Oral Hygiene TIPPS

Ask the patient what their current homecare regime involves and if they have any concerns or challenges with it.

Ask what their understanding of the causes of periodontal diseases is.

Listen to what they say, and explain any areas where information or support is needed.

• Talk with the patient about the causes of periodontal disease and why good oral hygiene is important.
• Use of a visual aid may help patients understand the disease process and the effects of plaque on the periodontal tissues.

Talk with the patient about what they have to do to achieve optimal plaque removal.

• Brush regularly using an effective technique.
  • For gum health, focus on the area where the tooth and gum meet.
  • Clean the teeth methodically, for example cleaning all of the outside surfaces of the teeth then moving to the inside surfaces.
  • Brushing twice a day for at least 2 minutes will ensure that all tooth surfaces are adequately cleaned.
  • Both manual and rechargeable powered toothbrushes are effective for plaque removal when used correctly.
  • Manual and rechargeable powered toothbrush heads should be small and of a medium texture and should be changed when obvious signs of wear appear.
• Use a fluoride-containing toothpaste and ‘spit don’t rinse’ during tooth cleaning.
• Clean interdentally as required.
  • Patients with a diagnosis of gingivitis should clean interdentally to control their inflammation.
  • Patients with a diagnosis of periodontitis should clean interdentally once a day.
  • Evidence suggests that interdental brushes may be more effective than floss at reducing plaque and gingivitis indices in sites where the interdental space allows their use.
  • To be effective, the brush should fit snugly into the interdental space without the wire rubbing against the tooth. More than one size of interdental brush may be required depending on the sizes of the interdental spaces present.
  • Dental floss or tape may be appropriate for spaces which are too small for interdental brushes.

Ask the patient to demonstrate their oral hygiene routine and watch while they do so to identify areas where they need support.

Provide personalised instruction and coaching on the best ways to perform effective plaque removal, concentrating not only on improving their understanding of why it is important but also the patient’s skill to remove plaque biofilm from the gingival margin and tooth surface.

Instruct the patient in the use of oral hygiene tools personalised to their situation. 

• For patients with periodontitis, intrasulcular brushing with a narrow, single tufted toothbrush may be helpful.

Demonstrate, in the patient’s mouth while they hold a mirror, how to systematically clean each tooth using a toothbrush (manual or rechargeable powered) as well as how to use interdental brushes and/or floss. If appropriate, advise the patient to wear their spectacles (including reading glasses) while cleaning their teeth.

Confirm that the patient knows what to do. If they do not, show the patient again.

Ask the patient to practise cleaning their teeth using a toothbrush and using the interdental cleaning aids while in the dental surgery and help them to improve their technique where needed. 

• This provides an opportunity to correct the patient’s technique if required and ensures that the patient has really understood what they need to do.  
• Confirming that the patient is doing the task well will boost confidence and also help them to remember when at home.

Ask the patient for some feedback.

• Ask how their teeth feel, as clean teeth should feel smooth to the tongue.
• Address any concerns the patient has if there is bleeding after brushing or interdental cleaning.
  • Gums may bleed more than normal in the first few days of using the correct oral hygiene technique and in patients who have recently stopped smoking.

Agree a plan which specifies how the patient will incorporate the new oral hygiene regime into their daily life.

• Ask the patient when would be the best time for them to brush and clean interdentally. Suggest using another regular activity as a reminder – such as immediately before going to bed and after getting up.

Tell the patient that you will ask for feedback about how they are managing with the new oral hygiene regime at the next visit, for example:

• “How are you managing with interdental cleaning aids?”
• “How did your action plan work?”
• “Are there any areas where you would like further support?”

Ensure you support the patient to achieve effective plaque biofilm removal by following-up on the advice at subsequent appointments.