CLINICAL FEATURE
adhesion may occur. 7 The ingredients of these polishing pastes may also support treatment: fluoride, zinc compounds and essential oils, which help reduce hypersensitivity, halitosis and prevent caries. Interdental cleaning with appropriate brushes or dental floss to remove interdental biofilm during the dental appointment is indispensable (Fig. 13). It is also necessary to clean the tongue to remove bacteria-rich tongue coating, as well as the stains arising from tea and nicotine consumption (Fig. 14). Use of a tongue gel is reasonable in this case. These usually contain zinc and tin compounds, which have antibacterial effects. Fluoridation of the exposed root surfaces and erosions is recommended as an adjuvant measure to prevent caries. Caution is advised in patients with exposed cervical regions when selecting fluoridation. Ideally, dentists should select fluoridation with a neutral pH value. Further steps include continued use of a fluoridated toothpaste for intraoral hygiene at home and the additional use of a fluoride gel. Fluoride promotes re-mineralisation and contributes to desensitisation of exposed dentine. Low-abrasive toothpaste should be used to avoid promoting further progression of the enamel loss. Intraoral health, lifestyle and the general medical history must be taken into account when planning the follow-up intervals. The patient is classified as having “risk profile 3: lifestyle habits” due to smoking. Due to his consumption of 10 cigarettes per day, he is at the border between moderate and increased disease risk. This means that he
should attend follow-up at intervals of 2 to 3 times per year. As patient needs change, this interval will be adjusted to prevent excessive or inadequate treatment. The objective is to prevent further loss of tooth structure and motivate the patient to reduce smoking and ideally cease smoking altogether. Providing good guidance to patients will determine the sustained success of dental and intraoral health maintenance in this patient. It is strongly and urgently recommended to schedule the next appointment immediately in the dental practice. SUMMARY 1. The medical history reveals that the patient is at low risk of complications, so there is nothing of note in terms of maintenance therapy for either the patient or dentist at present. 2. The risk of disease onset and of possible deterioration of the intraoral state is classified as moderate. Smoking is a decisive factor in this regard. 3. It is important to document findings during the therapeutic appointment. Bleeding- on-probing (BOP) status to measure periodontal pocket depth in the early stages of disease must be determined during each appointment. This is particularly important in smokers due to decreased tissue perfusion. 4. Motivating the patient to change their smoking behaviour must be prioritised. Repeating motivational statements regarding home-based intraoral hygiene is essential. This is important for preventing potential periodontitis and caries. 5. Treatment intervals of 4 to 6 months are recommended due to the moderate risk of intraoral disease. The removal of hard
and soft plaque is essential to maintain the current intraoral state. Further loss of hard tooth structure must be avoided at all costs. DA
REFERENCES 1. Schmalz G., Ziebolz D., Individualisierte Prävention-ein patientenorientiertes
Präventionskonzept für die zahnärztliche Praxis, ZWR- Das deutsche Zahnärzteblatt 2020;129;147- 156 2. Schmalz G., Ziebolz D., Individualisierte Prävention-fallorientierte Bedarfsprävention, ZWR- Das deutsche Zahnärzteblatt 2020;129;33-41 3. Schmalz G., Ziebolz D., Individualisierte Prävention-Implikation allgemeingesundheitlicher Faktoren, ZWR- Das deutsche Zahnärzteblatt 2019;128;295-304 4. Borojevic T. (2012). Smoking and periodontal disease. Materia socio-medica, 24(4), 274–276. https://doi.org/10.5455/msm.2012.24.274-276 5. Ardais R, Mário Tde G, Boligon J, Kantorski KZ, Moreira CH. The effect of smoking on bleeding on probing after nonsurgical periodontal therapy: a quasi- experimental study. Braz Oral Res. 2014;28:1-7. doi: 10.1590/1807-3107bor- 2014. vol28.0058. 6. Reibel J. Tobacco and oral diseases. Update on the evidence, with recommendations. Medical principles and practice: international journal of the Kuwait University, Health Science Centre, 12 Suppl 1, 22–32. (2003). https://doi. org/10.1159/000069845 7. Wang C, Zhao Y, Zheng S, Xue J, Zhou J, Tang Y, et al. Effect of enamel morphology on nanoscale adhesion forces of streptococcal bacteria: An AFM study. Scanning. 2015;37(5):313-21
ABOUT THE AUTHOR
Dr Romana Krapf MSC is an experienced dentist with a focus on prophylaxis, periodontology, implantology, and dental preservation. From 2006- 2007, she served as a
dental hygienist at a private dental practice in Düsseldorf, Germany where she managed the prophylaxis department before pursuing her dental studies and completing her PhD at the Ernst-Moritz-Arndt-University in Greifswald, Germany from 2007-2012. In 2018, she founded her own practice and completed her Master of Science degree in implantology and periodontology at DTMD University in Luxembourg in 2021. Additionally, she is a lecturer and a speaker at national and international conferences.
Fig. 13: Use of dental floss
Fig. 14: Tongue cleaning with a tongue scraper and tongue gel
41 DENTAL ASIA SEPTEMBER / OCTOBER 2024
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