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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]. 45 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). 47 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 parodontopatii. Editura Didactică şi Pedagogică R.A. Bucureşti, 2010. 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. 5. Nucă C, Amariei C, Rusu DL, Comşa C. Study on 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