure 7),
the disclosing of dental plaque (Figure 8.A and 8.B) and
measurement of the plaque indeces scores were
performed. According to the ,,problem” areas, revealed
by the disclosing agent, during this second session the
patient followed a personal roll tooth brushing and
dental flossing using the technique recommended by
the dentist (Figure 9).
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CASE PRESENTATION
MEDICAL CONNECTIONS • NUMBER 2 (34) • JUNE 2014
(oral health) for daily oral cleaning (a meticulous, timeconsuming and insufficient concrete work) is far-away.
One of the methods used for motivation, education
and patient awareness regarding the effectiveness and
correctness of personal tooth brushing is the use of
disclosing agent. Furthermore, since motivation and
patient skills decrease with time, regular motivation and
retraining of the patient is required.
Figure 9. Clinical aspect at the end
of the second cleaning session
Result
There was a 15% decrease in the O’Leary index
(final score 57%) and a final score of 55% for API index,
which indicates a satisfactory improved personal tooth
brushing tehnique at present (Figure 8.A, 8.B).
Discussion
In order to achieve an optimum level of oral
hygiene, emphasis must be placed on complete removal
of dental plaque through proper personal tooth
brushing technique, completed with proximal cleaning
aids. Often, patients have little knowledge and
information on how to carry out the daily oral hygiene,
therefore it is necessary to periodically educate and
motivate them in order to achieve a correct dental
plaque control.
In this respect, the dentist must have a preventive
behavior regarding patients’ attitudes toward oral
diseases and dental treatments. He has to educate and
motivate his patient for the establishment of preventive
measures: personal daily oral care and professional
cleaning during the regular dental check-ups. Patient
motivation is difficult to maintain because the reward
48
Conclusion
An improvement of the oral hygiene level,
quantified by the decrease in plaque indices scores was
achieved using disclosing agents. The patient, who is
finally pleased with her dental appearance is now
motivated to maintain a proper daily oral hygiene for a
good oral health and to promote the prerequisites for
setting prosthetic treatment and preserving the longterm therapeutic results.
References
1.Cuculescu M. Prevenţie primară în carie şi
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2.Furusawa M, Takahashi J, Isoyama M et al.
Effectiveness of dental checkups incorporating tooth
brushing instruction. Bull Tokyo Dell Coll
2011;52(3):129-33.
3. Da Silva D, Gonçalo C, De Sousa M, Wada RS.
Aggregation of plaque disclosing agent in a dentifrice. J
Appl Oral Sci 2004;12(2):154-8.
4.Oltean D, Pătroi G, Cuculescu M. Stomatologie
preventivă. Editura Anotimp, Craiova 1996.
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improving oral hygiene in a group of 12-year-old
children after a toothbrushing training programme.
OHDMBSC 2004;III(3):15-20.
Ilici et al