Power tooth brushes and periodontitits clients

From: Lynne H. Slim To: periotherapistgroup Sent: Wednesday, August 24, 2005 6:38 AM Subject: [periotherapist] Power Brushes and Periodontitis Clients Some of my periodontitis clients who have quite a bit of recession do not maintain well with a power brush because of the varying levels of the gingival margin around the mouth. If they want to use a power brush, I have them supplement by tracing with a rubber tip. . . with Total (triclosan) or a baking soda paste. I decided to experiment on myself and for the last four months, I have been using a new Sonicare in lieu of the rubber tip tracing (which I was doing BID). I visited my hygienist last week and she gave me an "F" for my home care. (I can't believe I am admitting this to the group but I did have several areas of BOP and some of my 3 mm probing depths suddenly became 4 mm probing depths. I do have some recession in the posterior quads. . . I am a long time clencher. . . but I was so shocked because I really thought that the power brush was doing a great job because my dentition felt GREAT every day and biofilm free. Apparently, I was not engaging the gingival margin like I thought I was. . . . I'll give the group a report on how I am doing in 3 month's time. This is anecdotal data, obviously, but it's interesting that even though some clients are using a powerbrush for a full two minutes, it might need to be supplemented with another biofilm-removing tool like the rubber tip. I use the baking soda powder (the one that is sweetened) and get great results. I am hopeful that my probing depths will return to 3 mm asap!! I have observed this particular problem in several of my three month periodontal maintenance patients who are highly susceptible to biofilms and bleed easily. Has anyone else noticed the same problem in any of their regular clients? - Lynne Hollister Slim, RDH, BSDH, MSDH I like powerbrushes. Am I passionate about them? I am passionate about teaching patients how to slow the recolonization of pathogenic bacteria and the powerbrush is only one tool that can accomplish this end. I recommend both the Sonicare and Braun to patients for a variety of reasons but I customize the oral hygiene care I recommend to patients. I do love to talk about the Cochrane studies on powerbrushes with patients and I tell them all about the lawsuit several years ago that resulted when there was a serious dispute between the Braun and Sonicare folks. I can barely remember the details but I can look for them if anyone is interested. It makes for good conversation because not many people know about it. Patients like it when I talk about microbiology and the science behind our recommendations. As a whole, they are good listeners and are better educated than patients in the past. They sometimes like to quiz you and I absolutely love that! Lynne M. Rethman: Me too. I know the details of the Cochrane systematic review (indeed I feature it in my EB lecture mostly to discuss how its results were subsequently misused (IMHO) by Porter Novelli, Oral B's ad agency). I also know some of the details of the infamous lawsuit, basically Sonicare built an ad campaign around what was a misplaced decimal point in their comparison data at one, and only one follow-up interval. Incredibly dumb... and the sad thing was that Jill (she consulted for Sonicare back then) asked me about the data before-hand and I told her that it must be a mistake or a meaningless statistical outlier. Lo and behold an ad campaign emerged and the legal crapstorm ensued. BTW, I like both Sonicare and Oral B's mechanized brushes -- a lot. I use them both. But the others leave me mostly unimpressed. Hey there it's Michelle from Canada. No ,I do not work for any of the companies. Of course I should get a kick back for all the recommending I do. LOL I have found that my experience is the same as Lynne's and I too I enjoy the challenge of motivation. I don't have a company preference. I do however like the "sonic" brushes much better. My clients brush longer and more effectively when the use a powerbrush. I often find that my geriatric patients brush better with a high-end power brush but not always. I had one of my favorite 3 month recare patients this week who uses a Braun Oral B that we recently gave to him at no charge and he is doing a better job of removing plaque/ biofilm. He is 'in love' with what he calls 'Christmas Trees' (614 proxabrush inserts) and he likes to talk about his use of the 'trees'! This particular patient is in his late nineties and everytime I greet him in the reception room I say: "Ready, Mr. So and So" and he says "I guess so". I have to repeat myself about ten times until he finally gets up from the chair and follows me inside. Once he settles in, he asks me every 5 minutes if we are done yet. I always look at him and ask him why he is asking me that question. Then he tells me a dirty joke and we repeat this conversation over and over again for a full 60 minutes and I have to work on him standing up because he feels dizzy if I place him in a semi-supine position! Oh, the many challenges we face! He's my favorite patient at the moment and I love him dearly. :) Lynne Slim