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GINGIVITIS/PERIODONTAL
PATIENT HOME CARE

Nonsurgical Perio Home Care

PREVENTION

TREATMENT  DIAGNOSIS

Goal: 

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Maintain your teeth for a lifetime 

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Prevent potential destructive effects of the bacteria

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Prevent progression and/or recurrence of disease

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Prevent disease from occurring in unaffected areas

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Ongoing Education is a Key

Start cleaning BETWEEN your teeth.  Periodontal disease begins between the teeth.  The area between the teeth are more prone to infection than facial or tongue gum tissue surfaces simply by anatomy.  This tissue is not keratinized like tissue found on the facial and tongue surfaces.  Non-keratinized tissue is more susceptible to breakdown.  It is also a very protected area, NOT reached by brushing or rinsing. 

Since the disease starts between the teeth, it makes sense to start cleaning in between the teeth and than brush.  You can clean this area with interdental brushes, picks, flos, sticks, oral irrigation, and automatic flossers.  remember this disease needs to be treated both in the office and at home.++

Why a Rotadent?

     Manual toothbrushes have been shown to remove an average of less than 50% of the plaque from the smooth area of the tooth and less from the areas between your teeth.*A Rota-dent is a site-specific instrument who's microfilaments are less abrasive than traditional bristle brushes. It has the ability to clean under the gum tissue and apply medications to the diseased areas.

     Power oral care products are more superior to a manual brushes in removing tooth stain.

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Charging your Rotadent:

  1. Your Rotadent toothbrush needs to charge for a full 24 hrs. before 1stuse.

  2. After a full charge unplug the charger from your Rotadent before you use it.

  3. When you begin to notice a loss of power in the toothbrush (usually in about 2-4 weeks), you will need to recharge your Rotadent over night or for about 24 hours.    

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Rotadent tips:

  1. You will need to replace your brush head tips every three months.

  2. You may purchase both brush head tips through our office.  Please call Rotadent company hotline: 1-800-752-2564 if you experience any problems with your Rotadent or need service for your Rotadent.  

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Using your Rotadent:              

  1. Brush teeth with Rotadent & toothpaste for 2 minutes.  This is important to remove the bacterial plaque.

  2. Pour a small amount of chlorhexidine into the cup. Dip the cup like tip of the Rotadent into the chlorhexidine. Apply this at the gum line of every tooth. Use it on the cheek side and tongue side for 2 minutes. Do this twice a day (after breakfast and supper).  You use this product regularly in order to inhibit bacteria growth. DO NOT RINSE with the chlorhexidine, this will cause staining of your teeth.

  3.  Place a pea size amount of fluoride gel on rounded tip of the Rotadent. Apply to all of the tooth surfaces: cheek side, tongue side & biting surface, of every tooth. Do not shallow the fluoride gel.  Do this before you go to bed. Do not eat or drink for 30 minutes after using the fluoride gel. 

 WARNING: Chlorhexidine and fluoride gel are prescription strength for pt. use only.  Keep away for small children & pets.  

If you have periodontal disease it is advised that you disinfect or change your toothbrush head between brushing to prevent self infection from periodontal germs that remain on your toothbrush for 4 hours or more after use.~

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To insure successful results following periodontal treatments, patient cooperation in maintaining  excellent oral hygiene is essential.

Periodontal appointments:

Please bring your Rotadent with you to every periodontal appointment with us. This allows us to go over your home care techniques & any improvements needed.

Products that presence research has not found useful in helping to prevent or heal periodontal disease:

Hydrogen peroxide and baking soda.

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Nutrition

It is recommended that you receive the daily minimum requirement for Vitamin C, calcium and an overall multivitamin supplement.  It has been found that people who do not consume adequate amounts of these nutrients have a higher rate of periodontal disease.# A healthy immune system is essential to controlling periodontal disease.
 

Based on evidence from a recent study, it can be concluded there is a significant relationship between dietary vitamin C intake and periodontal disease Therefore, individuals with periodontal disease may benefit from a dietary analysis and, when appropriate, from daily vitamin C supplementation. Journal of Contemporary Dental Practice  Vol. 5, No. 2, Page 1-13 6/04

Taking a Vit B complex supplement ( one capsule a day of either Vit-B (50 mg of the following: thiamine HCl, riboflavin, niacinamide, d-calcium pantothenate, and pyridoxine HCl; 50 g each of d-biotin and cyanocobalamin; and 400 mcg of folate) may help healing after root planing and scaling  and periodontal surgery because studies have shown that  vitamin-B complex (Vit-B), can positively influence wound healing processes.

CoQ-10 seems to affect the disease by affecting the immune response to the bacterial antigen.

