CLINICAL FEATURE
support the motivational discussions with the patient. They may allow improvements to be highlighted over the course of subsequent preventive dental appointments. Instruction and motivation are important components of these appointments. Good home-based intraoral hygiene behaviour and understanding are important for patients. Plaque accumulation is particularly evident in the cervical regions (Fig. 8). These must be discussed with the patient, and improvements to the teeth- brushing technique must be practised. A soft toothbrush attachment is recommended for home-based intraoral hygiene due to the presence of erosions and attritions. It is also necessary to check that the interdental brushes — used by this patient on a daily basis — are the correct size and encourage consistent use (Fig. 9). Good intraoral hygiene
minimises the risk of periodontitis from smoking.
concretions must be removed using ultrasonic and/or manual instruments (Fig. 10). Discolouration caused by nicotine and tea consumption can be removed easily using an air polisher (Fig. 11). When using more abrasive powder, it is essential to work from a cervical to coronal direction and never point the outlet nozzle towards the gingiva to prevent potential emphysema. Good suction on the contralateral side is essential to reduce aerosol formation. Additional biofilm can be removed using low-abrasive glycine powders. Repolishing is essential after using more abrasive powder (Fig. 12). Appropriate polishing pastes containing various ingredients and with corresponding gentle RDA values will seal and smooth unevenness on the tooth surface without extensively removing the tooth substance.
The patient should also be encouraged to clean the tongue, as this will remove nicotine stains and bacterial deposits and may prevent subsequent halitosis. Obviously, significant attention should also be paid to providing support and motivational advice regarding the desired behavioural change of smoking cessation. There are no limitations to the use of instrumentation during treatment due to the healthy general medical condition of the patient. It may be necessary to ask the patient whether their breathing is impacted during allergic phases. In the present case, the use of an air polishing system should be considered. The objective would be to control disease risk by removing supragingival and subgingival biofilm. The instruments can be selected based on patient needs. First, calculus and any
They also diminish natural and artificial colonisation niches where bacterial re-
Fig. 8: The arrows indicate plaque accumulations in the cervical region
Fig. 9: Use of the interdental brushes in the area near tooth 44/45
Fig. 10: Use of a piezo-driven ultrasonic device in the lingual area near tooth 36 (Proxeo Ultra, W&H, shown here)
Fig. 12: Rotary polishing with a disposable contra- angle using the Proxeo Twist, W&H
Fig. 11: Air polishing system used in the lingual area of the mandibular front teeth (Proxeo Aura, W&H)
40 DENTAL ASIA SEPTEMBER / OCTOBER 2024
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