In the role of the dental professional to ensure optimal patient care, the continuous and routine removal of dental biofilms needs to take place. Despite patients being able to treat through at-home care and chemotherapeutic agents, proper oral health care is an ongoing maintenance when combined with the help of the dental health professional. Studies indicate that inflammation in the mouth has been linked to conditions elsewhere in the body,1 and as a dentist working with a dental hygienist, patients need to be educated and assisted on this oral-systemic connection and how they can adequately remove this dental biofilm and work toward the goal of proper oral health.
In a recent THE NEXTDDS live training event, Dr. Christine Hovliaras discussed key strategies for managing and removing dental biofilms.
Mechanical Plaque Removal
Manual and electric toothbrushes, floss holders, and other oral irrigation and interdental devices provide perhaps the quickest and easiest way for patients to remove harmful dental biofilms. Brushing twice a day in the morning and evening, as well as recommending flossing every night before bed is the main goal for practitioners. In this way, dental biofilms can be removed by the patients themselves and prevent issues that can lead to dental caries and gingivitis.
However, patient compliance remains a consideration and must be part of any oral health instructions provided by dental professionals. In addition, it has been noted that patients brush their teeth too fast, falling short of the two-minute recommendation issued by the ADA.2 Thus, patient education is a must for new dentists working in collaboration with dental hygienists in order to ensure that specific oral health needs of their patients are met.
From the clinical perspective, periodontal debridement is used to stop the progression of periodontitis to restore that patient to healthy pocket depths and attachment levels.3 Supragingival and subgingival scaling are standard non-surgical treatments for periodontal disease as are local or systemic antimicrobial therapy. Root surfaces should be smooth upon completion of periodontal debridement, thereby reducing the potential recolonization of harmful bacteria. Dental calculus provides an environment conducive to the adhesion of bacteria and biofilm retention, which also contains endotoxins in gram-negative bacteria and can cause inflammation.
The objective of periodontal debridement is to disrupt the dental biofilm and remove the maximum amount of biofilm, calculus, periodontal bacteria, and debris on the root surfaces and at the gingival soft tissue. Through a combination of hand and ultrasonic scaling (for patients with tenacious calculus), this goal is achieved.
When compared with hand scaling, ultrasonic scaling can offer the dental professional a number of advantages.4 It can be less fatiguing and time consuming in debris removal, it can retain more tooth substance and structure, it can provide irrigation of the pocket during instrumentation because of the water used to cool the heated tip, and can provide superior access to tight subgingival areas.
There are two types of ultrasonic instruments:
- Magnetostrictive — A vibrational movement and frequency of 25,000 to 30,000 cycles per second via inserts connected to the handpiece. Power is distributed to all surfaces of the tip for removing deposits.
- Piezoelectric — Has a frequency of 25,000 to 50,000 cycles per second and contains quartz discs or ceramic plates in the handpiece that vibrate, rather than vibrating metal stacks on the magnetostrictive insert. A linear motion of the tip occurs and the two lateral sides of the tip provide the working stroke to remove calculus and other debris.
The goal of the dental professional is to assess each patient, conduct a proper oral examination, and obtain quality radiographs that permit preventive care and assessment. Dentists are also responsible for evaluating the patient’s periodontal and restorative health and identifying the appropriate treatment plan to provide optimal care. Working in a team in a proactive and engaging way with trust, respect, and value allows the dental assistant, the dental hygienist, and front office team to provide the highest level of professionalism and care for patients.
Click here to watch this THE NEXTDDS live training event.
- Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic Diseases Caused by Oral Infection. Clinical Microbiology Reviews. 2000;13(4):547-558.
- Creeth JE, Gallagher A, Sowinski J, et al. The effect of brushing time and dentifrice on dental plaque removal in vivo. J Dent Hyg 2009;83(3):111-6.
- Aimetti M. Nonsurgical periodontal treatment. Int J Esthet Dent. 2014 Summer;9(2):251-67.
- Chatterjee A. Baiju CS, Bose S, Shetty SS, Wilson R. Hand Vs Ultrasonic Instrumentation: A Review. Journal of Dental Sciences & Oral Rehabilitation Oct-Dec 2012.