Vitamin B-complex supplement in combination periodontal surgery resulted in statistically significant superior CAL gains when
compared to placebo. J Periodontol 2005;76:1084-1091
Effects of Vitamin-B Complex Supplementation on Periodontal Wound
Healing - Dr. Rodrigo F. Neiva et al.Journal of Periodontology 2005, Vol. 76, No. 7, Pages 1084-1091

Effect of Vitamin D and Calcium on Periodontitis

The anthropological record indicates that we are exposed to considerably less ultraviolet radiation (required for the synthesis of vitamin D) and consume considerably less calcium than did our early ancestors. Most U.S. citizens have calcium intakes and serum levels of vitamin D far below recommended values.  Numerous articles indicate that vitamin D and calcium deficiencies result in bone loss and increased inflammation, which are well recognized symptoms of periodontal disease. For more than 40 years, investigators have suggested that calcium intake may be associated with alveolar bone resorption, and more recently there have been a number of studies in which investigators have suggested that calcium and vitamin D may benefit periodontal health, and it has been suggested that calcium deficiency may be a risk factor for periodontal disease. There has not, however, been a vitamin-D-calcium-periodontitis clinical trial in which randomization and masking were carefully controlled, the periodontal disease status of patients known, periodontal disease measures were the primary outcomes, and levels of intake optimized to produce maximal effects. Such research might demonstrate that calcium and
vitamin D are important adjuncts to standard treatments for preventing and treating periodontal disease.
J Periodontol 2005;76:1576-1587.Dr. Charles F. Hildebolt Journal of Periodontology 2005, Vol. 76, No. 9, Pages 1576-1587

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Mouthrinse

Use Chlorhexidine daily.

Use a fluoridated rinse daily: The fluoride rinse shows a significant inhibition of plaque regrowth.  Although the effect on plaque regrowth showed Chlorhexidine rinsing was superior to that with fluoride, the fluoride rinse was not associated with side effects.  Fluoride rinse may represent an effective alternative to Chlorhexidine rinse as an adjunct to oral hygiene.
Mouthrinse on Supragingival Plaque Regrowth Giuseppe Pizzo, Rosario Guiglia, Monica La Cara, Giovanna Giuliana, and Matteo D'Angelo regrowth. J Periodontol 2004;75:852-857.

Avoid alcohol based mouthrinses,  Alcohol actually makes periodontal disease WORSE.

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Use Fluoride daily

Fluoride enhancement of chlorhexidine uptake by hydroxyapatite and enamel powders.

The purpose of the present study was to examine the in vitro adsorption of chlorhexidine and fluoride to hydroxyapatite and tooth enamel powders. Samples of hydroxyapatite or enamel powder were suspended in aqueous solutions of chlorhexidine gluconate 2.0; chlorhexidine acetate 1.5%; sodium fluoride of various concentrations (0.2%, 1%, 2%) and mixtures of sodium fluoride and chlorhexidine. The data obtained in the study show that chlorhexidine and fluoride adsorb to hydroxyapatite and tooth enamel in vitro. Furthermore, the amount of fluoride adsorbed to hydroxyapatite is reduced in the presence of chlorhexidine in the solution. A probable explanation for this effect may be that there is a competitive adsorption of fluoride and chlorhexidine on to the same binding sites on the hydroxyapatite. Additionally, the presence of fluoride dramatically increases the affinity of chlorhexidine for hydroxyapatite. The fact that fluoride strongly enhanced the adsorption of chlorhexidine to hydroxyapatite and enamel, indicates that fluoride may be of clinical interest beyond the prevention of caries and gum disease.

1: J Oral Rehabil. 1984 Jan;11(1):65-70. Related Articles, Links Ben-Yaakov D, Friedman M, Hirschfeld Z, Gedalia I.
PMID: 6583372 [PubMed - indexed for MEDLINE]

 

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Water Jets

Water jets are wonderful at reducing periodontal pathogens in pockets up to six millimeters and reducing bleeding and inflammation. For perio purposes, the motion of the water pulsing across the opening of the sulcus/pocket creates a suction that virtually sucks out the free-floating bacteria from under the gingival crest. This action dramatically decreases the number of pathogens in the pocket. Instructions -The tip of the water jet should be pointing directly between the teeth from the outside to the inside, apical to the contact - not directly at the pocket - for flushing. 

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February 06, 2008

++Five Tips to Share with Patients, Ms. O'Hehir, Dental Equipment & Materials, pg 80-81 May/June 2004
~"The effects of toothpaste on the residual microbial contamination of toothbrushes".  Warren, Goldschmidt, Thompson, Storthz, Keene, JADA Vol 132  pg 1241-1245 Sept 2001.
* Prevention: The Key to Successful Nonsurgical Periodontal Treatment, Dr Gottehrer, Dr. Light,Dentistry,  pg 82-87; Today January 2002.
+WebMed on Periodontal Disease.
#ADA, Periodontal Health Important to Consumers. Sept. 2001.

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