Winter 2000 New Member Forum

Dr. Kami Hoss

Excellent oral hygiene is an important factor in achieving excellent orthodontic results — but that’s easier said than done. We struggle with the challenge of keeping patients motivated and cooperative. Orthodontic appliances generally add to the accumulation of plaque and make brushing and flossing a difficult task. To complicate things even more, we treat a wide range of people: from five to 85 years old (my youngest/oldest patients), male and female, with different personalities, and representing different racial groups and cultural backgrounds. Therefore, we need a variety of techniques, ideas, and products to reach different patients. Like many others, I have tried just about anything to increase motivation and improve oral hygiene; some have worked, some have not. Following is a list of things that have worked in our office:

During our initial exam and as part of the office tour, we take standard intra-oral and extra-oral photographs with a digital camera. During the exam, we display these photographs on a large computer monitor when discussing plans for diagnosis and treatment. Because of the enlarged images of the teeth on the screen, plaque is easily visible, which gives us a great opportunity to review the importance of oral hygiene. After we place all the brackets, bands, and wires, patients are supplied with a tooth-brushing kit that includes a regular brush, a travel brush, a proxy brush, floss, floss threader, timer, wax, and certain written instructions. We also provide the At-Home Orthodontics CD-ROM from ORMCO, which gives patients detailed brushing and flossing instructions. Patients who have computers at home also receive a customized copy of the CD to use during their orthodontic treatment as a reference for instructions, emergencies, etc. In addition to these complimentary items, we carry a variety of for-sale items such as a Sonicare toothbrush, Peroxyl, prescription fluorides, etc.

From the first appointment, we emphasize the importance of excellent oral hygiene and we review the practice at every appointment. During their orthodontic treatment, if patients are not practicing good oral hygiene, we remove wires for a period of at least two weeks and do not replace them until oral hygiene is ideal. Every time we take the wires out, we add one month to a patient’s estimated treatment time, and they see it right there on the computer screen. We do the same thing for lack of cooperation and broken brackets. This has proved to be very effective.

We also encourage patients who have great oral hygiene and those who continually show improvement by offering things such as movie tickets or gift certificates to Baskin Robbins (yum, yum). In addition, we stress the importance of frequent cleanings by their general dentist or hygienist. This is emphasized through quarterly newsletters, On-Hold messages, and progress reviews.

Dr. Bernard Chang

As we all know, good oral hygiene is a vital part of a successful orthodontic treatment. Oral hygiene education starts at the initial exam. I point out the problems to patients who present with poor hygiene during the first visit, informing them that braces will not be placed until hygiene is acceptable. After our patients receive their appliances, my staff spends time teaching them proper brushing and flossing techniques.

Educating patients in proper diet not only prevents broken appliances, but improves oral hygiene. We provide them with an oral hygiene kit that includes a toothbrush with a proxy brush, dental floss, floss threaders, disclosing tablets, and orthodontic wax. In addition to these items I highly encourage our patients to purchase Colgate’s Phos-Flur rinse (sodium fluoride and acidulated phosphate topical solution). In the past we have dispensed fluoride, but found most of our patients were not using it regularly. We feel if patients purchase the fluoride, they are more inclined to use it.

We grade our patients on their oral hygiene at the beginning of each appointment. We will not work on our patients until their oral hygiene is acceptable. If our patients have chronic hygiene problems, I inform them that their braces may need to be removed until the condition improves. I also request that their general dentist participate by seeing the patient more frequently for their prophy and cleaning appointments.

Patients with poor oral hygiene can be as challenging as the high angle, open bite, tongue thrusting patients. Taking braces off and seeing decalcification and caries is very disappointing to both the patient and the doctor. That is why we place oral hygiene as a top priority for our patients.

Dr. Bridget M. Powers

After the routine lecture on how important brushing is to maintain healthy teeth during the tortuous, joyous event called braces, we attempt a mild scare by proudly displaying the opposing photos of clean- and yucky-mouth final photos. We tuck these pictures neatly into their outgoing oral hygiene kits. Nestled with the photos, each patient will also find a fancy electric toothbrush with a complimentary travel case, floss threaders, floss (waxed), ACT mouth rinse, and disclosing tablets—all scheduled and demonstrated by the friendly resident Treatment Coordinator. We, the people at Smile Power orthodontics, then proudly escort our new patient out the door with a smile, a wave, and newly pumiced, clean teeth.

OH = B, C, D; OH / TBI / CONS w/parents RE OHI; All the chart shorthand for Uh Oh, Oh No. Usually coupled with poor Coop Elastics, HG, etc. I now begin the bargaining phase of our oral hygiene program for a typical patient, "Zach." I remember positive reinforcement from some college intro psyche class . . . hmm let’s try the orthobuck program. Nothing broken and good brushing. . . "Here, young impressionable one, take this token monetary reward for accomplishing the basics. You may cash these in for valuable prizes." A ray of excitement leaps from his eyes as he nods his head and promises to do his best, while eying the Blockbuster gift certificates.

Next appointment, about six weeks later. Hmmm, the orthobuck program isn’t working on this one. What to do now? Show and Tell phase initiates. After years of talking to young children and teens, I finally discovered that pellicle, material alba and bacterial colonies do not motivate their young souls. So I begin with "Look at this gunk on your teeth!" I deftly scale material from the hard-to-reach upper left one and display it to him. "Please brush carefully at the sink and clean your teeth." He returns after a grueling 30 seconds. Now begins the lecture: "If you don’t do this… then you may get spots and holes in your teeth. You don’t want that do you?" He agrees, his head hanging just a bit in dismay.

Next appointment and bacterial colonies are still having a party. From here I begin the Philosophical debate phase. Okay. Brushing is not good. I have spaces to close, the Herbst was just delivered, the expansion phase is not complete… Parents have received the letter, patient has had the lectures and introduction to the orthobuck program, and scare tactics imposed. What do I do? Remove wires and re-evaluate? Discontinue treatment? Well, I must continue to obtain the Andrews six keys. I don’t want the referring doctors to think this is how I finish a case.

Today, teenage Zach turned his oral hygiene life around. After completing each phase of the rehabilitation program, he decided to brush his teeth. I asked him what inspired him. He replied a bit nervously that he didn’t want to lose all of his teeth at 20 years of age. Note to self: add the denture scare to the show and tell phase…

With a silent hooray and a congratulatory phrase, I proudly send Zach off to better days of flossing. As I walk back to the orthodontic bay, a little lighter in step with the new accomplishment, I overhear the assistant beginning the oral hygiene lecture on yet another candidate for the OH reform program.

Editor's Comment: Dr. Michael A. Sales

Well, I certainly didn’t stir up any controversy with the oral hygiene issue. Our panelists seem too agree, as do I, that excellent oral hygiene is the only acceptable standard. We often run into difficulties along the way and I believe the options open to us are well articulated in this overview.

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